Public Notice
Health and Family Services
(Medical Assistance Reimbursement of Nursing Homes)
State of Wisconsin Medicaid Nursing Facility Payment Plan: FY 07-08
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, 2007.
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 2007-2009 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 $15,899,106 all funds, ($8,954,705 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 2007-2009 Biennial Budget Bill and to disburse the $15,899,106 allotted in the bills to a rate increase of approximately 2% 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. Changing references to previous years for descriptive reasons will be done where 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 2007-2008 period.
5.
Modify the targets in the property allowance in Section
3.532.
6.
Rewrite Section
3.775 to establish protocols for disbursing Operating Deficit Reduction funds and to clarify the mechanics of the disbursement.
7.
Create Section
2.140 to explain which residents will be included in the counts on the dates in Section
5.422.
8.
Modify Sections
1.250-
1.255,
1.270 and
3.526(e) to indicate their application only to the Operating Deficit Reduction program in Section
3.775.
9.
Modify Sections
1.256 and
1.260 to indicate application only to RN, LPN, NA and Ward Clerk wages.
10.
Modify Section
4.851 to allow the Department Secretary to implement the temporary evacuation provisions.
11. Implement any modifications as directed by State statutory changes or non-statutory language in the 2007-09 state budget.
12.
Modify the weighting factors of the RUGs case mix index and the level of care case mix index in Section
3.100 to continue the transition RUGs as the primary case mix factor.
13.
Modify Section
3.140 for special rate adjustments and recalculations after January 1, 2006.
14.
Modify Section
3.900 to clarify the frequency and mechanism for case mix adjustments to the payment rates.
15.
Modify Section
1.317.
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.
