Rick Abrams
Chief Executive Officer

Dear WiCAL Members:

As Wisconsin continues to see steady growth in the assisted living sector, The Wisconsin Health Care Association and Wisconsin Center for Assisted Living remains committed to serving our assisted living members through their financial, regulatory, and workforce challenges. We value your trust and confidence in our continued work, and we are honored to serve so many assisted living providers committed to serving their communities.

Assisted living continues to demonstrate its importance as part of Wisconsin’s health care continuum, and the profession is not immune to many of the challenges facing the health care sector:

• Operational costs have increased significantly due to hyper-inflation that has required providers to boost salaries and pay premium prices to staffing agencies, as well as skyrocketing costs for the goods and services you need so that you can care for your residents;
• Ongoing workforce shortages, as providers continue to be challenged to attract and retain staff;
• A trend of increased assisted living regulatory scrutiny by the state across all settings; and
• Continued payment challenges as providers navigate Wisconsin’s Family Care system, including challenges related to MCO rate payments.

Despite growing challenges in Assisted Living, you keep coming back each and every day to care for your residents. WHCA/WiCAL staff remain inspired by your commitment to your residents and staff, and we thank you for all that you and your colleagues continue to do for your residents, your staff, and the communities you serve.

As we look back on 2023 and also turn our attention toward the future, it is clear that we continue to make tremendous progress as an organization and as a profession. WHCA/WiCAL would like to provide our WiCAL members with a year-end review of our advocacy efforts on behalf of Assisted Living providers across Wisconsin, including ongoing efforts and the outcomes of advocacy from earlier in the year.

• Budget success:
  • WHCA/WiCAL was integral in securing important funding in the 2023-25 state budget for Family Care, including $264 million in additional state and federal funding:
    • $38.5 million for the Direct Care Workforce Fund, and
    • $226 million over the biennium to maintain a 5% cost-to-continue increase for HCBS.
  • Our success with the 2023-25 state budget builds upon the success that we achieved in the 2021-23 budget:
    • $104.2 million increase in Direct Care Workforce Fund;
    • Increases in facilities’ capitated rates of 3.5% in May 2021 and 5% in January 2022. Both of these increases are retained in the 2023-25 state budget.

