The Department of Health Services is in the early stages of developing a fee schedule for some Medicaid home and community-based services.
It’s one of the initiatives funded by hundreds of millions of federal dollars coming into Wisconsin due to the American Rescue Plan Act.
DHS is targeting supportive home care and personal care services as well as those provided in four residential settings: one-to-two-bed adult family homes, three-to-four-bed adult family homes, residential care apartment complexes and community-based residential facilities.
“This is the scope at this time because ultimately this in and of itself will be a significant lift,” Grant Cummings, director of the Bureau of Rate Setting at DHS, told members of the Long Term Care Advisory Council on Tuesday.
Cummings said they’re focused on maintaining access and minimizing disruption for members. Transparency is also a priority, and they’re hoping to work with providers, managed care organizations and advocates to create fair rates.
“We want to be adequate for the work being done, but also, for the state’s fiscal interests, we want to be efficient in the rates that we are setting,” he said.
Cummings said that they’re speaking with managed care organizations to identify the activities provided by each service and hope to create a uniform definition and develop draft cost tiers.
They’re planning to survey providers this fall, with a goal of having the actuarial firm Milliman develop draft rates by February.
The rates would be open for public feedback in March, with finalization expected in April. They’d take effect in July.
The plan came out of a recommendation from the Governor’s Task Force on Caregiving to establish rate bands.
LeadingAge CEO John Sauer, who was a member of the task force and helped develop its rate bands proposal, said he’d like the focus to be on developing “fair and equitable rate bands” rather than the “sense that these are minimum rate bands.”
“What we’re really looking for is to move away from the rate suppression that really resulted in suppression of wages and benefits for caregivers,” he said. He hopes the rate bands “better reflect” the needs for wages and benefits.
Cummings said a fee schedule would require all providers to be paid the same, even those that are being paid more that that now. Having a minimum fee schedule allows them to set a floor while requiring managed care organizations to provide the services members need, he said.
That provides more flexibility for implementing the initiative too, Cummings added.
DHS staff also provided an update on other efforts funded by the dollars due to the American Rescue Plan Act, including a one-year pilot aimed at providing services to those expected to become eligible for Medicaid to keep them off the program.
The pilot, estimated to cost around $40 million, would provide around 5,000 Wisconsinites with an up to $7,200 annual benefit. It would last a year and be administered by up to 10 aging disability resource centers and tribal aging and disability specialist agencies.
Those covered by the pilot could use the money for a wide variety of services, including medical equipment, assistive technology, home and vehicle modifications, and transportation. Dollars could also go to personal care, care management, home care, meals and internet services.
Carrie Molke, director of the DHS Bureau of Aging & Disability Resources, said that 3 percent of older adults in the state are on Medicaid programs.
“There’s a whole lot of other people who are also very much in need and are on the cusp of needing more help,” she said. “We’re trying to keep people healthier longer and not having to spend down all of their personal resources to qualify for that in a full-benefit Medicaid program.”
Curtis Cunningham, DHS assistant administrator for benefits and service delivery, said they’re also planning to provide around $15 million through a first round of grants to enhance, improve and strengthen home and community-based services.
They’re hoping to roll the application out next month, with recipients receiving between $200,000 and $2 million.
The federal government recently gave states an additional year, until March 2025, to spend the dollars made available through the American Rescue Plan Act.
That “obviously creates an interesting dynamic” for how the projects might interact with the state’s 2023-25 biennial budget process, including for a 5 percent rate increase that went into effect earlier this year, Cunningham said.