WHCA BOARD OF DIRECTORS MEETING

9 a.m., Tuesday, March 22, 2016 Terrace B Seminar Room – M3 Insurance 828 John Nolen Dr. Madison, WI 53713

CLICK HYPERLINKS FOR RELEVANT DOCUMENTS

I. Consent Items A. Reports/Updates – District Activities

1. President’s Report – Mike Schanke 2. December 2015, January and February 2016 Board Meeting Minutes, 2/22/16 Attendance 3. Financial Report – February 2016 (Kiley) 4. PAC Report (McGinn)

II. Old Business A. Family Care (Vander Meer, McGinn, Purtell)

1. DHS Releases Concept Paper 2. DHS hearings on Concept Paper 3. SB 687 / AB 856 – MCO Bill signed into law

B. Legislative Activity (Vander Meer, McGinn, Purtell) 1. Update on AB 791: CBRF Acknowledgement Forms & SUBSTITUTE AMENDMENT 2. Dementia Redesign Bills

C. Update on 2016 Workforce Survey (Van Camp) D. Pneumococcal Vaccinations Update (Purtell) E. Reporting and Returning overpayments (Purtell) F. Payroll Based Journal (Vander Meer)

III. New Business A. Payment Council Recommendations (Vander Meer, Van Camp)

1. Reimbursement reforms related to workforce 2. Labor regions

B. Elizabethkingia Update (Purtell) C. HCBS Update (Vander Meer, Purtell) D. Third-Party Liability (Vander Meer, Van Camp) E. Wireless Handheld DQA Memo (Purtell) F. 2016 Spring Conference (MacKenzie) G. Meeting with consultants on May 12 (Vander Meer)

IV. Reports A. WiCAL Council Report (Kelm) B. WHCA Committee Reports: Payment Council, Political Affairs Liaison, and Quality Advancement. C. DON Council Report (Pettis) D. AHCA Reports (Vander Meer) E. WHCA District Presidents’ Reports

V. Adjournment

NEXT SCHEDULED BOARD OF DIRECTORS MEETING TBD

extends its appreciation to: WHCA/WiCAL Service Corporation and M3 Insurance

1 -- WHCA Board Packet -- March 2016

WHCA BOARD OF DIRECTORS MEETING

Monday, February 22, 2016 9 a.m.

Terrace B Seminar Room – M3 Insurance 828 John Nolen Drive, Madison, WI 53713

MINUTES Chairperson: Mike Schanke The WHCA Board of Directors meeting was called to order at 9 a.m. by Board President Mike Schanke. I. Consent Items A) Determination of Quorum

It was determined that there was a quorum. B) Certification of Board Member Replacements

There were no Board Member replacements.

C) Adoption of Agenda

There were no agenda additions

D) Minutes of Previous Board Meeting The minutes were approved.

E) Treasurer’s Report – Jeremy Kiley

No formal report. II. President’s Report – Mike Schanke A) Reports/Updates – Legislative Activities

1. AB 791 – bill has passed the Assembly on a voice vote on Feb. 18. WHCA/WiCAL Director of

Government Relations Jim McGinn said the Senate will be a tougher sell.

2. AB 687 – “Casey Kasem Bill” a. WHCA/WiCAL is the only group opposed to the bill. b. The bill has passed both chambers of the legislature.

3. PAC Report

a. WHCA/WiCAL Director of Government Relations Jim McGinn said checks are coming in, albeit a little slow

b. We need to raise enough for the PAC to play a role in competitive open seats due to several retirements.

III. Old Business A) Family Care/IRIS 2.0 Update

WHCA Executive Director John Vander Meer said that he has been meeting with IHAs to discuss the FC redesign. The executive committee met on Friday, Feb. 12 to discuss the redesign in order to make sure LTC community was heard before publication of DHS concept paper. The board discussed the redesign in terms of how other organizations were reacting, what priorities WHCA/WiCAL should promote, and strategies moving forward. Vander Meer said he would testify at the Madison DHS hearing on the redesign and encouraged other members to testify at either the Madison or Eau Claire hearings.

IV. New Business

A) Introduction of Jim Stoa as WHCA/WiCAL Communications Director

Vander Meer introduced Jim Stoa as the association’s new Communications Director.

B) Reporting and Returning Overpayments

WiCAL Executive Director Brian Purtell discussed the CMS finalized Medicare overpayment rule

C) Pneumococcal Vaccinations

Purtell discussed concerns about the Prevnar 13 pneumococcal vaccinations, including the issuing of IJs in recent weeks.

V. Reports

A) WiCAL Council Report i. Dale Kelm was unable to attend the meeting. ii. Vander Meer said the association is continuing to explore the possibility of having an AL

administrator training program along with LeadingAge Wisconsin. iii. Vander Meer discussed the potential for the association to hire a dedicated AL staff

position.

B) WHCA Committee Reports i. Payment Council

1. Schanke said there is no new information, but the Payment Council was meeting following the board meeting.

ii. Quality Advancement 1. Schanke said there is no new information, but the Quality Advancement Committee

was meeting following the board meeting.

C) AHCA Reports i. Vander Meer reported on the following:

1. AHCA meeting to address payroll based journal (PBJ) 2. Vander Meer handed out information on PBJ.

ii. The board discussed whether the association should pressure the congressional delegation to delay PBJ beyond implementation date.

D) WHCA District Presidents’ Reports i. Jeremy Kiley, d10, said that DON Council had an effective handout for legislative

meetings.

E) Spring Conference Report i. WHCA/WiCAL Membership Director Skitch MacKenzie said the brochure for the Spring

Conference would be out the following week.

F) Public Outreach i. Board President Mike Schanke discussed the idea of partnering with LeadingAge

Wisconsin to spend $50K apiece to do a public outreach effort on workforce issues. ii. Vander Meer said there would be no vote today, since the board needs to get a better idea

of how our $50,000 would be used.

VI. Adjournment A motion to adjourn was made by Kevin Larson and seconded by Cliff Woolever and approved by members of the Board unanimously.

NEXT SCHEDULED BOARD OF DIRECTORS MEETING

Tuesday, March 22, 2016 9:00 a.m.

Terrace B Seminar Room – M3 Insurance 828 John Nolen Drive, Madison, WI 53713

WHCA/WiCAL extends its appreciation to the following

Preferred Associate Members: WHCA/WiCAL Service Corporation

and M3 Insurance

WHCA BOARD OF DIRECTORS MEETING

9:00 a.m., Tuesday, January 26, 2016 M3 Insurance

828 John Nolen Dr. Madison, WI 53713

MINUTES

I. Consent Items A. Reports/Updates – District Activities

1. President’s Report – Mike Schanke

Board President Mike Schanke reported on the previous day’s Executive Committee meeting. He noted they discussed workforce issues, payment issues. He noted that AHCA will be sending a team out to WI to provide a two-day seminar on bundled payments, ACOs, etc. This seminar will be available to WHCA/WiCAL staff and the Board of Directors. He also explained that the Executive Committee discussed making changes to improve membership engagement moving forward. The organization will be mission driven and metric based.

a) Executive Committee Retreat

(1) WHCA/WiCAL Strategic Plan (2) Committees, Legislative Outreach and Membership Engagement (3) Communications Director Search

2. Financial Report – November 1-30, 2015; December 1-31, 2015

Board Treasurer Jeremy Kiley reported on the organization’s financial report. Kiley explained that conventions did well in 2015, Fall was very successful so the Association is doing well. All expenses are in line, resulting in positive $51,000.

3. PAC Report

WHCA/WiCAL Director of Government Relations Jim McGinn reported on the status of the PAC. As of now, only a few members have contributed to the PAC. McGinn noted that it is an election year and we need to be visible. There is a current balance of $300. McGinn mentioned that a goal of $30,000 from $2/bed representing 15,000 beds should be a reasonable goal. He also mentioned that WHCA/WiCAL is in need of a new PAC Treasurer. JVM has approached Tom Graves about this.

II. Old Business A. Legislative Activity

1. Update on Speaker’s Task Force on Dementia

On Friday (Jan 22) afternoon, a series of bills (10) were introduced. Scheduled for a hearing on Monday morning at 9am (25th). WHCA/WiCAL staff developed testimony on one bill – CBRF antipsychotic acknowledgement form. This would make the process in CBFRs similar to that in SNFs. CBRF would have to gather forms and present to resident to sign. WHCA argued that we aren’t prescribing this, the physician is, and therefore the physician should get this consent from the resident. Purtell argued that this could cause confusion on the part of the resident and result in non-clinical person having to answer questions. The Association’s thought was if some info is good, more info is better and is considering a fallback. McGinn stated that the likelihood of the bill passing is high and the likelihood of all 10 passing is high. WiCAL Council will continue discussion of fallback option.

2. SB 487 / AB 674: Relating to: visitation of residents of certain facilities by adult children.

Brian Purtell explained that there are vehicles in place for this already (guardianship laws, Power of Attorney for healthcare). Purtell read the bill and asked the Board for opinions. The Board officially opposes the bill. A motion to oppose the bill was made by Board member Deb Klatkiewicz, seconded by Board member Tom Graves and unanimously passed by Board Members.

3. Medicaid Budget Update

WHCA Executive Director John Vander Meer noted that the Medicaid budget is in balance.

4. Legislative visits

Vander Meer encouraged members to contact their legislators. He mentioned that WHCA/WiCAL will be disseminating information on how to conduct a facility visit. He reiterated that it is an election year and one of the key things we can do, in addition to contributing to PAC is remaining engaged with our legislators. This is particularly important for facilities located in Joint Finance Committee member districts. It is also important for facilities located in districts of Assembly in Health and Aging and Long Term Care Committee members. This is a critical time period.

B. Telemedicine Coverage Update

Vander Meer discussed a memo from the Department that indicated that facilities have to be designated branch offices to provide telemedicine in behavioral health and substance abuse. The original memo doesn’t match what is being said now. Board member Deb K explained that Marshfield clinic does telehealth in their own clinics but can’t do in it other facilities any longer. Assembly Bill 664 exempts schools from being designated branches.

C. Clinical Performance Measures – Pilot Participants

WHCA/WiCAL Director of Data & Research Analysis Kate Van Camp updated the Board on the status of the pilot study. Our goal was to fill 10 slots. We currently have 5 filled. We can still add additional facilities until the webinar at the end of February.

D. Family Care

1. Update on redesign

Vander Meer explained that the concept paper is due by April 1. Vander Meer, Brian Shoup and John Sauer of LeadingAge WI have a meeting February 23 to discuss Family Care redesign. The paper will be out by that time. WI Long Term Care Coalition (advocates and MCOs) will be releasing thoughts preemptively on redesign next week. WHCA/WiCAL will be following closely, as this is a critically important issue to the membership. Purtell may be presenting 20-30 webinar breaking down FC changes.

2. Wisconsin Long-Term Care Coalition Plan

Vander Meer explained that the Coalition is expected to release an advanced response to the state’s Family Care redesign concept paper.

3. AB 453: Expansion of Family Care to Rock County

WHCA/WiCAL Director of Government Relations Jim McGinn reported that this legislation which expands the Family Care program to Rock County just passed in senate. It is now on Governor’s desk awaiting his signature.

4. Outreach to Legislature

Vander Meer emphasized the importance of outreach to the Legislature.

E. CMS Region V Meetings

Vander Meer stated that since the Board last met, CMS Region V held a meeting in Chicago. CMS, State representatives and state provider associations were in attendance. Pat Vernig, Otis Woods, Brian Purtell and John Vander Meer attended. Vernig is Regional Director for Madison. Vander Meer noted that Vernig will likely be filling Juan Flores’ position. There were two days’ worth of meetings.

WHCA/WiCAL Director of Legal Services Brian Purtell reported on Conditions of Participation: CMS is working on draft and is not talking comments into account. He said that members shouldn’t assume Conditions aren’t going to happen. Purtell thinks they will be adopted in October. WHCA/WiCAL has a placeholder for a roadshow presentation in November.

1. Data Trends

Purtell reported on data trends that were shared at the CMS meeting. Attendants were given survey data and frequency information. Purtell: Continues to show WI being an outlier because of high level of severity. We seem to be treated differently. There is a disparity.

2. Bundled Payments – CCJR

Purtell reported on the details included on the comprehensive joint replacement rule, which will affect eight Wisconsin counties.

3. HCBS Update

Purtell confirmed that an AL facility connected to an SNF by a covered walkway is not IN a facility and thus not subject to any heightened scrutiny.

4. CMP Funds Purtell provided an overview of the discussion regarding the use of civil money penalty fines. Some CMS Region V officials believe these funds can exclusively be used for nursing homes. Otis Woods expressed that he thought these funds could ultimately be used by ALFs once a resource like the Clinical Resource Center is in the public domain.

5. Life Safety Codes

Purtell reported there was a Life Safety code presentation by two engineers. They presented examples of things that result in deficiency. There was also an extended presentation on sepsis.

6. Payroll-Based Journal and Electronic Staffing Data Collection

Vander Meer explained that once PBJ begins, July 1, members will be submitting info electronically. He stated that facilities can voluntarily begin participating now. Purtell noted the importance of starting now to test the process and become comfortable with it before the mandatory July 1 start date.

III. New Business

A. Board Member Openings

Vander Meer noted that there are several openings on the Board. He stressed that we want to operate at full strength and that there is a list of openings in packet.

B. 2016 Workforce Survey

Van Camp explained that WHCA/WiCAL is working with the other provider associations to create a survey we can send out every 6 months for longitudinal data. The survey will be released later this week. It is about 20 questions and needs to be completed for each member facility.

C. Member Use of LTC Trend Tracker

Vander Meer attended a meeting in Arizona that discussed using this resource. A suggestion was made to use the dashboard as an agenda for your quality committee meeting in building. Derived uses of TT: sharing quality indicators with hospitals in your area. Good discussion of readmissions, etc. Helps maintain relationships.

D. AHCA/NCAL liaison issues

Schanke will serve as representative on Council of States.

IV. Reports

A. WiCAL Council Report

WiCAL Council Chair Dale Kelm reported that at the previous WiCAL Council meeting, the Council set up agenda for future meetings. District 11 needs a representative and District 2 need to validate. The Council discussed developing an AL manager training program. Bridgestone (purchased Harmony facilities) will remain in WHCA/WiCAL.

