Healthesystems attended the May 19, 2026, meeting of the Wisconsin Workers’ Compensation Advisory Council (WCAC), where the Department of Workforce Development (DWD) provided updates on ongoing efforts to revise the state’s medical treatment guidelines (MTGs) and implement a new hospital fee schedule.
Agency representatives noted that the medical treatment guideline updates remain delayed due to committee quorum issues on the Health Care Provider Advisory Committee, though recruitment efforts are ongoing. The DWD continues work to update Chapter DWD 81 medical treatment guidelines used in medical necessity disputes, which have not been revised since November 1, 2007. A new scope statement is expected later this summer to extend the agency’s rulemaking authority beyond the current June 18, 2026, expiration date.
Meanwhile the hospital fee schedule is still in the early planning and rulemaking stages. Under 2025 Act 15, the hospital fee schedule will establish five geographic regions, with maximum reimbursement set at 120% of the 75th percentile of in-network commercial negotiated rates for each service within each region, with payer liability limited to the lowest of the schedule, contract rate, or billed charge.
DWD is currently focused on implementation planning following its April 27 Request for Information (RFI), including evaluating vendor procurement options, timelines, and potential third-party support. Rulemaking will be required, and several operational components remain under review, including eligibility criteria, covered services, and payment timing.
The hospital fee schedule must be operational by July 1, 2027, with additional stakeholder engagement anticipated throughout the process.
A new hospital fee schedule represents a significant policy shift that could impact how payers approach reimbursement, strategies, and cost containment in a state that has historically lacked a formal fee schedule, contributing to higher costs and variability. Because treatment guidelines are used in dispute-related medical necessity reviews, updates are needed to ensure they reflect current standards of care.
