Public notices
Health and Family Services
(Medical Assistance Reimbursement of Nursing Homes)
State of Wisconsin Medicaid Nursing Facility Payment Plan: FY 04-05
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 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.
The Department is proposing changes in the methods of setting rates for payment to nursing homes and, therefore, in the plan describing the nursing home reimbursement system. The changes are effective July 1, 2004.
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. Several new policy proposals such an an incentive for phasing out entire facilities and are quality-of-care incentives are included. 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 Medicaid residents is approximately $23,314,000 all funds, ($13,601,400 FFP), excluding patient liability.
The proposed changes implement 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 $23,314,000 allotted in the bill through a rate increase of approximately 2.6 percent. 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, the inflation and deflation factors in Section
5.300, and targets in Sections
3.000 and
5.000.
2. Changing references to previous years for descriptive reasons will be done where necessary.
3. Adjust the labor factors listed in Section
5.410.
4. Delete the minimum occupancy factor in Section
3.030.
5. Change the dates in 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 2004-2005 period.
6. Establish an incentive for phasing out entire facilities in Section
4.580.
8. Modify the targets in the property allowance in Section
3.532.
9. 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 Medicaid patient days.
10. Revise the inflation percentages for property tax and municipal fees in Section
5.710.
11. Change the base allowance and the incentive for the Exceptional Medicaid/Medicare Utilization incentive in Sections
5.920 and
2.710.
12. Create a new cost center combining Support Services, Administration and Fuel and Utilities into a single cost center.
13. Eliminate the over-the-counter Drugs cost center and adjust the payment for Direct Care Supplies and Services.
14. Eliminate the labor adjustment factor for Direct Care Supplies and Services.
15. Create a quality-of-care incentive in Section
2.700.
17. Modify Section
4.500 to allow payment adjustments for a group of facilities with a common operator or common ownership, if they close a facility and have a significant reduction in Medicaid residents.
18. Modify cost report for ICF's-MR.
19. Establish a standard allowance for employee meals allocated to fringe benefits or stop treating employee meals as a fringe benefit.
20. Eliminate the individualized plan of care requirement for the Specialized Rehabilitation Psychiatric Services.
21. Clarify Direct Care language in Section
2.110.
22. Clarify definitions in Sections
3.500 and
5.810.
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
P.O. Box 309
Madison, WI 53701-0309
Attention: Nursing Home Medicaid Payment Plan or by faxing James Cobb at 608-264-7720The 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.
