Wisconsin’s Rehabilitation Services and Managed Care for People with Disabilities Featured at New York Summit
Senior executives and other members of the New York State Rehabilitation Association (NYSRA) will learn about Wisconsin’s experience with managed long-term care from Thomas Cook, executive director, Rehabilitation for Wisconsin in Action at the Rehabilitation Summit in Albany, N.Y. Mon., Sept. 10, 2012.
Cook will provide the keynote address “Community Rehabilitation Services: A Work in Progress,” and is a featured speaker for a breakout session, “Lessons Learned and Opportunities Explored under Managed Care: An Interactive Dialogue.”
Wisconsin’s long-term managed care program, Family Care, has been in the news as the result of a class action lawsuit filed Aug. 21, 2012 in the U.S. District Court for the Western District of Wisconsin against the Wisconsin Department of Health Services (DHS), DHS Secretary Dennis Smith, and three managed care organizations in the program - Care Wisconsin, Community Health Partnership, and Northern Bridges. The Family Care lawsuit is being followed closely in New York, which is adopting a similar managed care program.
Since 1972, Cook has worked in direct support, operational, policy, design, and consulting roles related to services for people with disabilities. He began serving as RFW's executive director in Oct. 2008. Under Cook’s leadership, RFW in Action was the first provider association to support calls for a legislative audit of Family Care, Wisconsin’s managed care and long-term care program for frail elders and people with disabilities. Cook is currently consulting with the state of North Dakota as part of the JVGA – Potentia team on the use of the Supports Intensity Scale for resource allocation and service planning for people with intellectual and developmental disabilities.
Journal Sentinel reporter Nicole Levy wrote an in-depth article about the hazards people with developmental disabilities, their families, and caretakers are facing when saving money is more important than providing safe, healthy, and consistent services for Wisconsin's most vulnerable citizens.
Managed care organizations like Care Wisconsin have trimmed the rates they pay residential providers over the last few years, but this year's cuts are more drastic because Family Care is serving more clients on a budget that hasn't grow enough to accommodate them, residential providers say.
On March 19, in response to an order by the federal center for Medicaid and Medicare, Gov. Scott Walker lifted an enrollment cap of 43,000 members that the state Legislature had placed on Family Care last year. The cap had been instituted to restrain the program's rising costs (60% of which are financed by federal Medicaid), to re-evaluate its stability and to reduce some of the state's $3.5 billion budget deficit.
The Aug. 31 New Richmond News features an op-ed about shrinking government resources and changes in Wisconsin's long-term care system for people with disabilities.
On the Family Care website, four goals for the system are outlined at the very top of the page:
1. CHOICE: Give people better choices about the services and supports available to meet their needs.
2. ACCESS: Improve people’s access to services.
3. QUALITY: Improve the overall quality of the long-term care system by focusing on achieving people’s health and social outcomes. 4. COST-EFFECTIVENESS: Create a cost-effective long-term care system for the future.
For some in the system, the fourth goal now seems to be the primary focus of state bureaucrats. For those clients whose daily reimbursement rates have been cut in half, neither choice nor access nor quality can possibly be improved as a result.
The New Richmond News reports that the Wisconsin Department of Health Services has been slashing the Family Care program budget, and published an article today, "Family Care rate cuts have clients, families up in arms." (PDF download. Article not yet available online).
On Aug. 22, 2012, Attorney Rock Pledl filed a lawsuit on behalf of 26 individuals with disabilities in the United State District Court for the Western District of Wisconsin against the Wisconsin Department of Health Services (DHS), DHS Secretary Dennis Smith, and three managed care organizations (MCOs) in the Family Care program - Care Wisconsin, Community Health Partnership, and Northern Bridges.
The legal complaint (PDF) details drastic cuts that were made in the payment rates for residential services, forcing housing providers to make discharge notices to the guardians of people with developmental disabilities.
The plaintiffs are currently being served in homes operated by larger corporate providers and in smaller owner-occupied homes. The suit alleges that payment reductions made by the MCOs were coordinated with DHS and that, as a result, the residential providers can no longer safely maintain these individuals in their community.
In one case, the payment rate for a 44 year-old man with behavioral challenges was reduced by Community Health Partnership (CHP) from $177.51 a day in 2008 to $56.66 a day in June 2012. In another case, the daily rate for a 34 year-old non-ambulatory man who is 100 percent dependent on group home staff for all personal hygiene and other care was reduced by Northern Bridges (NB) from $284.70 to $112.00 in August 2012.
The day programs of at least two of the plaintiffs are also being affected by the rate cuts. One individual was forced by CHP to give up one day of programming at RFW in Action member St. Croix Industries so that she could live in a home operated by Paradigm Services. Another plaintiff who is served by RFW in Action member Diversified Services in a supported employment enclave, is uncertain about whether she will be able to keep her job after the owner-occupied adult family home gave notice to NB that she could no longer be served at the lower payment rate.
The complaint asks the court for a “permanent injunction directing all of the defendants to: (1) restore the rates paid to residential providers who serve the plaintiffs and the proposed class members to the rates in effect on January 1, 2012, and (2) maintain residential provider rates at the January 1, 2012 level until the defendants develop an accurate method of setting residential provider rates that does not discriminate against individuals with developmental disabilities.”
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Earn continuing education credits from more than 30 learning sessions, including these must-attend pre-conference workshops.
- Aging With Developmental Disabilities: Adapting Person-centered Supports to Changing Health and Social Needs
- Technology to Support People with Cognitive-behavioral Challenges in the Workplace
- Increasing Non-profit Sustainability & Impact in a Rapidly Shifting Marketplace
There's a terrific article in the West Bend, Wis., Daily News that explains The Threshold's early intervention services, also know throughout the state as a Birth to Three program. The Bauder family connected with The Threshold to help their two-year-old son improve his speaking ability when his father noticed he only had about 10 percent of the language skills that are typical of children that age.