• DHFS 2007-09 Budget Request (Summary of LTC Items)
• Legislative Audit Bureau Releases Audit of Central and Southern Institutions
• PUBLIC HEARING NOTICES
• DHFS-DDES, BQA, BQC MEMOS
• NEW LEGISLATION

Department of Health and Family Services 2007-09 Budget Request
http://www.dhfs.state.wi.us/aboutDHFS/OSF/Budget/DHFS07-09Budget.pdf

This document is the DHFS budget request to the Department of Administration and the Governor for the upcoming 2007-09 Biennial Budget.  These items are not final.  The final budget will be introduced as legislation in February 2007.  The legislature will then hold public hearings and will likely modify the budget.  The budget is historically passed by June 30th, with the fiscal biennium beginning on July 1, 2007 and ending on June 30, 2009.

DHFS 2007-09 Budget Request
Statewide Expansion of Family Care (Long-Term Managed Care)

• DHFS has requested a 3% rate increase per year for Family Care, and has also requested additional funding for the major expansion of the Family Care program, as part of Governor Doyle’s plan to implement the program statewide over the next 5 years.
• DHFS requested increased funding for Family Care: an increase of  $25,441,000 in FY 2008 and an increase of $60,287,400 in FY 2009 (state and federal MA matching funds) to expand Family Care.
• By June 2009, 75% of the state population will have access to a Family Care Aging and Disability Resource Center.
• By June 2009, 62% of the state population will be covered by a Family Care “Care Management Organization”.
• Statute Change: Provide the Department the authority to expand Family Care statewide, create an appropriation for county contributions to support the expanded program, allow counties that implement Family Care more flexibility in spending Community Options Program funding for children and people with mental illness, and make a number of technical changes to the Family Care statute.
• Statute Change: Extend the deadline for the establishment of the Family Care benefit on an entitlement basis for non-MA persons who are functionally eligible for Family Care from January 1, 2008 to January 1, 2010.

Nursing Homes

• Place Monitors in Nursing Facilities: Allow the department to place a monitor in a nursing facility when financial difficulties are identified or when the licensee has been charged and/or convicted of Medicare or Medicaid fraud or patient abuse/neglect.   Increase the time limit for nursing homes to request a hearing regarding enforcement actions from 10 days to 60 days.
• Repealing the Nursing Home Bed Bank - Repeal provisions allowing nursing homes to delicense beds if their bed occupancy is below the minimum patient day occupancy standards established by the Department for Medicaid nursing home services reimbursement.  The provision is obsolete because Medicaid no longer imposes occupancy standards for reimbursement purposes.
• Medicaid Providers Repayments to Recipients in Case of Retroactive Eligibility - To comply with federal law, prohibit a health care provider from keeping the difference between the amount paid by Medicaid and the amount a private pay applicant for Medicaid paid in cases where the applicant has been found eligible for Medicaid retroactively.
• Medicaid Outpatient Prescription Drug Coverage for Medicare Eligible Individuals - Exclude outpatient drug coverage for drugs covered by Medicare Part D for persons who are eligible for full-benefits under Medicaid and who are also eligible for Medicare Part D coverage.  Prescription drugs that are excluded from Medicare Part D coverage would still be covered by Medicaid.

Medicaid Base Re-Estimate
The Department requests an increase of $90,278,200 GPR, and $84,603,700 FED and a decrease of ($32,183,700) SEG in FY08 and an increase of $214,792,700 GPR and  $224,071,400 FED and a decrease of ($36,806,000) SEG in FY09 to fund the ongoing cost for the Medical Assistance (MA) program.  Total MA expenditures are projected to be  $4,621,657,800 AF ($1,810,047,000 GPR, $78,198,200 SEG, $9,124,400 PR, and  $2,724,288,200 FED) in FY08 and $4,881,526,800 AF ($1,935,070,600 GPR, $73,575,900  SEG, $9,124,400 PR, and $2,863,755,900 FED) in FY09.    The base reestimate adjusts MA base expenditures to account for projected changes in recipient caseloads, service intensity, the federal financial participation matching rate, and costs to continue in various services and programs.    The Department is projecting overall caseload to decrease by (0.8%) in FY07 and increase 4.3% in FY08 and 3.2% in FY09.  It is estimated that caseload changes will cost $108,690,200 AF ($50,375,300 GPR) in FY08 and an additional $121,543,700 AF ($42,631,100 GPR) in FY09.

