Health and Family Services
Medical Assistance Reimbursement of Nursing Homes
State of Wisconsin Medicaid Nursing Facility Payment Plan: FY 08-09
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
, 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 Centers for Medicare and 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, 2008.
The proposed changes would update the payment system and make various payment-related policy changes. Some of the changes are necessary to implement provisions in the Wisconsin 2007-2009 Biennial Budget . 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 $36,955,200 all funds, ($21,781,400 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 the 2007-2009 Biennial Budget Bill and to disburse the $35,781,200 allotted in the bill to a rate increase of approximately 5% for nursing facilities and the $1,174,000 allotted for a rate increase of 2% for ICF-MRs. These modifications will include adjustments to the maximums, per diems, and other payment parameters in Sections 5.400
, the inflation and deflation factors in Section 5.300
, and targets in Sections 3.000
2. Changing references to previous years for descriptive reasons will be done where necessary.
3. Modify the labor factors listed in Section 5.410
4. Change the dates of the definitions of base cost reporting period, common period, and rate payment year in Sections 1.302
, and 1.314
to reflect the 2008-2009 period.
5. Modify the targets in the property allowance in Section 3.532
6. Revise contact names and addresses.
7. Revise Section 2.140
to explain which residents will be included in the counts on the dates in Section 5.422
8. Delete Sections 1.256
as they refer to the owner compensation test.
10. Adjust Sections 2.700
to include an incentive for Medicaid patients in a prior approved innovative area
11. Consider payment adjustments for facilities that provide services to bariatric residents.
12. Modify the weighting factors of the RUGs case mix index and the level of care case mix index in Section 3.100
to complete the transition RUGs as the primary case mix factor.
13. Eliminate all references to the level of care and the level of care case mix index.
14 Modify the direct care calculation in 3.100 to eliminate the common period base plus the inflation increment and create a single reimbursement period allowance.
15. Clarify the allocation of direct care expense between nursing facilities and ICF-MRs for facilities with combined cost reports
16. Explore alternative mechanisms to implement the regional labor factors in Section 5.400
17. Eliminate Sections 2.750
, the temporary inflation adjustment for ICF-MRs.
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 Long Term Care
Attention: Nursing Home Medicaid Payment Plan
P.O. Box 7851
Madison, WI 53703-7851
or by faxing 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 on the proposed changes may be sent to the Division of Long Term Care, 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 B274 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.