State of Wisconsin Assisted Living News

DQA Background Check Reminder

It is a Mandatory Requirement to Submit Four - Year Renewal of Licensee Background Check regardless of when a DQA regulated entity last submitted an application for licensure, certification or registration, if an entity wishes the license approval to continue, the license holder or legal representative submit the completed forms for the required four-year renewal process. Failure to comply with any provision of background information gathering requirements subjects entities to certain sanctions, including denial, revocation, non-renewal, or suspension of regulatory approval.

All license holders/legal representatives must have complied with the requirements by June 30, 2008, however only half of all license holders/legal representatives have complied. Those who have not may get citied if this compliance is not taken care of immediately.

Access the DQA Regulated Entity Background Check Process web page to obtain the necessary forms for the Existing License Holder Four-Year Renewal Background Check Process. See DQA Memo 08-015 for more information.

Volunteer Ombudsman Program is ending

From Letter received by Heather Bruemmer, Executive Director/State Ombudsman, State of Wisconsin Board on Aging and Long Term Care:

It is with no small measure of disappointment that the Board on Aging and Long Term Care (BOALTC) announces that the Volunteer Ombudsman Program for Assisted Living will be ending July 31st, 2008.

In early 2007, the Volunteer Ombudsman Program began a project to expand services into the Assisted Living arena, enlisting Volunteer Ombudsmen to make visit in Community Based Residential Facilities (CBRF). This expansion included the hiring of an additional Volunteer Coordinator in a project position for 18 months to recruit, screen and place up to 36 CBRF Volunteer Ombudsmen into selected individual facilities.

The 18 months has come to an end and due to the lack of continuing funding, we are not able to continue this project position. The project has realized many accomplishments and has seen the same success as the Volunteer Program's nursing home counterpart. As an agency, the BOALTC will be conducting legislative advocacy to ensure that the achievements of this project are not lost. The BOALTC will be seeking authorization and funding to renew the Volunteer Ombudsman Program - Assisted Living in the future. I encourage you to contact your legislator to advocate for the program's importance and continuance.

DFHS is now officially DHS (Department of Health Services)

The Wisconsin Department of Health and Family Services (DHFS) is now officially known as the Wisconsin Department of Health Services (DHS). Other Important Changes include:

The website, which is now located at http://dhs.wisconsin.gov.
All Department employees have email addresses that are as follows: (first name).(last name)@wi.gov Example: John.Smith@wi.gov
Providers needing to get own AL memos from DHS should sign up using the E-mail Subscription Services
NOTE: old email address and link will be redirected until further notice.
Northern (Rhinelander) Regional Office Change- Susan Murphy is currently the intern Assisted Living Regional Director. They will be filling the position in the near future.

IRIS - a new alternative to Managed Care

This new program is called IRIS, which stands for "Include, Respect, I Self-Direct." Consumers who are eligible for publicly funded long-term care on or after July 1, 2008 in counties where Family Care is operating will now have another choice when deciding which program will best meet their needs. Please see Memo DLTC Info Memo Series 2008-06

Medication Waste

A difficult issue for facilities is the disposal of medications. Some can be considered as hazardous as lead or mercury. The Division of Quality Assurance has issued three memos (06-022, 07-008, and 08-003) which give facilities some sort of direction in the disposal process.

Although DQA has issued memos meant to help facilities, they do not specify a method of disposal. In addition to these memos, facilities should follow guidelines issued by the Department of Natural Resources, the Environmental Protection Agency, and other governmental agencies. Memos are located online.

Medication Stability in Food

The Division of Quality Assurance issued memo 07-012 regarding the involuntary administration of psychotropic medications. It maintains that the mixing of medications with food can be considered involuntary administration. It is because of this memo that a lot of discussion regarding the affects of mixing medications with food has arisen. Some medications cannot be given with food.

Crushed medication is sometimes mixed with applesauce or other foods and is then set aside. These foods may have low pH which will possibly begin to break down the medication, affecting its stability and effectiveness. If possible, avoid mixing medication with food, setting it aside, or storing it for later use. If medication is mixed with food, it should be administered immediately.

Integrated Evacuation Planning for Long Term Care Facilities

The State of Wisconsin expert panel on Healthcare Facilities Evacuation Planning has adopted a policy on the "Evacuation of Healthcare Facilities." LTC organizations helped in the development of the policy, and helped to identify a need to network, educate, and support such organizations. The city of Madison and the Metro Area Medical Response System have established a strategy to support long term area facilities within Dane County by offering training and technical assistance with development of comprehensive emergency management plans and evacuation procedures.

Melissa Waller, a consultant with Pre-Emergency Planning, LLC, will serve as the Dane County Long Term Care Disaster Preparedness Liaison. Her assistance will include training sessions, one-on-one or site visits, phone consultations, and resource networking to support the planning process with each facility. Training sessions will be offered to all LTC facilities in Dane County.