B. WHCA Committee Reports

Vander Meer stressed that the organization will hold more meetings in 2016 for all committees.

C. DON Council Report

Joey Pettis reported that the DON Council has a Symposium coming up in February as well as a leadership program in May and June. She noted a Council President change, it is now held by a DON in a hospice setting. The Council met with Juan Flores about IJs. RFODs and UW educators were present as well. They explained the lack of long term care education and requested more data. There will be some sort of follow-up.

D. AHCA Reports

Vander Meer said there are expected to be more changes in 5 Star ratings in April or May.

E. WHCA District Presidents’ Reports

V. Adjournment

1:29 PM 03/11/16 Accrual Basis

WHCA/WiCAL

Comparative Balance Sheet As of February 29, 2016

Feb 29, 16 Feb 28, 15 % Change

ASSETS

Current Assets

Checking/Savings

Petty cash 100.00 100.00 0.0%

Cash Operating-Town 154,307.06 166,069.14 -7.08%

Operating Reserve 457,190.65 539,768.84 -15.3%

Total Checking/Savings 611,597.71 705,937.98 -13.36%

Accounts Receivable

Dues Receivable-Members 450,814.10 345,174.43 30.61%

Dues Receivable-Assoc Memb 16,350.00 16,699.75 -2.09%

Dues Receivables WiCAL 20,496.86 16,078.12 27.48%

Dues Receivable AHCA 242,281.27 228,605.24 5.98%

Non-Dues Receivables 60,363.06 69,669.07 -13.36%

Total Accounts Receivable 790,305.29 676,226.61 16.87%

Other Current Assets

Undeposited Funds 0.00 4,638.81 -100.0%

Accrued SC Dividend/Other 5,000.00 6,333.30 -21.05%

Prepaid Insurance 2,262.78 2,435.22 -7.08%

Prepaid-Other 3,312.63 4,576.59 -27.62%

Total Other Current Assets 10,575.41 17,983.92 -41.2%

Total Current Assets 1,412,478.41 1,400,148.51 0.88%

Fixed Assets

Office Equipment 15,889.56 17,381.36 -8.58%

Total Fixed Assets 15,889.56 17,381.36 -8.58%

Other Assets

MacKenzie/Lynn Scholarship Fund 61,691.49 55,105.44 11.95%

Total Other Assets 61,691.49 55,105.44 11.95%

TOTAL ASSETS 1,490,059.46 1,472,635.31 1.18%

LIABILITIES & EQUITY

Liabilities

Current Liabilities

Accounts Payable

Accounts payable -893.01 -893.01 0.0%

Total Accounts Payable -893.01 -893.01 0.0%

Other Current Liabilities

AHCA Dues Payable 335,253.67 375,677.42 -10.76%

NCAL Dues Payable 5,839.51 2,310.71 152.72%

Sales Tax Payable 67.31 47.57 41.5%

Deferred Revenue-WiCAL 29,866.81 23,231.31 28.56%

Deferred Revenue-WHCA 480,653.20 484,398.18 -0.77%

Deferred Revenue-Conv Ass 11,687.50 11,812.50 -1.06%

Deferred Revenue-Assoc Memb 37,714.50 37,087.80 1.69%

Accrued Pension/Other 7,089.02 6,962.08 1.82%

Total Other Current Liabilities 908,171.52 941,527.57 -3.54%

Total Current Liabilities 907,278.51 940,634.56 -3.55%

2 -- WHCA Board Packet -- March 2016

1:29 PM 03/11/16 Accrual Basis

WHCA/WiCAL

Comparative Balance Sheet As of February 29, 2016

Feb 29, 16 Feb 28, 15 % Change

Long Term Liabilities

MacKenzie/Lynn Scholarship Trst 61,691.49 55,105.44 11.95%

Total Long Term Liabilities 61,691.49 55,105.44 11.95%

Total Liabilities 968,970.00 995,740.00 -2.69%

Equity

Net Assets 426,655.26 378,223.85 12.81%

Net Income 94,434.20 98,671.46 -4.29%

Total Equity 521,089.46 476,895.31 9.27%

TOTAL LIABILITIES & EQUITY 1,490,059.46 1,472,635.31 1.18%

3 -- WHCA Board Packet -- March 2016

1:47 PM 03/11/16 Accrual Basis

WHCA/WiCAL

Comparative Income Statement January through February 2016

Jan - Feb 16 Jan - Feb 15 $ Change % Change

Income

WHCA Dues 96,285.00 96,524.64 -239.64 -0.25%

Convention Assessment 2,337.50 2,362.50 -25.00 -1.06%

WiCAL Income 5,213.80 423.50 4,790.30 1,131.12%

Associate Members 7,987.50 7,287.20 700.30 9.61%

Fall Convention 21,562.50 23,062.50 -1,500.00 -6.5%

Spring Conference 59,526.00 85,580.00 -26,054.00 -30.44%

Directory & Other Advertising 10,750.00 13,550.00 -2,800.00 -20.66%

Educational Seminars 19,319.00 11,218.00 8,101.00 72.21%

Special Service Income 2,030.00 2,146.00 -116.00 -5.41%

Interest Income 358.70 375.65 -16.95 -4.51%

Miscellaneous Income 10.00 10.04 -0.04 -0.4%

GFM Scholarship Fund Income 4,545.00 4,786.00 -241.00 -5.04%

Service Corp. Dividend 5,000.00 6,333.30 -1,333.30 -21.05%

Total Income 234,925.00 253,659.33 -18,734.33 -7.39%

Gross Profit 234,925.00 253,659.33 -18,734.33 -7.39%

Expense

General 12,788.87 10,850.20 1,938.67 17.87%

Office 20,968.19 20,207.86 760.33 3.76%

Salaries 78,860.04 90,947.95 -12,087.91 -13.29%

Fringe Benefits 27,497.85 29,012.95 -1,515.10 -5.22%

Travel 977.52 682.00 295.52 43.33%

Fall Convention -2,250.57 0.00 -2,250.57 -100.0%

Spring Conference 1,008.32 2,277.37 -1,269.05 -55.72%

Ed. Seminars 431.65 891.70 -460.05 -51.59%

Reconciliation Discrepancies 0.03 40.14 -40.11 -99.93%

GFM Scholarship Fund Expenses 208.90 77.70 131.20 168.86%

Total Expense 140,490.80 154,987.87 -14,497.07 -9.35%

Net Income 94,434.20 98,671.46 -4,237.26 -4.29%

Page 3 of 4

4 -- WHCA Board Packet -- March 2016

2:01 PM 03/11/16 Accrual Basis

WHCA/WiCAL

Income Statement January through February 2016

Jan - Feb 16 Budget % of Budget

Income

WHCA Dues 96,285.00 584,155.00 16.48%

Convention Assessment 2,337.50 14,175.00 16.49%

WiCAL Income 5,213.80 16,800.00 31.04%

Associate Members 7,987.50 47,625.00 16.77%

Fall Convention 21,562.50 155,916.00 13.83%

Spring Conference 59,526.00 167,170.00 35.61%

Directory & Other Advertising 10,750.00 40,312.00 26.67%

Educational Seminars 19,319.00 44,710.00 43.21%

Special Service Income 2,030.00 11,083.00 18.32%

Interest Income 358.70 2,100.00 17.08%

Miscellaneous Income 10.00 100.00 10.0%

GFM Scholarship Fund Income 4,545.00 0.00 100.0%

Service Corp. Dividend 5,000.00 30,000.00 16.67%

Total Income 234,925.00 1,114,146.00 21.09%

Gross Profit 234,925.00 1,114,146.00 21.09%

Expense

General 12,788.87 142,502.00 8.98%

Office 20,968.19 111,902.00 18.74%

Salaries 78,860.04 554,768.66 14.22%

Fringe Benefits 27,497.85 170,619.00 16.12%

Travel 977.52 13,300.00 7.35%

Fall Convention (2,250.57) 33,613.00 (6.7%)

Spring Conference 1,008.32 27,466.00 3.67%

Ed. Seminars 431.65 15,744.00 2.74%

Reconciliation Discrepancies 0.03 0.00 100.0%

Special Service Expenses 0.00 13,251.00 0.0%

GFM Scholarship Fund Expenses 208.90 0.00 100.0%

Total Expense 140,490.80 1,083,165.66 12.97%

Net Income 94,434.20 30,980.34 304.82%

Page 4 of 4

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Table of Contents

Executive Summary ....................................................................................................................................... 3

Introduction .................................................................................................................................................. 6

Public and Stakeholder Engagement ............................................................................................................ 6

Guiding Principles ......................................................................................................................................... 7

Program Design ............................................................................................................................................. 8

Member Self-Direction of Long-Term Care Services .................................................................................... 8

Family Care Partnership ................................................................................................................................ 9

Integrated Health Agencies ........................................................................................................................ 10

Family Care/IRIS 2.0 Regions ...................................................................................................................... 10

Continuous Open Enrollment ..................................................................................................................... 11

Aging and Disability Resource Centers (ADRCs) ......................................................................................... 12

Payments to IHAs ........................................................................................................................................ 12

Quality Measures ........................................................................................................................................ 13

Contracting With Any Willing and Qualified Provider ................................................................................ 14

Considerations for Tribes and Tribal Members .......................................................................................... 14

Next Steps ................................................................................................................................................... 14

Addendum 1 – Family Care/IRIS 2.0 Benefit Chart ..................................................................................... 15

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Executive Summary Since the Family Care Program was developed almost 20 years ago, it has provided greater independence, more consumer choice, and community inclusion for adults with disabilities and frail elders. Family Care was built on principles of self-determination and a true member-centered approach to designing care plans and services to meet each individual’s long-term care needs and include each individual’s preferences about how and where they live. The Include, Respect, I Self-Direct (IRIS) program was implemented in 2008 and offers the opportunity for adults with disabilities and frail elders to have an even greater say in the services and supports they need and how they want those services and supports to be delivered.

2015 Wisconsin Act 55 offers the opportunity to build upon the foundation of Family Care and IRIS, by enhancing the scope of services available to long-term care consumers and extending the programs to every county. All eligible adults with disabilities and frail elders will have access to coordinated primary, acute, and behavioral health services, in addition to long-term care services. The next generation of Family Care and IRIS will support the person’s overall health and well-being, not just their long-term care needs.

Act 55 directs the Department of Health Services (DHS) to make a variety of changes to the Family Care program. Under the direction of Governor Scott Walker, DHS will implement a new care model, Family Care/IRIS 2.0, which will expand Family Care statewide and transition to an outcome-based model that coordinates all of an individual’s care needs. These changes will preserve this essential safety net program for Wisconsin’s frail elders and adults with disabilities by maintaining essential health care services while slowing expenditure growth.

Wisconsin will establish a coordinated-care model that focuses on the overall health of the individual and will manage all of an individual’s care needs, including long-term care, primary and acute care, and behavioral health care. This model will allow Wisconsin to shift away from a more fragmented approach of providing care to frail elders and adults with disabilities, to ensuring that the total health outcome of an individual is coordinated. Care coordination reduces the likelihood of long-term nursing home stays and improves the member’s overall health, which may reduce the need for other long-term care services. Family Care/IRIS 2.0 will improve the delivery of long-term care services and will establish a strong link between an individual’s long-term, behavioral health, acute, and primary care needs. This will lead to better health outcomes, improved utilization of long-term care services, and more independence for frail elders and adults with disabilities who are living in the community.

It is essential that changes are made now to ensure Wisconsin’s long-term care programs will continue to be cost-effective, sustainable, and available for years to come.

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Among the most significant challenges facing Wisconsin in the next 20 years will be caring for the rapidly increasing older population. The population of those aged 65 and older will double by the year 2035. In addition, adults with disabilities are living longer, fuller lives in the community because of the support and services they receive through Medicaid programs. The state’s overall population growth coupled with changing demographics will greatly increase demand for Wisconsin’s long-term care programs.

Wisconsin is committed to maintaining excellence in health and long-term care coverage for our residents, while recognizing that significant growth in the cost of the Medicaid program impacts other essential priorities including education, transportation, and tax relief. The long-term care population including elderly and people with disabilities comprise less than 20 percent of the Medicaid enrollment, yet in fiscal year 2016, long-term care costs for this group is budgeted at $3.4 billion, or 40 percent of the Medicaid budget. For individuals currently in long-term care managed care programs, acute and primary care costs grew 10 times faster than their overall Medicaid costs from 2010 through 2015. For individuals currently in IRIS or a legacy waiver program, their acute and primary care costs grew 12 times faster. The combined impact of an aging population and increase in cost requires bold reform to protect these essential services for future generations. These reforms work to slow the growth of expenditures by improving health rather than more drastic options of decreasing eligibility or reducing benefits.

Act 55 requires DHS to submit this Concept Paper to the Joint Committee on Finance to serve as the foundation for the waiver submission to the federal Centers for Medicare and Medicaid Service (CMS) for approval to implement these significant reforms to Family Care. The waiver will be developed in accordance with principles determined by CMS to be essential elements of a strong managed long-term care services and supports program. As required by CMS, the draft waiver will be released for public review and comment before it is submitted to the federal government for approval.

This reform is about building upon Wisconsin’s successful managed long-term care system by supporting the overall health and well-being of individuals, not just their long-term care needs. Improving health outcomes will not only allow individuals to live longer fuller lives, but also will slow expenditure growth in Medicaid.

The Concept Paper outlines the following features of the proposed new model, Family Care/IRIS 2.0.

Family Care/IRIS 2.0 will serve adults with physical disabilities, adults with developmental disabilities, and frail elders who meet financial and functional eligibility requirements.

Members will decide whether to fully self-direct their long-term care services, have their long-term care services fully managed, or have a blend of care management and self-direction. They can change this decision as their needs change.

DHS will contract with integrated health agencies (IHAs). Wisconsin will have three Family Care/IRIS 2.0 regions and three IHAs will serve each region. DHS will select IHAs through a competitive Request for Proposal (RFP) process. Aging and Disability Resource Centers (ADRCs) will continue to provide unbiased enrollment

counseling to assist individuals in making a choice of which IHA to select. There will be continuous open enrollment in Family Care/IRIS 2.0.

