Public notice
Elections Board
Pursuant to 42 USC 15406, notice is given that the State Elections Board has made available a preliminary version of the State Plan for public comment. A copy of the preliminary plan and the Help America Vote Act of 2002 can be obtained at the State Elections Board website:
http://elections.state.wi.us.
A copy of the preliminary plan may also be obtained by contacting the State Elections Board.
Written comments may be submitted to the State Elections Board at:
Wisconsin State Elections Board
132 East Wilson Street, Suite 200
PO Box 2973
Madison, WI 53701-2973
608-266-8005
608-267-0500
Date, Time and Place of Hearings
Wednesday, May 21, 2003 at 9:30 a.m.
Brookfield Public Safety Building
Municipal Courtroom
2100 North Calhoun Road
Brookfield, Wisconsin
Wednesday, June 4, 2003 at 1:00 p.m.
State Capitol Building
Room 225 NW
Madison, Wisconsin
Monday, June 9, 2003 at 1:00 p.m.
Eau Claire County Courthouse
County Boardroom, Room 2560
721 Oxford Avenue
Eau Claire, Wisconsin
The hearing sites are accessible to persons with disabilities.
The State Plan is required as a condition for the receipt of federal funds under the Help America Vote Act of 2002 (HAVA). P.L. 107-252. HAVA was enacted by Congress to make sweeping reforms in the way elections are conducted. The Act addresses improvements to voting systems and voter access. It includes requirements for a centralized voter registration database, privacy and independence in the voting process, access for people with disabilities and voter outreach.
The State Elections Board will take public comments into account when preparing the State Plan to be filed with the federal Election Assistance Commission. The deadline for submitting written comments on the preliminary State Plan is June 20, 2003.
Health and Family Services
(Medical Assistance Reimbursement of Nursing Homes)
State of Wisconsin Medicaid Nursing Facility Payment Plan: FY03-04
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 Family Services, 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 is now in effect as approved by the Center for Medicare/Medicaid Services (CMS).
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, 2003.
The proposed changes would update the payment system and make various payment-related policy changes. Some of the changes are necessary to implement various budget policies contained in the Wisconsin 2003-2005 Biennial Budget. Some of the changes are technical in nature, while others clarify various payment plan provisions.
The estimated increase in annual aggregate expenditures attributable to these changes for nursing homes serving MA residents is approximately $81,070,040 all funds, ($47,357,473 FFP), excluding patient liability.
The proposed changes are being implemented to comply with Wisconsin Statutes governing Medicaid payment systems, particularly s.
49.45 (6m), Wis. Stats.
The proposed changes are as follows:
1. Modify the methodology to adjust the reimbursement for nursing homes within the parameters of 2003-2005 Biennial Budget Bill and to disburse the $81,070,040 allotted in the bill to a rate increase of approximately 7.9%. These modifications will include adjustments to the maximums, per diems, and other payment parameters in Sections
5.400,
5.500,
5.600,
5.700,
5.800 and
5.900, changes in the occupancy percentage used to establish the minimum occupancy standard in Sections
3.030, the inflation and deflation factors in Section
5.300, and targets in Sections
3.000 and
5.000.
2. Change references to previous years for descriptive reasons will be done where necessary.
3. Update the labor regions listed in Section
5.410.
4. Modify the minimum occupancy factor in Section
3.030.
5. Change the dates of the definitions of base cost reporting period, common period, and rate payment year in Sections
1.302,
1.303 and
1.314 to reflect the 2003-2004 period.
6. Change the phasedown method in Section
4.520 for new agreements or extensions of current agreements after July 1, 2003.
7. Establish an incentive for phasing out entire facilities in Section
4.580.
8. Increase the Exceptional Medicaid/Medicare Utilization Incentive in Section
2.710.
9. Clarify the annual bed bank loss language in Section
3.060.
11. Modify the targets in the property allowance in Section
3.532.
12. Modify Section
3.775, which deals with non-state operated government-owned facilities, to accommodate changes in cost finding and rate setting methods. Payment would be distributed primarily based on the amount Medicare would pay for comparable services at each facility less the Medicaid payment to that facility.
13. Revise the inflation percentages for property tax and municipal fees in Section
5.710.
14. Increase the base allowance for the Exceptional Medicaid/Medicare Utilization incentive in Section
5.920.
