SECRETARY HELENE NELSON
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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 BALANCED REGULATION AND RATIONALIZED FINANCING: MANAGED LONG TERM CARE RESPECT VALUES STATEMENT 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

Relationships

Empowerment to make choices

Services to meet individual need

Physical and mental health

Enhancement of consumer participation

Community and family participation

Tools for maximum independence


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VISION STATEMENT

All Wisconsin elders and people with disabilities

will have the supports and health care services

they need to live as independently as possible in

the setting of their choice.


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CMS COMPREHENSIVE SYSTEMS CHANGE

GRANT APPLIES TO NURSING HOMES

Envisions all LTC as a single universe

Nursing home and community-based care accessed through managed care systems

Public/private partnerships and regional coalitions

Universal assessment and outcome evaluation tools

Anticipates rebalancing the LTC continuum and transforming the role of nursing homes

25% less nursing home bed capacity statewide

Sub-acute, rehab, and specialty 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 vs state regulatoryphilosophies

Financing

Consumer choice and cost-effectiveness

Redefining and downsizing nursing homes

Assuring geographical access to NH beds

Protecting consumers/preserving quality during reform

Workforce quality and stability

Flexibility to meet individual needs and preferences

Incorporating acute and primary care

Integrating mental health

Prevention and early intervention

Enhancing and expanding Information Technology


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CURRENT SYSTEM

Managed Care

Family Care (partially integrated)

Medicaid payment from State

PACE & Partnership (fully integrated)

Medicaid payment from State

Medicare payment from CMS

Fee-for-Service

Multiple county-based programs including Medicaid Waivers

Federal, state and local LTC funds


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REFORMED SYSTEM

Expand Managed LTC Statewide

Integrate funding sources

Integrate long term care and acute/primary care

Implement risk based managed care contracts

Set actuarially sound rates

Purchase for outcomes:

Quality of life, quality of care

High integrity, data driven, CQI


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THE FAMILY CARE PROGRAM

CMS approved Medicaid waiver to pilot program in 2001 (map)

Single point of entry Resource Centers

Risk-based contracts with Care Management Organizations

Long term care provided by CMO, includes nursing home care

CMO care management team oversight by RN and SW

Person-centered, creative, flexible, choice, cost effectiveness

State Survey Agency regulates providers

CMOs purchase services for quality and cost-effectiveness

Consumer outcomes are measured in three domains

by interviewing consumers directly:

1. self determination and choice

2. community integration

3. health and safety


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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 acute & primary care

MA Fee-for-Service--LTC Services (i.e. personal care, home health, nursing facility & other institutional care);

Community Options Program-Waiver (COP Waiver) for elders & people w/ phys. disabilities

Waivers for people w/ dev. Disabilities

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 fee-for-service LTC services


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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/member in 4 counties and

$55/month/member in Milwaukee by:

Reducing use of institutions

Keeping people healthier

BIPARTISAN SUPPORT


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Managed long term care shifts

quality oversight and rate

setting downstream, through

care management organizations,

closer to the communities and

consumers LTC providers 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 path Wisconsin has chosen to pursue

balanced regulation and rationalized financing.


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RESPECT VALUES STATEMENT

Relationships

Empowerment to make choices

Services to meet individual need

Physical and mental health

Enhancement of consumer participation

Community and family participation

Tools for maximum independence


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