Provisions of 2007 Wisconsin Act 20
eliminated caps for dental care, hearing care and vision care and increased the lifetime cap to $7,500. Prior to those changes, the annual cap for dental care was $2,500, $1,500 per hear for hearing care and $500 for vision care. The lifetime cap was $5,000. The authorized funding for the 2007-09 biennium was $1,492,000. Of that amount, expenditures in FY08 were $1,277,700, which left a balance of $214,300 to cover FY09 payments. As a result, the program was closed in October, 2008 (FY08-09 expenditures $1,662,500); the provisions of Act 20 had increased the expenditures more than projected. The authorized funding for 2009-11 biennium is $1,991,500. However, based on the proposed rule changes the estimated demand is $1,493,500 ($711,200+$782,300) which would decrease expenditures by $210,550in FY10 and $287,500 in FY11. Thus the projected biennial savings as a result of the proposed rule changes would be approximately $498,000.
Please contact James A. Stewart, 30 West Mifflin Street, P.O. Box 7843, Madison, WI 53707-7843 or Phone: (608) 266-3733 or E-Mail: firstname.lastname@example.org
to request a copy of the fiscal estimate.
State fiscal effect
Fund sources affected
Affected Ch. 20
Text of Proposed Rules
SECTION 1. VA 2.01 (1) (u) is created to read:
VA 2.01 (1) (u) “Vision care" means provision of one vision examination by a licensed health care provider and provision of corrective eyeware.
SECTION 2. VA 2.01 (1) (v) is created to read:
VA 2.01 (1) (v) “Change in refractive error" means an increase of sphere, cylinder and/or power of at least the following: Sphere Power of + or - .25 diopter; Cylinder Power of + or - .5 diopter; Axis Change of + or - .25 to.75 diopters at 5 degrees, + or – 1 to 2 diopters at 3 degrees or + or – 2.25 or more diopters at 2 degrees.
SECTION 3. VA 2.01 (3) (d) is created to read:
VA 2.01 (3) (d) A dental health care professional must indicate in writing that the dental procedures performed were directly necessary to dental care. Such procedures shall not exceed $500.00 in any consecutive 12 month period except where a full or partial upper and / or a lower denture is required. The grant for such denture or dentures shall not exceed $900 for one or $1,400 for both in any consecutive 60 month period.
SECTION 4. VA 2.01 (3) (e) is created to read:
VA 2.01 (3) (e) Hearing care shall not exceed $200.00 in any consecutive 12 month period except where a left and / or a right hearing aid is required. The grant for each hearing aid shall not exceed $1,300 in any consecutive 48 month period. A participant may obtain a grant to fund an additional or a more costly hearing aid or set of hearing aids and a related examination, if a licensed audiological health care professional identifies, in writing, compelling medical circumstances which have required this added assistance.
SECTION 5. VA 2.01 (3) (f) is created to read:
VA 2.01 (3) (f) A grant for vision care shall not exceed $400.00 in any consecutive 12 month period; however, a participant may obtain a grant for replacement glasses before 12 consecutive months have elapsed if the eyewear is prescribed because of a documented change in refractive error
SECTION 6. VA 2.01 (3) (g) is created to read:
VA 2.01 (3) (g) A participant may obtain a grant for an additional visit to a licensed vision care provider and for a more costly set of corrective eyewear or for an additional set of corrective eyewear where an optometrist or an ophthalmologist identifies in writing a compelling medical circumstance which has required this added assistance.
Agency Contact Person
James A. Stewart, Chief Legal Counsel
30 West Mifflin Street, P.O. Box 7843
Madison, WI 53707-7843
Phone: (608) 266-3733
Notice of Hearing
NOTICE IS HEREBY GIVEN That pursuant to ss. 45.50 (1) (a)
, 45.03 (2)
and 45.03 (4)
, Stats., and Chapter 227
of the Wisconsin Statutes, the Wisconsin Department of Veterans Affairs will hold a public hearing to consider the repeal of section VA 1.11 (8)
and the amendment of section VA 1.11 (11)
, Wis. Adm. Code, relating to the duties and responsibilities of the secretary.
Date and Time:
February 19, 2010
At 9:45 a.m.
