Public Notices

public_notices Wisconsin Administrative Register No. 618, 6/30/2007

Public Notices

Public Notice

Health and Family Services

(Medicaid Reimbursement for Non-Institutional Providers of Services:
State of Wisconsin Medicaid Payment Plan for FY 2007-2008 and 2008-2009)

The State of Wisconsin reimburses providers for non-institutional services provided to medical assistance recipients under the authority of Title XIX of the Social Security Act and ss. 49.43 to 49.497, Wisconsin Statutes. This program, administered by the State's Department of Health and Family Services, is called Medicaid.

Under current law, non-institutional Medicaid 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 modifies the maximum fee schedules to implement Medicaid rate changes authorized by the Legislature.

The Wisconsin Legislature is in the process of completing work on the 2007 to 2009 State Budget. The new State Budget is expected to increase rates for non-institutional providers.

Pending final legislative action, the Department is proposing an increase in the rates for reimbursement for these non-institutional providers of services under Medicaid. The amount of the increase will be 1% in state fiscal year (SFY) 2007-08 and an additional 2% in 2008-09 (for a total of 3%), compared to current rates, with certain exceptions. Federally Qualified Health Centers and Rural Health Centers will receive no rate increase, since Medicaid currently pays their costs of serving Medicaid recipients. The rate increase will not be applied to common carrier transportation allocations to counties. Effective July 1, 2007, Medicaid fee-for-service pharmacy claims will no longer be reduced by 50 cents per claim, as they have been since July 2005. This change does not apply to SeniorCare. Rates for psychotherapy and evaluation services provided by psychiatrists will be increase by 20%, beginning in SFY 2008. In addition, funding will be provided to increase capitation rates for managed care organizations so that these providers can increase rates to non-institutional providers with which they contract. The Department's proposals involve no change in the definition of those eligible to receive benefits under Medicaid, and the benefits available to eligible recipients remain the same.

It is estimated that this change will increase annual aggregate Medicaid expenditures by $14,130,700 all funds in SFY 2007-08 ($5,814,200 state GPR and $8,316,500 federal) and $44,063,700 all funds in SFY 2008-09 ($17,240,700 state GPR and $26,823,000 federal).

Proposed Change

The proposed change is to modify the rate for reimbursement for these non-institutional providers of services by an increase of 1% beginning July 1, 2007 and an additional 2% beginning July 1, 2008, increase rates for psychotherapy and evaluation services provided by psychiatrists by 20%, beginning July 1, 2007, and increase reimbursement to pharmacies for Medicaid by $0.50 beginning July 1, 2007.

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
Division of Health Care Financing
P.O. Box 309
Madison, 53701-0309
Phone
James Vavra
Director, Bureau of Fee-for-Service Health Care Benefits
[phone]
Fax
[phone]
Attention: James Vavra
E-Mail
vavrajj@@dhfs.state.wi.us

A copy of the proposed change is 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 change may be sent by FAX, e-mail, or regular mail to the Division of Health Care Financing at the address given above. 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.

All written comments received 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.

Public Notice

Health and Family Services

(Medicaid Reimbursement for Inpatient Hospital Services:

Acute Care and Children's Hospitals Major Border Status Hospitals

Non State Public and Private Psychiatric Hospitals State of Wisconsin Medicaid
Payment Plan for FY 2007-2008 and 2008-2009)

The State of Wisconsin reimburses hospitals for inpatient hospital services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and Chapter 49 of Wisconsin Statutes. This program, administered by the State's Department of Health and Family Services, is called Medicaid or Medical Assistance.

Under current law, Wisconsin hospitals are paid on a reimbursement system based on Diagnosis Related Groupings (DRGs). The DRG system covers Acute Care Hospitals, Children's Hospitals, Non State Public and Private Psychiatric Hospitals, and Major Border Status Hospitals. Each hospital is assigned a unique hospital specific DRG base rate. This rate includes adjustments for differences in wage levels, includes an amount for capital expenditures, and payment enhancements for qualifying Disproportionate Share Hospitals and facilities with Graduate Medical Education programs. In addition, a cost outlier payment is made when the cost of providing services exceeds a pre-determined trimpoint. The Department intends to modify the inpatient rate setting methodology to implement Medicaid rate changes authorized by the Legislature.

The Department is proposing to implement a rate setting methodology change for inpatient hospital services for those facilities previously subject to the DRG reimbursement system. This change will impact inpatient hospital services provided by three classes of inpatient hospital providers: 1) Acute Care and Children's Hospitals; 2) Major Border Status Hospitals; and 3) Non State Public and Private Psychiatric Hospitals. The effective date for these proposed changes will be July 1, 2007.

Acute Care and Children's Hospitals

Under the proposed changes, the Department will develop a provider specific, cost based DRG payment system adjusted by case mix with additional payments made to eligible disproportionate share hospitals and outlier payments for high-cost cases. Payment rates will be derived using the most recently available audited Medicare cost reports at the time of rate calculation. The provider specific, cost based DRG rates for providers will be adjusted as necessary to ensure budget compliance.

