55.01 (4t) "Nursing facility" has the meaning given in s. 46.279 (1) (b).
SECTION 19. 55.045 of the statutes is amended to read:
55.045 Funding. The Except as provided in s. 49.45 (30m) (a), the appropriate county department designated under s. 55.02 shall within the limits of available state and federal funds and of county funds required to be appropriated to match state funds, provide for the reasonable program needs of persons who are protectively placed or who receive protective services under this chapter, including reasonable expenses for the evaluations required by s. 55.06 (8). Payment and collections for protective placement or protective services provided in public facilities specified in s. 46.10 shall be governed in accordance with s. 46.10. The department may require that a person who is protectively placed or receives protective services under this chapter provide reimbursement for services or care and custody received, based on the ability of the person to pay for such costs.
SECTION 20. 55.06 (5) of the statutes is amended to read:
55.06 (5) Notice of a petition for placement shall be served upon the person sought to be placed, by personal service, at least 10 days prior to the time set for a hearing. Upon service of the notice, the person sought to be protected shall be informed of the complete contents of the notice. The person serving the notice shall return a certificate to the circuit judge verifying that the petition has been delivered and notice given. The notice shall include the names of all petitioners. Notice shall also be served personally or by mail upon the person's guardian ad litem, legal counsel, guardian, if any, presumptive adult heirs, and upon other persons who have physical custody of the person to be protected whose names and addresses are known to the petitioner or can with reasonable diligence be ascertained, to any governmental or private body or group from whom the person to be protected is known to be receiving aid, and to such other persons or entities as the court may require. Notice shall also be served personally or by mail upon the department at least 10 days prior to the time set for hearing if the person sought to be protected may be placed in a center for the developmentally disabled. The department shall be allowed to submit oral or written testimony regarding such a placement at the hearing. Notice shall also be served personally or by mail, at least 10 days before the time set for hearing, upon the county department that is participating in the program under s. 46.278 of the county of residence of the person sought to be protected, if the person has a developmental disability and may be placed in an intermediate facility or a nursing facility. The incompetent or proposed incompetent is presumed able to attend the hearing unless, after a personal interview, the guardian ad litem certifies to the court that the person is unable to attend.
SECTION 21. 55.06 (8) (intro.) of the statutes is amended to read:
55.06 (8) (intro.) Before ordering the protective placement of any individual, the court shall direct a comprehensive evaluation of the person in need of placement, if such an evaluation has not already been made. The court may utilize available multidisciplinary resources in the community in determining the need for placement. The board designated under s. 55.02 or an agency designated by it shall cooperate with the court in securing available resources. Where applicable by reason of the particular disability, the appropriate board designated under s. 55.02 or an agency designated by it having responsibility for the place of legal residence of the individual as provided in s. 49.001 (6) shall make a recommendation for placement. If the court is considering placement of the individual in a center for the developmentally disabled, the court shall request a statement or testimony from the department regarding whether the placement is appropriate for the person's needs and whether it is consistent with the purpose of the center under s. 51.06 (1) unless testimony was provided by the department under sub. (5). If the individual has a developmental disability and the court is considering placement of the individual in an intermediate facility or a nursing facility, the court shall request a statement or testimony from the county department of the individual's county of residence that is participating in the program under s. 46.278 as to whether the individual's needs could be met in a noninstitutional setting. A copy of the comprehensive evaluation shall be provided to the guardian, the guardian ad litem, and to the individual or attorney at least 96 hours in advance of the hearing to determine placement. The court or the cooperating agency obtaining the evaluation shall request appropriate information which shall include at least the following:
SECTION 22. 55.06 (9) (a) of the statutes is amended to read:
