Documentation of Medicaid Payment Rates

PUBLIC NOTICE

Health Services

Documentation of Medicaid Payment Rates

  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 Plus program under the authority of Title XIX and Title XXI of the Social Security Act and ss. 49.471 and 49.665 of the Wisconsin Statutes. The covered services and reimbursement rates are the same for both Medicaid and BadgerCare Plus. 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.

  The Wisconsin Department of Health Services is proposing to amend the Medicaid state plan to insert language to assist the reader in locating the maximum allowable fee schedule for Medicaid services.

The Wisconsin Department of Health Services is proposing to amend the Medicaid state plan to insert language that states that the fee schedule rates are the same for both governmental and private Medicaid providers, except where otherwise noted in the state plan.

  The Medicaid state plan currently includes language describing rate methodologies for non-institutional providers of services to Medicaid recipients. The current language indicates that " In general, the department will pay the lesser of a provider's usual and customary charge or a maximum fee established by the department."

  The proposed amendment creates specific language that provides, in the Medicaid state plan, detail as to how to find the actual rates paid as well as the effective dates of rates for individual services. The amendment meets the requirement of 42 CFR § 447.203 (a), which requires the State Medicaid Agency to maintain documentation of payment rates.

  The proposed language will provide an address ( url ) through which the reader can obtain actual rate schedules on the Department's web site. In addition, as noted in the proposed state plan language, the Department's web site provides the effective dates of current and past reimbursement rates.

Proposed Change

  The proposal will have no change on existing rates or policies. It will merely provide additional information in the Medicaid state plan on how to obtain existing rate schedules and their effective dates. As a result, t he projected fiscal effect of these changes will be zero, as it applies to general purpose revenue (GPR), federal match (FED), and all funds. The effective date of the proposal will be July 1, 2015.

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
Al Matano
Bureau of Fiscal Management
Division of Health Care Access and Accountability
Department of Health Services
P.O. Box 309
Room 318
Madison , WI 53701-0309

Phone
Al Matano
[phone]

FAX
[phone]
Attention: Al Matano

E-Mail
[e-mail]

  A copy of the proposed changes 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 318 of the State Office Building , 1 West Wilson Street , Madison , Wisconsin . Revisions may be made in the proposed changed methodology based on comments received.