Medicaid State Plan Amendments

This amendment complies with the Consolidated Appropriations Act of 2022 and makes changes to the state plan so that health insurance companies cannot deny reclamation claims for the Agency not obtaining prior authorization for the item or service through the health insurance company and requiring health insurance companies to process reclamation claims within 60 days of receipt of such claims.

This SPA allows for coverage of medically necessary prescribed drugs that are not covered outpatient drugs, including drugs authorized for import by the U.S. Food and Drug Administration. Administration (FDA), during drug shortages.

This SPA modifies the language provisions for coverage of weight loss drugs as outlined on the Wisconsin Medicaid Drug Search Tool found on the state’s website.

This SPA provides assurance in Attachment D that the benefit package provided for all individuals through the postpartum extension complies with section 1937 of the Act, including the provision of essential health benefits (EHBs) and that no treatment limitations that are more restrictive than the Alternative Benefit Plan (ABP).

This plan amendment updates the case mix data source from the Resource Utilization Groups (RUGs) to the Patient-Driven Payment Model (PDPM).

This plan amendment increases payment rates for dental services, pharmacy dispensing fees, lactation counseling services, and personal assistance services (PAS).

This amendment is to add Elevated Blood Lead (EBL) level education visits for children under 21 years of age, and Lead Hazard Risk Assessments for children under 21 years of age.

This amendment is to add coverage for the human papillomavirus (HPV) vaccine for persons 46 years of age or older who meet certain medical criteria.

This amendment is to update the plan to broaden coverage of nursing services in schools by removing the requirement that nursing services be listed in an to Individualized Education Program (IEP), as well as amend the tobacco cessation counseling services to include that these services must be provided by a licensed practitioner.

This amendment is to add Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) to the FQHC and RHC sections of its Medicaid State Plan to be in compliance with CAA 2023.