Public Notice: Notice re. Wisconsin Medicaid Eligibility for Single Case Agreements

PUBLIC NOTICE PUBLIC NOTICE

Department of Health Services

Wisconsin Medicaid Eligibility for Single Case Agreements

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 M 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).

• • Negotiated Payments for Unusual Cases:

• o DHS will modify §7400 Negotiated Payments for Unusual Cases to remove reference to applicability for in-state hospitals, which are not eligible under state policy.

• o DHS will modify §7400 Negotiated Payments for Unusual Cases to require requests for negotiated payments be submitted prior to admission or during the stay. Submissions after the stay will be accepted only at the discretion of the state.

These changes will be effective July 1, 2025. The changes to Medicaid and BadgerCare Plus are in total projected to result in no increase in annual expenditures.

Copies of Changes 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

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.