Contract Amendment for Medicaid and BadgerCare HMO Services
Exhibit
10.1(b)
Contract
Amendment for Medicaid and BadgerCare
HMO
Services
The
Contract entered into for the period February 1, 2006 through December 31,
2007
between the State of Wisconsin acting by or through the Department of Health
and
Family Services, hereinafter referred to as “Department,” and Managed Health
Services, hereinafter referred to as the “Contractor,” is hereby amended
effective January 1, 2007 as follows:
| 1. |
Article
XVIII, C. Add language below at the
beginning:
|
An
HMO
may be eligible for an enhanced rate increase by region if all of the following
applies:
a.
The
HMO
serves a county that has at least 20,000 eligible Family Medicaid
and BadgerCare enrollees;
b.
As
of
November 1, 2006, the enrollment limits of the HMOs serving that county
are not sufficient for the Department to enroll all of those eligible
enrollees;
and,
c.
The
HMO
agrees to increase its enrollment limit that was in effect on November
1,
2006.
If
the
HMOs that increase their enrollment limits under this paragraph 1., do not
increase sufficient for the Department to enroll all eligible enrollees then
the
Department may assign a higher enrollment limit for each of those
HMOs.
An
HMO
that accepts this enhanced rate increase cannot decrease its enrollment limit
for two years from the date the increase is effective without the approval
of
the Department.
| 2. |
Delete
Addendum IIIA - Rate Chart. Replace with new Addendum IIIA - Rate
Chart.
(Attached)
|
3. All
other
terms and conditions of the February 1, 2006 through December 31,
2007
contract and any prior amendments that are not affected by this
Amendment
shall remain in full force and effect through the end of the contract
period.
|
HMO
Name
|
Department
of Health and Family Services
|
|
Official
Signature
/s/
Xxxxx XxXxxx
|
Official
Signature
/s/
Xxxxx X. Xxxxxx
|
|
Printed
Name
Xxxxx
XxXxxx
|
Printed
Name
Xxxxx
X. Xxxxxx
|
|
Title
President
& CEO
|
Title
Administrator
Division
of Health Care Financing
|
|
Date
12-14-06
|
Date
0-0-00
|
|
CY
2007 Final AFDC/HS Children Capitation Rates by Age/Gender & Rate
Region
|
|||||||||||||||
|
effective
January 1st, 2007
|
|||||||||||||||
|
All
Services Capitation Rate by Age/Gender and Rate
Region
|
|||||||||||||||
|
|
Rate
Region >
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
40
|
13
|
18
|
30
|
67
|
|
Age
Range
|
Age
Code
|
Duluth/
Superior
|
Wausau/
Rhinelander
|
Green
Bay
|
Twin
Cities
|
Marshfield/
Xxxxxxx Point
|
Appleton/
Oshkosh
|
La
Crosse
|
Madison
|
Southeast
Wisconsin
|
Milwaukee
Xxxxxx
|
Xxxx
Xxxxxx