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Family Care/IRIS 2.0 is consistent with federal regulations requiring that individuals dually eligible for Medicaid and Medicare have the right to choose to obtain their Medicare benefits through fee-for-service Medicare or through a managed Medicare program.

To create this Concept Paper, DHS developed and executed a robust plan to collect stakeholder input. DHS conducted eight public hearings; met with councils, boards, and committees that advise DHS on its long-term care programs; and held additional meetings with a variety of stakeholders to collect more focused input.

10 -- WHCA Board Packet -- March 2016

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Introduction The Family Care and IRIS programs serve more than 55,000 of Wisconsin’s frail elders and adults with physical and/or developmental disabilities, who meet both the Medicaid financial eligibility requirements and who have functional limitations that meet statutorily established thresholds. The Family Care and IRIS programs are currently offered in 64 counties. 2015 Wisconsin Act 127 authorizes DHS to implement Family Care in Rock County in July 2016. The remaining seven counties have not implemented Family Care and operate the legacy county-based long-term care programs. In these counties, people in need of services are on waiting lists. Family Care/IRIS 2.0 will be available in all 72 counties and will eliminate waiting lists for services.

Both Family Care and IRIS have been successful and have received broad stakeholder support. Both programs have proven to be fiscally prudent compared to the legacy county-based long-term care system, while meeting the growing demand for long-term care services. Act 55 offers the opportunity to build upon the foundation of Family Care and IRIS by enhancing the scope of services available to long-term care consumers, and extending the programs to every county. All eligible adults with disabilities and frail elders will have access to better-coordinated primary, acute, and behavioral health services, in addition to long-term care services. The next generation of Family Care and IRIS will support the person’s overall health and well-being, not just their long-term care needs.

The Family Care/IRIS 2.0 plan outlined in this document reflects the Department’s approach that remains centered on the fundamental principles of self-determination and empowerment, member-centeredness, quality, consumer choice, and fiscal stability.

Public and Stakeholder Engagement Recognizing the significance and importance of Act 55 provisions related to Family Care/IRIS 2.0, DHS developed and executed a plan to solicit stakeholder input that was used to create this Concept Paper.

More than 770 people attended eight public hearings that were held throughout Wisconsin. The hearings were live-streamed via a webcast to allow people to participate remotely. The archived

webcasts have been viewed more than 3,400 times. DHS received testimony from 556 people. Testimony was accepted in person at the public hearings

or in writing by email or U.S. mail. A dedicated Family Care/IRIS 2.0 web page was created to provide a centralized and easily accessible

point for information and to allow people to be notified when updates are posted. The web page is available at https://www.dhs.wisconsin.gov/familycareiris2/index.htm

DHS made presentations to and had discussions with stakeholders, including: o Tribal representatives. o Statutorily established boards and councils charged with providing input to DHS on its long-term

care programs, including the Governor’s Committee for People with Disabilities; State Council on Alcohol and Other Drug Abuse; Statutory Council on Blindness; Board on Aging and Long

11 -- WHCA Board Packet -- March 2016

7

Term Care; Tribal Long Term Care Study Group; Wisconsin Council on Physical Disabilities; Council on Mental Health; Board for People with Developmental Disabilities (BPDD); Independent Living Council of Wisconsin; and the Council for the Deaf and Hard of Hearing.

o Centers for Medicare and Medicaid Services (CMS). Two additional public hearings will be held regarding the Concept Paper in March 2016.

Upon the Legislature’s approval of the Concept Paper, DHS will develop formal waiver and/or state plan authority documents to submit to CMS. DHS will release these documents for public review and will conduct another formal public comment period prior to submission to CMS.

Guiding Principles Early in the planning process, DHS identified the following key principles and concepts to guide the development of Family Care/IRIS 2.0.

Program participants have the right to live independently, with dignity and respect. Personal choice, self-determination, person-centered planning, and cultural competence will remain

key tenets. Program participants will continue to have a choice of self-direction as well as a choice of providers

in the communities in which they live, including the option to receive services from tribal providers. People who wish to self-direct their long-term care services will continue to have the ability to self-

direct all current IRIS services. The focus on natural supports and connections to family, friends, and community will continue. The current range of benefits is unchanged. The management of the primary, acute, and behavioral

health benefits will be added to the existing array of long-term care services. Person-centered plans will continue to be developed in the most cost-effective manner possible. Appeal and grievance rights will be preserved. All enrollees will have access to ombudsman services. Independent and unbiased enrollment counseling will be available to all program participants. DHS will develop strong contractual obligations for vendors and DHS staff will continue rigorous

oversight to assure contract compliance and high-quality programs. Transparency and access to contracts, policies, and procedures will continue. A strong emphasis will be placed on quality, health, and safety. Family Care/IRIS 2.0 will build on the strengths and key features of the current Family Care and IRIS

programs. These changes will help ensure that these programs will continue to be cost-effective, sustainable,

and available for years to come.

12 -- WHCA Board Packet -- March 2016

8

Program Design Family Care/IRIS 2.0 will provide a continuum along which an individual may choose how much self-direction they prefer. Individuals may choose to be in a fully managed program, choose to self-direct some long-term care services, or choose to fully self-direct all long-term care services. Individuals will be able to choose the amount of self-direction that best meets their needs and preferences.

Family Care/IRIS 2.0 will include long-term care services currently covered under Family Care and IRIS as well as Medicaid-covered acute, primary, and behavioral health services. Addendum 1 provides a list of covered services and indicates which services can be self-directed.

IHAs will focus on the overall health of the individual by establishing a coordinated care model that covers the individual’s long-term care, behavioral health, and primary care needs.

IHAs must offer all services that are currently provided in the Family Care program, including home-delivered meals, supported employment, transportation, and supportive home care.

In addition, IHAs must offer most services that are currently provided through fee-for-service to members today, including outpatient acute care, inpatient hospitalization, therapy services, and personal care.

IHAs will not be required to cover prescription drugs, which will continue to be available fee-for-service similar to other managed care contracts like BadgerCare Plus and SSI Managed Care.

IHAs are required to support personal choice, self-determination, person-centered planning, and cultural competence.

Each member will have a care team that is unique to the individual to develop a care plan that is custom tailored to the individual.

Members who are also eligible for Medicare (dual eligibles) may choose to receive Medicare benefits through fee-for-service or from any Medicare Advantage plan available to them, regardless of whether the IHA has a relationship with that Medicare Advantage Plan.

Member Self-Direction of Long-Term Care Services The option for members to self-direct long-term care services is a key feature of the current Family Care and IRIS programs. Under Family Care/IRIS 2.0, members will continue to have maximum flexibility regarding self-direction of long-term care services and will have greater flexibility to change the number and type of services they self-direct.

Family Care/IRIS 2.0 will allow members to self-direct long-term care services in an environment where all care is coordinated.

Members may self-direct all or some of their long-term care services. The long-term care services that are available to IRIS participants today will continue to be available under Family Care/IRIS 2.0. See Addendum 1 for a full list of services that may be self-directed.

13 -- WHCA Board Packet -- March 2016

9

Members will not be able to self-direct primary, acute, and behavioral health services. Members will be enrolled in an IHA that will continue to be responsible for the member’s primary

care and behavioral health needs. Members that choose to self-direct long-term care services will have a care team that will include an

IRIS self-direction specialist. The care team will be required to guarantee that long-term care services are coordinated with primary and behavioral health care services. o IHAs will be required to offer IRIS Consultant Agency (ICA) and Fiscal-Employer Agency (FEA)

services. To offer a choice for the member, the IHA will be required to contract with an external IRIS self-direction specialist entity for these services and will also be required to provide the services directly. Members may choose if they want to work with the external IRIS self-direction specialist or work with the IHA’s designated staff.

o Self-directed budgets will be set after the IHA has completed an assessment and worked with the member to develop a member-centered plan. The member’s budget is based on the services the member elects to self-direct. DHS will approve and rigorously monitor the IHA assessment and budget-setting processes. Members will have the ability to appeal the self-direction budget to DHS.

o Members will not be required to return to the ADRC if they want to begin to self-direct services or stop self-directing services.

Family Care Partnership The Family Care Partnership Program is an integrated Medicare and Medicaid program that provides comprehensive services for frail elders and adults with developmental or physical disabilities. The program integrates health and long-term support services, and includes home and community-based services, physician services, and all medical care.

Family Care Partnership is currently available in 14 counties. DHS will continue to offer Family Care Partnership in these counties. Individuals in these counties may enroll in Family Care/IRIS 2.0 or Partnership. Individuals who choose Partnership must enroll in a managed care organization’s (MCO) Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) for their Medicare benefits. The MCO is then responsible for providing all Medicare and Medicaid primary, acute, behavioral health, and long-term care services.

MCOs are the entities currently contracted with DHS to provide Family Care Partnership. MCOs are similar to IHAs and are required to be licensed by the Office of the Commissioner of Insurance (OCI) as insurers. DHS intends to continue contracts with current Family Care Partnership MCOs to ensure continuity for members enrolled in the Family Care Partnership program. DHS will continue to work with CMS to explore the possibility of expanding Partnership to more counties to increase consumer choice.

14 -- WHCA Board Packet -- March 2016

10

Integrated Health Agencies DHS will contract with IHAs to provide Family Care/IRIS 2.0. OCI will require IHAs to be licensed as insurers.

Act 55 requires that DHS have multiple IHAs in each region. DHS intends to contract with three IHAs per region. Having three IHAs in each region will meet several important goals and requirements.

CMS requires that members have a choice of managed care entities. Members will have a choice of IHAs. Providers will not be limited to negotiating with one IHA, which will create a more level playing field

for negotiations. There will be greater program stability for members, providers, and DHS. If one IHA fails to meet

contract obligations or does not wish to continue its contract with DHS, members can be transitioned to the remaining IHAs.

DHS will use the RFP process to select the three IHAs for each region. An RFP allows DHS to select IHAs who scored the highest compared to its peers and to control the number of IHAs in each region. This will help to ensure an adequate population base to manage IHA financial risk.

Once selected through the RFP process, DHS will enter into a contract with the IHA that is contingent upon a successful financial and operational readiness review that will be conducted by DHS. Readiness reviews will ensure that each IHA is prepared to serve Family Care/IRIS 2.0 members and has:

An adequate provider network for long-term care, primary, acute, and behavioral health services throughout the region.

Adequate staffing levels and training, including 24/7 on-call support, competence in areas such as behavioral health, integrated employment, and member rights.

Appropriate systems capacity for member and provider enrollment, functional screen, service authorizations, quality monitoring, financial tracking, analytics, reporting, and claims processing.

DHS will provide oversight to ensure ongoing compliance with program requirements.

Family Care/IRIS 2.0 Regions There will be three Family Care/IRIS 2.0 regions. DHS applied an actuarial analysis to determine the regional population that would be sufficient to support three IHAs per region. Based on the actuarial analysis, dividing the state into three regions ensures that each IHA can manage the financial risk as it provides acute, primary, behavioral health, and long-term care services.

DHS also considered the following factors:

IHAs will be required to serve all counties within a given region. Each region will have at least three IHAs.

15 -- WHCA Board Packet -- March 2016

11

IHAs will be able to submit proposals for one or more regions. Adequate population base is necessary to mitigate financial risk. A mix of urban and rural areas in each region will help to ensure sufficient IHA participation in all

regions, as well as adequate network of providers for all covered benefits with reasonable time and distance access.

Developing regions by combining current Family Care regions will minimize disruption in the transitions.

The remaining non-Family Care counties (Adams, Dane, Florence, Forest, Oneida, Taylor, and Vilas) will transition to Family Care/IRIS 2.0 when it is implemented in the region in which they are located.

Final decisions about the order in which the regions will transition to Family Care/IRIS 2.0 have not yet been determined.

Continuous Open Enrollment Under Family Care/IRIS 2.0, there will be continuous open enrollment. At any time, an individual may make Family Care/IRIS 2.0 enrollment decisions such as joining a program, switching a program, or changing IHAs.

Several factors were considered in deciding to maintain continuous open enrollment:

Only a small number of Family Care and Partnership enrollees choose to switch programs. In 2015, of the 43,541 people enrolled in Family Care and Partnership, only 533 enrollees, or 1.2 percent requested to switch to another program or MCO to meet their long-term care needs.

Allowing individuals the ability to change IHAs at any time gives IHAs an incentive to retain members by providing high-quality services.

Establishing time-limited open enrollment periods increases administrative complexity by requiring special open-enrollment periods.

In order to ensure cost-effective care, it is important to allow newly eligible individuals who meet the functional eligibility criteria to enroll in an IHA immediately. Immediate enrollment prevents individuals from entering higher-cost placements that Medicaid will then have to fund.

16 -- WHCA Board Packet -- March 2016

12

Aging and Disability Resource Centers (ADRCs) Aging and Disability Resource Centers (ADRCs) will continue to have an integral role in the long-term care system. ADRCs serve as a single point of entry into long-term care services and programs. ADRCs help people obtain information, evaluate their options, and make informed decisions about the programs, services, and supports that can best meet their needs. ADRCs help people plan for their future, maximize their personal resources, prevent the need for expensive care, and help to prevent or delay the need to access services through publicly funded programs. All of this helps to ensure a sustainable long-term care system. ADRCs will continue to have a prominent role in Family Care/IRIS 2.0. ADRCs will: Perform the initial functional eligibility screen. Provide unbiased enrollment counseling. Inform people of their appeal rights. Assist individuals in choosing an IHA or MCO. Assist individuals in determining if they want to self-direct long-term care services. Assist with processing enrollment. Serve as a resource for members even after they have enrolled in a program.

Payments to IHAs DHS proposes a prospective risk-based capitation strategy for IHAs that will enable members to receive the benefits that they need and encourage quality outcomes. A prospective risk-based capitation is similar to how DHS operates other Medicaid managed care programs such as BadgerCare Plus.

DHS will utilize its contracted actuary to analyze program costs for prior years. Capitation rates will be set annually based on past program costs.

Capitation rates for members self-directing services will be developed to preserve budget authority for members and to guarantee both full and partial self-direction of long-term care services.

