Tuesday, May 24, 2011

From Sara Finger

Tuesday, May 24, 2011

 6:21 PM 

Committee takes up MA omnibus

Among the provisions:

- Adopts alternative 1 from budget paper 340. Increase funding in the bill by $45.4 million in 2011-12 and $53.2 million in 2012-13 to reflect funding adjustments summarized in discussion point 16 of the LFB paper. In addition, revise statutory provisions relating to the UW lapse to the MA trust fund to reduce the annual lapse amounts in 2011-12 and 2012-13 from $27.5 million to an amount up to $20.3 million annually.

Also, adopt alternative 2 with a modification. Increase funding in teh bill by $15.5 million in 2011-12 and $40.5 million in 2012-13 to reflect revised enrollment growth projections.

Also, delete the provision in the bill that would require DHS to lapse $25 million in the first year of the biennium.

- Adopt alternative 1 in budget paper 341, which would adopt Gov. Walker's proposal to reduce funding for the MA program by $133.3 million in 2011-12 and by $333.3 million in 2012-13 to reflect the administration's estimate of the savings achieved by making various unspecified changes to the MA program.

In addition, adopt alternative 2b from the LFB paper which would require DHS to submit quarterly reports to the JFC containing: updated descriptions of any MA changes implemented by DHS; updated estimates of the projected savings from those changes; and updated projections of the total MA benefit expenditure during the biennium and an analysis of how the expenditures compare with the funding provided.

- Adopt alternatives A1, B1, C1, and D1 in budget paper 342. The motion would prohibit DHS from enrolling more people into Family Care, Family Care Partnership, PACE or IRIS programs than the total number of persons participating in all of those programs in that ADRC region on June 30, or the effective date of the bill, whichever is later. DHS could only enroll people in the long-term care programs that are offered in that person's county of residence.

The enrollment cap would not apply after June 30, 2013. The months when the provision is in effect would nto be counted toward a person's statutory requirement that DHS have sufficient capacity to offer the Family Care benefit to all entitled people after the first three years the benefit is available in a county.

DHS could enroll any individual into the Family Care-related programs who is relocated from a nursing home, intermediate care facility for the mentally retarded, or State Center for People with Developmental Disabilities if the individual has resided in the facility for at least 90 days, the facility is not licensed, an emergency exists or the facility is closing or downsizing.

In addition, DHS is required to do a cost-effectiveness study of the programs compared to one another and to standard MA card services. The findings must be presented to the JFC by March 1, 2012.

Under the motion, care management organizations that provide the Family Care benefit are prohibited from including in their contracts with providers any provision that would require providers to return funding in excess of the cots of service to the CMO.

Also, provide $12.6 million in 2011-12 and $12.6 million in 2012-13 to fund Family Care services to individuals on waitlists who are in urgent need of long-term services, as determined by DHS. The funds must specifically be used to serve individuals on a temporary basis until the individual is permanently enrolled in the program.

- On budget paper 343, increase funding for SeniorCare by $6.8 million in 2011-12 and by $3.3 million in 2012-13 to reflect a reestimate of the costs to fully fund the program, based on current law.

- Adopt alternative 5 from budget paper 344, which would eliminate the governor's proposal to require SeniorCare participants to enroll in Medicare Part D.

- Adopt alternative 1 from budget paper 345, adopting Walker's proposal to institute a Medicare Part A cutback. Reduce funding in the bill by $1.7 million in 2011-12 and $2.4 million in 2012-13.

- Delete the governor's recommendation in budget paper 346 to eliminate base funding for the EACH payment and to repeal statutory provisions relating to this payment. Increase funding in the bill by $4.3 million in 2011-12 and $4.3 million in 2012-13 to support supplemental payments to hospitals.

- Adopt alternative A3 in budget paper 348, which would increase funding in the bill by $465,700 GPR and $713,700 FED in 2011-12 and by $468,100 GPR and $711,300 FED in 2012-13, so that $39.1 million would be budgeted for supplemental payments to municipal nursing homes annually.

- Orders DHS to study whether using competitive bidding for the purchase of generic drug equivalents provided to MA recipients would generate savings. A report is due to the JFC by Dec. 31.

-- Prohibit DHS from requiring prior authorization for wheelchair repairs that cost less than $300 for power wheelchairs and $150 for manual models. The provision would apply to all MA-related programs.

- Require DHS to seek approval from the Centers for Medicare and Medicaid Services that would permit friends and family of individuals enrolled in MA to contribute to the individual's burial trust, up to a limit of $4,500, without the individual losing eligibility in the MA program.

- Repeal provisions from 2011 Act 10 authorizing DHS to promulgate rules to implement MA program changes that conflict with the specific statutory sections identified in the Act 10.

Instead, establish a passive review process for any changes to the MA program that would otherwise be in conflict with statutory sections specifically identified in Act. 10.

- On budget paper 347, adopt modification to reduce funding by $532,600 in 2011-12 and $607,800 in 2012-13 to reflect revised estimates of project payments to Wisconsin Physician's Services, based on a reestimate of the number of children who will be enrolled in the CLTS and Birth-to-3 programs.

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