SECTION 1. VA 6.001 is created to read:
VA 6.001 Definitions. In this chapter, the following terms shall have the designated meanings:
(1) “Bed capacity” means the number of beds that may be filled based on the amount authorized by the USDVA and licensed by the department of health services.
(2) “Case mix weight” means a value established by the department of health that may increase based on the level of care provided.
(3) “Cost of care” means an amount established annually by the department that is calculated separately for each home based on services provided. “Cost of care” consists of the calculation of both direct and indirect care costs, as defined in subs. (4) and (6).
(4) “Direct care costs” means a home’s expenses that are incurred and attributable to services that directly benefit the member consisting of items under s. VA 6.01 (11) and (12), subject to approved biennial funding. (5) “Home” has the meaning given for “veterans home” in s. 45.01 (12m), Stats. (6) “Indirect care costs” means a home’s expenses incurred for common or joint purposes and are services that are provided on behalf of a member. “Indirect care costs” include costs for services such as housekeeping, laundry, administration, food services, debt service, municipal services, and utilities.
(7) “Level of care” means a classification that corresponds to the services required to be provided to a member based on the member’s physical or mental condition and abilities.
(8) “Patient day” means a day that a bed is assigned to a member and includes the day of admission but not the day of discharge. In this subsection, “day” means the 24-hour period ending at midnight.
(9) “Private pay rate” means the amount members pay who have sufficient income and resources to fully reimburse the department for the cost of care and maintenance they received at a home.
(10) “USDVA” means the United States department of veterans affairs.
SECTION 2. VA 6.01 (2) (a) and (b), and (3) (a) 2. are amended to read:
VA 6.01 (2) (a) Except as provided in par. (b), no person may be admitted to a home unless the person has submitted an application on forms furnished by the home and the application has been approved by the commandant. Each question shall be fully and accurately answered and the completed application shall be properly executed. An applicant shall authorize the department to conduct a criminal background check of his or her criminal record. Upon admission of the applicant as a member, the completed application shall be a valid and binding contract by and between the member and the home.
(b) A person may be admitted into a home on a conditional basis pending the completion of the processing of his or her application process.
(3) (a) 2. A physician’s report of physical examination indicating the applicant’s need for nursing home level of care.
SECTION 3. VA 6.01 (3) (c) is created to read:
VA 6.01 (3) (c) Documentation required under par. (a) 2. may be requested to be resubmitted at least annually to determine the level of care appropriate for the member’s needs.
SECTION 4. VA 6.01 (4), (7), (8), and (16) are amended to read:
VA 6.01 (4) Spouse. In addition to the documents required under sub. (3), an applicant who is a spouse of a veteran shall furnish a certified copy of his or her the certificate of marriage to the veteran or any other verifiable evidence of marriage that is acceptable to the department.
(7) Eligibility, determination. If the applicant or the county veterans service officer assisting the applicant with the application requests a review of a determination of ineligibility, the matter shall be referred to the secretary department for review.
(8) Readmission. A former member may be readmitted to a home only if he or she submits by submitting a new application with the documents required under sub. (3) (b) and the application is approved by the commandant on the basis of the commandant’s determination that the home is able to provide appropriate care for the applicant. A former member who was given an undesirable or dishonorable discharge may be readmitted only if the commandant is satisfied that the conduct leading to the discharge will not be repeated. The commandant may also require that an applicant for readmission shall have paid pay moneys which that the applicant owed to the home.
(16) Charges for care and maintenance shall be computed every January for the various categories levels of care provided by a home. The computations shall be based upon the estimated costs of care to be incurred by the home for the succeeding annual period. The department may update charges in July to reflect changes in costs during the year. Charges shall be made for actual care and maintenance provided to a member. The calculation of the cost of care and maintenance is comprised of direct and indirect costs incurred by a home on behalf of its members.
SECTION 5. VA 6.01 (16) (a) and (b) are created to read:
VA 6.01 (16) (a) Formula for calculating the private pay rate. The private pay rate shall be based on formulas using the following steps:
1. For each level of care provided to a member, determine the number of patient days.
2. Add together all patient days for each level of care to determine the total number of patient days.
3. For each level of care received, divide the number determined under subd. 1. by the amount determined under subd. 2. Each result equals the ratio of patient days for a level of care.
4. Identify the bed capacity.
5. To determine an occupancy rate, divide the average number of members in a home for the last reported fiscal year by the bed capacity identified under subd. 4.
6. For each level of care, multiply the bed capacity identified under subd. 4. by the amount identified under subd. 5. Multiply that total by 365. Multiply that total by the amount identified under subd. 3. for the corresponding level of care. Each result equals the projected patient days for a level of care.
7. Add together all the projected patient days identified under subd. 6. for each level of care. The result equals the total number of projected patient days.
8. For each level of care, multiply the total number of projected patient days determined under subd. 6. by the corresponding case mix weight provided by the department of health. Each result equals the weighted patient days for a level of care.
9. Add together all the weighted patient days for each level of care. The result equals the total number of weighted patient days.
10. For each level of care, divide the amount determined under subd. 8. by the amount determined under subd. 9. Each result equals the weighted patient day ratio for a level of care.
11. For each level of care, multiply the amount determined under subd. 10. by the direct care costs. Each result is the allowable direct care cost for a level of care.
12. For each level of care, divide the amount determined under subd. 11. by the amount determined under subd. 8. Then multiply it by the corresponding case mix weight. Each result equals the daily direct care cost for a level of care.
13. Divide the indirect care costs as determined by the department for the home and divide it by the total number of projected patient days determined under subd. 7. Each result equals the daily indirect care cost for a level of care.
14. Add together the amounts calculated under subds. 12. and 13. The result equals the projected private pay rate for a level of care.
Note: See Appendix for illustration depicting the formula used to calculate the private pay rate.
(b) Rate reduction. When applicable, the department shall reduce the daily rate of pay by the amount of the per diem reimbursement paid on behalf of a member by the USDVA.
