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Medicaid State Plan Amendments

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.

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Showing 71 to 80 of 772 results
Transmittal Number: UT-23-0012
State: Utah
Summary: This amendment tracks cost sharing using the state's Provider Reimbursement Information System (PRISM).
Approval Date:
Effective Date:
Topics:
  • Premiums
  • Cost Sharing
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: UT-23-0008
State: Utah
Summary: This amendment updates the utilization trend for the outpatient hospital upper payment limit in State Fiscal Year 2024.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: UT-23-0013
State: Utah
Summary: Update to inpatient hospital services reimbursement methodology
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: UT-23-0005
State: Utah
Summary: This SPA proposes to allow the state to enter into value-based contracts with manufacturers.
Approval Date:
Effective Date:
Topics:
  • Value Based Purchasing
  • Prescribed Drugs
  • Supplemental Rebates and Managed Care
  • Preferred Drug Lists
  • Covered Outpatient Drug
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: UT-23-0010
State: Utah
Summary: Annual Rebasing Update
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: PA-23-0010
State: Pennsylvania
Summary: Makes a DSH payment add-on per FFS and managed care day; the daily add-on is tiered dependent on the qualifying facility's Medicaid day to total ratio. This additional DSH pool will not be redistributed if overpayments occur, but recouped and federal share returned.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: PA-22-0037
State: Pennsylvania
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 provide one-time lump sum supplemental payments to non-emergency medical transportation (NEMT) providers for the period beginning July 1, 2022 through April 30, 2023. This amendment also waives signature requirements for the dispensing of drugs during the public health emergency, effective March 1, 2020.
Approval Date:
Effective Date:
Topics:
  • Disaster Relief
  • Reimbursement
  • Prescription Drugs
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: UT-23-0004
State: Utah
Summary: The purpose of this SP A is to provide language to facilitate reimbursement for pharmacist cognitive services such as MTM services and contraceptive prescribing.
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
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Transmittal Number: PA-23-0001-A
State: Pennsylvania
Summary: To adopt the changes to the eligibility rules for the Former Foster Care Children eligibility group, as enacted by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, Pub. L. No. 115-217, section 1002.
Approval Date:
Effective Date:
Topics:
  • Eligibility
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT
Transmittal Number: UT-23-0009
State: Utah
Summary: The purpose of this SPA is to update pricing for medical supplies and durable medical equipment (DME).
Approval Date:
Effective Date:
Topics:
  • Reimbursement
Links:
SHARE THIS MEDICAID STATE PLAN AMENDMENT