P.O. Box 309
Madison, WI 53701-0309
Written Comments
Written comments on the proposed change are welcome. Comments should be sent to the above address. Comments received on the change will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily at;
Bureau of Health Care Financing
Room 250, State Office Building
One West Wilson Street
Madison, WI
Public Notice
Health and Social Services
(Medical Assistance Reimbursement of Nursing Homes)
The State of Wisconsin reimburses Medicaid-certified nursing facilities for long-term care and health care services provided to eligible persons under the authority of Title XIX of the Federal Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. This program, administered by the State's Department of Health and Social Services (which will be re-named the Department of Health and Family Services on July 1, 1996), is called Medical Assistance (MA) or Medicaid. Federal statutes and regulations require that a state plan be developed that provides the methods and standards for setting payment rates for nursing facility services covered by the payment system. A plan that describes the nursing home reimbursement system for Wisconsin (methods of payment for costs incurred by efficiently and economically operated providers) is now in effect as approved by the federal Health Care Financing Administration (HCFA).
The Department is proposing changes in the methods of payment to nursing homes and, therefore, in the plan describing the nursing home reimbursement system. The changes are effective July 1, 1996.
The proposed changes would update the payment system and make various payment-related policy changes, including modifications requested by HCFA in its approval of the 1995-1996 nursing facility payment plan. Some of the changes are necessary to implement various budget cost containment policies contained in the 1995-97 State Budget, Wis. Act 27. Some of the changes are technical in nature; some clarify various payment plan provisions.
The estimated increase in annual aggregate expenditures attributable to these changes for nursing homes serving MA residents is approximately $34,000,000 all funds ($17,000,000 FFP), including patient liability.
The proposed changes are being implemented to assure adequate funding related to increases in costs incurred by efficiently and economically operated facilities, and to comply with Wisconsin statutes governing Medicaid payment systems, particularly s. 49.45 (6m), Wis. Stats.
For the following proposed changes, the plan amendment proposals are being developed and are not available at this time. See below for discussion of public meetings.
These proposed changes are as follows:
1. Modify the methodology to adjust the reimbursement for nursing homes within the parameters of the 1995-97 State Budget Act, 1995 Wis. Act 27, which may be by application of a percent change based on the previous year's rates.
2. Modify the methodology to adjust for inflation.
3. Modify standards to determine base payment amounts with consideration for the facility's previous year's rates and the facilities' allowable cost as reported in 1995 cost reports.
4. Modify plan provisions to continue to reflect implementation of provision of the federal Omnibus Budget Reconciliation Acts (OBRA) relating to nursing homes.
5. Revise various references to specific years and related provisions to clarify the base year, the rate year, and various payment policies which are specific to a given year.
6. Incorporate technical revisions as needed in select sections requiring clarification.
7. Incorporate miscellaneous changes to implement the intent of the payment plan, including provisions to address special situations such as new facilities, facility phase downs, and changes of ownership.
For the following proposed changes, the plan amendment proposals are available at this time. See below for discussion of public meetings.
1. Modify section 3.522 to incorporate the Dodge Construction Index into the re-evaluation of assets provisions to reflect the annual assurance within the plan amendment.
2. Modify section 5.710 to state the methodology used for the blended increment for facilities with expenses for both property taxes and payments for municipal services.
3. Amend sections 1.240 and 3.011 (c) to clarify policy on the ch. 150, Wis. Stats., Resource Allocation Program.
4. Modify section 3.011 and related sections on the licensed bed adjustments to reflect continuing provisions as well as modifications included in the Act 27 and incorporated in the 95-96 payment plan.
5. Revise section 1.248 on the definition of self-insurance costs.
6. Modify section 1.900 to clarify applicability of policy to offset otherwise allowable costs for what should have been billed to Medicare Parts A and B as primary payor.
7. Revise sections 2.800, 3.800, and 3.810 to clarify that the over-the-counter drug allowance is limited to Medicaid costs and Medicaid patient days.
8. Modify sections 3.400 and 5.710 to change the computation of the property tax allowance.
9. Modify section 3.525 (a) on the minimum useful life schedules used for major remodeling, new construction, bed additions, and bed deletions.
10. Revise section 1.270 on the payment parameters for working capital debt.
11. Revise section 6.110 to clarify that the chart of accounts basis for preparing the uniform cost report must be acceptable to the Department.
12. Modify policies affected by section 4.000 to address payment rate modifications and adjustments effective July 1, 1996.
13. Revise section 3.115 on the reclassification of Medicare patient days to Intensive Skilled Nursing patient days.
14. Modify section 3.775 to update the Intergovernmental Transfer Program provisions.
15. Modify section 1.281 to adjust payments for therapy space to ensure that Medicaid is secondary payor to Medicare and payments reflect equitable share of overhead-related payments.
16. Revise section 3.110 to permit separate ICF 1 and ICF 2 rates.
17. Revise section 3.110 to allow setting a composite rate for ICF 3 and ICF 4 residents.
Copies of the Proposed Changes
Copies of the proposed changes are available free of charge by writing to:
Attention: Nursing Home State Payment Plan
Bureau of Health Care Financing
Division of Health
PO Box 309
Madison, WI 53701-0309
The proposed changes may be reviewed at the main office at any county department of social services or human services.
