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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 amendment revises payment methodologies for inpatient hospital services. Specifically, this amendment eliminates the length of stay outlier payment; clarifies that Medicare cost report data is obtained through the Health Cost Reporting Information System (HCRIS) maintained by the Center for Medicare and Medicaid Services (CMS); increases the standard DRG group rate; increases the "trimpoint" amount for hospitals to qualify for a cost outlier payment; proposes supplemental disproportionate share hospital (DSH) payments for State, County and Private hospitals; creates a second level of supplemental payments to essential access city hospitals; increases the amount of inpatient access payments to acute care, children's, rehabilitation, and critical access hospitals.
Summary: This State Plan Amendment removes parents/caretaker relatives with income above I 00 percent and at or below 200 percent of the FPL from the current alternative cost sharing pages. These individuals will instead be subject to nominal cost sharing as described on pages 4.18-A and 4.18-C of the Wisconsin State Plan.
Summary: This SPA transmitted a proposed revision to New Hampshire's approved Title XIX State Plan in order to remove the 18 visit service limit on physician and advanced registered nurse practitioners (ARNP) to change the psychotherapy service limit from 12 to 18 visits for adults age 21 and over and from 12 to 24 the visits for children under age 21.
