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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: The amendment continues provisions for disproportionate share hospital payments to certain acute care hospitals that further Pennsylvania's goal of enhanced access in economically distressed areas.
Summary: The amendment continues provisions for certain inpatient supplemental payments and establishes the aggregate limit for DSH and the supplemental payments for 2012-2013.
Summary: This amendment modifies the State's methods and standards for setting public nursing facility (NF) payment rates. Specifically, this amendment continues the use of a budget adjustment factor in setting rates for the 2012-2013 rate year.
Summary: This SPA changes payment policy for pharmacy services. For brand name and single source drugs, the estimated acquisition cost (EAC) will change from wholesale acquisition cost (WAC) plus 7% to WAC plus 3.2%. For generic drugs, the EAC will change from WAC plus 66% to WAC.
Summary: This amendment revises the State Plan to increase nominal copayments for prescription drugs and certain other services based on the State payment for the service up to the maximum allowable under 42 CFR 447.54 to the categorically and medically needy.
