Public Notice: Medicaid Reimbursement

PUBLIC NOTICE

Department of Health Services

Medicaid Reimbursement for Behavioral Treatment Services

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 Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and s. 49.471 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.

Change in Payment Methods

In July 2014, the federal Centers for Medicare and Medicaid Services (CMS) directed states to cover autism treatment services under the Medicaid State Plan. Previously, CMS has allowed states to provide coverage for these services under Home and Community Based Waiver Programs. To comply with this guidance, the Department has developed a behavioral treatment benefit under ForwardHealth for Medicaid and BadgerCare Plus members.

As part of the benefit development, authority for reimbursement of behavioral treatment services is transferring from the Children’s Long Term Supports Waivers, a Home and Community Based Waivers Program authorized under 1915(c) of the Social Security Act, to the Wisconsin Medicaid state plan (known as ForwardHealth) authorized under 1905(a) of the Social Security Act.

Wisconsin Medicaid has submitted a draft state plan amendment to CMS in order to obtain the necessary authorizations to provide and reimburse for behavioral treatment services under the state plan.

The change will be effective January 1, 2016, and will apply to claims with dates of service on or after that date. The change to Medicaid and BadgerCare Plus is projected to result in increased annual expenditures of $7,000,000 all funds (AF), composed of $4,076,100 federal match (FED) and $2,923,900 state funds/general purpose revenue (GPR), for state fiscal year 2016 (July 1, 2015 to June 30, 2016). The change is projected to result in increased annual expenditures of $14,000,000 all funds (AF), composed of $8,152,200 federal match (FED) and $5,847,800 state funds/general purpose revenue (GPR), for state fiscal year 2017 (July 1, 2016 to June 30, 2017).

Copies of Changes

Copies of the state plan amendment may be obtained free of charge by calling or writing as follows:

Regular Mail:

Al Matano

Bureau of Fiscal Management

Division of Health Care Access and Accountability

P.O. Box 309

Madison, WI 53701-0309

Fax:

[phone]

Attention: Al Matano

Telephone:

Al Matano

Bureau of Fiscal 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.