Statewide Waiver of Certain Sections of Wisconsin Administration Code Chapter HFS 88, Relating to the Provision of Information to an Aging and Disability Resource Center and Referral to a Resource Center - DQA Memo 08-019

With the passage of the State's budget, Adult Family Homes (AFHs) in counties with a resource center certified by the Secretary of the Department of Health and Family Services are no longer obligated to meet the requirements in Wis. Admin. Code Â§HFS 10.73(3) and (4). The purpose of this statewide waiver is to notify facilities of the elimination of the statutory requirement to (a) provide information about the services of an aging and disability resource center and available screening for family care benefit eligibility, and (b) the requirement to make referrals to an aging and disability resource center.

Recent FDA Medication Recalls and Compliance- DQA Memo 08-020

The Centers for Medicare and Medicaid Services (CMS) has become aware, during facility surveys nationally, of instances where facilities have not been in compliance with various Food and Drug Administration (FDA) recalls. Recent recalls have included heparin products and Digitex (r). These recalls were due to adverse effects occurring in patients, including deaths. Therefore, facility removal of the recalled products is imperative for patient safety. The FDA information on recalled products and lot numbers may be accessed at the FDA web site.

Pharmacy providers and distributors and health care providers should be monitoring their supplies, including, for example, crash carts and storage cabinets, and removing recalled products in order to assure that recalled products are not available for patient/resident use.

In response to the recent finding nationally, CMS has asked the state survey agencies to do the following:

Distribute a list of recalled heparin drugs to surveyors
Include a check of the possible presence of these recalled drugs during the course of surveys
Request a copy of any facility-written procedures for implementing drug recalls
Request a description of staff notification and education efforts used to ensure that recalled heparin is not used for patient care.

For further information, please contact Doug Englebert at (608) 266-5388.

Governor Proclaims June as Long-Term Caregiver Month

The Wisconsin Long Term Care Workforce Alliance today announced that it will roll out a campaign to recognize the critical and indispensable role long term care workers serve in maintaining the health, safety, and well being of Wisconsin's elderly and persons with disabilities beginning in June. Alliance

Chairperson, John Schnabl, noted that caregivers in all long term care settings need to be acknowledged and valued for their personal compassion and professional commitment in the care of Wisconsin's most vulnerable citizens: "Too often caregivers are not given the same respect and dignity they provide daily to those for whom they care. Their work is physically, mentally, and emotionally challenging and it's important that the public appreciates everything they do, every day."

The Alliance's awareness campaign includes a 60-second radio spot that will be aired statewide for a two-week period beginning June 9th. [More]

"Not in My Backyard" Bill hearing

SB 268 had a hearing on March 5. WALA and all provider associations testified strongly against it. It is - in our words - the "Not In My Backyard bill" which would limit the placement of assisted living and other types of facilities by making it (our words again) almost impossible for a DD or even ALZ facility to open in certain communities. There is a lawsuit pending against Mequon and other communities that have put similar legislation in place in their cities. [Info on Senate Bill 268]

List of Communicable Diseases Updated

Effective March 1, 2008, Wisconsin's list of Reportable Communicable Diseases changed. Revisions to Appendix A of Administrative Rule HFS 145 were adopted by the Department of Health and Family Services and published in the Wisconsin Administrative register on January 31, 2008. For a complete list and the implications of these changes, contact WALA.

Kevin Coughlin Wins Prestigious Award

Kevin Coughlin, Director of the Bureau of Assisted Living, was one of nine winners of Governing Magazine's Public Official of the Year. I met the writer, Penelope Lemov, at the awards dinner on November 6 in Washington DC at the legendary Willard Hotel, and she was impressed with Kevin, as you can see from her story. When I chatted with Elder Witt, the Deputy Publisher & General Manager of Governing Magazine, she emphasized that the award is for innovative collaborators.

Kevin, the shoe fits. Congratulations to you and your team. Kevin, we are proud.

Kevin Coughlin: Common-Sense Compliance

by PENELOPE LEMOV | photograph by MICHAEL KIENITZ

Photo of Kevin Coughlin "Kevin Coughlin wasn't a stranger to assisted-living systems when he took over the assisted-living program in Wisconsin in 2003 - he'd spent seven years managing a private facility before going to work for the state. But like Bratton (WALA note - another winner), he had a talent for asking the right questions. Why were all the state's assisted-living facilities being regulated the same way, when some clearly needed more attention and some could function with less? Coughlin's decision to rationalize the regulatory process led to myriad improvements across the state - and made Wisconsin a national model for meeting the growing demand for assisted living.

