Public Notices

public_notices Wisconsin Administrative Register No. 663, 3/31/2011

Public Notices

Health Services

Medical Assistance Reimbursement to Hospitals

Pay For Performance Payment Plan for State Fiscal Year 2011-2012

The State of Wisconsin reimburses hospitals for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and Chapter 49 of Wisconsin State Statutes. This program, administered by the State's Department of Health Services (Department), is called Medicaid or Medical Assistance.

The Department is proposing to modify inpatient hospital pay for performance measures and associated payment rates for state fiscal year 2011. The pay for performance measures are projected to distribute $5,000,000 all funds in state fiscal year 2011, composed of $1,930,000 general purpose revenue (GPR) and $3,070,000 federal funds (FED).

The Joint Committee for the Review of Administrative Rules met in Executive Session on March 1, 2011 and adopted the following motion:

Copies of Proposed Change

A copy of the proposed change may be obtained free of charge at your local county agency or by calling or writing as follows:

Regular Mail

Division of Health Care Access and Accountability

P.O. Box 309

Madison, WI 537001-0309

State Contact

Krista Willing, Section Chief

Hospital Rate Setting

[phone] (phone)

[phone] (fax)

[e-mail]

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

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

Health Services

Medicaid Reimbursement for Health Homes

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, 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 currently in effect.

The State of Wisconsin intends to create state plan language that provides for health home services. A proposed amendment will be submitted to the federal Centers for Medicare and Medicaid Services with a proposed effective date of April 1, 2011, or possibly a later date.

A recent change to federal law provided that a State may at its option submit a state plan amendment under which the State provides a designated provider, a team of health care professionals operating with such a provider, or a health team with payments for the provision of health home services to each eligible individual with certain chronic conditions that selects such provider, team of health care professionals, or health team as the individual's health home. Payments for such services are treated as medical assistance for purposes of section 1903 (a) of the Social Security Act, which provides for reimbursement to the states for the federal share of expenditures under the Medicaid program.

Payment for these services must be consistent with §1902 (a) (30) (A) of the Social Security Act. Payment may be tiered according to severity and intensity of need as allowed under §1945 (c) (2) (A) of the Social Security Act.

This proposal is estimated to increase Wisconsin Medicaid expenditures by $2 million, all funds, in each of State Fiscal Years 2011 and 2012. This amount is composed of 90% federal match and 10% general purpose revenue, or GPR, during the first 8 fiscal year quarters the home health state plan amendment is in effect. The federal match rate will decrease to the match rate applicable to Medicaid services generally (currently, approximately 59%) thereafter.

Copies of the Proposed Change:

A copy of the proposed change may be obtained free of charge at your local county agency or by calling or writing as follows:

Regular Mail

Alfred Matano
Division of Health Care Access and Accountability

PO Box 309

Madison, WI 53701-0309

Phone

Alfred Matano

Division of Health Care Access and Accountability

[phone]

FAX

[phone]

Attention: Al Matano

E-Mail

[e-mail]

A copy of the proposed change is 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 change 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.

All written comments received will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 472 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made based on comments received.