SECRETARY HELENE NELSON STATE OF WISCONSIN DEPARTMENT OF HEALTH AND FAMILY SERVICES LONG TERM CARE QUALITY SUMMIT FEBR

1. SECRETARY HELENE NELSON STATE OF WISCONSIN DEPARTMENT OF HEALTH AND FAMILY SERVICES LONG TERM CARE QUALITY SUMMIT FEBRUARY 20-21, 2006 MINNEAPOLIS, MINNESOTA

2. BALANCED REGULATION AND RATIONALIZED FINANCING: MANAGED LONG TERM CARE

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

12. 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

13. 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

14. Managed long term care shifts quality oversight and rate setting downstream, through care management organizations, closer to the communities and consumers LTC providers serve.

15. (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

16. 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.

17. 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