|
Xxx
Xxxxxx Xxxxxx
|
Xxxxxxx
Xxxxxx
|
Xxxxxxxx
Xxxxxx
|
|
<1
|
A
|
$
366.94
|
$
357.21
|
$
361.51
|
$
389.16
|
$
352.89
|
$
325.99
|
$
318.85
|
$
345.01
|
$
328.93
|
$
350.28
|
$
317.61
|
$
327.61
|
$
391.72
|
$
359.32
|
|
01-05
|
B
|
$
79.37
|
$
77.04
|
$
77.69
|
$
83.30
|
$
77.43
|
$
70.68
|
$
69.21
|
$
74.66
|
$
70.59
|
$
74.75
|
$
68.42
|
$
70.54
|
$
83.65
|
$
75.88
|
|
06-14
|
C
|
$
67.82
|
$
65.65
|
$
66.00
|
$
70.52
|
$
66.99
|
$
60.49
|
$
59.30
|
$
63.81
|
$
59.88
|
$
63.06
|
$
58.24
|
$
60.07
|
$
70.65
|
$
63.44
|
|
15-20F
|
E
|
$
242.68
|
$
236.03
|
$
238.16
|
$
256.61
|
$
235.58
|
$
215.92
|
$
211.53
|
$
228.17
|
$
216.34
|
$
229.36
|
$
209.41
|
$
217.27
|
$
256.78
|
$
234.29
|
|
15-20M
|
D
|
$
93.43
|
$
90.71
|
$
91.20
|
$
98.18
|
$
91.84
|
$
83.29
|
$
81.74
|
$
87.85
|
$
82.69
|
$
87.16
|
$
80.29
|
$
83.71
|
$
97.69
|
$
88.38
|
|
21-34F
|
G
|
$
351.51
|
$
342.17
|
$
345.21
|
$
372.80
|
$
340.87
|
$
312.70
|
$
306.48
|
$
330.44
|
$
313.49
|
$
332.33
|
$
303.33
|
$
315.88
|
$
372.20
|
$
340.21
|
|
21-34M
|
F
|
$
202.81
|
$
197.43
|
$
198.93
|
$
215.20
|
$
197.29
|
$
180.51
|
$
177.08
|
$
190.62
|
$
180.51
|
$
190.97
|
$
174.79
|
$
182.85
|
$
214.03
|
$
195.43
|
|
35+F
|
I
|
$
428.98
|
$
417.77
|
$
421.32
|
$
455.80
|
$
416.06
|
$
381.65
|
$
374.22
|
$
403.22
|
$
382.47
|
$
405.25
|
$
370.09
|
$
386.59
|
$
454.01
|
$
415.33
|
|
35+M
|
H
|
$
338.91
|
$
330.00
|
$
332.78
|
$
359.93
|
$
328.88
|
$
301.54
|
$
295.68
|
$
318.55
|
$
302.08
|
$
319.99
|
$
292.35
|
$
305.34
|
$
358.51
|
$
327.81
|
|
Dental_No
Chiropractic Service Capitation Rate by Age/Gender and Rate
Region
|
|||||||||||||||
|
|
Rate
Region >
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
40
|
13
|
18
|
30
|
67
|
|
Age
Range
|
Age
Code
|
Duluth/
Superior
|
Wausau/
Rhinelander
|
Green
Bay
|
Twin
Cities
|
Marshfield/
Xxxxxxx Point
|
Appleton/
Oshkosh
|
La
Crosse
|
Madison
|
Southeast
Wisconsin
|
Milwaukee
Xxxxxx
|
Xxxx
Xxxxxx
|
Xxx
Xxxxxx Xxxxxx
|
Xxxxxxx
Xxxxxx
|
Xxxxxxxx
Xxxxxx
|
|
<1
|
A
|
$
366.54
|
$
356.73
|
$
361.17
|
$
388.36
|
$
352.30
|
$
325.60
|
$
318.35
|
$
344.67
|
$
328.72
|
$
350.25
|
$
317.37
|
$
326.63
|
$
391.57
|
$
359.12
|
|
01-05
|
B
|
$
78.96
|
$
76.55
|
$
77.34
|
$
82.48
|
$
76.82
|
$
70.28
|
$
68.70
|
$
74.31
|
$
70.38
|
$
74.71
|
$
68.17
|
$
69.54
|
$
83.51
|
$
75.66
|
|
06-14
|
C
|
$
67.20
|
$
64.92
|
$
65.48
|
$
69.29
|
$
66.08
|
$
59.89
|
$
58.54
|
$
63.28
|
$
59.55
|
$
63.01
|
$
57.87
|
$
58.56
|
$
70.42
|
$
63.12
|
|
15-20F
|
E
|
$
241.16
|
$
234.22
|
$
236.87
|
$
253.58
|
$
233.32
|
$
214.44
|
$
209.63
|
$
226.86
|
$
215.56
|
$
229.22
|
$
208.49
|