Written Comments/Meetings
Written comments on the proposed changes may be sent to the Bureau of Health Care Financing, Division of Health, at the above address. The comments will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 250 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changes based on comments received. There will also be public meetings to seek input on the proposed plan amendment. If you would like to be sent a public meeting notice, please write to the above address. Revisions may also be made in the proposed changes based on comments received at the public meetings.
Public Notice
Health & Social Services
(Medical Assistance Reimbursement of Hospitals)
The State of Wisconsin reimburses hospitals for medical services provided to low-income persons under the authority of Title XIX of the Federal Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. Medicaid or Medical Assistance (MA) is administered by the State's Department of Health and Social Services (which will be renamed the Department of Health and Family Services effective July 1, 1996). Federal statutes and regulations require state plans, one for outpatient services and one for inpatient services, which provide the methods and standards for paying for hospital outpatient and inpatient services.
State plans are now in effect for the reimbursement of outpatient hospital services and inpatient hospital services. The Department is proposing to make several changes in these plans effective July 1, 1996.
Proposed changes in the state plan for reimbursement for outpatient hospital services may include:
1. Revision of the rural hospital adjustment percentages to ensure that payments do not exceed authorized funds.
2. Modification of the retrospective final settlement of outpatient reimbursement to include the rural hospital adjustment in the reimbursement which is limited to the hospital's cost of providing outpatient services in order to comply with s. 49.45 (3) (e) 4.,Wisconsin Statutes.
3. For outpatient services provided by hospitals not located in Wisconsin, reduction of payment to reflect the level of payment provided instate hospitals.
4. For hospitals not located in Wisconsin, clarification that reimbursement for outpatient laboratory services is limited to the laboratory fee schedule of the Medicaid program.
5. Modification of qualifying criteria, as mandated by the state's 1995-1997 biennial budget, to allow a hospital not operated by a county to receive an indigent care allowance if the hospital contracts with a county-administered general assistance program to serve persons covered by the county's general assistance program and provides a significant proportion of its services to such persons.
6. To carry out mandates of the 1995-1997 biennial budget, adjustment of the criteria for determining that a hospital provides a significant proportion of its services to low-income persons and modification of the methodology for determining the indigent care allowance.
7. For hospitals that combine into one hospital operation either through merger or consolidation or for a hospital that absorbs the operation of another hospital through purchase or donation, establishment of a methodology to combine the financial and statistical data of the individual hospitals to determine if the combined or absorbing hospital qualifies for the indigent care allowance in order to implement mandates of the 1995-1997 biennial budget.
8. Adjustment of the maximum funding for indigent care allowances to that available under the 1995-1997 biennial budget and modification of the methodology for determining indigent care allowances to maintain compliance with federal payment limits.
9. Modification of supplemental payments to essential access city hospitals (EACH) to maintain compliance with federal upper-limits on payments to hospitals.
10. With Medicaid and Medicare cost reporting encompassed in the same cost reporting form, changing the due date by which a hospital must submit its cost report to coincide with Medicare due date requirements to promote administrative efficiency of hospitals.
11. Modification of administrative adjustment procedures for outpatient reimbursement and elimination of the administrative adjustments committee, in order to promote administrative efficiency by eliminating procedural requirements which are not needed under the current rate-setting methodology.
12. To promote administrative efficiency, addition of policies and procedures by which a hospital would be required to request review and modification of how Department staff are carrying out provisions of the outpatient rate setting methodology before the hospital could pursue legal review through administrative hearing or court appeal.
13. Modification of the calculation for a case mix administrative adjustment to more appropriately recognize the cost of a change in outpatient case mix.
Proposed changes in the state plan for reimbursement for inpatient hospital services may include:
1. For the payment system which is based on diagnosis-related groups (DRGs), adjustment of DRG weighting factors, standard DRG base rates, area wage indices, and capital and medical education payments to implement the average rate adjustment provided by the 1995-1997 biennial budget.
2. Adjustment of payment rates and payment maximums for AIDS treatment, ventilator care and brain injury treatment to implement the average rate adjustment provided by the 1995-1997 biennial budget.
3. Revision of the rural hospital adjustment percentages to ensure that payments do not exceed authorized funds.
4. Updating the disproportionate share adjustment parameters to recognize the more current proportion of services provided by hospitals to Medicaid recipients.
5. Modification of supplemental payments to essential access city hospitals (EACH) to maintain compliance with federal upper-limits on payments to hospitals.
6. Modification of qualifying criteria, as mandated by the state's 1995-1997 biennial budget, to allow a hospital not operated by a county to receive an indigent care allowance and a general assistance disproportionate share supplement if the hospital contracts with a county-administered general assistance program to serve persons covered by the county's general assistance program and provides a significant proportion of its services to such persons.
7. Adjustment of the criteria for determining that a hospital provides a significant proportion of its services to low-income persons and modification of the methodology for determining the indigent care allowance and the general assistance disproportionate share supplement to implement mandates of the 1995-1997 biennial budget.
8. For hospitals that combine into one hospital operation either through merger or consolidation or for a hospital that absorbs the operation of another hospital through purchase or donation, establishment of a methodology to combine the financial and statistical data of the individual hospitals to determine if the combined or absorbing hospital qualifies for the indigent care allowance and a general assistance disproportionate share supplement in order to implement mandates of the 1995-1997 biennial budget.