This rate setting method will incentivize IHAs to provide high-quality cost-effective care. The capitation payments will meet all federal requirements relative to actuarial soundness. IHAs will be held accountable for ensuring high-quality care through pay-for-performance

requirements, which align reimbursement with member-care outcomes. IHAs will be required to report detailed encounter data to DHS. Using this data will allow DHS to

audit both IHAs and providers to address utilization, quality, and cost.

This payment model encourages IHAs to invest in home and community-based long-term care services for members to prevent or avoid use of more costly services.

17 -- WHCA Board Packet -- March 2016

13

Quality Measures DHS will implement a multi-faceted approach to ensure quality within Family Care/IRIS 2.0. DHS will use outcome measures that allow comparison not only among IHAs in Wisconsin, but also allow comparison across other states. Elements of the quality plan will include:

Consumer Outcomes o Required reporting on a variety of health care performance measures including prevention and

treatment using Healthcare Effectiveness Data and Information Set (HEDIS®). o Required reporting using National Core Indicators™(NCI) to assess outcomes of services

provided to individuals addressing key areas of concern including employment, rights, service planning, community inclusion, choice, and health and safety.

o Required reporting of institutional admissions and relocations o Required reporting of potentially preventable medical services resulting from the quality of

long-term care services.

Consumer Satisfaction. o Independent evaluations to assess consumer feedback. o Mechanisms for members to file appeals and grievances and DHS monitoring of appeals and

grievances. o IHA and MCO scorecards that will be made available to the public. o Access to ombudsman services for all members.

Contract Compliance

o DHS oversight of IHAs, including the quality of care management practice, access to quality providers, and mechanisms to ensure that members receive services that are timely and high-quality.

o Annual Quality Reviews and Care Management Reviews conducted by a contracted External Quality Review Organization.

o Statutory requirements for licensed insurers regulated and monitored by OCI. o Required reporting to DHS and DHS monitoring of serious incidents, members changing

programs, or members changing IHAs. o DHS-conducted audits of direct service providers. o Ongoing fiscal oversight o An accreditation incentive program that may include substitution of accreditation for certain

contract requirements, financial incentives, or consideration during the procurement process.

18 -- WHCA Board Packet -- March 2016

14

Contracting With Any Willing and Qualified Provider DHS will require IHAs to adhere to Act 55 requirements to contract with any willing and qualified provider of long-term care services. As required by Act 55, this provision will be in place for a minimum of three years.

The IHA must allow any provider of long-term care services to serve as a contracted provider if: o The provider agrees to be reimbursed at the IHA’s contract rate negotiated with similar

providers for the same care, services, and supplies; and o The facility or organization meets all guidelines established by the IHA related to quality of care,

utilization, and other criteria applicable to facilities or organizations under contract for the same care, services, and supplies.

If the IHA declines to include an individual or group of providers in its network, it must give the affected providers written notice of the reason for its decision.

In establishing provider and management subcontracts, the IHA shall seek to maximize the use of available resources and to control costs.

Considerations for Tribes and Tribal Members DHS is committed to implementing Family Care/IRIS 2.0 in a manner that acknowledges and respects the culture and sovereignty of Wisconsin tribes. Under Family Care/IRIS 2.0, tribes can continue to be service providers under contract with IHAs. IHAs will be motivated to contract with tribal service providers as one way to achieve tribal cultural sensitivity.

While Family Care/IRIS 2.0 will be phased in statewide, DHS remains committed to having a tribally operated waiver. DHS continues to work with Tribal Nations and CMS to realize this goal.

Next Steps A final implementation timeline for Family Care/IRIS 2.0 is dependent upon approval of the Concept Paper by the Joint Committee on Finance and upon federal approval. The next steps in the implementation process are shown below.

Approval of the Concept Paper by the Joint Committee on Finance Development of formal waiver and/or state plan authority documents to submit to CMS Required public notice and comment period prior to submission Submission to and approval from CMS Release of RFP to select IHAs IHA selection and DHS readiness review Implementation and transition

19 -- WHCA Board Packet -- March 2016

15

Addendum 1 – Family Care/IRIS 2.0 Benefit Chart

Benefits Can be Self-Directed Long-term Care Benefits

Adaptive Aids Adult Day Care Adult Family Home 1-2 bed Adult Family Home 3-4 bed Assistive Technology/Communication Aids Care Management Services ICA – IRIS Specialist Community Based Residential Facility (CBRF) Consultative Clinical and Therapeutic Services Consumer Education and Training Services Counseling and Therapeutic Services (includes Customized Goods and Services)

Daily Living Skills Training Day Habilitation Services Durable Medical Equipment Medical Supplies Environmental Accessibility Adaptations Financial Management Services Fiscal Employment Agent Home Health Housing Counseling Meals: Home Delivered Nursing (includes Respiratory Care, Intermittent, Community and Private Duty)

Nursing Home (incl. ICF-IID) Personal Care Personal Emergency Response System (PERS) Prevocational Services Relocation Services Residential Care Apartment Complexes (RCAC) Respite Care Self-directed Personal Care Services Specialized Equipment and Supplies Support Broker Supported Employment (Ind. and Small Group) Supportive Home Care (includes Live in caregiver) Training Services for Unpaid Caregivers Transportation Non-emergency Medical Transportation Specialized – Community Vocational Futures Planning and Support (VFPS)

20 -- WHCA Board Packet -- March 2016

16

Benefits Can be Self-Directed Acute and Primary Benefits

Ambulance

Ambulatory Prenatal

Ambulatory Surgical Center

Anesthesiology

Audiology

Blood

Chiropractic

Dental

Diagnostic Testing

Dialysis Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

Family Planning

Hospice

Hospital

Independent Nurse Practitioner

Laboratory and X-ray

Nurse Midwife

Occupational Therapy

Physical Therapy

Physician

Podiatry

Prenatal Care Coordination

Respiratory Care for Ventilator-assisted Recipients

Rural Health Clinic

School-based

Speech/Language Pathology

Vision

Drugs Fee-for-service Behavioral Health Services

Behavioral Health Inpatient Behavioral Health Outpatient Behavioral Health Day Treatment Community Support Program (CSP) Comprehensive Community Services (CCS) Community Recovery Services (CRS) Crisis Intervention To be determined

21 -- WHCA Board Packet -- March 2016

3/18/2016 DHS Holds Hearings on Family Care 2.0 Concept Paper  WiHCA/WiCAL

http://www.whcawical.org/publications/careconnection/march112016/dhsholdshearingsfamilycare20conceptpaper/ 1/3

DHS Holds Hearings on Family Care 2.0

Concept Paper

The Wisconsin Department of Health Servicesheld public hearings on its draft FamilyCare/IRIS 2.0 Concept Paper in Eau Claire andMadison on Monday this week. WHCAExecutive Director John Vander Meer testifiedon behalf of the Association during theMadison meeting.

Click HERE to view recorded versions of thehearings.

DHS panelists present at the hearingsincluded:

Bill Hanna, Assistant Deputy Secretary atWisconsin Department of Health Services

Anne Olson, DHS-DLTC-Bureau of Agingand Disability Resources

Melody Yeager, Human Service Area Coordinator, DHS-Northern Region

Margaret Kristen, Director, DHS-DLTC-Bureau of Managed Care

Dave Varana, Director, DHS-DLTC-Bureau of Long Term Care Financing

As has been reported in CareConnection in recent weeks, the Concept Paper outlines a planthat divides the state into three managed care regions, with at least three integrated health

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DHS Holds Hearings on FamilyCare 2.0 Concept Paper

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Screenshot of the webcast of WHCAExecutive Director John Vander Meertestifing in the Family Care/IRIS 2.0

Concept Paper public hearing in Madisonon Monday, March 7, 2016. During his

testimony, Vander Meer pointed out theConcept Paper is silent on the issue of

Wisconsin's workforce crisis in long-termcare.

22 -- WHCA Board Packet -- March 2016

3/18/2016 DHS Holds Hearings on Family Care 2.0 Concept Paper  WiHCA/WiCAL

http://www.whcawical.org/publications/careconnection/march112016/dhsholdshearingsfamilycare20conceptpaper/ 2/3

agencies placed as a result of an RFP process in each region. DHS released its draft of theconcept paper on the redesign of the state’s Family Care program that the Department isrequired to submit to the Legislature’s Joint Finance Committee by April 1, 2016.

While Vander Meer addressed several of the issues that the Concept Paper was silent on,given the time constraints, he emphasized the main central issue facing Wisconsin’s long-term care provider community, which was not even mentioned in the concept paper —Wisconsin’s Caregiver Crisis.

Compounding under-funding and workforce problems for provider, within the ConceptPaper, DHS proposal calls for a prospective risk-based capitation that will use an actuary toanalyze costs for previous years and use them to set capitation rates. The fact that thissystem will not offer and adjustment to an already under-funded system, this strategy willonly continue to perpetuate the under-funding of skilled nursing and assisted living facilityproviders.

“It is the nurses, CNAs, personal care workers and other caregivers, not case managers, whoprovide the ‘Care’ in Family Care,” Vander Meer said during his testimony. “When theredesign of Family Care was initially proposed, advocates for Family Care/IRIS 2.0 stated thatthe redesign could realize savings of $100 million annually. WHCA/WiCAL continues tostrongly encourage the Department to reinvest the savings resulting from Family Care/IRIS2.0 back into the hard-working caregivers who provide the critical care our most vulnerablecitizens deserve.”

According to a recent survey of nearly 700 providers conducted by WHCA/WiCAL and allother state skilled nursing and assisted living provider associations, 1 in 7 frontline caregiverpositions remain unfilled, which stretches the current workforce to assure there is effectivepersonnel to meet residents’ needs. Demand for long-term care will only continue to grow.

The following provisions WHCA/WiCAL has consistently advocated  for in the past thatwere not addressed in the DHS Family Care/IRIS 2.0 Redesign Concept Paper thatWHCA/WiCAL members ask that Department officials carefully consider:

Timeliness of payments: If a provision requiring IHAs to provide timely payments isn’tincluded in the redesign, many providers in the state may not be able to meet payroll,further exacerbating the workforce crisis. In some cases, facilities may even have toclose their doors, causing even greater access problems in rural areas.

Provider Appeals: Providers should have the right to contest the rate that they havebeen given based on the acuity of a resident they care for.

Rate Transparency: There is no language requiring IHAs to disclose their paymentmethodologies to providers, and no language requiring there to be any connectionbetween the actual costs for providers to provide the care.

Functional Screen: There is no language calling for any kind of update in the FunctionalScreen, which is an inadequate measure for determining the cost of care to facilities.

Behavioral Health: There is no information of how mental health and behavioral serviceswill be covered in the new system.

Standardized Provider Contract: There is no mention of a standardized providercontract in the concept paper. Differing contracts between MCOs are a constant problemfor providers that can and should be addressed in the redesign.

Scope of Services: The scope of services providers are expected to provide; and how,and under what circumstances, the individual and collective cost of those services willbe projected and rolled into the capitation rates paid to the IHAs.

Shared Savings: In the event that facilities are able to realize savings for the programthose facilities should have the opportunity to share in that savings.

“WHCA/WiCAL looks forward to working with Secretary Kitty Rhoades and other DHS officialsto address these issues and the crisis in Wisconsin’s long-term care workforce,” Vander Meersaid.

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23 -- WHCA Board Packet -- March 2016

3/18/2016 DHS Holds Hearings on Family Care 2.0 Concept Paper  WiHCA/WiCAL

http://www.whcawical.org/publications/careconnection/march112016/dhsholdshearingsfamilycare20conceptpaper/ 3/3

Next Article »

If the Concept Paper receives approval, DHS will develop a formal waiver, allow publiccomment on the proposal, and then submit it to CMS. After receiving federal approval, DHSwill issue request for proposals from prospective IHAs, select and review the agencies andimplement the program.

Please stay tuned to CareConnection and WHCA/WiCAL Member Alerts for more informationon the Family Care/IRIS 2.0 Redesign and details on the advocacy campaign the Associationwill be asking members to assisted with.

FURTHER READING

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24 -- WHCA Board Packet -- March 2016

2015‐2016 Wisconsin Legislature

An Act to renumber and amend 46.2895 (2); to amend 46.2895 (3) (b) 5. and 46.2895 (13); and to create 46.284 (2)

(br), 46.284 (4m), 46.2895 (2) (b), 46.2895 (2) (c), 46.2895 (3) (e), 46.2895 (4) (o), 46.2895 (4) (p), 46.2895 (4) (q),

46.2895 (4) (r), 46.2895 (4r) and 46.2895 (6) (cm) of the statutes; Rela ng to: long‐term care districts and care

management organiza ons. (FE)

Status: Enacted into law

History

Date / House Ac on Journal

2/1/2016 Sen. Introduced by Senators Marklein, Cowles, Lasee, Lassa, Petrowski, Roth,

Vukmir and Olsen;

cosponsored by Representa ves Krug, Novak, Bernier, Edming, Knodl,

Mursau, A. O , Petryk, Quinn, Rohrkaste, Tauchen, Ti l, Tranel,

VanderMeer and Knudson

2/1/2016 Sen. Read first  me and referred to Commi ee on Health and Human Services

2/3/2016 Sen. Withdrawn from commi ee on Health and Human Services and

rereferred to joint commi ee on Finance pursuant to Senate Rule 46(2)(c)

2/9/2016 Sen. Senate Amendment 1 offered by Senator Marklein

2/10/2016 Sen. Public hearing held

2/10/2016 Sen. Fiscal es mate received

2/10/2016 Sen. Fiscal es mate received

2/10/2016 Sen. Execu ve ac on taken

2/11/2016 Sen. Report introduc on of Senate Amendment 2 by Joint Commi ee on

Finance, Ayes 16, Noes 0

2/11/2016 Sen. Report adop on of Senate Amendment 1 recommended by Joint

Commi ee on Finance, Ayes 16, Noes 0

2/11/2016 Sen. Report passage as amended recommended by Joint Commi ee on

Finance, Ayes 16, Noes 0

2/11/2016 Sen. Available for scheduling

2/15/2016 Sen. Placed on calendar 2‐16‐2016 pursuant to Senate Rule 18(1)

2/16/2016 Sen. Senate Amendment 3 offered by Senators Bewley, Ringhand, L. Taylor,

Carpenter, Hansen, Shilling, Erpenbach, Miller and Vinehout

2/16/2016 Sen. Read a second  me

2/16/2016 Sen. Senate Amendment 1 adopted

2/16/2016 Sen. Senate Amendment 3 laid on table, Ayes 19, Noes 13

2/16/2016 Sen. Ordered to a third reading

2/16/2016 Sen. Rules suspended

2/16/2016 Sen. Read a third  me and passed, Ayes 32, Noes 0

2/16/2016 Sen. Ordered immediately messaged

2/16/2016 Asm. Received from Senate

2/16/2016 Asm. Read first  me and referred to commi ee on Rules

2/16/2016 Asm. Made a special order of business at 2:46 PM on 2‐18‐2016 pursuant to

Assembly Resolu on 29

2/18/2016 Asm. Read a second  me

2/18/2016 Asm. Assembly Amendment 1 offered by Representa ve Meyers

2015 Senate Bill 687 http://docs.legis.wisconsin.gov/2015/proposals/sb687

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25 -- WHCA Board Packet -- March 2016

Date / House Ac on Journal

2/18/2016 Asm. Assembly Amendment 1 laid on table, Ayes 61, Noes 34

2/18/2016 Asm. Ordered to a third reading

2/18/2016 Asm. Rules suspended

2/18/2016 Asm. Read a third  me and concurred in

2/18/2016 Asm. Ordered immediately messaged

2/19/2016 Sen. Received from Assembly concurred in

2/25/2016 Sen. Report correctly enrolled

2/25/2016 Sen. Presented to the Governor on 2‐25‐2016

3/2/2016 Sen. Report approved by the Governor on 3‐1‐2016. 2015 Wisconsin Act 215

3/2/2016 Sen. Published 3‐2‐2016

Content subject to change after proofing by Chief Clerk staff.