Kevin Coughlin didn't set out to turn Wisconsin's assisted-living system upside down. He just wanted to inject its regulatory process with a dose of common sense. But Coughlin's rational approach has, in fact, been both revolutionary and successful: He has managed to shift the old "gotcha" relationship between regulator and provider to a collaborative process that has translated into safer homes for the frail and elderly residents in the state's 2,700 assisted-living facilities."

Visit this page for more on Kevin or read the the full story on all the award winners.

The nine winners in 2007 are: Bill Bott, Deputy Chief Information Officer, Missouri; William J. Bratton, Police Chief, Los Angeles; Debra Campbell, Planning Director, Charlotte; Kevin Coughlin, Director, Bureau of Assisted Living, Wisconsin; Natwar Gandhi, Chief Financial Officer, Washington, D.C.; Christine O. Gregoire, Governor of Washington State; Bill Leighty, former Chief of Staff to former Gov. Mark Warner, Virginia; Fabian NÃºÃ±ez, Speaker, California Assembly; Bill White, Mayor of Houston.

HFS-83 Rewrite Hearings Scheduled

As you can see in the list of HFS-83 hearings dates and places, the public hearings on the HFS-83 rewrite begin December 7 and are scheduled for mid December in the five BAL regions. We just learned about this late last week and we are asking that you review the proposed rule and prepare your own views to the Initial Proposed Rulemaking Order. The purpose of the hearings is to give you, the public, a voice on the proposed rule and any changes you may wish to make. The rewrite had been a four+ year collaborative effort and WALA has been at the forefront of this process for you.

Now that the hearings are scheduled, it is critical that you read the proposed rule to determine its impact on the assisted living industry and your own operations.

You can easily access all the DHFS pertinent rewrite documents. WALA recommends that you review all the documents, though there may be some overlap between them. (The earlier 2006 version on the DHFS website was recently revised - be sure to use the most current revision at this link.)

We encourage you to send WALA your comments electronically to help us see if there are implications we may have missed. (Due to the short lead time, send electronically only, please.)

WALA will develop policy as approved by WALA Board of Directors for action. Talking points to be used by WALA members at the hearings will be determined from these policies. We encourage you to talk to each other, the WALA Board, Legislative Committee, other providers and those who will be impacted by the new rule to help formulate your own views and concerns about the proposed rule. The more people who review the documents the better chance there is in finding potential issues. We encourage you to testify and/or send comments to the state. Emailed comments from any WALA member are welcome - email comments to Jim Murphy at jmurphy@ewala.org.

Written comments to the state may be submitted at the public hearing or submitted to the contact person listed (Pat Benesh, Quality Assurance Program Specialist, Division of Quality Assurance, 1 West Wilson St. Room 1150, Madison, WI 53701 Phone: 608-264-9896 Fax: 608-267-7119 benespa@dhfs.state.wi.us). Comments may also be made using the Wisconsin Administrative Rule Website.

Legislative Update

Wisconsin Senate Replaces Senate Majority Leader the Day After Budget Passes - The day after the Wisconsin Legislature passed the State Budget, Senate Democrats who control the majority voted to elect a new leader. Senator Russell Decker (D-Weston) was elected to replace Senator Judy Robson (D-Beloit) as the Wisconsin Senate Majority Leader. The change has been treated by the press as being controversial. Senate Majority Leader Russell Decker last week announced the following changes to the Senate Committees:

Sen. Decker (D-Weston) replaces Sen. Robson (D-Beloit) as Senate Majority Leader.
Sen. Miller (D-Monona) was appointed as Co-Chair of the Joint Finance Committee.
Sen. Miller (D-Monona) will remain the Chair of the Senate Committee on Environmental and Natural Resources and Senate Democratic Caucus Chair.
Sen. Julie Lassa (D-Stevens Point) has been appointed as member of Joint Finance Committee.
Sen. Judy Robson (D-Beloit) has been appointed as member of Joint Finance Committee.
Sen. Robert Jauch (D-Poplar) was removed from the Joint Finance Committee.
Sen. Robert Jauch (D-Poplar) has been appointed Chair of the new Senate Committee on Tax Fairness and Family Prosperity.
Sen. Lena Taylor (D-Milwaukee), Chair of the Senate Committee on Judiciary and Corrections will also include "Housing" issues.
Sen. Jon Erpenbach (D-Middleton), the Chair of the Senate Committee on Health and Human Services Committee will also include "Insurance, Economic Development and Job Creation" issues.

Wisconsin Budget: Provisions Impacting Long-Term Care - As reported two weeks ago, the Wisconsin Legislature passed the 2007-09 Biennial Budget and Governor Doyle signed the proposal, with limited vetoes, into law. A 15-page comprehensive review of the final budget is available at WALA. Below is a shorter summary impacting long-term care providers. If you would like more detail on any of these provisions, please contact WALA lobbyist Forbes McIntosh at: mcintosh@broydrick.com.

