Public notices
Health and Family Services
(Medical Assistance Reimbursement for In-Home Autism Services)
The State of Wisconsin reimburses providers of covered 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 and Family Services, is called Medical Assistance (MA) or Medicaid. 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 now in effect. Under current state plan language, non-institutional MA providers are paid the lesser of: (a) their usual and customary charges; or (b) maximum fees established by the Department for each procedure. The Department from time to time modifies the maximum fee schedules to implement MA rate changes authorized by the Legislature.
The Department is proposing to reduce maximum fees for providers of intensive in-home autism services effective July 1, 2003 or after, consistent with the Governor's transition proposal for these services that was adopted by the Joint Committee on Finance in the SFY '03-'05 biennial budget deliberations. For the 4-month period from July 1 through October 31, 2003, the estimated decrease in expenditures from this rate change for autism service providers is $4,698,500 all funds, ($1,953,600 GPR and $2,744,900 FED).
Proposed Change
The proposed change is to decrease reimbursement rates to providers of intensive in-home autism services.
Copies of the Proposed Change
A copy of the proposed change may be obtained free of charge by calling or writing as follows:
Regular Mail
Marge Hannon Pifer
Bureau of Fee-for-Service Health Care Benefits
Division of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309
Phone
Marge Hannon Pifer
(608) 266-1940
FAX
(608) 266-1096
Attention: Marge Hannon Pifer
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 Health Care Financing. The FAX number is (608) 266-1096. The e-mail address is
pifermh@dhfs.state.wi.us. Regular mail can be sent to the above address. 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.
Health and Family Services
(Medical Assistance Reimbursement of Hospitals)
The State of Wisconsin reimburses hospitals for medical services provided to low-income persons under the authority of Title XIX of the Federal Social Security Act and sections 49.43 to 49.47, Wisconsin Statutes. The Wisconsin Department of Health and Family Services administers this program that is called Medicaid or Medical Assistance (MA). Federal statutes and regulations require state plans, one for outpatient services and one for inpatient services, that provide the methods and standards for paying for hospital outpatient and inpatient services.
State plans are now in effect for the reimbursement of outpatient hospital services and inpatient hospital services. The Department is proposing to make changes to the provisions contained in the inpatient plan effective July 1, 2003 to implement provisions of 2003 Senate Bill 44, the 2003-2005 state budget bill, and maintain compliance with federal payment limits, and for administrative efficiencies.
Outpatient Hospital Services
No proposed changes in the state plan for reimbursement of outpatient hospital services.
Inpatient Hospital Services
Proposed changes in the state plan for reimbursement for inpatient services may include:
1. For the payment system based on diagnosis-related groups (DRGs):
a. Elimination of the adjustment to payment rates for the estimated indirect cost hospitals may incur for the operation of a medical education program, also known as the indirect medical education adjustment.
b. Modification of the methodology of calculating the cost of a hospital stay that is used in constructing DRG weighting factors for administrative simplification.
c. Replacing separate DRG weight schedules for each of the following three groups of hospitals with one combined schedule of DRG weights for psychiatric stays in (1) institutions for mental disease (IMDs), but not including the Milwaukee County Mental Health Center, (2) general hospitals with a Medicare exempt psychiatric unit, and (3) general hospitals not having an exempt psychiatric unit for administrative simplification.
d. Continuation of unique DRG weights for psychiatric stays at Milwaukee County Mental Health Center.
2. Construction of a common DRG weighting factor for groups of DRGs in which the individual DRGs have low Medicaid utilization and have similar average cost in order to reduce large annual fluctuations in weights and to provide more predictable payment for low volume DRGs.
3. Modification of the disproportionate share adjustment parameters to recognize a more current proportion of services provided by hospitals to Medicaid recipients.
4. For the general assistance disproportionate share supplement, modification of the criteria for a hospital to qualify for the supplement and modification of the methodology for distributing the available funds to qualifying hospitals in order to maintain compliance with federal payment limits and to implement provisions of the 2003-2005 state budget act.
Implementation of the above changes to the State Plan for inpatient services is expected to reduce the annual expenditures of the Wisconsin Medical Assistance Program by $19,104,000 ($7,900,000 GPR and $11,204,000 FED) for state fiscal year 2003-2004.
Copies of Proposed Changes and Proposed Payment Rates
Copies of the proposed changes will be sent to every county social services or human service department main office where they will be available for public review. For more information, interested persons may fax or write to:
Hospitals, Physicians and Clinics Section
Division of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309
Fax: (608) 266-1096
Written Comments
Written comments on the proposed changes are welcome and should be sent to the above address. The comments received on the changes will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. at:
Division of Health Care Financing
Room 350, State Office Building
One West Wilson Street
Madison, WI