2015 Senate Bill 687 http://docs.legis.wisconsin.gov/2015/proposals/sb687

2 of 2 3/18/2016 1:41 PM

26 -- WHCA Board Packet -- March 2016

2015‐2016 Wisconsin Legislature

An Act to renumber and amend 46.2895 (2); to amend 46.2895 (3) (b) 5. and 46.2895 (13); and to create 46.284 (2)

(br), 46.284 (4m), 46.2895 (2) (b), 46.2895 (2) (c), 46.2895 (3) (e), 46.2895 (4) (o), 46.2895 (4) (p), 46.2895 (4) (q),

46.2895 (4) (r), 46.2895 (4r) and 46.2895 (6) (cm) of the statutes; Rela ng to: long‐term care districts and care

management organiza ons. (FE)

Status: Tabled

History

Date / House Ac on Journal

2/3/2016 Asm. Introduced by Representa ves Krug, Novak, Bernier, Edming, Knodl,

Mursau, A. O , Petryk, Quinn, Rohrkaste, Tauchen, Ti l, Tranel,

VanderMeer and Knudson;

cosponsored by Senators Marklein, Cowles, Lasee, Lassa, Petrowski, Roth,

Vukmir and Olsen

2/3/2016 Asm. Read first  me and referred to Joint Commi ee on Finance

2/9/2016 Asm. Assembly Amendment 1 offered by Representa ve Krug

2/10/2016 Asm. Public hearing held

2/10/2016 Asm. Execu ve ac on taken

2/10/2016 Asm. Assembly Amendment 2 offered by Joint Commi ee on Finance

2/11/2016 Asm. Report Assembly Amendment 1 adop on recommended by Joint

Commi ee on Finance, Ayes 16, Noes 0

2/11/2016 Asm. Report passage as amended recommended by Joint Commi ee on

Finance, Ayes 16, Noes 0

2/11/2016 Asm. Referred to commi ee on Rules

2/15/2016 Asm. Fiscal es mate received

2/15/2016 Asm. Fiscal es mate received

2/16/2016 Asm. Made a special order of business at 2:06 PM on 2‐18‐2016 pursuant to

Assembly Resolu on 29

2/18/2016 Asm. Laid on the table

Content subject to change after proofing by Chief Clerk staff.

2015 Assembly Bill 856 http://docs.legis.wisconsin.gov/2015/proposals/ab856

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                 February  4,  2016      To:   Members,  Wisconsin  State  Assembly    From:   John  Sauer  and  Tom  Ramsey,  LeadingAge  Wisconsin     Brian  Purtell  and  Jim  McGinn,  Wisconsin  Health  Care  Association/WI  Center  for  Assisted  Living     Forbes  McIntosh,  Wisconsin  Assisted  Living  Association     Dan  Drury,  Residential  Services  Association  of  Wisconsin    Subject:    Opposition  to  2015  Assembly  Bill  791  as  Amended    The  associations  listed  above  represent  all  of  the  state’s  assisted  living  provider  associations.  We  wish  to  commend  Representative  Mike  Rohrkaste  and  the  members  of  the  Speaker’s  Task  Force  on  Alzheimer’s  and  Dementia  for  their  hard  work  and  willingness  to  address  this  dreaded  disease,  which  is  the  6th  leading  cause  of  death  in  America  and  the  only  one  in  the  top  ten  which  cannot  be  prevented,  treated  or  cured.    AB  791  is  one  of  the  ten  bills  forwarded  by  members  of  the  task  force  in  its  “Wisconsin  Cares”  legislative  package.  The  bill  would  require  a  community-‐based  residential  facility  (CBRF)  to  obtain  a  signed  acknowledgement  form  from  a  CBRF  resident  with  a  degenerative  brain  disorder,  or  that  resident’s  legal  representative,  prior  to  administering  a  psychotropic  medication  with  a  black  box  warning  to  that  resident.    NOTE:  A  black  box  warning,  or  “boxed  warning”  on  a  medication,  means  an  adverse  reaction  to  the  drug  may  lead  to  death  or  serious  injury;  it  is  the  strictest  warning  put  in  the  labeling  of  prescription  drugs  by  the  federal  Food  and  Drug  Administration  (FDA).  A  “legal  representative”  as  defined  under  DHS  83.02  (28),  the  CBRF  code,  means  a  person  who  either  is  the  health  care  agent  under  an  activated  power  of  attorney  for  health  care  (POAHC),  a  guardian  appointed  by  the  court,  or  a  person  appointed  as  a  durable  power  of  attorney.    The  acknowledgement  form  required  under  AB  791  would  be  created  and  made  available  by  the  Department  of  Health  Services  (DHS)  and  would  acknowledge  the  receipt  of  the  following  information  by  the  resident  or  legal  representative:  1)  An  informational  form  indicating  the  resident  has  been  prescribed  a  medication  with  a  black  box  warning;  2)  A  FDA  information  sheet  on  the  psychotropic  medication  with  a  boxed  warning  that  has  been  prescribed;  and  3)  Contact  information  for  the  individual  who  prescribed  the  medication  if  the  resident  or  legal  representative  have  questions  or  seek  additional  information.    The  members  of  our  four  associations  oppose  AB  791  as  amended  for  the  following  reasons:    

1) AB  791  was  the  only  bill  in  the  “Wisconsin  Cares”  package  not  adopted  by  a  unanimous  vote  of  the  Assembly  Committee  on  Mental  Health  Reform,  which  recommended  for  passage  AB  791  as  amended    on  a  6-‐4  vote  that  included  both  bipartisan  support  and  opposition.  Assembly  Amendment  1  improves  the  bill  but  not  to  the  extent  that  it  overcomes  our  opposition.    

2) AB  791  is  patterned  on  the  informed  consent  for  psychotropic  medications  requirements  for  nursing  homes  found  under  s.  50.08,  Wis.  Stats.  But  CBRFs  are  not  nursing  homes.  

3) Unlike  nursing  homes,  CBRFs  are  not  required  to  have  a  medical  director,  mandated  physician-‐resident  visits,  or  professional  nursing  staff  on  site  at  all  times.  Care  in  CBRFs  generally  is  provided  by  non-‐certified  resident  care  staff  or  

28 -- WHCA Board Packet -- March 2016

certified  nurse  aides.  The  level  of  medical  and  nursing  expertise  in  a  CBRF  is  significantly  less  than  that  found  in  a  nursing  home.  

4) In  practical  terms,  a  CBRF  under  AB  791  will  provide  the  resident  or  legal  representative  with  an  acknowledgement  form,  acknowledging  they  received  one  piece  of  paper  saying  they’ve  been  prescribed  a  psychotropic  medication  with  a  black  box  warning  and  another  piece  of  paper  with  a  FDA  information  sheet  on  that  medication.  What  they  won’t  be  able  to  provide  to  the  resident  or  his/her  family  members  is  an  answer  to  what  all  that  information  means.  That’s  why  the  acknowledgement  form  under  AB  791  also  contains  the  prescriber’s  contact  information,  basically  acknowledging  that  CBRFs  in  general  don’t  have  staff  with  the  qualifications  or  expertise  to  answer  the  question  “what  does  all  this  mean?”  Such  a  non-‐response  would  seem  to  add  to  the  resident  or  legal  representative’s  frustration  and  uncertainty,  not  diffuse  it,  especially  at  a  time  when  a  loved  one  is  in  crisis.  

5) Informed  consent  when  psychotropics  are  in  use  is  vital  regardless  of  the  setting  but  AB  791  is  not  an  informed  consent  bill.  The  bill  merely  requires  acknowledgement  that  specified  information  about  certain  medications  has  been  received,  not  consent  to  administer  those  medications.      

6) If  the  goal  of  the  bill  is  to  decrease  the  use  of  dangerous  drugs  by  CBRF  residents  with  Alzheimer’s  disease,  AB  791  misses  the  mark  because  it  doesn’t  require  the  prescriber  to  be  part  of  the  conversation.  In  the  end,  CBRFs  don’t  prescribe  medications.  

7) Some  of  the  state’s  larger,  more  sophisticated  CBRFs,  located  primarily  in  urban  settings,  utilize  the  nursing  home  informed  consent  process  as  a  best  practice.  However,  that  practice  is  non-‐legally  binding;  AB  791  would  force  needless  duplication  by  requiring  those  facilities  to  obtain  the  acknowledgement  form  despite  already  having  on  file  a  signed  informed  consent  form  for  the  same  medication.  

8) Section  1  of  AB  791  as  amended  requires  a  physician  and  other  medication  prescribers  who  prescribe  a  psychotropic  medication  to  a  CBRF  resident  with  a  degenerative  brain  disorder  to  notify  the  CBRF  if  the  prescribed  medication  has  a  black  box  warning.  Wouldn’t  the  goal  of  AB  791  be  achieved  by  simply  amending  this  section  of  the  bill  to  extend  this  notification  requirement  to  include  the  resident  and  their  legal  representative,  as  well  as  the  CBRF?  

9) The  added  language  on  Line  17,  Page  6  of  the  bill,  and  Section  17  should  be  deleted.  Under  s.  50.08  (3m),  nursing  homes  are  not  required  to  obtain  written  informed  consent  when  a  resident  is  prescribed  a  psychotropic  medications  off  premises;  CBRFs  should  not  be  held  to  a  higher  standard.  

10) Sections  18-‐22  of  the  bill  could  jeopardize  care  decisions  in  a  CBRF  by  postponing  the  administration  of  needed  medication  to  an  Alzheimer’s  resident  exhibiting  challenging  behaviors  until  the  CBRF  has  jumped  through  the  “hoops”  of  seeking  a  signed  acknowledgement  form  or  oral  consent.  A  prudent  CBRF  seeking  to  avoid  regulatory  sanctions  in  that  situation  may  simply  transfer  that  individual  to  a  hospital  emergency  room  rather  than  seeking  to  comply  with  AB  791,  an  outcome  we  assume  most  would  hope  to  avoid.  

11) Our  members  can  support  AB  791  only  if  the  bill  is  amended  to  require  the  prescriber  of  the  psychotropic  medication  with  a  black  box  warning,  not  the  CBRF,  to  obtain  the  signed  acknowledgement  form  from  the  CBRF  resident  with  a  degenerative  brain  disorder  prior  to  the  administration  of  that  medication.  

 In  addition:    

• Please  clarify  whether  the  bill  applies  to  a  medication  with  a  boxed  warning  or  a  psychotropic  medication  with  a  boxed  warning.    Boxed  warnings  apply  to  medications  beyond  the  scope  of  this  bill;  we  submit  the  bill  should  be  amended  to  clarify  AB  791  applies  to  the  use  of  psychotropic  medications  with  boxed  warnings  by  individuals  with  Alzheimer’s  disease  or  a  related  dementia.  

• Under  Section  4  of  the  bill,  identify  or  provide  a  link  to  what  FDA  information  is  required.  Our  attempt  to  find  the  required  information  on  the  drug  Risperdal  resulted  in  a  58-‐page  “information”  sheet.  

• Under  Section  20  of  the  bill:  Must  the  physician  be  physically  present  in  the  CBRF  to  determine  that  an  emergency  situation  exists  or  can  that  determination  be  made  over  the  phone  after  the  CBRF  presents  the  fact  situation?  How  does  the  CBRF  show  “good  faith  effort”  under  Section  22  of  the  bill?  

• Some  CBRFs  provide  hospice  care;  others  allow  hospice  care  providers  to  serve  their  residents.  The  use  of  psychotropic  medications  might  be  more  appropriate  in  hospice  care.  A  hospice  care  exemption  under  AB  791  should  be  considered.    

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LRBs0389/1

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2015 − 2016 LEGISLATURE

ASSEMBLY SUBSTITUTE AMENDMENT 1,

TO ASSEMBLY BILL 791

February 18, 2016 − Offered by Representative ROHRKASTE.

AN ACT to renumber 50.08 (3) (h); to amend 50.08 (2) and 50.08 (3) (a); and to

create 50.08 (3) (bg), 50.08 (3) (bh), 50.08 (3) (fr) and 50.08 (3) (h) 2. of the

statutes; relating to: informed consent for psychotropic medications in

community−based residential facilities.

