• Wisconsin Elections Update
• DHFS Releases LTC Information Paper #3: LTC Expansion “Readiness Template”
• Federal: CBO Report “Medicaid Spending Growth and Options for Controlling Costs”
• Federal: CMS Unveils New Medicaid Anti-Fraud Program
• WISCONSIN NEWS ARTICLES OF INTEREST…
• PUBLIC HEARING NOTICES
• DHFS-DDES, BQA, BQC MEMOS
• NEW LEGISLATION

 Wisconsin Elections Update
The deadline for nomination papers to be placed on Wisconsin’s election ballot has passed and the races for state office are now determined.  The September 12th Primary Election and the November 7th General Election include the following offices: U.S. Senate (Herb Kohl); Governor and Lt. Governor; Attorney General; Secretary of State; Treasurer; all eight Congressional districts; all 99 state assembly districts; and odd numbered state senate districts.

In the assembly 66 of the 99 seats are being contested and in the state senate 13 of the 17 available seats are being contested.  The election for Governor and State Attorney General will be the most visible races this year, with incumbent Democrat Governor Doyle vs. Republican Congressman Mark Green and incumbent Democrat Attorney General Peg Lautenschlager vs. the winner of the Republican primary.

A new poll released from "Rasmussen Reports" shows Governor Doyle with 46% and his Republican challenger with 41%.   Also noted in the poll, Democrat U.S. Senator Herb Kohl received 60% in the poll over his Republican challenger with 27% of the vote.  Six-month campaign finance reports released last week show that Republican gubernatorial challenger Mark Green raised $60,000 more than Governor Doyle over the past six months, however Governor Doyle overall has $2 million more cash-on-hand than his challenger.  Mark Green had $3.2 million in the bank, versus Governor Doyle with $5.2 million.

DHFS Releases LTC Information Paper #3: LTC Expansion “Readiness Template”
The Wisconsin Department of Health and Family Services (DHFS) – Division of Disability and Elder Services (DDES) released on July 17, the third in a series of informational papers intended to assist organizations and consortiums that wish to become a Managed Care Organization (MCOs) in the statewide expansion of Family Care.  Family Care is Wisconsin’s managed care program for long-term care services, which DHFS is in the process of expanding statewide over the next five years.  This informational paper is entitled: Long-Term Care Expansion “Readiness Template”.  This paper is meant to describe the certification expectations DHFS has for any MCO at the point it is ready to begin operating under a risk-based contract to provide long-term care services and, in some cases, long-term care and acute and primary health care services. This tool does not list tasks that need to be accomplished in the planning phase prior to when the organization is ready to respond to a Request for Proposals. Rather, it identifies tasks that need to be accomplished during the implementation phase prior to when any enrollments in Family Care may begin.

DHFS is providing the template now so that planning consortia may have a full understanding of what an MCO must accomplish to meet certification requirements. The first column of the template is organized according to major business areas and conveys both the flow of the MCO’s business process and the consumer’s experience, beginning with enrollment. The second column indicates what the Department will be using as a gauge to determine that the MCO has developed the necessary business systems. The third column describes in more detail the business systems that the MCO needs to have in place to succeed.

To view a copy of this or past informational papers, please send an e-mail to our lobbyist, Forbes McIntosh at mcintosh@broydrick.com

Federal: CBO Report “Medicaid Spending Growth and Options for Controlling Costs”
On July 13, 2006 the Congressional Budget Office (CBO) testified and released its report on “Medicaid Spending Growth and Options for Controlling Costs” to the U.S. Senate Special Committee on Aging.  The report provides a detailed analysis of Medicaid spending and future projections of growth in the program.  The CBO report also provides several avenues by which Congress might consider in its attempt to reduce the growth of Medicaid’s spending, which as the report comments “all of them involve difficult trade-offs”.

