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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 plan amendment updates the inpatient hospital state plan to require that hospitals be located within the State of Wisconsin in order to qualify for payments under the standard Disproportionate Share Hospital (DSH) payment program.
Summary: This SPA allows coverage of medically necessary prescribed drugs that are not covered outpatient drugs, including drugs authorized for import by the U.S. Food and Drug Administration (FDA), during drug shortages.
Summary: 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.
Summary: This plan amendment updates rates for nursing facilities based on the most recent cost report data available (i.e., fiscal year ending Sept. 30, 2023); applies a 1.8% inflation factor in the calculation of the October 1, 2024, payment rates; maintains the previously approved cost center standards determining general services standards at 110% of the mean, and determining laundry, housekeeping, and maintenance standards at 105% of the mean; maintains the minimum occupancy used for Medicaid rate setting purposes at 85%; and increases the square footage allowance used for capital cost reimbursement purposes from $276.71 to $283.25
