Wisconsin Department of Health Services

Bill HannaArea Administration Director

WHSFMA ConferenceMay 6, 2015

Department of Health Services

Fiscal Updates

Wisconsin Department of Health Services

2015-2017 State Budget

• Aging & Disability Resource Centers• Emergency detention procedures• Mental health treatment program

consolidation • Community Options Program (COP) re-

allocation of funding & creation of Children’s Community Options Program (CCOP)

Wisconsin Department of Health Services

MH Consolidation & CCOP

* Note the new base funding for COP does not include transfers made in the Medicaid cost to continue re-estimate budget item to reflect implementation of Family Care in the seven northeast counties in 2015.

Wisconsin Department of Health Services

New MH Community Aids

Profile 559 – IMD Regular +Profile 571 – IMD OBRA +Profile 501 – CSP Waitlist +Profile 517 – Certified Mental Health Program +Lesser of full COP allocation (profile 367) or actual 2013 COP expenditures for MH/AODA =NEW Mental Health Community Aids

* Note this is the Governor’s budget proposal and is subject to change during the budget process

Wisconsin Department of Health Services

CCOPProfile 577 – Family Support +Remaining COP funds* (profile 367) after the reallocation to MH community aids =Children’s Community Options Program

* This provision only applies to counties not operating a legacy long-term care program (CIP/COP-W).* *Note this is the Governor’s budget proposal and is subject to change during the budget process

Wisconsin Department of Health Services

Prepayments• DHS will not issue prepayments beginning

in 2016• Federal government will not allow DHS to

draw federal funds prior to expenditures being reported

• DHS does not have the budget authority to fund prepayments with GPR

Wisconsin Department of Health Services

DHS 1 – Uniform Fee• The Secretary has authorized the

Department to begin the rule making process to update DHS 1

• DHS published a memo dated March 18, 2015 to provide clarity related the DHS 1 https://www.dhs.wisconsin.gov/uniform-fee/dhs-1-uniform-fee-system-memo.pdfo A client must have an established ability to pay

before a county can bill or otherwise pursue payment

o Inpatient care is subject to ability to pay provisions

Wisconsin Department of Health Services

Audit Resolution Team• DHS has a new Department wide

comprehensive approach to reviewing County audits

• Super circular places more emphasis on internal controlso Segregation of dutieso CARS reports and reconciliations being reviewedo Information technology

• Other common findingso Proper contract procedures o Purchase of service audits reviewedo Proper claiming and allocation methodologies

Wisconsin Department of Health Services

Autism Benefit Changes

• Federal requires autism services to be provided via Medicaid not a waiver

• The children’s long term support (CLTS) program will continue to provide other support and services to eligible children

• Tentative changes will be effective 1/1/16 pending approval from the federal government

• Sign-up to receive updates via email: https://www.dhs.wisconsin.gov/clts/waiver/autism/updates.htm

Wisconsin Department of Health Services

WIMCR & CCS Reconciliations

• Trainings scheduled May 18 – 22• 2014 CCS cost reporting manual is available:https://www.dhs.wisconsin.gov/publications/p0/p01009.pdf https://www.dhs.wisconsin.gov/publications/p0/p01009-iv.pdf

• Residential rate setting and billing guidancehttps://www.dhs.wisconsin.gov/ccs/expansion/ccsresidentialratesettingguidance.pdf

• 2013 WIMCR pick-up session scheduled May 1 – 29

• 2014 cost report scheduled June – August

Wisconsin Department of Health Services

Income Maintenance Operational Analysis

• A comprehensive assessment of IM administration across the State

• Required by the 2015 DHS/IM consortia contract• Four phases

o Planning (April – May)o Data Gathering (May – July)o Analysis (July – September)o Reporting (September)

• The project seeks to identify efficiencies gained through the current IM model and share practices supporting efficient IM program operations while maintaining high quality customer service.

Wisconsin Department of Health Services

ICD 10• ForwardHealth will require ICD-10 diagnosis codes

and ICD procedure codes to be indicated, when applicable, on claim and prior authorization request submissions with dates (dates of service, dates of discharge, requested start dates, etc.) on and after October 1 , 2015

• The ForwardHealth ICD-10 Code Set Transition Home Page provides FAQs, trainings, references, and resources

https://www.forwardhealth.wi.gov/WIPortal/Tab/42/icscontent/html/ICD10/ICD10Home.htm.spage#