Public Notices

public_notices Wisconsin Administrative Register No. 678, 6/14/2012

Public Notices

Health Services

WAIVER RENEWAL

DEPARTMENT OF HEALTH SERVICES

NOTICE OF PUBLIC HEARING

NOTICE IS HEREBY GIVEN that pursuant to s. 49.688, Stats., the Department of Health Services will hold a public hearing on renewal of the SeniorCare program, which requires the submission of a waiver renewal application to the federal Centers for Medicare and Medicaid Services (CMS).

Hearing Date(s) and Location(s)

Date and Time	Location
Thursday, June 28, 2012 10:00 a.m. to 12:00 noon Friday, June 29, 2012 10:00 a.m. to 12:00 noon	Portage County Annex 1462 Strongs Avenue Stevens Point, WI 54481 State Office Building 141 NW Barstow, Room 151 Waukesha, WI 53188

Testimony may be presented at either of the two hearings through a telephone conference line. After you call the conference line at [phone], please enter the access code 5906120.

Accessibility

English
DHS is an equal opportunity employer and service provider. If you need accommodations because of a disability or need an interpreter or translator, or if you need this material in another language or in an alternate format, you may request assistance to participate by contacting Al Matano at [phone]. You must make your request at least 7 days before the activity.

Spanish
DHS es una agencia que ofrece igualdad en las oportunidades de empleo y servicios. Si necesita algún tipo de acomodaciones debido a incapacidad o si necesita un interprete, traductor o esta información en su propio idioma o en un formato alterno, usted puede pedir asistencia para participar en los programas comunicándose con Kim Reniero al número [phone]. Debe someter su petición por lo menos 7 días de antes de la actividad.

Hmong
DHS yog ib tus tswv hauj lwm thiab yog ib qhov chaw pab cuam uas muab vaj huam sib luag rau sawv daws. Yog koj xav tau kev pab vim muaj mob xiam oob qhab los yog xav tau ib tus neeg pab txhais lus los yog txhais ntaub ntawv, los yog koj xav tau cov ntaub ntawv no ua lwm hom lus los yog lwm hom ntawv, koj yuav tau thov kev pab uas yog hu rau Al Matano ntawm [phone]. Koj yuav tsum thov qhov kev pab yam tsawg kawg 7 hnub ua ntej qhov hauj lwm ntawd.

Copies of Waiver Documents

A copy of waiver documents, including the waiver application once complete, may be obtained from the department at no charge by downloading the documents from http://www.dhs.wisconsin.gov/seniorcare/ or by contacting:

Regular Mail
Al Matano
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 53707-0309

Phone
Al Matano
[phone]

FAX
[phone]

E-Mail
[e-mail]

Analysis Prepared by the Department of Health Services

Statute interpreted:

Section 49.688, Wis. Stats.

Statutory authority:

Section 49.688, Wis. Stats.

Explanation of agency authority:

Section 49.688 (11) directs the department to request from the federal Secretary of Health and Human services a waiver, under 42 USC 1315 (a), of federal Medicaid laws necessary to permit the Department of Health Services to conduct a project to expand eligibility for medical assistance, for purposes of receipt of prescription drugs as a benefit.

Related statute or rule:

N/A.

Plain language analysis:

The State of Wisconsin Department of Health Services (DHS) is requesting a three-year extension of its Section 1115 Demonstration Waiver for the SeniorCare prescription drug assistance program. The current waiver is scheduled to expire on December 31, 2012. The State requests that the waiver be extended for an additional three-year period, from January 1, 2013 to December 31, 2015.

The Department will request a waiver extension that keeps the SeniorCare program in its current form. Per the recommendation of the SeniorCare Advisory Committee, the Department will add one enhancement to the SeniorCare program: an enhancement to services provided to members by their pharmacist to assist them with taking their medication properly.

History of the Program

On July 1, 2002, The State of Wisconsin received the necessary waiver approvals from the Center for Medicare & Medicaid Services (CMS) to operate a portion of SeniorCare, a prescription drug benefit for seniors, as a five-year demonstration project. Through its partnership with the federal government, the SeniorCare waiver extends Medicaid eligibility through Title XIX to cover prescription drugs as a necessary primary health care benefit.

Population and Numbers Served

The target population for services under this demonstration project is seniors 65 years of age or older with income at or below 200% of the federal poverty level (FPL), which is $22,340 for an individual and $30,260 for a two-person family in 2012. Each month the SeniorCare waiver program serves about 60,000 seniors.

Summary of, and comparison with, existing or proposed federal regulations:

The federal equivalent to SeniorCare is Medicare Part D. SeniorCare is the only program of its kind.

Agency contact person:

  Al Matano
Division of Health Care Access and Accountability
P.O. Box 309
Madison, WI 53707-0309
[phone] (telephone)
[phone] (fax)
[e-mail]

Place where comments are to be submitted and deadline for submission:

Comments may be submitted to the agency contact person listed above or to http://www.dhs.wisconsin.gov/seniorcare/ until Monday, July 16, 2012 at 4:30 p.m.

