Public Notice: Medicaid Reimbursement for Outpatient Hospital Services

Public Notice

Health Services

Medicaid Reimbursement for Outpatient Hospital Services:

Acute Care, Children’s, Critical Access, Psychiatric, and Rehabilitation Hospitals

The State of Wisconsin reimburses hospitals for outpatient 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. 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.

Effective March 1, 2019, DHS will update the allowable reasons for an outpatient payment rate appeal by removing §6200(a), which provides for an appeal to the outpatient rate based on incomplete or incorrect data in the Medicare cost report submitted by the hospital to the federal Healthcare Cost Report Information System (HCRIS). Hospital providers will continue to have the ability to appeal based on the remaining reasons included in the state plan. The outpatient state plan will also be updated to include an additional reason for appeal based on the Department using the incorrect cost report accessed under section 4214 in the outpatient hospital state plan.

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. The Department 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 March 1, 2019.

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

Karl Hauth

Bureau of Benefits Management

Division of Medicaid Services

P.O. Box 309

Madison, WI 53701−0309

State Contact

Karl Hauth

[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 per the above information. All written comments received will be reviewed, considered, and made 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 to the proposed change based on comments received.