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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: CMS is approving this SPA which amends the State Plan to increase the professional dispensing fee paid to pharmacies by 1% from $10.08 to $10.18.
Summary: CMS is approving this SPA which proposes to amend the State Plan to allow the State to enter into outcomes-based contract arrangements with drug manufacturers through supplemental rebate agreements.
Summary: Proposes updates in State Plan Pages based on 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 updates the Department of Health professional dispensing fee (PDF) for brand name, generic and over-the-counter (OTC) outpatient drugs to align with current costs.
Summary: This amendment proposes to allow the New York State Department of Health to move to actual acquisition cost (AAC) using the National Average Drug Acquisition Cost (NADAC) as the primary basis for its lower of reimbursement methodology for prescription drugs submitted for payment to the medical assistance program, along with a professional dispensing fee (PDF) of $10.00.
Summary: This amendment proposes to update the state Medicaid program' s drugs on which it may exclude from coverage or otherwise restrict in order to comply with the requirements of the 21' Century Cures Act.
Summary: This amendment clarifies that Psychiatric Treatment Facilities for Children and Youth (PRTF) providers are permitted to access medically necessary drugs by utilizing fee-for-service pharmacies beginning with the date a child is determined Medicaid eligible.
Summary: Removes barbiturates, beniodiazepines, and agents used to promote smoking cessation from the list of drugs the state Medicaid program may exclude from coverage or otherwise restrict in order to comply with the requirements of Section 2502( a) of the Affordable Care Act.
