Legislative Updates

WPSA proposes change of HFS 105.17 in order to allow MA personal care providers to contract with partnerships and MCOs directly using their own MA number instead of using MA numbers belonging to counties. READ MORE>

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Scope Statement for the Rule on PCW Background Check Disclosure

Health and Family ServicesMgmt. & Technology & Strategic Finance, Chs. HFS 1

Subject       

Revises Chapter HFS 12, relating to caregiver background checks, to specify crimes for which an entity must disclose, to a client or the client's guardian, a conviction of a caregiver who is assigned to provide personal care services to the client in the client's personal residence and to specify who is a “substitute caregiver”.

Policy Analysis       

Effective November 1, 2008, 2007 Wisconsin Act 172 creates s. 50.065 (2m) (a) and (b), Stats., to require entities, including home health agencies and temporary employment agencies to conduct background checks of caregivers who are assigned to provide personal care services to a client in the client's private residence. The entity is further required to disclose to the client, or to the client's guardian, information regarding any conviction of the caregiver of a crime that is specified by the department by rule, and information concerning that person's history of child abuse or neglect; abuse or neglect of a client; misappropriation from a client; or denial of licensing or certification to serve as an entity. The statute exempts entities from having to make the referenced disclosures for “substitute caregivers” as the  department defines that term by rule.        2007 Wisconsin Act 172 also requires the department to specify by rule, the crimes for which an entity must disclose a conviction of its caregivers who are assigned to provide services in a client's personal residence. Under s. 50.065 (2m) (d), Stats., as created by 2007 Wisconsin Act 172, the department intends to propose a list of crimes for which an entity must disclose the conviction to a client or client's guardian, and a definition of the term “substitute caregiver”. The department may also propose additional updates to the rules.        The creation of s. 50.065 (2m) (a) and (b) first applies to placement of caregivers that are made on April 10, 2008. The 2007 Wisconsin Act 172 takes effect November 1, 2008.

Statutory Authority       

Sections 50.065 (1) (ag) 1. a., (d), (f), (2) (d), (4), (5), (6)(b) and (c), and (2m) (d) as created by 2007 Wisconsin Act 172, and 227.11 (2) (a), Stats.

Entities Affected by the Rule       

Entities that may be affected by the proposed rule include temporary employment agencies, homes health agencies, assisted living facilities, and consumer advocates, including the Board on Aging and Long Term Care.

Comparison with Federal Regulations       

There are no comparable existing or proposed federal regulations.

Estimate of Time Needed to Develop the Rule

The Department estimates that it will take 500 hours to draft the rulemaking order. In drafting the rule, the Department will seek the participation of the Wisconsin Personal Services Association, the Wisconsin Home Care Advisory Committee, the Wisconsin Assisted Living Association, Disability Rights Wisconsin Inc., and the Board on Aging and Long Term Care.

 

BUSH SEEKS BIG MEDICARE AND MEDICAID SAVINGS

February 2, 2007
By Robert Pear, NY TIMES

WASHINGTON, Feb. 1 - President Bush will ask Congress in his budget next week to squeeze more than $70 billion of savings from Medicare and Medicaid over the next five years, administration officials and health care lobbyists said Thursday.

The proposals, part of a White House plan to balance the budget by 2012, set the stage for a battle with Congress over entitlement spending. Even some
administration officials say they cannot imagine approval of such large cutbacks in a Congress now controlled by Democrats.

Mr. Bush is also expected to propose changes in the Children's Health Insurance Program to sharpen its focus on low-income families. The changes could reduce federal payments to states that cover children with family incomes exceeding twice the poverty level. Under federal guidelines, a family of four is considered poor if its annual income is less than $20,650. The child health proposal, like those for Medicare and Medicaid, is likely to touch off a fight on Capitol Hill.

Senator Hillary Rodham Clinton of New York and other Democrats are seeking major expansions of the children's health program, though they have not said how they would pay for the changes. One measure of the political difficulty facing the president's plan for Medicare and Medicaid is that he sought $20 billion less in savings from the two programs last year, when Republicans controlled Congress, and few of those proposals were adopted.

Representative Charles B. Rangel, the New York Democrat who heads the House Ways and Means Committee, said Thursday: "There is a large area for potential compromise and agreement, but with these latest Medicare proposals, the president is just asking for controversy. He still acts as if Republicans were in complete control and Democrats had lost the election."Mr. Bush has repeatedly said that Medicare has serious long-term financial problems, and many experts share his concern.

"If you want to balance the budget eventually and you do not want tax increases," said Joseph R. Antos, an economist at the American Enterprise Institute, "you have no choice but to propose substantial reductions in Medicare. The president's budget is an opening bid, the start of negotiations with Democrats over health care and other programs."

Taken together, Medicare and Medicaid cover more than one in four Americans. Federal spending for the two programs totaled $554 billion last year, or about 21 percent of all federal spending - a little more than Social Security. With no change in existing law, spending on the two health programs is expected to rise at a brisk pace, averaging more than 7 percent a year in the next decade.

