Public Notices

Wisconsin Administrative Register No. 696, 12/31/2013

Public Notices

Health Services

Medicaid Payment for Graduate Medical Education for Underserved and Rural Regions
State of Wisconsin Medicaid Payment Plan for Rate Year 2014

The State of Wisconsin is implementing a new program to provide grants for new residency positions in existing graduate medical education (GME) programs, under the authority of Act 20, the 2013-2015 Biennial Budget. Eligible entities for these grant dollars will be hospitals with accredited GME programs serving low-income populations. This grant program will be administered by the State's Department of Health Services (DHS).

Payments will be used to support new residents in primary care (family medicine, general internal medicine, and pediatrics), general surgery, and psychiatry; priority will be given to hospital-based programs serving rural and underserved populations. No resident will receive more than $75,000 and no existing GME program will receive more than $225,000 annually. All eligible hospitals for the GME grant funds serve the State's Medical Assistance (MA/Medicaid) population.

The following changes will be contained in the January 1, 2014 inpatient hospital state plan amendment:

  The criteria for eligibility and payment specifications will be defined.

  The methodology used to award payments to residency programs 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 graduate medical education residency funds in the amount of $1,500,000 all funds per state fiscal year. This amount was provided for in Act 20 and is consistent with the current aggregate Medicaid budget approved by the Legislature.

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 the proposed change will be January 1, 2014.

Copies of the Proposed Change

A copy of the proposed change may be obtained free of charge 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

David Hoffert, Hospital Rate Setting Section Chief

Bureau of Fiscal Management

[phone](phone)

[phone] (fax)

[e-mail]

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 [phone]. The email address is [e-mail]. Regular mail can be sent to the address listed 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 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 Inpatient Hospital Services:
Acute Care Hospitals, Children's Hospitals, Critical Access Hospitals, Major Border Status Hospitals, Non State Public, Psychiatric Hospitals, and Rehabilitation Hospitals
State of Wisconsin Medicaid Payment Plan for Rate Year 2014

The State of Wisconsin reimburses hospitals for inpatient hospital services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and Chapter 49 of Wisconsin Statutes. This program, administered by the State's Department of Health Services (DHS), is called Medicaid or Medical Assistance.

The Wisconsin Medicaid inpatient 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. Critical Access Hospitals are paid on a provider specific, cost based DRG base rate adjusted as necessary to ensure budget compliance. 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. Effective January 1, 2014, DHS will be updating the inpatient hospital rates for rate year 2014.

The following changes will be contained in the January 1, 2014 inpatient hospital state plan amendment:

•   Effective January 1, 2014, inpatient hospital rates for Rate Year 2014 will be published.

•   Effective January 1, 2014, outlier payment trimpoints for Rate Year 2014 will be published.

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 material impact on projected annual aggregate Medicaid expenditures in state fiscal year 2014. DHS maintains the same hospital budget approved by the Legislature.

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 January 1, 2014.

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

David Hoffert, Hospital Rate Setting Section Chief

Bureau of Fiscal Management

[phone](phone)

[phone] (fax)

[e-mail]

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 [phone]. The email address is [e-mail]. 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, Critical Access Hospitals, Major Border Status Hospitals, Non State Public, Psychiatric Hospitals, and Rehabilitation Hospitals
State of Wisconsin Medicaid Payment Plan for Rate Year 2014

The State of Wisconsin reimburses hospitals for outpatient hospital services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and Chapter 49 of Wisconsin Statutes. This program, administered by the State's Department of Health Services (DHS), is called Medicaid or Medical Assistance.

Under the current Medicaid Outpatient Hospital State Plan, effective April 1, 2013, the Wisconsin Medicaid outpatient program uses a reimbursement system which is based on Enhanced Ambulatory Patient Groupings (EAPGs). This is a discrete cost-specific reimbursement methodology that allows DHS to reimburse providers based on case mix. Acute Care, Psychiatric, Rehabilitation, Children's, Out-of-State, and new hospitals are paid under the EAPG system using a statewide base rate, which is adjusted to stay within the State's available funding for outpatient hospital services. Effective January 1, 2014, this rate will also include a payment enhancement for facilities with Graduate Medical Education programs. Critical Access Hospitals are also paid using the EAPG system, but the base rate is based on each hospital's specific, prospective costs. Effective January 1, 2014, DHS will be updating the outpatient hospital rates for rate year 2014.

Due to the redistributive nature of the implementation of the EAPG reimbursement system, DHS decided to limit the fiscal impact to individual providers during the first year of implementation. Specifically, DHS limited the financial impact to a +/- 5% corridor of the projected payments a non-Critical Access Hospital would have received under the outpatient per visit reimbursement methodology, effective February 1, 2013. The final base rate, therefore, for each non-Critical Access Hospital was based on this Fiscal Corridor adjustment to the Wisconsin statewide base rate for Rate Year 2013. Effective January 1, 2014, for Rate Year 2014, this corridor will be removed in conjunction with the publication of new EAPG base rates.

