PUBLIC NOTICE
Department of Health Services
(Medical Assistance Reimbursement of Nursing Homes)
State of Wisconsin Medicaid Nursing Facility Payment Plan:
July 1, 2016 through June 30, 2017
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 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 proposed would be effective July 1, 2016.
The proposed changes would update the payment system and make various payment-related policy changes.
The estimated net increase in annual aggregate expenditures attributable to these changes for skilled nursing homes serving MA residents is approximately $7,617,400 AF (3,186,300 GPR), 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. This notice represents information known as of June 2, 2016. The changes may be modified by later legislative mandates. The proposed changes are as follows:
1. Modify the methodology to adjust the reimbursement for nursing homes within the parameters of 2015-2017 Biennial Budget Bill, which included a 1% rate increase for increased acuity for state fiscal year (SFY) 2017, as identified above. These modifications will include adjustments to the maximums, per diems, and other payment parameters in Sections 5.400, 5.500, 5.700, 5.800 and 5.900, the inflation and deflation factors in Section 5.300, and targets in Sections 3.000 and 5.000. 2. The methodology will factor in the effect on patient liability of the cost of living adjustment (COLA) increases in Social Security and Supplemental Security Income programs, effective January 1, 2016.
3. Potentially incorporate changes into the rate for ventilator-dependent residents under Section 4.691, as a result of further study the Department is carrying out in this area. 4. Potentially revise the approach to calculating the direct care target maximum by removing the $2 per patient day window, in which facilities whose direct care costs are within $2 of the maximum direct care target are reimbursed at the maximum level.
5. Update the Reporting Period and Dates Available in Sections 4.720, 5.421, and 5.422 6. Modify contact names and addresses, as necessary.
7. Modify references to previous years for descriptive reasons, and correct typographical errors as necessary.
8. Modify the labor factors listed in Section 5.410. 9. Modify the case mix weight listed in Section 5.420. 10. Change the dates of the definitions of base cost reporting period.
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
Bureau of Long Term Care Financing
Attention: Nursing Home Medicaid Payment Plan
P.O. Box 7851
Madison, WI 53703-7851
or by faxing Rene Eastman at 608-266-2713.
Written Comments/Meetings:
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.
