Legislative Audit Bureau
January 27, 2000
The Honorable, The Legislature:
We have completed an evaluation of county nursing home funding, as directed by the Joint Legislative Audit Committee. In fiscal year (FY) 1998-99, the State provided $698.1 million in state and federal funds to care for Medical Assistance recipients requiring skilled care in 417 skilled nursing facilities, including 47 that are county-owned.
Administrators of county-owned facilities have expressed concern that current Medical Assistance funding is not sufficient to cover their costs. In FY 1998-99, 44 of the 47 facilities reported deficits, which totaled $66.6 million. County officials argue these deficits were incurred, in part, because their facilities provide care to a disproportionate share of residents who present challenging behaviors in addition to their other medical needs and who are more costly to care for than other nursing home residents.
Based on our analysis, it appears that residents of county-owned facilities generally present more challenging behaviors than residents of privately owned facilities. For example, as part of the most recently completed facility certification survey, the percentage of residents reported to exhibit challenging behaviors was 41.9 percent in county-owned facilities, and 27.1 percent in privately owned facilities.
To address their concerns, county officials have suggested the State increase reimbursement through the Intergovernmental Transfer program, which provides direct supplemental payments to county-owned facilities. County officials believe additional reimbursement is justified because the percentage of county losses funded by this program has declined each year since the program's creation, from 86.1 percent in FY 1993-94 to 55.7 percent in FY 1998-99.
If the Legislature believes additional funding is warranted, it has a number of options for increasing reimbursements to counties and other skilled nursing facilities that serve individuals exhibiting challenging behaviors. However, such increases would require the Legislature to appropriate additional general purpose revenue to fund program costs, may serve as a disincentive to controlling county nursing home costs, and may hamper efforts to increase the amount of care provided in less restrictive, community-based settings.
We appreciate the courtesy and cooperation extended to us by the Department of Health and Family Services and by the county officials and administrators of the nursing facilities we contacted during the course of the audit. The Department's response is Appendix IV.
Sincerely,
Janice Mueller
State Auditor
State of Wisconsin
Ethics Board
February 1, 2000
The following lobbyists have been authorized to act on behalf of the organizations set opposite their names.
For more detailed information about these lobbyists and organizations and a complete list of organizations and people authorized to lobby the 1999 session of the legislature, visit the Ethics Board's web site at
http://ethics.state.wi.us
Beglinger, Robert Wisconsin Federation of Teachers
Fitzgerald, Moira E Northwestern Mutual Life Insurance Company
Kammer, Peter Wisconsin Energy Corporation (formerly Wis Electric Power Co)
Kammer, Peter Milwaukee Metropolitan Sewerage District
Schwartzer, Daniel Wisconsin Association of Provider Networks
Springer, Thomas J Wisconsin Academy of Ophthalmology
The Honorable, The Senate:
Also available from the Wisconsin Ethics Board are reports identifying the amount and value of time state agencies have spent to affect legislative action and reports of expenditures for lobbying activities filed by the organizations that employ lobbyists.
Sincerely,
Roth Judd
Director
__________________
Relating to the scheduling of certain drugs under ch.
961, Stats., the uniform controlled substances act.
Submitted by Department of Regulation and Licensing.
Report received from Agency, January 28, 2000.
Referred to committee on Health, Utilities, Veterans and Military Affairs, February 1, 2000.
__________________
The committee on Economic Development, Housing and Government Operations reports and recommends:
Relating to delivery of an ordinance to adopt or repeal a county or premier resort area tax.
No action taken.
Robert Wirch
Chairperson
__________________
Senator Robson, with unanimous consent, asked that the Senate recess until 11:51 A.M..
10:36 A.M.
11:51 A.M.
The Senate reconvened.
Senator Risser in the chair.
__________________
Senate Bill 99
Relating to: certain statutes dealing with motor vehicle dealers, salespersons and sales finance companies (Revision Bill).
Read a second time.
Ordered to a third reading.
Senator Chvala, with unanimous consent, asked that the bill be considered for final action at this time.
Senate
Bill 99
Read a third time and passed.
Senate Bill 215
Relating to: deferred payment agreements between public utilities and customers.
Read a second time.
The question was: Adoption of Senate substitute amendment 1 to Senate Bill 215?
Adopted.
Ordered to a third reading.
Senator Chvala, with unanimous consent, asked that the bill be considered for final action at this time.
Senate
Bill 215
Read a third time and passed.
Senate Bill 241
Relating to: programs for children at risk of not graduating from high school.
Read a second time.
The question was: Adoption of Senate amendment 1 to Senate Bill 241?
Adopted.
Ordered to a third reading.
Senator Chvala, with unanimous consent, asked that the bill be considered for final action at this time.
Senator Zien, with unanimous consent, asked to be added as a coauthor of Senate Bill 300.
Senator Zien, with unanimous consent, asked to be added as a cosponsor of Assembly Bill 448.
Senator Drzewiecki, with unanimous consent, asked to be added as a coauthor of Senate Bill 300.
Senator Drzewiecki, with unanimous consent, asked to be added as a cosponsor of Assembly Bill
448.
Senate Bill 241
Read a third time and passed.
Senate Bill 242
Relating to: planning grants for retained 4th graders and making an appropriation.
Read a second time.
Senator Burke, with unanimous consent, asked that Senate Bill 242 be referred to the Joint Committee on Finance.
Senate Bill 259
Relating to: creating a consumer privacy advocate in the department of justice and making an appropriation.
Read a second time.
Senator Burke, with unanimous consent, asked that Senate Bill 259 be referred to the Joint Committee on Finance.
