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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 seeks an exception to 42 CFR § 455.502, which requires each state to establish a Recovery Audit Contractor (RAC) program. The state seeks this exception because it is unable to procure a RAC vendor due to the small fee-for-service claims volume in the state.
Summary: Updates the scope of the state's pharmacist-covered services in order to align with Iowa's new protocols for (1) pharmacists ordering and dispensing naloxone and nicotine replacement therapy tobacco cessation products, and (2) pharmacists ordering and administering vaccines.
Summary: Proposes to allow the state to comply with the Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271).
Summary: This adjusts the professional dispensing fee from $10. 02 to $10. 07 per prescription, based on a recent cost of dispensing survey of lowa Medicaid enrolled pharmacy providers.
Summary: This amendment proposes to revise Iowa's Medicaid Supplemental Drug Rebate Agreement, along with removing a nonprescription nicotine replacement therapy from Iowa's excludable drug category on the state plan pages.
Summary: This SPA proposes to bring Iowa into compliance with the actual acquisition cost reimbursement requirements in the Covered Outpatient Drug final rule with comment.
Summary: This amendment proposes to allow for the inclusion of Medicaid managed care utilization for the accrual of supplemental rebates through the SSDC IOWA Medicaid Supplemental Drug Rebate Agreement.
Summary: Remove barbiturates benzodiazepines and agents used to treat smoking cessation from the list of drugs a Medicaid program may exclude from coverage or otherwise restrict.
