IL-22-0006
Updates rates for Occupational Therapy (OT).
CA-22-0006
Adjusts rates for Radiological services so that they do not exceed 80% of the corresponding Medicare rate.
MN-22-0011
Physician payment rates.
IN-21-0017
This State Plan Amendment makes conforming changes to the Medicaid State Plan to bring Indiana Medicaid into compliance with the new Bipartisan Budget Act (BBA) of 2018 singed into law by the Centers for Medicare and Medicaid Services (CMS) February 9, 2018. This new legislation requires modifications in coordination of benefits claims processing rules.
OK-21-0018
This amendment updates the state's Alternative Benefit Plan (ABP) to remove and replace section 1945 health homes with hospice services as a benefit for Oklahoma's Medicaid Expansion Adults.
TX-22-0006
This amendment is to conform the state plan to Section 210 of the Consolidated Appropriations Act, 2021 (Public Law 116-260) related to mandatory Medicaid coverage of routine patients costs furnished in connection with participation in qualifying clinical trials.
KS-22-0009
This amendment assures that Kansas will cover the mandatory benefit for costs of routine services related to participation in clinical trials in the state plan.
NV-21-0008
This SPA demonstrates the state’s compliance with section 5022 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act.
Pricing Comparison for Blood Disorder Treatments
This pricing comparison table illustrates the relationship of published pricing benchmarks commonly used by state Medicaid agencies and the Medicare program for ingredient cost reimbursement of blood disorder products to the average acquisition cost (AAC) for these products.
Although these specialty blood disorder products are not required to be reimbursed at AAC, CMS believes that this table will be helpful for states to use for analyzing, understanding and monitoring the relationship of AAC pricing to commonly used pricing benchmarks.
When evaluating the adequacy of total Medicaid reimbursement for blood disorder product claims, the professional dispensing fee should be adequate to assure access consistent with 1902(a)(30)(A). Guidance to states concerning Medicaid coverage and reimbursement for clotting factors, anti‐hemophilia drugs and other services provided to Medicaid beneficiaries with blood disorders can be found in the Medicaid Drug Rebate Program Notice, State Release No. 182.
When proposing a change to a reimbursement methodology, state Medicaid programs are required to submit a State Plan Amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS) for review and approval.
This table will be updated semi-annually.
| Name | Year |
|---|---|
| Name | Year |