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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 any signature requirements for the dispensing of drugs during the Public Health Emergency.
Summary: This SPA includes reimbursement methods that use, among others, the National Average Drug Acquisition Cost (NADAC), plus a professional dispensing fee of $10.50 for covered outpatient drugs. This SPA also includes reimbursement rates for 340B drugs, long-term care and specialty drugs, drugs purchased at a nominal price, and physician administered drugs.
Summary: Incorporates the language mandated in 1902 (a)(85) and Section 1004 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act
Summary: Proposes to update the reimbursement methodology for drugs procured through the 340B program to allow for claim-level identification of 340B drug
Summary: This amendment proposes to remove barbiturates, benzodiazepines, 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.
Summary: Allows primary care physicians that practice in family medicine, general internal medicine, pediatric medicine, and related subspecialists to receive increased payments for certain primary care services and vaccine administration in calendar years 2013 and 2014.