Representative Jim McCrery of Louisiana, the senior Republican on the Ways and Means Committee, said: "The current rate of growth in Medicare, fueled by rising health costs and an aging population, is unsustainable. If Congress does not undertake sensible reforms soon, the system will be swamped as the baby boom generation begins to retire. Taxes will rise, benefits will be cut, and the entire economy will suffer." Under the president's plan, some Medicare beneficiaries would shoulder added costs. At present, about 4 percent of the 43 million beneficiaries must pay more than the standard monthly premium - it is $93.50 this year -because they have high incomes: more than $80,000 for individuals and $160,000 for married couples. The president's budget would require more people to pay the higher premiums, but administration officials would not immediately provide details.

Most of the proposed savings, however, would come from health care providers. Mr. Bush is expected to propose freezing Medicare payments to home health agencies and reducing the inflation allowance paid to hospitals, nursing homes and other providers. Hospitals plan to fight the president with lobbying and advertising. "Two-thirds of hospitals already lose money treating Medicare beneficiaries," said Richard J. Pollack, executive vice president of the American Hospital Association. The president's budget also assumes that Medicare payments to doctors will be cut at least 8 percent next year, as provided under a formula in existing law.

Administration officials said Mr. Bush would not try to curb payments to private managed care plans, which currently enroll more than eight million Medicare beneficiaries. But many Democrats in Congress want to do so, because, they maintain, Medicare overpays the plans, which they see as a step toward privatizing the program.

Insurance companies are mobilizing beneficiaries to lobby against any cuts in Medicare payments to private plans. Mohit M. Ghose, a spokesman for America's Health Insurance Plans, a trade group, said, "Any cuts would take away benefits from millions of low-income people and members of minority groups, who enroll in private plans because they cannot afford the high out-of-pocket costs in the traditional Medicare program."

 

WPSA Update: 2007-2009 State Budget

This week, the Department of Administration released its report on agency
budget requests and revenue projections for the upcoming 2007-09 budget.  If
all agency requests were approved by the Governor, Wisconsin would have a
$1.6 billion deficit for the biennium.  Thus, Governor Doyle will have to
trim agency budget requests in order to balance the budget without raising
taxes as he prepares his 2007-09 biennial budget proposal to be presented to
the Legislature in late January or early February.  Increases in health care
costs and operation of the state's correctional institutions will present
Doyle with major challenges.

In the report, the figures show that even though state tax revenues are
projected to increase over both years of the next biennium, the increases,
if realized, would be $1.63 billion less than state agencies are seeking in
their spending proposals.

The figures do not cover all anticipated spending requests. Agency budget
requests do not normally include any funds for prospective increases in debt
service, fuel and utilities, state employee compensation and fringe benefits
or UW faculty pay adjustments. Consequently, total spending requests are
understated in the report. Also not included are capital budget requests.
The DHFS budget request does not include any provider rate increases under
the Medical Assistance program.

State tax revenues are projected to increase from $12.491 billion in the
current fiscal year (which ends June 30, 2007) to $12.941 billion in FY
07-08 and to $13.462 in FY08-09. Over the biennium, the total increase would
be more than $1.4 billion. Meanwhile, existing tax law changes and property
tax credits will reduce revenues and increase state spending by more than
$600 million in the next biennium.

The revenue estimates assume the national economy will continue to grow over
the next three years, with Wisconsin's economic outlook reflecting the
national projections. Estimates released on Monday reflect current
appropriations and agency requests for the next two fiscal years. The
projections will be reviewed again by the Dept of Administration and Revenue
as Doyle prepares his budget. The Legislative Fiscal Bureau may use new
estimates when it produces a General Fund condition statement for the
Legislature in January.

In the report released Monday, DOA Secretary Bablitch notes the state faces
many spending pressures, but points to health care costs increasing at rates
higher than the general inflation rate, posing a "continuing challenge" for
the state's Medical Assistance program, BadgerCare, SeniorCare, state health
insurance contracts and all state institutions providing health care
coverage for "unique populations."

Bablitch also takes note of increased costs for operating the Department of
Corrections facilities, in part because of tougher criminal penalties
legislation. The school levy tax credit will increase by $124 million
annually, starting in FY07-08 as part of paying for two-thirds of school
costs in 2006-07 and freezing property taxes on the median value home in
December 2006. Previously-enacted tax cuts and the increased property tax
credits account for more than $600 million in the next biennium.

Milwaukee Journal Sentinel-State Budget Short $1.6 Billion:
http://www.jsonline.com/story/index.aspx?id=533054  

Madison Capital Times--Doyle faces hard choices as budget work begins:
http://www.madison.com/tct/news/index.php?ntid=108315&ntpid=0

Milwaukee Journal Sentinel-Doyle Defends Deficit Spending:
http://www.jsonline.com/story/index.aspx?id=534011

See the DOA report: http://www.doa.state.wi.us/docs_view2.asp?docid=6185

Press release from DOR on revenue projections:
http://www.wispolitics.com/index.iml?Article=77676