Medicaid State Plan Amendments

This plan amendment updates the payment methodology for certain rehabilitative services and establishes authority for a bundled rate methodology for Comprehensive Health Assessment (CHA) services.

This plan amendment updates the payment methodology for certain personal care services.

This plan amendment proposes to implement an Ambulance Service Provider Fee Reimbursement Program for eligible Wisconsin Medicaid private ambulance providers.

This amendment proposes to update cost sharing requirements.

This amendment adds coverage for behavioral health provided by credentialed School Psychologists, School Social Workers, and School Counselors in school-linked settings under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit and adds those providers as eligible for the Targeted Rate Increase fee schedule.

This SPA expands the continuum of community-based services and evidence-based practices available through Medi-Cal specialty behavioral health delivery systems by adding coverage for assertive community treatment (ACT), clubhouse services, and coordinated specialty care for first episode psychosis (CSC) and making other clarifications under the rehabilitative mental health services benefit.

This amendment is to conduct Medicaid presumptive eligibility (PE) determinations. PE groups: children under age 19, parents and other caretaker relatives, pregnant women, adults, and former foster care children, the effective date is May 12, 2023. PE for individuals needing treatment for breast or cervical cancer, the effective date is January 1, 2023.

This SPA amends the State plan to update Physician Administered Drug (PAD) reimbursement rates.

This SPA amendment, the state is implementing the final round of rate increases from a 2019 rate study, adding a new service called Person-Centered Future Planning, increasing the rate for Financial Management Services, and adding a new provider type to Community Living Arrangement Services.

This amendment is to update state plan assurances in accordance with federally mandated quality reporting requirements for the Child Core Set and the behavioral health quality measures on the Adult Core Set outlined in 42 CFR 431.16 and 437.10 through 437.15.