Bi-Monthly State Health Officer Briefing

1. Bi-Monthly State Health Officer Briefing Sheri Johnson, Ph.D. DPH Administrator & State Health Officer February 23, 2007

2. Agenda Announcements 07-09 Governor�s Budget � overview Workforce Grant Update FLIP � Facilities Licensing Inspection Program Wrap-Up

3. SHO Bi-Monthly Webcast Material & Agenda Link http://dhfs.wisconsin.gov/aboutDHFS/dph/webcast/index.htm

4.  Announcements

5. Governor�s 07-09 Biennial Budget Bill Themes DHFS-related Provisions SAGE: $20. 8 million GPR biennial increase for SAGE program of lower class sizes for K-3; $2,250 per pupil, beginning 2007-08 4K: $3 million for 4-year old kindergarten starting 2008-09 School Breakfasts: 50% increase in state�s reimbursement rate Wisconsin Covenant Scholars: program for students who maintain B average in high school and stay out of trouble; guarantees college education; 8th graders in Spring of 2007 first class to sign, for college entry in 2011 Child Care Subsidies: proposing several measures to make up declining federal funds in this arena, including a child care co-payment of $10 per month for a family of four, with income at 100% of the federal poverty limit (approx $20,000 in 2006) $2.8 million for child care rating system $2.4 million for education for child care workers $9.8 million for emergency assistance to families, including impending homelessness SAGE: $20. 8 million GPR biennial increase for SAGE program of lower class sizes for K-3; $2,250 per pupil, beginning 2007-08 4K: $3 million for 4-year old kindergarten starting 2008-09 School Breakfasts: 50% increase in state�s reimbursement rate Wisconsin Covenant Scholars: program for students who maintain B average in high school and stay out of trouble; guarantees college education; 8th graders in Spring of 2007 first class to sign, for college entry in 2011 Child Care Subsidies: proposing several measures to make up declining federal funds in this arena, including a child care co-payment of $10 per month for a family of four, with income at 100% of the federal poverty limit (approx $20,000 in 2006) $2.8 million for child care rating system $2.4 million for education for child care workers $9.8 million for emergency assistance to families, including impending homelessness

6. Goals Pursue Fiscal Responsibility: No general tax increases, reduce advance commitments Increase access to affordable, high quality health care Dramatically reduce tobacco use Provide all children the opportunity to succeed Strengthen K-12 school and UW systems Continue momentum for job creation and economic development Expand state aid to municipalities and counties

7. BadgerCarePlus (BC+) Provides access to affordable health care for all children In addition to all children, expands eligibility to other new populations: Youth (aged 18 through 20) aging out of foster care Pregnant women from 185-300% federal poverty level (FPL) Caretaker relatives up to 200% FPL Parents with children in foster care up to 200% FPL Farmers and other self-employed individuals up to 200% FPL, contingent on depreciation calculations

8. BadgerCarePlus,continued Streamlines eligibility Promotes prevention and healthy behavior Establishes benchmark plan for majority of expansion populations Budget neutral: funded through greater use of managed care, administrative savings, and a new co-pay and premium structure Requires federal approval Target implementation date: Jan. 2008

9. Health Care Coverage for Childless Adults Extends BC+ health coverage to childless adults up to 200% FPL BC+ Benchmark plan with carve-out for mental health services Mental health services to be provided through county structure, as is done currently BC+ cost-sharing applies

10. Health Care Coverage for Childless Adults, con�t. Intended to replace General Assistance Program in Milwaukee (GAMP): state and county funding for GAMP will be reallocated for use in new program Eligibility determination to be done by state-run centralized application processing operation Requires federal approval Target implementation date: Jan. 2009

11. Public Health Smoking Prevention and Cessation: Increase tobacco tax by $1.25/pack $20 million/year funding in addition to current $10 million base funding for a total of $30 million/year for smoking prevention and cessation efforts

12. Public Health, continued MA Family Planning Waiver for Males Vital Records Automation Federally mandated Vital Record Fees are increased: fee revenue used to fund automation, increased child abuse and AODA prevention services, increased domestic abuse services, and provide add�l funding to counties AIDS/HIV Program: Fully funds projected caseload in Drug Assistance Program Enroll eligible individuals from AIDS Drug Assistance Program to HIRSP, use savings generated to increase funding to life care services

