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.
