Public Notices
Department of Health Services
State of Wisconsin Medicaid Nursing Facility Payment Plan: FY 10-11
(Medical Assistance Reimbursement of Nursing Homes)
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 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, 2010.
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 2009-2011 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 $ 777,774,199 all funds, ($ 508,634,090 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 the 2009-2011 Biennial Budget Bill and to disburse the $ 777,774,199 allotted in the bills to a rate increase of approximately 2% for nursing homes and 2% for ICF-MRs. 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. Modify references to previous years for descriptive reasons 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 2010-2011 periods.
5. Modify contact names and addresses.
6.
Revise Section
3.775 to conform with current practice.
7.
Modify Section
3.655 to clarify the Department's approval procedure for innovative projects.
8.
Modify Section
4.920 to stipulate that only total replacement facilities that were approved by the Department in State Fiscal Year 2008-2009 are eligible for a higher URC maximum.
9.
Modify the parameters for bed hold in Section
1.510 by eliminating language that provided for a fixed number of vacant beds to be used in calculating eligibility for bed hold.
10.
Modify Section
3.122,
5.422 and related sections to allow for an averaging of the Case Mix Index changes for the four “picture dates" over the rate year.
11.
Modify Section
5.422 and related sections to allow for semi-annual rate changes based on new Case Mix Indices instead of quarterly changes.
12.
Modify Section
3.520 and related sections to exclude "wound type" therapy. from the property or other portions of the rate.
13.
Change reference to “T2" to “T1" in Sections
3.532 and
5.810.
14.
Change the reference to “ISN" to an acuity measure in Section
4.694 relating to special payments for residents with AIDS.
15.
Modify Section
3.710 to reflect current practice.
16.
Change Section
6.320 to clarify transportation billing is done on a claim form separate from the rate claim form.
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 Long Term Care
Attention: Nursing Home Medicaid Payment Plan
P.O. Box 7851
Madison, WI 53703-7851
or by faxing James Cobb at 608-264-7720.
Written Comments/Meetings
Written comments on the proposed changes may be sent to the Division of Long Term Care, 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 B274 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.
