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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.
This SPA proposes to amend the pharmacy page's provision to cover all prescriptions for FDA-approved oral contraceptives for up to a 12-month supply at one time.
Summary: The SPA clarifies how the premium assistance program determines if premium assistance is estimated to be cost effective and aligns with policies and current practice.
Summary: This amendment allows MO HealthNet to consider participants eligible for, but not enrolled in, a managed care plan for
the Health Insurance Premium Payment (HIPP) program, and determine whether enrolling such participants in HIPP would be cost effective.
Summary: To continue coverage of prescribed drugs that are not covered outpatient drugs in cases of a drug shortage, where the state determines coverage of the drug (including a drug authorized for import by the FDA) is medically necessary.
Summary: Amends Delaware Title XIX State plan specifically to attest that the Delaware Medicaid Transportation program is in compliance with section 1902(a)(87) of the Social Security Act.
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).