Public Notices

public_notices Wisconsin Administrative Register No. 582, 6/14/2004

Public notices

Health and Family Services

(Medical Assistance Reimbursement for Services Provided by Free-Standing End Stage Renal Disease 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 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.

The Wisconsin Department of Health and Family Services is proposing to modify the reimbursement methodology for services provided by free-standing end stage renal disease (ESRD) providers. The Department's proposal involves no change in services.

2003 Act 33, the 2003-2005 biennial budget, directed the Department to change the Medicaid reimbursement structure for free-standing ESRD clinics. The Department will establish a free-standing ESRD provider-specific composite rate per dialysis visit that includes all covered ESRD services provided to Wisconsin Medicaid recipients eligible on the date of service. The provider-specific composite rate shall be based primarily on Medicare reimbursement. Free-standing ESRD provider-specific composite rates may be adjusted to reflect changes in pharmaceutical costs and state budgetary constraints, among other things.

Composite reimbursement rates will cover the dialysis and all dialysis-related services, including but not limited to, pharmaceutical drugs and supplies. Providers will not receive separate reimbursement for these items. The composite reimbursement will be paid each time dialysis is provided. For each covered dialysis service, the Department shall pay the free-standing ESRD provider-specific composite rate established by the Department.

Proposed Change

The proposed change is to adopt a free-standing ESRD provider-specific composite rate per dialysis visit that includes all covered end stage renal disease services that are or could be provided to a Wisconsin Medicaid recipient on the date of service. The change will apply to dialysis services provided on dates of service on or after July 1, 2004.

The projected fiscal effect of these changes is a savings of $4.79 million GPR and $6.71 FED for a total of $11.5 million AF in state fiscal year 2005.

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

[phone]

FAX

[phone]
Attention: Marge Hannon Pifer

E-Mail

[e-mail]

A copy of the proposed change are 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 Department. The FAX number is [phone]. The e-mail address is [e-mail]. 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. Revisions may be made in the proposed changed methodology based on comments received.