From Forbes McIntosh, Government Policy Solutions, WALA Lobbyist
The Wisconsin Department of Health Services Wisconsin Long-Term Care Advisory Council met on last week in Madison. Among the discussions were the following:
Brian Shoup, DHS Division of LTC Administrator, gave an update on the implementation of the Family Care/IRIS changes that were contained in the 2015-17 biennial state budget that was adopted earlier this summer. Shoup said there will be six public hearings around the state – in Green Bay, Wausau, Hayward, LaCrosse, Madison and Milwaukee – at which stakeholders and the public can provide input on the program’s future. In addition, two more hearings will be held – one for LTC advocate groups in Madison and one for Native American tribes in Wisconsin – for a total of eight hearings this fall.
Shoup said the division was charged in the state budget with developing a concept paper for program changes to present to the legislature’s Joint Finance Committee (JFC). Input from the hearings will be used by DHS in developing the proposal that will be presented to JFC in April 2016. According to Shoup, the JFC will vote the proposal up or down, with no amendments. If it is approved, DHS will begin working on the waiver that will be submitted to the U.S. Centers for Medicare and Medicaid Services (CMS). There will then be another public comment period by CMS in 2016 – 30 days for comments from the public, 60 days for comments from Native American tribes. The goal is to have final implementation of the changes by January 2017.
Shoup said that DHS staff have held two retreats in recent weeks to identify the key decisions that DHS will have to make as part of the redesign planning process – and that list has swelled now to 170. DHS will also be meeting with various stakeholder groups prior to the JFC paper submission.
DHS posed a series of questions to the advisory council members on how the LTC system in Wisconsin can better support family caregivers. As the state’s population continues to age, DHS wants to do a statewide outreach effort to get people to start thinking earlier about the issue of family caregiving – both as the care recipient and caregiver. Sam Wilson of AARP said one issue nationally is that there has not been any strategy from a national public policy standpoint relating to family caregiving – and there has been very little discourse between agencies on what they are trying to achieve. However, Wilson noted that U.S. Senator Tammy Baldwin is a co-author of bipartisan federal legislation introduced this summer, the RAISE Family Caregivers Act, which would direct the Health and Human Services Secretary to establish a National Family Caregiving Project to develop and sustain a national strategy to support family caregivers. And closer to home, Wilson noted Senate Bill 19, a Democrat-authored bill introduced in February that would require hospitals to provide a patient with an opportunity to designate a lay caregiver who would receive instruction regarding patient aftercare following hospital discharge.
Council member Robert Kellerman said he expects legislation to be introduced next year authorizing the creation of Investicare, an initiative that would allow people to save money to finance their long-term care needs.
Other council discussion on this topic included: the importance of providing respite for family caregivers, a place to match caregivers with respite providers, the role of ADRCs, the need for more futures planning, and the resource gap for families in crisis.
Council members were asked to send additional comments on this topic to Council Chair Heather Bruemmer or Wendy Fearnside at DHS.
The council discussed challenges relating to increasing integrated employment for people with physical or developmental disabilities. DHS staff said they have developed a self-assessment tool for non-residential LTC providers that they will be required to complete as part of compliance with new federal Home and Community Based Services waiver rules. The tool will need to be completed by: prevocational work settings, adult day care, day services and children’s child centers. One piece of the puzzle in community-integrated employment is that many employers have never even been asked to hire a person with a developmental disability. Other challenges include lack of transportation to some places of employment (i.e. in industrial parks or rural areas where there is no bus service). Council members noted that state Medicaid rules currently prohibit personal care services outside of the home – and if a person needs help with things such as toileting, that would be a deterrent to employment. The council agreed that DHS should investigate possibly changing state Medicaid laws to allow Medicaid personal care services in the workplace.