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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: Modifies Wisconsin's methodology for payment by adjusting the reimbursement rate for nursing homes and intermediate care facilities for individuals with intellectual disabilities.
Summary: Amends the provisions governing reimbursement for non-state intermediate care facilities for persons with intellectual disabilities (ICFs/IID) to increase the reimbursement rates to facilities that downsized from over 100 beds to less than 35 beds prior to December 31, 2010, without the benefit of a cooperative endeavor agreement.
Summary: The purpose of this SPA is to amend the provisions governing reimbursement for end stage renal disease (ESRD) facilities in order to allow contracted independent laboratories to bill the Medicaid program directly for the provision of covered non-routine laboratory services instead of receiving reimbursement from the ESRD facility
Summary: Amendment is to modify third party liability (TPL) rules related to special treatment of certain types of care and payment and to allow for payment up to 100 days after a claim is submitted for claims related to support enforcement; to modify TPL rules around preventive pediatric services; and to modify the cost avoidance changes for prenatal services and coordination of benefits cost avoidance when processing claims for prenatal services, including labor and delivery, and postpartum care claims.
Summary: The purpose of this state plan amendment is to adopt provisions governing reimbursement outside of the inpatient hospital per diem for donor human breast milk provided to hospitalized premature newborns in order to ensure access to an effective treatment to reduce the incidence of severe complications.
Summary: This time-limited state plan amendment to respond to the COVID-19 national emergency. The purpose of this amendment is to increase the cap for supplemental disproportionate hospital share (DHS) payments to qualifying hospital providers.
Summary: This time-limited state plan amendment responds to the COVID-19 national emergency. The purpose of this amendment is to cover the new optional group for COVID testing, and remove language that requires Pediatric Day Healthcare Center (PDHC) closure in order for families to receive services in a residential setting.
