Public Notices
Public Notice
Dept. of Health and Family Services
(Medicaid 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 Chapter 49.43 to 49.47, Wisconsin Statutes. The Wisconsin Department of Health and Family Services administers this program that is called Medicaid or Medical Assistance (MA). Federal statutes and regulations require state plans, one for outpatient services and one for inpatient services, that 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 changes to the rate provisions contained in the outpatient hospital services plan, effective July 1, 2000. The updated rates would apply to Medicaid payments for hospital discharges in the state fiscal year beginning July 1, 2000 and ending June 30, 2001.
As required by federal statute and regulations, the proposed payment rates are restricted by the federal Medicare upper limit requirement and target a share of funding to hospitals which serve a disproportionate number of low-income patients.
Outpatient Hospital Services
Proposed changes in the state plan for reimbursement for outpatient hospital services may include:
1.
Adjustments to the outpatient hospital rate per visit to reflect a one (1) percent increase in outpatient hospital payments to implement a provision of the 1999-2001 budget act.
2. 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. A hospital must be an acute care hospital located in Wisconsin and have Medicaid allowable charges equal to at least 8% of the hospital's total gross revenue in the most recent fiscal year in order to qualify for the supplement.
3. Revision of the rural hospital adjustment percentages to ensure that payments do not exceed authorized funds. The amount paid for this adjustment would not change. However, this modification would cause a redistribution of the funds among qualifying hospitals.
4. 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 outpatient payments versus inpatient payments.
5. 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.
Inpatient Hospital Services
Proposed changes in the state plan for reimbursement for inpatient hospital services may include:
1.
For the payment system based on diagnosis-related groups (DRGs), adjustment of DRG weighting factors, modification of the peer group structure for psychiatric DRG weights and the standard DRG base rates and area wage indices.
2. Use of a more current three-year period of hospital claims in the annual recalibration of reimbursement weighting factors for diagnosis related groups (DRGs) in order to enhance administrative efficiency and utilize more recent cost data.
3. Delete provisions that established a length of stay adjustment for hospitals that are institutions for mental disease (IMD). This adjustment applied only for the rate year beginning July 1, 1999.
4. 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.
5.
Updating of the disproportionate share adjustment parameters to recognize a more current proportion of services provided by hospitals to Medicaid recipients.
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 payments versus outpatient payments.
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.
Payments for these adjustments would maintain compliance with federal payment limits. Implementation of the above changes to the State Plan for inpatient and outpatient services is expected to change the annual expenditures of the Wisconsin Medicaid program by $2.8 million for state fiscal year 2000-2001.
Copies of Proposed Changes and Proposed Payment Rates
Copies of the proposed changes will be sent to every county social services or human service department main office 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
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
Dept. of Health and Family Services
(Medical Assistance Reimbursement for Personal Care Services)
The State of Wisconsin reimburses agencies for workers providing in-home personal care 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. The program through which this is done is called Medical Assistance (MA) or Medicaid, and is administered by the State's Department of Health and Family Services (the Department). 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 section entitled “Methods and standards for establishing non-institutional reimbursement rates" indicates that “In general, the department will pay the lesser of a provider's usual and customary charge or a maximum fee established by the department."
The Department is proposing to modify the methods by which it calculates the maximum fee that the Department will use to reimburse workers providing in-home personal care services. The Department's proposal involves an increase in funds available to providers of these services. The MA benefits offered under the in-home personal care services will remain the same.
The Department is changing its methods and standards in this manner because of the enactment of 1999 Wisconsin Act 187. The state's estimate of any expected increase or decrease in annual aggregate Medicaid expenditures shows an increase of $23,500,000 (Federal Financial Participation-FFP $13,900,000) in state fiscal year (SFY) 2000-01. The legislation initiating this action appropriates $9.6 million state general purpose revenue (GPR) in FY 2000-01.
Proposed Change
The proposed change is to increase the hourly medical assistance reimbursement rates to agencies for providing in-home personal care services by $3.25, effective July 1, 2000. The Legislature has appropriated $9.6 million GPR for that purpose in the FY 2000-01.
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:
Attention: State Plan Coordinator
Division of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309
Telephone:
Mary Laughlin, Budget Unit
(608) 261-7833
FAX:
(608) 266-1096
Attention: State Plan Coordinator
E-Mail:
Copies of the proposed change are 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 changes may be sent by FAX, e-mail, or regular mail to the Division of Health Care Financing. The FAX number is (608) 266-1096.
The e-mail address is
matana@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 350 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changed methodology based on comments received.
The State of Wisconsin
Department of Administration
Bureau of Integrated Document Services
Document Sales and Distribution Section
P.O. Box 7840
