Legeslative Agenda | Legislative Archive

WEEKLY LONG-TERM CARE UPDATE February 11, 2005

2005-07 Biennial Budget
Governor Proposal
PRELIMINARY REVIEW

MEDICAL ASSISTANCE – GENERAL

Health Care Quality Improvement Fund: Promote adoption of medical technology information systems to reduce medical errors, improve the ability to measure quality healthcare outcomes and improve patient safety. A Board will be created that will be comprised of healthcare leaders, including the Department of Administration’s chief information officer, and will be charged with evaluating information technology improvements and plans. The board will receive $10 million from the health care quality improvement fund to make loans and grants to health care providers for technology projects, including such activities as implementing integrated data repositories, automating patient records and creating clinical decision making systems.

Eliminate “Grace Month” Policy: The Governor recommends reducing funding for Medical Assistance and BadgerCare benefits to reflect deletion of the "grace month" policy so that eligibility is terminated at the end of the 12-month benefit period and not after 13 months, as is the current policy. The fiscal effect reflects the net effect of increased administrative costs and one-time changes to the Client Assistance for Reemployment and Economic Support system and decreased Medical Assistance benefits costs.

Non-Emergency Medicaid Transportation Broker: The Governor recommends procuring a vendor to coordinate all non-emergency transportation used by Medical Assistance recipients to reflect additional estimated program savings. Savings will be achieved by increasing coordination with other transportation systems and improving the allocation of resources by: (a) encouraging shared ridership; (b) improving provider dispatching; (c) reducing administrative costs; and (d) reducing fraud.

SSI Managed Care: The Governor recommends extending the use of managed care to provide medical care to disabled individuals enrolled in the Supplemental Security Income (SSI) program to the maximum extent possible. (Savings: FY06 $3,220,500: FY07 $9,285,500)

LOCAL GOVERNMENT FUNDING

Shared Revenue: Fully fund (maintain) at current levels.

K-12 Education: Move Education funding from the local property taxes to state 2/3 funding commitment. Increase General School Aids by $850 million ($700 million in additional equalization aid and $150 million in levy credits).

Local Government Property Tax Spending Limit: Require a two-year tax freeze that allows growth in local levies to increase at the rate of inflation plus 60% of growth in new construction in the region. Allow levy limits to exceed the freeze by referendum and provides more than $83 million for local units ($58 million for municipalities and $25 million for counties) that hold increases to 85% of the allowable limits; and bonus payments of $10 million for municipalities and $10 million for counties that keep increases even lower. The freeze will exempt TIFs, debt service and Technical colleges.

Allow Counties to enter into revenue sharing agreements with municipalities or other counties and to expand the scope of revenues permitted under local revenue-sharing agreements to include state payments and fees.

MENTAL HEALTH AND HOME AND COMMUNITY BASED CARE

Mental Health\AODA: Provide expenditure authority to support establishment of pilot mental health and substance abuse screening, assessment and treatment initiatives for parents and children involved in the child welfare system outside of Milwaukee County. Funding is supported by the creation of a child abuse prevention and child mental health surcharge on felony and misdemeanor convictions. (FY06 $557,600: FY07 $1,673,100

Extend MA Coverage for Youths Leaving Out-of-Home: The Governor recommends extending Medical Assistance coverage to youths who, on their 18th birthday, are in out-of-home care in foster homes, group homes, residential care centers or medical institutions. Coverage is effective January 1, 2007, and youths will remain eligible for Medical Assistance until they reach the age of 21.

CIP 1A \ Reduction of State Centers: The Governor recommends reducing staff at Northern Wisconsin Center by 145.0 FTE PR positions to reflect a higher than estimated number of placements in the community. 2003 Wisconsin Act 33 assumed that 20 long-term residents would remain, but now only 2 to 4 are projected to remain at the center. The Governor further recommends reducing funding at the Central and Southern Wisconsin Centers to reflect Act 33 position reductions. The positions were removed as part of the act, but funding was not. Finally, the Governor recommends adding 44.5 FTE PR positions at Southern Wisconsin Center because the 35 placements assumed in Act 33 were not achieved; only 16 residents were placed in the community.

Community Aids: The Governor recommends the following changes in the Community Aids program: (a) decrease Social Service block grant funding and provide a corresponding increase in federal Title IV-E funding in each year of the biennium; and (b) implement a technical correction in the Family Care Community Aids adjustment.

Community Opportunities and Recovery Waiver: The Governor recommends reducing expenditure authority in the Medical Assistance program to reflect the implementation of a new 1915(c) home and community-based waiver program. The community options and recovery waiver will relocate nursing home residents with co-occurring mental and physical health conditions into the community. (Savings: FY06 $18,000: FY07 $192,900).

Independent Living Centers: The Governor recommends transferring funding to the Department of Workforce Development to support Independent Living Centers. See Department of Workforce Development, Item #13.

Management of Home Care, Personal Care and Private Duty Nursing Services: The Governor recommends reducing expenditure authority to reflect savings resulting from expected reductions in costs related to home care, personal care and private duty nursing services. (Savings: FY06 $2,047,400: $8,009,000).

Nursing Home to Community Relocations: The Governor recommends moving additional nursing home residents to the community as part of the Community Integration Program II. Savings from these community relocations will be used to reduce Medicaid expenditures and to make acuity-based rate adjustments to nursing home payments. (Savings: FY06 $1,950,700: FY07 $7,234,000).

