Public notices
Health and Family Services
(Medical Assistance Reimbursement of Nursing Homes)
State of Wisconsin Medicaid Nursing Facility Payment Plan: FY 05-06
The State of Wisconsin reimburses Medicaid-certified nursing facilities for long-term care and health care services provided to eligible persons under the authority of Title XIX of the Federal 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 setting payment rates for nursing facility services covered by the payment system. A plan that describes the nursing home reimbursement system for Wisconsin is now in effect as approved by the Centers for Medicare and Medicaid Services (CMS).
The Department is proposing a change in the methods of payment to nursing homes and, therefore, in the plan describing the nursing home reimbursement system. The change is effective May 1, 2006.
The estimated increase in annual aggregate expenditures attributable to these changes for nursing homes serving MA residents is approximately $3,047,400 all funds, ($1,762,000 FFP), excluding patient liability.
The proposed change is being implemented to comply with Wisconsin Statutes governing Medicaid payment systems.
The proposed change is as follows:
Disburse $3,047,499 all funds excluding patient liability, as a one time manual payment, to nursing facilities with active provider numbers as of April 30, 2006 based on the number of Medicaid patient days they incurred during state fiscal year 2004-2005. State- and tribal-owned or operated facilities are excluded from this payment.
Copies of the Proposed Changes:
Copies of the available proposed changes and proposed rates may be obtained free of charge by writing to:
Division of Health Care Financing
Attention: Nursing Home Medicaid Payment Plan
P.O. Box 309
Madison, WI 53701-0309
or by faxing James Cobb at 608-264-7720.
The available proposed changes may be reviewed at the main office at any county department of social services or human services.
Written Comments/Meetings:
Written comments on the proposed changes may be sent to the Division of Health Care Financing, at the above address. The 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 changes based on comments received. There will also be public meetings to seek input on the proposed plan amendment. If you would like to be sent a public meeting notice, please write to the above address. Revisions may, also, be made in the proposed changes based on comments received at these forums.
Health and Family Services
(Medical Assistance Reimbursement of Hospitals)
The State of Wisconsin reimburses hospitals for medical services provided to Medical Assistance recipients under the authority of Title XIX of the Federal Social Security Act and ss.
49.43 to
49.47, Wisconsin Statutes. This program, administered by the Wisconsin Department of Health and Family Services (the Department), is called Medicaid or Medical Assistance (MA). 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 for inpatient hospital services and another section is in effect for outpatient hospital services. The Department is proposing changes to existing sections of the Medicaid state plan for inpatient and outpatient hospital services that describe cost-based funding of governmental hospitals. The changes will be effective April 1, 2006.
Changes in the state plan for reimbursement for inpatient services include modification of Section 8000, Funding of a Medicaid Deficit in Governmental Hospitals to clarify the methodology used to determine a Medicaid loss for qualifying hospitals under the provision. The estimated fiscal effect of these changes in State Fiscal Year 2005-06 is approximately $3.5 million all funds, comprised of $2 million federal financial participation (FED) and $1.5 million state expenditures.
Changes in the state plan for reimbursement for outpatient services include modification of Section 7000, Funding of a Medicaid Deficit in Governmental Hospitals to clarify the methodology used to determine a Medicaid loss for qualifying hospitals under the provision. The estimated fiscal effect of these changes in State Fiscal Year 2005-06 is approximately $1.5 million all funds, $900,000 FED and $600,000 state expenditures.
Copies of Proposed Changes and Proposed Payment Rates
Copies of the proposed changes will be sent to every county social services or human service department main office where they will be available for public review. For more information, interested persons may fax or write to:
Hospitals, Physicians and Clinics Section
Division of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309
Fax: (608) 266-1096
Written comments on the proposed changes should be sent to the above address. The comments received on the changes will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. at:
Division of Health Care Financing
Room 350, State Office Building
One West Wilson Street
Madison, WI
