Analysis by the Legislative Reference Bureau
health and human services
Health
Under current law, DHFS levies, enforces, and collects assessments on all occupied, licensed beds of nursing homes and intermediate care facilities for the mentally retarded (facilities) that are not state-owned or state-operated or federally owned or federally operated, except occupied, licensed beds for which payment is made under the federal Medicare program. The assessments are $32 per calendar month per bed of a nursing home and $100 per calendar month per bed of an intermediate care facility for the mentally retarded (facility). Each assessment is on the average number of occupied, licensed beds of a nursing home or facility for the calendar month before the month of assessment, based on an average daily midnight census that is computed and reported by the nursing home or facility and verified by DHFS. At the end of each month, each nursing home and facility must submit to DHFS the occupied, licensed bed count and the assessment amount due.
This bill expands the assessments on occupied, licensed beds of nursing homes and facilities to apply the assessments to all licensed beds, including beds occupied by residents whose costs are paid under the federal Medicare program, regardless of whether the nursing home or facility is privately owned or is owned or operated by the state or the federal government. Under the bill, the amount of the assessment per licensed bed of a nursing home is increased to up to $116 per calendar month and the amount of the assessment per licensed bed of a facility is increased to up to $435 per calendar month in fiscal year 2003-04 and to up to $445 per calendar month in fiscal year 2004-05. Of the amounts received from the assessment, $14,300,000 in fiscal year 2003-04, $13,800,000 in fiscal year 2004-05, and beginning July 1, 2005, 45% in each fiscal year must be deposited in the general fund, and the remainder must be deposited in the Medical Assistance trust fund. Under the bill, DHFS is authorized to promulgate as emergency rules a revision to existing rules that establish procedures and requirements for levying the assessment.
For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 25.77 (3) of the statutes is created to read:
25.77 (3) All moneys received under s. 50.14 (2) from assessments on licensed beds of facilities except $14,300,000 in fiscal year 2003-04 and $13,800,000 in fiscal year 2004-05 and, beginning July 1, 2005, 45% in each fiscal year.
SECTION 2. 50.14 (title) of the statutes is amended to read:
50.14 (title) Assessments on occupied, licensed beds.
SECTION 3. 50.14 (1) (a) of the statutes is amended to read:
50.14 (1) (a) Notwithstanding s. 50.01 (1m), "facility" means a nursing home or an intermediate care facility for the mentally retarded, which is not state-owned or state-operated, federally owned or federally operated or that is not located outside the state.
SECTION 4. 50.14 (2) of the statutes is renumbered 50.14 (2) (intro.) and amended to read:
50.14 (2) (intro.) For the privilege of doing business in this state, there is imposed on all occupied, licensed beds of a facility, except occupied, licensed beds for which payment is made under 42 USC 1395 to 1395ccc, an assessment that shall be deposited in the general fund and that is $100 per calendar month per occupied, licensed bed of an intermediate care facility for the mentally retarded may not exceed $435 in fiscal year 2003-04 and may not exceed $445 in fiscal year 2004-05 and is $32 an assessment that may not exceed $116 per calendar month per occupied, licensed bed of a nursing home. The assessment shall be on the average number of occupied, licensed beds of a facility for the calendar month previous to the month of assessment, based on an average daily midnight census computed and reported by the facility and verified by the department. Charged bed-hold days for any resident of a facility shall be included as one full day in the average daily midnight census deposited in the general fund, except that in fiscal year 2003-04, amounts in excess of $14,300,000, in fiscal year 2004-05, amounts in excess of $13,800,000, and, beginning July 1, 2005, in each fiscal year, amounts in excess of 45% of the money received from the assessment shall be deposited in the Medical Assistance trust fund. In determining the number of occupied, licensed beds, if all of the following apply:
(a) If the amount of the beds is other than a whole number, the fractional part of the amount shall be disregarded unless it equals 50% or more of a whole number, in which case the amount shall be increased to the next whole number.
