Public Notice: Medicaid Reimbursement for PACE

The Wisconsin PACE program covers enrollees if they meet the nursing home admission criteria and are age 55 or over. The PACE rates are based on encounter data and functional status for a nursing home eligible population age 55 years or over. The PACE regulation at 42 CFR 460.182(b)(1) requires that the capitation amount be less than the Amount that Would Otherwise have been Paid (AWOP) under the state plan if the participants were not enrolled in PACE. Starting with rate year 2019, the Department will update the methodology to calculate the AWOP by eliminating legacy waiver data from the calculation and instead use managed care data as allowed under Centers for Medicare and Medicaid Services (CMS) PACE rate guidance released in 2015. The Department is in the process of working with CMS to develop the exact calculation that will be used to ensure that PACE rates are lower than what would otherwise have been paid using recent Fee for Service and/or Managed Care data. Consistent with CMS guidance, the Department intends to rebase the AWOP annually but at least every 3 years.

The change to Medicaid will be effective January 1, 2019 and is projected to result in no change in expenditures.

Copies of Changes

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

Regular Mail:

Karl Hauth

Bureau of Benefits Management

Division of Medicaid Services

P.O. Box 309

Madison, WI 53701-0309

Fax:

[phone]

Attention: Grant Cummings

Telephone:

Karl Hauth

[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 Medicaid Services. 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.