Public Notice: Notice re. Medicaid Reimbursement of Covered Services

PUBLIC NOTICE

Department of Health Services

Updating the physician administered drug reimbursement methodology language by the Medical Assistance Program

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 in effect.

Proposed Change

Effective April 1, 2023, the Department is proposing to update the language which describes the physician administered drug reimbursement methodology. The Department is revising the reimbursement methodology language for physician- administered drugs to better align with recent changes to the Medicare Fee Schedule, which may now contain rates for some drugs no longer fitting the description of “Average Sale Price (ASP) Drug Price plus 6%”.

The change will be effective April 1, 2023. The change to Medicaid, BadgerCare, and BadgerCare Plus is projected to result in increased annual expenditures of $0 all funds (AF), composed of $0 federal match (FED) and $0 state funds/general purpose revenue (GPR).

Copies of Changes

Copies of the reimbursement methodology Medicaid state plan amendment may be obtained free of charge by calling or writing:

Mail: Bailey Dvorak

Bureau of Benefits Policy Division of Medicaid Services

P.O. Box 309

Madison, WI 53701-0309

Phone: [phone]

Fax: [phone]

Attention: Bailey Dvorak

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 as described above. All written comments will be reviewed and considered.

Because the State Office Building at 1 West Wilson Street, Madison, Wisconsin is currently closed to the public, written comments will not be available for in person public review. Requests to review written comments received may be submitted to the Division of Medicaid Services as described above. Revisions may be made in the proposed change based on comments received.