49.45(6m)(ag)3p.d.d. The system may include incentives for providing high quality of care. 49.45(6m)(ag)6.6. Standards for capital payment that will be based upon replacement value of a facility as determined by a commercial estimator with which the department contracts and criteria and limitations as determined by the department. 49.45(6m)(ag)7.7. Assurance of an acceptable quality of care for all medical assistance recipients provided nursing home care. 49.45(6m)(am)(am) In determining payments for a facility under the payment system in par. (ag), the department shall consider all of the following cost centers: 49.45(6m)(am)1.1. Allowable direct care costs, including, if provided, any of the following: 49.45(6m)(am)1.a.a. Personal comfort supplies; medical supplies; over-the-counter drugs; and nonbillable services of a ward clerk, activity person, recreation person, social worker, volunteer coordinator, teacher for residents aged 22 and older, vocational counselor for residents aged 22 and older, religious person, therapy aide, therapy assistant, and counselor on resident living. 49.45(6m)(am)1.bm.bm. Nonbillable services of a registered nurse, licensed practical nurse, and nurse aide. 49.45(6m)(am)2.2. Allowable support service costs, including the following allowable facility expenses: 49.45(6m)(am)2.a.a. Dietary service for the provision of meals to facility residents. 49.45(6m)(am)2.b.b. Environmental service for the provision of maintenance, housekeeping, laundry and security service. 49.45(6m)(am)2.c.c. Allowable fuel and utility costs, including the facility expenses that the department determines are allowable for the provision of electrical service, water and sewer services, and heat. 49.45(6m)(am)2.d.d. Allowable administrative and general costs, including costs related to the facility’s overall management and administration and allowable expenses that are not recognized or reimbursed in other cost centers and including the costs of commercial estimators approved by the department under par. (ar) 6. 49.45(6m)(am)4.4. Property tax or municipal service costs paid by the owner of the facility for the facility. 49.45(6m)(am)5m.5m. Allowable interest expense of the facility, less interest income of the facility and less interest income of affiliated entities, to the extent required under the approved state plan for services under 42 USC 1396. 49.45(6m)(am)6.6. Capital payment necessary for the provision of service over time, including allowable facility expenses for suitable space, furnishings, property insurance and movable equipment for patient care. 49.45(6m)(ap)(ap) If the bed occupancy of a nursing home is below the minimum patient day occupancy standards that are established by the department under par. (ar) (intro.), the department may approve a request by the nursing home to delicense any of the nursing home’s licensed beds. If the department approves the nursing home’s request, all of the following apply: 49.45(6m)(ap)1.1. The department shall delicense the number of beds in accordance with the nursing home’s request. 49.45(6m)(ap)2.2. The department may not include the number of beds of the nursing home that the department delicenses under this paragraph in determining the costs per patient day under the minimum patient day occupancy standards under par. (ar). 49.45(6m)(ap)3.3. The nursing home may not use or sell a bed that is delicensed under this paragraph. 49.45(6m)(ap)4.a.a. Every 12 months following the delicensure of a bed under this paragraph, for which a nursing home has not resumed licensure under subd. 5., the department shall reduce the licensed bed capacity of the nursing home by 10 percent of all of the nursing home’s beds that remain delicensed under this paragraph or by 25 percent of one bed, whichever is greater. The department shall reduce the statewide maximum number of licensed nursing home beds under s. 150.31 (1) (intro.) by the number or portion of a number of beds by which the nursing home’s licensed bed capacity is reduced under this subdivision. 49.45(6m)(ap)4.b.b. Subdivision 4. a. does not apply with respect to the delicensure of beds between October 14, 1997, and the date that is 60 days after October 14, 1997, during the period of any contract entered into by a nursing home prior to January 1, 1997, if the contract requires the nursing home to maintain its current licensed bed capacity. 49.45(6m)(ap)5.5. A nursing home retains the right to resume licensure of a bed of the nursing home that was delicensed under this paragraph unless the licensed bed capacity of the nursing home has been reduced by that bed under subd. 4. The nursing home may not resume licensure of a fraction of a bed. The nursing home may resume licensure 18 months after the nursing home notifies the department in writing that the nursing home intends to resume the licensure. If a nursing home resumes licensure of a bed under this subdivision, subd. 2. does not apply with respect to that bed. 49.45(6m)(ap)6.6. If subd. 4. b. applies and the nursing home later resumes licensure of a bed that was delicensed between October 14, 1997, and the date that is 60 days after October 14, 1997, the department shall calculate the costs per patient day using the methodology specified in the state plan that is in place at the time that the delicensed beds are resumed. 49.45(6m)(ar)(ar) In determining payments for a facility under par. (ag), the department may establish minimum patient day occupancy standards for determining costs per patient day and shall apply the following methods to calculate amounts payable for the rate year for the cost centers described under par. (am): 49.45(6m)(ar)1.a.a. The department shall establish standards for payment of allowable direct care costs under par. (am) 1. bm., for facilities that do not primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state and separate standards for payment of allowable direct care costs, for facilities that primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state. The standards shall be adjusted by the department for regional labor cost variations. The department shall treat as a single labor region the counties of Dane, Dodge, Iowa, Columbia, Richland, Sauk, and Rock and shall adjust payment so that the direct care cost targets of facilities in Dane, Iowa, Columbia, and Sauk counties are not reduced as a result of including facilities in Dodge, Richland, and Rock Counties in this labor region. For facilities in Douglas, Dunn, Pierce, and St. Croix counties, the department shall perform the adjustment by use of the wage index that is used by the federal department of health and human services for hospital reimbursement under 42 USC 1395 to 1395ggg.