HomeMy WebLinkAboutResolution 2016 (51) Resolution No. 51 (2016)
ST ROUK,,, RESOLUTION REGARDING IMPLEMENTATION OF THE
' ' MARCH 2014 CENTERS FOR MEDICARE AND MEDICAID
SERVICES HOME AND COMMUNITY BASED SERVICES
REGULATIONS
1 WHEREAS, for nearly 120 years St. Croix County has been providing care for people,
2 beginning in 1897 when the County first opened a setting to serve residents with mental illness;
3 and
4
5 WHEREAS, continuation of this commitment to providing care was reaffirmed when the
6 St. Croix County Board of Supervisors approved bonding to build a new 50 bed public nursing
7 home with the addition of two community based residential facilities (CBRF), one 10 bed facility
8 for dementia and one 40 bed facility for memory care and frail elderly; and
9
10 WHEREAS, the total project budget is approximately $21,400,000 and the County has
11 contracted with an architectural firm that has designed a person-centered resident-directed
12 neighborhood model; and
13
14 WHEREAS, the new 50 bed nursing home and 10 bed CBRF will be completed in
15 November of 2016 and the 40 bed CBRF is estimated to be completed in September of 2017; and
16
17 WHEREAS, the addition of the community based residential facilities will provide
18 seniors an opportunity to age in place should they desire to do so; and
19
20 WHEREAS, the new 10 bed community based residential facility will provide services
21 for individuals with dementia which is aligned with needs identified by the State of Wisconsin in
22 work that was completed in February of 2014 on Dementia Care System Redesign-A Plan for a
23 Dementia-Capable Wisconsin; and
24
25 WHEREAS, the implementation of the March 2014 Centers for Medicare and Medicaid
26 Services (CMS) Home and Community Based Services (HOBS)regulations assures that
27 Medicaid-waiver beneficiaries receive home and community-based services which are fully
28 integrated into their communities and that the settings where services are delivered are non-
29 institutional; and
30
31 WHEREAS, in the March 2014 regulation, CMS presumes that certain settings have
32 institutional qualities and do not meet the requirements for home and community-based settings,
33 thus are ineligible to provide home and community-based services unless such settings are able
34 to overcome this presumption via a heightened standard of proof, and
35
36 WHEREAS, St. Croix County must meet the heightened standard of proof as the
37 community based residential facilities are on the grounds of the publicly operated nursing home;
38 and
39
40 WHEREAS, in June of 2015, after receiving and reviewing St. Croix County's request
41 for heightened scrutiny review, Wisconsin Department of Health Services Secretary Kitty
42 Rhoades forwarded this request to U.S. Department of Health Services Secretary Sylvia Burwell;
43 and
44
45 WHEREAS, in March of 2016, on behalf of St. Croix County, U.S. Senator Baldwin
46 received a response from CMS which indicated that a setting presumed to have qualities of an
47 institution could not be determined to be compliant with the home and community-based settings
48 regulatory requirement until it is operational and occupied by beneficiaries receiving services
49 there, as to comply with the settings regulations, requirements beyond the physical structure of
50 the setting itself must be met; and
51
52 WHEREAS, in addition to the physical location and design, the June 2015 St. Croix
53 County request for heightened scrutiny also included community integration, resident's rights
54 and person's experience; and
55
56 WHEREAS, given the now articulated response from CMS, St. Croix County must
57 resubmit the heightened scrutiny request once individuals are served because as a new provider
58 of community based residential services, St. Croix County is not afforded the opportunity to
59 work with the State of Wisconsin to address the presumption of ineligibility and become
60 compliant by March 17, 2019 which is the time frame afforded existing providers that must
61 address similar presumptions; and
62
63 WHEREAS, the March 2016 decision by CMS for St. Croix County will limit access to
64 Medicaid beneficiaries at our facility until such time as a resubmittal and CMS approval is
65 received; and
66
67 WHEREAS, this decision is likely to limit future development of other like providers
68 that serve Medicaid beneficiaries; and
69
70 WHEREAS, within our local area, access for Medicaid beneficiaries to community
71 based residential facilities is a concern and may result in seniors accessing higher cost
72 institutional care to meet their needs; and
73
74 WHEREAS, at a joint meeting of the Ad Hoc Health Center Construction Committee
75 and the Health and Human Services Board held on September 29, 2016 a motion to submit this
76 resolution at the next Health and Human Services Board meeting was unanimously approved.
77
78 THEREFORE, BE IT RESOLVED by the St. Croix County Board of Supervisors that
79 the 10 bed and 40 bed community based residential facilities on the grounds of the St. Croix
80 County Health and Rehab Center, a 50 bed public nursing home, should be granted the ability to
81 serve home and community based waiver recipients in need of services at the onset of the facility
82 opening, and be afforded the opportunity to demonstrate to the State of Wisconsin Department of
83 Health Services and CMS that the setting overcomes the presumption of ineligibility prior to the
84 March 17, 2019 effective date of the CMS HCBS regulations.
85
86 FURTHER, BE IT RESOLVED that the St. Croix County Board of Supervisors directs
87 the County Clerk to forward this resolution to the office of the Governor, Assembly Members
88 and Senators representing St. Croix County, Wisconsin U.S. Senators, U.S. 7th District
89 Representative, Wisconsin Counties Association, Wisconsin Department of Health Services
90 Secretary, and the Chairperson and Ranking Member of the U.S. Senate Special Committee on
91 Aging.
Legal–Fiscal–Administrative Approvals:
Legal Note:
Fiscal Impact: No fiscal impact
e
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Headwr a] nssi51mc C Camel 16 hent M' Fin ice irectur I 016
Pa County Admini 1.0l6l2016
10/11/16 Health & Human Services Board APPROVED
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RESULT: APPROVED [UNANIMOUS]
MOVER: Ron Kiesler, Vice Chair
SECONDER: Paulette Anderson, Supervisor
AYES: Logelin, Babbitt, Coulter, Long, Kiesler, Anderson, Leibfried, Rasmussen
ABSENT: Lisa Ramsay
Vote Confirmation.