$
213.54
|
$
256.24
|
$
233.50
|
|
15-20M
|
D
|
$
92.32
|
$
89.39
|
$
90.25
|
$
95.96
|
$
90.18
|
$
82.20
|
$
80.35
|
$
86.89
|
$
82.11
|
$
87.05
|
$
79.62
|
$
80.98
|
$
97.29
|
$
87.80
|
|
21-34F
|
G
|
$
348.90
|
$
339.06
|
$
342.99
|
$
367.59
|
$
336.99
|
$
310.15
|
$
303.24
|
$
328.19
|
$
312.14
|
$
332.10
|
$
301.75
|
$
309.47
|
$
371.24
|
$
338.86
|
|
21-34M
|
F
|
$
200.73
|
$
194.95
|
$
197.16
|
$
211.05
|
$
194.21
|
$
178.48
|
$
174.49
|
$
188.83
|
$
179.42
|
$
190.78
|
$
173.53
|
$
177.74
|
$
213.27
|
$
194.34
|
|
35+F
|
I
|
$
425.21
|
$
413.28
|
$
418.12
|
$
448.27
|
$
410.47
|
$
377.97
|
$
369.53
|
$
399.97
|
$
380.51
|
$
404.90
|
$
367.81
|
$
377.34
|
$
452.64
|
$
413.38
|
|
35+M
|
H
|
$
335.90
|
$
326.42
|
$
330.22
|
$
353.92
|
$
324.42
|
$
298.60
|
$
291.94
|
$
315.96
|
$
300.51
|
$
319.72
|
$
290.52
|
$
297.94
|
$
357.42
|
$
326.25
|
|
Chiropractic_No
Dental Service Capitation Rate by Age/Gender and Rate
Region
|
|||||||||||||||
|
|
Rate
Region >
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
40
|
13
|
18
|
30
|
67
|
|
Age
Range
|
Age
Code
|
Duluth/
Superior
|
Wausau/
Rhinelander
|
Green
Bay
|
Twin
Cities
|
Marshfield/
Xxxxxxx Point
|
Appleton/
Oshkosh
|
La
Crosse
|
Madison
|
Southeast
Wisconsin
|
Milwaukee
Xxxxxx
|
Xxxx
Xxxxxx
|
Xxx
Xxxxxx Xxxxxx
|
Xxxxxxx
Xxxxxx
|
Xxxxxxxx
Xxxxxx
|
|
<1
|
A
|
$
366.90
|
$
357.18
|
$
361.48
|
$
389.13
|
$
352.85
|
$
325.96
|
$
318.82
|
$
344.98
|
$
328.90
|
$
350.25
|
$
317.58
|
$
327.58
|
$
391.69
|
$
359.30
|
|
01-05
|
B
|
$
74.35
|
$
72.46
|
$
73.21
|
$
79.17
|
$
71.68
|
$
66.09
|
$
64.73
|
$
69.89
|
$
66.53
|
$
70.70
|
$
64.28
|
$
66.89
|
$
79.14
|
$
72.66
|
|
06-14
|
C
|
$
59.76
|
$
58.29
|
$
58.80
|
$
63.89
|
$
57.75
|
$
53.13
|
$
52.13
|
$
56.14
|
$
53.36
|
$
56.56
|
$
51.58
|
$
54.21
|
$
63.41
|
$
58.27
|
|
15-20F
|
E
|
$
234.43
|
$
228.49
|
$
230.79
|
$
249.81
|
$
226.12
|
$
208.38
|
$
204.17
|
$
220.32
|
$
209.66
|
$
222.70
|
$
202.58
|
$
211.28
|
$
249.37
|
$
228.99
|
|
15-20M
|
D
|
$
85.61
|
$
83.56
|
$
84.21
|
$
91.75
|
$
82.87
|
$
76.15
|
$
74.77
|
$
80.41
|
$
76.36
|
$
80.85
|
$
73.83
|
$
78.02
|
$
90.67
|
$
83.37
|
|
21-34F
|
G
|
$
342.66
|
$
334.09
|
$
337.30
|
$
365.52
|
$
330.72
|
$
304.62
|
$
298.59
|
$
322.03
|
$
306.33
|
$
325.19
|
$
296.02
|
$
309.45
|
$
364.25
|
$
334.54
|
|
21-34M
|
F
|
$
195.93
|
$
191.14
|
$
192.77
|
$
209.54
|
$
189.40
|
$
174.22
|
$
170.95
|
$
184.07
|
$
174.94
|
$
185.42
|
$
169.10
|
$
177.85
|
$
207.85
|
$
191.01
|
|
35+F
|
I
|
$
419.39
|
$
408.99
|
$
412.73
|
$
447.91
|
$
405.06
|
$
372.87
|
$
365.66
|
$
394.08
|
$
374.70
|
$
397.50
|
$
362.15
|
$
379.61
