Friday Update September 24, 2004

Wisconsin Minimum Wage Increases Blocked and may be Delayed for at Least Two Years
After 6 hours of testimony and debate, the Joint Committee for the Review of Administrative Rules (JCRAR) voted on a party line 6-3 to object to the Department of Workforce Development (DWD) administrative rule that would have raised Wisconsin’s minimum wage from $5.15 per hour to $5.70 (October 2004) and then to $6.50 (October 2005).  The Assembly Committee chair, Rep. Glenn Grothman stated during the hearing that he had hoped to find a compromise with the department on the minimum wage increases.  Since no compromise was reached, Rep. Grothman and 5 other Republican committee members voted in opposition.

Wisconsin law requires that the legislature now pass a bill opposing the minimum wage increases, or that provides for some type of compromise.  The bill will be introduced in January 2005 and will most likely pass both houses of the legislature.  However, if a compromise is not reached on the bill between the Republican led legislature and the Democrat Governor, Governor Doyle will most likely veto the bill – which means the administrative rule will be able to move forward and the minimum wage increases will be instituted.  Since the legislative session is 2 years, the minimum wage increases could be stalled until the fall of 2006.  However, if a compromise is reached, a bill could be passed and the new compromise on minimum wage increases could be implemented as early as January 2005.

DHFS Submits 2005-2007 Budget Request – HIGHLIGHT SUMMARY
This summary is rather long, but below are all the items that impact long-term care.  Please note there are no specific requests for increased reimbursement to providers.  This information will not be available until the Governor’s budget is introduced in January or February 2005.  Again, this is DHFS’ request – therefore there is no guarantee that the items will be included in the Governor’s budget.

Life Lease: (DIN 5603)
The Department requests a reduction of ($258,100) GPR and ($353,400) FED in FY06 and ($711,300) GPR and ($955,700) FED in FY07 and statutory language changes to implement Life Lease, an expansion of the CIP II waiver program (enhanced CIP II reimbursement) for adults who are elderly or physically disabled. Under Life Lease, CIP II funding would be available to counties for all nursing home residents who wish to relocate to the community, without the requirement that the nursing home bed close. The Life Lease funding would be available for as long as the relocated individual uses community based long-term care. Counties would no longer receive Life Lease funding for a person after the person dies or returns to a nursing home. Life Lease will generate cost savings to the MA budget because community care for relocated individuals is on average less expensive than institutional care. As of July 2004, there were 492 elderly and physically disabled individuals in institutions who have expressed a desire to live in a community setting and were on waiting lists for community long term care programs. The Department projects that counties will be able to relocate 315 individuals from nursing homes to the community in the 2005-2007 biennium under Life Lease.

Life-Span Respite (DIN 5604):
Eliminate the Life-Span Respite Program because the funding is being reallocated to the children’s long-term support program. (s.46.986). The Department requests a decrease of ($150,600) GPR and an increase of $101,900 FED in FY06 and an increase of $150,600 GPR and $506,900 FED to reflect the reallocation of $225,000 GPR in both years of the biennium from the Life-Span Respite program to expand the children’s long-term support program.

Community Opportunities and Recovery Waiver
(Nursing Home Relocation Waiver for Persons with Serious Mental Illness)(DIN 5621):
The Department requests a reduction of ($29,900) GPR and ($17,600) FED in FY06 and ($163,500) GPR and ($117,100) FED in FY07 to implement a new Medicaid 1915(c) Home and Community-Based Waiver program. The new Community Opportunities and Recovery (COR) waiver will be created for the purpose of relocating residents of nursing homes who have co-occurring mental health and physical health conditions into the community. The new waiver will include long-term support services and mental health community services specific to the needs of the person with a mental health diagnosis and condition that is severe, persistent and may require periods of intense supervision and support to remain safely in the community. This new waiver will also provide the community-based supports that better meet the Americans with Disabilities Act Title II goal, as applied in the Supreme Court Olmstead decision, which requires states to provide mental health treatment and long-term supports in the most integrated and least restrictive setting.  The Department intends to apply for a waiver to the federal government by the end of CY04. As part of this budget proposal, statutory language is being requested to direct the Department to implement the waiver within the limits of available federal, state, and county funds once approval from the federal Department of Health and Human Services is received.

