Wisconsin Department of Health Services Nursing Home Methods

Wisconsin Department of Health Services Nursing Home Methods Public Meeting Dave Varana, Chief Nursing Home Policy and Rate Setting Section Division of Long Term Care Jim Robinson, Director Center for Health Systems Research and Analysis UW-Madison April 21, 2015 2: 00– 4: 00 p. m. 1 W Wilson, Room 751 DLTC, Bureau of Long Term Care Financing

Wisconsin Department of Health Services Agenda • Welcome and opening remarks • ORBS Automated Cost Report System • Potential changes to the Methods o Rate setting changes o Clarifications o Typographical corrections and edits • Preliminary rate modelling estimates o Case mix index (CMI) trend estimate o Inflation forecast o Behavioral – Cognitive Impairment Incentive (BEHCI) review • CMS Home and Community-Based Setting (HCBS) Waiver funding rule • Next steps DLTC, Bureau of Long Term Care Financing 2

Wisconsin Department of Health Services Opening Remarks Welcome! • Housekeeping items o Sign-in sheet o Teleconference attendance o Use of mute button • Email for meeting materials DLTC, Bureau of Long Term Care Financing 3

Wisconsin Department of Health Services Automated Cost Report System • “ORBS” system fully operational o Sign up & registration: email Greg Leighty o Training & support § Training video available on the DHS NH-Rates website. § Call your auditor! § ORBS Help Desk. • Key websites o https: //orbs. chsra. wisc. edu/ o https: //www. dhs. wisconsin. gov/nh-rates/index. htm DLTC, Bureau of Long Term Care Financing 4

Wisconsin Department of Health Services Proposed Methods Changes Potential Rate Change Ventilator Rate Review – s. 4. 691 • Directly affects four providers • Second year of review • Data collection continues DLTC, Bureau of Long Term Care Financing 5

Wisconsin Department of Health Services Proposed Methods Changes Potential Rate Change Effective date for RUGS score – s. 2. 410 • Picture quarter approach very accurate overall. • Lags occur between admit date and MDS assessment. o Most common cause of “NA” records for Title 19 residents • Future analysis on potential rate affects needed. o Higher percentage of “NA” records in “All Resident” data DLTC, Bureau of Long Term Care Financing 6

Wisconsin Department of Health Services Proposed Methods Changes Clarifications & Edits Patient day definition – s. 1. 315 • Partial day billing is not allowed in Forward. Health. • Methods allow reporting of partial days. • Overstating patient days on Schedule 6 lowers rate. • Revise Methods to align with billing rules. DLTC, Bureau of Long Term Care Financing 7

Wisconsin Department of Health Services Proposed Methods Changes Clarifications & Edits No bed hold billing for Traumatic Brain Injury units – s. 1. 510 • Not allowed per DHS internal policy. • Language not included in Methods. • TBI providers have not billed bed hold. DLTC, Bureau of Long Term Care Financing 8

Wisconsin Department of Health Services Proposed Methods Changes Clarifications & Edits Obsolete reference to Financial Accounting Standards Board (FASB) guidance – s. 3. 523 • Update needed to reflect current reference • Obsolete reference to FASB Statement No. 13 (GAAP) • Current reference: ASC 840 -30 DLTC, Bureau of Long Term Care Financing 9

Wisconsin Department of Health Services Proposed Methods Changes Clarifications & Edits Confusing reference to GAAP – s. 3. 525 (3) • Depreciation is calculated according to straight line. • Other approaches may be allowable under GAAP, but not under the Methods. DLTC, Bureau of Long Term Care Financing 10

Wisconsin Department of Health Services Proposed Methods Changes Clarifications & Edits Clarifying lease maximum determination – s. 3. 523 (3) • Current Methods language on lease maximum for new or replacement facilities is vague. • Revision documents current audit practice. DLTC, Bureau of Long Term Care Financing 11

Wisconsin Department of Health Services Proposed Methods Changes Clarifications & Edits Routine Methods language edits • Updates will be made to effective dates and rate periods. • Formatting fixes, spelling errors and similar typographical errata will be corrected as identified. DLTC, Bureau of Long Term Care Financing 12

Wisconsin Department of Health Services Preliminary Rate Scenario Factors Case Mix Index (CMI) Trend Estimate Jim Robinson, CHSRA DLTC, Bureau of Long Term Care Financing 13

Wisconsin Department of Health Services Preliminary Rate Scenario Factors Inflation Forecast Jim Robinson, CHSRA DLTC, Bureau of Long Term Care Financing 14

Wisconsin Department of Health Services Preliminary Rate Scenario Factors BEHCI Incentive Review Jim Robinson, CHSRA DLTC, Bureau of Long Term Care Financing 15

Wisconsin Department of Health Services Home and Community-Based Setting (HCBS) Waiver Funding Rule New rule affects public and private providers • Community-Based Residential Facilities (CBRF). • Adult Family Homes (AFH): 1– 2 bed, 3– 4 bed. • Resident Care Apartment Complex (RCAC). • Family Care funding for residents in Skilled Nursing Facilities is not affected. • Provider self-assessment tool will be released statewide on April 22, 2015. DLTC, Bureau of Long Term Care Financing 16

Wisconsin Department of Health Services Next Steps Key upcoming events • April 30 Cost Report deadline • June public meeting o Budget information should be available. • Vent Rate workgroup • August public meeting o Scenario modelling results DLTC, Bureau of Long Term Care Financing 17

Wisconsin Department of Health Services Thank You The annual Methods update process relies on provider feedback and expertise. The audit team appreciates your engagement and commitment. DLTC, Bureau of Long Term Care Financing 18