Wisconsin LTC Update (Monday, May 14, 2007)
- Contact Your Legislators This Week!
Advocate for 5% Rate Increases & Changes to Family Care
- Budget: Joint Finance Committee Deletes License Fees for CBRFs & Adult Family Homes
- PUBLIC HEARING \ MEETING NOTICES
- STATE AGENCY MEMOS (DHFS, OQA, DDES, etc.)
- MISCELLANEOUS LTC MEETING NOTICES
- LEGISLATIVE BILL WATCH (Bills, Resolutions & New Legislation)
URGENT: Contact Your State Legislators This Week!
Advocate for 5% Rate Increases for Long-Term Care Providers and Changes to Family Care
The Joint Finance Committee has been voting on modifications to the Wisconsin 2007-09 Biennial Budget (Senate Bill 40) over the past three weeks. The Joint Finance Committee budget process will determine whether programs such as CIP, COP, Personal Care Services and Nursing Home Medicaid Reimbursement will receive any increases for the next two years. The voting process will continue through the end of May, which means long-term care funding and Family Care could come up for a vote by the committee next week. All Wisconsin long-term care provider directors and their staff are requested to contact their respective state representative and state senator. If you have not contacted your legislators yet – do it now. If you have contacted your state legislators once already – do it again! We need your help in obtaining real rate increases for long-term care providers – contacting your legislators will make a difference.
To find out who your state legislators are, click on: http://waml.legis.state.wi.us/
Message:
5% Rate Increase for Essential Long-Term Care Programs:
The priority issue for POS members is obtaining 5% annual rate increases for existing long-term care programs such as CIP, COP, Community Aids, Home Health and Personal Care Services, Assisted Living and Nursing Homes. Today, due to inadequate reimbursement for care being provided, a crisis within the long-term care system has been allowed to worsen. Please keep in mind that many of these programs, such as CIP and COP, have not received a general rate increase from the state in nearly six years and for some programs it has been nearly a decade.
Although Family Care is expected to be expanded statewide, many areas of the state will not see the program implemented for up to five years. Our direct caregivers, the elderly and disabled individuals we serve, and in particular “quality care,” cannot be expected to try and survive while we wait for a new funding program to be instituted. An annual 5% rate increase for all long-term care providers will have a positive and direct impact on maintaining and improving quality care to our most vulnerable population, the frail elderly and the disabled.
Consumer Freedom of Choice – Family Care: Maximize consumer choice and protect their right to access CMO-approved care and services through adoption of an “enrollee freedom of choice” provision. This provision would permit all qualified long term care providers to participate and provide services through a Family Care-affiliated CMO on the condition the provider accepts the CMO’s established fee schedule and meets its quality standards.
Minimum Payment Standards – Family Care: Require all State contracts with existing and evolving Family Care CMOs to establish CMO provider payments at a rate not less than the fee-for-service Medicaid rate. Further, require that any CMO provider payments that are based on the Medicaid rate be paid according to the certified Medicaid payment rate applicable to the provider on the date in which the service was provided. Due to the fact that the state and the CMOs operate under different fiscal years, allow providers to retrospectively bill for and be paid by the CMO for adjustments to the Medicaid rate. The CMO fiscal year is January 1 – December 31; the State fiscal year is from July 1 – June 30.
Timely Payment of Services – Family Care: Assure all state contracts with existing and evolving Family Care CMOs include specific, consistent, and enforceable standards for timely processing and payment on provider claims for services provided to Family Care enrollees. Thirty Day Payment Requirement: Within thirty (30) calendar days of receipt of bill, the CMO shall pay at least 90 percent of clean claims from subcontractors for services in the Family Care benefit package that receive advance authorization from the CMO; at least 99 percent of the claims will be paid within ninety (90) calendar days. The CMO also agrees not to delay payment to subcontractors pending subcontractor collection of third party liability (TPL).
Informal Dispute Resolution – Family Care: Require all State contracts with existing and evolving Family Care CMOs to implement and maintain an independent informal dispute resolution process to address the concerns and complaints of CMO enrollees and providers.
Require CMOs to Pass Through Rate Increases to Both Institutional and Non-Institutional Providers:
The budget bill includes funding to increase capitation rates for managed care organizations so that Family Care CMOs could increase rates to non-institutional providers with which they contract. [LFB Summary: Page 269, Item #6]. POS requests that this statutory language be amended to require CMOs to pass through any MA rate increases the Legislature provides to the institutional and/or non-institutional MA providers with which they contract.
