Learn More About the New ED Care Management Program

Program may pay qualifying hospitals up to $1,000 per patient

May 18, 2018

Learn more about the new Intensive Care Coordination Program legislation that incentivizes Wisconsin hospitals and health systems to offer care coordination services for patients who are high utilizers of emergency departments (EDs). Designed to study the impact of a provider-based care coordination program in Medicaid, Wisconsin Act 279 includes a provision that will reimburse hospitals a minimum of $250 and a maximum of up to $1,000 over a 12-month period for care management services. WHA will continue to work with the Wisconsin Department of Health Services (DHS) on implementing this new program, which is expected to be rolled out later in 2018:

  • Hospitals and health systems can earn up to $1,000 per Medicaid patient if the hospital can successfully reduce frequent emergency department utilization among at least half of the target patient population.
  • DHS will award up to $1.5 million annually, and is required to share any savings experienced from the intensive care coordination programs with qualifying hospitals and health systems.
  • Overall, the state and federal funding authorized by the Legislature for this program is limited to $2.25 million. Any expenditures for payments (not shared savings) beyond this appropriation must be reauthorized by the Legislature.

Read the WHA Act 279 and other legislative summaries in the Member Portal: log in at members.wha.org

This story originally appeared in the May 18, 2018 edition of WHA Newsletter