SECTION 5. 50.14 (2) (b) of the statutes is created to read:
50.14 (2) (b) The number of licensed beds of a nursing home includes any number of beds that have been delicensed under s. 49.45 (6m) (ap) 1. but not deducted from the nursing home's licensed bed capacity under s. 49.45 (6m) (ap) 4. a.
SECTION 6. 50.14 (3) of the statutes is amended to read:
50.14 (3) By the end of each month, each facility shall submit to the department the facility's occupied licensed bed count and the amount due under sub. (2) for each occupied licensed bed of the facility for the month preceding the month during which the bed count and payment are is being submitted. The department shall verify the bed count number of beds licensed and, if necessary, make adjustments to the payment, notify the facility of changes in the bed count or payment owing and send the facility an invoice for the additional amount due or send the facility a refund.
SECTION 7. 50.14 (4) of the statutes is amended to read:
50.14 (4) Sections 77.59 (1) to (5), (6) (intro.), (a) and (c) and (7) to (10), 77.60 (1) to (7), (9) and (10), 77.61 (9) and (12) to (14) and 77.62, as they apply to the taxes under subch. III of ch. 77, apply to the assessment under this section, except that the amount of any assessment collected under s. 77.59 (7) in excess of $14,300,000 in fiscal year 2003-04, in excess of $13,800,000 in fiscal year 2004-05, and, beginning July 1, 2005, in excess of 45% in each fiscal year shall be deposited in the Medical Assistance trust fund.
SECTION 9124. Nonstatutory provisions; health and family services.
(1) ASSESSMENT OF FACILITY LICENSED BEDS; REVISED RULES.
(a) The department of health and family services shall submit in proposed form a revision of rules required under section 50.14 (5) (b) of the statutes to the legislative council staff under section 227.15 (1) of the statutes no later than the first day of the 4th month beginning after the effective date of this paragraph.
(b) Using the procedure under section 227.24 of the statutes, the department of health and family services may promulgate as emergency rules a revision of rules required under section 50.14 (5) (b) of the statutes for the period before the effective date of the revised rules submitted under paragraph (a), but not to exceed the period authorized under section 227.24 (1) (c) and (2) of the statutes. Notwithstanding section 227.24 (1) (a), (2) (b), and (3) of the statutes, the department of health and family services is not required to provide evidence that promulgating a rule under this paragraph as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this paragraph.
SECTION 9324. Initial applicability; health and family services.
(1) ASSESSMENT OF FACILITY LICENSED BEDS. The treatment of sections 25.77 (3) and 50.14 (title), (1) (a), (3), and (4) of the statutes, the renumbering and amendment of section 50.14 (2) of the statutes, and the creation of section 50.14 (2) (b) of the statutes first apply to assessments that are due on the first day of the 2nd full calendar month after the effective date of this subsection.
(End)
LRB-0208LRB-0208/2
DAK:kmg:cph
2003 - 2004 LEGISLATURE
DOA:......Blaine - BB0047, Increase access to community-based long-term care for nursing home residents
For 2003-05 Budget -- Not Ready For Introduction
2003 BILL
AN ACT ...; relating to: relocation of nursing home residents to communities under community integration programs and making an appropriation.
Analysis by the Legislative Reference Bureau
health and human services
Medical Assistance
Under current law, several community integration programs in DHFS provide reimbursement under Medical Assistance (MA) for the relocation or diversion from institutions into communities of MA recipients. Services provided under these programs are permitted MA reimbursement under waivers of federal MA laws. The number of persons served is not to exceed the number of nursing home beds that are delicensed. One of these programs, commonly known as "CIP II," provides home or community-based care to persons who are relocated from institutions other than the state centers for the developmentally disabled and to persons who meet MA level-of-care requirements in nursing homes. Another program, commonly known as "CIP IB," provides home or community-based care to persons with developmental disabilities who are relocated from institutions other than the state centers for the developmentally disabled and to persons who meet MA level-of-care requirements in intermediate care facilities for the mentally retarded or brain injury facilities. Under CIP IB, if a county owns the institution from which an individual is relocated to the community, the county must submit a plan for delicensing a bed of the institution in order to receive CIP IB funding.
