WISCONSIN LONG-TERM CARE UPDATE
July 10, 2006

• DHFS Memo Statewide Expansion of Family Care and Option for “Fully-Integrated System”
• Legislature May Act on Protective Placements and Services for Developmentally Disabled
• Wisconsin Supreme Court Decision on Medical Malpractice Awards
• HHS Issues Final Regulations in Determining Citizenship of MA Recipients
• Governor Doyle Creates Healthcare Council
• PUBLIC HEARING NOTICES
• DHFS-DDES, BQA, BQC MEMOS
• NEW LEGISLATION

DHFS Memo on Statewide Expansion of Family Care and Option for “Fully-Integrated System”
Wisconsin: Statewide Expansion of Family Care and a Call for a “Fully-Integrated System”
The Department of Health and Family Services (DHFS) released an informational memo last Friday entitled: “Managed Long-Term Care Expansion Planning – Information #2”.  The informational memo outlines DHFS’ expectations and the process by which it intends to expand managed long-term care (i.e. Family Care) statewide over the next five years.

In the memo DHFS announced that it would issue Requests for Proposals (RFPs), the first later this summer, to begin the contracting process with planning groups that wish to become the Family Care Managed Care Organizations (MCOs). DHFS stated that other RFPs would be released by region, as the planning groups in those regions indicate their readiness to respond to an RFP.

DHFS also stated that it would be open to RFP proposals that “go beyond Family Care by incorporating acute and primary care into a benefit package along with long-term care”.  However, as DHFS points out in the memo, the “Department does not currently have federal authority to operate a fully integrated Medicaid program that incorporates long-term care and acute/primary care into one benefit package”.  But, DHFS will pursue this authority with CMS if any MCO or planning group communicates to DHFS that it would want to offer a fully integrated Medicaid benefit package.

DHFS expressed that while there is no expectation that every regional plan will include one or more MCOs interested in or able to integrate acute and primary care into its benefit package, the State does welcome such options. DHFS stated that no preference for integrating acute and primary care would be included in the scoring of “initial” RFPs, which suggests that DHFS will give preference to these types of proposals in the future.

Legislature May Act on Protective Placements and Services for Developmentally Disabled
The State Senate and Assembly will hold their final legislative session day on Wednesday, July 12, 2006.  This session day has been reserved for only acting on any outstanding employee union contracts.  No legislation is supposed to be taken up on Wednesday, since all legislation that was not acted upon in May is now considered dead.  However, Senate and Assembly leadership are expected to bend the rules and allow Senate Bill 731 to be taken up and passed on Wednesday.  Senate Bill 731 is a “trailer bill” meant to clean-up several inconsistencies created when three other pieces of legislation passed earlier this year that impacted protective placements, protective services, involuntary administration of psychotropic medication, guardianships, conservatorships, wards and services for adults at risk and elder adults at risk.  Two amendments maybe attached to the bill, which is meant to fix some other inconsistencies.  Basically, the three other bills (now law) did not fit well into state statutes, which the Revisor of the Statutes has recommended a technical trailer bill to fix these inconsistencies.  At this time no organization opposes the bill.

Wisconsin Supreme Court Decision on Medical Malpractice Awards
The Wisconsin Supreme Court ruled 4 – 3 in the “Robert W. Bartholomew v. Wisconsin Patients Compensation Fund” last week that a claimant can receive pre-death and post-death medical malpractice damages, a decision that reverses portions of a 2004 Supreme Court ruling (Maurin v. Hall) that limited pre-death and post-death awards.  Basically, this means that medical malpractice that causes death to a patient can result in two awards: pre-death non-economic damages for a patient’s pain and suffering and 2) post death award for the surviving relatives’ loss in a wrongful death lawsuit.

The jury awarded a total of $1.2 million in “pre-death and post death” medical malpractice actions:

• $500,000 to the estate of Helen Bartholomew for her non-economic damages for pre-death pain and suffering;
• $350,000 to Robert Bartholomew individually for his non-economic damages for his pre-death loss of his wife's society and companionship; and
• $350,000 to Robert Bartholomew individually for his non-economic damages for his post-death loss of his wife's society and companionship.