CBRF Pre-Admission Assessment:
Delete provision that makes a CBRF resident ineligible for COP, COP-Waiver, and CIP II funding if he or she fails to undergo the preadmission assessment or consultation; delete requirements on CBRFs to notify applicants of the pre-admission requirement and to complete “statement of financial condition” forms for new residents; and as a condition of licensure, require CBRFs to distribute a DHFS or county brochure to all prospective residents with information about long term care programs (s.46.27 and s.50.035(7))

Spousal Support for Individuals Receiving Long Term Care Services (DIN 5463):
The Department requests a reduction of ($86,000) GPR and ($117,800) FED in SFY06 and a reduction of ($532,600) GPR and ($719,300) FED in SFY07 to reflect the savings from strengthening statutory provisions that allow county corporation counsels to pursue support payments from a community spouse to assist in paying for the needs of an institutionalized spouse.

Estate Recovery for the PACE and Partnership Programs (DIN 5464):
The Department requests a reduction of ($12,600) GPR and ($17,300) FED and an increase of $29,900 PR in SFY06 and a reduction of ($59,400) GPR, ($79,900) FED and an increase of $139,300 PR in SFY07 to reflect the savings associated with applying estate recovery provisions to the PACE and Partnership programs and changing the methodology for estate recovery under Family Care.

Medicaid, BadgerCare and SeniorCare Pharmacy Reimbursement (DIN 5466):
The Department requests a reduction of ($7,272,000) GPR and ($9,094,800) FED in SFY06 and ($10,559,700) GPR and ($13,880,400) FED in SFY07 to reflect the savings associated with reducing pharmacy reimbursement rates. This proposal consists of the following measures: (a) a reduction in pharmacy reimbursement for brand name drugs from the average wholesale price (AWP) minus 13% to AWP minus 16.0%, (b) the elimination of the SeniorCare 5% enhancement for brand name drugs, and (c) a reduction of the dispensing fee from $4.38 to $3.88 per prescription.

Third Party Liability: (DIN 5467)
The Department requests a reduction of ($1,461,100) GPR and ($2,028,900) FED in SFY06 and a reduction of ($1,526,400) GPR and ($2,063,600) FED in SFY07 to perform additional third party liability (TPL) identification and recovery activities that supplement the existing TPL activities of the Department.  Currently, the Department identifies third party liability coverage by matching the Medicaid eligibility file against 80 of the major insurance carriers in Wisconsin. Under this proposal the Department plans to contract with a vendor to perform additional TPL identification and recovery activities. A vendor will be able to access a broader base of insurance coverage including self-funded insurers. The contract would be on a contingency basis and only for new forms of insurance coverage identified that are not in the state system. In addition to the contingency fee, there will be state administration costs to identify the new matches for determining the contingency fee.

SSI Benefits and Administration Re-estimate: (DIN 5600)
To fully fund SSI and CTS administrative costs the Department requests an increase of $1,486,700 PRS (federal TANF) in FY06 and an increase of $322,500 PRS (federal TANF) in FY07 to fund projected SSI and Caretaker Supplement expenditures in the next biennium. This request is composed of a change in benefits of $934,100 in FY06 and ($174,000) in FY07; and a change in administrative costs of $552,600 in FY06 and $496,500 in FY07.

Administration of SSI Program: (DIN 5601)
The Department requests an increase of $6,000 PR and a reduction of ($150,000) PRS in both years of the biennium, and statutory changes to improve the administration of benefit payments in the state SSI and Caretaker Supplement program. The funding reductions reflect TANF savings expected to result from the statutory changes. The Department requests statutory changes to provide DHFS with explicit authority to promulgate rules to guide the administration of eligibility and benefit payment under the SSI and Caretaker Supplement programs. These changes will strengthen the Department’s ability to recoup overpayment of benefits, which will reduce benefit expenditures by ($150,000) TANF per year in FY06 and FY07. The Department also requests statutory language authorizing the Department to promulgate rules to recoup benefits in all DHFS programs. The Department also requests statutory changes to include SSI and Caretaker Supplement among programs for which DHFS is required to investigate fraud and to update the fraud investigation statutes to be consistent with the current administrative structure between DHFS and DWD. Collections from these fraud investigations are expected to total $50,000 PR per year. The Department requests an increase of $6,000 PR in spending authority to fund the fraud investigations.

