Arizona Medicaid State Plan Amendments

This page lists State Plan Amendments (SPAs) to the Medicaid State Plan that have been submitted to the Centers for Medicare and Medicaid Services (CMS). If the SPA was approved by CMS, the approval letter is provided.

2018 Amendments

SPA 18-011 – EMS Rates
Updates the State Plan to make update to EMS rate methodologies.

SPA 18-010 – GME 2019
Updates the State Plan to continue the GME program for FY2019.

SPA 18-009 – FQHC Alternative Payment Model
Updates the State Plan to update the alternative payment methodology for federally qualified health centers to include quality measures.

SPA 18-008 – DSH Third Party Payments
Updates the State Plan to exclude third party payments from the Medicaid shortfall calculation.

SPA 18-007 - DSH Budget Changes
Updated the State Plan regarding DSH pools 4 and 5 in response to budget changes passed by the Arizona State Legislature.

SPA 18-006 - Asset Verification
Updated the State Plan to describe AHCCCS acquisition of an Asset Verification system through the NESCO consortium.

SPA 18-005 – Personal Needs Allowance
Updates the State Plan to provide personal needs allowances for income garnished for child support or spousal maintenance.

SPA 18-004 – 638 FQHC
Updates the State Plan to change the reimbursement rates for specialty drugs dispensed by IHS/638 facilities.

SPA 18-003 – IHS/638 Specialty Drugs
Updates the State Plan to change the reimbursement rates for specialty drugs dispensed by IHS/638 facilities.

SPA 18-002 – DRG Rebase
Updates the State Plan to rebase the DRG rates.

SPA 18-001 – NF Rate Updates
Updates the State Plan to make changes to NF payments.

2017 Amendments

SPA 17-017 – Nursing Facilities Differential Adjusted Payments
Updates the State Plan establishes differential adjusted payments for nursing facilities.

SPA 17-016 – Integrated Clinic, Physician, Physician’s Assistant and Registered Nurse Practitioner Differential Adjusted Payments
Updates the State Plan establishes differential adjusted payments for Integrated Clinic, Physician, Physician’s Assistants and Registered Nurse Practitioners.

SPA 17-015 – Inpatient Differential Adjusted Payments
Updates the State Plan establishes differential adjusted payments for inpatient care.

SPA 17-014 – Other Provider Rates
Updates the State Plan to update the other provider rates.

PA 17-013 – Outpatient Hospital Rates
Updates the State Plan to update OP Hospital Rates.

SPA 17-012 – LTAC and Rehab Rates
Updates the State Plan to update LTAC and Rehab rates.

SPA 17-011 – Ambulance Rates
Updates the State Plan to make changes to ambulance rates.

SPA 17-009 – Share of Cost
Updates the State Plan to make changes to the share of cost deduction by expanding the list of services eligible for a share of cost deduction and adding a reasonable restriction on the period in which the expense occurred.

SPA 17-008 – Adult Emergency Dental and Occupational Therapy
Updates the State Plan to add a benefit for adult emergency dental services and occupational therapy.

SPA 17-005 - Disproportionate Share Hospital
Updates the State Plan to transition the Disproportionate Share Hospital program from Arizona's 1115 waiver into the state plan.

SPA 17-004 – NF Rate Update
Updates the State Plan to make changes to NF payments.

SPA 17-003 – American Indian Medical Home
Adds the American Indian Medical Home program in the State Plan.

SPA 17-002 – DRG Pediatric Policy Adjustor
Updates the State Plan to make changes to the DRG pediatric policy adjustor.

SPA 17-001 – Prop 206 NF Rate Update
Updates the State Plan to make changes to NF payments.

2016 Amendments

SPA 16-013 – DRG Updates
Updates the State Plan to make changes to DRG payments.

SPA 16-012-B – Outpatient Services Value Based Purchasing (VBP) differential adjusted payment
Updates the State Plan to include Value Based Purchasing (VBP) differential adjusted payment for hospitals providing outpatient hospital services and providers registered with AHCCCS as integrated clinics.

SPA 16-012-A – Inpatient Hospitals Value Based Purchasing (VBP) differential adjusted payment
Updates the State Plan to include Value Based Purchasing (VBP) differential adjusted payment for Hospitals providing inpatient hospital services.

SPA 16-012-C – Value Based Purchasing Nursing Facilities
Updates the State Plan to include Value Based Purchasing (VBP) differential adjusted payment for nursing facilities.

SPA 16-011 – ABP Podiatrist Services
Updates the State Plan to add podiatrist services under the other licensed practitioner benefit.

SPA 16-010-E – Ambulance and Air Ambulance Rates
Updates the State Plan to make changes to ambulance and air ambulance rates.