Rehabilitation Agency Therapy Rates: The Governor recommends reducing funding for Medical Assistance benefits to reflect a restructured reimbursement rate for therapy services provided by rehabilitation agencies. The new rate for rehabilitation agencies would be set at an amount that is five percent greater than the rates currently paid to independent providers. This change is intended to correct a large disparity in the rates which rehabilitation agencies are paid. (Savings: FY06 $1,002,900: FY07 $2,005,700)

SEIU Quality Home Care Initiative

Upon the request of a county board, DHFS is to assist in recruiting and training people to provide personal care services. Personal care services are medically oriented activities that assist a person with activities of daily living, such as assistance with bathing, toileting, skin care, and meal preparation.

NURSING HOMES

Nursing Home Bed Tax\Rate Increase: The Governor recommends increasing the assessment levied against licensed nursing home beds from $75 per bed per month to $125 per bed per month. The Governor also recommends using a portion of these revenues to support a 1.4 percent annual rate increase for nursing homes. Finally, the Governor recommends using the remaining revenues from the assessment to support ongoing benefit costs in the Medical Assistance program.

Nursing Home to Community Relocations: The Governor recommends moving additional nursing home residents to the community as part of the Community Integration Program II. Savings from these community relocations will be used to reduce Medicaid expenditures and to make acuity-based rate adjustments to nursing home payments. (Savings: FY06 $1,950,700: FY07 $7,234,000).

Medical Assistance \ Inadvertent Double Counting of Nursing Home Bed Assessment: The Governor recommends adjusting funding for Medical Assistance benefits to reflect new estimates of federal financial participation, caseload, prescription drug costs and corrected technical errors. The Governor also recommends reducing the department's estimate of GPR-Earned by $6,675,000 in FY06 and $5,775,000 in FY07, to reflect an inadvertent double counting of nursing home bed assessment revenue in both the Medical Assistance trust fund revenue estimate and the department's GPR-Earned estimate. (FY06 $194,881,600: FY $367,885,000)

Community Opportunities and Recovery Waiver: The Governor recommends reducing expenditure authority in the Medical Assistance program to reflect the implementation of a new 1915(c) home and community-based waiver program. The community options and recovery waiver will relocate nursing home residents with co-occurring mental and physical health conditions into the community. (Savings: FY06 $18,000: FY07 $192,900).

COMMUNITY CORRECTIONS

AODA Treatment Units: Provide funding and position authority to create a 174-bed alcohol and other drug abuse (AODA) unit at Racine Correctional Institution and a 36-bed unit at Taycheedah Correctional Institution to support alcohol and other drug abuse treatment to inmates. (FY06 $1,230,200 and 25.5 positions: FY07 $1,458,100 and 25.50 positions)

Community Reintegration and Reentry: The Governor recommends providing funding and position authority to support enhanced reintegration services to mentally ill, female and medium-security male inmates prior to release from prison. This includes $750,000 in FY06 and $1,000,000 in FY07 to provide enhanced contracted services that will emphasize communication, coordination and information sharing between institutions, agents, the offender, the offender's family, community support agencies and mentoring groups.

Community Alternative to Revocation Expansion: Adjust expenditure authority and expanding local housing and treatment options available to offenders at risk of being revoked to prison for technical rule violations. This includes funding for additional halfway house beds, temporary living placement beds, day reporting centers and electronic monitors for offenders. The result of this initiative will be to reduce the department's reliance on contract prison beds. (FY06 $555,700: FY07 $555,700)

Sexually Violent Persons: The Governor recommends providing funding to support an increased population of sexually violent persons due to 2003 Wisconsin Act 187, which changed the definition of a sexually violent person. The increase in population will require opening and staffing two 25-bed units at Sand Ridge Secure Treatment Center and one 30-bed unit at the Wisconsin Resource Center. In addition, the Governor recommends re-estimating the costs of the conditional release program, the supervised release program and the competency evaluation program.

Enhanced Support for Offender Transition to the Community: The Governor recommends providing increased expenditure authority for purchase of services for offenders. Purchase of services includes funding for halfway house beds, temporary living placements, day reporting centers, employment services, treatment and other services in the community. In addition, the Governor recommends reducing the maximum probation supervision term for misdemeanors from two years to one year for Class A misdemeanor offenses and six months for Class B and C misdemeanor offenses. The maximum probation supervision term for misdemeanor offenses involving domestic abuse, nonconsensual sexual contact with another person, crimes against children and misdemeanors committed while possessing a firearm will remain at the current two-year maximum. Any resulting savings will be reinvested in enhanced support for offenders transitioning to community supervision. (FY06 $3,737,700: FY07 $4,374,000)

Earned Release Program: The Governor recommends increasing bed capacity for the Earned Release Program. The result of this initiative will be to reduce the department's reliance on contract prison beds.

Health Care Services: The Governor recommends providing funding and reducing position authority for health services. The department is investigating a number of cost containment strategies, including a review of the drug formulary, regional hospital coverage, protocols for disease management and contracts with health care professionals to provide health services to adults and juveniles in correctional institutions and centers.

Corrections Items Not Approved by Governor:

Community Caseload Growth

Community Corrections Field Supervision