• Minimum Fee Schedule:
  • WHCA/WiCAL is currently working along with other provider associations and the Department of Health Services (DHS) to advocate for additional funding for minimum fee schedule implementation. DHS intends to submit a funding request to the legislature’s Joint Finance Committee (JFC) for approval of $269 Million in one-time American Rescue Plan Act (ARPA) HCBS dollars to fund implementation. WHCA/WiCAL is active in advocating for this funding, and is already engaging with key legislators. One potential challenge is that some JFC members may be reluctant to accept the one-time infusion for implementation of the minimum fee schedule if it means the state will have to continue that funding level with state dollars in the next budget, or else cause a “cut” to rates.
  • Our main priority right now is securing the $269 Million through direct lobbying and member mobilization to targeted legislators. DHS has indicated that they have a contingency plan in case the Joint Finance Committee does not accept their request for use of ARPA dollars. We would have to review any plan to ensure it benefits providers – but again, our focus for now is on the $269 Million.
• Legislative issues:
  • Also included in the budget was a $5 million earmark for a Complex Patient pilot. We have heard from many SNF providers that one part of the solution to finding proper placement for complex patients in post-acute settings will be the availability of assisted living beds once the individual is ready for discharge from the SNF to a lower-acuity/more appropriate setting. WHCA/WiCAL is proposing a plan to allow nursing homes and assisted living settings to apply for funding to care for different profiles of complex patients, including Mental Health, Behavioral Needs, Substance Use Disorder including alcohol and drugs, Wound Care, Obesity, Dialysis, Non or semi ambulatory disability and intravenous therapy.
  • We are engaging with a state senator on a bill he has authored which would create an Essential Visitor program during outbreaks of communicable disease in hospitals and in post-acute settings, including assisted living centers. We have worked with the bill author to make sure the legislation is not overly burdensome on providers. For example, the author agreed to add language to the bill which gives providers the ability to forego the bill’s requirements if the facility would instead prefer to rely on CDC or CMS guidance during an outbreak. The bill has also been amended to provide liability protections for providers.
    • The bill is far from a sure thing to be taken up by the legislature and signed into law, but we wanted to make sure that the bill’s policy was as workable as possible in case it sees any momentum.
  • We have also engaged with another state senator on a bill that would create more burdensome notice requirements for some circumstances of involuntary discharge. The bill only applies to SNF and CBRF. We oppose the bill. We also don’t want to see the concept extended to other settings, including RCAC and AFH. We did offer a potential alternative idea that was more provider-friendly, but at this point we believe the senator plans to maintain the bill’s general framework as-is. We are confident that our opposition to the bill will make it very difficult for it to move much further in the legislative process.
  • WHCA/WiCAL has also been made aware of draft legislation to require additional requirements of AFH operators when a home determines it must close or change level of services/accepted payor types. The bill would require AFHs to provide comprehensive relocation services in cooperation with DHS and any MCOs in those circumstances, similar to current requirements for nursing homes and CBRFs. WHCA/WiCAL has begun preliminary outreach to the legislator who drafted the bill to share provider concerns, primarily that AFHs are not equipped with staff to handle the workload involved in the comprehensive relocation planning and implementation of the plan.
• Ch. 88/Adult Family Home state regulations:
  • WHCA/WiCAL recently met with Bureau of Assisted Living (BAL) staff to discuss a number of issues, including Ch. 88 (at our request). The last update we received from BAL was that the Ch. 88 redraft is currently being processed within the DHS Office of Legal Counsel. At that point, the draft rule will then be made available for public comment. We do expect the new rule draft to be published in the near future. WHCA/WiCAL asked BAL personnel directly if they made significant changes to the initial Ch. 88 draft after receiving feedback from the Advisory Committee, along with WHCA/WiCAL and other stakeholders, but BAL was careful not to share too much detail ahead of publication of the new draft.
    • Once the new draft is published, there will be a 30-day public comment period. WHCA/WiCAL will review the new rule and likely convene our Ch. 88 work group for a discussion and for mobilizing providers to submit comments.
  • On a related note, DHS recently released draft new standards for 1-2 bed certified adult family homes. WHCA/WiCAL is currently in the process of reviewing these proposed standards.

• Political/campaign efforts:
  • Outside of our direct lobbying and member advocacy efforts, WHCA/WiCAL also has been successful in increasing our presence on the campaign front. In 2022, WHCA/WiCAL successfully raised about $220,000 in campaign donations, including nearly $175,000 in corporate donations and about $45,000 in individual donations to the WHCA/WiCAL Political Action Committee. We continue to be active in raising funds for 2023 and will once again look to be a major player in the 2024 election cycle on both sides of the aisle. While the Wisconsin legislative floor session is expected to adjourn in March or April of 2024 at the latest, we will have regular exposure to key decisionmakers at numerous events throughout the campaign season and into 2025. We believe it is important to support those decisionmakers who support the LTC sector, and being a major player on the fundraising side also gives us more opportunities to speak with legislative leaders ahead of the next budget cycle.

WHCA/WiCAL welcomes any questions, thoughts, or concerns you may have either about our 2023 advocacy efforts, or about future advocacy. Further, we remain committed as your association to serving your individual needs as a member. Whether it be clarification on payment issues, or guidance with regulatory issues, or ensuring quality educational and member services are available to you, we are committed to being your ultimate resource as an assisted living provider. Remember: you are not alone in the work you do, and WHCA/WiCAL stands ready to assist you in your noble work however we can. Please do not hesitate to reach out to WHCA/WiCAL staff at any time.

Sincerely,

William “Rick” Abrams
CEO
rick@whcawical.org
516-241-2879 (cellular/text anytime)