Public Notice: Medicaid Reimbursement

PUBLIC NOTICE

Department of Health Services

(Medicaid Reimbursement for Hospice Services)

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

Change in Payment Methods

Among the services provided to recipients of services under Medical Assistance, BadgerCare , and BadgerCare Plus are hospice services.

The hospice benefit is an optional state plan service that includes an array of services furnished to terminally ill individuals. These services include: nursing, medical social services, physician services, counseling services to the terminally ill individual and the family members or others caring for the individual at home, short-term inpatient care, medical appliances and supplies, home health aide and homemaker services, physical therapy, occupational therapy and speech-language pathology services.

Effective October 1, 2016, hospice services shall be reimbursed at the rates published by the federal Centers for Medicare and Medicaid Services (CMS) at the following link:

https://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/downloads/medicaid-hospice-rates-ffy-2016.pdf

These rates will be updated by CMS and adopted by the Department on an annual basis. The national hospice reimbursement rates provide rates for each of the following four levels of hospice care, and a service intensity add-on payment:

1) routine home care where most hospice care is provided.

2) continuous home care which is furnished during a period of crisis and primarily consists of nursing care.

3) inpatient respite care which is short-term care and intended to relieve family members or others caring for the individual.

4) general inpatient care which is short term and intended for pain control or acute or chronic symptom management which cannot be provided in other settings.

As noted above, the change will be effective October 1, 2016. The change will apply to claims with dates of service on or after that date. The change to Medicaid and BadgerCare Plus is projected to result in no change in expenditures.

The implementation date is the first day of the first quarter of federal fiscal year 2017 and is the first day of the second quarter of state fiscal year 2017.

Copies of Changes

Copies of the amendment to the Medicaid state plan 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

P.O. Box 309

Madison, WI 53701-0309

Fax :

[phone]

Attention: Al Matano

Telephone :

Al Matano

Bureau of Fiscal Management

[phone]

E-Mail :

[e-mail]

Copies of the state plan change will be made 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 Division of Health Care Access and Accountability. 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.