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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: Implements Substance Use Disorder (SUD) benefits already in NJ's Alternative Benefit Plan. Updates mental health rates and changes the Medication Assisted Treatment (MAT) that is reimbursed through Medicaid to allow billing of a weekly bundled rate.
Summary: This SPA revises the state plan to incorporate language that authorizes the state to enter into value-based contract arrangements with drug manufacturers through supplemental rebate agreements.
Summary: Allows the Texas Health and Human Services Commission (HHSC) to make Medicaid Direct Graduate Medical Education payments to nine non-state government-owned and operated teaching hospitals.
Summary: The SPA increases the personal needs allowance (PNA) to $70 for individuals and $140 for couples medical institutions and residential settings in accordance with COLA adjustments and legislative funding.
Summary: This amendment reimburses certain physician administered drugs (PAD), referred to as Clinician Administered Drug and Implantable Drug System Devices (CADDs), using the state's existing lesser of methodology under the pharmacy reimbursement methodology.
Summary: This SPA is adding a cost-based reimbursement process for school-based IEP direct services based on certified public expenditures including a process for quarterly reconciliation and final settlement based on actual expenditures.
Summary: This will provide for reimbursement for long-acting reversible contraceptives (LARCs) inserted immediately after childbirth and prior to discharge from the hospital.