|
$
445.38
|
$
409.17
|
|
35+M
|
H
|
$
330.45
|
$
322.27
|
$
325.20
|
$
352.96
|
$
319.19
|
$
293.80
|
$
288.13
|
$
310.50
|
$
295.23
|
$
313.16
|
$
285.35
|
$
299.19
|
$
350.90
|
$
322.38
|
|
No
Chiropractic & No Dental Service Capitation Rate by Age/Gender and
Rate Region
|
|||||||||||||||
|
|
Rate
Region >
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
40
|
13
|
18
|
30
|
67
|
|
Age
Range
|
Age
Code
|
Duluth/
Superior
|
Wausau/
Rhinelander
|
Green
Bay
|
Twin
Cities
|
Marshfield/
Xxxxxxx Point
|
Appleton/
Oshkosh
|
La
Crosse
|
Madison
|
Southeast
Wisconsin
|
Milwaukee
Xxxxxx
|
Xxxx
Xxxxxx
|
Xxx
Xxxxxx Xxxxxx
|
Xxxxxxx
Xxxxxx
|
Xxxxxxxx
Xxxxxx
|
|
<1
|
A
|
$
366.50
|
$
356.70
|
$
361.14
|
$
388.33
|
$
352.26
|
$
325.57
|
$
318.32
|
$
344.64
|
$
328.69
|
$
350.22
|
$
317.34
|
$
326.60
|
$
391.54
|
$
359.09
|
|
01-05
|
B
|
$
73.94
|
$
71.97
|
$
72.86
|
$
78.35
|
$
71.07
|
$
65.69
|
$
64.22
|
$
69.54
|
$
66.32
|
$
70.66
|
$
64.03
|
$
65.89
|
$
79.00
|
$
72.45
|
|
06-14
|
C
|
$
59.14
|
$
57.55
|
$
58.28
|
$
62.66
|
$
56.84
|
$
52.53
|
$
51.36
|
$
55.61
|
$
53.03
|
$
56.51
|
$
51.21
|
$
52.70
|
$
63.18
|
$
57.95
|
|
15-20F
|
E
|
$
232.91
|
$
226.68
|
$
229.50
|
$
246.78
|
$
223.86
|
$
206.90
|
$
202.28
|
$
219.01
|
$
208.88
|
$
222.56
|
$
201.66
|
$
207.55
|
$
248.83
|
$
228.21
|
|
15-20M
|
D
|
$
84.50
|
$
82.24
|
$
83.26
|
$
89.53
|
$
81.22
|
$
75.06
|
$
73.39
|
$
79.45
|
$
75.78
|
$
80.74
|
$
73.16
|
$
75.29
|
$
90.27
|
$
82.79
|
|
21-34F
|
G
|
$
340.05
|
$
330.97
|
$
335.08
|
$
360.31
|
$
326.84
|
$
302.07
|
$
295.35
|
$
319.78
|
$
304.98
|
$
324.96
|
$
294.44
|
$
303.04
|
$
363.29
|
$
333.18
|
|
21-34M
|
F
|
$
193.85
|
$
188.66
|
$
191.00
|
$
205.39
|
$
186.32
|
$
172.19
|
$
168.36
|
$
182.28
|
$
173.85
|
$
185.23
|
$
167.84
|
$
172.74
|
$
207.09
|
$
189.93
|
|
35+F
|
I
|
$
415.62
|
$
404.50
|
$
409.53
|
$
440.38
|
$
399.47
|
$
369.19
|
$
360.97
|
$
390.83
|
$
372.74
|
$
397.15
|
$
359.87
|
$
370.36
|
$
444.01
|
$
407.22
|
|
35+M
|
H
|
$
327.44
|
$
318.68
|
$
322.64
|
$
346.95
|
$
314.72
|
$
290.86
|
$
284.39
|
$
307.91
|
$
293.66
|
$
312.89
|
$
283.52
|
$
291.79
|
$
349.81
|
$
320.82
|
|
An
HMO may be eligible for a 2.7% increase above the rate effective
1/1/2007
if all of the following applies:
a.
the HMO serves a county that has at least 20,000 eligible Family
Medicaid
and BadgerCare enrollees;
b.
as of November 1, 2006, the enrollment limits of the HMOs serving
that
county are not sufficient for the Department to enroll all of those
eligible enrollees; and,
c.
the HMO agrees to increase its enrollment limit that was in effect
on
November 1, 2006.