Family Care: Statewide Expansion: Provide funding to allow statewide expansion of Family Care. In addition, provide a 3% rate increase in FY2008-09 to Family Care CMOs.
Family Care: "Any Willing Provider": Require Family Care CMO's to contract with any willing provider under certain criteria.
Family Care: Expand Ombudsman Services: Provide funding for 1 additional ombudsman position to provide services for Family Care enrollees.
MA: Retroactive Eligibility Repayments: Repeal current law provision that permits a health care provider to retain the difference between an amount an MA applicant or other person paid to the provider for an MA-eligible service and the amount MA paid to the provider after the individual became retroactively eligible for MA. Instead, require the provider, upon receipt of the MA payment, to reimburse the recipient or other person for services provided to the recipient during the retroactive eligibility period, by the amount of the prior payment.
MA: Asset Transfers: Implement new federal restrictions on asset transfers for MA eligible individuals enacted as part of the federal Deficit Reduction Act of 2005 (the DRA).
MA: Penalties for Submitting False Claims: Creates penalties for individuals that make false claims in order to obtain MA. (Much more details available upon request).
MA: Partnership\LTC Insurance & MA Eligibility: Repeal current law that directs DHFS to participate in the partnership program. Instead direct DHFS to pursue and amendment to the state MA Plan in order to participate in the partnership program. Institute certain requirements on LTC insurers.
Home Health: Personal Care: Provide 1.5% rate increase in FY2008-09 for home health services. No rate increases in FY2007-09 provided.
Home Health: Automated Monitoring System: Implement an automated provider monitoring system that would document all hours worked by home health, private duty nursing and personal care workers.
Home Health: Quality Home Care Commission: Annual $167,000 for DHFS to distribute to the WI Quality Home Care Commission to provide services to consumers and providers of homecare and personal care services. In other states this organization was created by SEIU to organize independent homecare workers.
LTC: Volunteer Ombudsman Program: Provide funding for 4 new training positions to recruit and train volunteer Board on Aging and LTC Ombudsman.
ICF-MR: Rate Increase: Increase ICF-MR bed assessment to provide a 2% annual rate increase for ICF-MRs and allow DHFS to set the amount of the bed assessment for each fiscal year, subject to a specified formula.
Nursing Home: Rate Increases, etc: If you are interest in nursing home rate increases; End Bed Assessment Skim; or Rock County Labor Region, contact WALA for details.

Memos of interest

Activity Professionals: Wisconsin DQA Memo 07-017 (October 10, 2007) - Approval of the Modular Education Program for Activity Professionals. Wisconsin representatives of a national activity professional association (WRAP) have requested the Bureau's approval of the "Modular Education Program for Activity Professionals." This course was developed by the National Association of Activity Professionals (NAAP) and the National Certification Council of Activity Professionals (NCCAP). This memorandum announces the Bureau's approval of this program as a "state-approved program." Any successful graduate of the program is considered a qualified activity professional under federal reg 42 CFR 483.15(f)(2)(iv).

COP Risk Reserve: This new informational memo clarifies the Department of Health and Family Services (DHFS) policy on approving the use of Community Options Program (COP) Risk Reserve and on awarding COP High Cost Funds as counties implement managed long-term care expansion. (CRAIG - Break here to end of this memo) Counties have asked the Department to clarify allowable uses of COP Risk Reserve funds prior to, and during, a transition to Family Care. COP Risk Reserve may not be used to offset the required contribution of county funds under managed long term care expansion. However a county may use COP Risk Reserve for the following purposes as detailed in the memo. The Complete memo 2007-12 is online at DHFS.

Legislative Bill Watch (Abridged. For additional, contact WALA)

SB 268: (CBRF, AFH Community Oversight) Community oversight of residential care centers for children and youth, group homes, community-based residential facilities, and adult family homes. (S-Economic Development, Job Creation, Family Prosperity and Housing)
SB 283: (Alzheimer Regulation) The care and treatment of persons with Alzheimer's disease or related dementia in residential care facilities, providing an exemption from emergency rule procedures, and requiring the exercise of rule-making authority (S-Public Health, Senior Issues, Long Term Care and Privacy).
AB 137: (Prescription Drugs) Eligibility for and deductible amounts under the prescription drug assistance program for the elderly, providing an exemption from emergency rule procedures, and requiring the exercise of rule-making authority (A-Health and Healthcare Reform).
AB 213: (MA Estate Recovery and LTC Insurance) Long-Term Care Partnership Program (A-Aging and Long Term Care).
AB 224: (Liability) Immunity from liability for a health care provider, health care facility, or employee of a health care provider or health care facility that, in good faith, reports a violation of the law or of a clinical or ethical standard by another health care provider, health care facility, or employee of a health care provider or health care facility.
AB-493: (Alzheimer Provider Regulation) The care and treatment of persons with Alzheimer's disease or related dementia in residential care facilities, providing an exemption from emergency rule procedures, and requiring the exercise of rule-making authority. A-Aging and Long Term Care

by Forbes McIntosh, WALA Lobbyist (Abbreviated - for complete info, contact WALA)

Elder Abuse Stores in the Newspaper

All this week the Wisconsin State Journal newspaper has been running a seven part series on elder abuse. Assisted living is mentioned as well. We encourage you to read the entire series at http://www.madison.com/wsj/ as it is not a pretty picture of how we care for our elderly. The Friday 11/9/07 story is titled, "Caregiving in Crises."