13. eHealth Will reduce medical errors, improve safety and decrease health care costs Incentives to increase the use of electronic medical record systems $10 million/year: grants to organizations to invest in eHealth information systems Tax credits for eHealth investment

14. Department of Children and Families Unifies programs from DHFS and DWD that serve children and families: Child welfare Child care regulation and policy Child support W-2 Women Infant and Children program and Emergency Food Assistance Home Visiting Will strength and improve access to services to help children grow up safe, healthy, and successful in strong families To become effective July 2008 No state positions cut

15. Department of Children and Families, con�t. Community Aids Basic County Allocation (BCA) 27% of total BCA is transferred to new Dept. to be contracted to counties Composed of 31% of non-Milw. counties BCA and 15% of Milw. BCA Percentages based on CY2004-05 county reports of BCA expenditures Counties given flexibility to transfer funding between �Kids BCA� and �DHFS BCA� up to CY2015 Tribal Child Care earmarked portion of Community Aids also transferred to new Dept.

16. Other KidsFirst and Children/Family Items Foster Care Rates: 5% increase/year in CY08 and CY09 Quality Care program to improve quality of child care Home Visiting Program for first-time parents: Phased-in beginning January 2009 Milwaukee Child Welfare (MCW) Fully funds projected caseload Provides state funding to offset drop in federal child welfare funding Provides permanent funding for case manager recruitment, retention, and training efforts initiated in 05-07 biennium

17. Children/Family Items, continued Kinship Care and State Foster Care and Adoption Assistance Programs Fully funds projected caseload Implements new Federal requirements related to foster parent background checks (�Adam-Walsh legislation�) Allows Department to use available excess federal funding for a tribal child welfare high cost fund

18. Children/Family Items, continued Increased Domestic Abuse funding: $950,000/year Foster Youth Independent Center (Milwaukee): $50,000/year Early Childhood Initiative (Dane County): $500,000/year All three initiatives funded by revenue from vital record fee increase

19. Medicaid / BadgerCare / SeniorCare Preserves health care safety net: No reductions in service coverage or eligibility criteria Maximizes external funding Restructures Medicaid funding Implements federal mandates Adopts targeted cost-savings measures Increases MA rates to providers

20. MA: Maximize External Revenue Hospital Assessment of 1% of gross revenue Used primarily to support increased hospital reimbursement Increase in Nursing Home Bed Assessments Used to support nursing home rate increases Insurance Intercept Strengthen MA Audit Efforts: 5 add�l audit project positions UW Physician Revenue Maximization

21. MA: Restructure Financing New Segregated Health Care Quality Trust Fund created Revenue: Tobacco tax revenue Hospital Assessment revenue Interest from state tobacco endowment $175 million in Patient Compensation Fund revenue in FY08 Uses: eHealth grants Tobacco reduction efforts Health Care coverage for childless adults Remainder for MA program

22. Medicaid/BadgerCare/SrCare: New Fed Mandates Medicaid Asset Transfers: New fed restrictions on the ability of individuals to transfer assets prior to enrolling in Medicaid Net biennial savings of $7.4 million AF due to delay in MA eligibility for affected individuals Citizenship and Identity Verification: New fed requirement that requires applicants to document their citizenship and identity $755,000/year provided to counties and tribes for increased eligibility determination (i.e. Income Maintenance) workload

23. Medicaid/BadgerCare/SrCare: New Fed Mandates Third Party Liability: new fed law broadens scope of entities to provide insurance coverage info. Medi-Medi Fraud Identification: fed initiative to strengthen identification of fraud in Medicare and Medicaid False Claims: fed law increases penalties for MA false claims and increases share of recoveries retained by state Medicare Part B Premiums: to comply with fed requirements, state will pay Medicare Part B premiums. Dual Medicaid/Medicare clients will not experience any change in service coverage or access

24. MA Targeted Cost Savings Pharmacy Benefit Management MA Eligibility Quality Assurance Telephonic Check-In for Home Health/Personal Care

25. MA: Provider Rate Increases Nursing Homes: 2% increase/year Funded with assessment revenue Hospitals: rate increases to cover 84% of cost, on average; up from current reimbursement at 63% of cost, on average Funded with assessment revenue Non-institutional Providers (other than waivers): 1% increase in FY08/add�l. 2% increase in FY09 Psychiatrists: 20% increase from $80.13 to $96.16/hour Pharmacists: $.50 increase in dispensing fee in MA and BadgerCare from $4.38 to $4.88

