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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 amendment revises the methodology used to calculate payment rates for inpatient hospital services. Specifically, it maintains the reimbursement rates in effect for fiscal year 2009 through fiscal years 2010 and 201 l with no inflation adjustment.
Summary: This amendment proposed to amend the State's approved Title XIX State Plan to reduce the maximum allowable cost paid for selected multi-source drugs from average wholesale price (AWP)-40% to AWP-45 %; require pharmacy providers to obtain prior authorization for certain drugs that are either high cost, subject to misuse or subject to excessive or inappropriate utilization, as determined by the State; change the prior authorization requirements for early refills from 75% to 85% of days supply; and allow the dispensing of an automatic fourteen (14) day supply of a drug when no prior authorization has been requested and granted.
Summary: This proposed plan transmitted an amendment to the approved Title XIX State plan proposing to increase the amount of resources that the spouse of an institutionalized individual can retain, otherwise known as the Community Spouse Protected Amount (CSPA).
