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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 updates the Disproportionate Share Hospital payment time period to the current fiscal year, the fiscal year amount, and the payment frequency.
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: This amendment proposes allowing the Division of Medicaid to remove references to Medicare regulations and in-home services, unfreeze reimbursement rates, and make other edits required by CMS to End-Stage Renal Disease (ESRD) Services.
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 plan amendment updates the rate year 2024 reimbursement for inpatient hospital services. Specifically, it implements a new rate for specialty inpatient psychiatric services for eating disorders, and makes technical edits to the Clinical Quality Incentive program.