26. MA/BadgerCare: Managed Care Rate Increases MA AFDC/Healthy Start HMOs: 3.4% increase/year BadgerCare HMOs: 4.5% increase/year Family Care CMOs: 3% increase/year Children�s Mental Health Mngd Care Programs : 3% increase/year PACE/Partnership: 4% increase/year SSI Managed Care: 5% increase/year

27. Other Health Care Financing Programs Food Share Employment and Training (FSET) program: becomes voluntary Remove the child support cooperation requirement in FoodShare program to expand access to food benefits to needy individuals Disease Aids: Fully funds projected caseload

28. Services for People with Disabilities Kids Long-term Care Planning funds ($250,000/year) to pilot managed care long-term support program for children Mandates insurance policies cover services for autism Allow carryover of Birth-Three funds Services for individuals who are blind and visually impaired Fully funds rehab teaching services to help individuals remain independent Uses federal funding approved by legislature in December 2006 SSI Program Fully funds projected caseload

29. Services for people with disabilities (con�t) WI Council on Developmental Disabilities: transferred from DHFS to Dept. of Administration Relocations from DD Centers under Community Integration Program (CIP IA): Projects 36 relocations in 07-09 biennium

30. Mental Health and AODA Services Raises floor for insurance policies for mental health and AODA coverage MetaHouse: AODA Treatment for Women: $250,000/year Uses vital record fee revenue Decreases Intoxicated Drivers Program (IDP) revenue to counties from $1.45 to $1.0 million, due to decrease in surcharge revenue Drug Abuse Surcharge (DAPIS): Fully funds DHFS budgeted level

31. Quality Assurance of Regulated Facilities Provides authority to DHFS to set through administrative rule licensing fees for Community-based residential facilities (CBRFs) and adult family homes

32. Institutional Mental Health Programs Sand Ridge: Provides funding and positions for building expansion 300-bed expansion: 100 new beds come on-line in Jan-June 2009 Conditional and Supervised Release, Outpatient Competency Exams and Treatment to Competency: Funding for projected caseload in conditional and supervised release and increased funding to meet outpatient treatment for competency needs Flexibility provided to use supervised and conditional release funding for outpatient treatment for competency,if needed Additional overtime funding provided to Mental Health Institutes Proposes (in capital budget) new institutional mental health program for female inmates at new facility on the Wisconsin Resource Center campus: To come on-line in 09-11 biennium

33. Family Care Expansion Managed care long-term care program Provides people better choices about where they live and the care they receive Improves access to services; eliminates waitlists Improves quality of services to clients Promotes prevention and wellness

34. Family Care Expansion,continued Aging and Disability Resource Center (ADRC) expansion: 75% of state covered by end FY09 Provide prevention services to keep people healthy, safe, and independent Provide information and assistance Serve as entry point to Family Care ADRCs in place at least 2 months prior to CMO implementation

35. Family Care Expansion, continued Care Management Organization (CMO) expansion: 62% of state covered by end FY09 Flexible, integrated, individualized mngd care benefit CMOs may be private organizations, public-private partnerships, or multi-county consortia; will serve multi-county areas Mngd care benefit may be long-term care benefit package or fully integrated acute and long-term care benefits Actual expansion site start-up dates will be determined based on sites� readiness

36. Family Care Expansion,continued Includes Elderly and Disability Advocacy component County Contribution: Budget assumes county contributes Community Aids and county spending on long-term care, based on CY05 DHFS data. County contribution is fixed over time Dept. will continue to work with counties to address county contribution issues

37. Community Aids/WI Medicaid Cost Reporting Prgm (WIMCR) WIMCR: WIMCR is phased-out, federal funding is fully passed through to counties under CSDRB program Phase-down period: CY08 and CY09 WIMCR fully eliminated and replaced by CSDRB in CY10 Effect on counties: Increases federal funding and eliminates administrative complexity and burden

38. Community Aids Base Community Aids funding remains stable Portion of Community Aids transferred to new Dept. of Children and Families to be contracted to counties Counties have flexibility to transfer funding between new �Kids BCA� and �DHFS BCA� up to CY2015

