Public Notices
Health Services
WAIVER RENEWAL
DEPARTMENT OF HEALTH SERVICES
NOTICE OF PUBLIC HEARING
NOTICE IS HEREBY GIVEN that pursuant to s.
49.688, Stats., the Department of Health Services will hold a public hearing on renewal of the SenorCare program, which requires the submission of a waiver renewal application to the federal Centers for Medicare and Medicaid Services (CMS).
Hearing Date(s) and Location(s)
Date and Time
|
Location
|
Friday, July 13, 2012
10:00 a.m. to 12:00 noon
|
St. Croix County Government Center
County Board Room
1101 Carmichael Road
Hudson, WI 54016
|
Hearings in Stevens Point and Waukesha were announced in a previous notice.
Accessibility
English
DHS is an equal opportunity employer and service provider. If you need accommodations because of a disability or need an interpreter or translator, or if you need this material in another language or in an alternate format, you may request assistance to participate by contacting Al Matano at (608)267-6848. You must make your request at least 7 days before the activity.
Spanish
DHS es una agencia que ofrece igualdad en las oportunidades de empleo y servicios. Si necesita algún tipo de acomodaciones debido a incapacidad o si necesita un interprete, traductor o esta información en su propio idioma o en un formato alterno, usted puede pedir asistencia para participar en los programas comunicándose con Kim Reniero al número (608)267-7939. Debe someter su petición por lo menos 7 días de antes de la actividad.
Hmong
DHS yog ib tus tswv hauj lwm thiab yog ib qhov chaw pab cuam uas muab vaj huam sib luag rau sawv daws. Yog koj xav tau kev pab vim muaj mob xiam oob qhab los yog xav tau ib tus neeg pab txhais lus los yog txhais ntaub ntawv, los yog koj xav tau cov ntaub ntawv no ua lwm hom lus los yog lwm hom ntawv, koj yuav tau thov kev pab uas yog hu rau Al Matano ntawm (608)267-6848. Koj yuav tsum thov qhov kev pab yam tsawg kawg 7 hnub ua ntej qhov hauj lwm ntawd.
Copies of Waiver Documents
A copy of waiver documents, including the waiver application once complete, may be obtained from the department at no charge by downloading the documents from
http://www.dhs.wisconsin.gov/seniorcare/ or by contacting:
Regular Mail
Al Matano
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 53707-0309
Phone
Al Matano
(608)267-6848
FAX
(608)261-7792
E-Mail
Analysis Prepared by the Department of Health Services
Statute interpreted:
Statutory authority:
Explanation of agency authority:
Section
49.688 (11) directs the department to request from the federal Secretary of Health and Human services a waiver, under
42 USC 1315 (a), of federal Medicaid laws necessary to permit the Department of Health Services to conduct a project to expand eligibility for medical assistance, for purposes of receipt of prescription drugs as a benefit.
Related statute or rule:
N/A.
Plain language analysis:
The State of Wisconsin Department of Health Services (DHS) is requesting a three-year extension of its Section 1115 Demonstration Waiver for the SeniorCare prescription drug assistance program. The current waiver is scheduled to expire on December 31, 2012. The State requests that the waiver be extended for an additional three-year period, from January 1, 2013 to December 31, 2015.
The Department will request a waiver extension that keeps the SeniorCare program in its current form.
History of the Program
On July 1, 2002, The State of Wisconsin received the necessary waiver approvals from the Center for Medicare & Medicaid Services (CMS) to operate a portion of SeniorCare, a prescription drug benefit for seniors, as a five-year demonstration project. Through its partnership with the federal government, the SeniorCare waiver extends Medicaid eligibility through Title XIX to cover prescription drugs as a necessary primary health care benefit.
Population and Numbers Served
The target population for services under this demonstration project is seniors 65 years of age or older with income at or below 200% of the federal poverty level (FPL), which is $22,340 for an individual and $30,260 for a two-person family in 2012. Each month the SeniorCare waiver program serves about 60,000 seniors.
