ADMISSION AGREEMENT — ATTACHMENT A — DAILY RATES
WVH–Chippewa Falls

2175 E. Park Ave.

Chippewa Falls, WI 54729

(715) 720-6775
Toll-free Fax (888) 966-8821	WVH–King

N2665 County Rd. QQ

King, WI 54946-0600

(715) 258-5586
Toll-free Fax (888) 966-8819	WVH–Union Grove

21425 G Spring St.

Union Grove, WI 53182

(262) 878-6702
Toll-free Fax (888) 966-8816

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):

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

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

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

(Non-Qualifying Veteran, Spouse, Surviving Spouse, Dependent)	USDVA per diem Effective 3/1/2020	Qualifying Veteran

Rate

(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

Full Care Rate

(Non-Qualifying Veteran, Spouse, Surviving Spouse, Dependent)	USDVA per diem Effective 3/1/2020	Qualifying Veteran

Rate

(less USDVA per diem )
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

(Non-Qualifying Veteran, Spouse, Surviving Spouse, Dependent)	USDVA per diem Effective 3/1/2020	Qualifying Veteran Rate

(less USDVA per diem)
IS	Intensive Skilled	$450.00	$115.62	$334.38
SNF	Skilled	$376.00	$115.62	$260.38

WDVA 4020A (04/20) Page 4 of 4

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WDVA 4020A (04/20) Page 1 of 4

WDVA 4020A - Admission Agreement - Attachment A - Daily Rates

Niehaus, Matt

2020-04-07

Niehaus, Matt - DVA

Department of Veterans Affairs