39. State Operation Issues Consolidate state attorneys and support staff in Dept. of Administration starting FY09 One unclassified legal counsel in cabinet agencies Restore power plant positions (41 FTE in DHFS) Employee benefits Waiting period for health insurance for new hires shortened from 6 to 2 months Health insurance coverage available to domestic partners of state employees Statewide $40 million state operations lapse/year

40. WI Division of Public Health Workforce Initiatives UpdateFebruary 23, 2007

41. WI Common Ground: Integrating Chronic Disease Informatics Systems Funded by Robert Wood Johnson $200,000 annually - three years Recipient: Division of Public Health Slide 2 - WI Common Ground Funded by Robert Wood Johnson, this three year grant is funded at $200,000 per year. Our goal is to improve the way we work through evaluating how our work is accomplished and how we could be more efficient and effective using available technology and information. We are starting with chronic disease because there is an identified need to link up systems that could help gather information or data, analyze and disseminate it to stakeholders, and help improve health outcomes. Slide 2 - WI Common Ground Funded by Robert Wood Johnson, this three year grant is funded at $200,000 per year. Our goal is to improve the way we work through evaluating how our work is accomplished and how we could be more efficient and effective using available technology and information. We are starting with chronic disease because there is an identified need to link up systems that could help gather information or data, analyze and disseminate it to stakeholders, and help improve health outcomes.

42. WI Common Ground: Integrating Chronic Disease Informatics Systems Overarching Goal: Improve chronic disease information systems through best practice knowledge and skill, creating a training infrastructure to disseminate techniques and continuously improve IT systems, developing a set of endorsed process and requirements, and establishing an implementation plan. Slide 3 This grant supports the use of public health information to make informed policy and practice decisions. Public health informatics is a systematic application of information and computer science and technology to public health practice, research, and learning. Slide 3 This grant supports the use of public health information to make informed policy and practice decisions. Public health informatics is a systematic application of information and computer science and technology to public health practice, research, and learning.

43. Objectives Train public health staff in informatics best practices Analyze and redesign business processes Define requirements for continuous quality improvement Increase community awareness of new/redesigned business processes Slide 4 Objectives: Starting with Chronic Disease, the outcomes of this grant includes evaluating the work we do and determining how we can be more efficient through the use information systems. Bullet one Our state and local health department workforce will have the opportunity to gain knowledge about informatics best practices, using TRAIN and MediaSite Live to disseminate the information. Bullet two This grant lays the foundation for continuous quality improvement with redesigned information systems. Slide 4 Objectives: Starting with Chronic Disease, the outcomes of this grant includes evaluating the work we do and determining how we can be more efficient through the use information systems. Bullet one Our state and local health department workforce will have the opportunity to gain knowledge about informatics best practices, using TRAIN and MediaSite Live to disseminate the information. Bullet two This grant lays the foundation for continuous quality improvement with redesigned information systems.

44. Objectives (continued) Establish ways to make public health chronic disease systems responsive and efficient Complete a roadmap, endorsed by DPH and public health systems partners, for improving chronic disease public health information systems Slide 5 Objectives (continued) Bullet one This project is aligned with the state health plan goal of an integrated public health information system and with our eHealth initiative (universal electronic health record adoption and exchange) Bullet two The grant relies on developing sound relationships with public health systems partners who will assist us in developing an implementation plan (a road map) to transform our chronic disease information systems. Slide 5 Objectives (continued) Bullet one This project is aligned with the state health plan goal of an integrated public health information system and with our eHealth initiative (universal electronic health record adoption and exchange) Bullet two The grant relies on developing sound relationships with public health systems partners who will assist us in developing an implementation plan (a road map) to transform our chronic disease information systems.

45. Project Team Project Director: Larry Hanrahan, PhD, MS, Director of Public Health Informatics and Chief Epidemiologist, Wisconsin Division of Public Health Nancy Chudy, BSN, MPH, Chronic Disease Epidemiologist, Wisconsin Division of Public Health Diana Ditsch, BA, MPH, Communication and Education Specialist, Wisconsin Division of Public Health Nancy McKenney, RDH, MS, Director of Workforce Development, Wisconsin Division of Public Health Donny Neuert, IT Project Leader, Wisconsin Division of Public Health If you have questions about this grant, please contact Larry Hanrahan, the Project Director or a member of this project team. This grant is off to a good start. It started in December of 2006, three of the project team members attended the a Kickoff and Business Process Analysis Training this past week.If you have questions about this grant, please contact Larry Hanrahan, the Project Director or a member of this project team. This grant is off to a good start. It started in December of 2006, three of the project team members attended the a Kickoff and Business Process Analysis Training this past week.