Summary of, and comparison with, existing or proposed federal regulations:
The federal equivalent to SeniorCare is Medicare Part D. SeniorCare is the only program of its kind.
Agency contact person:
Al Matano
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 53707-0309
(608)267-6848 (telephone)
(608)261-7792 (fax)
Place where comments are to be submitted and deadline for submission:
Fiscal Estimate
A copy of the full fiscal estimate may be obtained from the department's contact person listed above upon request.
PUBLIC NOTICE
Health Services
Medical Assistance Reimbursement of Nursing Homes
State of Wisconsin Medicaid Nursing Facility Payment Plan: FY 12-13
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 proposed would be effective July 1, 2012.
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 enacted in the Wisconsin 2011-2013 Biennial Budget, and update the payment system and methodology. Some of the changes are technical in nature; some clarify various payment plan provisions.
The estimated net decrease in annual aggregate expenditures attributable to these changes for skilled nursing homes serving MA residents is approximately $26,053,060 (All Funds), or $16,868,066 (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 11, 2012. The changes may be modified by later legislative mandates.
The proposed changes are as follows:
1.
Modify the methodology to adjust the reimbursement for nursing homes within the parameters of 2011-2013 Biennial Budget Bill. These parameters are divided into two parts. First, the Department will disburse the additional $7,433,000 AF ($4,475,000 FFP) that was appropriated to fund an assumed acuity increase of approximately 1% for nursing homes. Second, the number of Medicaid-funded patient days is projected to decline, which generates the overall funding decrease identified above. 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. The methodology will factor in the effect on patient liability of the 3.6% cost of living adjustment (COLA) increases in Social Security and Supplemental Security Income programs, which were effective January 1, 2012, as well as any additional COLA increase anticipated for January 1, 2013
.
3. Incorporate changes, if any, related to the design and implementation of a nursing facility downsizing incentive program, the details of which are still under development.
4. Incorporate changes, if any, to other existing incentive payment provisions. These incentive programs may be enhanced for nursing facilities that choose to both modernize and downsize.
5.
Evaluate the restricted use bed policy in Section
1.313 to determine whether or not an update to policy is warranted. Any such evaluation may or may not result in policy changes and/or reimbursement changes to providers.
6. Modifying references to previous years for descriptive reasons will be done where necessary.
7.
Modify the labor factors listed in Section
5.410.
8. Change the dates of the definitions of base cost reporting period.
9.
Clarify Section
1.248 regarding self-insurance as it relates to property insurance. Specify the section does not allow for reimbursement of property insurance claims as a function of self-insurance by adding the following language:
“Property insurance expense may include only premiums paid to a non-related insurance company where the provider retains interest in no portion of that premium. Allowable costs resulting from the liability assumed by a provider under any property insurance plan (either through self-funding or deductable) will be reported and reimbursed under Section 3.500 or Section 2.200."
10.
Alter Section
1.315 (RUGS .25 score and correct vent score references) and clarify both payment for bed-hold days. The language in paragraphs two and three, respectively, will read:
“Bed hold days reimbursed by the fiscal intermediary or patient are considered a patient day (Medicaid bed hold days must meet the billable criteria identified in Section 1.500.)
A patient day can not be counted as both a patient day and a bed hold day.
For cost allocation purposes, all bed hold days will be assigned Non-DD or DD bed hold case mix index values as specified in Section 5.420. For cost allocation purposes, patient days meeting the ventilator dependent requirements in Section 4.691 shall be classified at the ventilator level of care with a case mix index as specified in Section 5.420."
11.
Update the definition of “Rug-able" assessments in Section
2.140, and add “Medicare Assessment" to the last sentence, so that the passage reads:
“A RUG-able MDS assessment includes Admission Assessments, Annual Assessments, Quarterly Review Assessments, Medicare Assessments, Significant Change in Status MDS, and Significant Correction to Prior Comprehensive MDS Assessments."
