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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: To implement Express Lane Eligibility (ELE) to streamline and expedite renewal of eligible individuals in the Maryland Medicaid Assistance Program and Maryland Children’s Health Program (MCHP).
Summary: To expand coverage for school-based psychological services when provided to students who do not have an Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).
Summary: This amendment is to temporarily suspend otherwise covered benefits for the period January 1, 2024 through September 30, 2024 in response to the territory’s local funding shortfall.
Summary: This amendment proposes to allow Medicaid-enrolled pharmacists to bill Maryland Medicaid for professional services rendered within their lawful scope of practice.
Summary: To include coverage for peer recovery support services within the state’s Other Diagnostic, Screening, Preventive and Rehabilitative Services benefit and the Mandatory Medication-Assisted Treatment (MAT) benefit. Individual peer support services will be reimbursed at a rate of $16.38 per 15-minute unit, and group peer support services will be reimbursed at a rate of $4.55 per 15-minute unit. This SPA also removes the DATA 2000 waiver requirement for the prescribing of buprenorphone for opioid use disorder.
Summary: To reimburse for community violence prevention services. Coverage will be extending to this service at a fee-for-service rate of $32.76 per 30-minute increments up to a maximum of 100 increments in a rolling 12-month period.
Summary: This amendment preserves approved coverage of prescription drugs, dentures, and prosthetic devices while resolving a technical duplicate page number issue in Attachment 3.1A.
Summary: Updates the State Plan language regarding the Community First Choice program to accurately reflect the highest allotted budget for personal Assistance Services based on the Resource Utilization Groups (RUG), which is $43,680 annually.
Summary: To update State Plan language regarding the EPSDT program, including eligible provider types, clarifying limitations to dental and audiological services, and removing references to the 504 Written Individualized Program.
Summary: This amendment adds optometry services to the state plan, revises coverage of eyeglasses/contact lens, and adds a fee-for-service payment methodology for these benefits.
