New Horizons Un-Limited Inc.
Redesigning Wisconsin's Long Term Care System: Updated Summary
June 6, 1998
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The following is a brief NHU summary of the updated proposal by the Wisconsin Department of Health and Family Services (DHFS) to be submitted in the biennial budget request to the Governor, fall 1998 and to be considered by the State Legislature in 1999. The DHFS has updated the proposal as of April 1998. To view the DHFS summary of the updated proposal, visit the DHFS website under Long Term Care.
This new redesign to the service system for elderly and disabled people who need long term care and support is part of Governor Tommy Thompson's plan called "Family
Care." There are alterations that will affect Medicaid and will need Federal approval before this new system can go into effect.
Consider the NHU and DHFS summary of the proposal. This proposal has very long term consequences for possibly the rest of your life. Make sure it is going to be not only better, but at least adequate in meeting your needs. Even though you may be young or you are caring for a young, disabled person, understand that long term care is extremely difficult to obtain. Planning well in advance is absolutely essential.
Currently, the DHFS, various Centers for Independent Living, and other government agencies are sponsoring Consumer Forums at locations throughout Wisconsin regarding the new redesign proposal to gain further information on consumers' concerns, questions, and thoughts.
Plan to attend these Consumer Forums, forward your comments
to the DHFS, or contact your local Center for Independent Living to express
your opinion and views of the new LTC redesign.
Wisconsin's Long Term Care Redesign:
NHU Summary of the Updated Proposal
by the Wisconsin Department of Health and Family Services
- The new proposal covers older adults and other adults with disabilities, physical or developmental. Children may also be covered, and persons with mental illness, through
a separate, but linked system.
- Aging and Disability Resource Centers are proposed to be located in each
area of the state. These centers are proposed to provide information, assistance,
several services, options, benefits and resources for individuals and their
families. This is referred to as "one-stop shopping" to help both older adults
and the disabled and yet is supposed to maintain independence.
- Funds from all the past complex and confusing programs are proposed to be pooled
together to fund one new program called the "LTC benefit".
Yet, this program is supposed to be specifically tailored for each individual.
- A person must meet defined functional eligibility criteria. The
requirements are based on one's ability to manage everyday activities
for living independently of which there are two levels: comprehensive
(more severe) and intermediate (less severe).
- The new benefit will be managed by Care Management Organizations
(CMOs) whose task will be to manage support and services in a
cost-effective manner. These organizations may be public or
private, and are not supposed to be for profit.
- The CMO will receive a fixed monthly payment in relation to the
person's need for everyone enrolled in the program. It is
expected that the payments received by the CMO will be higher or lower
than the actual cost. However, this is not supposed to limit or expand one's
care.
- Community Options, Nursing Home Options, and Other Residential
Options are the main categories in which services will be offered by
the new benefit. However, in addition to these categories and services, the
new benefit is supposed to cover any other services a consumer may need.
- The costs of the services will be shared between the clients and
CMOs based on the extent if one's ability to pay. People with disabilities
who work are not supposed to lose their benefits.
- Institutional bias is proposed to be eliminated with the new program. People
with high levels of need are not supposed to be put on waiting lists.
- The LTC benefit will only be available through CMOs. At the
locations in which this takes place, Community Option Programs
and Community Based Waivers are not to be operated as separate programs.
- The consumer and their family will take part in the assessment
and care plan and where one decides to live is supposed to be his or her choice.
However, CMOs are proposed to take into consideration values, preference, quality,
cost, ability to meet needs in developing the care plan and living arrangements.
- Part of the legislation proposes a consumer bill of rights to protect consumers in settings and to include existing rights.
- There is proposed to be a complaint, grievance, and appeal procedure to aid
in the assurance that the program maintains a consumer focus and the
new system will focus on meeting the consumers requirements.
- For this proposal to obtain Federal approval the new system cannot
cost more than the LTC services under the current system.
Information for this editorial was obtained from the Wisconsin DHFS Long Term Care: Summary of LTC Redesign Proposal, April 1998.
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