12.
Update Sections 2.140 and 2.145, respectively, to exclude vent days. The language in Section 2.140 will read:
“Medicaid residents receiving payment under Section 4.691 will not be included in the picture date Medicaid FFS Non-DD CMI."
The language in Section 2.145 will read:
“Residents receiving payment under Section 4.691 will not be included in the picture date All-Resident Non-DD CMI."
13.
The following language will be added after the second paragraph of Section 2.140:
“Medicaid FFS Non-DD bed hold residents on the picture date are included in the Medicaid FFS Non-DD in-house CMI. The CMI applied to these bed hold residents is the RUG CMI applicable on the day prior to bed hold status, rather than the Non-DD Bedhold CMI specified in Section 5.420.
Non-DD bed hold residents on the picture date are included in the All-Resident Non-DD in-house CMI. The CMI applied to these bed hold residents is the RUG CMI applicable on the day prior to bed hold status, rather than the Non-DD Bedhold CMI specified in Section 5.420."
14.
Incorporate the Department's changes to the behavioral add-on in Section 3.657 (and in Section 5.970) to reflect the change to the new MDS and RUG system. Delete the second paragraph in Section 3.100 because this is discussed in Section 3.657 and should not be included in the Direct Care Allowance component of the methodology.
15.
Modify Sections 3.775 and 3.780 to reflect possible changes in the Medicare Upper Limit calculations.
16.
Update Section 4.691 to specify the vent rate is $500, removing the reference to $475.
17.
Update Section 3.122, 4.691 and 1.510 to clarify current practice, which is that vent bed-hold days will pay at the same bed-hold rate as any bed-hold day (i.e., 0.25), if qualified.
18.
Alter the Reporting Period, Picture Dates, and Dates Available in Section 5.421 as follows:
Reporting Period Picture Date Date Available
Jan 2010-Mar 2010 Mar 31 2010 July 31 2012
Apr 2010-Jun 2010 Jun 30 2010 July 31 2012
Jul 2010-Sept 2010 Sept 30 2010 July 31 2012
Oct 2010-Dec2010 Dec 31 2010 July 31 2012
Jan 2011-Mar 2011 March 31 2011 July 31 2012
Apr 2011-Jun 2011 Jun 30 2011 July 31 2012
July 2011-Sept 2011 Sept 30 2011 July 31 2012
Oct 2011-Dec 2011 Dec 31 2011 July 31 2012
19.
Alter the Picture Dates, and Dates Available as of Dates and Rate Effective Dates in Section
5.422 as follows:
Picture Date Data Available Rate Effective Date
As of Date
Dec 31 201 July 31 2012 July 1 2012
Mar 31 2012 Aug 31 2012 Oct 1 2012
Jun 30 2012 Nov 30 2012 Jan 1 2013
Sept 30 2012 Feb 28 2013 Apr 1 2013
20.
Update the dates in Section
4.720 as follows:
Cost report period Picture date Data available
includes month of: “as of " date
April 2010-June 2010 June 30, 2010 July 31, 2012
July 2010-September 2010 September 30, 2010 July 31, 2012
October 2010-December 2010 December 31, 2010 July 31, 2012
January 2011-March 2011 March 31, 2011 July 31, 2012
April 2011-June 2011 June 30, 2011 July 31, 2012
July 2011-September 2011 September 30, 2011 July 31, 2012
October 2011-December 2011 December 31, 2011 July 31, 2012
January 2012-March 2012 March 31, 2012 August 31, 2012
April 2012-June 2012 June 30, 2012 November 30, 2012
July 2012-September 2012 September 30, 2012 February 28, 2013
October 2012-December 2012 December 31, 2012 May 31, 2013
January 2013-March 2013 March 31, 2013 August 31, 2013
April 2013-June 2013 June 30, 2013 November 30, 2013
21. Modify contact names and addresses, as necessary.
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
Bureau of Financial Management
Attention: Nursing Home Medicaid Payment Plan
P.O. Box 7851
Madison, WI 53703-7851
or by faxing Tom Lawless at 608-266-2713.