The following changes will be contained in the January 1, 2014 outpatient hospital state plan amendment:

•   Effective January 1, 2014, outpatient hospital rates for Rate Year 2014 will be published.

•   Effective January 1, 2014, these rates will also include a payment enhancement for facilities with Graduate Medical Education programs.

•   Effective January 1, 2014, DHS will no longer be applying a Fiscal Corridor Adjustment to the statewide base rate for all Acute Care, Psychiatric, Rehabilitation, and Children's hospitals to limit the fiscal impact of the EAPG reimbursement system.

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 material impact on projected annual aggregate Medicaid expenditures in state fiscal year 2014. DHS maintains the same hospital budget approved by the Legislature.

The DHS 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 January 1, 2014.

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

David Hoffert, Hospital Rate Setting Section Chief

Bureau of Fiscal Management

[phone](phone)

[phone] (fax)

[e-mail]

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 [phone]. The email address is [e-mail]. 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

(Increased Federal Share of Funding for Clinical Preventive Services
Provided Under Wisconsin Medicaid)

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 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 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.

Change in Payment Methods

A broad array of services are provided to recipients of services under Medical Assistance, BadgerCare, and BadgerCare Plus. Among these services are clinical preventive services. A section of the federal Affordable Care Act (Public Law 111–148), section 4106(b), establishes a one percentage point increase in the federal medical assistance percentage (FMAP) for adult vaccines and clinical preventive services to states that cover, without cost-sharing, a full list of specified preventive services and adult vaccines. For a state to receive the one percentage point increase, the state must eliminate any requirements for co-payments for the list of preventive services. The Wisconsin Medicaid program intends to take advantage of this increase in FMAP and to meet the requirements to do so.

The change will be effective on January 1, 2014, and will apply to claims with dates of service on or after that date. The change to Medicaid, BadgerCare, and BadgerCare Plus is projected to result in increased annual expenditures of $1,875,000 all funds (AF), composed of $1,125,000 federal match and $750,000 general purpose revenue.

Copies of Changes

Copies of the changes to the Medicaid state plan to implement this change may be obtained free of charge by calling or writing as follows:

Regular Mail:

Rachel Currans-Henry

Bureau of Benefits Management

Division of Health Care Access and Accountability

P.O. Box 309

Madison, WI 53701-0309

Fax:

[phone]

Attention: Rachel Currans-Henry

Telephone:

Rachel Currans-Henry

Bureau of Benefits Management

[phone]

E-Mail:

[e-mail]

Copies of the state plan change will be made 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 changes may be sent by FAX, e-mail, or regular mail to the Division of Health Care Access and Accountability. The FAX number is [phone]. The e-mail address is [e-mail]. 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.

Health Services

(Medical Assistance Reimbursement for Health Home Services)

The state of Wisconsin reimburses providers for services provided to low-income persons under the authority of Title XIX of the Social Security Act and sections 49.43 to 49.47, Wisconsin Statutes. The Wisconsin Department of Health Services administers this program, which is called Medical Assistance or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and chapters 49.43 to 49.47 of Wisconsin Statutes. Together the Medical Assistance and BadgerCare Plus programs are referred to as ForwardHealth.

Section 1945 of the Social Security Act provides authority for a State, at its option as a State plan amendment, to provide health home services to individuals with chronic conditions. This authority allows states to pay a designated provider, a team of health care professionals operating with such a provider, or a health team as the individual's health home for purposes of providing the individual with health home services. Wisconsin has elected to use the designated provider approach for this benefit. Health home services will be available to individuals with chronic mental health or behavioral health conditions, starting March 1, 2014. The program will begin in Lincoln, Langlade, and Marathon Counties and expand statewide based on the results of the program in the three counties.

The health home model of care is a comprehensive approach to care management, integrating primary care, behavioral health, acute and long-term care. The patient's primary care physician and others involved in the patient's care collaborate on the development of a single plan of care. The patient is central to this care management approach. The primary goals are to improve the patient's experience of care, health outcomes and reduce costs.

Wisconsin Medicaid and BadgerCare Plus members with chronic mental health or behavioral health conditions will be eligible for these services.

This initiative is projected to result in increased annual expenditures of $914,400 all funds (AF), composed of $822,960 of federal match (FED) and $91,440 general purpose revenue (GPR). The start date, March 1, 2014, is the first day of the third month of the third quarter of state fiscal year 2014 and the first day of the third month of the second quarter of federal fiscal year 2014.

Written Comments and 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

Jami Crespo, Policy Analyst

Division of Health Care Access and Accountability

PO Box 309

Madison, WI 53701-0309

Phone

Division of Health Care Access and Accountability

[phone]

FAX

[phone]

Attention: Jami Crespo

E-Mail

[e-mail]

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, e-mail, or regular mail to the Division of Health Care Access and Accountability. The FAX number is [phone]. The e-mail address is [e-mail].

