Health and Family Services
(Medical Assistance Reimbursement for Services Provided by
Hospital Affiliated and Free-Standing End Stage Renal Disease Providers)
The State of Wisconsin reimburses providers for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss. 49.43
, Wisconsin Statutes. This program, administered by the State's Department of Health Services, is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare and BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and ss. 49.471
, and 49.67
of the Wisconsin Statutes. 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 Wisconsin Department of Health Services is proposing to modify the Medicaid reimbursement methodology for services provided by end stage renal disease (ESRD) providers. The Department's proposal involves no change in coverage of services.
2011 Act 32
, the 2011-2013 biennial budget, directed the Department to change the Medicaid reimbursement structure for ESRD providers. The Department will pay ESRD providers
a per diem rate set at a percentage of the Medicare reimbursement rate for the services that they provide. Initially, this amount will not exceed approximately 80% of the Medicare reimbursement rate. The percentage may be revised from time to time.
The proposed change is to adopt a reimbursement rate of a per diem rate not to exceed a percentage of the Medicare reimbursement rate for services provided by ESRD providers. Initially, that percentage is not to exceed approximately 80%. The change will apply to dialysis services provided on dates of service on and after September 10, 2011.
The projected fiscal effect of these changes is a savings of $3.1 million general purpose revenue (GPR) and $1.9 million federal match (FED) for a total of $5.0 million all funds (AF) for the 2011-2013 biennium.
Copies of the Proposed Change
A copy of the proposed change may be obtained free of charge by calling or writing as follows:
Bureau of Benefits Management
Division of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309
Attention: James Vavra
A copy of the proposed change are available for review at the main office of any county department of social services or human services.
Written comments are welcome. Written comments on the proposed changes may be sent by FAX, e-mail, or regular mail to the Department. The FAX number is (608) 266-1096.
The e-mail address is firstname.lastname@example.org
. Regular mail can 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.