Health and Family Services
(Medical Drug Coverage and Reimbursement)
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 Medicaid inpatient and outpatient hospital state plans effective July 1, 2005 to implement proposed provisions pending the approval of the 2005-2007 Wisconsin state budget act, and maintain compliance with federal payment limits, and for administrative efficiencies.
Outpatient Hospital Services
Proposed changes in the state plan for reimbursement for outpatient services may include:
1.
Remove the Border Metropolitan Statistical Area Supplement. The hospitals that once qualified for this adjustment are now Critical Access Hospitals. As such, they are paid at cost, which now makes them ineligible for the supplement.
2.
Remove the Hold Harmless provision from the rate per visit calculation. Eliminating this provision would result in an equitable allocation of the across-the-board rate increase as all providers would receive the same percentage of Medicaid costs in the outpatient rate.
3.
Limit reimbursement for therapy services provided in an outpatient hospital setting from the OP rate per visit to the rates paid to therapy providers.
Implementation of the above changes to the State Plan for outpatient services are expected to reduce payments by an estimated $4,375,000 All Funds ($2,529,625 FED, $1,845,375 GPR) due to reclassification of therapy services claims, and increase payments by an estimated $5,926,600 All Funds ($3,426,600 FED, $2,500,000 GPR) for general outpatient rate increase for state fiscal year 2005-2006.
Inpatient Hospital Services
Proposed changes in the state plan for reimbursement for inpatient services may include:
1. Change the trimpoint for outlier payments. Create one trimpoint for acute care hospitals.
2. Change methodology and maximum amount available for the General Assistance Disproportionate Share Hospital Allowance.
3. Remove the Critical Access Hospitals (CAHs) from the appendix for hospitals qualifying for exemption from capital cost reduction. This calculation does not affect the CAHs.
Implementation of the above changes to the State Plan for inpatient services are expected to decrease expenditures by $200,000 all-funds ($115,640 Fed, and $84,360 GPR).
Copies of Proposed Changes
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
