Public Notices
Department of Health Services
State of Wisconsin Medicaid Payment Plan: FY 2010-2011
Medical Assistance Reimbursement for Inpatient Hospital Services:
Acute Care Hospitals, Children's Hospitals, Major Border Status Hospitals,
Non State Public and Private Psychiatric Hospitals
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 Services, is called Medicaid or Medical Assistance.
Under the current Medicaid Inpatient Hospital State Plan, effective July 1, 2009, the rate-setting methodology for Acute Care, Major Border Status and Children's Hospitals is a provider specific, DRG payment system adjusted by case mix that assigns each hospital 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. Payments are adjusted as necessary to ensure budget compliance using a statewide base rate as the starting point of the rate setting process. 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 rate setting methodology changes 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 changes generally revert to the payment methodology in place during State Fiscal Year 2010. The Department intends to modify the inpatient rate setting methodology to implement these Medicaid rate changes with an effective date of July 1, 2010.
The following will be new for 2010-2011 and not reflected in the 2009-2010 rate methods:
• Restore full cost-based Critical Access Hospital Reimbursement.
• Hospital access payments will be updated and made in addition to base DRG payments.
• Critical Access Hospital access payments will be made in addition to base DRG payments.
• Hospital pay for performance criteria will be updated.
• Rate appeal provisions will be updated.
• Critical Access Hospital Settlements will be eliminated.
• The Rehab Hospital rate methodology will be aligned with the Psych Hospital methodology.
• The Disproportionate Share Payment methodology will be altered.
• The Rural Hospital Payment Adjustment will be revised.
• The Wage Index Policy will be updated.
This notification is intended to provide notice of the type of changes that are included in the amendment. Interested parties should obtain a copy of the actual proposed plan amendment to comprehensively review the scope of all changes.
Proposed Change
It is estimated that these changes will have no impact on projected annual aggregate Medicaid expenditures in state fiscal year 2010-11.
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, 2010.
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 Access and Accountability
P.O. Box 309
Madison, WI 53701-0309
State Contact
Krista Willing, Section Chief
Hospital Rate Setting
(608) 266-2469 (phone)
(608) 266-1096 (fax)
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 Access and Accountability. The FAX number is (608) 266-1096. The email address is
KristaE.Willing@wisconsin.gov. 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.
Department of Health Services
State of Wisconsin Medicaid Payment Plan: FY 2010-2011
Medicaid Reimbursement for Outpatient Hospital Services:
Acute Care Hospitals, Children's Hospitals, Major Border Status Hospitals,
Non State Public and Private Psychiatric Hospitals
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 Services (DHS), is called Medicaid or Medical Assistance.
Under the current Medicaid Outpatient Hospital State Plan, effective July 1, 2009, the rate-setting methodology for Acute Care, Major Border Status and Children's Hospitals is a provider specific, cost-based rate per visit. Out of state and new hospitals without cost reports are paid at a statewide average percent of charges.
The following changes will be contained in the July 1, 2010 outpatient hospital state plan amendment:
• Restore full cost-based Critical Access Hospital Reimbursement.
• Hospital access payments will be updated and made in addition to rates per visit.
• Rate appeal provisions will be updated.
• Critical Access Hospital Settlements will be eliminated.
Proposed Change
It is estimated that these changes will have no impact on projected annual aggregate Medicaid expenditures in state fiscal year 2010-11.
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, 2010.
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 Access and Accountability
P.O. Box 309
Madison, WI 53701-0309
