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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 amendment will discontinue the pharmacy Opt-In program, which requires recipients receiving more that eleven prescriptions per month to remain at one pharmacy.
Summary: The plan amendment updates the state plan to comply with the change in the law, which requires Part D drug coverage of barbiturates used in the treatment of epilepsy, cancer, or a chronic mental health disorder and benzodiazepines.
Summary: This SPA discontinue coverage of legend (prescription only) brand and generic agents used for symptomatic relief of cough and cold. The Agency will continue to cover certain over-the-counter (OTC) cough and cold products in an effort to provide cost effective alternatives to recipients.
Summary: This amendment proposes to clarify the description of prescribed drugs, revise the reimbursement methodology for North Carolina Estimated Acquisition Cost (NCEAC) for prescribed drugs and establish a 4 rate tier generic dispensing fee structure for reimbursement.
Summary: This SPA proposed to amend the maximum allowable cost for selected multi-source brand and generic drugs to range from average wholesale price (A WP) minus 72 percent to step down tiers through A WP minus 20 percent based on meeting specific invoice pricing criteria.
Summary: This amendment eliminates the trend factor increase for inpatient hospital rates for calendar year 2012. It also sunsets the supplemental payments to certain hospitals that performed utilization reviews, since those are now performed for the State by a third party contractor.
