The Legislature is considering the establishment of a new psychosocial services benefit targeted to individuals whose mental health needs are less severe than individuals with chronic mental illness, if allowed under federal MA law. The new benefit would be at county option, and counties would pay the state share of the MA cost. The Department would be directed to establish:
(a) the scope of services;
(b) recipient eligibility criteria; and
(c) provider certification for this benefit.
The benefit would be effective on the date established in the 1997-1999 budget act. The estimated increase in expenditures attributable to these changes is approximately $570,000 in federal financial participation funds in state fiscal year (SFY) 1998-1999. No state general purpose revenue (GPR) dollars are required.
In addition, the Legislature may require the Department to provide counties, if permitted under federal MA law, the option of reimbursing as an MA service those mental health and alcohol and other drug abuse services under s. 49.46 (2) (9b) 6f, Stats., that are provided to recipients age 21 and over in their place of residence or other community settings. Counties would be responsible for paying the state share of the MA cost. The estimated increase in expenditures attributable to these changes is approximately $50,000 FFP in SFY 1997-1998 and $250,000 FFP in SFY 1998-1999. No GPR dollars are required.
Copies of the Proposed Changes
Copies of the proposed changes will be sent to every county social services or human services department main office where they will be available for review. For more information, interested people may write to:
Melanie Foxcroft, State Plan Coordinator
Attn: State Plan Issue
Bureau of Health Care Financing
Division of Health
P.O. Box 309
Madison, WI 53701-0303
Written Comments
Written comments on the proposed changes are welcome. Comments should be sent to the above address. Comments received on the changes will be available for public review between the hours of 7:45 a.m. and 4:40 p.m. daily at:
Bureau of Health Care Financing
Room 250, State Office Building
One West Wilson Street
Madison, WI
Public Notice
Health & Family Services
(Medical Assistance Reimbursement of Nursing Homes)
State of Wisconsin Medicaid Nursing Facility Payment Plan: FY97-98
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 (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, 1997. The proposed changes which comprise this plan amendment will not be finalized until the public comment period is concluded. The public comment period will continue until at least September 1. The plan amendment's proposed changes will be effective retroactive to July 1, 1997. Individuals and organizations may obtain or review copies of the draft proposed changes covered by the plan amendment and may also attend the public meetings on the plan amendment. See the end of this notice for information about the public meetings and where to send for or to review copies of the draft proposed changes.
The proposed changes would update the payment system and make various payment-related policy changes. Some of the changes are necessary to implement policies that will be included in the Wisconsin 1997-99 Budget Act; 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 recipients is approximately $50,975,000 all funds ($30,014,100 federal), excluding patient liability.
The proposed changes are being implemented to ensure that there is adequate funding related to cost increases incurred by efficiently and economically operated facilities, and to comply with state statutes governing Medicaid payment systems, particularly s. 49.45 (6m), Wisconsin Statutes.
Some of the proposed changes implement policies contained in the State's 1995-97 budget. Since the biennial budget is not yet final, many of the proposals are not yet available. See the end of this notice for information on public meetings and how to obtain or review copies of drafts when available. The public meetings are intended as public discussion forums on nursing home State Plan amendment proposals which are available as drafts and proposals which are in process pending passage of the final budget for the 1997-99 biennium. The plan amendment will not be submitted to the federal Health Care Financing Administration or implemented until drafts have been discussed at public meetings and both written and oral comments have been reviewed and considered.
General proposed changes
The general proposed changes are as follows:
1. Modify the methodology to adjust reimbursement for nursing homes within the parameters of the 1997-99 Budget Act.
2. Modify plan provisions to continue the federal Omnibus Budget Reconciliation Act (OBRA) provisions relating to nursing homes.
3. 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.
4. Incorporate technical revisions as needed in select sections requiring clarification.
5. Incorporate miscellaneous changes as necessary to implement the intent of the payment plan.
6. Change the Wisconsin Administrative Code references in the plan from Department of Health and Social Services (DHSS) to Department of Health and Family Services (DHFS) to reflect the Department's name change.
Proposed changes published in an advance notice on June 30, 1996, to take effect July 1, 1997
1. Revise Section 3.110 to permit a separate ICF 1 rate and ICF 2 rate.
2. Revise Section 3.110 to allow a setting of a rate for ICF 3 and ICF 4 residents equal to the payment rate for ICF 3 residents.
Proposed changes to implement provisions of the 1997-99 Budget Act
1. Modify the methodology to distribute approximately 6.1% or $50,975,000 (all funds), excluding patient liability, whichever is less, in the payment rate year of July 1, 1997, through June 30, 1998.
2. Reduce the direct care maximums in Section 5.410 from 110% of the median.
3. Reduce the cost-sharing percentage in Section 3.532 for nursing homes with property costs in excess of the target from the current level of 40%. This reduction may include phase down provisions possibly for nursing homes subject to Section 1.600 Resource Allocation Program maximums.
4. Modify Section 3.115 and pertinent sections relating to the classification of all Medicare-funded nursing home days as intensive skilled nursing (ISN) days rather than the current reclassification of 12.5% of Medicare days.