ltvp Supw r 10/12/2016
St. Croix County Board of Supervisors Action:
Roll Call -Vote Requirement– Majority of Supervisors Present
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RESULT: ADOPTED [UNANIMOUS]
MOVER: Jill Ann Berke, Supervisor
SECONDER: Ron Kiesler, Supervisor
AYES: Sicard, Ring, Coulter, Sjoberg, Long, Bergren, Nelson, Berke, Ostness, Larson,
Hansen, Kiesler, Brinkman, Peterson, Anderson, Achterhof, Leibfried, Peavey
ABSENT: Christopher Babbitt
This Resolution was Adopted by the St. Croix County Board of Supervisors on November 1, 2016
Cindy Campbell, County Clerk
SUSAN IM COLI INS,IWIiAINI: U AMI
CHAIRMAN RANIKIN(�II H
'11n i ted �6, gate s � elate
SPECW COMM�11 EE ON M.3ING
WASHINCT(A, DC )01310-6400
(202) 224 5364
September 6, 2016
Mr. Michael Nardone
Director, Disabled and Elderly Health Programs Group
Centers for Medicare and Medicaid Services (CMS)
US. Department of Health and Hurnan Services
7500 Security Blvd
Baltimore, MD 21244
Dear Mr. Nardone:
We write to express concern regarding implementation of the home and community-
based services regulation issued by the Centers for Medicare and Medicaid Services (CMS) in
March 2014, We appreciate CMS's ongoing efforts to ensure that Medicaid beneficiaries
receiving horne and community-based services are fully integrated into their Communities, and
that the settings where home and community-based services are delivered are non-
institutional. We are hearing from our constituents, however, that certain aspects of the rule lack
clarity and that iriore specific guidance is needed to ensure a smooth transition process and to
avoid unintentional barriers to seniors' accessing important horne and com munity-based
services, including those provided in assisted living cornmunities.
Under the Social Security Act, states are required to provide long term care services
and supports in institutional settings, but all 50 states and the District Of Columbia also exercise
an option to provide home and community-based services to certain Medicaid beneficiaries who
would otherwise require an institutional level of care. It is our understanding that in the home
and co mmunity-based services regulation, CMS sought to improve individual choice and
promote community integration in order to ensure that beneficiaries have full access to the
benel'its Of COMITILInity living and are able to receive services in the most integrated setting
appropriate to their needs. As part of this effort, the final rule established new criteria for horric
and community-based care settings in order to be eligible for federal Medicaid reimbursement.
In the rule,, CMS stated an intent to dol-ine home and community-based settings by the
"nature and quality of individual's experience," instead of relying exclusively on "a setting's
location, geography, or physical characteristics." CMS also presumes, however, that certain
settings are ineligible to provide home and community-based services unless such settings are
able to meet a heightened standard of proof. Settings that are presumed ineligible under the rule
include. (1) settings located in a building that is also a publicly or privately-owned facility
providing inpatient institutional treatment; (2) settings located in a building on the grounds of or
immediately adjacent to a public institution; and (3) settings which isolate individuals receiving
Medicaid home and cornmunity-based services from the broader community. States bear the
responsibility ror ensuring that home and community-based services are delivered in eligible
Web Sile:hKp://,q(ingso'nale,gov
1 ,
settings, and must develop a plan to bring any non-compliant programs into compliance by
March 17, 2019,
We arc concerned about reports that the absence of guidance explaining CMS'
interpretation of the new requirements has led to a lack of clarity and created confusion among
providers that may ultimately limit their ability to serve Medicaid beneficiaries. In particular, we
seek more information regarding the criteria for basing whether certain settings are presumed
ineligible and how affected providers can complete the heightened scrutiny process to reverse
such a determination, including for: (1) secured memory care units; (2) assisted living
communities located in rural areas; and (3) assisted living communities that are located in a
separate or converted section, or on the campus of a nursing home.
Many seniors may find themselves unable to locate another appropriate non-
institutional setting should CMS ultimately determine that many of the assisted living settings
presumed ineligible under the rule are not eligible for federal financial participation. Because
seniors may have needs that can no longer be met through home health care alone, they may be
fbreed to transition into higher cost and more restrictive institutional settings, which seems
contrary to CMS's intent. There is strong demand among seniors for many of the specific
characteristics of these settings that arc subject to heightened review, Many seniors, for
example, prefer to, live near a nursing home or other such facility where more intense services
are readily available should they be needed. This can ease transitions for individuals with
conditions that might not follow a predictable trajectory, and may allow married couples to live
near one another in cases where care needs differ. Additionally, many seniors prefer to live in
rural areas and doing so may actually increase their proximity to loved ones.
We appreciate your prompt consideration of the concerns we have raised regarding
challenges faced by providers and seniors under the rule and took forward to your response.
Sincerely,
Susan M. Co tins Claire McCaskill
Chairman Ranking Member