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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 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 updates the plan by removing Medicare and other third party (non-Medicaid) ancillary costs from the allowable Medicaid reimbursement for Class I nursing facilities.
Summary: This plan amendment updates the plan by revising the Pay-For-Performance Supplemental Medicaid payment methodology to Class 1 nursing facilities from a per-diem add-on dollar amount to a flat per-diem multiplier methodology.
Summary: This SPA adds coverage of select prescribed drugs that are not covered outpatient drugs, and also adds coverage of prescribed drugs that are not covered outpatient drugs in cases of a drug shortage.
Summary: CMS is approving this time-limited state plan amendment to allow the state to implement temporary policies while returning to normal operations after the COVID-19 national emergency. The purpose of this amendment is to extend the waiver of premiums for the Buy-In program for Working Adults with Disabilities and the Buy-In program for Children with Disabilities.
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.