A few of the points raised from the CBO analysis include:

• The Medicaid program currently covers 60 million people, or about 20 percent of the U.S. population.
• Medicaid is the federal government’s largest health care program in terms of enrollment, covering more people than Medicare does.
• Federal spending for Medicaid will nearly double over the next 10 years, from $190 billion in FY 2006 to $363 billion in 2015.
• Although 75% of Medicaid enrollees are children and their parents, 70% of spending for benefits goes toward care for the program’s elderly and disabled enrollees.
• Although a number of options are available for reducing federal Medicaid costs in the future, many of them involve shifting costs to the states or to enrollees.

Avenues the federal government could consider to reduce the growth of Medicaid spending:

• Reduce the federal contribution (or match).
• Reduce mandatory benefits or restrict coverage.
• Increase Beneficiaries’ cost sharing.
• Encourage greater use of lower-cost services.

One of the areas of potential savings (reduction of Medicaid spending) discussed in the report is an effort to encourage a greater use of lower-cost services while limiting the use of services that were not cost-effective.  However, the CBO cautioned that this method of creating savings in Medicaid could prove difficult, “For example, the federal government might be able to encourage more use of community-based alternatives to nursing home care, given that community-based care is usually much less expensive per person than is institutional care. The potential demand for community-based services, however, is greater than the demand for institutional care. As a result, expanded coverage of community-based care is likely to substitute for some informal care provided in the home. If the expansion was not well targeted, the costs of meeting that increased demand for care could exceed the savings that might be generated by substituting community-based care for nursing home care.”  To view the report, go to: CBO Medicaid Report

Federal: CMS Launches Comprehensive Effort to Combat MA Fraud and Abuse
In an effort to halt theft, inappropriate use and simple mistakes that drain critical Medicaid program dollars, CMS last Tuesday launched an unprecedented effort to detect and prevent program fraud and abuse.

The new Medicaid Integrity Program (MIP) was created by the Deficit Reduction Act of 2005 with funds that will rise from $5 million in 2007to $75 million by fiscal year 2009 and each year thereafter. Congress specifically required the use of contractors to review the actions of those seeking payment from Medicaid, conduct audits, identify overpayments and educate providers and others on program integrity and quality of care. Congress also mandated that the agency devote at least 100 full-time staff to the project which will also be in collaboration with state Medicaid officials. (To view click on: CMS Press Release)

The MIP will employ several major strategies including:

• Collaboration and coordination with internal and external partners.

• Consultation with interested parties in the development of the comprehensive Medicaid integrity plan.
• Targeting vulnerabilities to the Medicaid program.
• Balancing MIP roles:

• Between providing training and technical assistance to states while also conducting oversight of their activities; and,

• Between supporting criminal investigations of suspect providers while concurrently seeking administrative sanctions
• Employing lessons learned in developing guidance and directives aimed at fraud prevention; and,
• Developing effective return on investment strategies.

NEWS ARTICLES OF INTEREST…

Milwaukee Journal Sentinel (July 14, 2006)
Hospice firm to pay government $13 million
Former Milwaukee employee blew whistle on Odyssey; she gets $2.3 million
Odyssey Health Care Inc., the second largest provider of hospice care in the United States, will pay the federal government $12.9 million to settle claims of Medicare over billing, according to the U.S. attorney's office in Milwaukee. The claims were made by a former Franklin woman, JoAnn Russell, who was fired by Odyssey after she questioned the company's bills to Medicare for hospice services, according to court records (More….)
http://www.jsonline.com/story/index.aspx?id=466917

Wisconsin State Journal (July 24, 2006)
State wants to expand Medicaid for families
When it comes to getting her two children medical coverage, Amanda Postel of Madison has a problem: She makes too little money - and too much.  Postel's family made about $36,000 last year, with the income concentrated in certain months. Even with insurance from one of her two part-time jobs, Postel said that's not enough to always cover medical expenses like co-pays and deductibles. But it's enough that in the months in which income is higher, Postel's family doesn't qualify for Medicaid programs aimed at poor families. (More…)
http://www.madison.com/wsj/mad/top/index.php?ntid=92086&ntpid=1

PUBLIC HEARING NOTICES

Senate Committee on Health, Children, Families, Aging and long Term Care
Tuesday, July 25, 2006   9:00 AM   State Capitol, Room 201-SE.