Increase ICF\MR Bed Assessment
Increase the bed assessment for intermediate care facilities for the mentally retarded (ICFs-MR) to 6 percent of gross revenues, to generate revenue for an offsetting rate increase for ICFs-MR and to create GPR savings.

The Department requests a decrease of ($1,467,300) GPR and an increase of $1,467,300 FED and $2,554,000 SEG in FY08 and a decrease of ($1,622,000) GPR and an increase of  $1,622,000 FED and $2,831,200 SEG in FY09 to reflect increasing the monthly assessment on licensed beds in Intermediate Care Facilities for the Mentally Retarded (ICFs-MR) to 6% of gross revenues and to fund a rate increase for Medicaid recipients in ICFs-MR.

Under this proposal, the Department will annually set the monthly bed assessment on licensed ICF-MR beds at the rate that on average equals 6% of ICF-MR gross revenues.  It is projected that the monthly assessment would increase from the current rate of $445 per month per bed to  $640 in FY 08 and $708 in FY 09.  The new assessment levels would increase total assessments by $2,554,000 in FY 08 and $2,831,200 in FY09.

Under this proposal, the Medicaid rate increase for ICF-MR nursing home services will equal  $2,554,000 All Funds in FY08 and $2,831,200 All Funds in FY09 for both private and public  (including state) ICFs-MR.

Currently a bed assessment of $445 per month is applied to 1,719 beds in Intermediate Care Facilities for the Mentally Retarded (ICF-MR), which serve developmentally disabled persons needing active treatment.  Almost all ICF-MR residents are Medicaid recipients.  The total number of licensed beds in ICFs-MR is projected to decline from 1,719 in FY06 to 898 in FY09, as residents relocate to the community under the Department’s ICF-MR restructuring initiative.   An increase in the ICF-MR bed assessment rate compensates for declining assessment revenue due to the decrease in the number of licensed beds.  Federal requirements allow for an assessment rate of up to 6% of gross revenues.

Community Aids

• DHFS requests an increase of $103,100 GPR and $32,400 FED in both years of the biennium as well as offsetting changes in federal funding to provide permanent full funding for the CY06 foster care rate increase in Community Aids and to re-estimate federal funding for the program.  The net fiscal effect of the changes in this budget item is to maintain Community Aids at its base CY06 level. Community Aids provides funding to counties to use for social, mental health, alcohol/drug abuse and disability services.  Community Aids is composed of GPR and federal funds. This budget item decreases Social Services Block Grant (SSBG) funding by  ($78,600) FED and federal child welfare IV-B Subpart 1 funding by ($255,300) FED annually to reflect changes in the availability of federal funding and requests an offsetting increase in federal IV-E foster care funding of $333,900 FED annually.  Act 25, the 2005-07 biennial budget, enacted a 5% increase in CY06 for rates paid by counties and the state to foster care parents for children in their care.  To permanently fully fund counties for the CY06 foster care rate increase, this budget item requests increases to Community Aids of $103,100 GPR and $32,400 FED annually.

