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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: Effective January 1, 2021, this amendment brings the Maine State Plan in compliance with the Electronic Visit Verification (EVV) requirements in Section 12006 of the 21st Century CURES Act.
Summary: Effective March 1, 2020, this amendment establishes coverage of COVID-19 vaccine administration and a reimbursement rate for COVID-19 vaccine administration for providers reimbursed on a fee-for-service basis.
Summary: Effective April 1, 2021, this amendment approves the continuation of the exception to the recovery audit contractor (RAC) requirements through April 30, 2023.
Summary: Effective June 1, 2021 until terminated on May 31, 2023, this amendment extends the exception to the Medicaid Recovery Audit Contractor (RAC) program.
Summary: Effective January 27, 2021, this amendment brings the state into compliance with a court order that instructs the state to cover medically necessary Applied Behavior Analysis (ABA) therapy to treat Autism Spectrum Disorder (ASD) for Medicaid Managed Care Organization (MCO) clients over the age of twenty and removes the limitation for managed care and fee-for-service enrollees in the Applied Behavior Analysis (ABA) therapy to treat Autism Spectrum Disorder (ASD.)
Summary: Effective January 01, 2021, this amendment adds substance use disorder (SUD) as an additional eligibility criterion for Health Home Services. For payments made to Health Homes providers for Health Homes participants who newly qualify based on the Health Homes program’s additional condition coverage under this amendment, a medical assistance percentage (FMAP) rate of 90% applies to such payments for 8 quarters from the effective date of this SPA. The FMAP rate for payments made to health homes providers will return to the state's published FMAP rate at the end of the enhanced match period.
Summary: Effective July 1, 2021 this amendment removes the 24-day per state fiscal year limit for covered inpatient physician and surgical services provided to adult SoonerCare members to align with current practices and for the purposes of the alternative benefit plan (ABP) for adults in the expansion group.