• The Senate committee will hold a public hearing on the Department of Health and Family Services’ (DHFS) Community Services Block Grant State Plan.

Senate Select Committee on Health Care Reform
Wednesday, July 26, 2006   10:00 AM   State Capitol, Room 411-South
Invited Speakers Only.   Presentation and discussion of various health coverage proposals.

• Rep. Curt Gielow, Rep. Jon Richards, Former DHFS Secretary Joe Leann, Lisa Ellinger. To discuss Wisconsin Health Plan (AB-1140).
• David Newby to discuss Wisconsin Health Care Partnership Plan (SB 698).
• Sen. Mark Miller to discuss SB-388.
• J. P. Wieske, Council for Affordable Health Insurance.

DHFS Long-Term Care Briefing #5
Critical Components of Managed Long-Term Care:  Provider Network Development
Wednesday, July 26, 2006   1:30 – 3:00 PM

Moderator:        Judith E. Frye, Associate Administrator
                        Division of Disability and Elder Services
                        Department of Health and Family Services

Presenter(s):     Robin Reser, Provider Network Developer
                        Richland County Health and Human Services

Gail Coleman, Compliance Officer
                        Elder Care of Wisconsin, Inc.
                                               
This webcast is the fifth in a series of briefings to assist long-term care planning grantees and others interested in expanding managed long-term care in Wisconsin.  This program is intended for senior managers who are planning for new organizational structures and processes.  The format will include a 50-60 minute presentation followed by 30-40 minutes for questions from the audience.

An extensive provider network is a critical component of managed care.  Family Care and Wisconsin Partnership Program managed care organizations are required by Federal and State regulations to ensure that their provider networks include sufficient numbers and types of providers to meet the needs and preferences of their members. 

This briefing will describe the role of provider network development in Medicaid managed health and long-term care and how this differs from fee-for-service long-term care.  The speakers will also highlight lessons learned from operating the current managed long-term care programs, Family Care and the Wisconsin Partnership Program.
To listen to the briefing or to obtain more information, please go to: http://dhfs.wisconsin.gov/managedltc/grantees/webcasts

DHFS 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

To view the rule changes: https://apps4.dhfs.state.wi.us/admrules/public/Rmo?nRmoId=387

Hearing Dates, Times and Locations:

• July 24, 2006     9:00 AM – 3:00 PM:

(Milwaukee) Southeastern Regional Office, 819 N. 6th St., Room 40

• July 25, 2006     9:00 AM – 3:00 PM:

(Madison) DHFS Building, 1 W. Wilson St., Room 751

• July 26, 2006     9:00 AM – 3:00 PM:

(Green Bay) Northeastern Regional Office, 200 N. Jefferson St., Room 152-A

• July 28, 2006     9:00 AM – 3:00 PM:

(Rhinelander) Northern Regional Office, 2187 North Stevens St., Large Conference Room

• July 31, 2006     9:00 AM – 3:00 PM:

(Eau Claire) Western Regional Office, 610 Gibson St., Room 123

DHFS - DDES and BQA, BQC Memos

DDES-BQA 06-010 (July 17, 2006)
Assisted Living Industry “State of the State”
The purpose of this memo is to announce a new Department website entitled "Assisted Living Industry -State of the State," which  can be found at: http://dhfs.wisconsin.gov/bqaconsumer/AssistedLiving/ ALtrends05.pdf. This link will be updated semi-annually, and will showcase industry and regulatory trends for assisted living. This is the result of on-going efforts on the part of BQA to provide information and data to consumers, providers, and other stakeholders in order to effect positive changes. Stats. • Assisted living facilities have grown by 16%; • Complaints received have decreased by 26%; • Only 13% of assisted living facilities make up 100% of all the complaints received; and • More facilities are qualifying for an abbreviated survey (improved compliance).

NEW LEGISALTIVE BILLS

 --- No New Bill Introduced This Week -----