Beginning on June 1, 2004, this bill requires a county department of human services, developmental disabilities services, or community programs of a county that participates in CIP II or CIP IB to perform a needs and costs-based assessment for nursing home residents who are eligible for but not receiving services under the program; who have received MA coverage for their nursing home care for at least 30 days; and who prefer services in the community, rather than in the nursing home. After completing the assessment, the county department must contact DHFS; if DHFS determines that costs for services for the nursing home resident are below the limit under a formula specified in the bill, or if DHFS determines that additional funding is available for above-limit costs, the county department must offer the home or community-based services to the nursing home resident. The county department must initiate the needs and costs-based assessment before the person has resided in the nursing home for 90 days or before the cost of the resident's nursing home care has been paid for under MA for 30 days, whichever is longer, and must complete the assessment within 90 days. A county department that fails to meet these requirements and offer home or community-based care to the resident must pay the nonfederal share of the resident's MA nursing home care, unless the resident refused to participate or the needs and costs-based assessment determined that relocation was not feasible. Beginning on January 1, 2004, DHFS is authorized to provide funding to counties from the MA trust fund, to conduct these relocation activities and to provide increased funding for services to the nursing home residents who are relocated to communities. The bill also eliminates the provision requiring a county to submit a plan for delicensing a bed of a county-owned institution from which an individual is relocated to the community.
For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 20.435 (4) (w) of the statutes, as affected by 2001 Wisconsin Act 16, section 717b, and 2003 Wisconsin Act .... (this act), is amended to read:
20.435 (4) (w) Medical assistance trust fund. From the Medical Assistance trust fund, biennially, the amounts in the schedule for meeting costs of medical assistance administered under ss. 46.27, 46.275 (5), 46.278 (6), 46.283 (5), 46.284 (5), 49.45, 49.472 (6), and 51.421 (3), for providing distributions under s. 49.45 (6tt), and for administrative costs associated with augmenting the amount of federal moneys received under 42 CFR 433.51, and for administrative relocation activities specified under ss. 46.277 (5) (am) and 46.278 (6) (am).
****NOTE: This is reconciled s. 20.435 (4) (w). This SECTION has been affected by drafts with the following LRB numbers: LRB-0194/8 and LRB-0208/1.
SECTION 2. 46.277 (1m) (ak) of the statutes is created to read:
46.277 (1m) (ak) "Nursing home" means a nursing home, as defined in s. 50.01 (3), that is certified as a provider of medical assistance, other than an intermediate care facility for the mentally retarded, as defined in s. 46.278 (1m) (am).
SECTION 3. 46.277 (2) (b) of the statutes is amended to read:
46.277 (2) (b) Fund Except as provided in subs. (3r) and (5) (bm), fund home or community-based services provided by any county that meet the requirements of this section.
SECTION 4. 46.277 (3) (c) of the statutes is amended to read:
46.277 (3) (c) Beginning on January 1, 1996, from the annual allocation to the county for the provision of long-term community support services under sub. (5), except as provided in subs. (3r) and (5) (bm), a county department participating in the program shall annually establish a maximum total amount that may be encumbered in a calendar year for services for eligible individuals in community-based residential facilities.
SECTION 5. 46.277 (3r) of the statutes is created to read:
46.277 (3r) RELOCATION OF NURSING HOME RESIDENTS. (a) In a county that is participating in the program, for each nursing home resident who has applied for participation and has been found eligible under sub. (4), but is not participating in the program and who indicates that he or she prefers to receive services in the community, rather than in the nursing home, the participating county department shall initiate a needs and costs-based assessment before the resident has resided in the nursing home for 90 continuous days or before the cost of the resident's nursing home care has been paid under Medical Assistance for 30 days, whichever is longer. The county department shall complete the needs and costs-based assessment within 90 days after initiating it.