55.06 (9) (a) The court may order protective services under s. 55.05 (2) (d) as an alternative to placement. When ordering placement, the court, on the basis of the evaluation and other relevant evidence, shall order the appropriate board specified under s. 55.02 or an agency designated by it to protectively place the individual. Placement by the appropriate board or designated agency is subject to s. 46.279 and shall be made in the least restrictive environment consistent with the needs of the person to be placed and with the placement resources of the appropriate board specified under s. 55.02. Factors to be considered in making protective placement shall include the needs of the person to be protected for health, social, or rehabilitative services; the level of supervision needed; the reasonableness of the placement given the cost and the actual benefits in the level of functioning to be realized by the individual; the limits of available state and federal funds and of county funds required to be appropriated to match state funds; and the reasonableness of the placement given the number or projected number of individuals who will need protective placement and given the limited funds available. The Except as provided in s. 49.45 (30m), the county may not be required to provide funding, in addition to its funds that are required to be appropriated to match state funds, in order to protectively place an individual. Placement under this section does not replace commitment of a person in need of acute psychiatric treatment under s. 51.20 or 51.45 (13). Placement Subject to s. 46.279, placement may be made to such facilities as nursing homes, public medical institutions, centers for the developmentally disabled under the requirements of s. 51.06 (3), foster care services and other home placements, or to other appropriate facilities but may not be made to units for the acutely mentally ill. If the appropriate board or designated agency proposes to place an individual who has a developmental disability in an intermediate facility or a nursing facility under an order under this paragraph, the county department shall develop a plan under s. 46.279 (4) and furnish the plan to the board or agency and to the individual's guardian. The board or agency shall place the individual in a noninstitutional community setting in accord with the plan unless the court finds that to do so is not in the individual's best interests. If the individual or the individual's guardian rejects the plan, the court shall take the rejection into consideration in determining whether or not the placement is in the individual's best interests. The prohibition of placements in units for the acutely mentally ill does not prevent placement by a court for short-term diagnostic procedures under par. (d). Placement in a locked unit shall require a specific finding of the court as to the need for such action. A placement facility may transfer a patient from a locked unit to a less restrictive environment without court approval.
SECTION 23. 55.06 (9) (b) of the statutes is amended to read:
55.06 (9) (b) Transfer may be made between placement units or from a placement unit to a medical facility other than those specified in pars. (c) to (e) by a guardian or placement facility without approval by a court. When transfer is made by a placement facility, 24 hours' prior written notice of the transfer shall be provided to the guardian, when feasible. If it is not feasible to notify the guardian in advance, written notice shall be provided immediately upon transfer, and notice shall also be provided to the court and to the board designated under s. 55.02 or an agency designated by it within a reasonable time, not to exceed 48 hours from the time of the transfer. Upon petition to a court by a guardian, ward, or attorney, or other interested person specifying objections to a transfer, or if the person is transferred to an intermediate facility or to a nursing facility, the court shall order a hearing, within 96 hours after filing of the petition or, if the person is transferred to an intermediate facility or to a nursing facility, within 96 hours after the transfer, to determine whether there is probable cause to believe that the transfer is consistent with the requirements specified in par. (a) and is necessary for the best interests of the ward. The court shall notify the ward, guardian, and petitioner of the time and place of the hearing, and a guardian ad litem shall be appointed to represent the ward. If the person is an adult who is indigent, the county of legal settlement shall be liable for guardian ad litem fees. If the person is a child, the person's parents or the county of legal settlement shall be liable for guardian ad litem fees as provided in s. 48.235 (8). The petitioner, ward, and guardian shall have the right to attend, and to present and cross-examine witnesses.
SECTION 24. 55.06 (9) (c) of the statutes is amended to read:
55.06 (9) (c) Transfer Subject to s. 46.279, transfer to a more restrictive placement, including a locked unit, may be made with notice to the guardian, the court and appropriate board designated under s. 55.02 or an agency designated by it in the manner prescribed in par. (b). Upon petition by a guardian, ward or attorney, or other interested person specifying objections to the transfer or if the person has a developmental disability and is transferred to an intermediate facility or a nursing facility, the court shall order a hearing as provided in par. (b).
SECTION 25. 55.06 (10) (a) of the statutes is renumbered 55.06 (10) (a) 1.
SECTION 26. 55.06 (10) (a) 2. of the statutes is created to read:
55.06 (10) (a) 2. If the person has a developmental disability and is placed in an intermediate facility or a nursing facility, the agency that is responsible for the protective placement shall notify in writing the county department of the county of residence of the person that is participating in the program under s. 46.278, at least 90 days before the review. The county department so notified shall develop a plan under s. 46.279 (4) and furnish the plan to the court that ordered the placement and to the person's guardian. The court shall order that the person be transferred to the noninstitutional community setting in accordance with the plan unless the court finds that to do so is not in the person's best interests. If the person or the person's guardian rejects the transfer, the court shall take the rejection into consideration in determining whether or not the transfer is in the person's best interests.
