Lisa Roys, Director of Communications
Department of Financial Institutions
Telephone (608) 266-0450
Mr. Thomas M. Boykoff, Administrator
Division of Savings Institutions
Department of Financial Institutions
Telephone (608) 261-4338
Public Notice
Department of Health and Family Services
(Medical Assistance Reimbursement for Case Management Services:
Targeted Case Management for Child Welfare Clients in Out-of-Home Care)
The State of Wisconsin reimburses providers for case management 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 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.
Among providers of case management services are those who provide targeted case management for families with children up to the age of 21 who are at risk of physical, mental, or emotional dysfunction. The recipients of this service make up what is called Target Group N.
The Wisconsin Department of Health and Family Services recently proposed to modify the rate methodology for targeted case management (TCM) services delivered by the Bureau of Milwaukee Child Welfare or its subcontractors for those clients in Target Group N where the child has been placed in substitute (out-of-home) care within Milwaukee County. The Department's proposal involved no change in the definition of the already existing group and the benefits remained the same. At this time, the Department is proposing to apply this methodology on a statewide basis.
The state's estimate of any expected increase or decrease in annual aggregate Medicaid expenditures shows an increase of $18,102,042 (Federal Financial Participation-FFP $10,651,241) in state fiscal year (SFY) 1999 and $24,136,056 (FFP $14,201,655) in SFY 2000. A decrease would take place in Title IV-E expenditures of $12,671,429 (FFP $6,335,715) in SFY 1999 and $16,895,239 (FFP $8,447,620) in SFY 2000.
The billing process will be established in such a manner as to prevent the processing of duplicate billings for the same client for the same service period. This will be accomplished by installing edits between procedure codes in the Wisconsin Medicaid Management Information System (MMIS) system. The methodology also contains a provision for adjusting the rate to an actual cost basis after completion of the federal fiscal year. In addition, amendments are being proposed to the Department's Cost Allocation Plan to ensure avoidance of duplicate claims for TCM and Title IV-E.
The Department is changing its methods and standards in this manner because this is a more efficient and comprehensive way to track the time expended in delivering these case management services.
The methodology uses the federally approved Random Moment Time Study (RMTS) as a tool in developing the monthly rate per client. Initially the Department requested from the U.S. Health Care Financing Administration (HCFA) authority to implement the new rate methodology in Milwaukee, effective April 1, 1998. At this time, the Department is seeking the authority to implement the methodology on a statewide basis.
Proposed Change
The proposed change is to: Create a new rate methodology which will employ the Random Moment Time Study (RMTS) as a tool in developing the monthly rate per client for targeted case management services.
Copies of Proposed Change
A copy of the proposed change may be obtained free of charge by calling or writing as follows:
Regular Mail
Attention: State Plan Coordinator
Bureau of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309
Phone
James Johnston
Policy Section Chief
(608) 267-9474
FAX
(608) 266-1096
Attention: State Plan Coordinator
E-Mail
A copy of the proposed change is 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 change may be sent by FAX, e-mail, or regular mail to the Bureau of Health Care Financing. The FAX number is (608) 266-1096.
The e-mail address is
matana@dhfs.state.wi.us. 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 250 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changed methodology, based on comments received.
Public Notice
Department of Health and Family Services
(Medical Assistance Reimbursement for Pharmaceutical Products:
Incentive Payments for Substituting Less Expensive Drugs)
The State of Wisconsin reimburses providers for pharmaceutical products 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 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 Wisconsin Department of Health and Family Services is proposing to modify the reimbursement for drugs by paying an incentive dispensing fee through the Pharmaceutical Care Codes to pharmacists for contacting prescribing providers to recommend that their orders be changed to a clinically appropriate but less expensive drug.
The Department's proposal involves no change in the drugs available to recipients of Medical Assistance. The benefits to recipients remain the same as are presently available.
The Department is changing its methods and standards in this manner because it will encourage therapeutic substitution, thus serving to reduce costs to the program without reducing the benefits available to recipients.
Proposed Change
The proposed change is to pay an incentive dispensing fee through the Pharmaceutical Care Codes to pharmacists for contacting prescribing providers to change orders to a clinically appropriate but less expensive drug. Pharmacies will be reimbursed this incentive payment only when a change in drugs occurs.
Copies of the Available Proposed Change:
A copy of the proposed change may be obtained free of charge by calling or writing as follows:
Regular Mail
Attention: State Plan Coordinator
Division of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309
Phone
James Johnston
Community Services Section Chief
(608) 267-9474
FAX
(608) 266-1096
Attention: State Plan Coordinator
E-Mail
A copy of the proposed change is available for review at the main office of any county department of social services or human services.