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.
PUBLIC NOTICE
Health Services
Medical Assistance Reimbursement to Hospitals
Pay For Performance Hospital Withhold for State Fiscal Year 2013
The State of Wisconsin reimburses providers, including hospitals, for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss.
49.43 to
49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (the Department), is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare and BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and ss.
49.471,
49.665, and
49.67 of the Wisconsin Statutes. 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.
The Department is implementing withhold-based inpatient hospital pay for performance measures for state fiscal year 2013. Fee-for-service inpatient hospital claims with dates of discharge between July 1, 2012, and June 30, 2013 and fee-for-service outpatient hospital claims with dates of service between July 1, 2012 and June 30, 2013 will be subject to a 1.5% withholding on each payable inpatient and outpatient hospital claim amount. The withheld amount will be redistributed at a later date to acute care, children's, critical access, and psychiatric hospitals that meet performance-based targets.
Copies of Proposed Change
A copy of the proposed change may be obtained free of charge at your local county agency or by calling or writing as follows:
Regular Mail
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 537001-0309
State Contact
A copy of the proposed change is available for review at the main office of any county department of social services or human services. Department staff have notified the health directors of Native American tribes in Wisconsin of this proposal and consulted with them at a meeting of the tribal health directors on June 27, 2012.
Written Comments
Written comments are welcome. Written comments on the proposed change may be sent by FAX, email, or regular mail to the Division of Health Care Access and Accountability. The FAX number is (608) 266-1096. The email address is
Sean.Gartley@wisconsin.gov. Regular mail can be sent to the above address. All written comments will be reviewed and considered.
All written comments received will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 350 of State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changed pay for performance measures based on comments received.
PUBLIC NOTICE
Health Services
Medical Assistance Reimbursement to Hospitals
Medicaid Reimbursement for Inpatient Hospital Services: Acute Care Hospitals, Children's Hospitals, Major Border Status Hospitals, Non State Public and Private Psychiatric Hospitals State of Wisconsin Medicaid Payment Plan for State Fiscal Year 2012-2013
The State of Wisconsin reimburses providers, including hospitals, for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss.
49.43 to
49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (DHS), is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare and BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and ss.
49.471,
49.665, and
49.67 of the Wisconsin Statutes. 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.
The Wisconsin Medicaid program uses a reimbursement system which is based on Diagnosis Related Groupings (DRGs). Under the current Medicaid Inpatient Hospital State Plan, effective July 1, 2011, the rate-setting methodology for Acute Care, Major Border Status and Children's Hospitals is a provider specific, DRG payment system adjusted by case mix that assigns each hospital a unique hospital specific DRG base rate. This rate includes adjustments for differences in wage levels, includes an amount for capital expenditures, and payment enhancements for qualifying Rural Hospitals and facilities with Graduate Medical Education programs. In addition, a cost outlier payment will be made when the cost of providing services exceeds a pre-determined trimpoint. Payments are adjusted as necessary to ensure budget compliance using a statewide base rate as the starting point of the rate setting process. Non State Public and Private Psychiatric and Rehabilitation Hospitals are paid on a provider specific, cost based per diem rate adjusted as necessary to ensure budget compliance.
The following will be new for 2012-2013 and not reflected in the 2011-2012 rate methods:
•
Hospital Access Payments will be updated and made in addition to the DRG base payments.
•
Critical Access Hospital Payments will be updated and made in addition to the DRG base payments.
In addition, the state plan will be modified to include language regarding non-payment policies for provider preventable conditions including health-care acquired conditions.
This notification is intended to provide notice of the type of changes that are included in the amendment. Interested parties should obtain a copy of the actual proposed plan amendment to comprehensively review the scope of all changes.
