1. 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

2. Agenda Welcome and opening remarks ORBS Automated Cost Report System
Potential changes to the Methods
Rate setting changes
Clarifications
Typographical corrections and edits
 Preliminary rate modelling estimates
Case mix index (CMI) trend estimate
Inflation forecast
Behavioral – Cognitive Impairment Incentive (BEHCI) review
CMS Home and Community-Based Setting (HCBS) Waiver funding rule
Next steps

3. Opening Remarks Welcome! Housekeeping items
Sign-in sheet
Teleconference attendance
Use of mute button
for meeting materials

4. Automated Cost Report System
“ORBS” system fully operational
Sign up & registration: Greg Leighty
Training & support
Training video available on the DHS NH-Rates website.
Call your auditor!
ORBS Help Desk.
Key websites

5. Proposed Methods Changes
Potential Rate Change
Ventilator Rate Review – s
Directly affects four providers
Second year of review
Data collection continues

6. Proposed Methods Changes
Potential Rate Change
Effective date for RUGS score – s
Picture quarter approach very accurate overall.
Lags occur between admit date and MDS assessment.
Most common cause of “NA” records for Title 19 residents
Future analysis on potential rate affects needed.
Higher percentage of “NA” records in “All Resident” data

7. Proposed Methods Changes
Clarifications & Edits
Patient day definition – s
Partial day billing is not allowed in ForwardHealth.
Methods allow reporting of partial days.
Overstating patient days on Schedule 6 lowers rate.
Revise Methods to align with billing rules.

8. Proposed Methods Changes
Clarifications & Edits
No bed hold billing for Traumatic Brain Injury units – s
Not allowed per DHS internal policy.
Language not included in Methods.
TBI providers have not billed bed hold.

9. Proposed Methods Changes
Clarifications & Edits
Obsolete reference to Financial Accounting Standards Board (FASB) guidance – s
Update needed to reflect current reference
Obsolete reference to FASB Statement No. 13 (GAAP)
Current reference: ASC

10. Proposed Methods Changes
Clarifications & Edits
Confusing reference to GAAP – s (3)
Depreciation is calculated according to straight line.
Other approaches may be allowable under GAAP, but not under the Methods.

11. Proposed Methods Changes
Clarifications & Edits
Clarifying lease maximum determination – s (3)
Current Methods language on lease maximum for new or replacement facilities is vague.
Revision documents current audit practice.

12. 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.

13. Preliminary Rate Scenario Factors
Case Mix Index (CMI) Trend Estimate
Jim Robinson, CHSRA

14. Preliminary Rate Scenario Factors
Inflation Forecast
Jim Robinson, CHSRA

15. Preliminary Rate Scenario Factors
BEHCI Incentive Review
Jim Robinson, CHSRA

16. 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.

17. Next Steps Key upcoming events April 30 Cost Report deadline
June public meeting
Budget information should be available.
Vent Rate workgroup
August public meeting
Scenario modelling results

18. The audit team appreciates your engagement and commitment.
Thank You
The annual Methods update process relies on provider feedback and expertise.
The audit team appreciates your engagement and commitment.