CIP-1A and State Centers

• The Department requests an increase of $2,642,500 PR and 73.86 FTE PR in both years of the biennium to reflect the number of individuals who relocated from the state centers for the developmentally disabled to the community under the Community Integration Program (CIP 1A).
• Restore Central Center Employee Positions: Central Center actually achieved 7 placements in FY06 and projects 5 placements in FY07.   Because actual relocations were lower than projected the Department requests that 46.20 FTE PR and $1,689,600 PR in salary, fringe and related non-salary budget authority be restored to the Center’s budget in FY08 and FY09.  Section 49.45(6b) of the statutes requires the Department to reduce reimbursement to the Centers by $325 per day for each placement in the CIP 1A program.  Per this statute, the center must reduce its budget by ($1,423,500) PR per year in FY06 and FY07.  The difference between the spending authority deleted in DIN 3003  ($3,113,100) and the amount restored in this decision item, $1,689,600, equals ($1,423,500).
• Restore Southern Wisconsin Center Positions: Act 25 deleted (64.30) FTE PR from Southern Wisconsin Center based on a projection of 50 placements from the center in the 2005-2007 biennium.  DIN 3003, Full Funding of Salaries and Fringe, deletes ($2,850,900) PR per year in salary and fringe budget associated with the (64.30) FTE PR deleted in Act 25.
• The Southern Wisconsin Center achieved 8 placements in FY06 and expects 8 placements in FY07.  Because of the lower than projected number of placements, the Department requests that 27.66 FTE PR and  $952,900 PR in salary, fringe and related non-salary budget authority be restored to the Center’s budget in FY08 and FY09.  The net reduction to the center’s budget, as a result of the 16 placements, will be ($1,898,000) PR in FY08 and FY09.  This amount represents the difference between the spending authority deleted in DIN 3003 ($2,850,900) and the amount restored in this decision item, $952,900.
• The Department requests an increase of $1,800,400 GPR and 7.53 GPR FTE and a reduction of ($1,800,400) PR and (7.53) PR FTE in FY08 and an increase of $1,819,500 GPR and 7.53 GPR FTE and a reduction of ($1,819,500) PR and (7.53) PR FTE in FY09 as a result of the reestimate of the GPR/PR funding split at the Mendota and Winnebago Mental Health Institutes to reflect changes in their patient populations

Sexually Violent Persons Program

• Consolidate Appropriations for Secure Treatment Facilities - Combine appropriations for the Wisconsin Resource Center and Sand Ridge Secure Treatment Facility into a single appropriation.
• DHFS Requests $3,689,400 and 95.35 full-time employee positions (which shall be funded from additional state revenues) in FY 2009 to provide required services to the projected population of Sexually Violent Persons in the 2007-09 biennium.
• DHFS Requests an increase of $423,700 in FY2008 and $1,543,300 in FY2009 to fund the projected costs of the outpatient competency examinations and the conditional and supervised release programs for the 2007-09 biennium.

SSI Benefits and Administration Re-estimate
DHFS requests an increase of $5,209,600 GPR and $169,100 PRS (TANF) in FY08 and an increase of $7,376,300 GPR and $136,800 PRS (TANF) in FY09 to fund projected SSI and Caretaker Supplement expenditures in the next biennium.  This request is composed of a change in benefits of $5,088,000 in FY08 and $7,254,700 in FY09 and a change in administrative costs of $290,703 in FY08 and $258,336 in FY09.

Other Requests Impacting LTC Providers
Streamlining Mandated Reports - Eliminate a number of statutorily mandated reports that are no longer necessary because the purpose for which the report was implemented has been achieved, the report duplicates information that is already published on the Department website or in other reports, or the information is communicated to the legislature in other ways.

Wisconsin Legislative Audit Bureau Releases Audit of Central and Southern Institutions
The Wisconsin Legislative Fiscal Bureau released its financial audits of Mendota and Winnebago Mental Health Institutes for the period July 1, 2004, through June 30, 2005. The audits were requested by the Department   of Health and Family Services to comply with requirements of the Joint Commission on Accreditation of Healthcare Organizations.

Mendota and Winnebago Mental Health Institutes are licensed and accredited hospitals that provide specialized diagnostic, evaluation, and treatment services for mentally ill children and adults. The Institutes also provide services to forensic patients referred to them through the criminal justice system.