SECTION 27. 55.06 (11) (c) of the statutes is amended to read:
55.06 (11) (c) Upon a finding of probable cause under par. (b), the court may order temporary placement up to 30 days pending the hearing for a permanent placement, or the court may order such protective services as may be required. If an individual who has a developmental disability is ordered, under this paragraph, to be temporarily placed in an intermediate facility or in a nursing facility, and if at the hearing for permanent placement the court orders that the individual be protectively placed, the court may, before permanent placement, extend the temporary placement order for not more than 60 days if necessary for the county department that is participating in the program under s. 46.278 to develop the plan required under s. 46.279 (4).
SECTION 9324. Initial applicability; health and family services.
(1) PREADMISSION SCREENING AND RESIDENT REVIEW. The treatment of section 49.45 (6c) (b) and (c) (intro.), 1., 2., and 3. of the statutes first applies to a screening or resident review performed on April 1, 2004.
(2) PETITIONS FOR PROTECTIVE PLACEMENT. The treatment of section 55.06 (5), (8) (intro.), and (9) (a) of the statutes first applies to petitions for protective placement filed on April 1, 2004.
(3) TRANSFERS OF PROTECTIVELY PLACED PERSONS. The treatment of section 55.06 (9) (b) and (c) of the statutes first applies to transfers of protectively placed individuals that are made on April 1, 2004.
(4) ANNUAL REVIEWS OF PROTECTIVELY PLACED INDIVIDUALS. The renumbering of section 55.06 (10) (a) of the statutes and the creation of section 55.06 (10) (a) 2. of the statutes first apply to reviews that are due on April 1, 2004.
(5) TEMPORARY PROTECTIVE PLACEMENTS. The treatment of section 55.06 (11) (c) of the statutes first applies to temporary protective placements that occur on April 1, 2004.
(6) REQUIRED COUNTY FUNDING OF SERVICES. The creation of section 49.45 (30m) (a) 2. and (c) of the statutes first applies to services provided to an individual who is initially placed in a facility under a petition for protective placement that is filed on, a transfer under section 55.06 (9) of the statutes that is made on, or a temporary protective placement under section 55.06 (11) (c) of the statutes that occurs on, April 1, 2004, or to a person who is initially placed in a facility before April 1, 2004, with respect to whom a review under section 55.06 (10) of the statutes is due on April 1, 2004.
(7) LIMITATION ON PAYMENT. The creation of section 49.45 (30m) (b) of the statutes first applies with respect to services under section 49.45 (30m) (a) 1. and 3. of the statutes that are provided to an individual on April 1, 2004.
SECTION 9424. Effective dates; health and family services.
(1) PLACEMENTS AND ADMISSIONS TO INTERMEDIATE AND NURSING FACILITIES. The treatment of sections 46.279, 49.45 (6c) (a) 6m., (b), and (c) (intro.), 1., 2., and 3., 49.46 (2) (a) 4. c. and (b) 6. a., 55.001, 55.01 (4g) and (4t), 55.045, and 55.06 (5), (8) (intro.), (9) (a), (b), and (c), and (11) (c) of the statutes, the renumbering of section 55.06 (10) (a) of the statutes, the renumbering and amendment of section 49.45 (30m) of the statutes, and the creation of sections 49.45 (30m) (a) 1., 2., and 3., (b), and (c) and 55.06 (10) (a) 2. of the statutes take effect on January 1, 2004.
(End)
LRB-0210LRB-0210/4
DAK:cjs&wlj:pg
2003 - 2004 LEGISLATURE
DOA:......Blaine - BB0049, Nursing home payment formula changes
For 2003-05 Budget -- Not Ready For Introduction
2003 BILL
AN ACT ...; relating to: changes to the formula for payment to nursing homes for services to medical assistance recipients.