|
|||||||||||||||
|
effective
January 1st, 2007
|
|||||||||||||||
|
All
Services
|
|||||||||||||||
|
|
|
Duluth/
|
Wausau/
|
|
|
Marshfield/
|
Appleton/
|
|
|
Southeast
|
|
|
|
|
|
|
|
|
Superior
|
Rhinelander
|
Green
Bay
|
Twin
Cities
|
Xxxxxxx
Point
|
Oshkosh
|
La
Crosse
|
Madison
|
Wisconsin
|
Milwaukee
|
Dane
|
Eau
Claire
|
Kenosha
|
Waukesha
|
|
Age
Range
|
Gender
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
|
Age
0
|
All
|
$366.94
|
$357.21
|
$361.51
|
$389.16
|
$352.89
|
$325.99
|
$318.85
|
$345.01
|
$328.93
|
$350.28
|
$317.61
|
$327.61
|
$391.72
|
$359.32
|
|
Age
1-14
|
All
|
$69.01
|
$65.90
|
$66.76
|
$68.74
|
$64.27
|
$64.47
|
$53.19
|
$70.74
|
$66.02
|
$64.07
|
$60.65
|
$59.53
|
$73.52
|
$67.36
|
|
Age
15-20
|
F
|
$143.47
|
$139.50
|
$140.36
|
$145.31
|
$132.66
|
$133.28
|
$110.58
|
$147.64
|
$138.64
|
$132.11
|
$128.70
|
$125.87
|
$151.90
|
$142.44
|
|
Age
15-20
|
M
|
$104.07
|
$100.57
|
$101.43
|
$104.79
|
$96.44
|
$96.85
|
$80.19
|
$106.96
|
$100.24
|
$96.12
|
$92.74
|
$90.77
|
$110.43
|
$102.76
|
|
Age
21-34
|
F
|
$218.97
|
$214.49
|
$215.45
|
$223.10
|
$201.06
|
$202.74
|
$168.40
|
$225.65
|
$212.88
|
$201.32
|
$198.58
|
$193.38
|
$231.37
|
$219.56
|
|
Age
21-34
|
M
|
$127.22
|
$124.53
|
$124.90
|
$129.72
|
$117.69
|
$118.06
|
$98.22
|
$131.15
|
$123.25
|
$116.66
|
$114.79
|
$112.33
|
$134.34
|
$126.84
|
|
Age
35-44
|
F
|
$283.84
|
$278.69
|
$279.74
|
$289.79
|
$260.27
|
$262.58
|
$218.25
|
$292.64
|
$276.37
|
$260.75
|
$258.18
|
$251.21
|
$299.69
|
$285.34
|
|
Age
35-44
|
M
|
$198.86
|
$195.19
|
$195.86
|
$203.04
|
$182.70
|
$184.08
|
$153.05
|
$205.04
|
$193.44
|
$182.58
|
$180.62
|
$175.96
|
$209.94
|
$199.59
|
|
Age
45+
|
F
|
$367.82
|
$361.13
|
$362.63
|
$375.42
|
$336.78
|
$340.12
|
$282.60
|
$379.19
|
$358.35
|
$338.13
|
$334.84
|
$325.50
|
$388.42
|
$370.14
|
|
Age
45+
|
M
|
$323.51
|
$317.14
|
$318.88
|
$329.51
|
$295.50
|
$299.04
|
$248.13
|
$333.34
|
$315.33
|
$298.01
|
$294.55
|
$285.83
|
$341.95
|
$325.80
|
|
Dental
Services - No Chiropractic
|
|||||||||||||||
|
|
|
Duluth/
|
Wausau/
|
|
|
Marshfield/
|
Appleton/
|
|
|
Southeast
|
|
|
|
|
|
|
|
|
Superior
|
Rhinelander
|
Green
Bay
|
Twin
Cities
|
Xxxxxxx
Point
|
Oshkosh
|
La
Crosse
|
Madison
|
Wisconsin
|
Milwaukee
|
Dane
|
Eau
Claire
|
Kenosha
|
Waukesha
|
|
Age
Range
|
Gender
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
|
Age
0
|
All
|
$366.54
|
$356.73
|
$361.17
|
$388.36
|
$352.30
|
$325.60
|
$318.35
|
$344.67
|
$328.72
|
$350.25
|
$317.37
|
$326.63
|
$391.57
|
$359.12
|
|
Age
1-14
|
All
|
$68.31
|
$64.76
|
$66.00
|
$67.41
|
$62.99
|
$63.69
|
$52.28
|
$69.86
|
$65.45
|
$63.95
|
$60.03
|
$58.49
|
$73.05
|
$66.85
|
|
Age
15-20
|
F
|