Proposed Change
It is estimated that these changes will have no impact on projected annual aggregate Medicaid expenditures in state fiscal year 2012-13.
The Department's proposals involves no change in the definition of those eligible to receive benefits under Medicaid, and the benefits available to eligible recipients remains the same. The effective date for these proposed changes will be July 1, 2012.
In addition to this public notice, Wisconsin's tribes were consulted at a meeting of the Tribal Health Directors on June 27, 2012.
Copies of the Proposed Change
A copy of the proposed change may be obtained free of charge at your local county agency or by calling or writing as follows:
Regular Mail
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 53701-0309
State Contact
Krista Willing, Deputy Director
Bureau of Fiscal Management
(608) 266-2469 (phone)
(608)266-1096 (fax)
A copy of the proposed change is available for review at the main office of any county department of social services or human services.
Written Comments
Written comments are welcome. Written comments on the proposed change may be sent by FAX, email, or regular mail to the Division of Health Care Access and Accountability. The FAX number is (608) 266-1096. The email address is
KristaE.Willing@wisconsin.gov. Regular mail can be sent to the above address. All written comments will be reviewed and considered.
All written comments received will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 350 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changed methodology based on comments received.
PUBLIC NOTICE
Health Services
Medicaid Reimbursement for Outpatient Hospital Services: Acute Care Hospitals, Children's Hospitals, Major Border Status Hospitals, Non State Public and Private Psychiatric Hospitals State of Wisconsin Medicaid Payment Plan for State Fiscal Year 2012-2013
The State of Wisconsin reimburses providers for services provided to Medical Assistance recipients, including hospitals, under the authority of Title XIX of the Social Security Act and ss.
49.43 to
49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services (DHS), is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare and BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and ss.
49.471,
49.665, and
49.67 of the Wisconsin Statutes. 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.
The Wisconsin Medicaid program uses a reimbursement system which is based on Diagnosis Related Groupings (DRGs). Under the current Medicaid Outpatient Hospital State Plan, effective July 1, 2011, the rate setting methodology for Acute Care, Major Border Status and Children's Hospitals is a provider specific, cost-based rate per visit. Out of state and new hospitals without cost reports are paid at a statewide average percent of charges.
The following changes will be contained in the July 1, 2012 outpatient hospital state plan amendment:
•
Hospital Access Payments will be updated and made in addition to the DRG base payments.
•
Critical Access Hospital Payments will be updated and made in addition to the DRG base payments.
In addition, the state plan will be modified to include language regarding non-payment policies for provider preventable conditions including health-care acquired conditions.
Proposed Change
It is estimated that these changes will have no impact on projected annual aggregate Medicaid expenditures in state fiscal year 2012-13.
The Department's proposals involves no change in the definition of those eligible to receive benefits under Medicaid, and the benefits available to eligible recipients remains the same. The effective date for these proposed changes will be July 1, 2012.
In addition to this public notice, Wisconsin's tribes were consulted at a meeting of the Tribal Health Directors on June 27, 2012.
Copies of the Proposed Change
A copy of the proposed change may be obtained free of charge at your local county agency or by calling or writing as follows:
Regular Mail
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 53701-0309
State Contact
Krista Willing, Deputy Director
Bureau of Fiscal Management
(608) 266-2469 (phone)
(608)266-1096 (fax)
A copy of the proposed change is available for review at the main office of any county department of social services or human services.
Written Comments
Written comments are welcome. Written comments on the proposed change may be sent by FAX, email, or regular mail to the Division of Health Care Access and Accountability. The FAX number is (608) 266-1096. The email address is
KristaE.Willing@wisconsin.gov. Regular mail can be sent to the above address. All written comments will be reviewed and considered.
All written comments received will be available for public review between the hours of 7:45 a.m. and 4:30 p.m. daily in Room 350 of the State Office Building, 1 West Wilson Street, Madison, Wisconsin. Revisions may be made in the proposed changed methodology based on comments received.
