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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 SPA implements the five-percent inflationary increase to the Health Home Per Member Per Month and Clinical outcome measure payment rates appropriated by its state legislature during the 2023 legislative session
Summary: This amendment inflationary increases appropriated by the state legislature and updates the Physician Administered Drug Payment Methodologies.
Summary: The purpose of the amendment is to update the quality measures and associated weights for the health home quality incentive payment methodology. The updated methodology was reduced from ten weighted measures to seven. The total quality incentive payment pool for this disbursement remained the same
Summary: This amendment provides assurance for compliance with third party liability requirements outlined in the Consolidated Appropriates Act (CAA) of 2022
Summary: This SPA proposed to revise the state’s reimbursement rate for physician administered drugs such that it will continually align with the Medicare Fee Schedule reimbursement rate.
Summary: This amendment extends the supplemental payments for qualifying, private hospitals and nursing facilities for an additional state fiscal year.
Summary: This State Plan Amendment implements a 16% inflationary increase for Community Mental Health Centers and Substance Use Disorder Agencies appropriated by the state legislature.
Summary: This SPA implements Wisconsin's yearly increase to hospital rates. Specifically, this SPA modifies the outpatient Enhanced Ambulatory Patient Grouping Reimbursement Methodology to create a new outpatient payment per visit add-on for outpatient dental services where deep sedation is provided.
