Public Notice: Medicaid Reimbursement for Nursing Facilities

PUBLIC NOTICE

Department of Health Services

(Medicaid Reimbursement for Nursing Facilities)

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. 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 medically necessary nursing facility services. The Department is proposing changes to the method of payment to nursing facilities, and therefore, the plan describing the nursing facility reimbursement system.

The change will be effective January 1, 2019, and will apply to claims with dates of service on or after that date. The change to Medicaid is projected to result in increased annual expenditures of $2,430,095 all funds (AF), composed of $1,442,747 federal match (FED) and $987,348 state funds/general purpose revenue (GPR), effective January 1, 2019.

The proposed changes are being implemented to comply with recent Federal legislation governing Medicaid payment systems, particularly section 503 of the Consolidated Appropriations Act of 2016 and section 5002 of the 21st Century Cures Act of 2016, which added section 1903(i)(27) to the Social Security Act. This notice represents information known as of December 10, 2018. The changes may be modified by later legislative mandates.

The proposed changes are as follows:

1. Include reimbursement for oxygen and certain respiratory supplies as part of the nursing facility daily rate, through an increase of either the direct care – other supplies and services target or the support services target in the payment methodology.

2. Cease separate reimbursement for oxygen and certain respiratory supplies – these supplies will now only be paid as part of the nursing facility daily rate.

Copies of Changes

Copies of the proposed Methods of Implementation for Nursing Home Payment Rates may be obtained free of charge by calling or writing as follows:

Regular Mail:

Karl Hauth

Bureau of Benefits Management

Division of Medicaid Services

P.O. Box 309

Madison, WI 53701-0309

Fax:

[phone]

Attention: Karl Hauth

Telephone:

Karl Hauth

[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 Medicaid Services. 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.