Public Notices

public_notices Wisconsin Administrative Register No. 593, 5/31/2005

Public notices

Health and Family Services

(Medical Assistance Reimbursement of Nursing Homes)

State of Wisconsin Medicaid Nursing Facility Payment Plan: FY 05-06

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 (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, 2005.

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 being considered in the Wisconsin 2005-2007 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 $36,747,130 all funds, ($21,313,335 federal financial participation), 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 2005-2007 Biennial Budget Bill and to disburse the $34,479,166 allotted in the bill to a rate increase of approximately 5% for nursing facilities and $2,267,964 allotted in the bill to a rate increase of approximately 3% for ICF-MRs. 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. Change references to previous years for descriptive reasons where necessary.

3. Modify the labor factors listed in Section 5.410.

4. Create a new cost center combining Support Services, Administration and Fuel and Utilities into a single cost center.

5. Change the dates of 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 2005-2006 period.

6. Re-write Section 3.775 Special Allowances for Facilities Operated by Local Units of Government.

7. Modify the calculation for the Medicare Upper Limit in Section 3.780 for ICF-MRs.

8. Modify Section 3.900, Reimbursement of State-Operated Facilities to include tribal-operated facilities.

9. Modify the targets in the property allowance in Section 3.532.

10. Modify Sections 2.710, 3.651 and 5.920, Exceptional Medicaid/Medicare Utilization Incentive to clarify issues concerning the movement of beds and homes in Milwaukee.

11. Delete Sections 1.270 (3) and 1,270 (4), disallowance from working capital interest expense.

12. Modify Section 5.150, All Non-Expendable, Reusable Materials, to differentiate between cushions and seating arrangements in wheelchairs.

13. Modify Section 3.531 (b), Maximum on Equalized Value.

14. Clarify Section 3.802, Ancillary Billable Services, to state that ancillaries mentioned in this section cannot be paid as part of the rate but can be billed by the facilities.

15. Revise Sections 1.256, Hospice and 1.315 Patient Days.

16. Modify Section 3.600, Capital Incentives, to address patient lifts.

17. Modify Section 2.720, Private Room Incentive, to include a due date for filing an affidavit.

18. Create a quality-of-care incentive in Section 2.700, Provider Incentives.

Copies of the Proposed Changes:

Copies of the proposed changes and proposed rates may be obtained free of charge by writing to:

Division of Health Care Financing

Attention: Nursing Home Medicaid Payment Plan

P.O. Box 309

Madison, WI 53701-0309

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/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.

Natural Resources

Notice of Availability of a Legislative Report Relating to Wisconsin's Air State Implementation Plan

All interested persons are advised that the Department of Natural Resources (DNR) intends to submit proposed rules as contained in Natural Resources Board Order AM-46-04 (Clearinghouse Rule No. 04-107) to the United States Environmental Protection Agency (USEPA) for incorporation into Wisconsin's air state implementation plan to meet requirements contained in the Federal Clean Air Act 42 USC 7401, et seq . DNR has submitted these proposed rules establishing programs for registration and general air permits and all supporting information as a report to the legislative standing committees for environmental matters as required under s. 285.14 (2), Stats. Information on AM-46-04 can be viewed on the following website: https://apps4.dhfs.state.wi.us/admrules/public/Rmo?nRmoId=186

If you are unable to make copies of this information from the website and would like copies of the information supplied to the Wisconsin legislative committees, please call Ralph Patterson, DNR, at 608-267-7546 or send a request via email to [e-mail].

Workforce Development

2005 Child Care Copay Schedule

(Effective March 27, 2005)

