Public Notice: Medicaid Reimbursement

PUBLIC NOTICE

Department of Health Services

(Medicaid Reimbursement for Dental Services)

The State of Wisconsin reimburses providers for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (the Department), is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and s. 49.471 of the Wisconsin Statutes. Federal statutes and regulations require that a state plan be developed that provides the methods and standards for reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is now in effect.

Change in Payment Methods

Among the services provided to recipients of services under Medical Assistance and BadgerCare Plus are dental services.

As part of the 2015-17 Biennial State Budget (2015 Wisconsin Act 55), the Wisconsin Legislature approved a targeted Medicaid rate increase for pediatric dental care and adult emergency dental services provided in four Wisconsin counties. The purpose of the targeted rate increase is for the Legislature to better understand and predict the fiscal impact of a possible future statewide rate increase.

The change will be effective October 1, 2016, and will apply to claims with dates of service on or after that date. The change to Medicaid and BadgerCare Plus is projected to result in increased annual expenditures of $13,780,000 all funds (AF), composed of $8,350,000 federal match (FED) and $5,430,000 state funds (general purpose revenue, or GPR).

The implementation date is the first day of the first quarter of federal fiscal year 2017 and is the first day of the second quarter of state fiscal year 2017.

Copies of Changes

Copies of the amendment to the Medicaid state plan may be obtained free of charge by calling or writing as follows:

Regular Mail:

Al Matano

Bureau of Fiscal Management

Division of Health Care Access and Accountability

P.O. Box 309

Madison, WI 53701-0309

Fax:

[phone]

Attention: Al Matano

Telephone:

Al Matano

Bureau of Fiscal Management

[phone]

E-Mail:

[e-mail]

Copies of the state plan change will be made available for review at the main office of any county department of social services or human services.

Written Comments

Written comments are welcome. Written comments on the proposed changes may be sent by FAX, e-mail, or regular mail to the Division of Health Care Access and Accountability. The FAX number is [phone]. The e-mail address is [e-mail]. Regular mail can be sent to the above address. All written comments will be reviewed and considered.

The written comments will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 350 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changed methodology based on comments received.