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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 time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to waive the counseling signature requirements for the dispensing of drugs during the COVID-19 Public Health Emergency.
Summary: CMS is approving this time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to expand telehealth, extend all prior authorization by automatic renewal without clinical review or time/quantity extensions, and adjust prior authorizations for medications.
Summary: Allows 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
Summary: This amendment is to bring the state plan into compliance with the applicable requirements of 42 Code of Federal Regulations (CFR) §447.518, relating to payment for covered outpatient drugs, specifically as it relates to addressing reimbursement methodology for 340B drugs, physician administered drugs, clotting factor, federal supply schedule and drugs purchased at nominal price.
Summary: Revises Texas pharmacy reimbursement methodology for the Medicaid fee-for-service program from the current methodology to one that pays pharmacies based on the drug ingredient cost, defined as the acquisition cost (AC), plus a professional dispensing fee.
Summary: The proposed amendment revises all references to the Pharmaceutical and Therapeutics Committee by inserting the Drug Utilization Review Board (DUR) Board In its stead. The scope of the DUR board is also updated to accurately reflect the membership makeup and current duties of that committee.
Summary: Updates the physicians and other practitioners' fee schedules and changes the reimbursement methodology for physician-administered drugs and biological products when a new national procedure code is assigned.
Summary: Removal of benzodiazepines, barbiturates, 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.
