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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 proposes to amend the pharmacy page's provision to cover all prescriptions for FDA-approved oral contraceptives for up to a 12-month supply at one time.
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 allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to temporarily extend for one year the following disaster relief flexibilities: targeted case management, telehealth, drug benefit, and behavioral health home requirements.
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: 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 entities qualified to make presumptive eligibility determinations, all for adjustments to benefits currently covered in the state plan (e.g. Personal Care Assistant Services; Care Management Organization Targeted Case Management Staffing), expand telehealth, adjust prior authorizations for medications, decrease certain payments (quarterly rather than monthly basis), expand bed hold limits due to COVID, and alteration of Behavioral Health Home travel protocols.
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: 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
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.
