4. 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 1999-2001 budget act and to maintain compliance with federal payment limits.
5. Criteria for funding of critical access hospitals to implement a provision the 1999-2001 budget act. Qualifying criteria include designation by Medicare and Wisconsin Medicaid as a critical access hospital. Establish a methodology to allow qualifying hospitals to receive reasonable cost reimbursement. Payments for this adjustment would maintain compliance with federal payment limits.
6. Establishment of qualifying criteria and a distribution methodology for a supplemental payment to certain hospitals to implement a provision of the 1999-2001 budget act.
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 (DRG's), adjustment of DRG weighting factors, standard DRG base rates, area wage indices, and capital and medical education payments to implement the overall rate adjustment provided by the 1999-2001 budget act.
2. Revision of the rural hospital adjustment percentages to ensure that payments do not exceed authorized funds. The total amount paid for this adjustment would not change. However, this modification would cause a redistribution of the funds among qualifying hospitals.
3. Updating of the disproportionate share adjustment parameters to recognize a more current proportion of services provided by hospitals to Medicaid recipients.
4. Revision of the indirect medical education adjustment percentage to meet the requirements of the 1999-2001 budget act relating to hospitals located in Wisconsin. The formula used to calculate the indirect medical education percentage includes a multiplier factor that when revised affects the amount of funds distributed to qualifying hospitals.
5. Modification of the direct medical education payment and the indirect medical education adjustment in order to meet the requirements of the 1999-2001 budget act relating to hospitals not located in Wisconsin.
6. Modification of supplemental payments to essential access city hospitals (EACH) to maintain compliance with federal payment limits. This modification would not change the total amount paid. It would, however, adjust the amount paid through inpatient versus outpatient.
7. 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 the 1999-2001 budget act and to maintain compliance with federal payment limits.
8. 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 the 1999-2001 budget act and to maintain compliance with federal payment limits.
9. Criteria for funding of critical access hospitals to implement a provision of the 1999-2001 budget act. Qualifying criteria include designation by Medicare and Wisconsin Medicaid as a critical access hospital. Establish a methodology to allow qualifying hospitals to receive reasonable cost reimbursement. Payments for this adjustment would maintain compliance with federal payment limits.
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 $7.1 million all-funds for state fiscal year 1999-2000. This amount is the combination of $9.8 million all-funds of expected increases and $2.7 million all-funds of expected decreases.
Copies of Proposed Changes and Proposed Payment Rates
Copies of the proposed changes will be sent to the main office of every county social service or human service department where they will be available for public review. For more information, interested persons may fax or write to:
Hospitals, Physicians and Clinics Unit
Division of Health Care Financing
Department of Health and Family Services
P. O. Box 309
Madison, WI 53701-0309
FAX (608) 266-1096
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:
Division of Health Care Financing
Room 350, State Office Building
One West Wilson Street
Madison, WI
Public Notice
Health and Family Services
(Medical Assistance Reimbursement for Non-Institutional Providers of Services:
State of Wisconsin Medicaid Payment Plan for FY 1999-2000 and 2000-2001)
The State of Wisconsin reimburses providers for non-institutional services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss. 49.43 to 49.497, Wisconsin Statutes. This program, administered by the State's Department of Health and Family Services, is called Medical Assistance (MA) or Medicaid.
Summary
Under current law, non-institutional MA providers, including physicians, dentists and home health agencies, are paid the lesser of: (a) their usual and customary charges; or (b) maximum fees established by the Department for each procedure. The Department modifies the maximum fee schedules to implement MA rate changes authorized by the Legislature.
The Wisconsin Legislature is in the process of completing work on the 1999-2001 State Budget. The new State Budget is expected to increase rates for non-institutional providers. The following MA benefits and services were included in calculation of the rate increase:
(a) ambulance transportation;
(b) certified nurse anesthetist;
(c) chiropractic;
(d) dental;
(e) durable medical equipment and disposable medical supplies;
(f) end-stage renal disease;
(g) family planning;
(h) federally qualified health centers (FQHCs);
(i) HealthCheck;
(j) hearing aids;
(k) home health;
(l) hospice;
(m) lab and x-ray;
(n) outpatient hospital psychology and mental health;
(o) personal care;
(p) physicians and clinics;
(q) podiatrists;
(r) prenatal care coordination;
(s) rural health clinic;
(t) transportation by specialized medical vehicle;
(u) therapies; and
(v) vision care.
Dental services were later the subject of separate legislative action and are not part of the action described in this notice.
Pending final legislative action, the Department is proposing an increase in the rates for reimbursement for these non-institutional providers of services under the MA program. The amount of the increase will be 1% in state fiscal year (SFY) 2000-2001. No increase is proposed for SFY 1999-2000. The Department's proposal involves no change in the definition of the already existing group and the benefits remain the same.
It is estimated that this change will increase annual aggregate Medicaid expenditures by $3,585,100 all funds in state fiscal year (SFY) 2001 ($2,131,300 federal and $1,453,800 state GPR). No change is projected for SFY 2000.
Proposed Change
The proposed change is to: Modify the rate for reimbursement for these non-institutional providers of services under the MA program by an increase of 1% beginning July 1, 2000. No rate increase is provided for non-institutional providers in state fiscal year (SFY) 1999-2000.
Copies of the Proposed Change
A copy of the proposed change may be obtained free of charge by calling or writing as follows:
Regular Mail
Bureau of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309
Phone
Mary Laughlin, Budget Unit Chief
Telephone (608) 261-7833
FAX
(608) 266-1096
Attention: Mary Laughlin
E-Mail
