Public notices
Health and Family Services
(Medical Assistance Reimbursement for Services Provided by
Hospital-Affiliated End Stage Renal Disease Providers)
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 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 Wisconsin Department of Health and Family Services is proposing to modify the reimbursement rate for services provided by hospital-affiliated end stage renal disease (ESRD) providers. This notice is being published in compliance with
42 CFR § 447.205, which requires the state Medicaid agency to provide public notice of any significant proposed change in its methods and standards for setting payment rates for services.
The Department's proposal involves no change in services.
Proposed Change
2005 Act 25, the 2006-2007 biennial budget, directed the Department to change the Medicaid reimbursement rate for hospital-affiliated ESRD clinics. The Department will pay hospital-affiliated ESRD providers the Medicare reimbursement rate for the services that they provide.
Wisconsin Medicaid will reimburse hospital-affiliated ESRD providers the full Medicare payment plus the Medicare coinsurance and deductible, minus any applicable Medicaid copayments. A Medicaid-certified hospital-affiliated ESRD provider operates under the common ownership, licensure, or control of a hospital, but is not an outpatient hospital.
The proposed change is to adopt the Medicare reimbursement rate for services provided by hospital-affiliated ESRD providers. The change will apply to dialysis services provided on dates of service on and after November 1, 2005.
For the remainder of FY 06 (from November 1 to June 30th, 2006), the projected fiscal effect of these changes is a savings of $50,200 General Program Revenue and $70,300 Federal for a total of $120,500 All Funds. For the full FY 07, the savings will be $101,000 General Program Revenue and $140,000 Federal for a total of $241,000 All Funds.
In September 2005, the Department will also submit to the federal Department of Health and Human Services (HHS) a proposed Medicaid State Plan Amendment reflecting this change. The Amendment is proposed to be effective on November 1, 2005. HHS has 90 days to approve, deny, or request further information about the proposed amendment.
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
Al Matano
Bureau of Fee-for-Service Health Care Benefits
Division of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309
Phone
Al Matano
(608) 267-6848
FAX
(608) 266-1096
Attention: Al Matano
E-Mail
A copy of the proposed change are 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 Department. The FAX number is (608) 266-1096.
The e-mail address is
matana@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. Revisions may be made in the proposed changed methodology based on comments received.
