Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 108 - General Administration › Section DHS 108.02 - Department rights and responsibilities

Current through June 24, 2024
(1) DIFFERENT
				BENEFITS FOR DIFFERENT GROUPS. The department may offer MA benefits to the
				categorically needy which are different from the benefits offered to the
				medically needy, subject to ss.
				49.46 (2) (a)
				and 49.47 (6) (a),
				Stats. For the categorically needy, benefits shall meet federal minimum
				standards of coverage under 42 CFR 435.100-135. The department
				need not provide the same benefits that the categorically needy receive to
				individuals who are determined to be medically needy. The department is not
				required to provide the same amount, duration and scope of services to all the
				different groups who make up the medically needy population.
(2) REIMBURSEMENT METHODS AND PAYMENT LEVELS.
				The department may establish the reimbursement methods and payment levels for
				program services subject to the requirements of federal and state statutes,
				regulations and chs.
				DHS
				101 to
				107 and this chapter. Notice of
				specific changes or updates to payment levels shall be communicated to the
				service providers by the department through periodic publication of provider
				handbooks.
(3) ADVISORY COMMITTEES.
				The department may appoint and make use of professional advisory committees on
				an ad hoc basis to provide expertise for development of service or
				reimbursement policies.
(4)
				PROVIDER HANDBOOKS AND BULLETINS. The department shall publish provider
				handbooks, bulletins and periodic updates to inform providers of changes in
				state or federal law, policy, reimbursement rates and formulas, departmental
				interpretation, and procedural directives such as billing and prior
				authorization procedures, specific reimbursement changes and items of general
				information. The department shall inform providers in a handbook, bulletin or
				other publication of specific services requiring collection of benefits from
				medicare or other health care plans under s.
				DHS 106.03
				(7) before benefits are claimed from the MA
				program. Information regarding eligibility for medicare or for another health
				care plan as identified on the recipient's MA identification card shall also be
				included in these publications.
(5)
				NOTIFICATION OF RECIPIENTS. The department shall publish periodic notification
				to eligible recipients, as necessary, to provide general information regarding
				MA program benefits and procedural requirements, and to notify recipients of
				any benefit or eligibility changes.
(6) NOTICE OF CHANGE IN METHOD OR LEVEL OF
				REIMBURSEMENT.
(a) Except as provided in par.
				(b), the department shall publish a public notice in the Wisconsin
				administrative register of any significant proposed change in the statewide
				method or level of reimbursement for a service, in compliance with
				42 CFR
				447.205. This notice shall include
				information on the procedure for obtaining details of the proposed change, why
				the change is proposed and how to provide public comment to the
				department.
(b) Changes for which
				no public notice is required include the following:
1. Changes to conform with medicare methods
				and federally-invoked upper limits on reimbursement;
2. Changes required of the department by
				court order; and
3. Changes in
				wholesalers' or manufacturers' prices of drugs or materials, if the
				department's method of reimbursement is based on direct or wholesale prices as
				reported in a national standard such as the American druggist blue book, plus a
				pharmacy dispensing fee.
(c) Notice in the Wisconsin administrative
				register shall constitute official notice by the department to its contracted
				health service providers of a contractual change.