Use Caregiver Background Check Fees
To Pay Vendor for Caregiver Investigation Contract: (DIN 5602)
The Department requests $50,000 FED and $50,000 PR in both years of the biennium to fund investigations of misconduct by caregivers employed by health care and long term care providers. The Department also requests a modification of s. 50.065(8) to allow caregiver investigations to be funded with caregiver background check fees. Investigations are performed by Department staff and by a private vendor. Because of staff reductions in the 2003-2005 biennium, the Department is contracting a greater number of cases with the private vendor. The funding increase is needed to fund the caregiver investigation contract at the projected level and avoid a backlog in the 2005-2007 biennium. There is sufficient caregiver background check fee revenue on an ongoing basis to support the $50,000 PR in annual expenditures.

Children’s Long Term Support: (DIN 5604)
The Department requests a decrease of ($150,600) GPR and an increase of $101,900 FED in FY06 and an increase of $150,600 GPR and $506,900 FED to reflect the reallocation of $225,000 GPR in both years of the biennium from the Life-Span Respite program to expand the children’s long-term support program. Specifically, the children’s long-term support program would utilize $74,400 reallocated GPR and $101,900 FED in FY06 and $375,600 reallocated GPR and $506,900 FED in FY07. This proposal has no net GPR effect. This funding would be used for 10 pilot site slots and 10 statewide crisis slots in FY06 and 35 pilot site slots and 25 statewide crisis slots in FY07. The children’s long-term support waivers are a federal Medical Assistance home and community based waiver program focused on the needs of children and their families. The children’s long-term support home and community-based waivers target children with physical, sensory, and developmental disabilities, and children with severe emotional disturbance. Currently, there are approximately 3,500 children waiting to receive services in at least one of the existing long-term care programs, including Family Support, the Community Options Program, and Medical Assistance waivers. This reallocation would expand the existing children’s long-term support program by an estimated 80 children. The Life Span Respite funding is currently used to contract for the administration of the Life-Span Respite Program and to fund five regional pilot projects that build respite care infrastructure in their service areas. The funding cannot be used for direct respite services.

Milwaukee County Mental Health Complex Funding
The Department requests a decrease of ($782,100) GPR and an increase of $1,779,300 FED and $416,900 SEG in FY06 and a decrease of ($725,600) GPR and an increase of $1,936,600 FED and $413,900 SEG in FY07 to reflect that the Milwaukee County Mental Health Complex (MCMHC) will no longer be designated an institution for mental disease (IMD). Under federal law, nursing homes designated IMDs are ineligible for federal Medicaid reimbursement for residents aged 22 through 64. Nursing homes are designated IMDs if the Department has determined that a majority of residents in this age range have a mental illness and/or developmental disability and are in need of specialized services to treat their condition.

State Independent Living Council: (DIN 5608)
The Department requests a decrease of ($34,000) GPR, ($306,100) PRS, and (1.5 PRS) FTE in both years of the biennium to reflect the establishment of the State Independent Living Council (SILC) as a non-profit corporation effective July 2005. The Council is currently attached to the Department.  The federal Rehabilitation Act requires all states to establish independent living councils. The federal Rehabilitation Services Administration (RSA) recently determined Wisconsin to be out of compliance with the Rehabilitation Act because SILC operates within a state agency. On August 5, 2004, Governor Doyle issued an executive order establishing the board as an independent non-profit corporation effective July 1, 2005 to comply with the Act.  The Department requests that $34,000 GPR deleted from the DHFS budget be transferred to the Department of Workforce Development and allocated to the board on an ongoing basis. DWD will also allocate $306,100 in federal vocational rehabilitation funds directly to the council annually. These actions will preserve the Council’s total funding from the state at its current level.

