PUBLIC NOTICE
Department of
Health Services
(Medical Assistance Reimbursement of Nursing Homes)
State of Wisconsin Medicaid Nursing Facility Payment Plan
:
July 1, 201
5
through June 30, 201
6
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, 20
1
5
.
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 201
5
-201
7
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 $(
13,655,000
)
(All Funds), or $(
7,952,500
) (FFP), excluding patient liability.
The decrease is associated with a projected decline in the number of submitted claims for institutional patient days in the upcoming fiscal year, and does not include a per diem rate reduction.
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
5
, 201
5
. 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 ho
mes within the parameters of 201
5
-20
1
7
Biennial Budget Bill
.
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.
The
methodology
will factor in the
effect on patient liability of the
cost of living adjustment (COLA) increases
in Social Security and
Supplemental Security Income programs, effectiv
e
January 1, 201
5
.
3.
Potentially incorporate changes into the rate for ventilator-dependent residents under Section
4.691
, as a result of further study the Department is carrying out in this area.
4.
Potentially r
evise the approach to calculating the acuity-based rate adjustment
established under
a facility-specific case mix index using RUGS scores for the entire quarter
under s.
2.140
,
as a result of further study the Department is carrying out in this area.
5.
Revise
Section
1.315
to
align the definition of a patient day with Medicare payment principles and to better reflect current reimbursement procedures in Wisconsin’s MMIS
:
6.
Revise section 1.510 to clarify the longstanding Department policy that bed hold days may not be billed for a resident of a traumatic brain injury unit.
7.
Potentially incorporate changes into the Behavioral/Cognitive Impairment Incentive, as a result of further study the Department is carrying out in this area.
8.
Revise section 3.523 to clarify current audit practice relative to establishment of lease maximums for new or replacement facilities.
9.
Update
the Reporting Period and Dates Available in Section
s
4.720
,
5.421
, and
5.422
10.
Modify contact names and addresses, as necessary.
11.
Modify references to previous years for descriptive reasons
, and correct typographical errors as necessary
.
12.
Modify the labor factors listed in Section
5.410
.
13.
Modify the case mix weight listed in Section
5.420
.
14.
Change the dates of the definitions of base cost reporting period.
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
Long Term Care Financing
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.
