18. Revise the inflation percentages for property tax and municipal fees in Section 5.710.
19. Increase the base allowance for the Exceptional Medicaid/Medicare Utilization incentive in Section 5.920.
20. Redefine the cost-based direct care cost center in Sections 2.100 and 3.100 to include only RN, LPN, certified nurse's assistants costs and the resident living staff costs. CNAs in the 90-day training period and single task workers would also be included.
21. Create a new component in direct care for ward clerks, OTC drugs and the special services on schedule 21 & 24. This would be a level of care/case mix-adjusted payment component with an incentive.
22. Modify the labor factors in section 5.410 for St. Croix and Pierce County using the Medicare hospital cost index. This index is used in determining the labor region adjustment to direct care cost targets in section 3.126.
23. Add s. 3.050 (5) to exclude beds transferred between nursing homes that are consistent with section 150.345, Wis. Statutes, in the calculation of beds for rate setting.
24. Any modifications as enacted by the Wisconsin Legislature.
Copies of the Proposed Changes:
Copies of the available proposed changes and proposed rates may be obtained free of charge by writing to:
Division of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309
Attention: Nursing Home Medicaid Payment Plan
or, by faxing James Cobb at 608-264-7720.
The available proposed changes may be reviewed at the main office at any county department of social services or human services.
Written Comments/Meetings:
Written comments on the proposed changes may be sent to the Division of Health Care Financing, at the above address. The 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 changes based on comments received. 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 write to the above address. Revisions may also be made in the proposed changes based on comments received at these forums.
Department of Health and 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 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 provisions contained in the inpatient plan effective July 1, 2002 to implement provisions of 2001 Act 16, the 2001-2003 state budget act, and maintain compliance with federal payment limits.
Outpatient Hospital Services
No proposed changes in the state plan for reimbursement of outpatient hospital services.
Inpatient Hospital Services
Proposed changes in the state plan for reimbursement for inpatient services may include:
1. For the payment system based on diagnosis-related groups (DRGs), adjustment of DRG weighting factors, modification of the method of determining the cost of claims for determining DRG weighting factors and adjustment of DRG weighting factors, modification of the standard DRG base rates and area wage indices.
2. Revision of the rural hospital adjustment percentages to ensure that payments do not exceed authorized funds.
3. Modification of the disproportionate share adjustment parameters to recognize a more current proportion of services provided by hospitals to Medicaid recipients.
4. 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 maintain compliance with federal payment limits and to implement provisions of the 2001-2003 state budget act.
Implementation of the above changes to the State Plan for inpatient services is expected to change the annual expenditures of the Wisconsin Medical Assistance Program by $752,000 for state fiscal year 2002-2003.
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 Section
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. at:
Division of Health Care Financing
Room 350, State Office Building
One West Wilson Street
Madison, WI
