Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 537001-0309
State Contact
Sean Gartley
Bureau of Benefits Management
(608) 267-9313 (phone)
(608) 266-1096 (fax)
A copy of the proposed change is available for review at the main office of any county department of social services or human services. Department staff have notified the health directors of Native American tribes in Wisconsin of this proposal and will consult with them.
Written Comments
Written comments are welcome. Written comments on the proposed change may be sent by FAX, email, or regular mail to the Division of Health Care Access and Accountability. The FAX number is (608) 266-1096. The email address is
Sean.Gartley@wisconsin.gov. Regular mail can be sent to the address above. All written comments will be reviewed and considered.
All written comments received will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 350 of State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changed pay for performance measures based on comments received.
Department of Health Services
Medical Assistance Reimbursement to Hospitals
Pay For Performance Hospital Withhold
The State of Wisconsin reimburses providers, including hospitals, for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss.
44.43 to
49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (the Department), is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create BadgerCare and BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and ss.
49.471,
49.4665, and
49.67 of the Wisconsin Statutes. Federal statutes and regulation 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 Department is modifying its withhold-based inpatient / outpatient hospital pay for performance program. Fee-for-service inpatient hospital claims with dates of discharge between May 15, 2013, and March 31, 2014, and fee-for-service outpatient hospital claims with dates of service between May 15, 2013, and March 31, 2014, will be subject to a 1.5% withholding on each payable inpatient and outpatient hospital claim amount. At the conclusion of the proposed ten and a half month measurement cycle, the Department will transition to an annual twelve month measurement cycle beginning April 1, 2014, and April 1 in subsequent years.
In addition to the change in duration of the measurement cycle, the Department will make the following two changes from the previous cycle's measures.
1.
The Healthcare Personnel Influenza Vaccination Measure will be transitioned from pay for reporting (i.e., if a hospital reports data for the measure it is deemed in compliance) to pay for performance (i.e. hospital is evaluated on its performance as compared to its baseline and / or the national average).
2. The Department will add an Early Elective Induced Delivery measure as a pay for reporting measure (i.e., if a hospital reports data for the measure it is deemed in compliance).
The Department will make payments to hospitals prior to December 31, 2014, and prior to December 31 in subsequent years to those hospitals that meet the performance requirements.
The fiscal impact of this change is likely to be minimal. As in previous years, the total amount redistributed is funded through the 1.5 percent withheld from fee-for-service claims. Based on data from previous years, the Department anticipates total payments of approximately $6 million all funds, composed of approximately $3.6 million federal monies, or FED, and $2.4 million general purpose revenues, or GPR. The amount of the actual payments will be determined by the accounting performed as to which hospitals met performance-based targets prior to December 31, 2013, and prior to December 31 of subsequent years.
The effective date of the change will be May 15, 2013.
Copies of Proposed Change
A copy of the proposed change may be obtained free of charge at your local county agency or by calling or writing as follows:
Regular Mail
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 537001-0309
State Contact
Sean Gartley
Bureau of Benefits Management
(608) 267-9313 (phone)
(608) 266-1096 (fax)
A copy of the proposed change is available for review at the main office of any county department of social services or human services. Department staff have notified the health directors of Native American tribes in Wisconsin of this proposal and will consult with them.
Written Comments
Written comments are welcome. Written comments on the proposed change may be sent by FAX, email, or regular mail to the Division of Health Care Access and Accountability. The FAX number is (608) 266-1096. The email address is
Sean.Gartley@wisconsin.gov. Regular mail can be sent to the address above. All written comments will be reviewed and considered.
All written comments received will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 350 of State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changed pay for performance measures based on comments received.
