Public Notices

public_notices Wisconsin Administrative Register No. 586, 10/14/2004

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 rate for services provided by free-standing end stage renal disease (ESRD) providers. This notice is being published in compliance with 42 CFR § 447.205, which requires the state Medicaid agency to provide public notice of any significant proposed change in its methods and standards for setting payment rates for services. The Department's proposal involves no change in services.

Proposed Change

2003 Act 33, the 2003-2005 biennial budget, directed the Department to change the Medicaid reimbursement rate for free-standing ESRD clinics. The Department will pay free-standing ESRD providers the Medicare reimbursement rate for the services that they provide.

Wisconsin Medicaid will reimburse free-standing ESRD providers the full Medicare payment plus the Medicare coinsurance and deductible, minus any applicable Medicaid copayments. Wisconsin Medicaid will issue interim payments at the estimated Medicare levels for claims with DOS on and after November 1, 2004, until the system is fully operational and able to process claims according to Medicare's guidelines. This is currently estimated to be April 15, 2005. Once claims are processed at Medicare's reimbursement rate, the interim payments will be reconciled against the claim payments.

The proposed change is to adopt the Medicare reimbursement rate for services provided by free-standing ESRD providers. The change will apply to dialysis services provided on dates of service on and after November 1, 2004.

The projected fiscal effect of these changes is a savings of $4.041 million GPR and $5.659 million FED for a total of $9.7 million AF in state fiscal year 2005.

Notice of this change was previously given in the Administrative Register on June 14, 2004, with a proposed effective date of July 1, 2004. Notice is being republished to announce a new effective date and to correct certain information relating to the proposed rate methodology. On September 29, 2004, the Department also submitted to the federal Department of Health and Human Services (HHS) a proposed Medicaid State Plan Amendment reflecting this change. The Amendment is proposed to be effective on November 1, 2004. HHS has 90 days to approve, deny, or request further information about the proposed amendment.

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.