Wis. Dept. of Veterans Affairs
Board Room, 8th Floor
30 West Mifflin Street
The public hearing site is accessible to people with disabilities. If you have special needs or circumstances that may make communication or accessibility difficult at the hearing, please contact James A. Stewart at (608) 266-3733 or email@example.com
Submission of Written Comments
Written comments may be submitted to James A. Stewart, 30 West Mifflin Street, P.O. Box 7843, Madison, WI 53707-7843. Phone: (608) 266-3733 E-Mail: jimmy. firstname.lastname@example.org
Comments should be submitted no later than March 5, 2010.
Analysis Prepared by the Wisconsin Department of Veterans Affairs
Explanation of agency authority
The department is charged with operating skilled nursing facilities and employing supervisory personnel for these facilities. Skilled nursing facilities require administrators who have met state and federal standards and are licensed to operate a skilled nursing facility. The department has created the division of homes and an administrator to supervise the operation of these facilities. The board has determined as a matter of policy that all commandants and the division administrator should be licensed to operate skilled nursing facilities. The board has also determined that the Secretary should not be required to directly supervise the commandants since the division of homes and the attendant administrator position was created for that purpose.
Related statute or rule
Section 50.04 (2) (a)
, Wis. Stats., and s. DHS 132.41
, Wis. Adm. Code. These laws require every skilled nursing facility within the state to operate under the supervision of an administrator licensed under Ch. 456
, Wis. Stats.
Plain language analysis
The amendment of VA 1.11 (1) (a) will limit employment, after January 1, 2011, in the positions of commandant or administrator, division of homes to individuals who are licensed as skilled nursing home administrators by the State of Wisconsin or who obtain such licensure within 90 days of initiating employment in the position. The department believes that this requirement will provide better management and more accountability for the skilled nursing facilities. The repeal of VA 1.11 (8) will realign the direction of the commandants from direct supervision by the Secretary to direct supervision by the Administrator, Division of Homes.
Comparison with federal regulations
There is no current or pending federal regulation which would provide subsistence or health care aid for the eligible veterans under this program.
Comparison with rules in adjacent states
38 CFR 51.210
(2) (i) requires any skilled nursing facility receiving per diem payments from the United States Department of Veterans Affairs to be supervised by an administrator who is licensed by that state. 42 CFR 431.703
requires any skilled nursing facility receiving medical assistance (Medicaid) payments from the United States Department of Health and Human Services to be supervised by an administrator who is licensed by that state. Both skilled nursing facilities currently have administrators licensed as nursing home administrators within the management structure. The proposed rules will ensure that the senior official at all skilled nursing facilities operated by the department, as well as the Administrator, Division of Homes, are licensed in accordance with these requirements.
77 Ill. Admin. Code § 340.1370
(a) (Illinois Veterans' Home Code)
(a) There shall be a full-time administrator licensed under the Nursing Home Administrators Licensing and Disciplinary Act for each licensed facility. The licensee will report any change of administrator to the Department, within five days.
Iowa Code § 35D.13(2) (Veterans Home)
2. The commandant shall be a resident of the state of Iowa who served in the armed forces of the United States and was honorably discharged, and is a licensed nursing home administrator.
MCL § 36.10
(Michigan's Veterans' Facility)
Sec. 10. The board of managers shall appoint a commandant for the home, who shall be an ex-officer, soldier, sailor, or marine, whose salary shall be such amount as shall be appropriated by the legislature, and who shall nominate, for the action of the board of managers, all necessary subordinate officers, who shall also be ex-officers, soldiers, sailors, or marines, who may be dismissed by the commandant for inefficiency or misconduct. In case of every removal, a detailed statement of the case shall be reported to the board of managers by the commandant. No member or former member of the board of managers shall be eligible to election or appointment as commandant of the facility until the expiration of at least 1 year from the date of the end of his term as member of the board of managers or the date of his resignation as such member.
Mich. Admin. Code R 325.20111(2) (Licensing of Nursing Homes)
(2) The governing body shall appoint a licensed nursing home administrator and shall delegate to the administrator the responsibility for operating the home in accordance with policies established by the governing body. An administrator and all other persons in supervisory positions shall be not less than 18 years of age.
