Medicaid State Plan Amendments

This plan amendment updates the Disproportionate Share Hospital payment time period to the current fiscal year, the fiscal year amount, and the payment frequency.

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.

With this amendment, the state will permanently adopt COVID-19 PHE flexibilities; and add Remote Supports & Host Home Service modalities to align with the state's 1915(c) HCBS waivers.

To update reimbursement methodology for Rehabilitation Day Services and Psychosocial Rehabilitation (Clubhouse) Services. To add screening, as a new service under the Mental Health Rehabilitative Services benefit. To rename Community Based Intervention Level 1, Multisystemic Therapy. To add a new service, Attachment and Biobehavioral Catchup, as a preventive service. To update the structure of Methadone Services in Opioid Treatment Programs.

This SPA in which the state will document its methodology for considering reasonably predictable changes in income.

This amendment updates State Plan language regarding the Community First Choice program to reduce the provider requirements for emergency response.

Memorialize changes made during the COVID-19 Public Health Emergency to the My Health GPS Health Home Program. Modifications to the My Health GPS Program include changes to staffing ratios, provider payment reimbursement methodologies, and administering the needs assessment portion of a beneficiary's level of care review.

This SPA amendment is to update the organization and administration of the State Medicaid Agency and reflects internal organizational change.

This amendment proposes to expand coverage for prescription contraceptives to up to a 12-month supply.

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.