Budget: Joint Finance Committee Deletes License Fees for CBRFs & Adult Family Homes
The Joint Finance Committee last week voted 16-0 to delete Governor Doyle’s budget provision that would have authorized the Department of Health and Family Services (DHFS) to establish by rule a biennial license fees for Adult Family Homes and Community Based Residential Facilities (CBRFs), including CBRF per resident fees. Currently, Wisconsin’s licensing fees are established by statute: (a) for an AFH, a biennial fee of $135; (b) for a CBRF, a biennial fee of $306, plus a biennial fee of $39.60 per resident. The revenues generated by these fees support DHFS staff positions that oversee and license these facilities. The proposal would have directed DHFS to submit rules to implement the fees to the Legislative Council staff no later than November 1, 2007.
Deleting this provision will continue to require DHFS to seek Joint Finance Approval of CBRF and Adult Family Home fee increases through future state budget bills or through separate legislation – which is more difficult for DHFS to obtain at this time.
PUBLIC HEARING \ MEETING NOTICES
Senate Committee on Public Health, Senior Issues, Long Term Care and Privacy
Tuesday, May 15, 2007 9:30 AM 411 South, State Capitol
Public Hearing on the following:
- AB-52: An exception for law enforcement dogs to the requirement that a dog that bites a person be quarantined.
- SB-30: Permitting a mother to breast-feed in any public or private location where she is otherwise authorized to be.
- Note: In order that we may hear from as many different people as possible at this hearing, testimony is requested to be limited to 5 minutes or less.
Assembly Committee on Aging and Long Term Care
Tuesday, May 15, 2007 10:00 AM 225 Northwest, State Capitol
Executive Session on the following:
- AB-279: Protective placements and protective services; involuntary administration of psychotropic medication; guardianships, conservatorships, and wards; and services for adults at risk and elder adults at risk.
Joint Finance Committee
Thursday, May 17, 2007 10:00 AM 412-East, State Capitol
Executive Session on the following:
STATE AGENCY MEMOS (DHFS, OQA, DDES, etc.)
DQA Memo 07-007 (May 9, 2007)
Wisconsin Nurse Aide Competency Testing and Registry Services Update
The purpose of this memo is to provide updated information regarding the current status of the Department of Health and Family Services' (DHFS) contract for nurse aide competency testing and registry services. The memo provides an increase in testing fees that will become effective July 1, 2007. This memo contains important information for long-term care providers on the following topics:
- Testing & Registry Contract Background Information;
- 2007-2008 Contract Amendments;
- Wisconsin Nurse Aide Candidate Handbook; and
- Nurse Aide Training and Testing Resources.
DDES Memo 2007-06 (May 8, 2007)
Nursing Home Recognition for Performance (R4P) Quality Initiative
This memo informs all stakeholders of a change in course regarding the Department's 2007 Nursing Home Recognition for Performance (R4P) Quality Initiative, announced on December 8, 2006, via DDES Info Memo 2006-21. The Department has decided to delay implementation of its nursing home performance measurement and quality recognition effort in order to develop and fund a more robust and sophisticated quality measurement system, targeting the state’s '09-'11 biennium. Therefore, the DHFS 2007 Nursing Home Recognition for Performance Quality Initiative has been withdrawn.
DQA Memo 07-006 (May 4, 2007)
Department of Health and Family Services (DHFS) Reorganization
On April 9, 2007, Department of Health and Family Services (DHFS) announced that the DHFS reorganization proposal had been approved by the Department of Administration. As a result of the reorganization, the Office of Quality Assurance became the Division of Quality Assurance (DQA), a move that is considered to make the mission and focus of DQA stronger within the department. The purpose of this memo is to notify the provider community of name and other organizational changes that have occurred as a result of the reorganization. The DQA is responsible long-term care facility\program surveys and for assuring the safety, welfare and health of persons using health and community care provider services in Wisconsin.
DDES Memo 2007-05 (May 3, 2007)
Revision to COP-W/CIP II variance policy
This memo revises the Department's COP-W/CIP II variance policy to allow for placement of clients in a community-based residential facilities (CBRF) attached to nursing homes provided the lead agency requesting a variance from the policy attests that the proposed living arrangement is in a home-like setting and that the consumer indicates that he or she has chosen the arrangement. DHFS proposes to allow for a variance from existing waiver policy to allow consumers to choose a CBRF attached to a nursing home provided that: 1) the consumer indicates that he or she has chosen this living arrangement and 2) the lead agency attests that the CBRF provides a home-like setting for its residents.
