Public Notices
Department of Health Services
(Medical Assistance Reimbursement of Nursing Homes)
State of Wisconsin Medicaid Nursing Facility Payment Plan: FY 09-10
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 are effective July 1, 2009. Some items may require legislative action and approval.
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 in the Wisconsin 2009-2011 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 $50,176,900 all funds, ($35,347,475 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. This notice represents information known as of June 10, 2009.
The proposed changes are as follows:
1.
Modify the methodology to adjust the reimbursement for nursing homes within the parameters of 2009-2011 Biennial Budget Bill and to disburse the $50,176,900 allotted in the bill to a rate increase of approximately 2% for nursing homes and 2% 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. Modifying 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,
1.303, and
1.314 to reflect the 2009-2010 period.
5. Modify contact names and addresses.
6.
Modify Section
2.140 to specify which residents will be included in the quarterly patient-day census.
7.
Delete Sections
3.657 and
5.960 regarding Pressure Sore Prevention Incentive.
8.
Replace the Behavior / CI Allowance with a Provider Incentive. The new Incentive shall be based on the Medicaid FFS residents' behavioral scores from the cost report period. Revise Sections
2.140,
2.7000,
3.122,
3.127,
3.128 and
5.460 and create a new sub-section in Section
3.600 accordingly.
9.
Delete Section
1.400 and any reference to Nursing Home Appeals Board.
10.
Modify Section
3.510 to identify nominal asset value on purchase.
11.
Modify Section
3.050 to exclude all restricted use beds from rate setting.
12.
Modify Sections
3.775 and
3.780 to reflect possible changes in the calculation of the Medicare Upper Limit. The calculation should reflect that the Supplemental Payment will use the CPE's methodology of adjusting for case mix.
13.
Modify Section
3.124 to reflect the calculation of the direct care allowance by comparing the case-mix-neutral (CMN) Nursing Services Expense to a range of Nursing Services Targets.
14.
Create a section to define a three-year moving average of the labor factors in Section
5.410.
15. Modify sections 1.282, 3.801, 6.310, 6.320 concerning medical transportation.
16.
Modify Section
5.940, the Medicaid Access Incentive.
18. Modify 2.250 to re-define amounts payable under Administrative and General Services.
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.
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.
