WALA News for July 2, 2009
1. New WALA Store Products Are Here!
DHS 83 Quality Compliance Worksheets
A Tool To Help You Meet and Exceed the New CBRF Regulations
This is a one-of-a-kind guide to help CBRFs comply with DHS 83.
CBRFs need to move as quickly as possible to achieve full compliance. There are dozens of changes that CBRFs will need to make, in all aspects of their operations.
The WALA DHS 83 Quality Compliance Worksheets will help you achieve full DHS 83 compliance in a timely, organized and cost-effective manner.
$99.00 for Members, $149.00 for Non-Members
DHS 83 Code
Bound with a Table of Contents for easy navigation.
Available Now! $10.00 or 3/$25.00 for Members
A Larger Print Version will be available by Monday 7/6/09
R esidents Rights Poster from WALA
11"x17" Poster
$10.00 for Members, $20.00 for non-Members
18"x 24" Poster
$35.00 for Members, $52.00 for Non-Members
22" x 28"
$45.00 for Members, $67.00 Non-Members
Shipping & Handling fees may apply. More details at www.ewala.org
2. How the Wisconsin Budget will Impact Assisted Living
Governor Doyle on Monday signed into law the Wisconsin 2009-2011 Biennial Budget, which takes effect on July 1, 2009. Governor Doyle made 81 vetoes before signing the budget into law. This is the first budget that has passed on time in over 30 years. Wisconsin's fiscal year begins on July 1 and ends on June 30. The theme of the Wisconsin budget for long-term care providers is: Unspecified Medicaid Cuts; Fee Increases; Labor Agreements; and, Columbus Park.
Major Medicaid Cuts - Unspecified, but Coming in Mid-July
The Governor proposed and the Legislature increased the level of cuts to Medicaid and Medicaid related programs - totaling nearly $590 million in cuts over the next two years. Although the Governor and Legislature instituted significant cuts to Medicaid - they neglected to specify how these cuts would be instituted. Instead, on July 17th the Department of Health Services will announce how the cuts will be made and how much individual Medicaid programs will be affected. WALA will update members with more details as they become available.
Assisted Living Fee Increases
The Legislature accepted the Governor's recommendations to increase Licensing fees on provider types and even expanded licensure and fees to 1-2 bed adult family homes and fees on personal care service providers. In addition, in the future the Department of Health Services will have the authority to increase fees by administrative rule. Under current law, DHS must seek approval from the Legislature by passing a bill into law. In addition DHS is now authorized to assess a $200 fee on health care providers where DHS took an enforcement action for a violation and DHS subsequently conducts a "Re-Visit" or "Re-Inspection" for compliance.
Ombudsman Services to RCACs
Expand the definition of "long-term care facility" to include residential care apartment complexes (RCACs), as it relates to the Board's authority to provide ombudsman services to residents. In addition, require each RCAC to post, in a conspicuous location in the RCAC, a notice, provided by the Board, of the name, address, and telephone number of the Board's ombudsman program.
Wisconsin Quality Home Care Commission (WQHCA)
The Service Employees International Union (SEIU) was successful after many years of including a provision in the budget that would allow for the creation of an authority (WQHCA) that would provide for collective bargaining agreements with independent home-care workers. The WQHCA will create a statewide registry of independent home care workers. If a majority of the homecare workers on the registry agree - they will likely be represented by SEIU. This is a strategy that has been instituted in other states since the early 1990's.
Property Tax Exemptions for Certain Types of Housing (Columbus Park)
The Legislature provided for a partial fix to the "Columbus Park" issue as it relates to property tax exemptions for Religious, Educational and Benevolent Associations and Retirement Homes for the Aged. Also, the budget defines "low-income housing"; exemptions for WHEDA housing projects. These modifications and summary are lengthy and will require special report to the membership of these changes. If you wish more information on this issue, contact WALA lobbyist Forbes McIntosh at forbes@wis-gps.com
3. DQA Memo 09-026 Discontinuing the Issuance of Annual/Biennial Certificates
Certified Residential Care Apartment Complexes (RCACs) are required to pay an annual certification fee and submit an annual report. Adult Day Care providers (ADCs) are required to pay a biennial certification fee and submit a biennial report.
