Public Notice
Department of Health 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. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is in effect. The Department is proposing changes to the fee-for-service Medical Assistance (MA) maximum fee rates for a number of services pursuant to changes mandated in 2021 Wisconsin Act 58, the 2021–2023 biennial state budget. The changes would be effective January 1, 2022. The impacted services and the changes being implemented are listed below:
—Rates for selected ambulance services will be set to 80% of the 2021 Medicare urban rate paid in Wisconsin.
—Rates for hearing aid and audiology services will be set to 75% of the 2021 Medicare rate paid in Wisconsin. Medicaid services for which there is no comparable Medicare rate will be increased 19%.
—Rates for selected adaptive behavioral treatment services will be increased by 15%.
—Rates for child and adolescent day treatment will be increased by 20%.
—Rates for spinal manipulation performed by chiropractors will be set to 70% of 2021 —Medicare reimbursement paid in Wisconsin.
—Rates for selected dental services will be increased by 40%.
—Rates for selected emergency room physician services will be increased by 15%.
—Rates for selected nursing care services in home health agencies that are licensed under Wis. Stat. § 50.49 will be increased 7.95%. —Rates for services by opioid treatment providers will be increased by 5%.
—Rates for evaluation and management services by primary care physicians for medication-assisted treatment (MAT) will be increased by $5.
—Rates for outpatient mental health and substance abuse services will be increased by 15%.
—The hourly rate for personal care services (Healthcare Common Procedure Coding System code T1019: Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment [code may not be used to identify services provided by home health aide or certified nurse assistant]) will increase to $20.80.
—Rates for physical therapy will be increased by 5.99%. Select codes within this category will also receive a 5% rate increase in response to ARPA.
—Rates for speech-language pathology services will be set to 75% of the 2021 Medicare rate paid in Wisconsin.
The change to Medicaid, BadgerCare, and BadgerCare Plus is projected to result in increased annual expenditures of $62,200,000 all funds (AF), composed of $38,200,000 federal match (FED) and $24,000,000 state funds/general purpose revenue (GPR), effective January 1, 2022 – December 31, 2022.
Copies of Changes
Copies of the state plan change may be obtained free of charge by calling or writing as follows:
Mail:
Chris Thomas
Bureau of Rate Setting
Division of Medicaid Services
P.O. Box 309
Madison, WI 53701-0309
Phone:
(608) 266-2415
Fax:
(608) 266-1096
Attention: Chris Thomas
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 as described above. 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 the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed change based on comments received.