46. Public Health Workforce: Advancing the Plan Funded by the UW Partnership Fund for a Healthy Future $150,000 annually for three years Recipient: Division of Public Health Partners Wisconsin Public Health Association (WPHA) Wisconsin Area Health Education (AHEC) Program Slide 7 Public Health Workforce Advancing the PlanSlide 7 Public Health Workforce Advancing the Plan

47. Public Health Workforce: Advancing the Plan Overarching Goal: Take concrete steps toward establishing a culturally and linguistically competent public health workforce in sufficient numbers to carry out the core public health functions and essential public health services for diverse populations in Wisconsin communities. Slide 8 This grant initiative is consistent with the State Health Plan Infrastructure Priority to develop a diverse, sufficient, and competent workforce. We are working toward developing a public health workforce that better reflects the demographics of our communities.Slide 8 This grant initiative is consistent with the State Health Plan Infrastructure Priority to develop a diverse, sufficient, and competent workforce. We are working toward developing a public health workforce that better reflects the demographics of our communities.

48. Public Health Workforce: Advancing the Plan - Goals Provide cultural competence training and support to local health department personnel. Address the gap in racial and ethnic diversity of public health staff and improve capacity to provide culturally and linguistically appropriate services. Slide 9 This grant has four goals. Goal One: Cultural competence is a core public health competency. Our TRAIN Learning Management System will be enhanced to assist learners in tracking their learning experiences. (learning records, identifying courses and evaluating core public health competency) Goal Two: This grant addresses the challenges we face with the recruitment and retention of a diverse public health workforce. Through a strong partnership with the Area Health Education Center, cultural competence training will be offered to local health department personnel. Local health department support for sending staff to the training will be offered through this grant initiative. Slide 9 This grant has four goals. Goal One: Cultural competence is a core public health competency. Our TRAIN Learning Management System will be enhanced to assist learners in tracking their learning experiences. (learning records, identifying courses and evaluating core public health competency) Goal Two: This grant addresses the challenges we face with the recruitment and retention of a diverse public health workforce. Through a strong partnership with the Area Health Education Center, cultural competence training will be offered to local health department personnel. Local health department support for sending staff to the training will be offered through this grant initiative.

49. Public Health Workforce: Advancing the Plan � Goals (continued) Recruit and retain a public health workforce sufficient to meet Wisconsin�s needs, now and in the future. Maintain EdTRAC as the education and practice forum envisioned in the state health plan, to assure a competent public health workforce through a collaborative information and education network, coordinating efforts of our public health education and training partners to expand professional public health education and curricula in public health. Slide 10 Goals (continued) Goal Three: The Wisconsin Public Health Association will be taking the lead on developing a public health marketing and mentoring program, emphasizing minority recruitment strategies. Goal Four: As we speak, EdTRAC is convening public health practitioners and public health educators to collaborate workforce challenges. As a body of public health educators and practitioners, EdTRAC is advising and assisting the project team to support the grant program. Slide 10 Goals (continued) Goal Three: The Wisconsin Public Health Association will be taking the lead on developing a public health marketing and mentoring program, emphasizing minority recruitment strategies. Goal Four: As we speak, EdTRAC is convening public health practitioners and public health educators to collaborate workforce challenges. As a body of public health educators and practitioners, EdTRAC is advising and assisting the project team to support the grant program.

50. Public Health Workforce : Advancing the Plan - Project Interventions Establish a culturally and linguistically competent public health workforce through self assessment and training using an enhanced public health learning management system (TRAIN) Implement a marketing plan to recruit a public health workforce Establish a mentoring programs for new public health professionals Slide 11 Project Interventions By 2010 we anticipate our outcomes will show that: 50 local health departments utilize a learning management system to assess their progress in achieving cultural public health competence. More local public health staff have the capacity to provide culturally and linguistically appropriate services. 50 local health departments have mentoring programs to recruit and retain a diverse public health workforce. Slide 11 Project Interventions By 2010 we anticipate our outcomes will show that: 50 local health departments utilize a learning management system to assess their progress in achieving cultural public health competence. More local public health staff have the capacity to provide culturally and linguistically appropriate services. 50 local health departments have mentoring programs to recruit and retain a diverse public health workforce.

