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.
(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.
