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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.
Summary: CA-22-0065 revises the Medi-Cal reimbursement rate for physician administered drugs such that it will continually align with the Medicare Part B Fee schedule reimbursement rate.
This SPA proposes to increase the professional dispensing fee to $15.73 for pharmacies with an annual prescription volume between 0 and 39,999 prescriptions; $13.62 for pharmacies with an annual prescription volume between 40,000 and 69,999; or $11.52 for pharmacies with an annual prescription volume greater than or equal to 70,000.
Summary: 1)Incorporates federal HCPCS updates to Medical Clinic and Ambulatory Surgical Center fee schedules to remain compliant with
HIPAA; 2. Adds payment for specified drugs on Family Planning Clinic fee schedule; 3. As federally required by approved state
plan, updates physician-administered drug rates on Dialysis Clinic, Behavioral Health Clinic, and Medical Clinic fee schedules.
Summary: Proposes to apply a $2.50 copay to all brand drugs, except when the brand drug cost less than the generic equivalent. The proposed policy will result in a $1.50 increase in copays for some brand name drugs referred to as “preferred” brand name drugs.
Summary: This SPA removes language regarding client copayments. The copayment policy was not implemented, therefore the co-pay information is outdated and does not reflect current state agency policy