WALA is crafting a response to the story.

DQA FOCUS 2007 Registration Online

The Division of Quality Assurance has released registration details for their FOCUS 2007 conference on August 7 and 8 in Stevens Point. The pre-event on August 7 will cover abuse prevention, and is directed primarily at caregivers and supervisors; registration is $25 per person. The main conference on August 8 will cover a variety of topics throughout long-term care; the cost is $97. To register, call Leann Griffin at 608/267-1438 or visit their website.

Lodging is available at the conference host, the Stevens Point Holiday Inn and Convention Center (715/344-0200) and the Country Springs Hotel (800/998-2311). Ask for the "FOCUS 2007" block.

New Memo on Meds Disposal

After a flurry of questions at this year's WALA Conference, the Assisted Living Forum and more, a new memo has been developed to address issues of medication disposal. DQA 07-008: Medication Return, Donation and Disposal provides guidance for all categories of assisted living as well as a partial waiver of HFS 83.33(3)(j).

The waiver pertains to the 72 hour requirement for medication destruction or disposal. It states that if a CBRF contracts with a pharmacy or other company to dispose of their medication, it will be in compliance if the contractor picks up medication for disposal within 72 hours, or if the meds are locked away separate from active meds pending pickup. Read the full memo online

OQA Proposed To Become DQA

It seems like only yesterday (five months, to be exact) that we had to get used to saying "OQA, not BQA." Under a new proposal unveiled last week, the mantra would become "DQA, not OQA." The Department of Health and Family Services has asked the Department of Administration for permission to reorganize the long-term care side of DHFS.

OQA would be promoted to a Division; current OQA director Otis Woods would be the administrator of the new Division of Quality Assurance. The Division of Disability and Elder Services would be split in two, between a new Division of Long-Term Care and a Division of Mental Health and Substance Abuse.

These two rapid reclassifications within six months reflect the increased growth and importance of assisted living in Wisconsin. It is expected that this proposal will go through in the next month or two.

Biennial Budget: AL Highlights, Hearing Schedule

Governor Doyle released his 2007-09 biennial budget proposal last Tuesday. It included three primary items of interest to assisted living:

Family Care Expansion - Doyle proposed lifting the 50% cap on the program and expanding it statewide over the next five years.
No COP Increase - COP and other Medicaid Waiver programs received no funding increases in the budget.
RCAC Ombudsman - Under this budget, the Board on Aging and Long-Term Care would receive authority to expand the Ombudsman program into RCACs, although no additional positions or funding are provided. WALA has opposed RCAC Ombudsmen in the past, and we are planning to do so again.

The Joint Finance Committee will hold six public hearings on the budget in late March and early April:

Milwaukee - 3/20, 10:30 a.m.
Prairie du Chien - 4/4, noon
De Forest - 3/21, 10:00 a.m.
Rhinelander - 4/11, noon
Chippewa Falls - 3/27, noon
Green Bay - 4/12, 10:00 a.m.

Specific locations will be released in the near future. E-mail dbush@ewala.org if you are interested in testifying.

DHFS Offering Three Free Trainings Around The State

The Wisconsin Caregiver Project, an initiative of the state Office of Caregiver Quality, has developed three new trainings. Funded through a special grant from the Centers for Medicaid and Medicare Services, these programs are available to all direct care workers, managers and supervisors across the state. Trainings will be offered from March through June in various locations statewide. The three topics to be offered are: Responding to Challenging Situations, Conducting Internal Investigations and Experiential Training on Abuse and Neglect Prevention. For more information or to register visit the Wisconsin Caregiver Project

Doyle Wins Re-Election; Promises to Move Forward With Family Care Expansion

Governor Jim Doyle has become the first Democratic governor in 32 years to win re-election, defeating his Republican challenger U.S. Rep. Mark Green by a margin of 52 percent to 46 percent in the most expensive statewide contest in Wisconsin history. Voter turnout was above 50 percent and a number of wards in Milwaukee, Madison, Eau Claire and other cities reported ballot shortages and long lines. The Capital Times in Madison reported Doyle as saying that the expansion of Family Care is one of the top priorities for his second term. Current DHFS leadership and programming is not expected to change significantly.