51. Public Health Workforce : Advancing the Plan - Project Interventions (continued) Enhance career activities for K-12 and college students Convene EdTRAC, an education and practice forum, to coordinate public health education and curricula. Slide 12 Project Interventions (Continued) EdTRAC coordinates public health education and training partner efforts to expand professional health education and public health curricula. We will be off to a good start with this grant starting March 1, 2007. Slide 12 Project Interventions (Continued) EdTRAC coordinates public health education and training partner efforts to expand professional health education and public health curricula. We will be off to a good start with this grant starting March 1, 2007.

52. Project Team Project Director: Nancy McKenney, RDH, MS, Director of Workforce Development, Wisconsin Division of Public Health Donny Neuert, IT Project Leader, Wisconsin Division of Public Health Diana Ditsch, BA, MPH, Communication and Education Specialist, Wisconsin Division of Public Health Kelli Jones, RN, MSN, Minority Health Officer, Wisconsin Division of Public Health Sue Kunferman, RN, MSN, President, Wisconsin Public Health Association Academic Partner: Nancy Sugden, Assistant Dean, Academic Affairs, UW Medical School, Director, Wisconsin Area Health Education Center Slide 13 If you have questions about this grant, please contact Nancy McKenney, the Project Director or a member of this project team.Slide 13 If you have questions about this grant, please contact Nancy McKenney, the Project Director or a member of this project team.

53. Linking Education and Practice for Excellence in Public Health Nursing (LEAP) Funded by the Health Resources Services Administration Recipient: University of Wisconsin, School of Nursing Partners: Local health departments, Division of Public Health, community-based, population-focused organizations, WI schools of nursing Contact: Marilyn Haynes-Brokopp, MS, RN, BC, Clinical Associate Professor University of Wisconsin � Madison, LEAP Project Manager Slide 14 Slide 14

54. Goal The purpose of the LEAP Project is to improve competency for public health nursing practice in a changing public health system by educating public health nurses, student nurses, and nursing faculty in the knowledge and skills required for providing population-based, culturally competent public health nursing services. Slide 15 Recruiting and retaining public health nurses is a challenge throughout the state. Slide 15 Recruiting and retaining public health nurses is a challenge throughout the state.

55. Objectives Improved didactic and field PHN education experiences Regional learning collaboratives Faculty development Preceptor development Web-delivered CE in core population-based PHN competencies Mentored orientation program for new PHN Slide 16 Our public health partners at the University of Wisconsin � Madison are leading the way to link nursing education and practice to support culturally competent population-based nursing services. The objectives of the grant support this grant goal. We are appreciative of their efforts and the opportunity to support this grant Initiative. Slide 16 Our public health partners at the University of Wisconsin � Madison are leading the way to link nursing education and practice to support culturally competent population-based nursing services. The objectives of the grant support this grant goal. We are appreciative of their efforts and the opportunity to support this grant Initiative.

57. For more information on workforce initiatives, contact: Nancy McKenney, RDH, MS Director of Workforce Development WI Division of Public Health 608-266-7901 mckennr@dhfs.state.wi.us Nancy McKenney coordinates state-wide workforce development initiatives for the Division of Public Health. Please contact her if you have questions about workforce grants and initiatives. We will provide regular updates about state-wide workforce development activities. We are pleased that workforce development activities, consistent with our state health plan, are receiving priority for state and federal funding. Nancy McKenney coordinates state-wide workforce development initiatives for the Division of Public Health. Please contact her if you have questions about workforce grants and initiatives. We will provide regular updates about state-wide workforce development activities. We are pleased that workforce development activities, consistent with our state health plan, are receiving priority for state and federal funding.

58. Field Licensing and Inspection Program (FLIP) July 2005 to February 2007 Debi Peters, DPH Project Manager - BEOH

59. Functions Inspections via Facility Manager, Permit Manager and Inspections Produce Renewals and Process Lockbox Transactions Print Permits and Inspections in office and in field Produce Certificates Produce Reports