Public Notice: Medical Assistance Reimbursement of Nursing Homes

PUBLIC NOTICE

Department of Health Services

(Medical Assistance Reimbursement of Nursing Homes) State of Wisconsin Medicaid Nursing Facility Payment Plan: July 1, 2022 through June 30, 2023

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, 2022.

The estimated net increase in annual aggregate expenditures attributable to these changes for skilled nursing homes and intermediate care facilities for individuals with intellectual disabilities (ICF-IIDs) serving MA residents is approximately $170,375,400 AF ($67,600,700 GPR and $102,774,700 FED), excluding patient liability, acuity, and utilization adjustments.

The proposed changes are being implemented to comply with Wisconsin Statutes governing Medicaid payment systems, particularly s. 49.45 (6m), Wis. Stats and the parameters of the 2021-2023 biennial budget bill. This notice represents information known as of June 22, 2022. 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 and ICF-IIDs within the parameters of 2021-2023 biennial budget bill. These modifications will include adjustments to the targets, maximums, labor factors, property adjustments and other payment parameters in current sections 2.00, 3.00, 4.00, 5.00, 6.00 and 7.00.

2. The methodology will factor in the effect on patient liability of the cost-of-living adjustment (COLA) increases in Social Security and Supplemental Security Income programs.

Copies of the Proposed Changes:

Copies of the available proposed changes and proposed rates may be obtained free of charge by writing to:

Mail: Bailey Dvorak

Bureau of Rate Setting Division of Medicaid Services

Attention: Nursing Home Medicaid Payment Plan

P.O. Box 309 Madison, WI 53701-0309

Phone: [phone]

Fax: [phone]

Attention: Bailey Dvorak

E-Mail: [e-mail]

Written Comments/Meetings:

Written comments on the proposed changes may be sent to the Division of Medicaid Services, at the above address. 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 be made in the proposed changes based on comments received at these forums.