$141.57
|
$136.44
|
$138.33
|
$141.75
|
$129.21
|
$131.23
|
$108.13
|
$145.27
|
$137.12
|
$131.80
|
$127.04
|
$123.08
|
$150.64
|
$141.09
|
|
Age
15-20
|
M
|
$102.83
|
$98.56
|
$100.10
|
$102.46
|
$94.18
|
$95.50
|
$78.59
|
$105.41
|
$99.24
|
$95.91
|
$91.65
|
$88.95
|
$109.60
|
$101.87
|
|
Age
21-34
|
F
|
$216.43
|
$210.40
|
$212.73
|
$218.34
|
$196.44
|
$199.98
|
$165.12
|
$222.47
|
$210.84
|
$200.91
|
$196.37
|
$189.65
|
$229.68
|
$217.75
|
|
Age
21-34
|
M
|
$125.12
|
$121.15
|
$122.65
|
$125.79
|
$113.86
|
$115.78
|
$95.51
|
$128.52
|
$121.58
|
$116.32
|
$112.96
|
$109.25
|
$132.95
|
$125.34
|
|
Age
35-44
|
F
|
$280.54
|
$273.37
|
$276.20
|
$283.61
|
$254.25
|
$258.99
|
$213.98
|
$288.51
|
$273.72
|
$260.22
|
$255.30
|
$246.36
|
$297.50
|
$282.98
|
|
Age
35-44
|
M
|
$196.31
|
$191.08
|
$193.13
|
$198.27
|
$178.05
|
$181.31
|
$149.76
|
$201.86
|
$191.41
|
$182.17
|
$178.40
|
$172.22
|
$208.26
|
$197.78
|
|
Age
45+
|
F
|
$363.91
|
$354.85
|
$358.45
|
$368.12
|
$329.67
|
$335.88
|
$277.56
|
$374.31
|
$355.23
|
$337.49
|
$331.44
|
$319.78
|
$385.84
|
$367.36
|
|
Age
45+
|
M
|
$320.88
|
$312.89
|
$316.06
|
$324.58
|
$290.69
|
$296.17
|
$244.73
|
$330.04
|
$313.22
|
$297.57
|
$292.25
|
$281.96
|
$340.21
|
$323.92
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Chiropractic
Services - No Dental
|
|||||||||||||||
|
|
|
Duluth/
|
Wausau/
|
|
|
Marshfield/
|
Appleton/
|
|
|
Southeast
|
|
|
|
|
|
|
|
|
Superior
|
Rhinelander
|
Green
Bay
|
Twin
Cities
|
Xxxxxxx
Point
|
Oshkosh
|
La
Crosse
|
Madison
|
Wisconsin
|
Milwaukee
|
Dane
|
Eau
Claire
|
Kenosha
|
Waukesha
|
|
Age
Range
|
Gender
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
|
Age
0
|
All
|
$366.90
|
$357.18
|
$361.48
|
$389.13
|
$352.85
|
$325.96
|
$318.82
|
$344.98
|
$328.90
|
$350.25
|
$317.58
|
$327.58
|
$391.69
|
$359.30
|
|
Age
1-14
|
All
|
$59.36
|
$58.74
|
$58.82
|
$61.02
|
$54.18
|
$54.78
|
$45.62
|
$61.30
|
$58.10
|
$54.39
|
$54.52
|
$52.92
|
$62.53
|
$60.18
|
|
Age
15-20
|
F
|
$132.75
|
$131.54
|
$131.54
|
$136.74
|
$121.45
|
$122.51
|
$102.16
|
$137.15
|
$129.84
|
$121.36
|
$121.88
|
$118.52
|
$139.69
|
$134.46
|
|
Age
15-20
|
M
|
$94.05
|
$93.14
|
$93.19
|
$96.79
|
$85.97
|
$86.79
|
$72.34
|
$97.15
|
$92.02
|
$86.07
|
$86.37
|
$83.91
|
$99.02
|
$95.31
|
|
Age
21-34
|
F
|
$210.15
|
$207.96
|
$208.20
|
$216.06
|
$191.85
|
$193.89
|
$161.48
|
$217.02
|
$205.64
|
$192.48
|
$192.98
|
$187.34
|
$221.33
|
$213.00
|
|
Age
21-34
|
M
|
$120.10
|
$119.25
|
$119.04
|
$124.03
|
$110.25
|
$110.91
|
$92.64
|
$124.18
|
$117.40
|
$109.52
|
$110.26
|
$107.45
|
$126.23
|
$121.54
|
|
Age
35-44
|
F
|
$275.09
|
$272.21
|
$272.54
|
$282.80
|
$251.12
|
$253.79
|
$211.38
|
$284.07
|
