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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.
CMS is approving DE-19-0009 which amends the State Plan to allow Medicaid beneficiaries to request coverage from pharmacies of select FDA approved over-the-counter medications through an agreement with the Department of Public Health Medical Director for the purpose of generating a prescription and clarifies the coverage policy related to drugs indicated for the treatment of obesity.
Summary: This amendment updates the compliance oversight process under the False Claims Act such that Vermont Medicaid will ensure provider compliance through a document review electronically or via written correspondence and will no longer conduct site visits unless deemed necessary. This SPA is being amended under Section 1902(a)(68) of the Social Security Act.
Summary: This amendment allows the West Virginia Bureau of Medical Services to provide payments to private or public, non-state government hospitals on behalf of Medicaid individuals with a substance use disorder who are awaiting placement effective June 1, 2022.
Summary: The purpose of this SPA is Oklahoma’s Annual Rebasing of Rates for regular nursing facilities, nursing facilities serving residents with Acquired Immune Deficiency Syndrome (AIDS), and acute and regular Intermediate Care Facilities for Individuals with an Intellectual Disability (ICF/IIDs).
Increases rates for Out Patient Behavioral Health Agency Services, Residential Level of Care Substance Abuse Disorder Services and Independently Contracted Psychologists.