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Medicaid State Plan Amendments

A Medicaid and CHIP state plan is an agreement between a state and the Federal government describing how that state administers its Medicaid and CHIP programs. It gives an assurance that a state will abide by Federal rules and may claim Federal matching funds for its program activities. The state plan sets out groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed and the administrative activities that are underway in the state.

When a state is planning to make a change to its program policies or operational approach, states send state plan amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS) for review and approval. States also submit SPAs to request permissible program changes, make corrections, or update their Medicaid or CHIP state plan with new information.

Persons with disabilities having problems accessing the SPA PDF files may call 410-786-0429 for assistance.

Results

Displaying 2591 - 2600 of 15696

Ohio
This amendment modifies the eligibility criteria for Ohio’s Comprehensive Primary Care (CPC) program to prevent duplication of payments for CPC services and the new Comprehensive Maternal Care program services.  This SPA also re-aligns quality metrics to reflect accurate industry terminology.
Approval Date: March 15, 2023
Effective Date: January 1, 2023
Topics: Coverage and Reimbursement

Colorado
This SPA provides Colorado with approval to provide 12 months of continuous postpartum coverage to individuals enrolled in its Medicaid program.
Approval Date: March 14, 2023
Effective Date: July 1, 2022

Montana
This amendment makes permanent the addition of Intensive Outpatient Therapy, previously approved under disaster relief authority, remove a prior authorization requirement, and removes some face-to-face service delivery requirements. 
Approval Date: March 14, 2023
Effective Date: May 12, 2023
Topics: Coverage and Reimbursement

Maryland
The SPA uses American Rescue Plan Act (ARPA) reinvestment funds to establish peer recovery support services in SUD setting in alignment with behavioral health priorities and stakeholder response. This SPA also removed the waiver requirement for prescribing buprenorphine for opioid use disorder based on the federal Drug Enforcement Agency (DEA) Announcement.
Approval Date: March 14, 2023
Effective Date: January 1, 2023

Maryland

This SPA proposes the 2 items below-

1) Remove coverage for drugs used for anorexia, weight loss, and weight gain from the Pharmacy coverage pages.

2) Modify language on the Pharmacy coverage pages to reflect coverage of selective over-the-counter (OTC) medications.

Approval Date: March 14, 2023
Effective Date: January 1, 2023

Virginia
This plan amendment updates numerous non-institutional provider reimbursement methodologies.
Approval Date: March 13, 2023
Effective Date: July 1, 2022

New York
Proposes to allow Article 29-I Health Facilities to be reimbursed for care and services provided by exempt practitioners as defined under State law who were employed by an authorized setting as of June 24, 2022 and continue to work there or in another authorized setting, working under the supervision of a professional licensed pursuant to Article 153 (psychologists), 154 (social workers) or 163 (mental health practitioners) of the State Education law.
Approval Date: March 13, 2023
Effective Date: May 12, 2023

Delaware
This amendment requests for an exception from the Medicaid Recovery Audit Contractor (RAC) requirements.
Approval Date: March 13, 2023
Effective Date: October 1, 2022
Topics: Program Administration

Ohio
To continue coverage of prescribed drugs that are not covered outpatient drugs in cases of a drug shortage, where the state determines coverage of the drug (including a drug authorized for import by the FDA) is medically necessary.
Approval Date: March 13, 2023
Effective Date: May 12, 2023
Topics: Covered Outpatient Drug

Puerto Rico
Establishes compliance with the mandatory coverage and reimbursement of routine patient costs furnished concerning participation in qualifying clinical trials under Section 1905(gg) of the Social Security Act.
Approval Date: March 11, 2023
Effective Date: January 1, 2022