Public Notices
Department of Health Services
Medical Assistance Reimbursement of Registered Nurses
The State of Wisconsin reimburses registered nurses for medically necessary services provided to low-income persons through the State's Medical Assistance and BadgerCare Plus programs. The State's Medical Assistance and BadgerCare Plus programs are administered by the Wisconsin Department of Health Services (the Department) and operate under the authority of Title XIX and Title XXI of the Federal Social Security Act and chapters 49.43 to 49.47 of Wisconsin Statutes. Together the Medical Assistance and BadgerCare Plus programs are referred to as ForwardHealth.
The Department is making a change in reimbursement for registered nurses in independent practice. Effective for dates of service on and after December 1, 2009, Forward Health will discontinue separate reimbursement to registered nurses in independent practice for care coordination of private duty nursing services to members dependent on a ventilator for life support. This change makes the reimbursement to registered nurses in independent practice consistent with the reimbursement to home health agencies for the same services.
ForwardHealth will not reimburse Current Procedural Technology procedure code 99504 [Home visit for mechanical ventilator care (per hour)] with the “U1" modifier (RN case coordinator) for dates of service on or after December 1, 2009, regardless of prior authorization (PA).
The requirement for care coordination when more than one nurse is necessary to staff the member's case remains unchanged.
Private duty nursing services are covered under the Wisconsin Medical Assistance and BadgerCare Plus Standard Plan. Private duty nursing services are not covered under the BadgerCare Plus Benchmark Plan or the BadgerCare Plus Core Plan for Adults with no Dependent Children.
This notice applies to services members receive on a fee-for-service basis only. Managed care policy is established by individual managed care organizations. Managed care organizations are required to provide at least the same benefits as those provided under fee-for-services arrangements.
The reimbursement change described in this public notice is projected to result in a savings of $300,000 all funds, composed of $120,000 general purpose revenue (GPR) and $180,000 federal match (FED) in the current (2010) state fiscal year (July 1, 2009 though June 30, 2010) as well as state fiscal year 2011 (July 1, 2010 though June 30, 2011).
Written Comments
For more information or to submit written comments on the proposed change, interested persons may fax or write to:
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 53701-0309
Fax: (608) 266-1096
Copies of the proposed change and comments received on the change will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. at:
Division of Health Care Access and Accountability
Room 350, State Office Building
One West Wilson Street
Madison, WI
Copies of the conforming state plan change will also be made available for review at the main office of any county department of social services or human services.
