Section 122.05. Bed allocation methodology.

 

(1)   Nursing home beds exclusive of FDD beds.

(a) Distribution of the statewide allotment of new beds. In distributing among planning areas new nursing home beds exclusive of FDD beds from the allotment under s. DHS 122.04 (1) (a) 3. , the department shall proceed as follows:

1. Calculate for each planning area the population growth for the age cohorts under 65, 65 to 74, 75 to 84 and over 84 years of age for a 3-year period beginning in the calendar year for which the most current data on utilization of nursing homes are available;

2. Divide each planning area's population growth for each age cohort by the state growth in population for each cohort for those years to obtain the percentage that a planning area's growth represents of the total state growth by cohort;

3. Ascertain the statewide nursing home utilization percentage for each of the age cohorts in subd. 1. and multiply these by the new bed allotment for nursing homes exclusive of FDDs calculated pursuant to s. DHS 122.04 (1) (a) 3. to get the statewide allotment for each age cohort;

4. Multiply the statewide allotment for each age cohort by each planning area's percentage of state growth for its respective cohort calculated under subd. 2. ;

5. Add the 4 age cohort allotments for each planning area to determine the unadjusted new bed allotment for each planning area for nursing homes exclusive of FDDs;

6. Adjust downward the allotment for each planning area that has more beds per 1,000 residents age 65 and over than there are beds per 1,000 residents age 65 and over statewide by multiplying the unadjusted allotment for the planning area by the ratio of the number of existing and approved beds per 1,000 residents age 65 and over statewide to the number of existing and approved beds per 1,000 residents age 65 and over in the planning area as calculated from county level data, and subtracting the result from the unadjusted allotment. The result shall be the maximum new bed allotment for that planning area; and

7. Increase the unadjusted allotment for the remaining planning areas proportionately so that the total new bed allotments for all planning areas equal the total statewide new bed allotment calculated pursuant to s. DHS 122.04 (1) (a) 3. The result shall be the maximum new bed allotments for these planning areas.

(b) Distribution of a planning area's allotment of new beds.

1. The department shall distribute new nursing home beds exclusive of FDD beds within a planning area by:

a. Calculating the age-specific statewide use rates for long-term care services by adding the total statewide number of persons being served under a medical assistance waiver, exclusive of persons relocated from a state center for the developmentally disabled under s. 46.275 , Stats., and the total statewide number of persons utilizing nursing homes, exclusive of FDDs, for each of the age groups under 21, 21 to 54, 55 to 64, 65 to 74, 75 to 84 and 85+, and dividing the resulting sum for each age group by the current total statewide population for that age group. Utilization data shall be for December 31 of the most recent year for which data is available;

b. Determining the age-specific expected county use of long-term care services by multiplying each age-specific statewide use rate by the actual current population for each age group in each county as estimated by the Wisconsin department of administration;

c. Determining each county's total expected use of long-term care services by summing the age-specific calculations in subd. 1. b. for each county;

d. Determining the actual countywide use of long-term care services by adding the total number of residents of the county reported in the department's annual survey of nursing homes as residing in nursing homes, exclusive of FDD's, on December 31 of the recent survey year, and the number of persons being served under a medical assistance waiver, exclusive of persons relocated from a state center for the developmentally disabled under s. 46.275 , Stats., in the same year in that county; and

e. Determining the ratio of actual use to expected use by dividing the result of the calculation in subd. 1. d. by the result of the calculation in subd. 1. c.

2. Only applicants whose projects would be located in counties which meet both of the following conditions are eligible to compete for new beds:

a. The ratio of actual use to expected use as calculated in subd. 1. e. is less than one; and

b. The countywide occupancy rate as reported in the most recently available annual survey of nursing homes is greater than 94%. The countywide occupancy rate is calculated by dividing the sum of all patient days for all nursing homes exclusive of FDDs in a county, as reported in the annual survey of nursing homes, by the number of days in the calendar year and then dividing that result by the total current number of licensed nursing home beds in that county, exclusive of FDDs, as reported by the department's bureau of quality compliance.

3.

a. The department shall review the methodology under subds. 1. and 2. every 3 years in consultation with the area agencies on aging, the county social service or human service departments and representatives of the nursing home industry.

b. The department shall annually update data necessary to establish a priority list of counties for the purpose of allocating beds. The department may revise the priority list between annual updates to reflect changes in bed capacity resulting from approvals under this chapter, reductions in the capacity of existing nursing homes, facility closures, or relocations of beds or facilities within a planning area.

(c) Redistribution of closed nursing home beds.

1. The department may distribute nursing home beds, exclusive of FDD beds, made available in the state as a result of facility closure or bed capacity reductions which were not closed under a medical assistance waiver, as specified in 42 CFR 1396 n, and which were not replaced by CBRF beds converting to nursing home licensure. Except as provided in s. 150.40 , Stats., applications to replace or redistribute closed beds may be submitted only from counties which are eligible to compete for new beds under par. (b) .

2. Except as provided in s. 150.40 , Stats., the department shall redistribute beds under this paragraph to the planning area in which they were originally located.

3. The statewide average of nursing home beds for each 1,000 persons 65 years of age or over referred to in s. 150.40 , Stats., is calculated by dividing the total current number of licensed nursing home beds, exclusive of FDD beds, in the state, as reported by the department's bureau of quality compliance, by the total current estimated population of persons 65 years of age and older, as determined by the Wisconsin department of administration, and multiplying that result by 1,000.

4. The department may not approve more beds for redistribution within a planning area, or within a county if s. 150.40 , Stats., is applicable, than were made available as a result of facility closure or bed reduction in that planning area or county.

(2)   FDD beds.

(a) The department shall not approve the addition of new beds to a state center for the developmentally disabled or other FDD licensed under subch. I of ch. 50 , Stats., unless the beds are needed to serve persons who cannot adequately be served in an existing FDD, another nursing home or in a less costly or less restrictive setting. Need for the beds shall be determined by the department through an objective analysis of the developmentally disabled population in the planning area.

(b) The number of new beds allocated to the centers and other FDDs in an FDD planning area shall not exceed the number of persons requiring FDD care as determined under par. (a) for that planning area.

(c) In making the distribution of beds under s. DHS 122.04 (1) (b) 2. a. , the department shall use as its standard what best meets the needs of the population to be served.

History: Cr. Register, March, 1985, No. 351 , eff. 4-1-85; emerg. cr. (2) (c), eff. 1-1-87; r. and recr. (1) (b) and (c), Register, January, 1987, No. 373 , eff. 2-1-87; emerg. cr. (2) (c), eff. 5-31-87; cr. (2) (c), Register, October, 1987, No. 382 , eff. 11-1-87; am. (1) (a) (intro.), 3. and 7., (b) 2. intro. and (2) (a), r. (1) (b) 3., renum. (1) (b) 4. to be 3. and am., Register, January, 1991, No. 421 , eff. 2-1-91.