Public notice
Health and Family Services
Medical Assistance Reimbursement of Nursing Homes
State of Wisconsin Medicaid Nursing Facility Payment Plan: FY02-03
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 Center for Medicare/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 are effective July 1, 2002.
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 $41,621,800 all funds, ($24,973,080 FFP), excluding patient liability.
The proposed changes are being implemented to comply with Wisconsin Statutes governing Medicaid payment systems, particularly s. 49.45 (6m), Wis. Stats.
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 $41,621,800 allotted in the bill to a rate increase of approximately 4.0 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.
2. Changing references to previous years for descriptive reasons will be done where necessary.
3. Update the labor regions listed in Section 5.410.
4. Modify the minimum occupancy factor in Section 3.030.
5. Reduce the case mix weight for residents with a DD level of care in Nursing Facilities in Section 5.420.
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 2002-2003 period.
7. Change the phase down method in Section 4.520 for new agreements or extensions of current agreements after July 1, 2002.
8. Establish a standard per patient day amount over the formula rate during the phase down period to be reduced over extended periods is Section 4.520.
9. Establish an incentive for phasing out entire facilities in Section 4.580.
10. Increase the Exceptional Medicaid/Medicare Utilization Incentive in Section 2.710 and modify its calculation.
11. Create Section 3.031 to establish a minimum occupancy standard for facilities for the treatment of head injuries as defined in Section 4.692.
12. Modify Section 5.420 to add a case mix weight or alternate rate for residents with head injuries who require only maintenance level of care.
13. Clarify the annual bed bank loss language in Section 3.060.
15. Modify the targets in the property allowance in Section 3.532.
16. Modify Section 3.775 to revise the priority in sub-section A.4., modify the cost finding options for interim and final settlements, update the eligibility criteria in sub-section B, and revise the supplemental payment in sub-section C, including the definition of eligible nursing homes and the calculation of the final rate settlement.
17. Revise parameters and definitions for over-the-counter drugs in Sections 2.600.3.600, and 5.110.
18. Revise the inflation percentages for property tax and municipal fees in Section 5.710.
19. Increase the base allowance for the Exceptional Medicaid/Medicare Utilization incentive in Section 5.920.
20. Redefine the cost-based direct care cost center in Sections 2.100 and 3.100 to include only RN, LPN, certified nurse's assistants costs and the resident living staff costs. CNAs in the 90-day training period and single task workers would also be included.
21. Create a new component in direct care for ward clerks, OTC drugs and the special services on schedule 21 & 24. This would be a level of care/case mix-adjusted payment component with an incentive.
22. Modify the labor factors in section 5.410 for St. Croix and Pierce County using the Medicare hospital cost index. This index is used in determining the labor region adjustment to direct care cost targets in section 3.126.
23. Add s. 3.050 (5) to exclude beds transferred between nursing homes that are consistent with section 150.345, Wis. Statutes, in the calculation of beds for rate setting.
24. Any modifications as enacted by the Wisconsin Legislature.
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
P.O. Box 309
Madison, WI 53701-0309
Attention: Nursing Home Medicaid Payment Plan
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.
Department of Health and Family Services
Medical Assistance Reimbursement of Hospitals
The State of Wisconsin reimburses hospitals for medical services provided to low-income persons under the authority of Title XIX of the Federal Social Security Act and Chapter 49.43 to 49.47, Wisconsin Statutes. The Wisconsin Department of Health and Family Services administers this program that is called Medicaid or Medical Assistance (MA). Federal statutes and regulations require state plans, one for outpatient services and one for inpatient services, that provide the methods and standards for paying for hospital outpatient and inpatient services.
State plans are now in effect for the reimbursement of outpatient hospital services and inpatient hospital services. The Department is proposing to make changes to the provisions contained in the inpatient plan effective July 1, 2002 to implement provisions of 2001 Act 16, the 2001-2003 state budget act, and maintain compliance with federal payment limits.
Outpatient Hospital Services
No proposed changes in the state plan for reimbursement of outpatient hospital services.
Inpatient Hospital Services
Proposed changes in the state plan for reimbursement for inpatient services may include:
1. For the payment system based on diagnosis-related groups (DRGs), adjustment of DRG weighting factors, modification of the method of determining the cost of claims for determining DRG weighting factors and adjustment of DRG weighting factors, modification of the standard DRG base rates and area wage indices.
2. Revision of the rural hospital adjustment percentages to ensure that payments do not exceed authorized funds.
3. Modification of the disproportionate share adjustment parameters to recognize a more current proportion of services provided by hospitals to Medicaid recipients.
4. For the general assistance disproportionate share supplement, adjustment of the maximum available funding, modification of the criteria for a hospital to qualify for the supplement, and modification of the methodology for distributing the available funds to qualifying hospitals in order to maintain compliance with federal payment limits and to implement provisions of the 2001-2003 state budget act.
Implementation of the above changes to the State Plan for inpatient services is expected to change the annual expenditures of the Wisconsin Medical Assistance Program by $752,000 for state fiscal year 2002-2003.