Analysis by the Legislative Reference Bureau
health and human services
Medical Assistance
Under current law, payments to nursing homes for services to recipients under the Medical Assistance (MA) program, are made under a cost-based formula that considers certain costs of individual nursing homes, based on information from reports that the nursing homes submit to DHFS. The formula specifies cost centers of direct care, support services, fuel and utilities, net property tax or municipal services, administrative and general costs, interest expenses, and necessary capital payments. For direct care costs, DHFS must use standards that sample nursing homes in the state, as adjusted for regional labor cost variations. For nursing homes in Douglas, Pierce, and St. Croix counties, DHFS uses a federal Medicare program hospital wage index. To calculate a nursing home's payment rate, DHFS establishes a tentative payment rate by applying to information from nursing home cost reports certain standards and methods in calculating amounts payable for a rate year for the cost centers. DHFS then compiles a tentative average payment rate for each nursing home based on that nursing home's rates for cost centers that were in effect on June 30, 1994. Next, DHFS calculates a nursing home's projected cost per patient day. If the tentative payment rate is less than the tentative average payment rate, and if the projected cost per patient day is more than the tentative payment rate, DHFS sets the nursing home's average payment rate as the tentative average payment rate or the tentative payment rate, whichever is greater; if not, DHFS sets the nursing home's average payment rate as the tentative payment rate.
This bill requires DHFS to make a flat-rate payment for MA nursing home costs, as determined by DHFS, for personal comfort supplies and allowable support service costs. Beginning July 1, 2004, this bill requires MA payment to nursing homes to be made on a flat-rate basis for support services (dietary services, environmental services, fuel and utilities, administrative and general costs) and direct care costs (personal comfort supplies, medical supplies, over-the-counter drugs and nonbillable services for ancillary nursing home personnel). Under the bill, the cost centers on which cost-based payment will continue to be made are nonbillable direct care costs for registered nurses, licensed practical nurses, and nurse's assistants; property tax or municipal services; interest expenses; and necessary capital payments. The bill combines the cost centers identified as support services, fuel and utilities, and administrative and general costs into a single cost center and clarifies that "costs for property taxes and municipal services" refer to paid, rather than incurred, costs.
Lastly, the bill changes the procedure by which DHFS calculates a nursing home's payment rate, to require a calculation that is achieved by applying, to information from cost reports submitted by a nursing home, general standards for the nursing home payment system, information concerning the applicable cost centers, and costs for direct care, property taxes, municipal services, and capital payment, as affected by any adjustment necessary for charges for ancillary services and materials.
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. 49.45 (6m) (a) 4. of the statutes is repealed.
SECTION 2. 49.45 (6m) (ag) 2. of the statutes is amended to read:
49.45 (6m) (ag) 2. Standards Except as provided in subd. 3r., standards established by the department that shall be based upon allowable costs incurred by facilities in the state as available from information submitted under par. (c) 3. and compiled by the department.
SECTION 3. 49.45 (6m) (ag) 3m. of the statutes is amended to read:
49.45 (6m) (ag) 3m. For each state fiscal year 1999-2000, rates that shall be set by the department based on information from cost reports for the 1998 most recently completed fiscal year of the facility and for state fiscal year 2000-01, rates that shall be set by the department based on information from cost reports for the 1999 fiscal year of the facility.
SECTION 4. 49.45 (6m) (ag) 3m. of the statutes, as affected by 2003 Wisconsin Act .... (this act), is amended to read:
49.45 (6m) (ag) 3m. For each state fiscal year, rates that shall be set by the department based on information from cost reports for costs specified under par. (am) 1. bm., 4., 5m., and 6. for the most recently completed fiscal year of the facility.
SECTION 5. 49.45 (6m) (ag) 3r. of the statutes is created to read:
49.45 (6m) (ag) 3r. Flat-rate payment, as determined by the department, for costs specified under par. (am) 1. a. and 2.
SECTION 6. 49.45 (6m) (ag) 3r. of the statutes, as created by 2003 Wisconsin Act .... (this act), is amended to read:
49.45 (6m) (ag) 3r. Flat-rate payment, as determined by the department, for all costs specified under par. (am) 1. a. and 2.
SECTION 7. 49.45 (6m) (am) 1. a. of the statutes is amended to read:
49.45 (6m) (am) 1. a. Personal comfort supplies; medical supplies; over-the-counter drugs; and nonbillable services of a ward clerk, activity person, recreation person, social worker, volunteer coordinator, teacher for residents aged 22 and older, vocational counselor for residents aged 22 and older, religious person, therapy aide, therapy assistant, and counselor on resident living.
SECTION 8. 49.45 (6m) (am) 1. b. of the statutes is repealed.
SECTION 9. 49.45 (6m) (am) 1. bm. of the statutes is created to read:
49.45 (6m) (am) 1. bm. Nonbillable services of a registered nurse, licensed practical nurse and nurse's assistant.
