Public notice
Health and Family Services
(Medicaid Reimbursement of Rural Health Clinics)
The state of Wisconsin reimburses rural health clinics (RHCs) and federally qualified health clinics (FQHCs) for services provided to low-income persons under the authority of Title XIX of the Federal Social Security Act and sections 49.43 to 49.47 of the Wisconsin Statutes. The Wisconsin Department of Health and Family Services administers this program, which is called Medical Assistance or Medicaid. Federal statutes and regulations require a state plan that provides the methods and standards for paying for Medicaid services.
A state plan is in effect that provides for the reimbursement of RHCs and FQHCs. The Department is proposing to make changes in the provisions contained in the state plan that apply to RHCs and FQHCs. The changes will affect annual cost-of-service and reimbursement rate calculations for the previous calendar year, and thus will be effective retroactive to January 1, 2001.
Proposed Change
A recent change in federal law established a new prospective payment system for FQHCs and RHCs. This change was enacted into law under section 702 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000. BIPA amends section 1902(a) of the Social Security Act by repealing the reasonable cost-based reimbursement requirements for FQHC/RHC services previously at paragraph (13)(C) and instead requiring in paragraph (15) payment for FQHCs/RHCs consistent with a new prospective payment system (PPS) described in section 1902(aa) of the Act. Under BIPA, the new Medicaid PPS takes effect on January 1, 2001. However, the law also provides for the establishment of an alternative payment methodology to the PPS system.
The intent of the change in federal law is to ensure reimbursement of FQHCs and RHCs for 100% of their reasonable costs. The above-referenced change in federal law requires the state to analyze cost data for prior fiscal years to calculate rates according to the prospective payment system. The state must reimburse an FQHC or RHC at an amount that is at least equal to that calculated under the prospective payment system. The State will modify its state plan language as necessary to comply with these provisions.
Copies of Proposed Changes and Proposed Payment Rates
When available, a copy of the proposed state plan changes may be obtained free of charge by calling or writing as follows:
Regular Mail:
Division of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309
Attention: State Plan Coordinator
Fax:
(608) 266-1096
Attention: State Plan Coordinator
Telephone:
Mike Bormett
Deputy Bureau Director
Bureau of Fee-for-Service Health Care Benefits
(608) 261-7838
E-Mail:
A copy of the proposed 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 on the proposed changes are welcome and should be sent to the above address. The comments received on the changes will be available for public review between the hours of 7:45 and 4:30 p.m. at:
Division of Health Care Financing
Room 350, State Office Building
One West Wilson Street
Madison, WI
