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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 methods of implementation for NHs to eliminate the supplemental payment award to county homes and convert it into a prospective per-diem add-on for those facilities.
Summary: This plan amendment proposes that Tribal Federally Qualified Health Centers (FQHCs) may choose reimbursement for Medicaid covered services under one of two options, 1. Prospective Payment System (PPS) Rate, or 2. OMB All Inclusive Rate (AIR). In addition, Tribal FQHC Pharmacy dispensed drugs will be reimbursed according to the 1905(a)(12) prescribed drug benefit under either option.
Summary: This plan amendment extends the supplemental payments for qualifying, private hospitals and nursing facilities for an additional state fiscal year (SFY).
Summary: This amendment allows for coverage of select over-the-counter drugs manufactured by a firm that does not have a signed rebate agreement with the United States Department of Health and Human Services. Additionally, it allows South Dakota Medicaid to enter into value-based agreements with manufacturers on a voluntary basis.
Summary: This amendment is coverage of substance use disorder treatment services provided to eligible individuals in an eligible institution for mental diseases.
Summary: This plan amendment updates changes to the fee-for-service Medical Assistance (MA) maximum fee rates for Primary Care Providers, Emergency Department Services, Chiropractic Services and Personal Care Services and removed language that is no longer applicable.
Summary: This amendment removes the restriction of delivering personal care services in the home and allows services to be delivered elsewhere in the community (non-institutional settings).
Summary: The Centers for Medicare & Medicaid Services (CMS) has reviewed the proposed Wisconsin state plan amendment (SPA) to Attachment 4.19-A and B WI-24-0001, which was submitted to CMS on March 29, 2024. This plan amendment updates the Inpatient and Outpatient Hospital State Plans to increase the statewide Medicaid fee-for-service base rates for inpatient and outpatient services paid under the DRG and EAPG systems above and beyond the annual inflation increase.
