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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: The purpose of this SPA is to remove health homes language from Attachment 3.1F, due to the termination of the Health Homes Asthma and the Health Homes SMI programs.
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 requirements for signatures for dispensing of drugs during PHE.
Summary: Physician Administered Drugs (PADS) submitted under the medical benefit, including those drugs purchased through the 340B program, will be reimbursed at Medicare Part B fee schedule rates.
Summary: CMS is approving this state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to rescind the increase to the the pharmacy dispensing fee that was approved in Section D.8 of DR SPA KS-20-0012.
Summary: CMS is approving this time-limited state plan amendment (SPA) to respond to the COVID-19 national emergency. The purpose of this amendment is to establish coverage of prescribed drugs that are not covered outpatient drugs, including when the drug is authorized for import into the United States by the FDA, when the state determines coverage is medically necessary due to a recognized critical drug shortage.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to allow 2 presumptive eligibility periods during a 12-month period during the public health emergency; suspend cost-sharing for all COVID-19 related services; authorize up to 90-day supplies for maintenance drugs; expand prior authorization for medications; increases pharmacy reimbursement by adjusting dispensing fee; and make exceptions to the preferred drug list in case of drug shortages.
Summary: This SPA proposes changes to comply with requirements of the Covered Outpatient Drug Final Rule with comment (CMS-2345-FC) (81 FR 5170) for drug reimbursement.
Summary: This amendment updates provisions of the Nursing Facility (NF) and Nursing Facility for Mental Health (NF-MH) Quality Care Assessment Pass-Through. The Pass-Through is begin changed from a lump-sum payment to a per diem add-on.
