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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 will pay a $12 direct care add‐on to private (non-state) owned intermediate care facilities for individuals with intellectual disabilities (ICF/IID) for increased costs related to retaining and hiring direct care staff.
Summary: This plan amendment edits the provisions governing reimbursement for hospice services in order to ensure that the current payment methodology aligns with CMS requirements.
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Providers, Emergency Department Services, Chiropractic Services and Personal Care Services and removed language that is no longer applicable.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.
Summary: The proposed SPA would reimburse the LSU Dental Ambulatory Surgical Center providers (ASC) similar or equivalent rate to the outpatient hospital surgery fee schedule rate.
Summary: This amendment modifies the maximum amount allowed for the maintenance of a home of institutionalized beneficiaries to reflect the Social Security Adjustment (COLA).
Summary: This plan amendment adopt provisions in the Home Health Program in order to establish recruitment and retention fee for service (FFS) payments under the American Rescue Plan Act 9817 for services rendered to eligible FFS Medicaid beneficiaries.
