Public Notice: Wisconsin Medicaid Hospital Reimbursement Charges

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Pharmaceutical Professional Services Excluded from DRG Payments

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DHS will modify §6130 to indicate that the professional services of pharmacists enrolled in Medicaid are excluded from DRG-based payment for hospital claims, consistent with 2021 Wisconsin Act 98.

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Services Exempted from the DRG-Based Payment System:

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DHS will modify §7200 Payment for Ventilator-assisted Patients to reflect an updated per-diem rate of $1,612 for Medicaid recipients on a ventilator. This per-diem rate has been updated for inflation.

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DHS will modify §7500 Brain Injury Care to reflect a newly consolidated rate of $2,249 per-diem for coma recovery and neurobehavioral care. These services will no longer be paid at different rates. This newly consolidated rate has also been updated for inflation.

These changes will be effective 1/1/2024 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 $65.72 million all funds (AF), composed of $39.85 million federal match (FED) and $25.87 million state funds/general purpose revenue (GPR).

Copies of Changes

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

Mail:

       

Attention: DHS SPA Coordinator

Bureau of Benefits Policy Division of Medicaid Services

P.O. Box 309

Madison, WI 53701-0309

Fax: [phone]

Attention: DHS SPA Coordinator

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 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 Room 350 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed change based on comments received.