Health and Family 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 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.
The Wisconsin Department of Health Services is proposing to amend the Medicaid state plan to insert language to assist the reader in locating rate tables for Medicaid services.
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 s. 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, the 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 January 1, 2012.
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
Curtis Cunningham
Bureau of Fiscal Management
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 53701−0309
Phone
Curtis Cunningham
(608) 261−6858
FAX
(608) 266−1096
Attention: Curtis Cunningham
E−Mail
curtis.cunningham@dhs.wisconsin.gov
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 (608) 266−1096. The e−mail address is curtis.cunningham@dhs.wisconsin.gov. 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.
