P.O. Box 309
Madison, WI 53701-0309
Written Comments
Written comments on the proposed changes are welcome and should be sent to David Bodoh at the above address. Comments should be submitted by Monday, September 8. Later comments may be considered. Before finalizing any state plan changes, the Department may modify its proposed changes after considering the comments. A copy of the changes will be available from 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
Public Notice
Health and Family Services
(Medical Assistance Reimbursement of Noninstitutional Providers
for Noninstitutional Services)
The State of Wisconsin reimburses noninstitutional health care providers for services provided to Medical Assistance (MA) 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 State's Department of Health and Family Services (DHFS), is called Medical Assistance 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 now in effect.
Noninstitutional providers, such as physicians, dentists and home care agencies, are paid the lesser of:
(a) their usual and customary charges or
(b) maximum fees established by DHFS for each procedure.
The Department may make changes in the maximum fee schedules if authorized in the 1997-1999 state budget act.
The Legislature is considering a proposal to increase reimbursement by 2% for selected non-institutional providers for services provided effective July 1, 1997, and an additional 2% effective July 1, 1998, for services which may include: ambulance transportation, nurse practitioner, nurse midwife, certified nurse anesthetist, chiropractic, durable medical equipment and disposable medical supplies, family planning, early and periodic screening diagnostic and testing (HealthCheck) services, hearing aids, home care, laboratory, X-ray, psychology and mental health, physicians and clinics, podiatrist, prenatal care coordination, transportation by specialized medical vehicle, therapies, vision, and drug dispensing services. Additionally, the legislature is considering a 5% rate increase for dentists effective July 1, 1997, and an additional 5% effective July 1, 1998. Non-institutional providers with cost-based reimbursement, reimbursement linked to Medicare rates, or other price or cost-based methodologies may not receive an increase under this proposal.
The estimated fiscal impact of the proposal is to increase expenditures by $7,069,000 ($2,906,800 general purpose revenues (GPR) and $4,162,200 federal financial participation (FFP) funds) in state fiscal year (SFY) 1997-1998 and $14,282,600 ($5,909,800 GPR and $8,372,800 FFP) in SFY 1998-1999 for these rate increases.
Copies of the 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 review. For more information, interested people may write to:
Melanie Foxcroft, State Plan Coordinator
Attn: State Plan Issue
Bureau of Health Care Financing
Division of Health
P.O. Box 309
Madison, WI 53701-0303
Written Comments
Written comments on the proposed changes are welcome. Comments should be sent to the above address. Comments received on the changes will be available for public review between the hours of 7:45 a.m. and 4:40 p.m. daily at:
Bureau of Health Care Financing
Room 250, State Office Building
One West Wilson Street
Madison, WI
Public Notice
Health & Family Services
(Required Recipient Copayment for Certain
Medical Assistance Services)
The State of Wisconsin reimburses health care providers for 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 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 reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is now in effect.
Federal statutes and regulations permit states to require MA recipients to share in the cost of receiving certain MA services through the payment of a flat, nominal fee (copayment) per service. However, federal regulations establish maximum copayments for services and exempt some groups and services from copayments, including:
(a) recipients under the age of 18;
(b) categorically needy persons enrolled in health maintenance organizations;
(c) services relating to pregnancy;
(d) institutional services if individuals are required to spend all their income for medical expenses, except for the amount exempted for personal needs, and
(e) emergency, family planning and hospice services.
The Legislature is considering a proposal to decrease MA benefits funding by an estimated $815,700 ($334,900 state general purpose revenues (GPR) and $480,800 federal financial participation (FFP) funds) effective July 1, 1997, and $1,631,500 ($671,800 GPR and $959,700 FFP) effective July 1, 1998, to reflect the projected cost savings of:
(a) creating a copayment for specialized medical vehicle (SMV) services and free-standing ambulatory surgery services, and
(b) increasing current copayments for other services to the maximum amount permitted under federal law, excluding prescription and over-the-counter (OTC) drugs. The copayment for blood glucose monitoring reagent strips may remain at the current rate of $0.50.
Federal law establishes maximum copayment amounts for services in relation to the state's MA payment for the service, as shown in the following table:
State's MA Payment for Service
|
Maximum Recipient Copayment
|
$10.00 or less
|
$0.50
|
$10.01 to $25.00
|
$1.00
|
$25.01 to $50.00
|
$2.00
|
$50.01 or more
|
$3.00
|
It is the provider's responsibility to collect copayments. However, no participating provider may deny services to an MA recipient because of the recipient's inability to pay copayments. The MA program does not provide additional compensation to providers when they do not collect payment.
Copies of the 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 review. For more information, interested people may write to:
Melanie Foxcroft, State Plan Coordinator
Attn: State Plan Issue
Bureau of Health Care Financing
Division of Health
P.O. Box 309
Madison, WI 53701-0303
Written Comments
Written comments on the proposed changes are welcome. Comments should be sent to the above address. Comments received on the changes will be available for public review between the hours of 7:45 a.m. and 4:40 p.m. daily at:
Bureau of Health Care Financing
Room 250, State Office Building
One West Wilson Street
Madison, WI
Public Notice
Health & Family Services
(Medical Assistance Reimbursement of Providers of
Dental Services for Dental Sealants)
The State of Wisconsin reimburses providers for dental services provided to Medical Assistance recipients. This is done 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 reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is now in effect.
The Legislature is considering a proposal to increase funding to add dental sealants as a covered service for children under MA, effective January 1, 1998. Currently sealants are covered by MA only through the HealthCheck other services benefit, after a child has received a HealthCheck screening. Dental sealants are an important preventive measure that are expected to achieve a significant reduction in future dental expenditures. The fiscal impact of this proposal is to increase expenditures by an estimated $1,047,800 ($430,900 state general purpose revenues (GPR) and $616,900 federal financial participation (FFP) funds) in state fiscal year (SFY) 1997-1998 and $348,300 ($144,000 GPR and $204,300 FFP) in SFY 1998-1999.
Copies of the Proposed Change
Copies of the proposed change will be sent to every county social services or human services department main office where they will be available for review. For more information, interested people may write to:
Melanie Foxcroft, State Plan Coordinator
Attn: State Plan Issue
Bureau of Health Care Financing
Division of Health
P.O. Box 309
Madison, WI 53701-0303
