Attention: Nursing Home Medicaid Payment Plan
Bureau of Health Care Financing
Division of Health
P.O. Box 309
Madison, WI 53701-0309
Phone
Telephone (608) 264-6730
FAX
Attention: Nursing Home Medicaid Payment Plan
FAX number (608) 264-7720
E-Mail
Copies of the proposed changes will be available for review at the main office of any county department of social services or human services from July 15 through at least September 1.
Since changes will be continuously developed during the public comment period, additional materials will be developed and will be available by the options above or by attending the public meetings. If you request copies of the proposed changes, you will receive a copy of the final changes or the final plan amendment.
Before finalizing the plan amendment, the Department may modify its proposed changes after considering the comments received during the public comment period. The plan amendment will not be submitted to the federal government until after the public comment period and will be effective retroactively to July 1, 1998.
Written Comments
Except for the public meetings,
only written comments will be considered. Written comments on the proposed changes may be sent by FAX, E-mail, or regular mail to the Bureau of Health Care Financing. The FAX number is (608) 264-7720. The E-mail address is:
cobbjd@dhfs.state.wi.us. Regular mail may 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 250 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changes, based on comments received.
Public Meetings
There will also be public meetings to seek input on the proposed plan amendment. If you would like to be sent a public meeting notice, please fax or
write using the above addresses. The proposed changes may be revised, based on comments received at these forums.
Public Notice
Health & Family Services
(Medical Assistance Reimbursement of Hospitals)
The State of Wisconsin reimburses hospitals for medical services provided to low-income persons under the authority of Title XIX of the Federal Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. The State's Department of Health and Family Services administers this program which is called Medicaid or Medical Assistance (MA). Federal statutes and regulations require state plans, one for outpatient services and one for inpatient services, which provide the methods and standards for paying for hospital outpatient and inpatient services.
State plans are now in effect for the reimbursement of outpatient hospital services and inpatient hospital services. The Department is proposing to make several changes in these plans effective July 1, 1998.
Outpatient Hospital Services
Proposed changes in the state plan for reimbursement for outpatient hospital services may include:
1. Revision of the rural hospital adjustment percentages to ensure that payments do not exceed authorized funds. Modification of the qualifying criteria that requires a 55% combined Medicare and Medicaid utilization rate to allow greater consistency from year to year with regard to whether a hospital qualifies and to allow a number of hospitals with utilization rates consistently just below the qualifying rate to also qualify. The amount paid for this adjustment would not change. However, this modification would cause a redistribution of the funds among qualifying hospitals.
2. Modification of supplemental payments to essential access city hospitals (EACH) to maintain compliance with federal payments limits.
3. For the indigent care allowance, adjustment of the maximum available funding, modification of the criteria for a hospital to qualify for an allowance, and modification of the methodology for distributing the available funds to qualifying hospitals in order to carry out provisions of 1997 Wis. Act 27 and to maintain compliance with federal payment limits.
4. Modification of the procedures for processing administrative adjustments to require a hospital to respond to the Department's proposed adjustment only if there is a disagreement with the calculation. If the hospital does not respond by the specified due date, the proposed adjustment will be final. This will simplify what has been an administratively burdensome notification and response process.
5. Modification of the qualifying criteria for funding of Medicaid deficits in governmental hospitals to require a hospital to submit a request for this funding to the Department so it may determine if the hospital qualifies for funding under these provisions.
Inpatient Hospital Services
Proposed changes in the state plan for reimbursement for inpatient hospital services may include:
1. For the payment system which is based on diagnosis-related groups (DRGs), adjustment of DRG weighting factors, standard DRG base rates, area wage indices, and capital and medical education payments to implement the average rate adjustment provided by 1997 Wis. Act 27.
2. Updating the time period used for the qualifying criteria and determination of the payment for the pediatric supplement to reflect the most recent time period. Also, revision of the definition of Medicaid pediatric days to:
a) Exclude days of Medicaid covered stays on which Medicaid made no payment due to the stay being covered by some other payer such as private hospitalization insurance to more accurately reflect the intent of this provision; and
b) Count only the days for discharges that occurred within the specified year and not count a portion of the days related to discharges that occurred outside the specified year.
3. Modification of the cost report requirements for major border-status hospitals to allow the Department to use the most recent audited cost report available to establish rates, which is consistent with the basis for which the Department establishes rates for in-state hospitals.
4. Modification of the qualifying criteria for funding of Medicaid deficits in governmental hospitals to require a hospital to submit a request for this funding to the Department so it may determine if the hospital qualifies for funding under these provisions.
5. Revision of the rural hospital adjustment percentages to ensure that payments do not exceed authorized funds. Modification of the qualifying criteria that requires a 55% combined Medicare and Medicaid utilization rate to allow greater consistency from year to year with regard to whether a hospital qualifies and to allow a number of hospitals with utilization rates consistently just below the qualifying rate to also qualify. The total amount paid for this adjustment would not change. However, this modification would cause a redistribution of the funds among qualifying hospitals.
6. Updating the disproportionate share adjustment parameters to recognize a more current proportion of services provided by hospitals to Medicaid recipients.
7. Modification of supplemental payments to essential access hospitals (EACH) to maintain compliance with federal payments limits.
8. For the indigent care allowance, adjustment of the maximum available funding, modification of the criteria for a hospital to qualify for an allowance, and modification of the methodology for distributing the available funds to qualifying hospitals in order to carry out provisions of 1997 Wis. Act 27 and to maintain compliance with federal payment limits.
9. For the general assistance disproportionate share supplement, adjustment of the maximum available funding, modification of the criteria for a hospital to qualify for the supplement, and modification of the methodology for distributing the available funds to qualifying hospitals in order to carry out provisions of 1997 Wis. Act 27 and to maintain compliance with federal payment limits.
10. Modification of the procedures for processing administrative adjustments to require a hospital to respond to the Department's proposed adjustment only if there is a disagreement with the calculation. If the hospital does not respond by the specified due date, the proposed adjustment will be final. This will simplify what has been an administratively burdensome notification and response process.
Implementation of the above changes to the State Plans for inpatient hospital services and outpatient hospital services is expected to increase annual expenditures of the Wisconsin Medical Assistance Program by $2.4 million all funds ($1.4 million federal financial participation and $1.0 million general purpose revenue) for state fiscal year 1998-1999. This amount is the combination of $7.0 million all-funds of expected increases and a decrease of $4.6 million all-funds in general assistance indigent care allowance.
Copies of Proposed Changes and Proposed Payment Rates
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. A publication consisting of proposed DRG weights, DRG base rates, wage indices and other factors that comprise payment rates is available for review and comment. For more information, interested people may fax or write to:
Hospital 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 250, State Office Building
One West Wilson Street
Madison, WI
