Public Notice: (DHS) Outpatient Hospital Services

Public Notice

Health Services

Medicaid Reimbursement for Outpatient Hospital Services:

Acute Care, Children’s, Critical Access, Psychiatric , and Rehabilitation Hospitals

State of Wisconsin Medicaid Payment Plan for Rate Year 201 6

The State of Wisconsin reimburses hospitals for out patient 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 (the Department), is called Medical Assistance 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 Chapter 49 of the Wisconsin Statutes. Collectively, these programs are herein referred to as the Wisconsin Medicaid Program (WMP). Federal statutes and regulations require that a State Plan be developed that provides the methods and standards for reimbursement of covered services. Such a plan is currently in effect.

T he WMP uses a reimbursement system for outpatient hospital services which is based on Enhanced Ambulatory Patient Groupings (EAPGs) . The EAPG system is a discrete, cost-specific reimbursement methodology that allow s the Department to reimbur se providers based on case mix. The rate-setting methodology employs a provider - specific, EAPG base rate, which i ncludes a payment enhancement for facilities with g raduate m edical e ducation programs. The EAPG base rate for critical access hospitals is based on each hospital’s specific, prospective costs. Effective January 1, 2016 , the Department is updating the outpatient hospital rates for rate year 2016 (January 1, 2016 – December 31, 2016 ).

The following change s will be contained in the January 1, 201 6 outpatient hospital state plan amendment:

• O utpatient hospital rates will be updated for r ate y ear 201 6 .

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 state fiscal year 201 6 . The Department 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 propo sed changes will be January 1, 201 6 .

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

Christian Moran, Hospital Policy and Rate Setting Section Chief

Bureau of Fiscal Management

[phone] (phone)

[phone] (fax)

[e-mail]

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 per the above information. All writte n comments received will be reviewed, considered , and made 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 to the proposed change based on comments received.