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Proposed State Plan Amendments

Proposed State Plan Amendments

The State Plan Amendments below have been submitted to Centers for Medicare and Medicaid Services (CMS) for approval.


SPA 18-0011 Physician Administered Drugs (PAD)
State Plan Amendment (SPA) 18-0011 Physician Administered Drugs (PADs) has been submitted to allow the Division of Medicaid to reimburse for certain PADs under the pharmacy benefit to improve beneficiary access. These certain PADs are currently referred to as Clinician Administered Drug and Implantable Drug System Devices (CADDs) and include, but are not limited to, long-acting reversible contraceptives (LARCs), pregnancy maintaining agents, injectable atypical antipsychotic agents, and chemical dependency treatment agents. CADDs may be billed as either medical or pharmacy point-of-sale (POS) claims, effective July 1, 2018.

SPA 18-0015 Disproportionate Share Hospital (DSH) Payments 
State Plan Amendment (SPA) 18-0015 Disproportionate Share Hospital (DSH) Payments has been submitted to update the hospital DSH program effective October 1, 2018:
1. To clarify: a) The treatment of hospital assessments on hospital cost reports according to the entire Section 2122 of the Medicare Provider Reimbursement Manual 15-1,
b) Medicaid costs include Graduate Medical Education (GME) approved program costs in DSH calculations, c) Medicaid costs do not include costs associated with services covered by another third-party payer, including Medicare. When Medicaid eligible patients have access to coverage from another party, payments may be used as a proxy for cost offsets when calculating the Medicaid payment shortage or overage, d) The DSH payment period is from October 1 through September 30. The determination of a hospital DSH status is made annually for hospitals that meet the DSH requirements as of October 1, and 2. Add Section 5-6, Revised Allotments, which describes the treatment of revised DSH allotments.

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