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DMHSAS Numbered Memo 2011-06

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STATE OF WISCONSIN
Department of Health Services
Division of Mental Health and Substance Abuse Services

Date:  September 6, 2011
           Memo Series DMHSAS 2011-06

RE:     RATE INFORMATION FOR BILLING FOR SERVICES PROVIDED BY THE MENTAL HEALTH INSTITUTES            

To:     Listserv

For:    County Departments of Community Programs Directors
           County Departments of Developmental Disabilities Services Directors
           County Departments of Human Services Directors
           County Departments of Social Services Directors

From: Linda A. Harris, Administrator
           Division of Mental Health and Substance Abuse Services

Subject:  Rate Information for Billing for Services Provided by the Mental Health Institutes

Document Summary

Each year, the Wisconsin Department of Health Services (DHS) reviews and revises the rates charged for services at the state mental health institutes. The mental health institute rates are effective October 1, 2011. Rates are based on the actual cost of providing these services and the availability of third party revenues such as Medicare and Medicaid.

The October 1, 2011 average daily inpatient room rate increase will be 1.6 percent for Mendota Mental Health Institute and Winnebago Mental Health Institute. The daily rates at both facilities are the same and considered system-wide rates.

Rate Schedule
Mental Health Institutes

October 1, 2011 - September 30, 2012

Per Day Inpatient Rate Mendota Winnebago
Adult Psychiatric Services $984 $984
Geropsychiatric $1,036  
Child/Adolescent   $955
Forensic - all security levels $984 $984
Emergency Detention Add-On for first three days of service (plus intervening weekends and legal holidays) $200 $200
Non-Typical Services Add-on $200 $200

Day School - per hour

  $30

Emergency Detention Approvals

Effective June 30, 2009, s. 51.15 (2) changed to require approval of the need for detention from the County Department of Community Programs in the county where the individual was taken into custody prior to transporting the person for detention at either Mendota Mental Health Institute or Winnebago Mental Health Institute.

Services for Children and Elderly

Effective January 1, 2010, s.49.45 (30r) changed to require the county to provide the non-federal portion of the Medicaid payment for services for patients that are under 21 years of age, are under 22 years of age and who were receiving services immediately prior to reaching age 21, or who are 65 years of age or older. The Department will bill the county the full daily rate for these patients and return the federal share of the payment to the county when received. Effective April 1, 2010, Mendota Mental Health Institute stopped serving children and adolescents. Children and adolescents are being served at Winnebago Mental Health Institute.

Payment Protocol

Per s. 51.42(3)(as)2, the Department shall deduct the amount due for treatment at the institutes from any payment due from DHS to the county department.

Non-Typical Services

The Department seeks to minimize the shifting of costs whenever possible. Under a straight flat-rate system, some costs of non-typical services would be shifted to counties who are responsible for patients not having extraordinary costs. To minimize this, non-typical costs are broken out separately from the flat rate so that only those counties having patients requiring these unusual services incur these costs.

When a patient requires non-typical services or non-emergency outpatient medical care, the county will be notified 48 hours prior to initiating services and, in emergency situations, within 8 hours of initiating services. Notification will be by mail or FAX. The county is afforded the opportunity to discuss the situation with a representative of the institute empowered to act on behalf of the institute. The county and institute may agree to an alternative course of action or the county may request the discharge of the patient to pursue the county’s choice of an alternate course of action. If the county agrees to the proposed course of action or there is no agreement, the institute will continue the course of action and the county will be liable for the non-typical charge add-on from the institute.

Non-typical Services are defined as services not normally required by a patient; e.g., 1:1 coverage greater than 4 hours    within a 24-hour period for additional management and monitoring of dangerous patients’ behaviors such as self-harm, harm to others, suicide precautions and other behaviors deemed too severe to be managed within typical staffing patterns. Non-typical Services include, but are not limited to, outpatient medical care, 1:1 care greater than 4 hours in a 24-hour period and increased costs to provide mental health services specific to a particular patient, e.g. interpreter services for deaf or non-English speaking patients.
Emergency Situation is defined as a situation whereby a physician using his/her medical judgment determines serious harm will result to the patient if the proposed action is delayed 48 hours; e.g. hospitalization, outpatient medical care, or other non-typical services.

Inpatient Medical Related Hospitalization

When a patient requires inpatient hospitalization outside an institute, the county will be notified as soon as possible before the hospitalization or at a minimum within 8 hours of initiating services. Notification will be by mail or FAX. The county should work with the outside organization to determine the appropriate entity to be billed for the inpatient charges. The responsible entity will be billed directly by the outside organization for the hospitalization and all outside costs associated with it. The patient will be discharged to the outside organization for the period of hospitalization and re-admitted to the institute when discharged from the outside organization. The county is not billed daily institute rates during outside hospitalization.

Payment for Evaluation or Treatment Ordered by a Juvenile Court Under Chapter 938, Wis. Stats.

Medicaid (MA) will not pay for court ordered evaluation or treatment services provided to a juvenile under chapter 938 because these services are not considered to be medically necessary (the same as for services provided under the adult criminal code in sections 971.14 and 971.17, Wis. Stats.). Therefore, the county that orders evaluation or treatment services under chapter 938 is responsible for payment for these services, as required under sections 938.295, 938.34(6)(a), (b), and (c), 938.361, and 938.362, Wis. Stats. The county of the court ordering the examination or treatment will receive the bill. The rates charged to the county are based on the daily rates of the unit where the juvenile resides during his/her stay at the institute.

The only exception to county financial responsibility is when alcohol or other drug abuse treatment is determined to be medically necessary under paragraph 938.34(6)(am), in which case MA may pay for the service that is provided in an approved alcohol or substance abuse treatment unit.

Court-Ordered Adult Competency Evaluation Charges

s. 51.42(3)(as)1m allows the state to bill for stays at the institutes beginning 48 hours, not including weekends and legal holidays, after notification the evaluation is completed. This statute states, "A county department of community programs located in the county of the court ordering the examination, shall reimburse a mental health institute at the institute's daily rate for custody of any person who is ordered by the court to be examined at the mental health institute under s. 971.14(2) for all days that the person remains in custody at the mental health institute, beginning 48 hours, not including Saturdays, Sundays, and legal holidays, after the sheriff and county department receive notice under s. 971.14(2)(d) that the examination has been completed.”

Regional Office Contact: N/A

Central Office Contact:

          Michael Hughes
          Division of Mental Health and Substance Abuse Services
          1 West Wilson Street, P.O. Box 7851
          Madison, WI 53707-7851
          Telephone: (608) 267-2254
         

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Last Revised:  September 07, 2011