Democrats Take State Senate, Gain in Assembly

Election day brought a power shift in the Wisconsin Legislature as Democrats won a majority in the State Senate and gained in the Assembly. Republican Sens. Dave Zien and Ron Brown, both of Eau Claire, and Tom Reynolds of West Allis were unseated, while the Democratic candidate won the open Senate seat in Racine County. Democrats now hold an 18-15 majority in the upper chamber.

In the Assembly, Republicans maintained control but apparently lost at least seven seats. An eighth remains in play, the 43rd district in northern and western Rock County, where Republican incumbent Rep. Debi Towns currently leads by six votes out of 20,000 according to the unofficial tally. Should Towns hold her seat the GOP majority will be 53-46, down from the current 58-39 (there are two vacant seats, both previously held by Republicans).

With the new partisan makeup of the Legislature, there will be significant changes to the membership of committees that affect assisted living. The ranking Democrat on the Senate Committee on Health, Children, Families, Aging and Long-Term Care is Sen. Jon Erpenbach of Middleton, who is likely to take over as chair. Joint committees will have equal membership between Democrats and Republicans, including the budget-setting Finance Committee and the Committee for Review of Administrative Rules, which will examine the HFS 83 rewrite later this year.

Marriage Amendment Passes, May Affect Seniors

The state constitutional amendment on marriage was approved with 59 percent voting in favor. Concern over the effect on seniors of the so-called second sentence, a clause banning arrangements "substantially similar" to marriage, had led the Coalition of Wisconsin Aging Groups to oppose the amendment. There is a strong likelihood of litigation to determine what "substantially similar" means with regard to issues like domestic partnerships, visitation rights and health care decision-making.

BQA To Become OQA

Reorganization within the Department of Health and Family Services will raise the profile of long-term care within the Department. On October 15, the Bureau of Quality Assurance will be moved out of the Division of Disability and Elder Services and become of the Office of Quality Assurance (OQA). Otis Woods, the current BQA Director, will report directly to the DHFS Secretary as OQA Director. There are currently no changes planned in how BQA/OQA is organized. [Read the full memo on the change - BQA 06-023]

New Memo Clarifies Medication Review for CBRFs

A new memo from the Bureau of Quality Assurance discusses the review of medication orders and administration in community-based residential facilities. HFS 83.33(3)(a)(2) requires administrators to arrange regular reviews of resident medication regimens and the facility's medication administration practices. BQA 06-021 allows physicians and pharmacists to review a resident's medications at their place of work, by looking at written records-prescriptions, orders, etc.-and submitting a written report to the facility. It also states that an on-site review of proper medication administration must accompany the annual written review, and discusses reporting requirements for on-site reviews. The full text of the memo is available on the web.

Have Breakfast with BQA

In conjunction with the Bureau of Quality Assurance, WALA is pleased to present Breakfast with BQA, a FREE program bringing providers and regulators together in an informal setting. For the second year, WALA is assisting the Bureau in its provider outreach efforts, sponsoring this opportunity for all providers to meet with their local regulators in an informal give-and-take session. Breakfast with BQA will be held in all 5 BQA regions in October:

Wednesday, October 4 - Appleton (Green Bay region)
Thursday, October 5 - Merrill (Wausau region)
Tuesday, October 10 - Eau Claire
Wednesday, October 18 - Milwaukee
Thursday, October 19 - Middleton (Madison region)

Last Chance to Have Your Say on Managed Care Seminar

In October, WALA will be presenting a special seminar on managed care and the expansion of Family Care. We are in the final stages of planning this session, and your input is needed in helping us finalize the content of this presentation. What do you need to know about the future of managed care in Wisconsin? Please e-mail Jim Murphy at jmurphy@ewala.org with your thoughts and questions-and watch your mailbox for information on our Managed Care Seminar!

Survey Guides Now On Internet

The BQA has begun making survey guides available on the Internet and will no longer be providing a paper copy at the start of a survey, unless a provider does not have Internet access and requests a copy. However, surveyors will continue to distribute a contact page listing the website address, surveyor's name, surveyor's supervisor and contact information for both. [Survey guides.]

Federal Requirement to Verify Citizenship and Identify of Medicaid Recipients

On June 21, WALA received a memo from DHFS Secretary Nelson on the new federal requirement to verify citizenship and identify of Medicaid recipients. As you can see, DHFS could not move until they received guidelines from CMS, the federal Centers for Medicare and Medicaid Services. This makes the July 1 deadline very close.

