(6) REQUIRED COUNTY FUNDING OF SERVICES. The creation of section 49.45 (30m) (a) 2. and (c) of the statutes first applies to services provided to an individual who is initially placed in a facility under a petition for protective placement that is filed on, a transfer under section 55.06 (9) of the statutes that is made on, or a temporary protective placement under section 55.06 (11) (c) of the statutes that occurs on, April 1, 2004, or to a person who is initially placed in a facility before April 1, 2004, with respect to whom a review under section 55.06 (10) of the statutes is due on April 1, 2004.
(7) LIMITATION ON PAYMENT. The creation of section 49.45 (30m) (b) of the statutes first applies with respect to services under section 49.45 (30m) (a) 1. and 3. of the statutes that are provided to an individual on April 1, 2004.
SECTION 9424. Effective dates; health and family services.
(1) PLACEMENTS AND ADMISSIONS TO INTERMEDIATE AND NURSING FACILITIES. The treatment of sections 46.279, 49.45 (6c) (a) 6m., (b), and (c) (intro.), 1., 2., and 3., 49.46 (2) (a) 4. c. and (b) 6. a., 55.001, 55.01 (4g) and (4t), 55.045, and 55.06 (5), (8) (intro.), (9) (a), (b), and (c), and (11) (c) of the statutes, the renumbering of section 55.06 (10) (a) of the statutes, the renumbering and amendment of section 49.45 (30m) of the statutes, and the creation of sections 49.45 (30m) (a) 1., 2., and 3., (b), and (c) and 55.06 (10) (a) 2. of the statutes take effect on January 1, 2004.
(End)
LRB-0210LRB-0210/4
DAK:cjs&wlj:pg
2003 - 2004 LEGISLATURE
DOA:......Blaine - BB0049, Nursing home payment formula changes
For 2003-05 Budget -- Not Ready For Introduction
2003 BILL
AN ACT ...; relating to: changes to the formula for payment to nursing homes for services to medical assistance recipients.
Analysis by the Legislative Reference Bureau
health and human services
Medical Assistance
Under current law, payments to nursing homes for services to recipients under the Medical Assistance (MA) program, are made under a cost-based formula that considers certain costs of individual nursing homes, based on information from reports that the nursing homes submit to DHFS. The formula specifies cost centers of direct care, support services, fuel and utilities, net property tax or municipal services, administrative and general costs, interest expenses, and necessary capital payments. For direct care costs, DHFS must use standards that sample nursing homes in the state, as adjusted for regional labor cost variations. For nursing homes in Douglas, Pierce, and St. Croix counties, DHFS uses a federal Medicare program hospital wage index. To calculate a nursing home's payment rate, DHFS establishes a tentative payment rate by applying to information from nursing home cost reports certain standards and methods in calculating amounts payable for a rate year for the cost centers. DHFS then compiles a tentative average payment rate for each nursing home based on that nursing home's rates for cost centers that were in effect on June 30, 1994. Next, DHFS calculates a nursing home's projected cost per patient day. If the tentative payment rate is less than the tentative average payment rate, and if the projected cost per patient day is more than the tentative payment rate, DHFS sets the nursing home's average payment rate as the tentative average payment rate or the tentative payment rate, whichever is greater; if not, DHFS sets the nursing home's average payment rate as the tentative payment rate.
This bill requires DHFS to make a flat-rate payment for MA nursing home costs, as determined by DHFS, for personal comfort supplies and allowable support service costs. Beginning July 1, 2004, this bill requires MA payment to nursing homes to be made on a flat-rate basis for support services (dietary services, environmental services, fuel and utilities, administrative and general costs) and direct care costs (personal comfort supplies, medical supplies, over-the-counter drugs and nonbillable services for ancillary nursing home personnel). Under the bill, the cost centers on which cost-based payment will continue to be made are nonbillable direct care costs for registered nurses, licensed practical nurses, and nurse's assistants; property tax or municipal services; interest expenses; and necessary capital payments. The bill combines the cost centers identified as support services, fuel and utilities, and administrative and general costs into a single cost center and clarifies that "costs for property taxes and municipal services" refer to paid, rather than incurred, costs.
Lastly, the bill changes the procedure by which DHFS calculates a nursing home's payment rate, to require a calculation that is achieved by applying, to information from cost reports submitted by a nursing home, general standards for the nursing home payment system, information concerning the applicable cost centers, and costs for direct care, property taxes, municipal services, and capital payment, as affected by any adjustment necessary for charges for ancillary services and materials.
For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 49.45 (6m) (a) 4. of the statutes is repealed.
SECTION 2. 49.45 (6m) (ag) 2. of the statutes is amended to read:
49.45 (6m) (ag) 2. Standards Except as provided in subd. 3r., standards established by the department that shall be based upon allowable costs incurred by facilities in the state as available from information submitted under par. (c) 3. and compiled by the department.