Minn. R. 9050.0030(A) (Veterans Homes)
The commissioner of veterans affairs shall ensure compliance by the facility and staff with applicable statutes, with applicable rules of the Minnesota Department of Health and the Minnesota Department of Human Services, and with applicable health, safety, sanitation, building, zoning, and operations codes, including the following:
A. Minnesota Department of Health licensure and operations requirements in chapters 4655 and 4660 and Minnesota Statutes, sections 144.50 to 144.56 and 144A.02 to 144A.10.
Minn. R. 4655.1200 (Boarding Care Homes)
Subpart 1. The licensee in each nursing home or boarding care home shall be responsible for its management, control, and operation.
Subp. 2. The licensee shall develop written bylaws and/or policies which shall be available to all members of the governing body and shall assume full legal responsibility for matters under its control, for the quality of care rendered and for compliance with applicable laws and rules of legally authorized agencies. The responsibilities of the licensee shall include:
A. Full disclosure of each person having an interest of ten percent or more of the ownership of the home to the commissioner of health with any changes promptly reported in writing. In case of corporate ownership, the name and address of each officer and director shall be made known. If the home is organized as a partnership, the name and address of each partner shall be furnished. In the case of a home operated by a lessee, the persons or business entities having an interest in the lessee organization shall be reported and an executed copy of the lease agreement furnished. If the home is operated by the holder of a franchise, disclosure as specified above shall be made as to the franchise holder who shall also furnish an executed copy of the franchise agreement.
B. Appointment of a licensed nursing home administrator or a person in charge who shall be responsible for the operation of the home in accordance with law and established policies.
C. The authority to serve as administrator or person in charge shall be delegated in writing.
D. The administrator of a hospital with a convalescent and nursing care unit may serve both units. See the Nursing Home Administrator Licensing Law, Laws of Minnesota 1969, chapter 770.
E. Notification of the termination of service of the administrator or the person in charge as well as the appointment of a replacement shall be given within five days in writing to the commissioner of health by the governing body of the home. If a licensed nursing home administrator or person in charge of the boarding care home is not available to assume the position immediately, such notification to the commissioner of health shall include the name of the person temporarily in charge of the home. The governing body of a nursing home shall not employ an individual as the permanent administrator until it is determined that the administrator qualifies for licensure as a nursing home administrator in Minnesota. See the Nursing Home Administrator Licensing Law, Laws of Minnesota 1969, chapter 770.
F. Provision of a competent staff and maintenance of professional standards in the care of patients and residents.
G. Employment of qualified personnel. There shall be sufficient personnel to provide the basic services such as food service, housekeeping, laundry, and plant maintenance. Employees or volunteers under 18 years of age shall be under direct supervision.
H. Provision of facilities, equipment, and supplies for care consistent with the needs of the patients and residents.
I. Provision of evidence of adequate financing, proper administration of funds, and the maintenance of required statistics.
Only a licensee is responsible for the management, control and operation of a nursing home.
Summary of factual data and analytical methodologies
The department commissioned a report on the operation of its skilled nursing facilities by an independent consulting group, Pathways Health Services, Inc. The report reviewed the supervision of both facilities, as well as the supervision provided by the Administrator, Division of Homes. The report identified issues ensuring compliance with health care requirements, interaction with health care inspectors and advocacy for appropriate budget and staffing based on the current organizational structure. The report made recommendations that all commandants and the Administrator, Division of Homes be licensed. The Board has also received testimony from a member of its Long Term Care Committee who is a licensed nursing home administrator in Wisconsin. The testimony identified similar concerns and concurred with the solutions offered in the Pathways report. The Board has adopted the recommendation related to commandants and the Administrator, Division of Homes being licensed as nursing home administrators.
Analysis and supporting documents used to determine effect on small business
No analysis was performed regarding an economic impact statement.
Small Business Impact
These rules do not appear to have any effect upon small businesses, nor any significant fiscal impact upon the private sector.
Assumptions used in arriving at fiscal estimate
The proposed amendment will require that any individual employed as a commandant or as the administrator for the division of the Wisconsin Veterans Homes (WVH), shall be licensed under chapter 456 of the Wisconsin Statues or secure such licensure within 90 days of initiating employment. The proposed repeal will realign the direction of commandants from direct supervision by the secretary to direct supervision by the WVH's division administrator.
The proposed changes will have no fiscal effect on the department.