Wisconsin Long Term Care Advisory Council Updates

This information is provided by Government Policy Solutions in Madison, WI.

The Wisconsin Long-Term Care Advisory Council met on Tuesday, July 12. Some items discussed by Wisconsin Department of Health Services (DHS) staff:

DHS American Rescue Plan Act (ARPA) Initiatives Updates

HCBS grants: Curtis Cunningham, DHS assistant administrator, Benefits & Service Delivery, gave an update on American Rescue Plan Act initiatives, including home and community based services grants. A new grant-making process will create opportunities to strengthen HCBS programs in Wisconsin. Currently, more than 100,000 children and adults receive HCBS services in Wisconsin, and the new grant program will provide funding to assist providers with COVID-19 recovery and improve, enhance and expand their services.

DHS has contracted with a vendor/consulting group to administer this grant program. There will be $15 million in the first round of grant funding to support HCBS, with the grant program opening for applications in August 2022. Grant amounts may vary from $25,000 and up to $2 million per awardee, and proposals must be designed to strengthen HCBS in Wisconsin. Examples of some ways that grant dollars may be spent:

• Support organizations and providers as they recover from the impact of the COVID-19 pandemic.
• Develop and implement specialized training for direct care workers and managers.
• Help individuals with intellectual, developmental, and other significant disabilities find and retain work.
• Improve person-centered planning and implementation.
• Increase specialized care, services, and engagement for individuals with dementia, autism, children’s long-term care needs, or persons with other disabilities. 
• Expand the use of technology and telehealth by assisting HCBS providers with supplies and equipment.
• Reduce disparities and improve access to a diverse and culturally competent pool of HCBS providers.
• Develop other innovative ideas to improve HCBS services.
• Prepare information, including public health and educational materials, in accessible formats for people getting HCBS.
• Promote access to technology to facilitate human connection for people getting HCBS and their caregivers.
• Support quality initiatives that improve services and supports, and increase community engagement.
• Fund recruitment and retention activities for direct services workers of Medicaid HCBS providers.
• Purchase personal protective equipment and routine COVID-19 tests for direct services workers.

HCBS rate reform: A 5% rate increase for home and community-based services was rolled out starting January 1, 2022. It applies to multiple service providers who work with Medicaid programs such as Family Care, Family Care Partnership, IRIS, PACE, the Children’s Long-Term Supports waiver program, SSI Managed Care, BadgerCare Plus Managed Care, and Medicaid Fee for Service.

This initiative has three major components:

• A 5% rate increase (CMS just extended the ARPA guidance for spending the dollars from March 2024 to March 2025).
• Some DHS work groups have started meeting on this topic, including a rate setting work group.
• This will include tiered payment rates for personal care services (PCS) and supportive home care (SHC).

Grant Cummings, DHS, Director, Bureau of Rate Setting, said the HCBS fee increase is part of the ARPA funding. DHS implemented two mandatory provider rate increases for HCBS to immediately bolster providers during the pandemic to serve as a bridge until a fee schedule is established.

• June 1, 2021 – 5% increase to most HCBS waiver providers
• Jan. 1, 2022, - 5% increase to all HCBS providers

With stakeholder input (including WALA), DHS will be implementing a new minimum fee schedule, which will require:

• Capitation rate changes
• Identify DHS contract and/or waiver changes
• MCOs to re-determine member services and acuity
• MCOs to re-negotiate rates and provider contracts
• MCOs to re-process claims

Development of the new rate schedule got underway in April 2022 with DHS meetings with stakeholders (including WALA), as well as work group meetings starting in May 2022. The timeline includes:

• June 2022 – MCO interviews
• July 2022 – Creation of a uniform definition of activities as part of services/programs
• July-Aug 2022 – Develop draft cost tiers based on member needs, conditions and diagnosis
• July-Sept 2022 – create provider survey
• October 2022 – issue provider survey
• February 2023 – draft rates submitted to DHS
• March 2023 – release rates for public feedback
• April 2023 - finalize rates
• July 2023 – adjust MCO capitation rates to fund provider movement to new minimum rates

Assisted Living Reporting, Assessment and Certification: Dan Perron, DHS, Director, Bureau of Assisted Living, said the bureau is looking at ways to collect more data on the assisted living industry and its residents in Wisconsin. DHS is evaluating for potential implementation:

• An assisted living reporting tool to assess how well assisted living facilities can serve Wisconsin residents today and in the future.
• A member assessment to understand the needs of Wisconsin residents who access services, both in assisted living and in the community.
• Development of online platforms to track nonresidential HCBS reviews and 1-2 bed adult family homes.

The Bureau of Assisted Living collects a limited amount of information on AL facilities during the licensing process, and DHS is exploring possibly using or enhancing its e-licensure or e-renewal system to include components specific to facility assessment and resident assessment.

Some data fields that could possibly be collected and reported to DHS under the reporting effort: resident age, gender, race/ethnicity, marital status, number of client groups, settings from which the resident entered the facility, settings they are discharged to, admittance and discharge reasons, length of stay/days of care, etc.

Perron said additional data collection is essential for policy decision-making and also to identify trends. The data could increase DHS' ability to ensure health and safety standards are being met, manage its workload and anticipate trends in the industry; and to assist care providers in care planning, acuity and reimbursement.

DHS is still in the initial phases of this initiative, exploring means for data collection and identifying opportunities for stakeholder feedback.

More information

Click here to see the agenda from the Long-Term Care Advisory Council meeting.

Click here to see the meeting handouts.

Click here to see the DHS webpage "American Rescue Plan Act: Extra Funding for Home and Community-Based Services.”