Mendota and Winnebago Institutes reported a net loss for fiscal year 2004-05. Mendota reported a loss of $2.6 million, and Winnebago reported a loss of $1.7 million. In each case, operating revenues did not increase enough to offset increases in operating expenses, such as salary and fringe benefit costs. The Department increased daily patient rates effective October 1, 2005, and it anticipates another rate increase effective October 1, 2006.     As part of our audit, we reviewed the administration of approximately $405,000 in client funds by the Program of Assertive Community Treatment, an outpatient unit of Mendota. The report identified internal control concerns related to client funds administered by the Program of Assertive Community Treatment, including a lack of separation of duties and inadequate documentation.

To view the audit, click on: http://www.legis.state.wi.us/lab/

PUBLIC HEARING NOTICES

Senate Select Committee on Health Care Reform
Wednesday, September 27, 2006   10:00 AM   State Capitol, Room 411-S.
The committee will hear from the following invited speakers:
Laura Tobler, National Conference of State Legislatures Providing Access to Health Care for the Uninsured: State Activities Cheryl DeMars, CEO, The Alliance Employer Health Care Alliance Cooperative Dr. Ralph Kalies, CEO, BidRx Dr. Tom Kellenberger, VP Sales & Marketing, BidRx Doug McIntosh, Digital Health Care

DHFS – Riding the Wave to Long-Term Care Reform
October 9-11, 2006   Chula Vista Theme Resort, Wisconsin Dells, WI
This conference provides an opportunity for sharing and learning as Wisconsin’s long-term care system transitions to managed care. Special sessions are available throughout the conference for attendees to learn more about planning and preparation for managed care expansion and to ask questions directly to Department administration. Best practice approaches to ensure quality in Wisconsin’s current and future long-term care programs are provided through a vast array of workshop presentations.
http://dhfs.wisconsin.gov/ltc_cop/BLTS_Conference/RidingTheWave.HTM

Wisconsin Council on Long-Term Care Reform: Comprehensive System Change Committee
October 13, 2006  Time and Place: TBA

DHFS - DDES and BQA, BQC Memos

DDES Memo Series 2006-21 (September 15, 2006)
This memo describes county responsibility for implementing all target groups of the Children's Long-Term Support Medicaid Home and Community-Based Services Waivers (CLTS Waivers). This memo replaces DDES 2003-10, which outlined original implementation requirements of the CLTS Waivers.

DDES-BQA Memo 06-020 (September 11, 2006)
This memo outlines the current Wisconsin law that requires that the use of seclusion, isolation, and restraints for children should only be used in an emergency unless the use is approved by the Department on a case-by-case basis.

BQA 06-019 (September 7, 2006)
Temporary Change of Address for Bureau of Quality Assurance Southern Regional Office (SRO)
The Southern Regional Office of the Bureau of Quality Assurance has been moved to a temporary location with a new mailing address. The contact address for Nursing Homes, Assisted Living Facilities, and Intermediate Care Facilities will be:
Southern Regional Office
Bureau of Quality Assurance
2917 International Lane, Suite 300
Madison WI 53704

DDES Memo Series 2006-19 (September 5, 2006)
Advisory Notification of calendar year 2007 Community Aids Allocations
The purpose of this memo is to provide you with notification of your CY 2007 Community Aids Allocations.  The following information is described in this memo: I.  New Feature for CY 2007 Community Aids Allocation Spreadsheet; II.  Information on the 2007 Community Aids Allocation; III. Attachments – Public Participation Process Planning  – CY 2007 County Community Aids Allocation Spreadsheet.

The Pharmacy Newscapsule is a newsletter that is published regularly by the Bureau of Quality Assurance (BQA). This newsletter is a means of providing up-to-date information to staff who survey health and residential facilities regulated by BQA.  The material is presented with a "surveyor focus;" however, the information has been informative and helpful to providers and others as well.  Therefore, we are making copies of the newsletter available to you through this web site.

NEW LEGISALTIVE BILLS

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