CIP 1A Re-estimate (DIN 5204)
The Department requests a decrease of ($8,920,000) PR and (100.5) PR FTE in both years of the biennium to reflect the relocation of individuals from the state centers for the developmentally disabled to the community. Section 49.45(6b) of the statutes requires the Department to reduce reimbursement to the centers by $325 per day for each placement made under the Community Integration (CIP1A) program. The following changes are requested for each of the three centers based on actual placements made in FY04 and projected placements for FY05:

Northern Wisconsin Center:  The Department projects that at most 4 long term care residents will remain at the center in the 2005-2007 biennium and therefore requests the deletion of (145.0 FTE) PR and ($10,046,300) PR to reflect this population estimate. In addition, a separate decision item, DIN 5801, Administrative Transfers, deletes (6.0 FTE) PR and ($406,600) PR from the center’s budget to reflect the transfer of community capacity team staff from the center to the Bureau of Long Term Support to form a Regional Community Integration Team. With the reductions, a total of 128.5 FTE will remain at Northern Center to staff a 30 bed Intensive Treatment Program (ITP) and an expanded dental outreach clinic. ITP staff will provide care for any remaining long-term care residents in the next biennium


Central Wisconsin Center: The center achieved 4 placements in FY04 and projects 9 placements in FY05. The center must therefore reduce its budget by ($1,542,100) PR per year in FY06 and FY07 under s. 49.45(6b). A separate decision item, DIN 3003, Full Funding of Salaries and Fringe, deletes ($957,800) PR per year in salary and fringe budget associated with the 30.0 FTE deleted in Act 33. DIN 5801, Administrative Transfers, deletes ($361,600) PR per year from the center’s budget to reflect the transfer of 7.0 FTE from the center to the Bureau of Long Term Support to form a Regional Community Integration Team. This decision item deletes ($222,700) PR in FY06 and FY07 to bring the total reduction to ($1,542,100) PR per year.

Southern Wisconsin Center: The center achieved 8 placements in FY04 and expects 8 placements  (of the original goal of 35 placements) in FY05. Because of the lower than projected number of placements, the Department requests that 44.5 FTE and $1,471,400 PR in salary and fringe budget authority be restored to the Center’s budget in FY06 and FY07. The net reduction to the center’s budget resulting from 16 placements in 2003-2005 will be 41.5 FTE (deleted in FY05 in Act 33) and ($1,898,000) PR in FY06 and FY07.

HIRSP Eligibility of Individuals Receiving Limited MA Benefits (DIN 5441):
HIRSP Eligibility for Individuals receiving Limited MA Benefits (DIN 5441): Allow individuals who qualify for limited MA benefits and SeniorCare to be able to participate in the HIRSP program if they meet the other HIRSP eligibility criteria; prohibit individuals eligible for BadgerCare, COP waiver, CIP-II, CIP-I, Brain Injury Waiver, and Children Long Term Support Waivers to become HIRSP eligible; and allow individuals on COP regular to be HIRSP eligible only if they do not receive traditional Medical Assistance benefits. (s. 149.10(6) and 149.12(2)(f))

Other DHFS Requests for Statutory Changes:

Family Care Phase-In for Non-MA Eligible Persons: Extend to June 2008 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. (s.46.286(3)(d))

Combine Community Integration Program Funding: Provide the flexibility to counties to
use unexpended funds from CIP 1A in the CIP IB program, to help meet the county’s
needs to serve CIP IB-eligible individuals with developmental disabilities.
(s.46.275(5)(c))

DD Waiver Funds for New Construction Home Modifications: To conform to federal requirements, allow waiver funds under CIP 1A, CIP 1B, Brain Injury, and Children’s Long Term Support waivers to pay for new construction if done as part of an approved home modification. (s.46.275(5)(b)(1))

ICF-MR Restructuring: Allow the Department to create a flexible pool of funding from county funding under the ICF-MR Restructuring Initiative that would be used to assist counties in funding unanticipated costs related with relocating or diverting an individual from an ICF-MR. (s.49.45(30m)

ICF-MR Restructuring Shield Law: Allow for placements in an ICF-MR if providing community-based care would not be feasible within the limits of available state and federal funding and required county matching funds. (s. 46.279)

Exception for Family Care Counties for Institutional Cost Liability: Exempt Family Care counties that provide services to adults with developmental disabilities from the financial responsibility for the institutional costs of care for MA recipients who are not enrolled in Family Care. (s.49.45(30m))

Adult Protective Services: Provide the Department the flexibility to use guardianship grant funding for adult protective services as well. (s.46.977, s.20.435(7)(cg))

Definition of Licensed Adult Family Home: Redefine Adult Family Homes by operating model (corporate versus traditional) rather than by size. (s.50.01(1) and s.50.033)

-----------End of DHFS Budget Request Information -----


IMPORTANT DATES TO REMEMBER

RSA
November 5, 2004 at 10:00 AM Board Meeting (American Club in Kohler)

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

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

Medicaid\Healthcare Candidate Forums
Candidates will discuss their positions on Wisconsin’s most pressing health-related issues: Tobacco Control; Funding Medicaid; and, Healthcare for our seniors and citizens with disabilities.
 