SECTION 3. 49.45 (6m) (ag) 3m. of the statutes is amended to read:
49.45 (6m) (ag) 3m. For each state fiscal year 1999-2000, rates that shall be set by the department based on information from cost reports for the 1998 most recently completed fiscal year of the facility and for state fiscal year 2000-01, rates that shall be set by the department based on information from cost reports for the 1999 fiscal year of the facility.
SECTION 4. 49.45 (6m) (ag) 3m. of the statutes, as affected by 2003 Wisconsin Act .... (this act), is amended to read:
49.45 (6m) (ag) 3m. For each state fiscal year, rates that shall be set by the department based on information from cost reports for costs specified under par. (am) 1. bm., 4., 5m., and 6. for the most recently completed fiscal year of the facility.
SECTION 5. 49.45 (6m) (ag) 3r. of the statutes is created to read:
49.45 (6m) (ag) 3r. Flat-rate payment, as determined by the department, for costs specified under par. (am) 1. a. and 2.
SECTION 6. 49.45 (6m) (ag) 3r. of the statutes, as created by 2003 Wisconsin Act .... (this act), is amended to read:
49.45 (6m) (ag) 3r. Flat-rate payment, as determined by the department, for all costs specified under par. (am) 1. a. and 2.
SECTION 7. 49.45 (6m) (am) 1. a. of the statutes is amended to read:
49.45 (6m) (am) 1. a. Personal comfort supplies; medical supplies; over-the-counter drugs; and nonbillable services of a ward clerk, activity person, recreation person, social worker, volunteer coordinator, teacher for residents aged 22 and older, vocational counselor for residents aged 22 and older, religious person, therapy aide, therapy assistant, and counselor on resident living.
SECTION 8. 49.45 (6m) (am) 1. b. of the statutes is repealed.
SECTION 9. 49.45 (6m) (am) 1. bm. of the statutes is created to read:
49.45 (6m) (am) 1. bm. Nonbillable services of a registered nurse, licensed practical nurse and nurse's assistant.
SECTION 10. 49.45 (6m) (am) 1. d. of the statutes is repealed.
SECTION 11. 49.45 (6m) (am) 1. e. of the statutes is repealed.
SECTION 12. 49.45 (6m) (am) 3. (intro.) of the statutes is renumbered 49.45 (6m) (am) 2. c. and amended to read:
49.45 (6m) (am) 2. c. Allowable fuel and utility costs, including the facility expenses that the department determines are allowable for the provision of: electrical service, water and sewer services, and heat.
SECTION 13. 49.45 (6m) (am) 3. a. of the statutes is repealed.
SECTION 14. 49.45 (6m) (am) 3. b. of the statutes is repealed.
SECTION 15. 49.45 (6m) (am) 3. c. of the statutes is repealed.
SECTION 16. 49.45 (6m) (am) 4. of the statutes is amended to read:
49.45 (6m) (am) 4. Net property Property tax or allowable municipal service costs incurred paid by the owner of the facility for the facility.
SECTION 17. 49.45 (6m) (am) 5. of the statutes is renumbered 49.45 (6m) (am) 2. d.
SECTION 18. 49.45 (6m) (ar) 1. a. of the statutes, as affected by 2003 Wisconsin Act .... (this act), is amended to read:
49.45 (6m) (ar) 1. a. The department shall establish standards for payment of allowable direct care costs under par. (am) 1. bm., for facilities that do not primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state and separate standards for payment of allowable direct care costs, for facilities that primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state. The standards shall be adjusted by the department for regional labor cost variations.
****NOTE: This is reconciled s. 49.45 (6m) (ar) 1. a. This SECTION has been affected by drafts with the following LRB numbers: LRB-0210/3 and LRB-1252/2.
SECTION 19. 49.45 (6m) (ar) 2. (intro.) and 2. a. of the statutes are consolidated, renumbered 49.45 (6m) (ar) 2. and amended to read:
49.45 (6m) (ar) 2. For support service costs: 2. a. The , the department shall establish one or more standards for the payment of support service costs that take into account support service costs for a sample of all facilities within the state.
SECTION 20. 49.45 (6m) (ar) 2. b. of the statutes is repealed.
SECTION 21. 49.45 (6m) (ar) 2. d. of the statutes is repealed.
SECTION 22. 49.45 (6m) (ar) 3. of the statutes is repealed.
SECTION 23. 49.45 (6m) (ar) 5. of the statutes is repealed.