5. Modify Section 5.440 to increase the direct care increment, from 93% of the median of facilities in the State.
6. Amend Sections 2.650, 3.254 and 5.551 to increase the exceptional Medicaid utilization adjustment by increasing the additional payment to nursing homes with a high percentage of MA residents by increasing the base add-on to a facility's per diem rate from $0.25 per patient day.
7. Modify Section 3.000 on patient days, licensed bed adjustments and minimum occupancy relating to using a three-year average for the occupancy rate in applying the minimum occupancy standard and relating to a proposed bed bank policy. The modifications would allow a nursing home to delicense any of its nursing home beds to partially avoid the effect of the minimum occupancy standard on its Medicaid reimbursement.
8. Modify the Methods as necessary to implement a bed bank policy which would include a provision for recoupments.
9. Modify Section 3.775 to allow for the possible distribution of additional funds for operating deficits for facilities operated by local units of government.
Other proposed changes
1. Modify Sections 2.160, 3.123, 3.124, 3.125, 3.126, 3.128 and 5.420 and related sections to eliminate the emotionally disturbed supplement in accordance with 1995 Wisconsin Act 27, the 1995-97 budget act.
2. Create a section clarifying the authority of the Department to offset certain Medicare revenue against the related cost report expenses.
3. Modify Sections 3.220, 3.500, 3.700 and 5.300 through 5.900, as applicable, to adjust as may be necessary the payment parameters, factors, targets, maximums, increments and indices.
4. Modify the plan amendment to eliminate Section 7.000 since this section does not apply to the revised system for the plan amendment year. This includes the sample rate calculation included as part of the plan amendment, the policy on applicable formula maximums drafted to clarify the implementation of the Section 7.000 rate on rate payment system, and references to Section 7.000 throughout the plan amendment.
5. Amend Section 1.241 to clarify the use of “allowable” worker's compensation costs in self-insurance plans under Section 1.248.
6. Modify Section 1.600 to clarify that prior year Ch. 150 rates effective as maximums at time of plan amendment remain in effect and to update the citations relating to ch. 150, Stats., and ch. HFS 122.
7. Modify Section 3.254 relating to exceptional Medicaid utilization adjustment to clarify when payment adjustment is effective when ownership changes.
8. Amend Section 3.525 (a) to change the useful life reference from Medicare guidelines to American Hospital Association guidelines.
9. Amend Section 3.525 on depreciation and amortization policy, Section 3.526 on interest expense, Section 3.526 (c) and (d) on systematic reduction of debt, and related provisions in Section 3.500 specifically to clarify, as needed, the policies regarding letters of credit which may not be addressed currently in the plan amendment.
10. Amend Section 3.526 (c) on interest expense relating to reduction of debt to assure that reduction of debt is required.
11. Amend Section 3.526 (d) on interest expense relating to refinancing of debt to assure that the plan amendment addresses bonding letters of credit.
12. Eliminate Section 3.013 (b) to exempt homes with phase-down agreements from minimum occupancy requirement.
13. Modify Section 4.520 relating to payment rates during a phase-down period to explicitly state that the Section 3.500 property allowance is included in the minimum patient days calculation.
14. Modify Section 1.500 on billing for bed hold relating to the criteria for billing and to eliminate Sections 1.530 (1) and (2) exclusions for determining the licensed beds for billing.
15. Amend Section 4.850 relating to payment for services to permit payment of the facility's daily rate to the evacuated-use sites during the evacuation period and to allow a retrospective settlement or calculation for determination of, and payment for, extraordinary expenses.
16. Modify Section 5.430 relating to the labor regions for the direct care allowances to reflect a revised methodology and a rebasing of the labor regions.
17. Amend Section 3.529 on energy savings projects relating to project incentives.
18. Modify Section 3.537 on the maximum allowable decrease for the property allowance to clarify, if necessary, that the allowance in effect was the allowance calculated in the 1995-96 payment rates.
19. Create Section 3.776 describing the use of supplementary funding for local government-owned facilities which are either closing or being sold.
20. Modify Section 4.501 to prohibit facilities using Section 3.776 from receiving a special payment rate for significant decreases in licensed beds.
21. Modify Section 5.210 to reference allowable over-the-counter drugs.
22. Amend Section 2.500 as follows to describe what the property payment allowance covers beyond the value of the buildings.
23. Amend Section 1.270 to clarify revenues from invested funds.
24. Modify Section 4.120 to redefine material adjustments for this payment system.
25. Move payment-related parameters from Section 3.000 to Section 5.000.
26. Amend the Methods to renumber certain Sections, specifically 2.600-2.650, 2.800, 3.800, and 3.600.
27. Amend the plan amendment as appropriate to effect any changes necessary related to the above modifications to assure that the intent and the purpose of the above changes are achieved.
Proposed change to take effect January 1, 1998 (advance public notice)
1. Modify Section 5.164 relating to covered services, waivers and variances, and prior authorization to encourage the use of the most cost-effective durable medical equipment for the prevention and treatment of pressure relief sores, pressure sores, and decubiti.
Copies of the Available Proposed Changes
Copies of the available proposed changes may be obtained free of charge by calling or writing as follows:
