Public Notices
Health Services
Medicaid Reimbursement for Outpatient Hospital Services:
Measurement Year 2015 Pay-for-Performance Program Updates
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 the Wisconsin Statutes. This program, administered by the State's Department of Health Services (DHS), is called Medicaid or Medical Assistance.
To promote quality outcomes for its members, Wisconsin Medicaid currently operates a pay-for-performance (P4P) program covering outpatient hospital services: the Withhold P4P program, funded by a 1.5% withhold from fee-for-service (FFS) outpatient hospital claims. The program uses hospital-specific results on enumerated quality metrics to reward top-performing hospitals with a distribution of the funds withheld under the program each year. The program operates on an April 1 – March 31 measurement year (MY), with payout by the December 31 following the conclusion of an MY.
Effective April 1, 2014, DHS will be updating this P4P program for MY 2015 (April 1, 2014 – March 31, 2015 with payout by December 31, 2015). The following changes will be contained in the April 1, 2014 outpatient hospital state plan amendment:
•
Effective April 1, 2014, the list of quality measures for the Withhold P4P program will be updated to reflect data availability and program improvement for MY 2015.
•
Effective April 1, 2014, the methodology for distributing the bonus pool resulting from the Withhold P4P program will be updated and streamlined for MY 2015.
•
Effective April 1, 2014, an updated P4P Guide will be published detailing all of the above changes to the Wisconsin Medicaid Hospital P4P programs for MY 2015.
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 material impact on projected annual aggregate Medicaid expenditures in SFY 2014 (July 1, 2013 – June 30, 2014) or SFY 2015 (July 1, 2014 – June 30, 2015). DHS maintains the same hospital budget approved by the Legislature.
The Department's 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 April 1, 2014.
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
David Hoffert, Hospital Rate Setting Section Chief
Bureau of Fiscal Management
(608) 261-8397 (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
David.Hoffert@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.
Health Services
Medicaid Reimbursement for Inpatient Hospital Services:
Measurement Year 2015 Pay-for-Performance Program Updates
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 the Wisconsin Statutes. This program, administered by the State's Department of Health Services (DHS), is called Medicaid or Medical Assistance.
To promote quality outcomes for its members, Wisconsin Medicaid currently operates two distinct pay-for-performance (P4P) programs covering inpatient hospital services: the Assessment P4P program, funded by a $5 million (All Funds) allocation from Wisconsin Medicaid's Hospital Assessment program, and the Withhold P4P program, funded by a 1.5% withhold from fee-for-service (FFS) inpatient hospital claims. The two programs use different quality metrics and distribution methodologies to pay out their funds each year. Both programs operate on an April 1 – March 31 measurement year (MY), with payout by the December 31 following the conclusion of an MY, though the $5 million for the Assessment P4P program is budgeted on a state fiscal year (SFY) basis.
Effective April 1, 2014, DHS will be updating both P4P programs for MY 2015 (April 1, 2014 – March 31, 2015 with payout by December 31, 2015). The following changes will be contained in the April 1, 2014 inpatient hospital state plan amendment:
• Effective April 1, 2014, the list of quality measures for both P4P programs will be updated to reflect data availability and program improvement for MY 2015.
•
Effective April 1, 2014, the methodology for distributing the bonus pool resulting from the Withhold P4P program will be updated and streamlined for MY 2015.
•
Effective April 1, 2014, an updated P4P Guide will be published detailing all of the above changes to the Wisconsin Medicaid Hospital P4P programs for MY 2015.
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 material impact on projected annual aggregate Medicaid expenditures in SFY 2014 (July 1, 2013 – June 30, 2014) or SFY 2015 (July 1, 2014 – June 30, 2015). DHS maintains the same hospital budget approved by the Legislature.
The Department's 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 April 1, 2014.
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
David Hoffert, Hospital Rate Setting Section Chief
Bureau of Fiscal Management
(608) 261-8397 (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
David.Hoffert@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.
