Public Notices

public_notices Wisconsin Administrative Register No. 670, 10/31/2011

Public Notices

Health and Family Services

(Medical Assistance Reimbursement for Services Provided Under the Benchmark Plan)

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 Services, is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare and BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and ss. 49.471, 49.665, and 49.67 of the Wisconsin Statutes. 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.

Section 1937 of the Social Security Act provided authority for States to provide for medical assistance to one or more groups of Medicaid-eligible individuals, specified by the State in an approved state plan amendment, through enrollment in coverage that provides benchmark or benchmark-equivalent health care benefit coverage. Wisconsin did so, effective February 1, 2008. The current groups who receive benefits under Wisconsin's benchmark plan are pregnant women and infants with incomes between 200 and 300% of the Federal income poverty line, as well as newborns who are born to women with family incomes between 200 and 300% of the Federal income poverty line.

A recent change to federal law required States to provide emergency and non-emergency transportation services to those receiving coverage under a benchmark plan. In addition, EPSDT services are to be provided to individuals under 21 years of age. EPSDT stands for Early & Periodic Screening & Diagnostic Treatment Benefit, and it is described in section 1905(r) of the Social Security Act. The services available under EPSDT are described at the following link: http://www.cms.gov/MedicaidEarlyPeriodicScrn/02_Benefits.asp.

Wisconsin initially submitted its state plan amendment to assure the provision of these benefits to the federal Centers for Medicare and Medicaid Services (CMS) seeking an effective date of April 1, 2010. Based on the publication date of this notice, that effective date will instead be November 1, 2011. In addition to this public notice, Wisconsin's tribes were consulted at a meeting of the Tribal Health Directors on June 9, 2010.

Proposed Change

The proposed change is to assure the provision of emergency and non-emergency transportation services, as well as EPSDT services, to individuals receiving Wisconsin Medicaid services under the benchmark plan previously approved by the federal Centers for Medicare and Medicaid Services.

The projected fiscal effect of these changes is a savings of $31,000 general purpose revenue (GPR) and $46,000 federal match (FED) for a total of $77,000 all funds (AF) for the current state fiscal year.

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
James Vavra
Bureau of Benefits Management
Division of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309

Phone
James Vavra
[phone]

FAX
[phone]
Attention: James Vavra

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.