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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: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to pay Rural Health Clinics (RHCs) a Medical Assistance (MA) Fee Schedule rate, equivalent to the Medicare rate, for administration of COVID-19 vaccines beginning December 11, 2020 through the end of the PHE.
Summary: This SPA proposes to add prior authorization information on preferred and non-preferred drugs, as well as for High-Investment Carve-Out drugs when delivered in the inpatient setting.
Summary: This amendment provides coverage of COVID-19 prevention and treatment as benefits in Texas Medicaid, including coverage for conditions that may seriously complicate COVID-19 treatment.
Summary: This amendment proposes to increase the physical, occupational, and speech therapy limit for children from eight to 30 visits per year, which can be exceeded with prior authorization.
The proposed amendment updates the fee schedules for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies and Hearing Aids and Audiometric Evaluations.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to rescind premiums and cost-sharing. It reverts to co-pay amounts prior to the public health emergency (PHE) with exception of services, drugs, test and vaccines for treatment of COVID-19.
Summary: The proposed amendment updates the Medication Assisted Treatment (MAT) fee schedules and provides a new direct reference to the Physicians and Other Practitioners page. The requested effective date for the proposed amendment is September 1, 2022.