Public notices
Health and Family Services
(Medical Assistance Reimbursement of Nursing Homes)
State of Wisconsin Medicaid Nursing Facility Payment Plan: FY 06-07
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 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 are effective July 1, 2006.
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 in the Wisconsin 2005-2007 Biennial Budget and Act 211. 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 $25,618,300 all funds, ($14,735,646 federal financial participation, or FFP; also sometimes referred to as FED), 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 2005-2007 Biennial Budget Bill as well as Act 211 and to disburse the $25,618,300 allotted in the bills to a rate increase of approximately 2.8% for nursing homes. These modifications will include adjustments to the maximums, per diems, and other payment parameters in Sections
5.400,
5.500,
5.700,
5.800 and
5.900; the inflation and deflation factors in Section
5.300; and targets in Sections
3.000 and
5.000.
2.
Change references to previous years for descriptive reasons, as necessary.
3.
Modify the labor factors listed in Section
5.410.
4.
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 2006-2007 period.
5.
Modify the targets in the property allowance in Section
3.532.
7.
Delete reference to Support Services in Section
4.320.
8.
Correct the example in Section
3.410.
9.
Correct references in Section
1.511.
11.
Amend Section
3.980 so that it would apply only to ICF-MRs.
12.
Rewrite Sections
2.000 and
3.000 to reflect a transition to an acuity-based direct care payment.
13.
Rewrite Sections
2.000 and
3.000 to establish a payment adjustment for dementia and behavioral needs.
14.
Correct date in Section
3.531 (B).
15.
Delete Section
3.776.
16.
Modify Section
4.694.
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 to 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 to the proposed changes based on comments received at these forums.
