• Legislature Adjourns 2005-06 Session
• DHFS to Hold Web cast to Assist Entities on Creating Managed LTC
• Family Care Expansion Legislation Signed into Law
• Groups Call for Legislative Council Study on Mental Health Housing and Funding Issues
• Caregiver Association is Formed to Support Long-Term Care Workers
• DHFS Announces Public Hearing on Ch. 132 Administrative Rule Changes

Legislature Adjourns 2005-06 Session
The Wisconsin Senate and Assembly met on Tuesday and Wednesday of this week and adjourned the session.  This means that all legislation that has not passed both houses and is waiting for action by the Governor is now considered dead.  The legislative session does not technically end until July 12, 2006, which does leave the possibility the legislature returning in Special or Extraordinary Session on a specific issue or bill.  However, the Legislature could be done for the rest of this year.

DHFS to Hold Web cast to Assist Entities on Creating Managed LTC
The Wisconsin Department of Health and Family Services (DHFS) will be hosting two web casts on critical components of managed long-term care.  These are the third and forth in a series of briefings to assist long-term care planning grantees and others interested in expanding managed long-term care in Wisconsin.  The format will include a 50-60 minute presentation followed by 30-40 minutes for questions from the audience.

Tuesday, May 23rd  3:00 – 4:30 PM:
Critical Components of Managed Long-Term Care: Care Management
The focus of this briefing, Care Management, Part 2 is organizational processes necessary to support effective care management, including building interdisciplinary teams and person-centered decision making processes for service provision and purchasing. The speakers will also highlight how care management systems differ between the current fee-for-service waiver programs and managed long-term care programs.  This program is intended for senior managers who are planning for new organizational structures and processes. This is not a training program for interdisciplinary care management team members. 

Tuesday, June 6th   1:30 – 3:00 PM:
Critical Components of Managed Long-Term Care:  Quality Management Systems
A robust quality management system is a critical component of managed care.  Quality management systems are procedures and practices that determine the degree to which programs are operating as intended and achieving intended results, ensure remediation of identified problems, and maintain continuous system improvement.  This briefing will describe the Department's approach to quality management of managed long-term care and how this differs from quality management of fee-for-service long-term care.  The speaker will also highlight the expectations for Managed Care Organizations’ (MCO) quality management systems and the role of a federally mandated External Quality Review Organization (EQRO).

Visit this address http://dhfs.wisconsin.gov/LTCare/rfi/webcasts/index.htm to:

• Join the live presentation at the announced date and time;
• Find supplemental materials, including PowerPoint slides of the presentation; and
• View a recording of the Care Management, Part 2 web cast after the live broadcast.

Family Care Expansion Legislation Signed into Law
Last week, Governor Jim Doyle (D) signed Senate Bill 653 into law, legislation that authorizes the Department of Health and Family Services to contract with entities so that Family Care can be expanded beyond the 5-County pilot project.  Family Care is the long-term managed care pilot program that is currently run by Counties.  SB-653 will allow counties to contract with managed care entities to act as the care management organization, however the bill does not provide the funding necessary to expand Family Care statewide.  This necessary funding will likely be included in the 2007-09 budget, which will not be introduced until February 2007.

This new law also:

• Eliminates the limit for establishing Family Care pilot projects before July 1, 2001.
• Specifies that DHFS may contract with a county, a Family Care district, a tribe or band, the Great Lakes Intertribal Council, Inc., or two or more of these entities to administer the Family Care benefit as care management organizations or resource centers.
• Under current law, DHFS may establish resource centers and contract with entities to provide the Family Care benefit to no more than 29% of the Wisconsin population eligible for the Family Care benefit. This bill authorizes DHFS contract with the above entities to expand Family Care statewide under the following restrictions:
• DHFS may go beyond the 29% but less than 50% of the state population that is eligible for the family care benefit reside, if such a proposed contract receives advance approval from the Legislative Joint Finance Committee, under a passive review process.
• Notification by DHFS to the Joint Finance Committee concerning such a proposed contract must include the contract proposal and an estimate of the fiscal impact of the proposed addition that demonstrates cost neutrality.  However, to go beyond the 50% population limit, DHFS the Wisconsin legislature must provide specific authorization and necessary funding.
• Requires if DHFS intends to expand its use of capitation payments under managed care programs for provision of long-term care services over the number of capitated payments made on behalf of individuals enrolled in these managed care programs under 2005 Wisconsin Act 25, the department must first notify JCF of that intention, and JCF must approve the expansion.
• “Self Directed Services” Requires a care manager of a managed care program for provision of long-term care services must provide a mechanism by which an enrollee, beneficiary, or recipient of the program may arrange for, manage, and monitor his or her benefit directly or with the assistance of another person chosen by the enrollee, beneficiary, or recipient.
• “Self Directed Services” Requires that a care management organization provide each Family Care enrollee with a form on which the enrollee must indicate whether he or she has been offered the option of arranging for, managing, and monitoring his or her own Family Care benefit directly or with assistance.  The enrollee also must indicate whether he or she accepted or declined the option.  This same requirement applies to the care manager of a managed care program for provision of long-term care services.
• Requires DHFS Family Care evaluations\reports must include client access to services, the availability of client choice of living and service options (including the opportunity for the client to have self-directed services), quality of care, and cost effectiveness.
• Expands DHFS Family Care evaluations\reports to include all managed care programs for provision of long-term care services that are funded by Medical Assistance.
• Requires that care management organizations provide the Medicaid funding rate increase passed earlier this year to those nursing home facilities providing services under Family Care.

