An official website of the United States government
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.
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 amends Attachment 3 .1-A to reflect updates to the "Ohio Department of Medicaid Supplemental Rebate Agreement" template. This agreement is between pharmaceutical manufacturers and the state, and governs supplemental rebates for medications dispensed to Medicaid recipients.
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 prescription drugs for the duration of the COVID-19 Public Health Emergency.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to extend the reasonable opportunity period for certain non-citizens, allow hospital presumptive eligibility (PE) for additional groups and designates the State Medicaid Agency as a qualified entity for PE for MAGI groups, suspend all cost-sharing, modify the NF benefit to include health care isolation centers (HCIC) to provide COVID-related care for individuals who cannot safely remain at home or in a NF. It also suspends limits on private duty nursing services; allows physicians and other licensed practitioners, in accordance with state law, to order durable medical equipment; expands telehealth; and extends prior authorization for medications by automatic renewal without clinical review or time/quantity extensions. It also makes the following Payment changes: adds a telehealth originating site fee; increases payments for lab and NF services related to COVID; and increases limits on bed hold days. Finally, t designates COVID-19 quarantine or isolation levels of care as categorical qualification for pre-admission screening; and suspends state plan staffing requirements for NF ventilator weaning.
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: Proposes to specify that managed care plans contracted with the state will follow a unified Preferred Drug List, and that supplemental rebates will be collected for utilization for both fee-for-service and managed care participants.
Summary: This SPA proposes to bring Ohio into compliance with the provider-administered drug requirements in the Covered Outpatient Drugs final rule with comment period (CMS-2345-FC).
Summary: This amendment proposes to delay the implementation date of when the state will begin including utilization from participating MCOs for supplemental drug rebates.