$269.18
|
$251.97
|
$252.62
|
$245.21
|
$289.72
|
$278.83
|
|
Age
35-44
|
M
|
$191.81
|
$189.96
|
$190.06
|
$197.40
|
$175.33
|
$177.00
|
$147.52
|
$198.14
|
$187.65
|
$175.51
|
$176.14
|
$171.13
|
$201.91
|
$194.34
|
|
Age
45+
|
F
|
$357.42
|
$353.43
|
$354.08
|
$367.11
|
$325.91
|
$329.68
|
$274.44
|
$369.01
|
$349.81
|
$327.70
|
$328.23
|
$318.37
|
$376.58
|
$362.40
|
|
Age
45+
|
M
|
$314.35
|
$310.35
|
$311.35
|
$322.19
|
$285.92
|
$289.84
|
$240.95
|
$324.38
|
$307.81
|
$288.82
|
$288.73
|
$279.56
|
$331.52
|
$318.98
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||||||||||
|
No
Dental or Chiropractic
|
|||||||||||||||
|
|
|
Duluth/
|
Wausau/
|
|
|
Marshfield/
|
Appleton/
|
|
|
Southeast
|
|
|
|
|
|
|
|
|
Superior
|
Rhinelander
|
Green
Bay
|
Twin
Cities
|
Xxxxxxx
Point
|
Oshkosh
|
La
Crosse
|
Madison
|
Wisconsin
|
Milwaukee
|
Dane
|
Eau
Claire
|
Kenosha
|
Waukesha
|
|
Age
Range
|
Gender
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
|
Age
0
|
All
|
$366.50
|
$356.70
|
$361.14
|
$388.33
|
$352.26
|
$325.57
|
$318.32
|
$344.64
|
$328.69
|
$350.22
|
$317.34
|
$326.60
|
$391.54
|
$359.09
|
|
Age
1-14
|
All
|
$58.66
|
$57.61
|
$58.06
|
$59.70
|
$52.90
|
$54.00
|
$44.71
|
$60.42
|
$57.53
|
$54.27
|
$53.90
|
$51.88
|
$62.06
|
$59.67
|
|
Age
15-20
|
F
|
$130.85
|
$128.48
|
$129.51
|
$133.18
|
$118.00
|
$120.46
|
$99.71
|
$134.78
|
$128.32
|
$121.05
|
$120.23
|
$115.73
|
$138.43
|
$133.11
|
|
Age
15-20
|
M
|
$92.81
|
$91.14
|
$91.86
|
$94.46
|
$83.71
|
$85.44
|
$70.73
|
$95.60
|
$91.02
|
$85.86
|
$85.28
|
$82.09
|
$98.19
|
$94.42
|
|
Age
21-34
|
F
|
$207.61
|
$203.86
|
$205.48
|
$211.30
|
$187.23
|
$191.13
|
$158.21
|
$213.84
|
$203.60
|
$192.07
|
$190.77
|
$183.61
|
$219.64
|
$211.19
|
|
Age
21-34
|
M
|
$118.00
|
$115.87
|
$116.79
|
$120.10
|
$106.42
|
$108.63
|
$89.93
|
$121.55
|
$115.73
|
$109.18
|
$108.43
|
$104.37
|
$124.84
|
$120.04
|
|
Age
35-44
|
F
|
$271.78
|
$266.89
|
$269.00
|
$276.62
|
$245.10
|
$250.20
|
$207.11
|
$279.94
|
$266.53
|
$251.44
|
$249.73
|
$240.36
|
$287.53
|
$276.47
|
|
Age
35-44
|
M
|
$189.26
|
$185.85
|
$187.33
|
$192.63
|
$170.68
|
$174.23
|
$144.23
|
$194.96
|
$185.62
|
$175.10
|
$173.91
|
$167.39
|
$200.23
|
$192.53
|
|
Age
45+
|
F
|
$353.51
|
$347.14
|
$349.90
|
$359.81
|
$318.81
|
$325.44
|
$269.40
|
$364.13
|
$346.69
|
$327.06
|
$324.83
|
$312.65
|
$374.00
|
$359.62
|
|
Age
45+
|
M
|
$311.72
|
$306.10
|
$308.53
|
$317.26
|
$281.12
|
$286.97
|
$237.55
|
$321.08
|
$305.70
|
$288.38
|
$286.43
|
$275.69
|
$329.78
|
$317.10
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||||
|
An
HMO may be eligible for a 2.7% increase above the rate effective
1/1/2007
if all of the following applies:
a.
