9. Clarify the status of new resident admissions and re-admissions in the CMI.
10.
Correct an obsolete reference to certain types of equipment rental expenses in Section
2.251.
12.
Clarify the time period in which corrections to a facility's case mix index are allowable under Section
3.150.
13.
Clarify that the final rate determination is the sum of calculations made for each cost center under Section
3.700.
14.
Merge two duplicative sections relating to separately billable ancillary items by moving portions of Section
6.310 into Section
3.801 and Section
3.802, and a portion of Section
6.320 into Section
3.803, and deleting Section
6.300.
15.
Update the ventilator rate for SFY14 and correct obsolete references to a rate for extensive care patients by adding the updated rate and deleting portions of Section
4.691.
16.
Correct an obsolete reference to a special fixed rate for residents with HIV/AIDS in Section
4.694.
17.
Correct an obsolete reference to approval of uniform chart of accounts in Section
6.110.
18.
Modify Sections
3.775 and
3.780 to reflect possible changes in the Medicare Upper Payment Limit (UPL) calculations. This shall reflect any potential changes to bring the State's approach to calculating the UPL into alignment with the requirements of the recently-released SMD# 13-003.
19.
Update the Reporting Period, Picture Dates, and Dates Available in Section
5.421.
20.
Update the Picture Dates, and Dates Available as of Dates and Rate Effective Dates in Section
5.422.
21.
Update the dates in Section
4.720.
22. Update contact names and addresses, as necessary.
23. Update references to previous years for descriptive reasons, and correct typographical errors as necessary.
24.
Update the labor factors listed in Section
5.410.
25.
Update the case mix weight listed in Section
5.420.
26. Change the dates of the definitions of base cost reporting period.
27. Make any potential changes required by findings of an ongoing federal audit of ICF-IID rate-setting by the Office of Inspector General of the Department of Health and Human Services.
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 Long Term Care
Bureau of Financial Management
Attention: Nursing Home Medicaid Payment Plan
P.O. Box 7851
Madison, WI 53703-7851
or by faxing Dave Varana at 608-266-2713.
Written Comments/Meetings
Written comments on the proposed changes may be sent to the Division of Long Term Care, 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 B274 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.
Health Services
Medicaid Reimbursement for Inpatient Hospital Services:
Acute Care Hospitals, Children's Hospitals, Rehabilitation Hospitals, Critical Access Hospitals
State of Wisconsin Medicaid Payment Plan for State Fiscal Year 2013-2014
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.
49.43 to
49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (DHS), 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,
49.665, 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 Medicaid program uses a reimbursement system which is based on Diagnosis Related Groupings (DRGs). Under the current Medicaid Inpatient Hospital State Plan, effective February 1, 2013, the rate-setting methodology for Acute Care, Major Border Status and Children's Hospitals is a provider specific, DRG payment system adjusted by case mix that assigns each hospital a unique hospital specific DRG base rate. This rate includes adjustments for differences in wage levels, includes an amount for capital expenditures, and payment enhancements for qualifying Rural Hospitals and facilities with Graduate Medical Education programs. In addition, a cost outlier payment will be made when the cost of providing services exceeds a predetermined trimpoint. Payments are adjusted as necessary to ensure budget compliance using a statewide base rate as the starting point of the rate setting process. Non State Public and Private Psychiatric and Rehabilitation Hospitals are paid on a provider specific, cost based per diem rate adjusted as necessary to ensure budget compliance.
The following changes will be contained in the July 1, 2013 inpatient hospital state plan amendment:
• Access Payments for Acute Care Hospitals, Children's Hospitals, and Rehabilitation Hospitals will be updated and made in addition to the base payments.
• Access Payments for Critical Access Hospitals will be updated and made in addition to the DRG base payments.
• The methodology used to distribute disproportionate share payments to hospitals in state fiscal year 2013-14 will be defined.
This notification is intended to provide notice of the type of changes that are included in the amendment. Interested parties should obtain a copy of the actual proposed plan amendment to comprehensively review the scope of all changes.
Proposed Change
It is estimated that these changes will have a projected impact of an increase of expenditures in the amount of $36,792,000 all funds, composed of $15,000,000 general purpose revenue, or GPR, and $21,792,000 federal match, annual aggregate Medicaid expenditures in state fiscal year 2013-14.
The Department's proposal involves no change in the definition of those eligible to receive benefits under Medicaid, and the benefits available to eligible recipients remains the same. The effective date for these proposed changes will be July 1, 2013.
In addition to this public notice, Wisconsin's tribes were consulted at a meeting of the Tribal Health Directors.
Copies of the 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 53701-0309
State Contact
Krista Willing, Deputy Director
Bureau of Fiscal Management
(608) 266-2469 (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.
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
kristae.willing@wisconsin.gov. Regular mail can be sent to the above address. 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 the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changed methodology based on comments received.
Health Services
Medicaid Reimbursement for Outpatient Hospital Services:
Acute Care Hospitals, Children's Hospitals, Rehabilitation Hospitals, Critical Access Hospitals
State of Wisconsin Medicaid Payment Plan for State Fiscal Year 2013-2014
The State of Wisconsin reimburses providers for services provided to Medical Assistance recipients, including hospitals, under the authority of Title XIX of the Social Security Act and ss.
49.43 to
49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (DHS), 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,
49.665, 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.
Effective April 1, 2013, DHS implemented the Enhanced Ambulatory Patient Groupings (EAPG) reimbursement system as the new rate setting methodology for all outpatient hospital services. This is a discrete cost-specific reimbursement methodology that will allow DHS to reimburse providers more accurately based on case mix. Acute Care, Psychiatric, Rehabilitation, Children's, Out-of-State, and new hospitals will be paid under the EAPG system using a statewide base rate, which will be adjusted to stay within the State's available funding for outpatient hospital services. Critical Access Hospitals will also be paid using the EAPG system, but the base rate will be based on each hospital's specific, prospective costs.
The following changes will be contained in the July 1, 2013 outpatient hospital state plan amendment:
• Access Payments for Acute Care Hospitals, Children's Hospitals, and Rehabilitation Hospitals will be updated and made in addition to the EAPG payments.
•
Access Payments for Critical Access Hospitals will be updated and made in addition to the EAPG payments.
This notification is intended to provide notice of the type of changes that are included in the amendment. Interested parties should obtain a copy of the actual proposed plan amendment to comprehensively review the scope of all changes.
Proposed Change
It is estimated that these changes will have no impact on projected annual aggregate Medicaid expenditures in state fiscal year 2013-14.
The Department's proposal involves no change in the definition of those eligible to receive benefits under Medicaid, and the benefits available to eligible recipients remains the same. The effective date for these proposed changes will be July 1, 2013.
In addition to this public notice, Wisconsin's tribes were consulted at a meeting of the Tribal Health Directors.
Copies of the 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 53701-0309
State Contact
Krista Willing, Deputy Director
Bureau of Fiscal Management
(608) 266-2469 (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.
Written Comments
