Public Notices
Department of Health Services
(Medicaid Reimbursement for Prescription Drugs - Medication Therapy Management)
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 and BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and ss.
49.471,
49.665, and
49.67 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
The Department will be implementing a Medication Therapy Management benefit. The Medication Therapy Management benefit consists of services that are provided by a qualified, licensed pharmacist to a member, to optimize the therapeutic outcomes of that member's medications, and to reduce costs. Participation in Medication Therapy Management is voluntary and it is available to members in Wisconsin Medicaid, the BadgerCare Plus Standard Plan, the BadgerCare Plus Benchmark Plan, and the BadgerCare Plus Core Plan.
The Medication Therapy Management benefit will include two types of services: Intervention-Based Services and Comprehensive Medication Reviews and Assessments.
Intervention-Based Services are focused interventions between a pharmacist and a member. The services include the following:
- Instructing the member on using a medication device.
- Filling a pill box for a member.
- Changing a member's prescription when the member has an adverse reaction to the medication.
The prescriber must approve changes to the member's drug regimen. All members enrolled in a qualifying plan are eligible for this service.
Comprehensive Medication Reviews and Assessments (CMR/As) are comprehensive interventions between a pharmacist and a member to review the member's drug regimen. A CMR/A involves an in-depth, interactive review of the member's medication regimen, health history and lifestyle. The pharmacist must have a private or semi-private area in which to conduct the CMR/A. To be eligible for this service, a member must meet at least one of the following criteria:
- Is taking four or more prescriptions to treat two or more chronic conditions.
- Has diabetes.
- Has recently been discharged from a hospital or long-term care setting.
- Has experienced health literacy problems.
- Was referred by a prescriber due to issues that are impacting the member's health.
- Meets other criteria as defined by the Department.
Pharmacists must be specially trained through a Department-approved certification program in order to provide these services.
The change will be effective September 1, 2012, and will apply to claims with dates of service on or after that date. The change to Medicaid and BadgerCare Plus pharmacy reimbursement is projected to result in savings, reducing pharmacy expenditures by an estimated $2.7 million All Funds (AF) in state fiscal year (SFY) 2013, composed of $1.1 million general purpose revenue (GPR) and $1.6 million federal match (FED). In SFY 2014, the savings are projected to be $3.5 million AF, composed of $1.4 million GPR and $2.1 million FED.
Copies of Changes
Copies of the legislative enactment directing the change and conforming state plan change may be obtained free of charge by calling or writing as follows:
Regular Mail:
Rita Subhedar
Bureau of Benefits Management
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 53701-0309
Fax:
(608) 266-1096
Attention: Rita Subhedar
Telephone:
Rita Subhedar
Bureau of Benefits Management
(608) 266-3901
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 (608) 266-1096.
The e-mail address is
rita.subhedar@wisconsin.gov. 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.
Department of Health Services
(Medical Reimbursement for Transportation Services)
The state of Wisconsin reimburses providers for services provided to low-income persons under the authority of Title XIX of the Social Security Act and sections 49.43 to 49.47, Wisconsin Statutes. The Wisconsin Department of Health Services administers this program, which is called Medical Assistance 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 chapters 49.43 to 49.47 of Wisconsin Statutes. Together the Medical Assistance and BadgerCare Plus programs are referred to as ForwardHealth.
Among the providers reimbursed under the Medicaid and BadgerCare Plus programs are providers of transportation services. Recipients of medically necessary services are entitled to reimbursement for transportation services to medical appointments. Effective for dates of service on and after July 1, 2011, Wisconsin Medicaid and BadgerCare Plus began to provide transportation services through the use of a transportation manager. However, after that date, individuals who are enrolled in managed care in Milwaukee, Waukesha, Kenosha, Racine, Ozaukee, and Washington counties continued to receive transportation services through the managed care organizations who provide their health care services. Effective for dates of service on and after September 1, 2012, individuals in those counties - Milwaukee, Waukesha, Kenosha, Racine, Ozaukee, and Washington - will also begin to receive transportation services through the use of a transportation manager. Through a request for proposal (RFP) process, the Department of Health Services selected LogistiCare, LLC (LogistiCare) to provide transportation services through the transportation broker system. The transportation manager will begin to provide transportation services to Medicaid and BadgerCare Plus recipients in the six Wisconsin counties which were previously excluded from the use of the transportation manager.
The transportation manager system will be a more efficient way to deliver transportation services by providing a centralized way to provide these services. By centralizing administration of these services, it will also make it possible for the Department to control fraud or misuse of these services.
The cost of providing these services in will not change. It is hoped that the efficiencies inherent in the transportation manager model will eventually result in some savings. However, current projections are for a fiscal impact of no change in in costs to the federal government (FED), in the general purpose revenue (GPR), and in those two amounts together, referred to as all funds (AF). Federal fiscal year (FFY) 2012 began on October 1, 2011 and ends on September 30, 2012, while FFY 2013 will begin October 1, 2012 and end September 30, 2013.
Written Comments and 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
Rob Thomas
Division of Health Care Access and Accountability
PO Box 309
Madison, WI 53701-0309
Phone
Rob Thomas
Division of Health Care Access and Accountability