the HMO serves a county that has at least 20,000 eligible Family
Medicaid
and BadgerCare enrollees;
b.
as of November 1, 2006, the enrollment limits of the HMOs serving
that
county are not sufficient for the Department to enroll all of those
eligible enrollees; and,
c.
the HMO agrees to increase its enrollment limit that was in effect
on
November 1, 2006.
|
|||||||||||||||
|
CY
2007 Healthy Start Pregnant Women Capitation Rates by Rate Region
and
Service
|
||||||||||||||
|
effective
January 1st, 2007
|
||||||||||||||
|
2007
HSPW RATES
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
|
|
Duluth/
|
Wausau/
|
|
|
Marshfield/
|
Appleton/
|
|
|
Southeast
|
|
|
|
|
|
|
|
Superior
|
Rhinelander
|
Green
Bay
|
Twin
Cities
|
Xxxxxxx
Point
|
Oshkosh
|
La
Crosse
|
Madison
|
Wisconsin
|
Milwaukee
|
Dane
|
Eau
Claire
|
Kenosha
|
Waukesha
|
|
All
Services
|
$690.40
|
$646.80
|
$647.21
|
$745.55
|
$676.15
|
$637.81
|
$644.62
|
$713.23
|
$661.23
|
$809.72
|
$723.07
|
$778.83
|
$732.77
|
$677.14
|
|
Dental,
No Chiro
|
$688.47
|
$643.91
|
$645.83
|
$742.45
|
$672.58
|
$635.65
|
$642.31
|
$711.05
|
$659.85
|
$809.43
|
$721.78
|
$775.04
|
$732.10
|
$676.26
|
|
Chiro,
No Dental
|
$687.57
|
$644.74
|
$644.98
|
$742.53
|
$672.88
|
$634.18
|
$642.36
|
$710.08
|
$658.65
|
$805.17
|
$719.95
|
$776.88
|
$727.48
|
$674.81
|
|
No
Dental or Chiro
|
$685.64
|
$641.85
|
$643.60
|
$739.43
|
$669.31
|
$632.02
|
$640.05
|
$707.90
|
$657.27
|
$804.88
|
$718.66
|
$773.09
|
$726.81
|
$673.93
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
2007
Rates by service and Rate Region
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
All
Services
|
$690.40
|
$646.80
|
$647.21
|
$745.55
|
$676.15
|
$637.81
|
$644.62
|
$713.23
|
$661.23
|
$809.72
|
$723.07
|
$778.83
|
$732.77
|
$677.14
|
|
Medical
|
$685.64
|
$641.85
|
$643.60
|
$739.43
|
$669.31
|
$632.02
|
$640.05
|
$707.90
|
$657.27
|
$804.88
|
$718.66
|
$773.09
|
$726.81
|
$673.93
|
|
Dental
|
$2.83
|
$2.06
|
$2.23
|
$3.02
|
$3.27
|
$3.63
|
$2.26
|
$3.15
|
$2.58
|
$4.55
|
$3.12
|
$1.95
|
$5.29
|
$2.33
|
|
Chiro
|
$1.93
|
$2.89
|
$1.38
|
$3.10
|
$3.57
|
$2.16
|
$2.31
|
$2.18
|
$1.38
|
$0.29
|
$1.29
|
$3.79
|
$0.67
|
$0.88
|