SECTION 10. 49.45 (6m) (am) 1. d. of the statutes is repealed.
SECTION 11. 49.45 (6m) (am) 1. e. of the statutes is repealed.
SECTION 12. 49.45 (6m) (am) 3. (intro.) of the statutes is renumbered 49.45 (6m) (am) 2. c. and amended to read:
49.45 (6m) (am) 2. c. Allowable fuel and utility costs, including the facility expenses that the department determines are allowable for the provision of: electrical service, water and sewer services, and heat.
SECTION 13. 49.45 (6m) (am) 3. a. of the statutes is repealed.
SECTION 14. 49.45 (6m) (am) 3. b. of the statutes is repealed.
SECTION 15. 49.45 (6m) (am) 3. c. of the statutes is repealed.
SECTION 16. 49.45 (6m) (am) 4. of the statutes is amended to read:
49.45 (6m) (am) 4. Net property Property tax or allowable municipal service costs incurred paid by the owner of the facility for the facility.
SECTION 17. 49.45 (6m) (am) 5. of the statutes is renumbered 49.45 (6m) (am) 2. d.
SECTION 18. 49.45 (6m) (ar) 1. a. of the statutes, as affected by 2003 Wisconsin Act .... (this act), is amended to read:
49.45 (6m) (ar) 1. a. The department shall establish standards for payment of allowable direct care costs under par. (am) 1. bm., for facilities that do not primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state and separate standards for payment of allowable direct care costs, for facilities that primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state. The standards shall be adjusted by the department for regional labor cost variations.
****NOTE: This is reconciled s. 49.45 (6m) (ar) 1. a. This SECTION has been affected by drafts with the following LRB numbers: LRB-0210/3 and LRB-1252/2.
SECTION 19. 49.45 (6m) (ar) 2. (intro.) and 2. a. of the statutes are consolidated, renumbered 49.45 (6m) (ar) 2. and amended to read:
49.45 (6m) (ar) 2. For support service costs: 2. a. The , the department shall establish one or more standards for the payment of support service costs that take into account support service costs for a sample of all facilities within the state.
SECTION 20. 49.45 (6m) (ar) 2. b. of the statutes is repealed.
SECTION 21. 49.45 (6m) (ar) 2. d. of the statutes is repealed.
SECTION 22. 49.45 (6m) (ar) 3. of the statutes is repealed.
SECTION 23. 49.45 (6m) (ar) 5. of the statutes is repealed.
SECTION 24. 49.45 (6m) (av) 1. of the statutes is renumbered 49.45 (6m) (av) and amended to read:
49.45 (6m) (av) The department shall calculate a payment rate for a facility by applying the criteria set forth under pars. (ag) 1. to 5. and 7., (am) 1. to 5. bm., 4., 5m. and 6., and (ar) 1. to 5. , 4., and 6. to information from cost reports submitted by the facility, as affected by any adjustment for ancillary services and materials under par. (b).
SECTION 25. 49.45 (6m) (av) 2. of the statutes is repealed.
SECTION 26. 49.45 (6m) (av) 3. of the statutes is repealed.
SECTION 27. 49.45 (6m) (av) 4. of the statutes is repealed.
SECTION 28. 49.45 (6m) (av) 5. of the statutes is repealed.
SECTION 29. 49.45 (6m) (av) 5m. of the statutes is repealed.
SECTION 30. 49.45 (6m) (av) 6. of the statutes is repealed.
SECTION 31. 49.45 (6m) (bc) of the statutes is repealed.
SECTION 9424. Effective dates; health and family services.
(1) NURSING HOME PAYMENT FORMULA. The treatment of section 49.45 (6m) (ag) 2. and 3m. (by SECTION 4), (am) 1. a., b., bm., d., and e., 3. (intro.), a., b., and c., and 5., (ar) 1. a. (by SECTION 18), 2. (intro.), a., b., and d., 3., and 5., (av) 1., 2., 3., 4., 5., 5m., and 6., and (bc) of the statutes and the amendment of section 49.45 (6m) (ag) 3r. of the statutes take effect on July 1, 2004.
(End)
LRB-0211LRB-0211/5
DAK:jld:pg
2003 - 2004 LEGISLATURE
DOA:......Jablonsky - BB0050 Intensive treatment beds at centers for developmentally disabled
