A Proposal to Strengthen Wisconsin's System of Long Term Care
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DRAFT: For Discussion Only 7/22/97
Introduction
The long term care needs of Wisconsin's residents can not and should not wait to be addressed. Wisconsin has both the human and financial resources to legislate for and put into operation a fair and just system of service delivery in 1998. The attached proposal is presented to the Department of Health and Family Services and to the Legislature by a broad coalition of associations which work for and with Wisconsin's elders and people with disabilities.
"Building Upon What Works" proposes fundamental change in how Wisconsin manages the more than $2 billion in public funds which now pay for long term care services. It builds such change upon the foundation of the Community Options Program, a partnership among the State, its counties and its citizens which has become the most highly regarded and emulated long term care program in the country. It responds to the problems which have evolved in the long term care system over the past 30 years in a manner which builds upon, rather than replaces, the best of Wisconsin's long term care system.
In concert with the staff and management of the Department of Heath and Family Services and others, the associations sponsoring this proposal have actively participated in the extensive analysis of Wisconsin's Long Term Care system over the past two years. This document is not intended to duplicate that analysis, but to recommend fundamental and urgently needed changes based upon it. These changes will strengthen our long term care system in a manner which reflects the values of quality, community and freedom which are the foundation of the Community Options Program.
Members of these associations agree with the Department of Health and Family Services about the need to reform our long term care system. We believe there is now an urgency to move ahead in the many areas of agreement between the Department and the majority of the stakeholders in the system. The longer we wait to initiate this discussion within our Legislature, the longer people wait for the long term care services and support they need to remain in our communities.
This proposal includes what we believe are essential features of the Department of Health and Family Services long term care redesign plan, those elements with which there was agreement among the great majority of individuals and organizations involved in this planning process. It is our hope that it form the basis of a legislative agenda to be introduced this fall by the Department with our full and active support. By building upon what works, we believe the following reforms can be implemented in 1998.
Recommendations
- The State of Wisconsin will fund and provide long term care for older people and people with disabilities in the least restrictive setting.
- People will be able to choose the type, amount and location of services they require within the limits of funding available to them. Funding for people who meet the functional eligibility criteria will be provided according to levels of individual need. If people receiving services wish to move to a different setting or county, their funding goes with them.
- Local government (local government in this proposal refers to county, multi-county, or tribal agencies) will serve as a highly visible, single entry point for entering any part of the publicly-funded long term care system and as the agency responsible for providing or contracting for all publicly-funded long term care.
- As the agency responsible for providing or contracting for all publicly-funded long term care, local government will receive unified long term care funding from the following programs or sources of funding:
- the Community Options Program
- Community Aids;
- County matching funds;
- the Community Integration Programs;
- all nursing home and other institutional services; and
- Medicaid-funded assistive technology, home health, personal care, and transportation services.
- Given the lack of attention and analysis of the system of services to children with long term care needs, long term care programs which focus only on children shall not be integrated with other long term care funding streams at this time. The Department is directed to begin the proper analysis and study of children's long term care services with a goal of fully integrating the long term care system in 1999, in concert with a commission set up to represent the interests of children with long term support needs and their families.
- State specified and monitored performance criteria will be established for the provision and management of long term care services. In addition to health and safety requirements, local government will be required to meet specific performance and outcome requirements based upon the needs of the individuals being served A range of state monitoring options will be developed, including replacing agencies which do not meet criteria with a non-profit or quasi-governmental agency.
- While funding for long term care shall remain separate from funding of primary and acute health care, specific performance criteria will be established to require the local government long term care agency and the local acute health care delivery system to coordinate the provision of acute and primary care with long term care.
- Functional eligibility criteria for long term care will be developed based upon the characteristics and needs of individuals currently receiving long term care services in Wisconsin. Individuals currently receiving support and others who have needs similar to those individuals will remain eligible for services.
- All persons who meet eligibility criteria will receive an assessment of their needs for support and be entitled to a flexibly defined set of comprehensive long term care benefits. Upon completion of the transition to a reformed system, it is expected that funding which can reasonably be projected to be available will be sufficient to meet the needs of all persons eligible. During the transition, the state will establish target dates by which all individuals will receive public funding, as well as criteria for prioritizing individuals to leave waiting lists.
- Funding for single entry point functions, emergency and protective services will be provided to counties through a specific allocation for those purposes.
- Planning, budgeting and funding will be flexibly provided across calendar years. Funding not spent in a particular calendar year will be retained by local government for the express purpose of reducing waiting lists and improving services. Demonstration or pilot projects designed to aid in the transition to a new system shall not be funded through programs designed to provide direct support to individuals, such as the Community Options Program and the Community Integration Programs.
- A long term care policy board composed of at least 51% long term care recipients will be responsible for long term care program planning, oversight and policy making. Local government will remain responsible for long term care fiscal administration through its county executive and/or board structure.
- People receiving services will be individually and collectively brought into the system as partners in reducing costs and strengthening the use of support from family, friends and community. They will be given information about the amount of long term care funding provided to them and to others, and will be asked to work with the public system to reduce long term care costs in order to better serve more people.
- An agency free of conflict of interest (e.g., State Ombudsman, Independent Living Center, Wisconsin Coalition for Advocacy) will be funded to provide independent advocacy services.
Since the Department of Health and Family Services withdrew its long term care redesign proposal from public hearings as a result of the comments from our associations, it is important to note the most important areas with which we strongly disagree with the Department's plan. These objections were stated throughout the planning process, and again to the Department before they released the plan to the public. The most critical objections are with the intent of the department to:
- require the integration and management of acute health care and long term care under a managed care agency;
- require that at least two managed care agencies be available within each geographical area; and
- require a non-profit or government single entry point agency to be separate from the agency which manages long term care.
The most likely outcome of these requirements would have been the replacement of the current Community Options Program and county administered long term care system with proprietary-based managed care companies. We believe this dramatic change would result in a reduction in both the quality and the amount of long term care available to Wisconsin residents.
The significant changes proposed by this coalition ask the Department of Health and Family Services, the Governor and the Legislature to reform rather than to replace the current system. By building upon what works, and giving the Community Options Program and other county and tribal long term care agencies the same tools the department would propose giving to managed health care companies, we believe we can change our current system to meet the needs of Wisconsin citizens with long term care needs both in the near term and well into the Twenty-First Century.
Last updated: August 8, 1997
By: Gail Schwersenska