15. Redefine the cost-based direct care cost center in Sections
2.100 and
3.100 to include only RN, LPN, certified nurse assistants' costs and the resident living staff costs. Certified nurse assistants in the 90-day training period and single task workers would also be included.
16. Create a new component in direct care for ward clerks, over-the-counter drugs and the special services on schedule 21 & 24. This would be a level of care/case mix-adjusted payment component adjusted by the labor factors in Section
5.410 with an incentive.
17. Modify Section
3.90 to allow the payment to the Veteran?s Home at King to equal what that home could receive at the maximum of its Medicare Upper Limit.
18. Delete the energy & renovation private room incentives in Section
2.700.
19. Create a quality-of-care incentive in Section
2.700.
21. Create a payment supplement in section 3.100 for specialized rehabilitative services for residents with mental illness.
22. Amend section 3.900 to allow state-operated facilities to receive incentives in section 3.650.
Copies of the Proposed Changes:
Copies of the available proposed changes and proposed rates may be obtained free of charge by writing to:
Division of Health Care Financing
PO Box 309
Madison, WI 53701-0309
Attention: Nursing Home Medicaid Payment Plan
or by faxing your request to James Cobb at 608-264-7720.
The available 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 Division of Health Care Financing, 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 350 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 these forums.
Health and Family Services
(Medical Assistance Reimbursement for Intermittent Skilled Nursing Services Provided by Nurses in Independent Practice)
The State of Wisconsin reimburses providers for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss.
49.43 to
49.47, Wisconsin Statutes. This program, administered by the State's Department of Health and Family Services, 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 reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is now in effect.
The Department currently reimburses nurses in independent practice for intermittent skilled nursing services at a “visit" rate. Intermittent skilled nursing is for Medicaid recipients who need fewer than eight hours of nursing in a day.
The change would affect only those services provided by nurses in independent practice in those limited situations when they provide intermittent skilled nursing services. Nurses in independent practice may only provide intermittent skilled nursing services if no home health agency is available to provide and coordinate those services. This proposed change does not affect intermittent skilled nursing services provided by home health agencies.
The proposed minimum reimbursement for each intermittent skilled nursing service period would be for one hour of service based on the independent nurse provider rate. The rate is essentially the hourly rate nurses in independent practice receive for private duty nursing, skilled nursing service for those recipients who require eight or more hours of skilled nursing per day.
Reasons for the proposed change
The Department is proposing to modify its methods for calculating reimbursement rates for the following reasons.
Currently, the few nurses in independent practice who have provided these services have been paid a “per visit" rate that was developed specifically for home health agency services. The rate developed and established to reimburse home health agencies for comprehensive services including coordinating, training, and supervising services is inappropriate for the limited services nurses in independent practice are licensed to provide. The current maximum reimbursement rate for a skilled nursing visit is $84.28.
Nurses in independent practice providing intermittent skilled nursing services is an exception that has been requested only on rare occasions.
Fiscal impact of the proposed change
Projected total annual savings would be between $59,690 general purpose revenue (GPR) and $83,830 federal match (FED); and $71,463 GPR and $100, 364 FED, based on the 2002 utilization of intermittent skilled nursing services by the recipients continuing to be served in 2003. The high savings figure represents utilization of LPN-only services and the low figure represents RN-only services.
Proposed Change
The proposed change is to reimburse nurses in independent practice for intermittent skilled nursing services at an hourly rate rather than at the current “visit" rate. The reimbursement will be commensurate with the level of services they are authorized to provide. The change is to become effective August 1, 2003.
Copies of the Proposed Change:
A copy of the proposed change may be obtained free of charge by calling or writing as follows:
Regular Mail
Marge Hannon Pifer
Bureau of Fee-for-Service Health Care Benefits
Division of Health Care Financing
P.O. Box 309
Madison, WI 53701-0309
Phone
Marge Hannon Pifer
(608) 266-1940
FAX
(608) 266-1096
Attention: Marge Hannon Pifer
E-Mail
A copy of the proposed change are also available for review at the main office of any county department of social services or human services.
Written Comments:
Written comments are welcome. Written comments on the proposed changes may be sent by FAX, e-mail, or regular mail to the Department. The FAX number is 608-266-1096. The e-mail address is
pifermh@dhfs.state.wi.us. Regular mail can be sent to the above address. All written comments will be reviewed and considered.
The written comments will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 350 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changed methodology based on comments received.