Analysis by the Legislative Reference Bureau

This substitute amendment requires a community−based residential facility toprovide to a resident or e−mail or mail to a person acting on behalf of a resident aninformational form for administration of psychotropic medications to the sameindividuals and under similar circumstances as a nursing home is required to obtaininformed consent for administration of psychotropic medications under current law.Current law requires that a nursing home obtain written informed consent beforeadministering a psychotropic medication that contains a boxed warning to anyresident who has degenerative brain disorder with exceptions for emergencysituations. A psychotropic medication is an antipsychotic, an antidepressant,lithium carbonate, or a tranquilizer. A boxed warning is a warning, described infederal regulations, the text of which is contained in a black outlined box on thedrug’s label and in the full prescribing information.

Instead of written informed consent, the substitute amendment requires thatwhen first administering a psychotropic medication that has a boxed warning to a

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resident who has a degenerative brain disorder, a community−based residentialfacility shall provide to a resident or, if the resident is incapacitated, e−mail or mailto a person acting on behalf of the resident an informational form. Acommunity−based residential facility may administer the psychotropic medicationbefore the resident or person acting on behalf of the resident has the informationalform, but the community−based residential facility must provide the form to theresident or e−mail or mail the form to the person acting on behalf of the residentwithin 72 hours of first administering the psychotropic medication. The substituteamendment requires that the informational form contains a notification that theresident has been prescribed a medication that has a boxed warning and informationfrom the federal Food and Drug Administration for the specific psychotropicmedication the resident has been prescribed. The informational form also notifiesthe resident, or person acting on behalf of the resident, that if he or she seeks moreinformation that he or she should contact the prescriber of the medication. Thecommunity−based residential facility is required to include contact information forthe prescriber on the informational form.

The people of the state of Wisconsin, represented in senate and assembly, doenact as follows:

SECTION 1. 50.08 (2) of the statutes is amended to read:

50.08 (2) A physician, an advanced practice nurse prescriber certified under

s. 441.16 (2), or a physician assistant licensed under ch. 448, who prescribes a

psychotropic medication to a nursing home or community−based residential facility

resident who has degenerative brain disorder shall notify the nursing home or

community−based residential facility if the prescribed medication has a boxed

warning under 21 CFR 201.57.

SECTION 2. 50.08 (3) (a) of the statutes is amended to read:

50.08 (3) (a) Except as provided in sub. (3m) or (4), before administering a

psychotropic medication that has a boxed warning under 21 CFR 201.57 to a resident

of a nursing home who has degenerative brain disorder, a nursing home shall obtain

written informed consent from the resident or, if the resident is incapacitated, a

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SECTION 2

person acting on behalf of the resident, on a form provided by the department under

par. (b) or on a form that contains the same information as the form under par. (b).

SECTION 3. 50.08 (3) (bg) of the statutes is created to read:

50.08 (3) (bg) When first administering a psychotropic medication that has a

boxed warning under 21 CFR 201.57 to a resident of a community−based residential

facility who has a degenerative brain disorder, a community−based residential

facility shall provide to a resident or, if the resident is incapacitated, send by

electronic mail to a person acting on behalf of the resident an informational form

described under par. (bh). If the community−based residential facility does not have

the electronic mail address of the person acting on behalf of the resident, the

community−based residential facility shall send by mail a copy of the informational

form to the person acting on behalf of the resident. A community−based residential

facility may administer the psychotropic medication before the resident or person

acting on behalf of the resident has the informational form, but the

community−based residential facility shall provide the informational form to the

resident or send by electronic mail or mail the informational form to the person

acting on behalf of the resident within 72 hours of first administering the

psychotropic medication.

SECTION 4. 50.08 (3) (bh) of the statutes is created to read:

50.08 (3) (bh) 1. The department shall make available on its Internet site or,

upon request, by mail informational forms for obtaining a signature acknowledging

receipt of all of the following:

a. A notification, created by the department, indicating that the resident has

been prescribed a medication that has a boxed warning under 21 CFR 201.57.

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TJD&SWB:kjf/amn/wljSECTION 4

b. Information created by the federal food and drug administration for the

specific psychotropic medication the resident has been prescribed. The

community−based residential facility shall obtain the information sheet from the

federal food and drug administration or obtain information from the federal food and

drug administration’s Internet site.

2. The informational form under this paragraph shall contain a notification

that if the resident, or person acting on behalf of the resident, if applicable, seeks

more information the resident or person acting on behalf of the resident should

contact the individual who prescribed the medication. The community−based

residential facility shall indicate on the informational form contact information for

the prescriber of the medication.

SECTION 5. 50.08 (3) (fr) of the statutes is created to read:

50.08 (3) (fr) The community−based residential facility shall maintain a record

or maintain proof of providing or sending by electronic mail or mail an informational

form under par. (bg) for 15 months from the date the informational form is provided,

sent by electronic mail, or mailed.

SECTION 6. 50.08 (3) (h) of the statutes is renumbered 50.08 (3) (h) 1.

SECTION 7. 50.08 (3) (h) 2. of the statutes is created to read:

50.08 (3) (h) 2. The community−based residential facility shall use the most

current information available from the federal food and drug administration under

par. (bh) 1. b.

(END)

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

33 -- WHCA Board Packet -- March 2016

Sponsored by LeadingAge Wisconsin, WHCA/WiCAL, WALA, RSA of Wisconsin

Workforce Vacancy Survey

Recruitment and retention of direct care workers is a top concern for LTC providers. Consistent reporting of staffvacancy rates may be used to strengthen efforts to bring the growing workforce crisis to the attention of policymakers, bolster support for improved reimbursement to increase wages and benefits, and advance funding fortraining and scholarship options for persons interested in care-giving careers.

LeadingAge Wisconsin, WHCA/WiCAL, WALA, and RSA of Wisconsin ("associations") have joined together to gatherdata on direct care staffing vacancies. Provider members of the associations are being asked to complete thefollowing survey to determine vacancy rates and other workforce information for registered nurses (RNs), licensedpractical nurses (LPNs), certified nursing assistants (CNAs), and Direct Care Workers (non-CNA care staff such asresident assistants, CBRF certificate staff, or on-the-job trained workers). It is anticipated this survey will beconducted semi-annually.

Please complete one survey for each SNF, CBRF, RCAC, or AFH operated by your organization.

While participation in this survey is voluntary and confidential, the associations hope LTC providersunderstand the importance of gathering data to focus attention on the workforce crisis facing long-term andresidential care providers.

Survey Instructions:

Complete one survey for every SNF, CBRF, RCAC, or AFH operated by your organization

Include data from the two-week pay period closest to the date of this survey

1. Type of facility

SNF

CBRF

RCAC

AFH

2. Bed/unit/apartment capacity

3. County where the facility is located

1

34 -- WHCA Board Packet -- March 2016

4. Member of association

LeadingAge Wisconsin

WHCA/WiCAL

WALA

RSA of Wisconsin

DIRECT CARE WORKERS include non-CNA care staff such as resident assistants, CBRF certificate staff, or on-the-job trained staff.

RN

LPN

CNA

Direct Care Workers

5. How many individuals (not FTEs) does your facility employ in the following positions?

FOR QUESTION 6, to calculate full-time equivalents (FTEs), divide the total number of scheduled hours in the most recent two-weekpay period by 80.

RN

LPN

CNA

Direct Care Workers

6. How many FTEs did your facility employ in the following positions in the most recent two-week payperiod?

RN

LPN

CNA

Direct Care Workers

7. If qualified applicants were readily available, how many additional individuals (not FTEs) would yourfacility hire to fill vacancies in the following positions?

FOR QUESTION 8, to calculate full-time equivalents (FTEs), divide the total number of scheduled hours in the most recent two-weekpay period by 80.

2

35 -- WHCA Board Packet -- March 2016

RN

LPN

CNA

Direct Care Workers

8. How many FTEs do the vacancies listed in question 6 represent for the following positions? (Total hoursof the vacant positions for the most recent two-week pay period, divided by 80.)

9. What are the reasons you have vacant (open) positions? (check all that apply)

No applicants

Insufficient number of qualified applicants

Inability to compete with other employers

Facility doesn't have vacant positions

Other (maximum of 100 characters)

10. What strategies, besides hiring, have you used or are you using to keep your facility properly staffed?(check all that apply)

Ask existing staff to pick up additional hours

Double shifts/overtime

Financial incentives (bonuses, special shift differentials, etc.)

Outside temp agency/pool staff

Created/used internal pool

Utilized immigration options/foreign recruiting

Other (maximum of 100 characters)

11. In the past 12 months has your facility tried to use an external temporary staffing agency/pool to fill inthe care giving schedule?

Yes

No

Workforce Vacancy Survey

3

36 -- WHCA Board Packet -- March 2016

12. Was the temp agency/pool able to provide staff?

Yes

No

13. Did the temp agency/pool limit the number of staff they were able to provide?

Yes

No

14. Over the past 12 months, has your facility had to limit admissions due to lack of staff?

Yes

No

15. If yes, approximately how many admissions have you turned down because of staffing?

16. In the past 12 months, have CNAs or Direct Care Workers left your facility for a job outside of healthcare?

Yes

No

Don't know

17. Approximately how many CNAs or Direct Care Workers have left your facility for a job outside of healthcare?

18. What are the reasons CNAs or Direct Care Workers have taken a job outside of health care? (Check allthat apply)

Better pay

Better benefits

Better hours

Other (maximum of 100 characters)

4

37 -- WHCA Board Packet -- March 2016

19. Not including other healthcare providers, what local employers are the primary competition for yourCNAs or Direct Care Workers (i.e. WalMart, Kwik Trip, fast food, Starbucks, manufacturing, etc.)? Name asmany as applicable (maximum of 100 characters).

20. What is the starting hourly wage for your major, local, non-health care related competitor(s)?

Staff RN

LPN

CNA

Direct Care Workers

21. What is your facility's starting hourly wage for the following positions?

Staff RN

LPN

CNA

Direct Care Workers

22. What is your facility's average hourly wage for the following positions?

23. Does your facility offer health insurance to your full-time employees?

Yes

No

24. Does your facility offer health insurance to your part-time employees?

Yes

No

25. Estimate how many of your current employees receive their health insurance through BadgerCare

5

38 -- WHCA Board Packet -- March 2016

26. CNA training sites in my county are:

Very accessible (less than 15 minutes by car or public transportation)

Somewhat accessible (more than 15 but less than 30 minutes by car or public transportation)

Not very accessible (more than 30 but less than 60 minutes by car or public transportation)

Not accessible (more than 60 minutes)

No response

27. CNA testing sites in my county are:

Very accessible (less than 15 minutes by car or public transportation)

Somewhat accessible (more than 15 but less than 30 minutes by car or public transportation)

Not very accessible (more than 30 but less than 60 minutes by car or public transportation)

Not accessible (more than 60 minutes)

No response

28. CBRF training programs in my county are:

Very accessible (less than 15 minutes by car or public transportation)

Somewhat accessible (more than 15 but less than 30 minutes by car or public transportation)

Not very accessible (more than 30 but less than 60 minutes by car or public transportation)

Not accessible (more than 60 minutes)

No response

29. CBRF testing sites in my county are:

Very accessible (less than 15 minutes by car or public transportation)

Somewhat accessible (more than 15 but less than 30 minutes by car or public transportation)

Not very accessible (more than 30 but less than 60 minutes by car or public transportation)

Not accessible (more than 60 minutes)

No response

Thank you for completing the survey.

If you have other facilities, please press the DONE button below, return to the email and follow the Survey Monkey link to start anothersurvey.

6

39 -- WHCA Board Packet -- March 2016

3/18/2016 Pneumococcal Immunization: Expectations and Enforcement  WiHCA/WiCAL

http://www.whcawical.org/publications/careconnection/march42016/81042/ 1/3

Pneumococcal Immunization: Expectations

and Enforcement

WHCA/WiCAL wants to ensure that all nursinghome members are aware of and appreciate thesignificance of the Friday, February 12, 2016 Alertissued from the Division of Quality Assurance(“DQA”) entitled Prevnar 13 (PCV-13)Immunization for Preventing PneumococcalInfections as Part of the Standard of Practice forImmunizing Adults in Nursing Homes. This alertwas issued upon DQA surveyors identifyingseveral nursing facilities in the state that hadcompliance issues related to their pneumonia vaccination programs.

Specifically, the alert reminds facilities that the CDC Advisory Committee on ImmunizationPractices (“ACIP”) issued new recommendations in September 2014 with updatedrecommendations related to intervals in September 2015.

Specifically, the ACIP now recommends that adults age 65 years and older receive thepneumococcal conjugate vaccine (PVC-13, Prevnar-13) followed by the pneumococcalpolysaccharide vaccine (PPSV23, Pneumovax 23).

To clarify the issue, the CDC recommendation represents a significant shift in the thinkingwith regards to vaccination and intervals for individuals age 65 and older. There has been anunderstandable lag in the implementation of these recommendations for various reasons,including the fact that the F334 regulation is not reflective of these recommendations. Thatnotwithstanding, DQA has sought and received clarification from CMS and is enforcing therecommendation as a requirement for nursing facilities. Meaning, if your required policy

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March 4, 2016

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40 -- WHCA Board Packet -- March 2016

3/18/2016 Pneumococcal Immunization: Expectations and Enforcement  WiHCA/WiCAL

http://www.whcawical.org/publications/careconnection/march42016/81042/ 2/3

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related to influenza and pneumonia immunization is not reflective of the CDCrecommendations, you face citation for noncompliance.

Most significantly, no less than four nursing facilities have received or are facingImmediate Jeopardy Level Deficiencies for F334 and F501 (Medical Director) for non-compliance in their vaccinations programs.

We therefore recommend all facilities to review their immunization program, in particular thepneumonia vaccination policy, in concert with your Medical Director, to assure that it isreflective of the standard being enforced.

Facilities that have either received deficiencies or have had contact with the surveyors relatedto this issue are asked to contact Brian Purtell to discuss as we seek additional clarity withregard to this issue, in particular, resolution of the glaring conflict between the languageunderlying F334 and the expectations contained within the CDC recommendations.

Posted in Quality Assurance, Regulatory

Pneumococcal Immunization:Expectations and Enforcement

Spring Conference Brochure -Available NOW!

Elizabethkingia Outbreak: WhatYou Need to Know

WHCA/WiCAL Member Forum - ACommunity of Care

Brief: How States are Shifting toValue-Based Payments ThroughManaged Care

Payroll-Based Journal ResourcePage

Be Prepared: Payment ReformWorkshops in Eau Claire,Appleton, and Brookfield

Business Partners: ReviewExhibitor Prospectus and Registerfor Spring Conference ExpoToday!

