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
(608) 261-8397(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 (609) 266-1096. The email address is
David.Hoffert@wisconsin.gov. 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
(608) 261-8397(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
David.Hoffert@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, 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
