Medicaid State Plan Amendments

This SPA modifies the language provisions for coverage of weight loss drugs as outlined on the Wisconsin Medicaid Drug Search Tool found on the state’s website.

This amendment is to add Community Health Workers as Providers of Preventative Services to the Medicaid State Plan.

This amendment complies with the Consolidated Appropriations Act of 2022 and makes changes to the state plan so that health insurance companies cannot deny reclamation claims for the Agency not obtaining prior authorization for the item or service through the health insurance company and requiring health insurance companies to process reclamation claims within 60 days of receipt of such claims.

This plan amendment updates the Arizona disproportionate share hospital (DSH) pool 5 payment amounts and participant list, for the DSH state plan rate year ending 2023.

This plan amendment adds an add-on payment for Renal Dialysis.

This plan amendment adopts provisions governing qualifying criteria and reimbursement methodology for other rural hospitals in order to increase payments for outpatient hospital services.

This plan amendment updates the case mix data source from the Resource Utilization Groups (RUGs) to the Patient-Driven Payment Model (PDPM).

This plan amendment increases payment rates for dental services, pharmacy dispensing fees, lactation counseling services, and personal assistance services (PAS).

This amendment is to add Elevated Blood Lead (EBL) level education visits for children under 21 years of age, and Lead Hazard Risk Assessments for children under 21 years of age.

This amendment is to add coverage for the human papillomavirus (HPV) vaccine for persons 46 years of age or older who meet certain medical criteria.