  • Approved 5/12/2017
  • SPA 16-010-D – Nursing Facility Rates
    Updates reimbursement for Nursing Facilities rates for the period beginning October 1, 2016.

  • Approved 11/01/2016
  • SPA 16-010-C – Other Provider Rates
    Updates the State Plan to make changes to other provider rates.

    SPA 16-010-B – Outpatient Hospital Rates
    Updates the State Plan to make changes to outpatient hospital rates.

    SPA 16-010-A – Freestanding Psychiatric Hospital Rates
    Updates rates for freestanding psychiatric hospitals for the period beginning October 1, 2015.

    SPA 16-009 – General Medical Education 2017
    Updates GME funding for the service period July 1, 2016 through June 30, 2017 for programs with submitted IGAs.

    SPA 16-008 – LTAC and Rehab Hospitals
    Updates the State Plan to revise the effective date of rates to long term acute care and rehabilitation hospitals.

    SPA 16-007 – Freestanding Hospital-based Emergency Departments
    Updates the State Plan to include Freestanding Hospital-based Emergency Departments as a reimbursable provider under outpatient hospital services.

    SPA 16-006 – Treat and Refer
    Updates the State Plan to add to describe community paramedicine, otherwise referred to as Treat and Refer.

    SPA 16-005 – NF Provider Assessment
    Updates the State Plan to revise the assessment amounts for Nursing Facility supplemental funding.

    SPA 16-004 – Services by a Podiatrist
    Updates the State Plan to add services provided by a podiatrist as an Other Licensed Practitioner.


    SPA 16-003 – Vaccines and Immunizations
    Updates the State Plan to expand the types of vaccines and immunizations administered by pharmacists for AHCCCS members consistent with ARS §32-1974.

    SPA 16-002 – Air Ambulance Rates Update
    Updates the State Plan to revise Air Ambulance Rates.

    SPA 16-001 – Hospice Rates Update
    Updates the State Plan to revise Hospice Rates.

    2015 Amendments

    SPA 15-010 – DRG Update
    Updates the State Plan to revise DRG.

    SPA 15-009 – Rehab and LTAC Hospital Rates
    Updates the State Plan to describe payments to long term acute care and rehabilitation hospitals.

    SPA 15-008 – NF Assessment Out-of-State Exemption
    Updates the State Plan to exempt out of state nursing facilities from receiving supplemental payments.

    SPA 15-007 – APR DRG
    Updates DRG for the DCI and transition adjustment factors as of October 1, 2015.

    SPA 15-006 – Graduate Medical Education 2016
    Updates funding for GME programs for the service period July 1, 2015, through June 30, 2016 for programs with submitted IGAs.

    SPA 15-005-D – Nursing Facility Rates
    Updates reimbursement rates for Nursing Facilities the period October 1, 2015 to September 30, 2016 and permanently removes the automatic inflation factor beginning October 1, 2015.

    SPA 15-005-C – Other Provider Rates
    Updates rates for other provider services as of October 1, 2015.

    SPA 15-005-B – Outpatient Rates
    Updates rates for outpatient services as of October 1, 2015.

    SPA 15-005-A – Freestanding Psychiatric Hospital Rates
    Updates the rates for freestanding psychiatric hospitals as of October 1, 2015.

    SPA 15-004 - Ambulance Rates
    Updates Ambulance Rates in the State Plan.

    SPA 15-003 - Orthotics
    Updates the State Plan to reflect updates to the orthotic benefit.

    SPA 15-002 – Nursing Facility Assessment
    Updates the Nursing Facility assessment dollar amounts in State Plan.

    SPA 15-001 – Supplemental Drug Rebates
    Updates the State Plan to include supplemental drug rebates effective January 1, 2015.

    2014 Amendments

    SPA 14-014 – ABP Cost-Sharing
    Updates the State Plan to include cost-sharing for individuals with income over 100% FPL.

    SPA 14-013-D – Nursing Facility Rates
    Updates reimbursement rates for Nursing Facilities for the period October 1, 2014 to September 30, 2015.

    SPA 14-013-C – Other Provider Rates
    Updates reimbursement rates for other providers for the period October 1, 2014 to September 30, 2015.

    SPA 14-013-B – Outpatient Rates
    Continues current outpatient hospital reimbursement rates for the period October 1, 2014 to September 30, 2015.

    SPA 14-013-A – Freestanding Psychiatric Hospital Rates
    Continues rates for freestanding psychiatric hospitals for the period October 1, 2014 to September 30, 2015.

    SPA 14-012 - GME
    Updates GME funding for the service period July 1, 2014 through June 30, 2015 for programs with submitted IGAs.

    SPA 14-011 - Third Party Liability
    Updates the State Plan to reflect changes to Third Party Liability.

