Admission Agreement - Wisconsin



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|ADMISSION AGREEMENT — ATTACHMENT A — DAILY RATES |

| WVH–Chippewa Falls | WVH–King | WVH–Union Grove |

|2175 E. Park Ave. |N2665 County Rd. QQ |21425 G Spring St. |

|Chippewa Falls, WI 54729 |King, WI 54946-0600 |Union Grove, WI 53182 |

|(715) 720-6775 |(715) 258-5586 |(262) 878-6702 |

|Toll-free Fax (888) 966-8821 |Toll-free Fax (888) 966-8819 |Toll-free Fax (888) 966-8816 |

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SUMMARY:

• Pursuant to Chapter VA 6.01 (16) Wisconsin Administrative Code, the Wisconsin Department of Veterans Affairs (WDVA) must adjust care and maintenance charges, or daily rates, to reflect estimated costs.

• Daily rates will be calculated every January and may be revised in July of the same year to reflect any changes in costs.

• The WDVA will provide written notice sixty (60) days prior to the change in rates to members/legal representatives.

• Veterans with a permanent service-connected disability rating fitting one of the criteria below are entitled to receive nursing home care paid by the VA – see 38 USCS 1745(a)(3) (per VA Benefits Manual, sect 10.7):

o is in need of nursing home care for a service connected disability; or

o is rated at least 70 percent disabled due to a service-connected disability or disabilities; or

o has a rating of total disability based on individual unemployability (TDIU).

• Each Veterans Home receives a nursing care per diem, set by the United States Department of Veterans Affairs (USDVA), to help cover the cost of care for each qualifying veteran member.

• Veterans eligible for the USDVA per diem must meet requirements per 38 CFR 51.50 unless they were enrolled in the VA healthcare system prior to 2003.

• Daily rates will continue to be charged to maintain residency when a member is out of the facility. After 15 nights, a member may be discharged unless they request to maintain their residency at the full care rate.

• Member absence from the Wisconsin Veterans Home past midnight will be counted as a bed hold day.

Skilled Nursing Facility Bed Hold considerations:

Out of facility, hospital stay:

Qualifying Veteran: The USDVA per diem will continue for the first 10 consecutive nights of each hospital stay. The full care rate is charged beginning with day 11.

Non-Qualifying: Full care rate is charged for the entire absence.

Out of facility, other than hospital stay:

Qualifying Veteran: The USDVA per diem will continue for the first 12 nights of absence per calendar year. The full care rate is charged beginning with day 13.

Non-Qualifying: Full care rate is charged for entire absence.

WISCONSIN VETERANS HOME — CHIPPEWA FALLS

SKILLED NURSING FACILITIES

PRIVATE PAY DAILY RATES

(Effective March 1, 2020)

|Level of Care |Description |Full Care Rate |USDVA per diem Effective 3/1/2020|Qualifying Veteran |

| | |(Non-Qualifying Veteran, Spouse, | |Rate |

| | |Surviving Spouse, Dependent) | |(less USDVA per diem) |

|SNF |Skilled |$338.00 |$115.62 |$222.38 |

WISCONSIN VETERANS HOME — KING

SKILLED NURSING FACILITIES

PRIVATE PAY DAILY RATES

(Effective March 1, 2020)

|Level of Care |Description | |USDVA per diem Effective 3/1/2020|Qualifying Veteran |

| | |Full Care Rate | |Rate |

| | |(Non-Qualifying Veteran, Spouse, | |(less USDVA per diem ) |

| | |Surviving Spouse, Dependent) | | |

|IS |Intensive Skilled |$486.00 |$115.62 |$370.38 |

|SNF |Skilled |$408.00 |$115.62 |$292.38 |

|HOSPICE |Hospice |$408.00 |$115.62 |$292.38 |

WISCONSIN VETERANS HOME — UNION GROVE

SKILLED NURSING FACILITIES

PRIVATE PAY DAILY RATES

(Effective March 1, 2020)

|Level of Care |Description |Full Care Rate |USDVA per diem Effective |Qualifying Veteran Rate |

| | |(Non-Qualifying Veteran, Spouse, |3/1/2020 |(less USDVA per diem) |

| | |Surviving Spouse, Dependent) | | |

|IS |Intensive Skilled |$450.00 |$115.62 |$334.38 |

|SNF |Skilled |$376.00 |$115.62 |$260.38 |

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