DHS Releases State Agency Budget Request

The Department of Health Services has released their agency budget request for 2019-21, which can be viewed here: https://doa.wi.gov/budget/SBO/2019-21%20435%20DHS%20Budget%20Request.pdf. These requests help the Governor prepare the state budget, which will be introduced in January or February of 2019.


DHS is requesting a cost-to-continue budget for Medicaid, which is an additional $496 million GPR for the biennium. Part of this is to reflect increased long-term care costs due to statewide expansion of Family Care.  DHS also requests an increase for administrative costs, which they say includes EVV for personal care in addition to increased administrative costs from FoodShare and Medicaid work requirements and other federal requirements.


Interestingly, DHS is projecting fee-for-service decreases in intensity/use for personal care, private duty nursing and home health (likely due to Family Care/managed care expansion) but increased fee-for-service costs for hospitalizations and prescription drugs. DHS also projects that nursing facility patient days will decline by 5.0% annually in Fiscal Year (FY)19, FY20 and FY21.


The major funding items they request for the biennium are:


·         Increased Medicaid and FoodShare administrative funding for FSET and implementing Medicaid work requirements/FoodShare work requirements passed by the Legislature in the Spring  as well as new federal administrative requirements, such as EVV for personal care ($22.5 million GPR)

·         Increased costs for the FoodShare Employment and Testing Program, which DHS also plans to use as a way for people to meet the Medicaid work requirement they proposed to CMS for childless adults on BadgerCare ($64.2 million GPR)

·         Cost-to-continue for Medicaid ($496 million GPR). DHS says the significant events that will impact Medicaid in the biennium are:

o   Statewide Family Care, individuals continue to enroll off the waitlist in Adams and Dane

o   Eliminating the waiting list for the Children’s Long Term Support Program, children continue to enroll. In addition, DHS must implement a statewide rate schedule.

o   Expansion of SSI-Managed Care resulted in approximately 20,000 new managed care enrollees, this provides significant opportunities for cost-savings

o   Phase-out of the enhanced federal matching for CHIP will begin in this biennium. However, standard FMAP is projected to increase while CHIP FMAP decreases.  

o   Strong growth of the Regional Comprehensive Community Services (CCS) program

o   Increased costs for FQHCs

o   Medicaid enrollment mix—growth of EBD population—managed care intensity

·         Resources to address childhood lead poisoning ($11 million GPR)

·         Funding for Income Maintenance Consortia to comply with new public assistance requirements, such as work requirements, health savings accounts and drug screenings ($1.8 million GPR)

·         Expansion of the Mendota Juvenile Treatment Center ($11.6 million PR)

·         Funding to sustain the Emergency Dispatcher CPR requirements from legislation passed this session ($233,400 GPR)

·         Additional funding for outpatient competency examinations, conditional and supervised release, and treatment to competency programs ($4.5 million GPR)

·         Increased funding for Mendota and Winnebago Mental Health Institutes to reflect changes in their patient populations ($4.3 million GPR)

·         Increased funding for overtime costs at the Mental Health Institutes, DD Centers and the secure treatment centers ($7.7 million GPR)

Take the DHS Provider Survey on EVV Implementation!

DHS has developed a survey to gather provider feedback about electronic visit verification (EVV) for personal care. Input from providers is essential to the planning process for the EVV requirement. Results from this survey will be used by DHS to help plan for the implementation of the EVV requirement.

Please complete the following survey by August 6, 2018 by clicking on the link below. The survey should take about 5–10 minutes to complete.

EVV Survey

If you have any questions or comments regarding EVV, please contact us at DHSEVV@dhs.wisconsin.gov.

U.S. House Passes EVV Delay Legislation

The U.S. House acted on a voice vote Tuesday to pass H.R. 6042, which delays EVV financial penalties by 1 year and sets forth some standards about stakeholder input. Specifically, it requires CMS to hold at least one public meeting in 2018 to get feedback  from Medicaid stakeholders on the EVV guidance they issued on May 16, 2018.

This bill was introduced on June 7 by Congressman Brett Guthrie and is slightly different from the bill authored by Senator Lisa Murkowski.

During brief debate on the bill, Congressman Guthrie talked about how EVV is important for program integrity and that OIG has warned of fraud in personal care. He said the delay is needed to make sure that EVV is implemented effectively and that they have received feedback that more time is needed.

The U.S. Senate will now need to vote on this version of the bill before it becomes law. Contract Senators Ron Johnson and Tammy Baldwin and ask them to support this legislation! 

Ask Candidates About Their Plans for Solving the Workforce Crisis!

Election season is upon us again in Wisconsin! The statewide primary will be held August 14 and the general election is on November 6. 

Please attend candidate forums, listening sessions or engage candidates in conversation if you see them at community events this summer. 

Here are some questions would could ask:

1. What steps will you take to address the direct care worker crisis that is being driven by inadequate Medicaid reimbursement rates?

2. How will you ensure that Wisconsin’s long-term care system has an adequate provider network that guarantees access to care in the community?

