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News & Press: Regulatory

AL Forum Recap

Friday, March 24, 2017   (0 Comments)
Posted by: Sarah Bass
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The Wisconsin Department of Health Services held an Assisted Living Forum Tuesday in Madison. Some key items of discussion:
  • Bureau of Assisted Living Director Alfred Johnson reviewed some recent Division of Quality Assurance (DQA) memos, including
    • 17-002: This memo explains the new online license renewal process. This is the first phase of an online renewal process, the next phase will be for initial licensee certifications to be done online.
    • 17-005: This memo outlines the construction requirements for new Class C structures, and is an update/reissue of a previous memo. The memo clarifies that Class C would be an I-2 classification, with some additional requirements for Class C locations. Johnson said this is a much-needed change, because he said there are fewer nursing home beds available and more CBRF beds, with the result of some facilities being "borderline" on the needs of their residents being closer to "nursing home" needs but being in a CBRF setting. He said DHS needs to make sure the buildings can perform and provide needed protections for individuals.
  • Janet Estervig of DHS explained how DHS is working to implement the new federal  home and community based settings (HCBS) rule in non-residential settings. These non-residential settings include: adult day care, pre-vocational settings, day habilitation, children's day services and group supported employment. The non-residential settings have been asked to complete a self-assessment, similar to what residential settings had to do, but with more questions. Reviewers will next be looking at the DHS tool and developing benchmarks for determining compliance with the federal HCBS settings rule. She noted that although the deadline for compliance is March 2019, CMS officials have indicated that an extension of that deadline might be forthcoming. In response to concerns about how the federal rule will impact door lock requirements in residential settings, Johnson said DHS officials are looking into that. Forum participants requested that DHS issue a written memo with more information about federal door lock requirements in residential settings under the new HCBS rule.
  • Corinne Brown-Esqueda of DHS reviewed the mandatory requirement to submit 4-year renewal of license background check information. These renewals are held every four years and are due in to DHS by April 30, 2017. The background checks are separate from AL provider caregiver staff background checks. These are for specific people within the AL facility, including the professional license holder (owner or executive director/CEO), any non-client residents such as a person living in the facility who is not a client there (such as the owner and spouse, children age 10 or older, live-in caregivers, etc.), and facility board members (if applicable) who have contact with clients.
  • Alfred Johnson gave a State of Assisted Living presentation. Some statistics:
    • At the end of 2016, there were 4,166 assisted living facilities, the largest type was adult family home. Most initial applications are for adult family homes, most in the Kenosha/Racine or Fox Valley areas.
    • They are seeing increases in: resident acuity, medical issues (aging population), challenging behaviors, wandering/elopement, financial difficulties, lack of systems of care, lack of qualified staff (quantity of staff, as well as properly trained staff), complaints, testing the "boundaries" of AL care such as losing the homelike environment, insufficient application materials, etc.
    • Johnson noted that DQA is returning initial applications that are incomplete. The new policy is that incomplete applications will be returned to the applicant. If the applicant submits materials a second time and again is missing the required paperwork/documentation, the application will again be returned and that person will not be allowed to reapply for one year.
    • Johnson challenged AL providers to return to a resident-centered focus, with the well-being of the resident being the primary concern. But one AL Forum participant asked how providers can be expected to add staff and training with low rates from the MCO. Johnson said if a provider accepts a resident and also accepts a rate from an MCO, it is their responsibility to meet the resident's needs at that rate, and maybe don't accept a low rate from the MCO in negotiations.
    • The most self-reports in 2016 were in the subject of falls. Of the 1,228 falls investigated, 31 were issued statements of deficiency, no action was taken by DHS in the other cases.
    • In 2016, 2,719 citations were issued. The top cites for CBRFs were for service plan violations (not updated).
More information about this meeting, previous agendas, and future meetings is available at 

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