12. For hospitals that combine or have combined into one hospital operation either through merger or consolidation or for a hospital that absorbs or has absorbed the operation of another hospital through purchase or donation, modification of the method for establishing capital cost payment by limiting payment to the capital cost incurred by the combined or absorbing hospital and by limiting payment to that allowed by federal regulations in order to maintain program expenditures within available funding and to assure compliance with federal regulations.
13. For hospitals that combine or have combined into one hospital operation either through merger or consolidation or for a hospital that absorbs or has absorbed the operation of another hospital through purchase or donation, modification of the method for establishing direct medical education payment to limit payment to the amount incurred by the combined or absorbing hospital and to base the indirect medical educational payment adjustment on the size of the graduate medical education program of the combined or absorbing hospital to maintain program expenditures within available funding.
14. Modification of the methodology for establishing capital cost payment and direct medical education payment for major border-status hospitals so that the methodology is more comparable to that used for establishing instate hospital payments.
15. Establishment of a supplemental adjustment for a disproportionate share acute care hospital not in Milwaukee County that:
(a) Has a significantly high proportion of inpatient days for newborns;
(b) Is in a county that has, or is scheduled to have, mandatory or optional enrollment in Medicaid managed care for the next year; and
(c) Participates as a major provider of Medicaid HMO services in the county, in order to assure sufficient availability of hospital services through the Medicaid program.
16. Modification of administrative adjustment procedures for inpatient reimbursement and elimination of the administrative adjustments committee, in order to promote administrative efficiency by eliminating procedural requirements that are not needed or are rarely used under the current rate-setting methodology.
17. To promote administrative efficiency, addition of policies and procedures by which a hospital would be required to request review and modification of how Department staff are carrying out provisions of the inpatient rate setting methodology before the hospital could pursue legal review through administrative hearing or court appeal.
Implementation of the above changes to the State Plans for inpatient hospital services and outpatient hospital services are expected to increase annual expenditures of the Wisconsin Medical Assistance Program by $11.7 million all funds ($6.9 million federal financial participation and $4.8 million general purpose revenue) for the state fiscal year 1996-1997.
Copies of Proposed Changes
Copies of the proposed changes will be sent to every county social services or human services department main office where they will be available for public review. For more information, interested people may fax or write to:
Hospital Reimbursement Unit
FAX (608) 266-1096
Bureau of Health Care Financing
Division of Health
P. O. Box 309
Madison, WI 53701-0309
Written Comments
Written comments on the proposed changes are welcome and 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. daily at:
Bureau of Health Care Financing
Room 265, State Office Building
One West Wilson Street
Madison, WI
The State of Wisconsin
Department of Administration
Document Sales Unit
P.O. Box 7840
Dated Material. Please Do Not Delay!