3. Do you support continued funding of the $25 million of state funds provided to Family Care providers in the last state budget to help support direct care workers? 

Take WPSA's 2018 Rate Survey!

One of the most effective advocacy tools that WPSA used to secure a 2% per year MAPC rate increase in the 2017-19  state budget was the results of our workforce survey.

This data is now several years old and we know the workforce crisis has only gotten worse since our last survey.

Please take a few minutes to fill out the 2018 survey: https://docs.google.com/forms/d/e/1FAIpQLSeWxNMontUwM8ulVBIP-hU3hbQCjjXvDTPBOf-qrr6v7wbStA/viewform?usp=sf_link

New Survey on Employees and Caregiving

The Wisconsin Women’s Council (appointed by the Governor and the State Legislature) in partnership with the Wisconsin Family and Caregiver Support Alliance is looking for employers of all sizes to participate in a first annual survey on caregiving.  The intent of this survey is to improve information and other resources available to Wisconsin employers as they support caregivers on the job.

Survey Linkhttps://www.surveymonkey.com/r/WICaregiving 

The survey will take less than 10 minutes to complete.  Deadline to participate: May 31

For purposes of this survey, caregiving is defined as support provided to a family member (beyond typical care for a minor child) who may be an older adult or person with a disability.  Individual survey responses will remain confidential.  Survey results will be shared with participating employers.

If you have questions about the survey contact Christine Lidbury, Executive Director, Wisconsin Women’s Council Christine.Lidbury@wisconsin.gov  or Lisa Pugh, Co-chair, Wisconsin Family and Caregiver Support Alliance: Pugh@thearc.org.

Important Information About EVV

The state is currently developing a plan to implement Electronic Visit Verification for Personal Care, as required by the federal 21st Century Cures Act.  DHS has released the following update. For more information, visit:  https://www.dhs.wisconsin.gov/forwardhealth/evv.htm


In response to the federal 21st Century Cures Act, the Wisconsin Department of Health Services (DHS) is required to implement electronic visit verification (EVV) for Medicaid-covered personal care services and home health services. This requirement impacts any personal care and home health services, including services provided through Medicaid and BadgerCare Plus fee-for-service, BadgerCare Plus health maintenance organizations (HMOs), Supplemental Security Income HMOs, Family Care, Family Care Partnership, IRIS (Include, Respect, I Self-Direct), and Children’s Long Term Support Waiver. DHS is in the process of reviewing the Act to determine the specific services that will be subject to EVV.

Effective Dates

DHS plans to implement the new EVV requirement over a span of multiple years based on the federal 21st Century Cures Act requirements.

The federal 21st Century Cures Act requires EVV to be implemented for personal care services by January 1, 2019. DHS acknowledges that implementation of EVV by January 1, 2019, is not practical for personal care providers. As a result, DHS is not planning to implement the EVV requirement by January 1, 2019, and will continue to work with providers, partners, and the federal Centers for Medicare & Medicaid Services (CMS) to develop an appropriate and realistic timeline for EVV implementation. DHS will share updated information regarding the expected timeline with providers when available. Providers do notneed to do anything or purchase anything to be in compliance with the EVV requirement at this time.

The federal 21st Century Cures Act requires EVV to be implemented for home health services by January 1, 2023.


EVV is an electronic system that uses technologies to verify that authorized services were provided. Home care workers will be required to send information at the beginning and end of each visit to an EVV system, including:

  • Date of services.
  • Time of services.
  • Location of services.
  • Service type.
  • Individual providing services.
  • Individual receiving services.

DHS plans to implement EVV by establishing a single EVV vendor. This vendor will provide one EVV system to be used by all DHS programs and impacted providers, HMOs, managed care organizations (MCOs), and program administrators. Providers will not have to purchase an EVV system.

Additional Resources 

DHS has created a dedicated webpage where providers can view all current EVV information. DHS plans to update this webpage to provide current EVV information, including any updates on implementation timelines. Providers are encouraged to visit the webpage frequently to get all updated information on EVV.

CMS has also created an EVV website for the federal 21st Century Cures Act where providers can find more information.

DHS would like to hear from providers and stakeholders regarding the implementation of EVV. The input is essential to the planning process for this new requirement and will be used by DHS to make decisions in implementation planning and assist in determining the best way to be compliant with the federal requirement. Providers and other stakeholders can submit their questions or concerns to DHS by emailing: dhsevv@dhs.wisconsin.gov. Submissions to this email address will be used to develop a frequently asked questions document.

DHS is also planning to send a survey to providers to collect input on the EVV requirement. The survey will be sent to providers by email. Providers are highly encouraged to respond to the survey to provide input to DHS on the implementation of the EVV requirement.  

When implementation planning is completed, DHS will provide providers specific information about training, how to record visits, claims, technology, and all key steps of the process for the new EVV requirement. Providers are encouraged to visit the DHS EVV webpagefrequently for forthcoming ForwardHealth Updates and other communications regarding this implementation.