Friday Update August 13, 2004

Chair of Wisconsin Council on Long Term Care Reform Announces Resignation
George Potaracke, the Executive Director of the Wisconsin Board on Aging and Long-Term Care (BOALTC) announced today that he would be resigning as chair of the Wisconsin Council on Long Term Care Reform.  The announcement came as a surprise to many in the long-term care community.  Mr. Potaracke stated he made the difficult decision so he can better focus on his original responsibility, which is to be the advocate for long-term care consumers as Executive Director of the Board on Aging and Long-Term Care.

Mr. Potaracke also pointed out that he and the BOALTC board want to focus their efforts more on Wisconsin CBRF care (community-based residential facilities).  He stated that over the past several months he has had the opportunity to visit many CBRFs throughout Wisconsin – “good ones and many others that scare me”.  Mr. Potaracke pointed out that state programs fund many of the individuals living in the “other” CBRFs.  He stated that we have allowed CBRF care to deteriorate to a level that would not be tolerated in the nursing home arena.

Also, Mr. Potaracke stated his observation that if we continue down the path we are going, people (especially in Southeastern Wisconsin) will not even have a nursing home as an option.  This comment was made in his observation of the positive impact downsizing the number of nursing home beds in Wisconsin has had over the past years.


DHFS Associate Administrator Healthcare Financing, Peggy Handrich Retiring from DHFS
Peggy Handrich, current DHFS Associate Administrator of the Division of Healthcare Financing and former Medicaid Director, will be leaving (Retiring) DHFS effective August 20, 2004.  Peggy Handrich will be joining the consulting firm of Sellers Feinberg Healthcare Government Strategies – who you may recognize as the consultants hired by Wisconsin to obtain the $1 billion Inter-Governmental Transfer federal funding program in the 1999 Budget.


DHFS Bids on Federal Competitive Grants
The Department of Health and Family Services has placed bids on five separate competitive federal grants to obtain funding for service study, demonstration study and reform study efforts.  These grants are not intended to provide funding for care, rather the grants are meant to fund “studies” and “demonstrations”.  These are bids for competitive grants, therefore this grant funding is not guaranteed and many states will be proposing bids for these same grants.  Grants will be awarded by September 30, 2004.  The grants proposals include:
- Comprehensive System Reform Effort ($7 million requested for plan and design)
- Integrating Long-Term Supports with Affordable Housing Demonstrations  ($1 million requested)
- LIFE Account Feasibility and Demonstration Study ($100,000 requested)
- Bringing Dental Health Parity to Wisconsin ($300,000 requested)
- Mental Health: SSI Systems Transformation ($300,000 requested)


Push Continues for Long-Term Care Reform Proposal: “VISIONS”
Earlier this summer, the Wisconsin Counties’ Association (WCA) and the Wisconsin County Human Services Association (subgroup of WCA) proposed to the Department of Health and Family Services (DHFS) and the Wisconsin Council on Long-Term Care Reform a new reform proposal termed “VISIONS”.  The Council had created an ad-hoc committee to look at and improve the proposal.

“VISIONS” in short is a proposal to reform Wisconsin’s community options/integration system, which would focus mainly on funding and services for the developmentally disabled.  However, many organizations would like to see the VISIONS expanded to the elderly and include nursing home funding.

At today’s August 13th meeting of the Wisconsin Council on Long-Term Care Reform the discussion centered on whether the Council should support continuing work on creating a final VISIONS proposal.  The debate centered more around funding community-based programs; including nursing homes and nursing home funding in the VISIONS proposal; and, using the proposal to influence the Governor to increase overall healthcare provider funding.  The Council will continue to work with DHFS to create a final draft of VISIONS, in an effort to include the final proposal in the 2005-07 budget.

What Services Would “VISIONS” Impact:
- Home and Community-Based Waiver services, personal care, durable medical equipment (this may include DME or only specified items), specialized medical vehicles, ICF-MR services.
- Other card services that are still being considered are: home healthcare, skilled nursing services, and nursing home services.

Goals of “VISIONS”
- Achieve reform in long-term care by building off the existing county administered system and the existing Home and Community-Based Waivers.
- Create a long-term care benefit where client eligibility is consistent across participating counties, and where the state and local financing of the benefit is clearly defined.
- Advance reform that doesn’t require federal approval.
- Provide counties with the ability to authorize and direct some Medicaid card services to better coordinate Waiver services and Medicaid card services and to create a more cost effective delivery system.
- Integrate funding sources to the degree possible and streamline existing programs to reduce complexity and gaps in service, and to provide flexibility in meeting individual needs.
- Strengthen counties’ ability to do consumer centered care by involving all key players in care planning and care management, increasing opportunities for consumers to directly or indirectly access and manage care, and by increasing the focus on achieving consumer outcomes.
- Increase the quality and cost effectiveness of services in a provider network to assure members have adequate choice regarding how their desired outcomes are achieved.
- Strengthen counties’ ability to have well-developed local quality management functions that enable them to continuously monitor the level of quality, take effective and timely action to correct lapses in quality, and promote continuous systems improvement.
- Create incentives for collaboration between counties and with other public and private agencies.