Member Benefit: 10% Discount onOnline Dementia Care TrainingProgram

WHCA/WiCAL 2016 Media Guidesfor Continuum and MemberDirectory

National Nursing Home Week:May 8th - 14th

Exceptional Living CentersExpands Team to Support Growth

41 -- WHCA Board Packet -- March 2016

Tweet0 ShareShare 1LikeLike

The Final 60-Day Rule: the Good, the Bad, and the Ugly | Mintz Levin -... http://www.jdsupra.com/legalnews/the-final-60-day-rule-the-good-the-b...

1 of 6 3/18/2016 1:45 PM

42 -- WHCA Board Packet -- March 2016

The Final 60-Day Rule: the Good, the Bad, and the Ugly | Mintz Levin -... http://www.jdsupra.com/legalnews/the-final-60-day-rule-the-good-the-b...

2 of 6 3/18/2016 1:45 PM

43 -- WHCA Board Packet -- March 2016

The Final 60-Day Rule: the Good, the Bad, and the Ugly | Mintz Levin -... http://www.jdsupra.com/legalnews/the-final-60-day-rule-the-good-the-b...

3 of 6 3/18/2016 1:45 PM

44 -- WHCA Board Packet -- March 2016

The Final 60-Day Rule: the Good, the Bad, and the Ugly | Mintz Levin -... http://www.jdsupra.com/legalnews/the-final-60-day-rule-the-good-the-b...

4 of 6 3/18/2016 1:45 PM

45 -- WHCA Board Packet -- March 2016

The Final 60-Day Rule: the Good, the Bad, and the Ugly | Mintz Levin -... http://www.jdsupra.com/legalnews/the-final-60-day-rule-the-good-the-b...

5 of 6 3/18/2016 1:45 PM

46 -- WHCA Board Packet -- March 2016

The Final 60-Day Rule: the Good, the Bad, and the Ugly | Mintz Levin -... http://www.jdsupra.com/legalnews/the-final-60-day-rule-the-good-the-b...

6 of 6 3/18/2016 1:45 PM

47 -- WHCA Board Packet -- March 2016

3/18/2016 Payroll Based Journal  Member Resources  WiHCA/WiCAL

http://www.whcawical.org/2016/02/26/payrollbasedjournalresources/ 1/2

Payroll Based Journal – Member Resources

On October 1, 2015, CMS opened registration for thevoluntary period to participate in electronic submissionof payroll data, including staff start and end dates (forcalculating staff retention and turnover), and censusdata. The voluntary period from October 1, 2015 untilrequired submission of this data beginning on July 1, 2016 is the ONLY time that providerswill have the opportunity to “test” the process and determine how their payroll systeminterfaces with the Payroll-Based Journal (PBJ).

As a WHCA/WiCAL member, you have exclusive access to the recording of a recentwebinar on Payroll Based Journal Resources. 

Watch the recorded webinar here

Review the .PDF of the webinar presentation by Urvi Patel, MPH here 

Review the .PDF of the webinar presentation by WIPFLi, LLP here 

NEW: Time & Attendance Vendors with solutions 

According to CMS officials, it is unlikely to make any significant changes to the process orthe system and we strongly encourage members to consider registering for the voluntarysubmission period and submitting their data during the voluntary period.

AHCA PBJ Letter to Slavitt at CMS 

NEW: CMS response to letter of 1-13-2016 

PBJ One Pager Final Draft January 2016 

Supplemental Payment Principles 

Background

The Affordable Care Act requires CMS to collect electronic staffing data from nursingcenters. The Act requires this data to be auditable and verifiable. The information isintended to collect direct care staff (employed and contracted), employee turnover andtenure, and must include census data and case mix. Earlier this year, CMS announced they

Highlights

EDUCATION AND EVENTSREGISTER FOR SPRINGCONFERENCE -- APRIL 20,21, 22

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Register for the NursingHome Compliance WebinarSeries

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NEWSWHCA-WiCAL Announces NewCommunications Director 

WHCA/WiCAL Announces NewExecutive Director 

WHCA/WiCAL RecognizesShining Star Award Recipients 

Nursing Homes in WisconsinPrep for Massive, UnfundedMandates 

Partnership Will OfferCaregivers Cutting-EdgeOnline Care Dementia Trainingand Certification 

National Study ShowsWisconsin has the Second-Worst Medicaid FundingSystem 

Economic Impact ofWisconsin's SkilledNursing/Therapy Centers

RESOURCES

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48 -- WHCA Board Packet -- March 2016

3/18/2016 Payroll Based Journal  Member Resources  WiHCA/WiCAL

http://www.whcawical.org/2016/02/26/payrollbasedjournalresources/ 2/2

would require this information to be submitted by all nursing centers starting in July 2016.

When the required submission process begins, CMS will continue to require providers tosubmit Forms CMS 671 & CMS 672 at the time of survey. The data from these Forms will beused in calculating the Staffing Domain of the Five Star Rating System until late 2017 or early2018.

RESOURCESClinical Resource Center

CNA Training and RecruitmentResources

Spring Conference ExhibitorProspectus 

Spring Conference ExhibitorRegistration

Payroll Based JournalResources

Third-Party Liability Resources

Family Care Resources

Shining Star AwardsInformation

WHCA/WiCAL MembershipForum

GOLD Package MembershipApplication and Information

ORDER: Resident Rights orFuture Medical DecisionBooklets -- Packets of 50 areavailable for $58 plus S/H --click here to email in yourorder today

DHS-Division of QualityAssurance Memorandums

DHS-Division of QualityAssurance Regional Offices

PEAL Program Page

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© 2016 Wisconsin Health Care Association. All Rights Reserved131 West Wilson Street, Suite 1001 | Madison, WI 53703Phone: (608) 257-0125 Fax: (608) 257-0025 | Email Us WEBSITE DESIGN BY ILLUMINAGE

TEXT SIZE: S M L SHARE!

49 -- WHCA Board Packet -- March 2016

3/18/2016 Elizabethkingia Outbreak: What You Need to Know  WiHCA/WiCAL

http://www.whcawical.org/publications/careconnection/march42016/elizabethkingiaoutbreakwhatyouneedtoknow/ 1/3

Elizabethkingia Outbreak: What You Need

to Know

The Wisconsin Department of HealthServices – Division of Public Healthcontacted WHCA/WiCAL Wednesdayafternoon asking our association to helpnotify members of Wisconsin’s LTC providercommunity that the press release below wasgoing to be sent out. WHCA/WiCALmembers are advised that if they receiveany calls from members of the news mediaregarding this subject, they are encouragedto refer those calls directly to the DHS Press Office, which can be reached at (608) 266-1683.

The Wisconsin Department of Health Services (DHS), Division of Public Health (DPH) iscurrently investigating an outbreak of bloodstream infections caused by bacteriacalled Elizabethkingia. “The Elizabethkingia infection has been detected in 44 patients located in southeastern andsouthern Wisconsin. The majority of patients are over the age of 65 years, and all haveserious underlying health conditions,” said State Health Officer Karen McKeown. “As soon aswe were notified of the potential outbreak, Wisconsin’s disease detectives began workingimmediately to identify the source.”

Illness associated with Elizabethkingia typically affects people with compromised immunesystems or serious underlying health conditions, and can lead to death. While 18 patientswho tested positive for the Elizabethkingiainfection in this outbreak have died, it has not

Print | Archives | Article Library

FOR READY REFERENCE:Register for the DemystifyingPayment Reforms Workshops

Register for the Nursing HomeCompliance Webinar Series

Spring Conference Brochure 

Register for Spring Conference

Spring Conference ExhibitorProspectus 

Register for F-tag Webinars

Register for 2016 AHCA/NCALCongressional Briefing featuringChuck Todd

MembershipDirectory Advertising Prospectus 

Continuum AdvertisingProspectus 

March 4, 2016

DHS Releases Family Care 2.0Concept Paper

ADVOCACY. EDUCATION. EXCELLENCE.

LOG OUT

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50 -- WHCA Board Packet -- March 2016

3/18/2016 Elizabethkingia Outbreak: What You Need to Know  WiHCA/WiCAL

http://www.whcawical.org/publications/careconnection/march42016/elizabethkingiaoutbreakwhatyouneedtoknow/ 2/3

« Prev Article Next Article »

been determined if the cause is the bacterial infection, or the patients’ other serious healthconditions, or both. DPH was first notified of six potential cases between December 29, 2015 and January 4,2016 and set up statewide surveillance on January 5, 2016.  DPH then alerted health careproviders, infection preventionists, and laboratories statewide of the presence ofthe Elizabethkingia bacteria, and provided information as well as treatment guidance, whichhas led to a rapid identification of cases, and appropriate treatment.

“Determining the source of the bacteria affecting patients in Wisconsin is a complexprocess,” McKeown added. “While we recognize there will be many questions we cannot yetanswer, we feel it is important to share the limited information we have about the presenceof the bacteria, as we continue our work to determine the source.”

Following identification of the initial cluster, DPH staff initiated epidemiologic, laboratoryand environmental investigations to further characterize demographic and epidemiologicfeatures and determine risk factors and potential reservoirs for infection.

DHS and our partners are working closely on the investigation to determine the source of thebacteria, and are working diligently to contain the outbreak. A team of epidemiologists andlaboratory partners from the Centers for Disease Control and Prevention (CDC) is on siteassisting with the investigation. DHS is also working closely with state and local partnersincluding the Wisconsin State Laboratory of Hygiene, infection preventionists, and cliniciansin Wisconsin. DHS will continue to offer updates as information is available, to help ensure the health andsafety of those who may be vulnerable to bloodstream infections caused bythe Elizabethkingia bacteria.

For more information click HERE.

Posted in Clinical

Pneumococcal Immunization:Expectations and Enforcement

Spring Conference Brochure -Available NOW!

Elizabethkingia Outbreak: WhatYou Need to Know

WHCA/WiCAL Member Forum - ACommunity of Care

Brief: How States are Shifting toValue-Based Payments ThroughManaged Care

Payroll-Based Journal ResourcePage

Be Prepared: Payment ReformWorkshops in Eau Claire,Appleton, and Brookfield

Business Partners: ReviewExhibitor Prospectus and Registerfor Spring Conference ExpoToday!

Member Benefit: 10% Discount onOnline Dementia Care TrainingProgram

WHCA/WiCAL 2016 Media Guidesfor Continuum and MemberDirectory

National Nursing Home Week:May 8th - 14th

Exceptional Living CentersExpands Team to Support Growth

51 -- WHCA Board Packet -- March 2016

3/18/2016 Elizabethkingia Outbreak: What You Need to Know  WiHCA/WiCAL

http://www.whcawical.org/publications/careconnection/march42016/elizabethkingiaoutbreakwhatyouneedtoknow/ 3/3

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© 2016 Wisconsin Health Care Association. All Rights Reserved131 West Wilson Street, Suite 1001 | Madison, WI 53703Phone: (608) 257-0125 Fax: (608) 257-0025 | Email Us WEBSITE DESIGN BY ILLUMINAGE

TEXT SIZE: S M L SHARE!

52 -- WHCA Board Packet -- March 2016

Affected Programs: BadgerCare Plus, Medicaid To: Nursing Homes, HMOs and Other Managed Care Programs

Reminder: Exhausting Other Health Insurance Sources Before Submitting Nursing Home Claims to ForwardHealthExcept for a few instances, Wisconsin Medicaid and BadgerCare Plus are payers of last resort for any covered services. Therefore, providers are required to make a reasonable effort to exhaust all existing other health insurance sources before submitting claims or claim adjustments to ForwardHealth or to a state-contracted managed care organization. Effective for nursing home institutional claims and claim adjustments submitted with dates of service on and after April 1, 2016, ForwardHealth will be systematically enforcing this requirement. This ForwardHealth Update outlines the existing policy and provides timeframes for this enforcement.

Except for a few instances, Wisconsin Medicaid and BadgerCare Plus are payers of last resort for any covered services. Therefore, providers are required to make a reasonable effort to exhaust all existing other health insurance sources before submitting claims or claim adjustments to ForwardHealth or to a state-contracted managed care organization.

Systematic Enforcement of Other Health Insurance Billing Requirement

Effective for claims and claim adjustments with dates of service (DOS) on and after April 1, 2016, ForwardHealth will be systematically enforcing the requirement that nursing homes and facilities for the developmentally disabled make a reasonable effort to exhaust all other health insurance sources before submitting claims or claim adjustments to

ForwardHealth. For complete instructions regarding billing other health insurance sources and reasonable efforts for follow up if a timely response is not received, refer to the Online Handbook topics listed in the Payer of Last Resort section of this Update. To help providers comply with this requirement, effective for claims and claim adjustments with DOS from April 1, 2016, through June 30, 2016, ForwardHealth will use its Remittance Advice to notify nursing homes and facilities for the developmentally disabled of claims or claim adjustments that require commercial health insurance and Medicare billing but that did not include the results of this billing. These claims or claim adjustments will be identified by one of the following Explanation of Benefits (EOB) codes: • 1256, which states “Member is enrolled in Medicare

Part A on the Date(s) of Service.” • 0278, which states “Member is covered by a

commercial health insurance on the Date(s) of Service.”

During this three-month review period, providers will be reimbursed for claims or claim adjustments that should have indicated the results of commercial health insurance or Medicare billing but did not. However, in order to comply with federal requirements, ForwardHealth will be making claim adjustments in the future to account for any

53 -- WHCA Board Packet -- March 2016

commercial health insurance that should have been indicated. Starting July 1, 2016, claims and claim adjustments processed with DOS on and after April 1, 2016, that are submitted without the appropriate commercial health insurance or Medicare information will be denied with EOB code 1256 or 0278. When a provider receives a claim denial with EOB code 1256 or 0278, the provider should bill all other health insurance sources for the member prior to resubmitting the claim. If the resubmitted claim does not reflect the outcome of billing other insurance, the claim will be denied.

