Related statute or rule:
N/A
Plain language analysis:
Current language under s. VA 6.01 (16) provides “Charges for care and maintenance shall be computed every January for the various categories 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 Department establishes policy and procedures for setting private pay rates. The current rate setting calculation used by the Department is a formula-based process that uses the average census counts, the costs under s. 20.485(1) (gk), Stats., the bed days for each type of care provided, and the weighted costs of direct and indirect care.
The proposed rule revisions amend the Department’s current policy and procedure for calculating private pay rates by establishing the method and formula for calculating private pay rates for both nursing home care and assisted living care, including provisions for compiling costs separately for each facility, rather than as a single rate across all state-run veterans homes.
The proposed rule also includes modifications in order to comply with current statutes, rule drafting procedures, provide clarity, or amend outdated references.
Summary of, and comparison with, existing or proposed federal regulation:
38 CFR 51.40 establishes basic per diem rates in accordance with 38 USC 1741, which establishes the criteria for payment. 38 CFR 51.50 establishes per diem rates for eligible veterans for nursing home care. Comparison with rules in adjacent states:
Illinois: Illinois state veterans homes are run by the Illinois Department of Veterans’ Affairs and licensed by the Illinois Department of Public Health. Residents pay a maximum monthly maintenance fee established by the state and based on individual income and ability-to-pay. The cost of care is met through a combination of the maintenance fee paid by each resident, per diem granted by US Department of Veterans Affairs, and appropriated general revenue funds. The monthly cost is based only on the monthly income of the veteran and spouse and does not include other assets. The maximum amount is subject to change on an annual basis, depending on Social Security cost of living adjustments. The methodology for calculating cost of care is not defined in administrative rule.
Iowa: Iowa has one state veterans home with oversight provided by the Commission of Veterans Affairs. Cost of care is the aggregate semiannual per diem rate calculation according to the particular level of care as calculated in January and July of each year for the preceding six months and effective March 1 and September 1. The daily per diem charge is reduced by an amount equal to the appropriate Medicare Part B and Medicare Part D premiums paid by the enrolled member. The rate includes direct costs only.
Michigan: Michigan’s state veterans homes are overseen by the Michigan Veterans Affairs Agency, within the Department of Military and Veterans Affairs. The Board of Managers annually determines the per diem cost of care based on operational costs. These costs may change annually. The cost to individual members is determined by a monthly assessment based on each member’s ability to pay. The methodology for calculating cost of care is not defined in administrative rule.
Minnesota: Minnesota state veterans homes are overseen by the commissioner of the Minnesota Department of Veterans Affairs. Minnesota administrative rules provide for the specific method of calculating average daily per resident cost of care. Residents contribute to the cost of their care according to their means. The cost of care used to determine the maintenance charge of a resident is calculated annually and includes both direct and indirect costs. A change in the cost of care becomes effective on July 1 of the rate year following the reporting year used to calculate the cost of care. The cost of care must remain fixed for that rate year are compiled separately for each facility based on services provided.
Summary of factual data and analytical methodologies:
Pursuant to s. 45.51 (7) (b). Stats., members of veterans homes are required to “pay the amount due the state for care and maintenance of the member”. Section VA 6.01 (16) further requires the Department to charge for “actual care and maintenance provided to a member”. The current formula has been used at the King Veterans Home facility without significant deviation since 1999 and at the Union Grove Veterans Home since 2010. In its 2010 report, the Legislative Audit Bureau (LAB) recommended amendments to Chapter VA 6 to include a formula for calculating private pay rates for nursing home and assisted living care at the Wisconsin Veterans Homes, to include clear definitions for rate-setting terms such as “costs of care”. Therefore, the proposed rules incorporate the LAB recommendations contained in the report and codify the long standing and consistent rate calculations used to determine private per diem rates. Pursuant to s. 45.03 (2m), Stats., administrative rules prepared by the Department of Veterans Affairs must be provided to the Board of Veterans Affairs. Pursuant to s. 227.14 (2) (a) 6m., Stats., the Board may prepare a report containing written comments and its opinion regarding the proposed rules. The Board voted unanimously to approve the draft proposed rules and offered no additional comments. Analysis and supporting documents used to determine effect on small business or in preparation of economic impact analysis:
The Fiscal Estimate and Economic Impact Analysis is attached.
Fiscal Estimate and Economic Impact Analysis:
The department solicited information and advice from businesses, associations, local governmental units, and individuals in order to prepare the Economic Impact Analysis. No comments were received.
Effect on small business:
The proposed rules do not have an anticipated economic impact on small businesses, as defined in s. 227.114 (1), Stats. Agency contact:
Mindy Allen, Administrative Rules Coordinator
Department of Veterans Affairs
2135 Rimrock Road, P.O. Box 7843, Madison, WI 53707-7843, (608) 264-6085
Place where comments are to be submitted and deadline for submission:
Comments may be submitted to Mindy Allen, Administrative Rules Coordinator at the contact information listed above. Comments must be received at or before the public hearing to be held at 11:00 a.m. on December 13, 2019, to be included in the record of rulemaking proceedings.
TEXT OF RULE
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.