Groups Call for Legislative Council Study on Mental Health Housing and Funding Issues
Three organizations are requesting the legislature to implement a “Legislative Council Study” on mental health housing and funding issues.  The groups include: Grassroots Empowerment Project, Mental Health Association in Milwaukee County (NAMI) and the Wisconsin, and Disability Rights Wisconsin.  A “Legislative Council Study” is a research committee that is formed by the legislature and the non-partisan legislative service agency (Legislative Council) with representatives and experts on all sides of a particular issue.  Study committees are traditionally created during even-number years and are formed in the summer and provide a final report outlining the issue, the problems involved and possible solutions.  These study committees often last for 6-8 months and their final report normally becomes a legislative proposal that is introduced as a bill.  Often the legislation becomes law, since the final report is supposed to represent a compromise of all the parties involved.

The request for a study on mental health housing and funding issues stems from the problems recently brought to light in recent Milwaukee Journal Sentinel articles.  The request calls for a committee to study:

• Access to and funding for community based mental health services, including Community Aids, county tax levy, Medical Assistance, and private insurance; issues include the adequacy of funding, equity as compared to other disability groups, state and county responsibilities, impact on property tax, relationship to Medicaid managed care for SSI recipients, long term care reform, and management of fiscal resources;
• Costs for treating persons with mental illness in other service systems, such as child welfare, corrections, long term care, and physical health care, due to lack of access to appropriate community based mental health services;
• An assessment of market place factors relating to access to mental health care, including reimbursement levels, limited panel health plans, visit limitations, and recruitment and retention of providers;
• Impact of funding for mental health services on access to services across the state which are recovery oriented and have been shown to be effective in treating mental illness, including assertive community treatment, integrated mental health and substance abuse services, supportive housing and employment, effective screening and treatment for depression, and other evidence based and promising practices; and
• Access to safe, high quality, and affordable housing for persons with mental illness.

Caregiver Association is Formed to Support Long-Term Care Workers
The Wisconsin Association for Caregiver Excellence (WACE), a new association representing long-term caregivers was officially launched on Thursday, May 11, 2006 at the association’s first board of directors meeting. The immediate focus of the association is to seek funding and an executive director, then to begin recruiting members from among the direct care workers, in all care settings, across Wisconsin. WACE is incorporated as a nonprofit, 501c6, organization. The current board of directors includes:  Jackie Hauser (WACE chair), a care giver with Home Care Co-Op, in Watoma; Laura Gutowski (WACE vice chair), a care giver with with Morning Star Group Home in Wausau; Russell King (WACE secretary), Wisconsin Homecare Organization in Madison; Tracy Dudzinski (WACE treasurer), a care giver with Home Care Co-Op in Watoma; Bruce Bartholomew, a care giver with Oakwood Village LTC in Madison;  Barbara Bowers, UW-School of Nursing in Madison; Rose Boron, North Central Wisconsin Assisted Living Association in Plover; Neill DeClercq, UW-Extension School for Workers in Madison; Kathy Intravaia, New Health Services in Milwaukee; John Pett, a certified nursing assistant in Madison; Sally Sprenger, a home and personal care provider and trainer in Wauwatosa;  Alicia Treadwell, a care giver with New Health Services in Milwaukee; Donna Warzynski, Wisconsin Veterans Home in King; and Thomas Zwicker, Direct Care Alliance in Germantown.

DHFS Announces Public Hearing on Ch. 132 Administrative Rule Changes
The Department of Health and Family Services (DHFS) published public hearings on the proposal to repeal, renumber, renumber and amend, amend, and create rules relating to chapter 132, which regulates nursing homes.  The changes include:

• Repeal or revise outdated or overly prescriptive rule provisions
• Repeal provisions that are  duplicative of the requirements that are already stated in and monitored under Wisconsin ch. 50, Stats., 42 CFR  483, or chs. Comm 61 to 65.
• Creates rule provisions requiring applicants for nursing home licensure to:

• disclose the qualifications of any person with authority to manage the nursing home;
• any occurrences that required closure of a residential or health care facility or that required moving its  residents;
• and, any financial difficulties that a person or business entity connected with the nursing home has had in operating a residential or health care facility.

• Create a quality assurance and improvement committee to distribute funds as allowed under ss. 49.499  (2m), Stats., to nursing homes for innovative projects that improve the efficiency and cost effectiveness of operating a nursing home and that improve the quality of life of residents.

If you are interested in this administrative rule, please go to the following website to view the administrative rule and the notice, which provides a summary of the changes.
https://apps4.dhfs.state.wi.us/admrules/public/Rmo?nRmoId=387

Public Hearing Notice:
https://apps4.dhfs.state.wi.us/admrules/public/RetrieveRmoDocument?nDocumentId=2929