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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 allows coverage of authorized drug imports when there is inadequate supply of the fully FDA-approved, non-imported drug product during a recognized critical drug shortage.
Summary: This SPA allows coverage of medically necessary prescribed drugs that are not covered outpatient drugs, including drugs authorized for import by the U.S. Food and Drug Administration (FDA) during drug shortages.
Summary: This SPA proposes to amend the State Plan to cover prescribed drugs when medically necessary during drug shortages identified by the United States Food and Drug Administration (FDA).
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 extend SPA AK-23-0003 pharmacy dispensing fee rates after the end of the COVID-19 Public Health Emergency, through May 11, 2024.
Summary: This SPA adds coverage of prescribed drugs that are not covered outpatient drugs in cases of a drug shortage, as well as describe the reimbursement for prescribed drugs that are not covered outpatient drugs.
Summary: This amendment removes the list of specific drug categories for prescription drugs under EPSDT, as well as add language that states that certain prescription drugs are exempt from the prescription quantity limitations and will be listed on the agency’s website.
Summary: This amendment is to suspend temporarily pharmacy co-payments for dates of service starting February 21, 2024, through March 18, 2024, in response to the Change Healthcare cybersecurity incident in alignment with the CMCS Informational Bulletin.
