Public Notice: Revised Rates for Per Diem Hospital Providers

PUBLIC NOTICE

Department of Health Services

Changes to Startup Periods and Default Rates for Per Diem Hospital Providers

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.

Change in Covered Services and Payment Methods

The Department is making the following changes to the sections in Wisconsin’s Medicaid Hospital Inpatient State Plan (Attachment 4.19-A).

— Hospital Per-Diem Rates:

— DHS will modify §8221 to require a Medicare cost report with a six month reporting period minimum instead of the current twelve months to set individual hospital rates and conclude the start-up period for new psychiatric hospitals

— Psychiatric hospitals receiving reimbursement settlements for the start-up period will be required to provide ad hoc cost reporting data covering any part of the start-up period not included in the Medicare cost report submitted to CMS.

— Settlements will be handled at a factor of 85.08% of costs, per DHS targets.

— The default rate paid to per diem providers with insufficient claims volume to calculate an individual rate will be the median of the rates paid to other in-state, non-start-up providers of the same hospital type (i.e., a psychiatric hospital would be paid the median of the rates paid to other in-state psychiatric hospitals)

The Department is making the following changes to the sections in Wisconsin’s Medicaid Hospital Outpatient State Plan (Attachment 4.19-B).

— Hospital Per-Diem Rates:

— DHS will modify §4218 to require a Medicare cost report with a six month reporting period minimum instead of the current twelve months to conclude the start-up period for new psychiatric rate payments.

— Psychiatric hospitals receiving reimbursement settlements for the start-up period will be expected to provide cost report data covering any part of the start-up period not included in the Medicare cost report submitted to CMS.

— The default rate paid to per diem providers with insufficient claims volume to calculate an individual rate will be the median of the rates paid to other in-state, non-start-up providers of the same hospital type (i.e., a psychiatric hospital would be paid the median of the rates paid to other in-state psychiatric hospitals)

These changes will be effective November 1, 2024. The changes to Medicaid and BadgerCare Plus are projected to result in no change to annual expenditures.

Copies of Changes

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

Mail:

Attention: DHS State Plan Amendment (SPA) Coordinator

Bureau of Benefits Policy Division of Medicaid Services

P.O. Box 309

Madison, WI 53701-0309

Fax: [phone]

Attention: DHS State Plan Amendment (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.