Public Notices
Health Services
Annual Adjustment to Fees That May be Charged by a Health Care Provider for Providing Copies of a Patient's Health Care Records
Statutory Authority
Pursuant to Wis. Stat. §
146.83 (3f) (c) 2., each July 1, beginning on July 1, 2012, the Department of Health Services is required to adjust, by the percentage difference between the consumer price index for the 12-month period ending on December 31 of the preceding year and the consumer price index for the 12-month period ending on December 31 of the year before the preceding year, the dollar amounts specified under Wis. Stat. §
146.83 (3f) (b) that a health care provider may charge for providing copies of a patient's health care records.
Under the methods prescribed in Wis. Stat. §
146.83 (3f) (c) 2., the adjusted dollar amounts that a health care provider may charge for providing copies of a patient's health care records are as follows:
Schedule of Health Care Provider Records Fees
July 1, 2013 – June 30, 2014
Health Services
(Medical Assistance Reimbursement of Nursing Homes)
State of Wisconsin Medicaid Nursing Facility Payment Plan:
July 1, 2013 through June 30, 2014
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 proposed would be effective July 1, 2013.
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 enacted in the Wisconsin 2013-2015 Biennial Budget, and update the payment system and methodology. Some of the changes are technical in nature; some clarify various payment plan provisions.
The estimated net decrease in annual aggregate expenditures attributable to these changes for skilled nursing homes serving MA residents is approximately $(12,717,300) (All Funds), or $(7,630,400) (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. This notice represents information known as of June 12, 2013. The changes may be modified by later legislative mandates.
The proposed changes are as follows:
1.
Modify the methodology to adjust the reimbursement for nursing homes within the parameters of 2013-2015 Biennial Budget Bill. These parameters are divided into two parts. First, the Department will disburse the additional $13,128,600 AF ($7,877,200 FFP) that was appropriated to fund an assumed acuity increase of approximately 2.0% for nursing homes. Second, the number of Medicaid-funded patient days is projected to decline, which generates the overall funding decrease identified above. 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 Sections
3.655 (Nursing Home Modernization Incentive Program) to reflect the Department's enhanced focus on addressing behavioral and cognitive impairment issues, including dementia-related needs.
3. The methodology will factor in the effect on patient liability of the 1.7% cost of living adjustment (COLA) increases in Social Security and Supplemental Security Income programs, which were effective January 1, 2013.
4. Potentially incorporate changes into the Behavioral/Cognitive Impairment Incentive, as a result of further study the Department is carrying out in this area.
5.
Correct an obsolete reference in Section
1.120 relative to the statutory basis for Nursing Home Payment Rates.
6.
Modify Section
1.134 to provide for the possibility of alternate payment arrangements under certain circumstances.
7.
Correct an obsolete reference in Section
1.315.
8.
Clarify Section
1.530 regarding the proper calculation of the Bed Hold billing threshold.
9. Clarify the status of new resident admissions and re-admissions in the CMI.
10.
Correct an obsolete reference to certain types of equipment rental expenses in Section
2.251.
12.
Clarify the time period in which corrections to a facility's case mix index are allowable under Section
3.150.
13.
Clarify that the final rate determination is the sum of calculations made for each cost center under Section
3.700.
14.
Merge two duplicative sections relating to separately billable ancillary items by moving portions of Section
6.310 into Section
3.801 and Section
3.802, and a portion of Section
6.320 into Section
3.803, and deleting Section
6.300.
15.
Update the ventilator rate for SFY14 and correct obsolete references to a rate for extensive care patients by adding the updated rate and deleting portions of Section
4.691.
16.
Correct an obsolete reference to a special fixed rate for residents with HIV/AIDS in Section
4.694.
17.
Correct an obsolete reference to approval of uniform chart of accounts in Section
6.110.
18.
Modify Sections
3.775 and
3.780 to reflect possible changes in the Medicare Upper Payment Limit (UPL) calculations. This shall reflect any potential changes to bring the State's approach to calculating the UPL into alignment with the requirements of the recently-released SMD# 13-003.
19.
Update the Reporting Period, Picture Dates, and Dates Available in Section
5.421.
20.
Update the Picture Dates, and Dates Available as of Dates and Rate Effective Dates in Section
5.422.
21.
Update the dates in Section
4.720.
22. Update contact names and addresses, as necessary.
23. Update references to previous years for descriptive reasons, and correct typographical errors as necessary.
24.
Update the labor factors listed in Section
5.410.
25.
Update the case mix weight listed in Section
5.420.
26. Change the dates of the definitions of base cost reporting period.
27. Make any potential changes required by findings of an ongoing federal audit of ICF-IID rate-setting by the Office of Inspector General of the Department of Health and Human Services.
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
Bureau of Financial Management
Attention: Nursing Home Medicaid Payment Plan
P.O. Box 7851
Madison, WI 53703-7851
or by faxing Dave Varana at 608-266-2713.
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.
Health Services
