Public notice
Health and Family Services
(Medical Assistance Reimbursement for Family Planning Services)
The State of Wisconsin reimburses providers of family planning 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 and Family Services, is called Medical Assistance (MA) or Medicaid. 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.
The Department submitted a request for a waiver of federal law to the Centers for Medicare and Medicaid Services (CMS), an agency within the United States Department of Health and Human Services, and CMS granted the Department's request. The waiver request provides coverage for females of child-bearing age for family planning services. The waiver allows for the expansion of Medicaid services for a limited array of services to specific individuals who would not otherwise be eligible for Medicaid coverage. Through this expansion of coverage, the Department hopes to reduce the number of unwanted pregnancies in Wisconsin. The Department has determined that the proposed rate increase will be beneficial to assist in implementing the waiver program.
Section 49.46 (2) (a) 4. f. of the Wisconsin Statutes allows the Department to develop, implement and periodically update methods for reimbursing or paying family planning providers for allowable services. Under current law, non-institutional MA providers, including those providing family planning services, are paid the lesser of: (a) their usual and customary charges; or (b) maximum fees established by the Department for each procedure. The Department modifies the maximum fee schedules to implement MA rate changes authorized by the Legislature.
The estimated increase in annual expenditures from this rate increase for family planning providers is approximately $2,500,000 all funds, ($2,250,000 FFP).
Proposed Change
The proposed change is to increase office visit rates provided to Provider Type 71, family planning clinics to be more equitable with nurse midwives.
The Department's proposal involves no change in the benefits provided under the family planning services benefit under the Medicaid program.
Reasons for the Rate Increase
The reasons for the rate increase include the following:
1. To assure parity between family planning providers and nurse mid-wives.
2. To ensure access to family planning services for recipients and provider participation in the waiver program.
Copies of the Proposed Change
A copy of the proposed change may be obtained free of charge by calling or writing as follows:
Regular Mail
Dani Maculan
Budget and Children and Family Services Section Chief
Division of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309
Phone
(608) 261-7833
FAX
(608) 266-1096
Attention: Dani Maculan
E-Mail
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 Financing. The FAX number is (608) 266-1096. The e-mail address is maculdl@dhfs.state.wi.us. 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.
