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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: expand the services for which licensed pharmacists are allowed to bill MO HealthNet to include all services within their professional scope of practice.
Summary: Effective October 1, 2020, this amendment provides technical corrections to Page 12c of Attachment 3.1-A, which adds in necessary information that was previously omitted.
Summary: Updates the plan to expand coverage and reimbursement for vaccine administration in accordance with authorizations provided under the Public Readiness and Emergency Preparedness (PREP) Act declaration. Further, it clarifies the reimbursement methodology for medically necessary vaccines products; expands the list of practitioners able to order Home Health services; clarifies the administrative vaccine rate for children eligible under the Vaccine for Children (VFC) Program; and, incorporates reimbursement for administration of vaccinations to the adult population.
Summary: Brings MO into compliance with the professional dispending fee requirement in the Covered Outpatient Drug final rule with comment period (CMS-2345.FC)
Effective December 16, 2018, this amendment brings Missouri into compliance with items contained in the reimbursement requirements for the Covered Outpatient Drug final rule with comment period (CMS-2345-FC) and includes: reimbursement rates for long-term care, specialty drugs, drugs purchased at a nominal price, and physician administered drugs and reimbursement methods that use, among others, the National Average Drug Acquisition Cost (NADAC) for covered outpatient drugs.
Summary: Effective July 1, 2020, this amendment adjusts the Long-Term Care Reimbursement Plan for nursing facilities. Specifically, it establishes a unit cost increase, using the most recently audited cost report for each facility, and to provide parameters for the Quality Incentive Add-on Payment to Nursing Facilities.
Summary: This amendment makes permanent the authority to allow various provider types to order laboratory and radiology services. In addition, the state adds coverage of heart and lung transplants for adults and all medically necessary transplants for children under 21 year of age within the inpatient hospital benefit.
Summary: Specifically this amendment proposes an increase of $703,865 for both FFY 2019 and 2020. In addition, this amendment will make technical and editorial changes.