Fiscal Estimate

A copy of the full fiscal estimate may be obtained from the department's contact person listed above upon request.

Health and Family Services

(Cost sharing component of Medicaid 2014 and BadgerCare Plus Demonstration Projects)

The State of Wisconsin reimburses providers for services provided to Medical Assistance recipients under the authority of Title XIX of the Social Security Act and ss. 49.43 to 49.47, Wisconsin Statutes. This program, administered by the State's Department of Health Services, is called Medical Assistance (MA) or Medicaid. In addition, Wisconsin has expanded this program to create the BadgerCare and BadgerCare Plus programs under the authority of Title XIX and Title XXI of the Social Security Act and ss. 49.471, 49.665, and 49.67 of the Wisconsin Statutes. Federal statutes and regulations require that a state plan be developed that provides the methods and standards for reimbursement of covered services. A plan that describes the reimbursement system for the services (methods and standards for reimbursement) is now in effect.

Section 1115 of the Social Security Act provides the Secretary of Health and Human Services broad authority to authorize Research & Demonstration Projects, which are experimental, pilot, or demonstration projects likely to assist in promoting the objectives of the Medicaid statute. Flexibility under Section 1115 is sufficiently broad to allow states to test substantially new ideas of policy merit.

In September 2011, the Wisconsin Department of Health Services provided on its website an outline of its proposal to initiate the Medicaid 2014 Demonstration Project, a Research & Demonstration Project under the authority of Section 1115. Public comment was invited at that time as well as at the public hearings held on October 19 and 21. The waiver was approved by the federal government on April 27, 2012. Two waivers were approved - the Wisconsin Medicaid Section 1115 Health Care Reform Demonstration, and the Wisconsin BadgerCare Plus Health Insurance for Childless Adults Demonstration.

These two Demonstration Projects will be an initiative to test the policy impacts of the federal law on Medicaid to go into effect in 2014, including crowd-out policies, cost-sharing requirements, and adverse selection provisions.

The Patient Protection and Affordable Care Act (PPACA) will fundamentally change policies that govern state Medicaid programs. Wisconsin submitted these federal 1115 waivers to pilot several policies that will prepare our BadgerCare Plus programs to better align with the pending changes in federal law.

Cost Sharing

PPACA requires families and individuals to purchase insurance that will require premium and copayment contributions. Under PPACA, families purchasing private insurance would receive tax credits that would limit the cost of premiums to a percentage of family income. The percentages would range from 3.5% for families with income at 133% of the Federal Poverty Level (FPL) to 9.5% for families with incomes of at least 300% of the FPL. According to a recent study released by the Urban Institute, the estimated average annual premium cost for families with incomes between 138% and 200% FPL is $1,559 in 2014, with additional estimated out-of-pocket expenses of $457.

Wisconsin's Demonstration Projects will move toward aligning BadgerCare Plus cost-sharing provisions with those authorized by PPACA. This will demonstrate the impact of cost-sharing provisions on lower-income families above the poverty line. Questions the waiver evaluation will address will include whether or not participants will pay cost sharing, as well as whether or not the cost-sharing requirements will slow the growth of health care spending. The demonstration will consider policy choices related to the alignment of benefits and the equity of cost-share provisions for Medicaid, the Basic Health Plan and subsidized insurance.

Proposed Changes - Implementing Wisconsin's Demonstration Projects

As previously noted, the Wisconsin Department of Health Services is preparing to implement the recently approved Demonstration Projects, which will be Research & Demonstration Projects under the authority of Section 1115. Under the demonstrations, adults aged 19 and older who are eligible for BadgerCare Plus for families or are eligible for BadgerCare Plus for Childless Adults and have family incomes in excess of 133% of the FPL will be required to pay a monthly premium, unless they are otherwise exempt. Persons exempt from paying a premium are pregnant women, persons with a confirmed disability and members of American Indian tribes or Alaskan Natives and others eligible to receive services from Indian Health Services.

Failure to pay the required premium will result in the adults having a 12-month period of ineligibility for BadgerCare Plus for families or BadgerCare Plus for Childless Adults.

As required under federal law, Early and Periodic Screening & Diagnostic Treatment Benefit (EPSDT) services are to be provided to individuals under 21 years of age as an additional benefit under section 1937 of the Act.

In addition to this public notice, Wisconsin's tribes were consulted at a meeting of the Tribal Health Directors on October 25, 2011. The effective date of this change will be July 1, 2012. The projected fiscal effect of this initiative is an annual savings of $23.9 million general purpose revenue (GPR) and $35.8 million federal match (FED) for a total savings of $59.7 million all funds (AF) beginning July 1, 2012.