Public Notices
Department of Health Services
Medicaid Reimbursement for Residential Care Centers
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 Plus program under the authority of Title XIX and Title XXI of the Social Security Act and ss.
49.471 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.
Among the services provided to recipients of services under Medical Assistance and BadgerCare Plus are a group of services which fall under the rubric of Early and Periodic Screening, Diagnosis and Treatment (EPSDT). In Wisconsin these services are referred to as HealthCheck. EPSDT services are authorized under section 1905(a)(13) of the Social Security Act, which describes "other diagnostic, screening, preventive, and rehabilitative services."
Within EPSDT services, Wisconsin provides services in Residential Care Centers (RCCs). RCCs provide treatment to children for whom all other treatment options have failed. Children receiving this treatment are severely traumatized from abuse and neglect and have behavioral health disorders. RCCs provide comprehensive behavioral health treatment to children in out-of-home-care who are in need of services in a structured setting. They provide a pathway for children receiving these services to receive care back in the community, through foster parents or parents.
Change in Payment Methods
The Department is not proposing to change the benefits provided under the RCC benefit, nor is it proposing to change the rate methodology for these services. Rather, the Department is documenting the benefit and the rate methodology in the Medicaid state plan, based on conversations with staff of the Centers for Medicare and Medicaid Services. While the services have been provided under the rubric of EPSDT services as described in the state plan, they were not heretofore specifically enumerated in the state plan. With this change, and amendment to the Medicaid state plan will be submitted to CMS for its review and approval to specifically document RCC services and the rate methodologies employed to reimburse providers for those services.
Copies of Changes
Copies of the state plan pages implementing this change may be obtained free of charge by calling or writing as follows:
Regular Mail:
Al Matano
Bureau of Fiscal Management
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 53701-0309
Fax:
(608) 266-1096
Attention: [name]
Telephone:
Al Matano
Bureau of Fiscal Management
(608) 267-6848
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
alfred.matano@dhs.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 318 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changed methodology based on comments received.