	Child Care Co-Payment Schedule for Licensed and Certified Care
	Look down the column of the appropriate family size until you find the gross family monthly income level at or just less than the family income. Look to the right to find the appropriate co-payment by family and type of care.
	Gross Monthly Family Income- Family Size:									Weekly Licensed Care Co-Pay Amount Children in Subsidized Care:					Weekly Certified Care Co-Pay Amount Children in Subsidized Care:
	2	3	4	5	6	7	8	9	10 or more	1	2	3	4	5 or more	1	2	3	4	5 or more
70% FPL	748	939	1129	1319	1509	1699	1889	2080	2270	5	8	13	16	21	2	6	9	12	15
75% FPL	802	1006	1209	1413	1617	1821	2024	2228	2432	5	11	15	20	24	4	7	10	14	16
80% FPL	855	1073	1290	1507	1725	1942	2159	2377	2594	7	12	17	22	27	6	8	12	16	19
85% FPL	909	1140	1371	1602	1832	2063	2294	2525	2756	11	15	20	25	32	7	11	14	18	21
90% FPL	962	1207	1451	1696	1940	2185	2429	2674	2918	12	19	24	30	36	8	13	16	21	26
95% FPL	1016	1274	1532	1790	2048	2306	2564	2822	3080	15	22	29	36	42	11	16	21	24	30
100% FPL	1069	1341	1613	1884	2156	2428	2699	2971	3243	17	25	32	40	46	12	16	22	27	33
105% FPL	1123	1408	1693	1978	2264	2549	2834	3119	3405	20	27	35	42	49	14	19	24	29	35
110% FPL	1176	1475	1774	2073	2371	2670	2969	3268	3567	22	30	36	44	51	16	21	26	30	36
115% FPL	1230	1542	1854	2167	2479	2792	3104	3416	3729	25	32	40	47	54	17	22	28	33	39
120% FPL	1283	1609	1935	2261	2587	2913	3239	3565	3891	27	35	42	49	57	19	25	29	35	40
125% FPL	1336	1676	2016	2355	2695	3034	3374	3714	4053	30	38	45	51	61	21	26	32	36	43
130% FPL	1390	1743	2096	2449	2803	3156	3509	3862	4215	32	41	49	58	66	22	28	35	40	46
135% FPL	1443	1810	2177	2544	2910	3277	3644	4011	4377	35	44	54	64	72	25	30	38	44	50
140% FPL	1497	1877	2258	2638	3018	3399	3779	4159	4540	37	47	57	66	77	26	33	40	47	53
145% FPL	1550	1944	2338	2732	3126	3520	3914	4308	4702	40	49	58	69	79	28	35	41	49	55
150% FPL	1604	2011	2419	2826	3234	3641	4049	4456	4864	42	51	62	71	82	29	36	43	50	57
155% FPL	1657	2078	2499	2920	3342	3763	4184	4605	5026	44	54	64	73	84	30	39	44	52	58
160% FPL	1711	2145	2580	3015	3449	3884	4319	4753	5188	47	57	67	77	87	33	40	47	54	61
165% FPL	1764	2212	2661	3109	3557	4005	4454	4902	5350	48	59	69	78	89	34	41	49	55	62
170% FPL	1818	2279	2741	3203	3665	4127	4589	5050	5512	49	62	71	82	91	35	43	50	57	63
175% FPL	1871	2346	2822	3297	3773	4248	4724	5199	5674	50	63	74	84	93	35	44	51	58	65
180% FPL	1925	2414	2903	3392	3881	4370	4859	5348	5837	53	66	77	87	96	36	47	54	61	68
185% FPL	1978	2481	2983	3486	3988	4491	4993	5496	5999	54	67	79	88	98	37	49	55	62	69
	<<<---------- +185% of the Federal Poverty Level ------------->>>
190% FPL	2031	2548	3064	3580	4096	4612	5128	5645	6161	55	69	82	91	100	40	50	57	63	71
195% FPL	2085	2615	3144	3674	4204	4734	5263	5793	6323	57	71	84	93	104	40	52	59	66	72
200% FPL	2138	2682	3225	3768	4312	4855	5398	5942	6485	59	72	86	96	105	41	54	61	67	73
	<<<---------- +200% of the Federal Poverty Level ------------->>>

Note: The copayment rate for teen parents who are not Learnfare participants is minimum copay and is found by selecting the lowest income line (70%) FPL and then finding the copayment listed, under either licensed care or certified care, for the appropriate number of children. Parents who have left a W-2 employment position for unsubsidized work also qualify for the minimum copay for one month. Families with children who are authorized for 20 hours or less are subject to one half of their share of the family copay listed above for those children. No copay is required for parents who participate in Learnfare or Food Stamp Employment and Training. Foster parents do not have a copayment responsibility for the foster children in their care. Kinship care relatives caring for a child under a court order do not have a copayment responsibility. Kinship care relatives caring for a child without a court order pay the minimum copay, unless they are receiving a child care subsidy for another child who is subject to a copayment greater than the minimum copay.

Note: Pursuant to s. DWD 56.08 (3), the Department of Workforce Development is authorized to adjust the co-pay schedule with publication in the Wisconsin Administrative Register.