Public Notice: Revised Reimbursement of Additional Vaccines

ABP Public Notice 10/31/24:

(This public notice is being re-posted as required due to withdrawal of 23-0022)

The prior notice did not include the state’s method for assuring compliance with 42 CFR 440.345 related to full access to EPSDT services and the method for complying with the provisions of section 5006(e) of the American Recovery and Reinvestment Act of 2009 as a specific reference to the ABP (the notice submitted with the ABP only mentions the state plan).

PUBLIC NOTICE

Department of Health Services

Reimbursement of Additional Vaccines

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

Effective October 1, 2023, to come into compliance with the federal Inflation Reduction Act, the Department covers vaccines according to section 1905(a)(13)(B) of the Social Security Act (SSA).

The change will be effective October 1, 2023 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 $0 all funds (AF), composed of $0 federal match (FED) and $0 state funds/general purpose revenue (GPR).

An amendment will be made to update the ABP to reflect the following changes that have already been made to the Medicaid State Plan:

• covers vaccines according to section 1905(a)(13)(B) of the Social Security Act (SSA).

Copies of Changes

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

Mail:

Attention: Allie Merfeld

Administrators’ Office; Division of Medicaid Services

P.O. Box 309

Madison, WI 53701-0309

Fax: [phone]

Attention: DHS SPA Coordinator

E-Mail: [e-mail]

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.