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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 2631 - 2640 of 15693

Oregon
This SPA has been submitted as related to the Inflation Reduction Act of 2022 temporary, 5-year increase for physician administered biosimilar drugs that will be paid Medicare's Average Sales Price (ASP) plus 8% (rather than plus 6%).
Approval Date: March 1, 2023
Effective Date: November 5, 2022
Topics: Physician Administered Drugs

Arizona
Describes the State’s Drug Utilization Review (DUR) program.
Approval Date: March 1, 2023
Effective Date: October 1, 2022
Topics: Drugs and Related Services

Illinois
This amendment provides for a rate adjustments for Outpatient Hospitals.
Approval Date: March 1, 2023
Effective Date: January 1, 2023

South Carolina
This SPA terminates the Hemophilia program arrangement with the South Carolina Department of Health and Environment Control Agency, at their request.
Approval Date: March 1, 2023
Effective Date: March 1, 2023

Texas
CMS is issuing a technical correction to the approval package for TX-22-0028. TX-22-0028 introduced Page 1 of Supplement 5 to attachment 4.19-B as a NEW page, however a previously approved SPA already added Page 1 of Supplement 5 to attachment 4.19-B. This technical correction will make the page added by TN 22-0028 Page 1-a.
Approval Date: March 1, 2023
Effective Date: September 1, 2022

Pennsylvania
Proposes to amend the pharmacy pages provisions to cover select non-legend drug products.
Approval Date: March 1, 2023
Effective Date: January 1, 2023

Indiana
This amendment updates the alternative benefit plan to include coverage requirements for routine patient costs associated with participation in clinical trials and extends the prescription drug supply limit from thirty (30) days to ninety (90) days for the Health Indiana Plan (HIP) Basic group.
Approval Date: March 1, 2023
Effective Date: October 1, 2022
Topics: Alternative Benefit Plan

Michigan
Provides authority for coverage and payment of targeted case management for individuals age 18 and older who meet Medicaid eligibility requirements, have a chronic or complex physical or behavioral health need, and were recently incarcerated.
Approval Date: March 1, 2023
Effective Date: April 1, 2023

Kansas
Long acting reversible contraceptive (LARC) devices are no longer included in the Diagnosis Related Group (DRG) rates. LARC devices will be reimbursed on a fee-for-service basis.
Approval Date: March 1, 2023
Effective Date: January 1, 2023

Wisconsin
Effective for services on or after October 1, 2022, this amendment modifies the timeline of the Hospital Withhold Pay-for-Performance (HWP4P) program payments in the State Plan. HWP4P payments are made by the end of the
calendar year following the HWP4P measurement year.
Approval Date: March 1, 2023
Effective Date: October 1, 2022