Payer of Last Resort

Claims and claim adjustments submitted to ForwardHealth are routinely audited to ensure that Wisconsin Medicaid and BadgerCare Plus are payers of last resort; this includes reviewing other health insurance information provided on claims. The following topics found in the Online Handbook on the ForwardHealth Portal at www.forwardhealth.wi.gov/outline the requirements and processes for billing other health insurance sources: • Exhausting Commercial Health Insurance Sources

topic (topic #596) in the Commercial Health Insurance chapter of the Coordination of Benefits section

• Exhausting Medicare Coverage topic (topic #669) in the Medicare chapter of the Coordination of Benefits section

• An Overview for Nursing Homes topic (topic #3220) in the Medicare chapter of the Coordination of Benefits section

For information regarding which services require commercial health insurance and Medicare billing, including Medicare Supplemental and Medicare Advantage plans, refer to the following Online Handbook topics: • Services Requiring Commercial Health Insurance

Billing topic (topic #769) in the Commercial Health

Insurance chapter of the Coordination of Benefits section

• Services Requiring Medicare Advantage Billing topic (topic #770) in the Medicare chapter of the Coordination of Benefits section.

Note: Effective for DOS on and after April 1, 2016, nursing homes are required to bill commercial health insurance before submitting claims to ForwardHealth for skilled nursing home care if any DOS is within 120 days of the date of admission. If benefits greater than 120 days are available, nursing homes are required to continue to bill for them until those benefits are exhausted. For information regarding how to submit commercial health insurance and Medicare information on claims, refer to the following resources: • For paper claim submission, refer to service area-

specific claim submission completion instructions available in the Online Handbook.

• For electronic claim submission, refer to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Version 5010 Companion Guides, available at www.forwardhealth.wi.gov/WIPortal/Subsystem/Account/ StaticHTML.aspx?srcUrl=CompanionDocuments.htm.

• For Direct Data Entry on the Portal, refer to the ForwardHealth Portal User Guides, available at www.forwardhealth.wi.gov/WIPortal/content/Provider/ userguides/userguides.htm.spage.

Per Wis. Admin. Code § DHS 106.02(9)(a), in order to substantiate other insurance indicators and Medicare disclaimer codes used on a claim, providers are required to prepare and maintain truthful, accurate, complete, legible, and concise documentation of efforts to bill commercial health insurance and/or Medicare.

54 -- WHCA Board Packet -- March 2016

The ForwardHealth Update is the first source of program policy and billing information for providers. Wisconsin Medicaid, BadgerCare Plus, SeniorCare, and Wisconsin Chronic Disease Program are administered by the Division of Health Care Access and Accountability, Wisconsin Department of Health Services (DHS). The Wisconsin AIDS Drug Assistance Program and the Wisconsin Well Woman Program are administered by the Division of Public Health, Wisconsin DHS. For questions, call Provider Services at 800-947-9627 or visit our website at www.forwardhealth.wi.gov/.

P-1250

55 -- WHCA Board Packet -- March 2016

STATE OF WISCONSIN Department of Health Services Division of Quality Assurance

1 West Wilson Street PO Box 2969

Madison WI 53701-2969

Telephone: 608-266-8481

Fax: 608-267-0352 TTY: 888-241-9432

www.dhs.wisconsin.gov

Date: February 23, 2016 DQA Memo 16-004

To: Adult Family Homes Community-based Residential Facilities Certified Mental Health and AODA Programs Facilities Serving People with Developmental Disabilities (FDDs) Home Health Agencies Hospices Hospitals Nurse Aide Training Programs Nursing Homes Residential Care Apartment Complexes

From: Laurie Arkens, Director

Office of Caregiver Quality Division of Quality Assurance

Via: Otis Woods, Administrator

Division of Quality Assurance

Guidance Reminder Regarding Handheld Devices

and the Potential Misuse of Such Devices

This memorandum provides guidance to healthcare facilities and nurse aide training programs (further referred to as entities) on the fast-changing landscape of the internet and the misuse of handheld devices as a communication tool for social media such as Facebook, Twitter, Instagram, YouTube, LinkedIn, and Snapchat. Wireless handheld devices such as cameras on cell phones, PDAs, and laptops provide instant access to the internet and allow information to be transmitted electronically or maintained in another form or medium. Background Social media platforms such as Facebook, Twitter, Instagram, YouTube, LinkedIn and Snapchat enable people to communicate easily via the internet and to instantly share information and resources. Problems arise when handheld devices are used to share information, personal photographs, or videos of residents/patients/clients that may violate resident rights, HIPPA violations and may constitute Caregiver Misconduct. Social media content, including personal or private information can be rapidly disseminated and readily accessed by others including unintended recipients. One new outlet that is growing in popularity is Snapchat.com which is a photo messaging application that allows a person to snap a photo or a video, add a caption, and send to a friend. Photos appear for a few seconds and then

56 -- WHCA Board Packet -- March 2016

DQA Memo 16-004 February 23, 2016 Page 2 of 3 disappear with no lasting record. Inappropriate use of handheld devices in healthcare settings is growing nationwide. Resident and Patient Rights Wisconsin state statutes and administrative rules for regulated healthcare providers consistently address resident and patient rights to privacy in care, treatment and accommodations. All entities have an obligation to protect the rights of their residents/patients/clients. In addition to Department sanctions, the failure to protect a resident or patient’s privacy and confidential information could also form the basis for civil or criminal liability. HIPAA Protections If an entity is a “covered entity” under the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the entity has a duty to protect Individually Identifiable Health Information. Covered entities that violate HIPAA can face significant penalties, including fines and/or imprisonment for knowingly misusing Individually Identifiable Health Information. Please note that the Division of Quality Assurance (DQA) does not enforce HIPAA; HIPAA is under the jurisdiction of the federal Office of Civil Rights (OCR). However, Wisconsin statutes and administrative rules include privacy protection requirements that must be followed by licensed providers. Caregiver Misconduct Issues Along with resident rights violations and possible HIPAA violations, the misuse of handheld devices including distribution of photos and videos may also constitute caregiver misconduct. The Office of Caregiver Quality (OCQ) has primary responsibility for receiving, screening, and investigating allegations of caregiver misconduct and maintaining the Wisconsin Caregiver Misconduct Registry. Since 2009 the OCQ has seen an increase in the number of caregiver misconduct issues related to the increased use of wireless handheld devices such as cameras on cell phones, PDAs, and laptops. OCQ continues to receive reports of misconduct involving handheld devices and has substantiated several instances of caregiver misconduct related to the misuse of handheld devices. A review conducted by Pro Publica (Policing Patient Privacy) revealed 35 cases since 2012 in which nursing home or assisted living workers surreptitiously shared photos or videos of residents on social media. At least 16 cases involved Snapchat. Entity Responsibility To protect the safety of residents/patients/clients, it is recommended that entities adopt a written policy that defines the accepted appropriate use and the unaccepted inappropriate use of personal handheld devices in that entity’s healthcare setting. This policy may be included as part of the entity’s human resource policy and procedure manual and may incorporate the following:

That personal devices are never to be used to record images of residents/patients/or clients. If such images are needed for purposes of care or training, they should be obtained by authorized persons only and use only the equipment specified in the policy.

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DQA Memo 16-004 February 23, 2016 Page 3 of 3

Indicate that any authorized photographs or images are the sole property of the entity and that the distribution of these photographs or other images to any person outside the entity’s setting without written authorization for a permissible use is prohibited.

Define the areas of the entity and the circumstances in which personal cell phone and other wireless handheld devices may be used, i.e. on breaks or lunch in the break room or outside, etc. Specify the consequences for failure to abide by the entity’s policy.

Inform residents/patients/clients (or designated responsible agent) and family/visitors about privacy considerations and the use of personal cameras, cell phones and wireless handheld devices.

Ensure that all staff, contract/pool agency staff, students and volunteers are aware of and trained on the entity’s written policy on the use of personal cell phone and other wireless handheld devices.

Entities are strongly encouraged to regularly review and update policies and handbooks to assure that they are reflective of current (and future) technologies in order to assure resident/patient/client protection and privacy. Policies currently in place may not be reflective of the current usage/availability of cell phones/cameras. Consideration should also include that the use of personal devices can cause disruption and distraction to the caregiving process, aside from the privacy considerations. Articles and Resources Pro Publica Article: Nursing Home Workers Share Explicit Photos of Residents on Snapchat https://www.propublica.org/article/nursing-home-workers-share-explicit-photos-of-residents-on-snapchat?utm_campaign=sprout&utm_medium=social&utm_source=twitter&utm_content=1450706926 Social Media and Health Care Professionals: Benefits, Risks, and Best Practices Article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103576/ For information regarding HIPPAA requirements, please see the US Department of Health and Human Services website at http://www.hhs.gov/hipaa/index.html. If you have questions regarding Caregiver Misconduct issues, contact the OCQ at DHSCaregiverIntake@wisconsin.gov or (608) 261-8319

58 -- WHCA Board Packet -- March 2016

3/18/2016 Continuing Education  WiHCA/WiCAL

http://www.whcawical.org/aboutwhca/continuingeducation/ 1/3

Continuing Education

54th Annual Spring Conference — April 20-22

The 2016 WHCA/WiCAL Spring Conference and Exposition will beheld at the Kalahari Resort and Convention Center in WisconsinDells on April 20-22, 2016.

Check out the Spring Conference Brochure Here! 

ATTENDEE REGISTRATION:

Click here for the Spring Conference ONLINE registrationform (Form requires either Microsoft-supported Windows or Apple-supported operating system)

Click here for the Spring Conference PRINTABLE registration form   (Please print, complete, and fax in this two-page registration form if your computer isnot able to load the online registration page. WHCA/WiCAL’s fax number is 608-257-0025)

EARLY BIRD SPECIAL: Register for Spring Conference by March 25 to be automaticallyentered into a drawing for a free iPad!

EXHIBITOR REGISTRATION:

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OTHER UPCOMING EDUCATIONAL OFFERINGS

Demystifying Payment Reforms Workshop

No doubt about it – health care payment reforms are a mystery to many. And yet, yourorganization’s survival may depend on navigating complex new payment systems. In this

Highlights

EDUCATION AND EVENTSREGISTER FOR SPRINGCONFERENCE -- APRIL 20,21, 22

Register for theDemystifying PaymentReforms Workshops

Register for the NursingHome Compliance WebinarSeries

Register for FinancialAffairs Webinar Series --available only to members

NEWSWHCA-WiCAL Announces NewCommunications Director 

WHCA/WiCAL Announces NewExecutive Director 

WHCA/WiCAL RecognizesShining Star Award Recipients 

Nursing Homes in WisconsinPrep for Massive, UnfundedMandates 

Partnership Will OfferCaregivers Cutting-EdgeOnline Care Dementia Trainingand Certification 

National Study ShowsWisconsin has the Second-Worst Medicaid FundingSystem 

Economic Impact ofWisconsin's SkilledNursing/Therapy Centers

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session, we will demonstrate how the various paymentreforms will impact senior living providers.

Click HERE for more information.

This session will demystify the impact of payment reformssuch as value-based purchasing, accountable careorganizations, managed care organizations, bundling, andMedicare Advantage Plans. This session will also identifyactionable strategies for clinically integrating with acute careproviders and for attaining the level of clinical excellence tosucceed in the payment reformed world.

Eau Claire March 22, 2016 The Clarion Hotel — 2703 Craig Road Eau Claire, WI 54701 REGISTER

Appleton March 23, 2016 Holiday Inn Select — 150 Nicolet Road Appleton, WI 54914 REGISTER

Brookfield March 24, 2016 Midway Hotel Brookfield — 1005 S. Moorland Road Brookfield, WI 53005 REGISTER

Nursing Home Compliance Webinar

Series

WHCA/WiCAL is pleased to offer a new webinar series thisyear on six of the Top-10 F-tag citations from 2015. Weencourage you to participate in one or all six of theseworthwhile webinars, which can be purchased individuallyor are also available at a great package price. Register todayfor one or all of these webinars today!

F-Tag 314 – February 16, 2016 — AVAILABLE FOR ARCHIVEPURCHASE F-Tag 225 – March 15, 2016 F-Tag 329 – May 17, 2016 F-Tag 323 – June 14, 2016 F-Tag 371 – July 12, 2016 F-Tag 309 – August 16, 2016 All Webinars

Emergency Preparedness Workshop

July 20, 21, 22, 2016 — Registration and program information

coming soon!

SAVE THE DATE — Infection Control Summit

August 17-18, 2016 — Date Tentative 

SAVE THE DATE — Survey Update/Conditions of Participation

November 16, 17, 18, 2016 — Date Tentative

RESOURCESClinical Resource Center

CNA Training and RecruitmentResources

Spring Conference ExhibitorProspectus 

Spring Conference ExhibitorRegistration

Payroll Based JournalResources

Third-Party Liability Resources

Family Care Resources

Shining Star AwardsInformation

WHCA/WiCAL MembershipForum

GOLD Package MembershipApplication and Information

ORDER: Resident Rights orFuture Medical DecisionBooklets -- Packets of 50 areavailable for $58 plus S/H --click here to email in yourorder today

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60 -- WHCA Board Packet -- March 2016

3/18/2016 Continuing Education  WiHCA/WiCAL

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SAVE THE DATE — 65th Annual Fall Convention

The 2016 WHCA/WiCAL Fall Convention will be held at the Radisson – Green Bay on October19-21, 2016. PLEASE NOTE: No other information will be available until it is posted here.

Save the date information.

10% Discount on Online Dementia Care Training and

Certi∀cation

WHCA members can receive a 10% discounton HealthCare Interactive’s CARES onlinedementia care training programs (includingAlzheimer’s Association essentiALZ individualcertification). CARES meets the State of Wisconsin dementia training requirements, and eachstaff member who completes any of the 5 online training programs can get certified by theAlzheimer’s Association at no additional cost.   Pricing starts at $24.95 per person, and affordable site licenses are available. Just go towww.hcinteractive.com to make your purchase and use the promo code WHCA10 atcheckout to receive 10% off your entire order. If you have questions, or if you wish to placeyour order by phone, call us at (952) 928-7722.

ATTENTION VENDORS

Click to view the VENDOR INFORMATION CENTER

For more information about these upcoming events, please contact Skitch MacKenzie,WHCA/WiCAL Director of Education and Member Services.

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61 -- WHCA Board Packet -- March 2016