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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 is to extend the time frame for Targeted Case Management (TCM) for pregnant individuals receiving services after the end of their pregnancy to 12 months to align with the state’s extended eligibility coverage of 12 months post-partum for Medicaid-eligible pregnant individuals.
Summary: This amendment is to increase coverage of eyeglasses for individuals aged 21 and older to permit annual replacement that may be exceeded based on medical necessity.
Summary: This amendment is to increase the monetary limit for dental services coverage and removes a specified tooth restriction for certain restorative porcelain and ceramic substrate crowns for individuals aged 21 and older.
Summary: This amendment will allow Licensed Marriage and Family Therapists (LMFT) and LMFT Licensure Candidates in training to provide services as qualified behavioral health clinicians for covered rehabilitative services.
Summary: This SPA makes permanent telehealth flexibilities for home health services and to expand qualified providers to conform with federal regulatory changes.
Summary: This amendment establishes compliance with the mandatory coverage and reimbursement of routine patient costs associated with participation in qualifying clinical trials under Sections 1905(a)(30) and 1905(gg) of the Social Security Act.
Summary: This amendment clarifies the assurance that Guam provides EPSDT services pursuant to sections 1902(a)(10)(A), 1905(a)(4)(B), and 1905(r) of the Social Security Act.
Summary: The EPSDT Medicaid State Plan will be amended to update the of the fee schedule to implement a revised fee schedule, which reflects updated reimbursements rates for all services
Summary: revises the coverage location of Applied Behavior Analysis (ABA) services in the state plan, clarifies that ABA services are provided for individuals under the age of 21 pursuant to EPSDT, clarifies the qualified practitioners that can furnish ABA services in Montana, and makes conforming changes to the corresponding reimbursement pages.