    SPA 14-010 – Insulin Pumps
    Updates the ABP and State Plan to include insulin pumps as a covered benefit.

    SPA 14-009 – APR-DRG
    Describes the All Patient Refined Diagnosis Relation Group hospital reimbursement methodology in the State Plan for Inpatient dates of service on and after October 1, 2014.

    SPA 14-008 – Presumptive Eligibility
    Describes Presumptive Eligibility by Hospitals in Arizona.

    SPA 14-007 – Barbiturates, Benzodiazepines and Tobacco Cessation
    Updates the State Plan to remove barbiturates, benzodiazepines and agents used to promote tobacco cessation otherwise covered by Medicare Part D.

    SPA 14-006 – Alternative Benefit Plan (ABP)
    Aligns the ABP benefits for individuals enrolled in the new Adult Group with the current State Plan. In Arizona, the new Adult Group includes childless adults 0-100% FPL and adults without Medicare that are 100-133% FPL.

    SPA 14-005 – Medicaid Administration
    Addresses single state agencies delegation of appeals and determinations.

    SPA 14-004 – Therapies
    Revises the State Plan to reflect updates to therapies covered under the State Plan.

    SPA 14-003 – Medically Preferred Treatment Options
    Revises the State Plan to reflect updates to the orthotic benefit.

    SPA 14-002 – Coverage for over-the-counter or non-prescription medication
    Updates the State Plan to comprehensively describe coverage for over-the-counter or non-prescription medication.

    SPA 14-001 – ADHS Licensure Changes
    Revises the State Plan to reflect updates to the licensing of health programs.

    2013 Amendments

    SPA 13-017C – Reimbursement Rates for Other Providers
    Updates the State Plan to continue current reimbursement rates for other providers during the period October 1, 2013 to September 30, 2014.

    SPA 13-017B – Outpatient Rates
    Updates the State Plan to continue current outpatient hospital reimbursement rates for the period October 1, 2013 to September 30, 2014.

    SPA 13-017A – Inpatient Rates
    Updates the State Plan to continue current inpatient hospital reimbursement rates for the period October 1, 2013 to September 30, 2014.

    SPA 13-016 – Recovery Audit Contractors
    Updates the State Plan to include underpayments for Recovery Audit Contractors.

    SPA 13-015 – FMAP Rates Methodology
    Updates the State Plan to reflect the methodology for identification of applicable FMAP rates.

    SPA 13-014 – Elimination of 25-day In Patient Hospital Limit
    Updates the State Plan to eliminate the 25 day inpatient hospital limit beginning October 1, 2014.

    SPA 13-013 - MAGI Based Income Methodologies
    Updates the State Plan to apply Modified Adjusted Gross Income (MAGI)-based income methodologies in determining eligibility.

    SPA 13-012 – Graduate Medical Education
    Updates the State Plan for Graduate Medical Education program funding for service period July 1, 2013 through June 30, 2014.

    SPA 13-011 – Well Exams
    Updates the State Plan to include well exams as a covered service.

    SPA 13-010 – Citizenship and Immigration Status
    Updates the State Plan to include citizenship and non-citizen eligibility.

    SPA 13-009 – Residency
    Updates the State Plan to reflect that Arizona provides Medicaid to eligible residents of the state.

    SPA 13-008 – Optional MAGI-based Eligibility Groups
    Updates the State Plan to include optional MAGI-based eligibility groups (S14, S50, S51, S52, S53, S54, S55, S57 and S59), effective January 1, 2014.

    SPA 13-007 – Mandatory MAGI-based Eligibility Groups
    Updates the State Plan to include MAGI-based eligibility groups (S25, S28, S30, S32 and S33), effective January 1, 2014.

    SPA 13-006 – Prior Quarter Coverage
    Updates the State Plan to reflect that prior quarter coverage will be covered, effective January 1, 2014.

    SPA 13-005 – Eligibility Process
    Single streamlined application or alternative, Renewals, Coordination for enrollment and eligibility (agreements with Exchanges)

    SPA 13-004 Drug Coverage
    Updates the State Plan to exclude the coverage of barbiturates and benzodiazepines for dual eligibles as Part D covers them effective January 1, 2013.

    SPA 13-003 Primary Care Service Payments
    Updates the State Plan to reflect that reimbursements for certain Primary Care Services will comply with the Affordable Care Act.

    SPA 13-002 Technical Correction
    Updates the State Plan to make technical correction that incorporates the changes approved in SPA #11-017A.

    SPA 13-001 Tobacco Cessation Services for Pregnant Women
    Updates the State Plan to include Tobacco Cessation Counseling Services for Pregnant Women effective January 1, 2013.