Public Notice: Medical Assistance Reimbursement

PUBLIC NOTICE

Department of Health Services

(Medical Assistance Reimbursement of Ambulatory Surgical Centers)

The State of Wisconsin reimburses ambulatory surgical centers for medically necessary services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and Chapter 49 of the Wisconsin Statutes. This program, administered by the State's Department of Health Services (the Department), is called Medical Assistance or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare Plus program under the authority of Title XIX and Title XXI of the Social Security Act and Chapter 49 of the Wisconsin Statutes. Collectively, these programs are herein referred to as the Wisconsin Medicaid Program (WMP). Federal statutes and regulations require that a State Plan be developed that provides the methods and standards for reimbursement of covered services. Such a plan is currently in effect.

The Department is proposing changes to existing sections of the state plan related to ambulatory surgical center reimbursement. Under the proposal, the Department would end access payments to ambulatory surgical centers. The reason for the change is a change in state law passed by the Wisconsin Legislature. Expenditures on ambulatory surgical center reimbursement in State Fiscal Year (SFY) 2016 (July 1, 2015 to June 30, 2016) totaled $20 million all funds. This amount consists of approximately $84 million general purpose revenue (GPR) and $11.6 million federal match, or FED. Thus, the proposed change would result in a reduction of expenditures in those amounts. The Department proposes an effective date for this change of October 1, 2017.

Copies of the Proposed Changes

A copy of the proposed changes will be sent to every county social services or human service department main office where they will be available for public review. For more information, interested persons may fax or write to:

Ben Nerad, Hospital Policy and Rate Setting Section Chief
Bureau of Fiscal Management
Division of Medicaid Services
P.O. Box 309
Madison, WI 53701-0309
Fax: [phone]
[e-mail]

Written Comments

Written comments on the proposed changes are welcome and should be sent to the above address. The comments received on the changes will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. at:

Division of Medicaid Services
Room 350, State Office Building
One West Wilson Street
Madison, WI