(b) After completion of the needs and costs-based assessment, the county department shall contact the department regarding available funding.
(c) If the department determines that costs for home or community-based services for the nursing home resident, as determined under the needs and costs-based assessment, are equal to or less than the amount specified under sub. (5) (bm) 1., the county department shall offer and, if accepted, provide home or community-based services under this section to the nursing home resident, if the cost of the resident's nursing home care has been paid under Medical Assistance for at least 30 days.
(d) If the department determines that costs for home or community-based services for the nursing home resident, as determined under the needs and costs-based assessment, exceed the amount specified under sub. (5) (bm) 1., the department may ascertain whether additional funding, as specified under sub. (5) (bm) 2., is available. If additional funding is available and if the cost of the resident's nursing home care has been paid under Medical Assistance for at least 30 days, the county department shall offer and, if accepted, provide home or community-based services under this section to the nursing home resident.
SECTION 6. 46.277 (5) (am) of the statutes is created to read:
46.277 (5) (am) From the appropriation under s. 20.435 (4) (w), the department may provide reimbursement to a county for administrative activities by the county to relocate a nursing home resident under sub. (3r).
SECTION 7. 46.277 (5) (b) of the statutes is amended to read:
46.277 (5) (b) Total Except as provided in subs. (3r) and (5) (bm), funding to counties under the program may not exceed the amount approved in the waiver received under sub. (2).
SECTION 8. 46.277 (5) (bm) of the statutes is created to read:
46.277 (5) (bm) 1. Funding to a county for an individual who is relocated from a nursing home under sub. (3r) shall be no more than the per-person, per-day payment rate at the individual's level-of-care requirement for the nursing home under s. 49.45 (6m), indexed annually by the percentage of any annual nursing home average rate increase under s. 49.45 (6m), minus the amount that is obtained by subtracting the average annual costs for allowable charges under s. 49.46 (2) (a) and (b) payable on behalf of individuals in nursing homes from the average annual costs per medical assistance recipient for the allowable charges payable on behalf of individuals who are relocated into communities from nursing homes.
2. Notwithstanding the limitation on payment to a county under subd. 1., funding to a county for an individual who is relocated from a nursing home under sub. (3r) may include, in addition to the amount specified in subd. 1., an amount not to exceed the sum obtained by subtracting the total of all payments made for home or community-based services for nursing home residents relocated under sub. (3r) (c) from the amount available under subd. 1.
3. If a county department fails to complete a needs and costs-based assessment and offer home or community-based services under this section to a nursing home resident within the time period specified in sub. (3r) (a), the county shall pay the nonfederal share of Medical Assistance for his or her nursing home care unless the nursing home resident refused participation or the needs and costs-based assessment determined that participation was not feasible.
4. Funding to a county is available under subd. 1. or 2. only during the period in which a relocated individual continues to receive home or community-based care.
SECTION 9. 46.278 (1m) (bg) of the statutes is created to read:
46.278 (1m) (bg) "Nursing home" means a nursing home, as defined in s. 50.01 (3), that is certified as a provider of medical assistance, other than an intermediate care facility for the mentally retarded.
SECTION 10. 46.278 (3) (b) of the statutes is amended to read:
46.278 (3) (b) Fund Except as provided in subs. (4g) and (6) (bm), fund home or community-based services provided by any county that meet the requirements of this section.
SECTION 11. 46.278 (4g) of the statutes is created to read:
46.278 (4g) RELOCATION OF NURSING HOME RESIDENTS. (a) In a county that is participating in the program, for each nursing home resident who has applied for participation and has been found eligible under sub. (5), but is not participating in the program and who indicates that he or she prefers to receive services in the community, rather than in the nursing home, the participating county department shall initiate a needs and costs-based assessment before the resident has resided in the nursing home for 90 continuous days or before the cost of the resident's nursing home care has been paid under Medical Assistance for 30 days, whichever is longer. The county department shall complete the needs and costs-based assessment within 90 days after initiating the assessment.