Prior to July 1, 2009, staff in the Bureau of Assisted Living routinely sends new certificates to complexes and providers accompanied by a letter confirming receipt of the annual/biennial certification fee and report. With the continuing growth of the Assisted Living industry and limited Bureau of Assisted Living resources, we are challenged to find ways to streamline our operations, reduce spending, and maintain efficient procedures/practices.
The Bureau of Assisted Living, beginning July 1, 2009, will therefore no longer routinely issue renewal certificates or send confirmation letters. If a change requiring a new certificate is identified (i.e., change in capacity), a new certificate will of course be issued.
RCACs and ADCs must submit an annual or biennial report along with their annual/biennial certification fees within Department established timelines. Complexes and providers may assume their certification fees have been received by the Bureau of Assisted Living unless contacted by the appropriate regional office.
Certified RCAC and ADC certificates identify a "Current Certification Period." On or about July 1, 2009, all certified RCACs and ADC providers will receive a new certificate that will only identify the "Initial Certification Date." After July 1, 2009, the Department will no longer issue annual or biennial renewal certificates for RCACs or ADCs.
If you have any questions regarding the information contained in this memorandum, please feel free to contact your Assisted Living Regional Director. Regional contact information can be found at the following website: http://dhs.wisconsin.gov/rl_DSL/Contacts/alsreglmap.htm
4. New DQA Memos
DQA 09-023 Preadmission Requirements for Community-based Residential Facilities
http://dhs.wisconsin.gov/rl_dsl/Publications/09-023.htm
DQA 09-024 Preadmission Requirements for Residential Care Apartment Complexes
http://dhs.wisconsin.gov/rl_dsl/Publications/09-024.htm
DQA 09-025 Preadmission Requirements for Nursing Homes
http://dhs.wisconsin.gov/rl_dsl/Publications/09-025.htm
DQA 09-027 Heat Awareness
http://dhs.wisconsin.gov/rl_dsl/Publications/09-027.htm
5. Assisted Living Medication Packaging
By Doug Englebert, R. Ph.
On April 1, 2009 the new regulations for Community Based Residential Facilities (CBRF) took effect. As a result of substantial changes numerous questions have been brought forward. Additionally, old issues are resurfacing. One of those issues is medication packaging for unique situations.
Example: A CBRF resident obtains a new prescription after hours on Saturday which extends through Sunday when the resident's normal pharmacy is closed. The back-up pharmacy will send medication to the CBRF; however, the medication is in vials instead of the traditional blister packaging. How can the unit dose requirement be met?
This question arose under the old regulations as well as the new. Many CBRFs are set up in such a manner that the facility has no nurse oversight and, therefore, medications must be packaged in unit of use. However, there will be instances when back-up pharmacies, sample medications, and other issues lead to situations where the medications are not packaged in unit of use.
A CBRF can address such scenarios by making alternative plans. For example, if the routine for a resident's pharmacy is to fill ALL weekend prescriptions as emergencies and the back-up pharmacy uses multi-dose bottles, the facility will not be compliant. One way to address this situation is to carefully review medications through discussions with the pharmacist or physician and determine whether or not residents can wait until Monday to start medications. If a medication must be started during a weekend, other alternatives must be considered; i.e., medication set-up can be done in accordance with the CBRF rules. It is also possible to ensure that the back-up pharmacy can meet packaging needs.
The bottom line is that the resident, facility, and primary pharmacy must develop a plan to address packaging requirements that meet the resident and facility needs at all times.
6. Consultant Corner
By Doug Englebert, R. Ph.
1 . A CBRF resident takes the city bus to attend work once a week. His employer requires the resident's medications to be delivered to the facility and that facility staff hand medications to work staff. The facility does not feel it is safe to transfer the resident's punch card with him as he travels on the city bus. Codes do not allow staff to take medications out of unit dose packaging for routine events. How can the facility meet all requirements while also maintaining the resident's independent bus travel and allowing medication transfer between staff ?
A sample of multiple, potential options include:
a. The prescription may be changed so that the medication does not need to be taken at work.
b. The employer maintains a month's supply of medication so that handoffs can be made monthly rather than weekly.
c. After consideration, an employer may allow a resident to hand-off medications to work staff. If medication tampering is a concern, the use of some type of sealed, tamper-evident packaging may be possible.
The resident, work staff, facility staff, and the pharmacist need to discuss and understand all relevant regulations and/or requirements and find a viable solution that maintains the resident's desired level of independence.
