Copies of the proposed change will be sent to every county social services or human services department main office where they will be available for public review. For more information, interested people may write to:
State Plan Coordinator
Bureau of Health Care Financing
Division of Health
P.O. Box 309
Madison, WI 53701-0309
Written Comments
Written comments on the proposed change are welcome. Comments should be sent to the above address. Comments received on the change will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily at:
Bureau of Health Care Financing
Room 250, State Office Building
One West Wilson Street
Madison, WI
Public Notice
Health & Social Services
(Medical Assistance Reimbursement of Providers of Prenatal Care Coordination Services)
The State of Wisconsin reimburses providers for prenatal care coordination services provided to Medical Assistance (MA) recipients. This is done under the authority of Title XIX of the Federal Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. Medical Assistance (MA) or Medicaid is administered by the State's Department of Health and Social Services (which will be re-named Department of Health and Family Services on July 1, 1996). Federal statutes and regulations require that a state plan be developed that provides the methods and standards for reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is now in effect.
Currently, the target group for prenatal care coordination services includes pregnant women throughout the state who are expected to have difficulty receiving proper medical, social, educational, and other services and who are at high risk for adverse pregnancy outcomes, such as preterm births or low birth weight babies, due to medical and non-medical factors, as determined by the Department's risk assessment. All recipients remain in the target group at least until 60 days after delivery.
Effective July 1, 1996, the Department will expand the target group for prenatal care coordination services to also include Milwaukee County postpartum women and their infants who are at high risk for child abuse and neglect as determined by the Department. These recipients remain in the target group until the child is 7 years old.
This modification of the target group for the services is estimated to increase annual expenditures of the Wisconsin Medical Assistance Program by $2,863,000 all funds ($1,154,700 GPR and $1,708,300 FFP).
Copies of the Proposed Change
Copies of the proposed change will be sent to every county social services or human services department main office where they will be available for public review. For more information, interested people may write to:
State Plan Coordinator
Bureau of Health Care Financing
Division of Health
P.O. Box 309
Madison, WI 53701-0309
Written Comments
Written comments on the proposed change are welcome. Comments should be sent to the above address. Comments received on the change will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily at;
Bureau of Health Care Financing
Room 250, State Office Building
One West Wilson Street
Madison, WI
Public Notice
Health and Social Services
(Medical Assistance Reimbursement of Nursing Homes)
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 Social Services (which will be re-named the Department of Health and Family Services on July 1, 1996), 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 (methods of payment for costs incurred by efficiently and economically operated providers) is now in effect as approved by the federal Health Care Financing Administration (HCFA).
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, 1996.
The proposed changes would update the payment system and make various payment-related policy changes, including modifications requested by HCFA in its approval of the 1995-1996 nursing facility payment plan. Some of the changes are necessary to implement various budget cost containment policies contained in the 1995-97 State Budget, Wis. Act 27. 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 $34,000,000 all funds ($17,000,000 FFP), including patient liability.
The proposed changes are being implemented to assure adequate funding related to increases in costs incurred by efficiently and economically operated facilities, and to comply with Wisconsin statutes governing Medicaid payment systems, particularly s. 49.45 (6m), Wis. Stats.
For the following proposed changes, the plan amendment proposals are being developed and are not available at this time. See below for discussion of public meetings.
These proposed changes are as follows:
1. Modify the methodology to adjust the reimbursement for nursing homes within the parameters of the 1995-97 State Budget Act, 1995 Wis. Act 27, which may be by application of a percent change based on the previous year's rates.
2. Modify the methodology to adjust for inflation.
3. Modify standards to determine base payment amounts with consideration for the facility's previous year's rates and the facilities' allowable cost as reported in 1995 cost reports.
4. Modify plan provisions to continue to reflect implementation of provision of the federal Omnibus Budget Reconciliation Acts (OBRA) relating to nursing homes.
5. Revise various references to specific years and related provisions to clarify the base year, the rate year, and various payment policies which are specific to a given year.
6. Incorporate technical revisions as needed in select sections requiring clarification.
7. Incorporate miscellaneous changes to implement the intent of the payment plan, including provisions to address special situations such as new facilities, facility phase downs, and changes of ownership.
For the following proposed changes, the plan amendment proposals are available at this time. See below for discussion of public meetings.
1. Modify section 3.522 to incorporate the Dodge Construction Index into the re-evaluation of assets provisions to reflect the annual assurance within the plan amendment.
2. Modify section 5.710 to state the methodology used for the blended increment for facilities with expenses for both property taxes and payments for municipal services.
3. Amend sections 1.240 and 3.011 (c) to clarify policy on the ch. 150, Wis. Stats., Resource Allocation Program.
4. Modify section 3.011 and related sections on the licensed bed adjustments to reflect continuing provisions as well as modifications included in the Act 27 and incorporated in the 95-96 payment plan.
5. Revise section 1.248 on the definition of self-insurance costs.
6. Modify section 1.900 to clarify applicability of policy to offset otherwise allowable costs for what should have been billed to Medicare Parts A and B as primary payor.
7. Revise sections 2.800, 3.800, and 3.810 to clarify that the over-the-counter drug allowance is limited to Medicaid costs and Medicaid patient days.
8. Modify sections 3.400 and 5.710 to change the computation of the property tax allowance.
9. Modify section 3.525 (a) on the minimum useful life schedules used for major remodeling, new construction, bed additions, and bed deletions.
10. Revise section 1.270 on the payment parameters for working capital debt.
11. Revise section 6.110 to clarify that the chart of accounts basis for preparing the uniform cost report must be acceptable to the Department.
12. Modify policies affected by section 4.000 to address payment rate modifications and adjustments effective July 1, 1996.
13. Revise section 3.115 on the reclassification of Medicare patient days to Intensive Skilled Nursing patient days.
14. Modify section 3.775 to update the Intergovernmental Transfer Program provisions.
15. Modify section 1.281 to adjust payments for therapy space to ensure that Medicaid is secondary payor to Medicare and payments reflect equitable share of overhead-related payments.
16. Revise section 3.110 to permit separate ICF 1 and ICF 2 rates.
17. Revise section 3.110 to allow setting a composite rate for ICF 3 and ICF 4 residents.
Copies of the Proposed Changes
Copies of the proposed changes are available free of charge by writing to:
Attention: Nursing Home State Payment Plan
Bureau of Health Care Financing
Division of Health
PO Box 309
Madison, WI 53701-0309
The 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 Bureau of Health Care Financing, Division of Health, 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 250 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 the public meetings.
