The State of Wisconsin currently provides reimbursement for certain services provided by local governmental units to individuals eligible for Medicaid. Examples of the services provided by these entities include outpatient mental health services, alcohol and other drug abuse treatment, psychiatric services, personal care services, and case management services. The department makes payments to local governmental units for the specific services they provide to eligible Medicaid recipients in accordance with an established fee schedule. In addition, local governmental units currently may apply for additional funding from the department for any operating deficits incurred in providing these services to eligible Medicaid recipients. For purposes of determining the amount of any additional funding for incurred deficits, the department has established an audit and reconciliation process. Through this process the amount of the local government's payments eligible for federal matching funds is identified and the federal share of this amount is paid up to specified limits.
The department intends to change its methods and standards for setting payments by increasing the rates paid for certain services provided by local governmental units and by eliminating additional payments to these units for deficits incurred in delivering the services.
The department believes that by increasing the payment rates for services provided and by eliminating the deficit funding process, the goals of the program will be better met and administrative efficiency will be improved.
The department intends to establish the new rate amounts for the services by applying appropriate inflation factors to historical payment rates or by setting rates based on current prevailing charges. Any increase resulting from this change will not result in rates that exceed the maximum amounts permissible under federal regulations. The increased rate amounts will be in effect for services provided on or after January 1, 2003.
The estimated increase in aggregate expenditures for these rate increases is $ 12.9 million for fiscal year 2003 and $47.4 million on an annual basis thereafter.
Written comments:
Written comments on the proposed change may be sent within 30 days of publication of this notice to:
Department of Health and Family Services
Attention: Wisconsin Medicaid Program
P.O. Box 309
Madison, Wisconsin 53701-0309
Or by faxing to 608-266-1096
The comments will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in room 355 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changes based on comments received.
Health and Family Services
Medical Assistance Reimbursement for Home and Community-Based Waiver Services
The state of Wisconsin provides payment for home and community-based waiver services provided to certain persons eligible for Medicaid benefits under the authority of Title XIX of the federal Social Security Act. Home and community-based waiver services are provided under section 1915 (c) waivers of certain otherwise-applicable Medicaid state plan requirements. The department currently operates several home and community-based waiver programs that provide services to different eligible populations. Among the programs currently in operation are the Community Options Program (COP-W) and the Community Integration Program II (CIP II), which provide services to elderly persons and persons with physical disabilities, and the Community Integration Program I (CIP IA & IB), which provides services to persons with developmental disabilities.
Under these waiver programs, services are provided to individuals who would otherwise require institutionalization in a nursing home or an intermediate care facility for the mentally retarded (ICF/MR). To receive a waiver from the federal government, the department must demonstrate that expenditures for home and community-based services under this waiver will not exceed expenditures that would otherwise have been made to provide the services in institutional settings. The department has consistently met this requirement and has provided the federal government with documentation of the reduced cost of waiver program services through the federal waiver approval and waiver renewal processes.
Under the home and community-based waiver programs, services are provided by a Medicaid-certified unit of county government, either through county employees or contractors. For these waiver programs the state makes payments to the counties, which may vary depending upon the particular service needs of the individual. In addition, the counties provide local funding for services provided under these programs.
The department is providing notice that it intends to revise the method by which payments are made to counties for services provided to non-elderly individuals with physical or developmental disabilities under the home and community-based waiver programs (CIP I, CIP II and COP-W) by making the system prospective. The department believes that implementing a prospective payment system for these services will better meet the goals of the program and will improve administrative efficiency.
Based on the information currently available, the estimated annual increase in aggregate Medicaid expenditures related to this change is $75 million. The payments made to counties under this revised system will continue to comply with the conditions and limitations specified under the waiver and under federal regulations.
Written comments:
Written comments on the proposed change may be sent within 30 days of publication of this notice to:
Department of Health and Family Services
Attention: Home and Community-Based Waiver Program
P.O. Box 309
Madison, Wisconsin 53701-0309
Or by faxing to 608-266-1096
The comments will be available for public review between the hours of 7:45 AM and 4:30 PM daily in room 355 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changes based on comments received.
Health and Family Services
Medical Assistance Reimbursement for Certain Dental Services
Notice is hereby given that the Department of Health and Family Services intends to revise its methods and standards for the payment of certain dental services provided to individuals eligible for Medicaid under the authority of Title XIX of the federal Social Security Act. The Wisconsin Department of Health and Family Services administers the joint federal-state Medicaid program for the state of Wisconsin. This notice is intended to satisfy the requirements of
42 CFR 447.205.
Currently the department pays for all covered dental services provided to eligible Medicaid recipients in accordance with an established fee schedule, regardless of where those services are provided. Dentists enrolled in the Medicaid program who are affiliated with a dental school within the state provide a significant amount of dental services to Wisconsin's Medicaid population and may incur additional costs in the training and supervision of dental students. For this reason, the department intends to pay for dental services provided by dentists affiliated with dental schools within the state at a higher Medicaid rate than dental services provided by other dentists. The department believes that these fee increases will help assure continued access to dental services provided by dentists affiliated with dental schools within the state to the state's Medicaid population.
The estimated increase in aggregate Medicaid expenditures related to this change is $ 2.8 million for fiscal year 2003.
Written comments:
Written comments on the proposed change may be sent within 30 days of publication of this notice to:
Department of Health and Family Services
Attention: Wisconsin Medicaid Program
P.O. Box 309
Madison, Wisconsin 53701-0309
Or by faxing to 608-266-1096
The comments will be available for public review between the hours of 7:45 AM and 4:30 PM daily in room 355 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changes based on comments received.
