SECRETARY HELENE NELSON Condition OF WISCONSIN Branch OF Wellbeing AND FAMILY Benefits Long haul CARE QUALITY SUMMIT FEB.


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SECRETARY HELENE NELSON Condition OF WISCONSIN Branch OF Wellbeing AND FAMILY Benefits Long haul CARE QUALITY SUMMIT FEBRUARY 20-21, 2006 MINNEAPOLIS, MINNESOTA Adjusted REGULATION AND Justified FINANCING: Oversaw Long haul CARE Regard VALUES Explanation R elationships
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SECRETARY HELENE NELSON STATE OF WISCONSIN DEPARTMENT OF HEALTH AND FAMILY SERVICES LONG TERM CARE QUALITY SUMMIT FEBRUARY 20-21, 2006 MINNEAPOLIS, MINNESOTA

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BALANCED REGULATION AND RATIONALIZED FINANCING: MANAGED LONG TERM CARE

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RESPECT VALUES STATEMENT R elationships E mpowerment to settle on decisions S ervices to address individual issue P hysical and emotional wellness E nhancement of buyer interest C ommunity and family cooperation T ools for most extreme freedom

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VISION STATEMENT All Wisconsin older folks and individuals with handicaps will have the backings and human services administrations they have to live as autonomously as could reasonably be expected in the setting of their decision.

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CMS COMPREHENSIVE SYSTEMS CHANGE GRANT APPLIES TO NURSING HOMES Envisions all LTC as a solitary universe Nursing home and group based consideration got to through oversaw care frameworks Public/private organizations and territorial coalitions Universal appraisal and result assessment apparatuses Anticipates rebalancing the LTC continuum and changing the part of nursing homes 25% less nursing home bed limit statewide Sub-intense, recovery, and forte nursing home care

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Bayfield Developed by The Management Group Douglas Iron Ashland Vilas Sawyer Washburn Florence Burnett Oneida Price Forest Rusk Marinette Polk Barron Lincoln Langlade Taylor Chippewa St. Croix Menominee Oconto Dunn Marathon Shawano Door Clark Eau Claire Pierce Pepin Portage Kewaunee Wood Waupaca Outagamie Brown Buffalo Jackson Trempealeau Manitowoc Waushara Winnebago Adams Calumet La Crosse Monroe Green Marquette Juneau Lake Fond du Lac Sheboygan Vernon Columbia Dodge Ozaukee Richland Sauk Washington Crawford Dane Jefferson Milwaukee Iowa Waukesha Grant Racine Walworth Rock Green Lafayette Kenosha

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CONTINUING CHALLENGES OF LTC REFORM Federal versus state administrative theories Financing Consumer decision and expense viability Redefining and cutting back nursing homes Assuring geological access to NH beds Protecting buyers/saving quality amid change Workforce quality and security Flexibility to address individual issues and inclinations Incorporating intense and essential consideration Integrating emotional wellness Prevention and early mediation Enhancing and extending Information Technology

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CURRENT SYSTEM Managed Care Family Care (somewhat coordinated) Medicaid installment from State PACE & Partnership (completely coordinated) Medicaid installment from State Medicare installment from CMS Fee-for-Service Multiple region based projects including Medicaid Waivers Federal, state and nearby LTC stores

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REFORMED SYSTEM Expand Managed LTC Statewide Integrate subsidizing sources Integrate long haul consideration and intense/essential consideration Implement danger based oversaw consideration contracts Set actuarially stable rates Purchase for results: Quality of life, nature of consideration High honesty, information driven, CQI

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THE FAMILY CARE PROGRAM CMS sanction Medicaid waiver to experimental run program in 2001 (guide) Single purpose of passage Resource Centers Risk-based contracts with Care Management Organizations Long term consideration gave by CMO, incorporates nursing home care CMO care administration group oversight by RN and SW Person-focused, innovative, adaptable, decision, cost adequacy State Survey Agency controls suppliers CMOs buy administrations for quality and expense viability Consumer results are measured in three spaces by talking with shoppers specifically: 1. self determination and decision 2. group coordination 3. wellbeing and security

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How Family Care Simplifies Funding Non-Family Care Counties Family Care Counties Medicaid (MA) or Medicare Acute & Primary Care Medicaid (MA) or Medicare intense & essential watch over Service- - LTC Services (i.e. individual consideration, home wellbeing, nursing office & other institutional consideration); Community Options Program-Waiver (COP Waiver) for senior citizens & individuals w/phys. incapacities Waivers for individuals w/dev. Inabilities Community Integration Program II (CIP II) Brain Injury Waiver Community Integration Program (CIP 1A) Community Integration Program (CIP 1B) Community Supported Living Arrangements(CSLA) Community Options Program; Community Aids; Community Aids- - Alzheimer\'s Caregiver Support Program (AFCSP) Older Americans Act Services Independent Living Center Services Public Health Programs Family Care LTC or MA expense for-administration LTC administrations

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FAMILY CARE PILOT PROVEN SUCCESSFUL 5 FAMILY CARE PROGRAMS ACROSS STATE NO WAIT LISTS FOR COMMUNITY SERVICES SAVED MEDICAID $450/month/part in 4 regions and $55/month/part in Milwaukee by: Reducing utilization of establishments Keeping individuals healthier BIPARTISAN SUPPORT

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Managed long haul consideration shifts quality oversight and rate setting downstream, through consideration administration associations, closer to the groups and purchasers LTC suppliers serve.

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(SO, WHAT ELSE ARE WE DOING?) MEDICAID NH REIMBURSEMENT INITIATIVE Pay for Acuity, Buy Quality, Assure Access ACUITY : RUGS BASED RATES QUALITY : PAY FOR PERFORMANCE ACCESS : STATEWIDE DISTRIBUTION OF BEDS

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COMPREHENSIVE SYSTEMS CHANGE MANAGED LONG TERM CARE PUBLIC-PRIVATE PARTNERSHIPS REGIONAL COALITIONS ACUITY QUALITY ACCESS The way Wisconsin has decided to seek after adjusted regulation and legitimized financing.

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RESPECT VALUES STATEMENT R elationships E mpowerment to settle on decisions S ervices to address individual issue P hysical and psychological well-being E nhancement of purchaser interest C ommunity and family cooperation T ools for most extreme freedom

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