HHS Issues Final Regulations in Determining Citizenship of MA Recipients
The Federal Department of Health and Human Services last Thursday issued its "Interim Final Regulations" implementing the new provision in the "Deficit Reduction Act of 2005" (DRA) establishing new requirements for deterring the Citizenship of Medicaid recipients.  These "Interim" regulations are effective retroactive to July 1, 2006.   These regulations closely follow the guidance that was provided to State Medicaid Directors on June 9, 2006 in a letter from CMS with one major exception: "seniors and people with a disability who receive Medicare or Supplemental Security Income" are exempt from being required to provide the additional documentation under the regulation.  Public comments on the new rule will be considered.  To be assured consideration, comments must be received at one of the addresses provided below.  Electronically: http://www.cms.hhs.gov/eRulemaking or via regular mail: Department of Health and Human Services, Attention:  CMS-2257-IFC,  P.O. Box 8017,  Baltimore, MD  21244-8017.
To view the HHS Final Regulation, go to: Interim Final Rule Press Release

Governor Doyle Creates Healthcare Council
Governor Doyle issued an Executive Order last week that will create a “Healthy Wisconsin Council”, to improve access to affordable health insurance for businesses and individuals.  The comments and input received at the meeting will be used to develop the council’s action plan. Governor Doyle tasked the Healthy Wisconsin Council to develop an action plan to reduce the number of uninsured Wisconsin residents in half by 2010 and reduce health insurance premiums by as much as 30 percent for businesses.  In addition, the Council is to identify ways to strengthen the individual and small group insurance market and increase the number of businesses that offer comprehensive, affordable health insurance.  The Council must submit its action plan to the Governor by December 1, 2006.

The Council will be co-chaired by Dr. David Kindig, Emeritus Professor of Population Health Sciences at the University of Wisconsin-Madison School of Medicine, and Michael Weiden, Partner at Quarles & Brady, LLP.  The co-chairs will lead health care industry leaders, health insurance executives, small businesses, major employers, community leaders and government agencies in developing the action plan.

The Healthy Wisconsin Council is seeking input from small business owners and employees, among others, about creative ways to lower health insurance costs.  To learn more about the Healthy Wisconsin Initiative, visit http://www.wisconsin.gov/healthywisconsin.

PUBLIC HEARING NOTICES

Joint Committee on Administrative Rules
Wednesday, July 12, 2006   9:30 AM   State Capitol, Room 225-Northwest
Executive session on: LRB 5054 and LRB 5055: Services of a dental hygienist as a Medical Assistance program benefit; prohibiting DHFS from promulgating a rule under which dental hygienists may be certified as Medical Assistance providers for the provision of certain services.

Senate Committee on Health, Children, Families, Aging and Long Term Care,
Thursday, July 13, 2006   10:00 AM   State Capitol, Room 411-South
Community Living For Those With Mental Illness: Hearing: Invited speakers will provide an update to committee members regarding steps taken to address issues raised at the April 6, 2006 public hearing. The committee is planning to hear from the following people: Sinikka Santala, Administrator of the Division of Disability and Elder Services at the Department of Health and Family Services. Jim Hill, Administrator of the Milwaukee County Behavioral Health Division  Sandy Pasch, Member of the Mental Health Task Force for Milwaukee  Mitch Vesaas, Vice President of Tellurian UCAN, Inc. and Past President of NAMI Dane County  Bob Wrenn, President and CEO of Transitional Living Services

Joint Committee on Administrative Rules
Tuesday, July 18, 2006   10:00 AM   State Capitol, Room 300-Southeast

• NR 27.03(3)(c) 3: Endangered and Threatened Species Butler's garter snake
• INS 9: Revising Requirements for Insurers Offering Defined Network Plans.
• ATCP 10 and 11: Emergency Rule on Poultry Flock Certification

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

BQA Memo 06-015
July 7, 2006: Federal Caregiver Background Check Pilot Quarterly Data Collection Tool
The purpose of this memo is to inform entities covered by the Federal Caregiver Background Check Pilot of the changes in the data collection process.

DDES Memo 2006-10
June 29, 2006: Federally-Required Changes in Human Services Reporting System  (HSRS) Alcohol and Other Drug Abuse Reporting
Changes in federal requirements for substance abuse data collection through the Human Services Reporting System are described including the addition of four fields: living situation and arrests at admission and discharge for treatment services.

DDES Memo Series 2006-12
June 26, 2006: Rate Information For Billing For Services Provided By The Centers For Persons With Developmental Disabilities
Each year, the Wisconsin Department of Health and Family Services reviews and revises the rates charged for services at the centers for persons with developmental disabilities. The developmental disability center rates are effective on July 1, 2006.

NEW LEGISALTIVE BILLS

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