Madison, WI 53701-0309
State Contact
Krista Willing, Section Chief
Hospital Rate Setting
(608) 266-2469 (phone)
(608) 266-1096 (fax)
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 to the Division of Health Care Access and Accountability. The FAX number is (608) 266-1096. The email address is
KristaE.Willing@wisconsin.gov. Regular mail can be sent to the above address. All written comments will be reviewed and considered.
All written comments received 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.
Department of Health Services
State of Wisconsin Medicaid Payment Plan: FY 2010-2011
Medicaid Reimbursement for Outpatient Hospital Services:
Acute Care Hospitals, Children's Hospitals, Major Border Status Hospitals,
Non State Public and Private Psychiatric Hospitals
The State of Wisconsin reimburses hospitals for outpatient hospital services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and Chapter
49 of Wisconsin Statutes. This program, administered by the State's Department of Health Services (DHS), is called Medicaid or Medical Assistance.
Under the current Medicaid Outpatient Hospital State Plan, effective July 1, 2009, the rate-setting methodology for Acute Care, Major Border Status and Children's Hospitals is a provider specific, cost-based rate per visit. Out of state and new hospitals without cost reports are paid at a statewide average percent of charges.
The following changes will be contained in the July 1, 2010 outpatient hospital state plan amendment:
• Restore full cost-based Critical Access Hospital Reimbursement.
• Hospital access payments will be updated and made in addition to rates per visit.
• Rate appeal provisions will be updated.
• Critical Access Hospital Settlements will be eliminated.
Proposed Change
It is estimated that these changes will have no impact on projected annual aggregate Medicaid expenditures in state fiscal year 2010-11.
The Department's proposals 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 proposed changes will be July 1, 2010.
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
Krista Willing, Section Chief
Hospital Rate Setting
(608) 266-2469 (phone)
(608) 266-1096 (fax)
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 to the Division of Health Care Access and Accountability. The FAX number is (608) 266-1096. The email address is
KristaE.Willing@wisconsin.gov. Regular mail can be sent to the above address. All written comments will be reviewed and considered.
All written comments received 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.
