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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 2781 - 2790 of 15693

Utah

This SPA proposes to amend the reimbursement methodology for provider-administered drugs from the Average Sale Price (ASP) Drug Pricing File to the same methodology as other covered outpatient drugs, with the exception that no professional dispensing fee will be paid. This SPA also replaced the term Utah Estimated Acquisition Cost (UEAC) with Wholesale Acquisition Cost (WAC).

Approval Date: January 11, 2023
Effective Date: April 3, 2023
Topics: Covered Outpatient Drug Physician Administered Drugs Prescription Drugs Reimbursement

Colorado
CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency.  The purpose of this amendment is to extend the waiver of premiums for the Buy-In program for Working Adults with Disabilities and the Buy-In program for Children with Disabilities.
Approval Date: January 11, 2023
Effective Date: January 12, 2023
Topics: Disaster Relief Eligibility

New Mexico
CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency.  The purpose of this amendment is to implement a rate increase for providers of Personal Care Services (PCS) and Private Duty Nursing (PDN) services under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.
Approval Date: January 11, 2023
Effective Date: July 1, 2022
Topics: Disaster Relief Reimbursement

Louisiana
The purpose of this SPA is to establish the criteria for an acute care hospital to qualify as an urban metropolitan statistical area (MSA) facility in the New Orleans area and establish the reimbursement methodology for the provision of outpatient services.
Approval Date: January 11, 2023
Effective Date: October 11, 2022

Kansas
Physician Administered Drugs (PADS) submitted under the medical benefit, including those drugs purchased through the 340B program, will be reimbursed at Medicare Part B fee schedule rates.
Approval Date: January 10, 2023
Effective Date: November 11, 2022

North Carolina
CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency.  The purpose of this amendment is to increase the reimbursement for COVID-19 vaccines and boosters from $40 to $65, effective back to April 1, 2021, and to allow pharmacists to administer Monoclonal Antibodies (mAbs) therapy for COVID-19 to possibly avoid hospitalization.
Approval Date: January 9, 2023
Effective Date: April 1, 2021
Topics: Disaster Relief Reimbursement

Vermont
CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency.  The purpose of this amendment is to waiver Drug Counseling Signatures.
Approval Date: January 9, 2023
Effective Date: March 1, 2020
Topics: Disaster Relief Prescription Drugs

Virginia
To amend the state's paper alternative single streamlined application.
Approval Date: January 9, 2023
Effective Date: July 1, 2022

Maine
This plan amendment authorizes a 4.9% rate increase for Home Health Care services and Medical Social services.
Approval Date: January 9, 2023
Effective Date: July 1, 2022

Mississippi
This SPA is being submitted to allow the Division of Medicaid (DOM) to update the rates for durable medical equipment (DME) and Medical Supplies October 1, 2022 and July 1 of each year thereafter based on the Medicare Rural Rate in effect January 1 of that year, effective October 1, 2022.
Approval Date: January 5, 2023
Effective Date: October 1, 2022