WALA will let you know as we hear more

Nursing Home Diversion Slots Filling Up

IDHFS has already begun implementation of the Nursing Home Diversion Program approved by the Governor and Legislature in April. A memo was distributed at the May 16 Assisted Living Forum describing the status of the program. It outlines the criteria by which individuals are screened and lists the constraints on the program. Particularly, it states that a total of 150 slots are available statewide and the maximum per diem reimbursement is $85. Interested providers should contact their county's human services department ASAP; 20 slots had been filled at the time of the Forum. The full text of this memo can be viewed on the WALA website.

Managed Care Is Coming-What Do You Need To Know?

WALA is preparing a seminar this fall on the expansion of Family Care. We want to include the latest, most relevant information, and we need your help to put it together. What do you need to know about the future of managed care in Wisconsin? There are some major changes coming, and every provider needs to be prepared and informed.
Help us put together the best seminar we can for you! Please contact Jim Murphy at jmurphy@ewala.org or 608/288-0246 with your questions and comments.

New DHFS Hotline Established For Public Health Disasters

A 24-hour hotline has been established for providers to report public health emergencies. DHFS has trained staff on call if providers are faced with natural disasters, chemical or radiological incidents, communicable diseases or local human services crises. Additionally, fires resulting in serious injury or death must be reported to the hotline. The number is 608/258-0099; callers should identify themselves and have as much information as possible on the incident they are reported. More information is in BQA memo 06-008.

Variance Granted For New TB Test

The current HFS 83 requires that CBRFs administering a tuberculosis screening use the Mantoux 5TU PPD test. On May 2 the FDA approved another test, QuantiFERON-TB GOLD. Based on this approval, BQA is granting a statewide variance for providers to use the new test if they choose. Details on the new test can be found in BQA memo 06-009.

TPA/TABOR Defeatedâ€”Help Us Thank Legislators

After a flurry of activity in the closing days of the Legislature, a broad-based coalition of over a hundred organizations-including WALA-defeated the TABOR/TPA initiative. Thank you to everyone who contacted the six members of the State Senate we targeted, all of whom voted against TABOR/TPA. Your efforts were crucial in getting out the message that TABOR/TPA would hurt long-term care

FamilyCare Expansion Bill Signed

The bill to expand the FamilyCare program statewide from its five-county "pilot" phase was approved by the Legislature and signed by Governor Doyle on May 10. Now the initiative shifts to DHFS and the counties directly. There are ten consortia representing nearly all of Wisconsin's counties who are currently working to develop implementation plans for statewide FamilyCare.

WALA's position continues to be that programs to expand access and consumer choice in long-term care are good for Wisconsin, so long as providers receive adequate reimbursement to deliver quality care. We will make clear that FamilyCare is not a magic wand; the issue of adequate reimbursement for public-pay residents must be addressed if Wisconsin seniors are going to have a high-quality system of long-term care, especially with the coming retirement of the baby boom generation.

WALA is planning to bring you more information on the FamilyCare expansion at our Quality Outcomes Regional Workshop, to be held around the state in early October. More details will become available as the program comes together

Joint Finance Committee Approves FamilyCare Expansion, With Changes

Senate Bill 653/Assembly Bill 110, which would expand FamilyCare to more eligible individuals around the state, was approved by the Joint Finance Committee with a few changes. Amendments included a requirement for DHFS to continue evaluating the program on an ongoing basis, and a required review process by the Joint Finance Committee before the program can be expanded from its current level to 50% of the eligible state population.

The legislation was approved in early March by the State Senate, but would have to be approved again in its revised form. The full Assembly has not yet voted on it.

BQA Transportation Memo Now in Effect

The Bureau of Quality Assurance has officially put into effect their memo on transportation safety policies. It requires facilities that transport residents to develop and implement written policies to ensure the safety of residents. The final memo has been revised from the original draft released last fall; the most significant change is that the number of items required in a policy has been reduced to four, and those items have been streamlined and simplified. The full text of the memo is available on the BQA website.

Medicare Part D Helplines Now Available

Two new telephone helplines for Wisconsin residents trying to navigate the tangled web of Medicare Part D have been established. The Coalition of Wisconsin Aging Groups is helping adults 60 and over; their number is 866/456-8211. The Wisconsin Coalition for Advocacy has a line for those with disabilities under age 60 at 800/926-4862.

WALA would like to express our appreciation to the providers, pharmacists and advocates who have been going the extra mile to help those we serve go through the difficult task of transitioning into this new program.

RFOSes are now ALRDs

The BQA Assisted Living Section announced a change in title for all regional heads at the January Assisted Living Forum. Fomerly called Regional Field Operations Supervisor (RFOS), the head of each region will now be known as the Assisted Living Regional Director (ALRD)

From 2005

Provider Profiles Now Available on BQA Website

After much discussion and work, the Bureau of Quality Assurance has finally make provider profiles available on the Internet.