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 based on comments received.

Health Services

(Medical Assistance Reimbursement for Coverage of Prescription Drugs
Under Medicare Part D)

The state of Wisconsin reimburses providers for services provided to low-income persons under the authority of Title XIX of the Social Security Act and sections 49.43 to 49.47 and 49.688, Wisconsin Statutes. The Wisconsin Department of Health Services (the Department) administers this program, which is called Medical Assistance or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and chapters 49.43 to 49.47 of Wisconsin Statutes. Together the Medical Assistance and BadgerCare Plus programs are referred to as ForwardHealth.

Among the services provided, the state of Wisconsin covers legend and non-legend drugs and drug products and reimburses pharmacies for services provided to recipients of Medicaid and BadgerPlus. The Department proposes to make changes to coverage under these programs.

Proposed Changes

Effective for dates of service on and after January 1, 2014, barbiturates will become Medicare Part D-covered drugs in all instances. Claims for barbiturates for individuals who are dual-eligible, that is, are eligible for both Medicare and Medicaid, should be submitted to Medicare Part D. Non dual eligibles who are eligible for Medicaid may receive these drugs and be reimbursed under Medicaid.

This initiative is projected to result in reduced annual expenditures of $210,000 all funds (AF), composed of $126,000 federal match (FED) and $84,000 general purpose revenue (state funds).

Written Comments and 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

Pam Appleby
Division of Health Care Access and Accountability

PO Box 309

Madison, WI 53701-0309

Phone

Pam Appleby

Division of Health Care Access and Accountability

[phone]

FAX

[phone]

Attention: Pam Appleby

E-Mail

[e-mail]

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, e-mail, or regular mail to the Division of Health Care Access and Accountability. The FAX number is [phone]. The e-mail address is [e-mail]. 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 based on comments received.

Health Services

(Foster Care Medical Home)

The State of Wisconsin provides access to health care for low-income and medically needy persons under the authority of Title XIX of the Federal Social Security Act and sections 49.43 to 49.47 and 49.688, Wisconsin Statutes. The Wisconsin Department of Health Services administers this program, which is called Medical Assistance or Medicaid (MA). 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 subject of this notice is the Foster Care Medical Home Benchmark Plan. A public notice describing the Foster Care Medical Home Benchmark Plan appeared in the Wisconsin Administrative Register mid-November 2011 edition. In November 2011, Wisconsin submitted amendment 11-016 to the Centers for Medicare and Medicaid Services (CMS). CMS approved this amendment, Benchmark Plan B, Foster Care Medical Home, on July 10, 2012, with an effective date of July 1, 2012. CMS staff have subsequently requested that Wisconsin resubmit this information in a new format to fulfill the Alternative Benefit Plan (ABP) requirements of the Affordable Care Act.

Recipients of coverage under Wisconsin's Foster Care Medical Home Benchmark Plan receive Wisconsin's full existing Medicaid benefit package; in other words, all Medicaid state plan services available under Wisconsin's current state plan. Additional services are provided under the Foster Care Medical Home.

Habilitative services are available to those receiving benefits under the Foster Care Medical Home Benchmark Plan. This ensures that Wisconsin meets federal requirements to cover all essential health benefits. Habilitative services allow individuals to maintain or attain certain functioning levels and are distinct from rehabilitative services, which focus on restoring individuals to functioning levels lost due to injury or illness. Covered habilitative services available through Wisconsin's existing state plan include the following: physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders.

Copayments are not required from those who receive coverage under the Foster Care Medical Home Benchmark Plan.

In summary, the Foster Care Medical Home Benchmark Plan (Alternative Benefit Plan) will include all Medicaid state plan benefits, which include all of the following:

•   Essential Health Benefits: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services; laboratory services; and preventive and wellness services.

•   Enhanced periodicity schedule for Early and Periodic Screening, Diagnosis, and Treatment services (EPSDT).

•   Case management services.

•   Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) services.

•   Non-emergency transportation.

•   Family planning services and supplies.

The resubmission of the Foster Care Medical Home Benchmark Plan will be effective January 1, 2014.

As indicated in the November 2011 public notice, the change in services is projected to decrease expenditures by $300,000 in general purpose revenue (GPR) annually.

Copies of Proposed Changes

A copy of the proposed Medicaid program changes may be obtained free of charge by calling or writing as follows:

Regular Mail

Rachel Currans-Henry

Director, Bureau of Benefits Management

Division of Health Care Access and Accountability

P.O. Box 309
Madison, WI 53707-0309

Phone

Rachel Currans-Henry

[phone]

FAX

[phone]

E-Mail

[e-mail] .

Written Comments

Written comments are welcome. Written comments on the changes may be sent by FAX, e-mail, or regular mail to the Division of Health Care Access and Accountability. The FAX number is [phone]. The e-mail address is: [e-mail].

Regular mail can be sent to the above address.

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.