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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 1 to 10 of 109 results
Transmittal Number: IA-21-0017
State: Iowa
Summary: Updates the limitations surrounding day treatments and pain management to expand services based on medical necessity.
Approval Date:
Effective Date:
Topics:
  • Program Administration
  • Benefits
Links:
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Transmittal Number: IA-21-0011
State: Iowa
Summary: Implements the fee schedule rates for fy 2022
Approval Date:
Effective Date:
Topics:
  • Program Administration
Links:
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Transmittal Number: IA-21-0009
State: Iowa
Summary: Increases the professional dispensing fee from $10.07 to $10.38 per prescription,

based on a recent cost of dispensing survey of Iowa Medicaid enrolled pharmacy providers.
Approval Date:
Effective Date:
Topics:
  • Program Administration
  • Financing & Reimbursement
Links:
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Transmittal Number: IA-21-0006
State: Iowa
Summary: Proposes to add medication-assisted treatment (MAT) as a mandatory benefit in the Medicaid state plan
Approval Date:
Effective Date:
Topics:
  • Current State Plan
  • Program Administration
Links:
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Transmittal Number: IA-20-0019
State: Iowa
Summary: This amendment applies to the 1915(i) HCBS Day Habilitation service. Revises provider qualifications and scope of service to assure that services are delivered by qualified providers and provide a pathway to employment for participants.
Approval Date:
Effective Date:
Topics:
  • Program Administration
Links:
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Transmittal Number: IA-20-0015
State: Iowa
Summary: Updates the medical exemption process for the Iowa Health and Wellness Plan (IHAWP)
Approval Date:
Effective Date:
Topics:
  • Program Administration
Links:
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Transmittal Number: IA-20-0010
State: Iowa
Summary: Adds greater clarification around operationalization of the HH programs, including new provider roles intended to increase overall quality improvement. In addition, the SPA broadened the scope of qualifying conditions to include chronic pain and chronic obstructive pulmonary disease, and made updates the reimbursement rates for the payment tiers assigned to the Chronic Condition HH program.
Approval Date:
Effective Date:
Topics:
  • Financing & Reimbursement
  • Program Administration
Links:
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Transmittal Number: IA-20-0005
State: Iowa
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.
Approval Date:
Effective Date:
Topics:
  • Current State Plan
  • Program Administration
Links:
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Transmittal Number: IA-20-0001
State: Iowa
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.

 
Approval Date:
Effective Date:
Topics:
  • Current State Plan
  • Program Administration
Links:
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Transmittal Number: IA-20-0004
State: Iowa
Summary: Removes the exemption from third party liability for prenatal services in order to comply with the amended section 1902(a)(25)(E) of the Act and the CMCS Informational Bulletin issued on June 1, 2018
Approval Date:
Effective Date:
Topics:
  • Program Administration
Links:
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