These profiles include information on surveys and complaints, and are listed by facility name (not by corporate owner). Survey summaries include the result of each survey, a listing of any Statements of Deficiency issued, and whether or not the SODs were corrected. Complaint summaries include the basis of the complaint and whether or not it was substantiated. There is also a listing of any forfeitures that have been assessed, but it does not include specific dollar amounts.

The initial profiles were posted with the results of surveys through September 2005. AL Section Chief Kevin Coughlin has told WALA that in future, there will be a minimum 3 month delay before an SOD or complaint is added to a profile, to allow time for the investigation and appeals processes.

WALA encourages you to review your facilities' profiles regularly. If you find any inaccuracies in your profile, contact your regional BQA office.

Draft BQA Memo on Transporting Residents Released

At the November Assisted Living Forum in Madison, Kevin Coughlin, the Assisted Living Section Chief at the Bureau of Quality Assurance, distributed a draft memo that will apply to all BQA-regulated providers. The memo would require that all providers who transport clients, residents or patients develop and implement written policies to ensure safety. Spurred by incidents involving residents or clients left in vehicles, the memo is intended to build awareness among providers and staffs. It includes a number of items which must be included in a written policy:

A plan for in-service training of staff and volunteers who transport,
A plan for supervising those under transport,
A procedure to assess the risks of a given individual under transport,
A plan to address the safety of those under transport, and
A plan to evaluate the effectiveness of these policies.

The full text of the draft memo can be found on the WALA website or you can request a copy by calling Daniel Bush at 608/288-0246. This memo is on a fast track for implementation in January. If you have any comments, send them to dbush@ewala.org and we will forward them to BQA.

BQA No Longer Mailing Quarterly Updates

The south-central Wisconsin chapter of the Alzheimer's Association will be presenting a three-part educational series for families of those diagnosed with Alzheimer's or related dementia. "ABCs of Alzheimer's and Dementia" is designed to enhance participants' understanding of the disease, how it affects the patient and how to cope on a daily basis.

Sessions will be held on Wednesdays, October 5, 12 and 19, from 6 to 8 p.m. at Lake Edge Lutheran Church in Madison. The sessions are free, but donations are appreciated. For more details or to register, contact the Alzheimer's Association at 608/232-3400.

DHFS Announces Long-Term Care Reform Initiative

As part of reforming the state's Medical Assistance Program, the Department of Health and Family Services has issued a Request for Information to help DHFS develop strategies for faster, better implementation of statewide long-term care reforms, and to identify ideas for added federal MA waiver requests or other state/federal policy changes to enable cost-effective, timely reforms. Public and private organizations, industry groups and multi-county consortia are invited to give their input on long-term care reform. Additionally, DHFS has issued a Request for Proposals for planning and start-up grants, intended for regional partnerships that would be able to prepare for new service delivery models in 2007-09.

The ultimate goal of these reforms is to give consumers the flexibility offered by the full spectrum of long-term care, while making sure that care is cost-effective and accountable to taxpayers. The deadline for comments or proposals is December 31st. More details and forms can be found on the DHFS website.

Symposium on Best Practices in Caregiver Retention in Milwaukee Nov. 9

The Milwaukee Aging Consortium will be holding a symposium on Best Practices for Caregiver Retention as part of their Caregiver Retention Project. Keynoting the event is Di Findley, Executive Director of the Iowa CareGivers Association, and a number of breakout sessions on caregiver retention statistics and strategies are included. The symposium is on Wednesday, November 9th from 8:30 a.m. to 3:00 p.m. at Summit Place in West Allis. Registration is $15 and includes lunch. For more information or to register, call 414/289-0890. The registration deadline is Thursday, November 3rd.

Free Alzheimer's Educational Seminar Coming to Madison Nov. 8

The Wisconsin Comprehensive Memory Program at the UW Medical School will present its fourth annual community education seminar, "Alzheimer's Disease: The Complete Picture," on Tuesday, November 8th from 6 to 8 p.m. at Monona Terrace in Madison. Attendance is free, and registration is not required. For more details, contact the program at memory-research@medicine.wisc.edu or 608/263-2582

Cris Ros-Dukler Leaving BQA

Cris Ros-Dukler, the Director of the Bureau of Quality Assurance, will be leaving the Bureau in September. She has taken a position as Vice President of Growth and Development with a Chicago-based healthcare company, and will work in the Milwaukee area. Her last day with BQA will be September 9. WALA wishes Cris all the best in her new position.

ABCs of Alzheimer's and Dementia Coming to Madison

Doyle Vetoes Medicaid Increases, Makes Additional Cuts

Exercising his line-item veto power, Governor Jim Doyle left his mark on Wisconsin's 2005-07 biennial budget, which he signed on Monday. His veto message to the Legislature reflects

Adult Family Home Reclassification Proposed

The Department of Health and Family Services has drafted a proposal to reclassify adult family homes.

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