SECTION 24. 49.45 (6m) (av) 1. of the statutes is renumbered 49.45 (6m) (av) and amended to read:
49.45 (6m) (av) The department shall calculate a payment rate for a facility by applying the criteria set forth under pars. (ag) 1. to 5. and 7., (am) 1. to 5. bm., 4., 5m. and 6., and (ar) 1. to 5. , 4., and 6. to information from cost reports submitted by the facility, as affected by any adjustment for ancillary services and materials under par. (b).
SECTION 25. 49.45 (6m) (av) 2. of the statutes is repealed.
SECTION 26. 49.45 (6m) (av) 3. of the statutes is repealed.
SECTION 27. 49.45 (6m) (av) 4. of the statutes is repealed.
SECTION 28. 49.45 (6m) (av) 5. of the statutes is repealed.
SECTION 29. 49.45 (6m) (av) 5m. of the statutes is repealed.
SECTION 30. 49.45 (6m) (av) 6. of the statutes is repealed.
SECTION 31. 49.45 (6m) (bc) of the statutes is repealed.
SECTION 9424. Effective dates; health and family services.
(1) NURSING HOME PAYMENT FORMULA. The treatment of section 49.45 (6m) (ag) 2. and 3m. (by SECTION 4), (am) 1. a., b., bm., d., and e., 3. (intro.), a., b., and c., and 5., (ar) 1. a. (by SECTION 18), 2. (intro.), a., b., and d., 3., and 5., (av) 1., 2., 3., 4., 5., 5m., and 6., and (bc) of the statutes and the amendment of section 49.45 (6m) (ag) 3r. of the statutes take effect on July 1, 2004.
(End)
LRB-0211LRB-0211/5
DAK:jld:pg
2003 - 2004 LEGISLATURE
DOA:......Jablonsky - BB0050 Intensive treatment beds at centers for developmentally disabled
For 2003-05 Budget -- Not Ready For Introduction
2003 BILL
AN ACT ...; relating to: extended intensive treatment services at the state centers for the developmentally disabled and making an appropriation.
Analysis by the Legislative Reference Bureau
health and human services
Mental illness and developmental disabilities
Under current law, the state centers for the developmentally disabled may provide, among other services, intensive treatment services for up to 50 individuals with developmental disabilities who are also diagnosed as mentally ill or who exhibit extremely aggressive and challenging behaviors.
This bill removes the limit on the number of individuals who may be provided intensive treatment services at the state centers for the developmentally disabled. However, the bill conditions receipt of those services on a determination by DHFS that a licensed bed and necessary resources are available and on an agreement between DHFS and the individual's county of residence concerning a maximum discharge date for the individual. The bill also authorizes DHFS to impose on counties that pay for these services a progressive surcharge of an additional 10% of the amount paid under Medical Assistance (MA) for the intensive treatment services, for any part of the six-month period that an individual receives the services beyond the discharge date agreed upon by DHFS and the individual's county of residence. For each subsequent six-month period during any part of which the individual receives the services, the surcharge is increased by an additional 10%. From the moneys received under this surcharge, DHFS may provide payment to counties for one-time costs associated with relocating individuals into communities from state centers for the developmentally disabled under waiver of laws of the federal MA program (commonly known as "Medicaid").
For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 20.435 (2) (gL) of the statutes is created to read:
20.435 (2) (gL) Extended intensive treatment surcharge. All moneys received as payments of the surcharge for extended intensive treatment under s. 51.06 (5), for one-time payment of relocation costs for individuals under s. 46.275 (5) (e).
****NOTE: This SECTION involves a change in an appropriation that must be reflected in the revised schedule in s. 20.005, stats.
SECTION 2. 46.275 (5) (e) of the statutes is created to read:
46.275 (5) (e) From the appropriation under s. 20.435 (2) (gL), the department may provide moneys to a county to pay for one-time costs associated with the relocation under this section of an individual from a state center for the developmentally disabled.
SECTION 3. 51.06 (1m) (d) of the statutes is amended to read:
51.06 (1m) (d) Services for up to 50 individuals with developmental disability who are also diagnosed as mentally ill or who exhibit extremely aggressive and challenging behaviors.
SECTION 4. 51.06 (3) of the statutes is renumbered 51.06 (3) (a) and amended to read:
51.06 (3) (a) Individuals Subject to par. (b), individuals under the age of 22 years shall be placed only at the central center for the developmentally disabled unless the department authorizes the placement of the individual at the northern or southern center for the developmentally disabled.
SECTION 5. 51.06 (3) (b) of the statutes is created to read:
51.06 (3) (b) An individual may be placed at a center for the developmentally disabled for services under sub. (1m) (d) only after all of the following conditions are met:
1. The department determines that a licensed bed and other necessary resources are available to provide services to the individual.
2. The department and the county of residence of the individual agree on a maximum discharge date for the individual.
SECTION 6. 51.06 (5) of the statutes is created to read:
