Public Notices

public_notices Wisconsin Administrative Register No. 630, 6/30/2008

Public Notices

Health and Family Services

Medicaid Reimbursement for Inpatient Hospital Services:

Acute Care Hospitals, Children's Hospitals, Major Border Status Hospitals,

Non State Public and Private Psychiatric Hospitals

State of Wisconsin Medicaid Payment Plan for State Fiscal Year 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 the current Medicaid Inpatient Hospital State Plan, effective July 1, 2007, the rate-setting methodology for Acute Care, Major Border Status and Children's Hospitals is a provider specific, cost based DRG payment system adjusted by case mix. Additional payments are made to eligible disproportionate share and rural hospitals and outlier payments are made for high-cost cases. Payments are adjusted as necessary to ensure budget compliance. Non State Public and Private Psychiatric and Rehabilitation Hospitals are paid on a provider specific, cost based per diem rate adjusted as necessary to ensure budget compliance.

The Department is proposing to implement a rate setting methodology change for inpatient hospital services for Acute Care Hospitals, Children's Hospitals, Non State Public and Private Psychiatric Hospitals, and Major Border Status Hospitals. The proposed change reverts the payment methodology back to the methodology in place during State Fiscal Year 2006-2007. Under this methodology, each hospital will be 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, Rural Hospitals and facilities with Graduate Medical Education programs. In addition, a cost outlier payment will be made when the cost of providing services exceeds a pre-determined trimpoint. Payment rates will be adjusted as necessary to ensure budget compliance, using a statewide base rate as the starting point of the rate setting process. The Department intends to modify the inpatient rate setting methodology to implement these Medicaid rate changes with an effective date of July 1, 2008.

The Department also proposes to clarify the source of funding, definition of eligible cost, payment methodology, and timing of payments associated with the General Assistance Disproportionate Share Hospital (GA-DSH) Allowance described in section 8300 of the current State Plan. Changes to the GA-DSH program would have an effective date of July 1, 2008.

Proposed Change

The State Budget approved by the Wisconsin Legislature does not provide an increase in rates for inpatient services provided by hospitals. Proposed changes to the General Assistance Disproportionate Share Hospital program do not increase expenditures beyond the current state fiscal year 2008-2009 GA-DSH allotment. It is estimated that these changes will have no impact on annual aggregate Medicaid expenditures in state fiscal year 2008-09.

The Department's proposals 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, 2008.

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

Curtis Cunningham, Section Chief

Hospital Rate Setting

[phone]

Fax

[phone]

Attention Curtis Cunningham

Email

[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, email, or regular mail to the Division of Health Care Financing. The FAX number is [phone]. The email 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.