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.