Long-Term Care Reform Council “Questions Remaining” That Need to be Addressed:
- How can this reform address the nursing home bias for the frail elderly and persons with physical disabilities to help assure that older people and people with physical disabilities have access to services in the community?
- How can this reform address worker shortages?
- What administrative complexities of the current waivers can be addressed for all counties as part of the Community Options/Integration Reform?

How Will VISIONS be Funded:

Funding of the Waivers (VISIONS)
- A per person per month rate will be determined for eligible persons who enroll in the program and funding will be provided to counties for those people who enroll.
- Rates would be based on the functional needs indicated by the long-term care functional screen for enrolled members.
- The state will not buy out existing county funding expended on waiver services, and counties who participate in Community Options/Integration Reform will be responsible for paying an agreed upon percentage of the state share of the rate for each member.  This will replace the current structure of some state matched and some locally matched “slots”.
- If a county spends less than the aggregate of the per person per month payments, the county can use these “savings” to serve more people under VISIONS.
- If a county spends more than the aggregate of per person per month payments, the county will be liable for the full state share of these expenditures.

Funding of the Card Services (VISIONS)
- Counties participating in VISIONS will be provided state funding for the “Medicaid Card Costs” for services they authorize and counties will be responsible for paying for the state share of the Medicaid card services that their members utilize.
- DHFS would determine a per person per month rate for the county authorized cared services, and these funds will be provided to the counties on a monthly basis for each enrolled member.  The state would bill the counties for the state share of the Medicaid card costs utilized by VISIONS.
- If a county spends less on card services than the amount of funding provided to the county through the per person per month rate, the county can use any state savings as the county share of the waiver rate for additional people brought into the VISIONS program.
- If a county spends more on card services than the amount of funding provided to the county through the per person per month rate, the county is responsible for covering that expense through other funding sources such as community aids or county property tax.

If you would like a copy of the “Draft” proposal, please send an e-mail and the document will be sent.


Important Dates to Remember

Wisconsin Council on Long-Term Care
September 10, 2004
October 8, 2004
November 12, 2004
December 10, 2004

Wisconsin Council on Long-Term Care
Residential Options Task Force
August 20, 2004
September 17, 2004
October 15, 2004
November 19, 2004
December TBA, 2004

2004 Wisconsin Elections
September 14, 2004: Partisan Primary (state elections)
November 2, 2004: Presidential and General Elections (federal and state-wide elections)


Long-Term Care in the News…

Capital Times (August 12, 2004)
Medicare misgivings: Local seniors, advocates, pharmacists blast Rx drug plan
The new Medicare prescription drug benefit is creating a bureaucratic headache for many senior citizens and pharmacists without delivering much in the way of financial relief, speakers told U.S. Rep. Tammy Baldwin, D-Madison.
http://www.madison.com/tct/news/index.php?ntid=8289&ntpid=3


Wisconsin State Journal (August 9, 2004)
State debt doubles in decade Wisconsin borrows billions for expensive building projects
Wisconsin's debt more than doubled from 1992 to 2002 to nearly $15 billion, according to an analysis of census data.  The soaring debt means more state dollars that could go to other programs must instead go to pay off principal and interest on the loans for years to come.   € Wisconsin's state debt grew from $7.3 billion in 1992 to $14.9 billion in 2002, an increase of 104 percent.  € The amount of annual interest the state owes on its debt grew 48 percent, from $499 million in 1992 to $736.9 million in 2002.
http://www.madison.com/wsj/home/local/index.php?ntid=8086&ntpid=4

La Crosse Tribune (August 6, 2004)
Lobbyists kept busy by TABOR
Interest groups spent more than 9,200 hours bending legislators' ears on the Taxpayers' Bill of Rights — also known as TABOR — during the first half of 2004, the state Ethics Board reported Thursday.   That's about the same effort that went into the nine next most-heavily lobbied proposals combined. And it likely marks just the beginning of spending in the battle over the proposed constitutional amendment to cap growth in state and local government spending, said Erik Hayko, ethics board administrator.
http://www.lacrossetribune.com/articles/2004/08/06/news/z05tabor.txt


Duluth Superior News Tribune (August 6, 2004)
Report: Lobbying groups have spent $11.4 million in 2004
Organizations spent $11.4 million in the first half of this year to influence Wisconsin lawmakers, a good chunk of that effort on a proposed constitutional amendment to limit government spending that failed to come up for a vote, a report released Thursday said.  The state Ethics Board reported organizations spent 106,000 hours -- the equivalent of 4,417 days -- during the first six months of 2004 lobbying the Legislature and state agencies.
http://www.duluthsuperior.com/mld/duluthsuperior/news/local/9334293.htm