Public notice
Health and Family Services
(Medical Assistance Reimbursement of Nursing Homes)
State of Wisconsin Medicaid Nursing Facility Payment Plan: FY01-02
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 and Family 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 Federal Health Care Financing Administration (HCFA).
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 are effective July 1, 2001.
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 contained in the Wisconsin 2002-2004 Biennial Budget. Some of the changes are technical in nature; some clarify various payment plan provisions.
The estimated increase in annual aggregate expenditures attributable to these changes for nursing homes serving MA residents is approximately $120,578,500, all funds, ($72,347,100 FFP), excluding patient liability.
The proposed changes are being implemented to comply with Wisconsin Statutes governing Medicaid payment systems, particularly s. 49.45 (6m), Wisconsin Statutes.
The proposed changes are as follows:
1. Modify the methodology to adjust the reimbursement for nursing homes within the parameters of 2002-2004 Biennial Budget Bill and to disburse the $120,578,500 allotted in the bill to a rate increase of approximately 11.7 percent. These modifications will include adjustments to the maximums, per diems, and other payment parameters in Sections 5.400, 5.500, 5.600, 5.700, 5.800 and 5.900, changes in the occupancy percentage used to establish the minimum occupancy standard in Sections 3.030, the inflation and deflation factors in Section 5.300, and targets in Sections 3.000 and 5.000. The parameters for calculating the capital payment will be moved from Section 3.530 to Section 5.000 and will be updated.
2. Changing references to previous years for descriptive reasons will be done where necessary.
3. Eliminate the labor regions listed in Section 5.410 and all other references to them.
4. Begin a transition to a pricing system for all cost centers except property, property tax and provider incentives. Incorporate a price-based component in Sections 3.120, 3.200, 3.250, 3.300 and 3.800. Modify the application of the minimum occupancy factor in Section 3.030 on the price-based component. Create a case mix index based on resource utilization groups (RUGs) III in Sections 3.00 and 5.00.
5. Define restricted use beds in Section 1.300.
6. Change the dates of the definitions of base cost reporting period, common period, and rate payment year in Sections 1.302, 1.303, and 1.314 to reflect the 2001-2002 period.
7. Change the deadline for bed banking in Section 3.060 to the last day in the common period in Section 1.303.
8. Clarify the Exceptional Medicaid/Medicare Utilization Incentive in Section 2.710.
9. Create the Private Room Incentive in Section 2.720 (a) and create Section 2.270 (b).
10. Broaden and reorganize provisions for special allowances for locally operated facilities in Section 3.775.
11. Clarify Section 3.790.
12. Create a definition of Medicaid days in Section 1.317.
13. Revise Central office costs in Section 2.252.
14. Revise recognizable debt balances in Section 3.526 (b).
15. Revise refinancing-related interest expense in Section 3.526 (d).
16. Revise parameters for over-the-counter drugs in Sections 2.600 and 3.600.
17. Revise Section 1.173 to include supplemental questionnaires.
18. Revise Section 1.281 to accommodate the interaction between Medicare PPS revenues and therapy buyers.
19. Revise the inflation percentages for property tax and municipal fees in Section 5.710
20. Revise Section 3.900 by changing the reimbursement method for the Veterans Home at King.
21. Delete Section 3.780.
22. Define "extraordinary appeal" in Section 1.120.
23. Significantly increase the base allowance for the Exceptional Medicaid/Medicare Utilization incentive in Section 5.920.
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 Health Care Financing
Attention: Nursing Home Medicaid Payment Plan
P.O. Box 309
Madison, WI 53701-0309
or by faxing James Cobb at 608-264-7720.
The available proposed changes may be reviewed at the main office at any County Department of Social Services or Human Services.
Written comments/meetings:
Written comments on the proposed changes may be sent to the Division of Health Care Financing 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 350 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.
