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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: 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).
Summary: This SPA implements policies and procedures to coincide with the merger of the Utah Department of Health and the Utah Department or Human Services, effective July 1, 2022. The new name of single state agency is the Utah Department of Health and Human Services.
Summary: This State Plan Amendment proposes to increase the underlying per diem expenses for the Medicaid cost reports utilized in the calculation of the median beginning October 1, 2022.
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 reimburse federally qualified health centers (FQHCs) and rural health clinics (RHCs) for the administration of the COVID-19 vaccines. This reimbursement would include a separate reimbursement for the administration of the COVID-19 vaccine in addition to the prospective payment system (PPS) rate for qualifying FQHC/RHC encounters.
Summary: This amendment proposes to assure the American Rescue Plan Act’s (ARP) mandatory coverage of the COVID-19 vaccine, testing, and treatment without cost sharing.
Summary: Makes changes to reimburse Emergency Medical Services (EMS) providers for advanced life support services, basic life support services, and nonemergency medical transportation services within the providers' scope of practice at a rate that is comparable to the federal Medicare reimbursement rate for the service.
Summary: This State Plan Amendment (SPA) looks to provide Medicaid coverage for eligible members to receive general pediatric vaccine counseling as part of EPSDT. Beginning with dates of service on or after September 1, 2022, stand-alone general pediatric vaccination counseling as part of the early and periodic screening, diagnostic, and treatment (EPSDT) benefit will be reimbursed under CPT 99401 with modifier EP per the fee schedule. This SPA also relocates payment for Ambulance Response and Treat-no-Transport Services for Emergency Medical Technicians (EMT's) under the direction of a physician.
Summary: Updates the methodology for quality improvement incentives for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). Specifically, it updates funds available for the existing Quality Improvement Incentive (QII2) provision for ICF/IIDs, clarifies the number of Medicaid certified beds and reimbursement available, clarifies incentive priorities provided to facilities, updates the timing for submitting applications and clarifies payment incentives for COVID-19 staff vaccinations.
Summary: The State expands 1915i eligibility by accepting the attestation of an individual assessment of need, which the State Evaluation Team uses to determine am individual’s eligibility for this benefit, from additional licensed providers.