The Wisconsin Legislature is in the process of completing work on the 2007 to 2009 State Budget. The new State Budget may increase Medicaid inpatient rates for Acute and Children's Hospital providers located within the State of Wisconsin. The amount of the increase is estimated to be $122 million in state fiscal year (SFY) 2007-08 and $131 million in SFY 2008-09. In addition, funding will be provided to increase capitation rates for managed care organizations for the purpose of these health maintenance organizations increasing rates to inpatient hospitals with which they contract.

Major Border Status Hospitals

Under the proposed changes, the Department will develop a provider specific, cost based DRG payment system adjusted by case mix with additional payments made to eligible disproportionate share hospitals and outlier payments for high-cost cases. Payment rates will be derived using the most recently available audited Medicare cost reports at the time of rate calculation. The provider specific cost based DRG rates for providers will be adjusted as necessary to ensure budget compliance.

The Wisconsin Legislature is in the process of completing work on the 2007 to 2009 State Budget. The new State Budget does not provide an increase in rates for inpatient services provided by hospitals located outside the State of Wisconsin that qualify as Major Border Status Hospitals. It is estimated that this change will have no impact on annual aggregate Medicaid expenditures in state fiscal year (SFY) 2007-08 and SFY 2008-09.

Non State Public and Private Psychiatric Hospitals

Under the proposed changes, the Department will implement a rate setting methodology change for inpatient hospital services for Non State Public and Private Psychiatric Hospitals. The Department will develop a provider specific, cost based per diem payment rate. Payment rates will be derived using the most recently available audited Medicare cost reports at the time of rate calculation. Provider specific cost based per diem payment rates will be adjusted as necessary to ensure budget compliance.

The Wisconsin Legislature is in the process of completing work on the 2007 to 2009 State Budget. The new State Budget does not provide an increase in rates for inpatient services provided by Non State Public and Private Psychiatric Hospitals. It is estimated that this change will have no impact on annual aggregate Medicaid expenditures in state fiscal year (SFY) 2007-08 and SFY 2008-09.

Proposed Change

The proposed change is to modify the inpatient rates for Acute and Children's Hospitals under the MA program by an increase of $122 million beginning July 1, 2007 and $131 million beginning July 1, 2008, compared to current rates. The proposed changes to payment rates for Major Border Status Hospitals, Non State Public and Private Psychiatric Hospitals are not expected to impact annual aggregate Medicaid expenditures. The Department intends to update the inpatient hospital rate setting methodology to implement Medicaid rate changes authorized by the Legislature.

This proposal involves no change in the definition of those eligible to receive benefits under Medicaid, and the benefits available to eligible recipients remains the same. The effective date for these proposed changes will be July 1, 2007.

Copies of the Proposed Change

A copy of the proposed change may be obtained free of charge at your local county agency or by calling or writing as follows:

Regular Mail
Division of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309

Phone
James Vavra, Director
Bureau of Fee-for-Service Health Care Benefits
[phone]
Fax
[phone]
Attention James Vavra
E-Mail
[e-mail]

A copy of the proposed change is 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 change may be sent by FAX, e-mail, or regular mail to the Division of Health Care Financing. 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.

All written comments received 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.

Public Notice

Health and Family Services

(Medicaid Reimbursement for Outpatient Hospital Services

Hospitals within the State of Wisconsin

State of Wisconsin Medicaid Payment Plan for FY 2007-2008 and 2008-2009)

The State of Wisconsin reimburses hospitals for outpatient hospital services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and Chapter 49 of Wisconsin Statutes. This program, administered by the State's Department of Health and Family Services, is called Medicaid or Medical Assistance.

Under current law, Wisconsin hospitals outpatient payment rates are hospital-specific, cost-based and annually adjusted to recognize that hospitals vary significantly in the types of medical services they provide. Hospitals located in the State of Wisconsin are reimbursed for outpatient services at an interim rate per visit with a final cost settlement. However, reimbursed costs under the retrospective settlement are limited to a prospectively established ceiling amount. The ceiling amount is a prospective, hospital-specific rate per outpatient visit that is based on a hospital's historical cost and adjusted to stay within the State's available funding for outpatient hospital services. Critical access hospitals are exempt from the ceiling rate. The Department intends to update the outpatient rate setting methodology to implement Medicaid rate changes authorized by the Legislature.

The Department is proposing to update MA outpatient hospital payment rates for hospitals within the State of Wisconsin using the most recently available audited Medicare cost reports at the time of rate calculation. The Department will review and adjust the established hospital ceiling amount to stay within the State's available funding for outpatient hospital services. The provider specific cost based rates and ceiling amount will be adjusted as necessary to ensure budget compliance.