MISCELLANEOUS LTC MEETING NOTICES
Assisted Living Forum
Tuesday, May 15, 2007 10:00 AM – 2:00 PM Madison Area Technical College
211 N. Carroll St, Rm. 240, Madison, WI
- 10:00 a.m. Medication Issues (Doug Englebert)
- 10:30 a.m. Announcements (Kevin Coughlin)
- 11:00 a.m. Quarterly Update & Citation Pattern Analysis (Kevin Coughlin)
- 11:30 a.m. Division of Quality Assurance Update: Otis Woods, DQA Administrator
- 11:45 a.m. Lunch
- 12:30 p.m. Breakout Sessions
CBRF: Barbara Brock-Arndt (lead)
AFH: Sue Farmer (lead)
RCAC: Susan Blount (lead)
ADC: Colette Anderson (lead)
Wisconsin Council on LTC Reform – Committee on State and Local Stakeholder Participation
Monday, May 21, 2007 10:00 AM Coalition of WI Aging Groups (CWAG)
2850 Dairy Drive - Madison
DHFS Focus 2007 Conference: Coming Together: Mapping the Journey to Excellence
August 7-8, 2007 All Day Event Stevens Point, Wisconsin
LEGISLATIVE BILL WATCH (Bills, Resolutions & New Legislation)
Senate Bills:
- SB 32: (Nursing Home Diversions) Diversions under a community integration program of Medical Assistance-eligible persons from imminent entry into nursing homes. (S-Public Health, Senior Issues, Long Term Care and Privacy Committee)
- SB 40: (State Budget) Wisconsin 2007-09 Biennial State Budget: finances and appropriations. (Joint Finance Committee)
- SB 60: (Tort Reform) Evidence of lay and expert witnesses (S-Judiciary and Corrections).
- SB 71: (Pharmacy) Prohibit certain substitutions by pharmacists dispensing epilepsy drugs (S-Health and Human Services).
- SB 76: (Prescription Drugs) Eligibility for and deductible amounts under the prescription drug assistance program for the elderly, providing an exemption from emergency rule procedures, and requiring the exercise of rule-making authority (S-Public Health, Senior Issues, Long Term Care and Privacy).
- SB 85: (Tort Reform) Damages for frivolous claims (S-Judiciary and Corrections).
- SB 114 (MA Estate Recovery and LTC Insurance) Long-Term Care Partnership Program (S-Public Health, Senior Issues, Long Term Care and Privacy)
- SB 144: Changes relating to assets and divestment for Medical Assistance eligibility. (S-Health and Human Services)
- SB 147: Requiring a disease management program and health risk assessments. (S-Health and Human Services)
- SB 153: (Protective Placements) Protective placements and protective services; involuntary administration of psychotropic medication; guardianships, conservatorships, and wards; and services for adults at risk and elder adults at risk. (S-Judiciary and Corrections)
Assembly Bills:
- AB 94: (Publicly Financed Healthcare System) Establishing a publicly financed health care system for residents of this state, creating the Department of Health Planning and Finance, Health Policy Board, and regional consumer health councils, granting rule-making authority, and making appropriations (A-Health and Healthcare Reform).
- AB 121: (Tort Reform) Evidence of lay and expert witnesses (A-Corrections and Courts).
- AB 137: (Prescription Drugs) Eligibility for and deductible amounts under the prescription drug assistance program for the elderly, providing an exemption from emergency rule procedures, and requiring the exercise of rule-making authority (A-Health and Healthcare Reform).
- AB 150: (Pharmacy) Prohibit certain substitutions by pharmacists dispensing epilepsy drugs (A-Health and Healthcare Reform).
- AB 213: (MA Estate Recovery and LTC Insurance) Long-Term Care Partnership Program (A-Aging and Long Term Care).
- AB 224: (Liability) Immunity from liability for a health care provider, health care facility, or employee of a health care provider or health care facility that, in good faith, reports a violation of the law or of a clinical or ethical standard by another health care provider, health care facility, or employee of a health care provider or health care facility.
- AB 247: Notification of the state regarding a medical malpractice claim. (A-Judiciary and Ethics)
- AB 274: A state minimum wage and granting rule-making authority. (A-Jobs and The Economy)
- AB 279: Protective placements and protective services; involuntary administration of psychotropic medication; guardianships, conservatorships, and wards; and services for adults at risk and elder adults at risk. (A-Aging and Long Term Care)
LRB Co-sponsorship Memos: (Legislative Drafts Not Yet Introduced as a Bill)
None.
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