(b) After completion of the needs and costs-based assessment, the county department shall contact the department regarding available funding.
(c) If the department determines that costs for home or community-based services for the nursing home resident, as determined under the needs and costs-based assessment, are equal to or less than the amount specified under sub. (6) (bm) 1., the county department shall offer and, if accepted, provide home or community-based services under this section to the nursing home resident, if the cost of the resident's nursing home care has been paid under Medical Assistance for at least 30 days.
(d) If the department determines that costs for home or community-based services for the nursing home resident, as determined under the needs and costs-based assessment, exceed the amount specified under sub. (6) (bm) 1., the department may ascertain whether additional funding, as specified under sub. (6) (bm) 2., is available. If additional funding is available and if the cost of the resident's nursing home care has been paid under Medical Assistance for at least 30 days, the county department shall offer and, if accepted, provide home or community-based services under this section to the nursing home resident.
SECTION 12. 46.278 (6) (am) of the statutes is created to read:
46.278 (6) (am) From the appropriation under s. 20.435 (4) (w), the department may provide reimbursement to a county for administrative activities by the county to relocate a nursing home resident under sub. (4g).
SECTION 13. 46.278 (6) (b) of the statutes is amended to read:
46.278 (6) (b) Total Except as provided in subs. (4g) and (6) (bm), total funding to counties for relocating each person under a program may not exceed the amount approved in the waiver received under sub. (3).
SECTION 14. 46.278 (6) (bm) of the statutes is created to read:
46.278 (6) (bm) 1. Funding to a county for an individual who is relocated from a nursing home under sub. (4g) shall be no more than the per-person, per-day payment rate at the individual's level-of-care requirement for the nursing home under s. 49.45 (6m), indexed annually by the percentage of any annual nursing home average rate increase under s. 49.45 (6m), minus the amount that is obtained by subtracting the average annual costs for allowable charges under s. 49.46 (2) (a) and (b) payable on behalf of individuals in nursing homes from the average annual costs for the allowable charges payable on behalf of individuals who are relocated into communities from nursing homes.
2. Notwithstanding the limitation on payment to a county under subd. 1., funding to a county for an individual who is relocated from a nursing home under sub. (4g) may include, in addition to the amount specified in subd. 1., an amount not to exceed the sum obtained by subtracting the total of all payments made for home or community-based services for nursing home residents relocated under sub. (4g) (c) from the amount available under subd. 1.
3. If a county department fails to complete a needs and costs-based assessment and offer home or community-based services under this section to a nursing home resident within the time period specified in sub. (4g) (a), the county shall pay the nonfederal share of Medical Assistance for his or her nursing home care unless the nursing home resident refused participation or the needs and costs-based assessment determined that participation was not feasible.
4. Funding to a county is available under subd. 1. or 2. only during the period in which a relocated individual continues to receive home or community-based care.
SECTION 15. 46.278 (6) (f) of the statutes is repealed.
SECTION 9424. Effective dates; health and family services.
(1) NURSING HOME RESIDENT RELOCATION; FUNDING. The treatment of sections 20.435 (4) (w) (by SECTION 1), 46.277 (2) (b) and (5) (am), (b), and (bm) 1. and 2., and 46.278 (3) (b) and (6) (am), (b), (bm) 1. and 2., and (f) of the statutes takes effect on January 1, 2004.
(2) NURSING HOME RESIDENT RELOCATION; REQUIREMENTS. The treatment of sections 46.277 (1m) (ak), (3) (c), (3r), and (5) (bm) 3. and 4. and 46.278 (1m) (bg), (4g), and (6) (bm) 3. and 4. of the statutes takes effect on June 1, 2004.
(End)
LRB-0209LRB-0209/2
DAK:kjf/cjs/cmh:pg
2003 - 2004 LEGISLATURE
DOA:......Blaine - BB0048 Restrict admissions to ICF-MRs and nursing homes; increase access to community-based services
For 2003-05 Budget -- Not Ready For Introduction
