STATE OF WISCONSIN
Department of Veterans Affairs
(Clearinghouse Rule )
In the matter of rulemaking proceedings before the Department of Veterans Affairs.
PROPOSED ORDER OF THE
DEPARTMENT OF VETERANS AFFAIRS ADOPTING RULES
PROPOSED ORDER
An order of the Department of Veterans Affairs to repeal VA 6.01 (17); to renumber and amend VA 6.01 (16); to amend VA 6.01 (2) (a), (b), (3) (a) 2., (4), (7), (8), and (16), 6.02 (2) and (5), 6.03 (1), (6), and (9), 6.04 (8) and (14), 6.05 (5) and (9), and 6.06 (2); and to create VA 6.001, 6.01 (3) (c), (16) (a) and (b), and VA 6 Appendix; relating to rate setting at Wisconsin veterans homes.
Analysis prepared by the Department of Veterans Affairs.
ANALYSIS
Statutes interpreted:
Statutory authority:
Explanation of agency authority:
Section 45.03 (2), Stats., provides that the Secretary may promulgate rules necessary to carry out the purposes of this chapter and the powers and duties conferred upon it. Related statute or rule:
N/A
Plain language analysis:
Current language under s. VA 6.01 (16) provides “Charges for care and maintenance shall be computed every January for the various categories of care provided by a home. The computations shall be based upon the estimated costs of care to be incurred by the home for the succeeding annual period. The department may update charges in July to reflect changes in costs during the year. Charges shall be made for actual care and maintenance provided to a member.” The Department establishes policy and procedures for setting private pay rates. The current rate setting calculation used by the Department is a formula-based process that uses the average census counts, the costs under s. 20.485(1) (gk), Stats., the bed days for each type of care provided, and the weighted costs of direct and indirect care.
The proposed rule revisions amend the Department’s current policy and procedure for calculating private pay rates by establishing the method and formula for calculating private pay rates for both nursing home care and assisted living care, including provisions for compiling costs separately for each facility, rather than as a single rate across all state-run veterans homes.
The proposed rule also includes modifications in order to comply with current statutes, rule drafting procedures, provide clarity, or amend outdated references.
Summary of, and comparison with, existing or proposed federal regulation:
38 CFR 51.40 establishes basic per diem rates in accordance with 38 USC 1741, which establishes the criteria for payment. 38 CFR 51.50 establishes per diem rates for eligible veterans for nursing home care. Comparison with rules in adjacent states:
Illinois: Illinois state veterans homes are run by the Illinois Department of Veterans’ Affairs and licensed by the Illinois Department of Public Health. Residents pay a maximum monthly maintenance fee established by the state and based on individual income and ability-to-pay. The cost of care is met through a combination of the maintenance fee paid by each resident, per diem granted by US Department of Veterans Affairs, and appropriated general revenue funds. The monthly cost is based only on the monthly income of the veteran and spouse and does not include other assets. The maximum amount is subject to change on an annual basis, depending on Social Security cost of living adjustments. The methodology for calculating cost of care is not defined in administrative rule.
Iowa: Iowa has one state veterans home with oversight provided by the Commission of Veterans Affairs. Cost of care is the aggregate semiannual per diem rate calculation according to the particular level of care as calculated in January and July of each year for the preceding six months and effective March 1 and September 1. The daily per diem charge is reduced by an amount equal to the appropriate Medicare Part B and Medicare Part D premiums paid by the enrolled member. The rate includes direct costs only.
Michigan: Michigan’s state veterans homes are overseen by the Michigan Veterans Affairs Agency, within the Department of Military and Veterans Affairs. The Board of Managers annually determines the per diem cost of care based on operational costs. These costs may change annually. The cost to individual members is determined by a monthly assessment based on each member’s ability to pay. The methodology for calculating cost of care is not defined in administrative rule.
Minnesota: Minnesota state veterans homes are overseen by the commissioner of the Minnesota Department of Veterans Affairs. Minnesota administrative rules provide for the specific method of calculating average daily per resident cost of care. Residents contribute to the cost of their care according to their means. The cost of care used to determine the maintenance charge of a resident is calculated annually and includes both direct and indirect costs. A change in the cost of care becomes effective on July 1 of the rate year following the reporting year used to calculate the cost of care. The cost of care must remain fixed for that rate year are compiled separately for each facility based on services provided.
Summary of factual data and analytical methodologies:
Pursuant to s. 45.51 (7) (b). Stats., members of veterans homes are required to “pay the amount due the state for care and maintenance of the member”. Section VA 6.01 (16) further requires the Department to charge for “actual care and maintenance provided to a member”.