September 27: Hudson
Hudson Hospital, 405 Stageline Road, 6:00 PM – 8:00 PM

October 4: Fennimore
SW Wisconsin Technical Center, 1800 Bronson Blvd., 9:30 AM – 12:00 NOON

October 12: Kenosha
UW-Parkside, 900 Wood Rd., 5:30 PM-7:00 PM

October 27: Eau Claire
Chippewa Valley Technical College Gateway Campus, 620 W. Clairemont Ave., 5:00 PM – 7:00 PM

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


LONG-TERM CARE IN THE NEWS

Capital Times (September 23, 2004)
New state Rx deal could save $15M
The state has reached new rebate deals with prescription drug makers that could save medical assistance programs $15 million a year, state officials said Wednesday.  The state is using its purchasing power to negotiate lower prices with drug companies that wanted to supply the state's Medicaid, SeniorCare and BadgerCare programs, said state Division of Health Care Finance Administrator Mark Moody.
<http://www.madison.com/tct/news/index.php?ntid=10687&ntpid=1>

Milwaukee Journal Sentinel (September 22, 2004)
Mending mental health care: County, hospitals pair up to fund group homes for emergencies
In a move aimed at easing a crisis in emergency care of the mentally ill, Milwaukee County and four hospital systems have agreed to fund two new group homes next year, officials said Tuesday.  Health officials hope the $750,000 plan will at least end the troubling treatment delays that this year have periodically plagued the county's overcrowded Mental Health Complex and backed up patients in private hospital emergency rooms ill-equipped to handle acute mental problems.
<http://www.jsonline.com/news/metro/sep04/260727.asp>

Business Journal of Greater Milwaukee (September 22, 2004)
St. Camillus plans expansion, renovation
The Wauwatosa campus of long-term care and home health provider St. Camillus will undergo a $15 million-$17 million renovation that will add 75 new assisted living apartments, but reduce the number of beds in the campus' skilled nursing center by more than half, St. Camillus said Wednesday.  The project is expected to begin in November and be completed by the spring of 2006.
<http://milwaukee.bizjournals.com/milwaukee/stories/2004/09/20/daily29.html>

Capital Times: Front Page (September 21, 2004)
Doyle Lauds Seniors, Promises Fight For Affordable Rx Drugs
Gov. Jim Doyle vowed at a senior citizen conference here Monday to fight for affordable prescription drugs.  The Governor's Conference on Aging was the first the state has sponsored in more than a decade, and Doyle added "it won't be another decade before we meet again."  The governor also touted a pilot "life lease" program that would allow seniors to get out of nursing homes and use Medicaid dollars for care in their own homes and apartments.  Doyle also said he had directed the departments of Transportation and Health and Family Services to explore ways to provide more transportation for senior citizens.
<http://www.madison.com/archives/read.php?ref=tct:2004:09:21:387148:FRONT>

La Crosse Tribune (September 21, 2004)
Cigarette tax increase debated
Legislative candidates weighed in on cigarette taxes and health issues at a forum Monday in La Crosse.    Ten candidates attended the forum, sponsored by SmokeFree Wisconsin and other local groups advocating for people with disabilities.  Wisconsin's budget has a $224 million deficit because of shortfalls in federal Medicaid funding. SmokeFree Wisconsin proposes raising the cigarette tax by 85 cents, which would generate an estimated $223 million in new revenue.
<http://www.lacrossetribune.com/articles/2004/09/21/news/z02cig.txt>

Milwaukee Journal Sentinel (September 20, 2004)
Waukesha budget plan would boost taxes about 4%
Services, jail fuel county's increase; debate likely
The budget proposal seeks to reduce county spending by eliminating state highway maintenance workers for whom state funding has been cut. It would also cut back on recreational programming for developmentally disabled adults and drug treatment assistance for people with mental illness.  Areas where taxpayers are being asked to dig deeper into their pockets are in funding operation of the county's new consolidated emergency dispatch center as well as the expanded county jail.
<http://www.jsonline.com/news/wauk/sep04/260458.asp>