Rick Abrams
Chief Executive Officer

Dear Nursing Facility Members:

2023 was another very challenging year for our sector. The winds that continue to buffet us are substantial:

• Hyper-inflation that has caused providers to rapidly increase salaries to retain staff and to pay exorbitant prices to staffing agencies and for the goods and services you need so that you can care for your residents;
• Providers continue to be challenged to attract new staff and to retain the great staff they have;
• Providers continue to be faced with a punitive and oppressive survey system that seems oblivious to the realities on the care delivery floor.

However, despite these challenges, you keep coming back each and every day to care for your residents. Your resilience in the face of continuing adversity is inspiring, indeed amazing. On behalf of my staff colleagues at WHCA/WiCAL, thank you for all that you and your colleagues continue to do for the most vulnerable among us.

Yes, there are challenges but as 2023 ends and 2024 begins, it is clear that we continue to make tremendous progress as an organization and as a profession. Please allow me to highlight four important areas:

Finance: 

• In the previous two-year state budget (7/1/21-6/30/23), our nursing facilities received historic Medicaid increases. Governor Evers, his administration, and Legislative leaders believe in what you do and they showed their bipartisan support!
• In the current state budget (7/1/23 – 6/30/25), with the support of the State Legislature and Governor Evers, we achieved even more success:
  • We retained all of the gains that we made in the last budget, much of which was focused on the clinical components of the rate methodology;
  • Our priorities for the current state budget were two-fold, both of which we achieved:
    • We sought to achieve the same payment standard for Support Services as currently exists for Direct Care Nursing. We were successful so that the per patient day (ppd) Support Services payment rate has increased from $87.65 ppd to as high as $157.73 ppd.
    • We sought to have the six payment incentives paid as add-ons to a facility’s base rate; not as part of a facility’s base rate. We were successful here as well and the impact could be substantial for our members. For example, if your facility has 50 or fewer beds, you will receive the full $17.74 ppd incentive!
• In addition, facilities with ventilator units received a ppd payment increase of $200.

In the final analysis, almost $200 million in additional federal and state funding was infused into the Medicaid nursing facility payment system for the current two-year state budget cycle (7/1/23 -6/30/25).

Workforce: 

• Retaining and attracting great people continues to be a monumental challenge at both the management and entry levels:
  • Administrators and DONs continue leaving nursing facilities in ever increasing numbers. The 24/7 nature of the job, combined with the punitive, oppressive and unforgiving survey system, is driving these good people away. We have made great progress in reforming our Survey and Enforcement system in 2023. I will discuss those accomplishments in more detail below. Also in 2023, we have worked with the Evers Administration, the Department of Safety and Professional Services (DSPS), and the Nursing Home Administrators Examining Board to develop more educational options for mid-career long-term care professionals who wish to become nursing home administrators.
  • On the entry level side of the equation, I cannot say enough good things about the WisCaregiver Careers program. Funded with almost $6 million in American Rescue Plan Act (ARPA) funds, the program provides reimbursement and bonuses to nursing facilities for each CNA candidate who they successfully train and certify, retention bonuses to CNAs who remain employed at the same facility for at least six months, and bonuses to their mentors. The current state budget includes an additional $2 million in state funding so that the program will be fully funded through the entire two-year state budget cycle which ends on June 30, 2025.
  • The Biden Administration and CMS continue to review comments that have been submitted on its proposed national nursing facility minimum staffing rule. More than 40,000 comments were submitted nationwide, more than 18,000 of which were submitted by the long-term care sector. In Wisconsin, we submitted more than 1,000 comments. Thank you to all of you who took the time to do your part!

We all want our nursing facilities to be adequately staffed, but a “one size fits all” minimum staffing standard that ignores the unique case mix within each nursing facility and that ignores the continuing challenges in attracting and retaining staff should be rejected in its entirety!

Regulatory Reform: 

I have already said enough about the punitive and oppressive survey environment. With the assistance and guidance of our Survey, Certification, and Enforcement Reform Task Force and other very engaged members, we are doing something about it:

• We are finalizing for introduction, if necessary, Survey and Enforcement Reform legislation that is modeled after the bill that was enacted in 2022 in Michigan;
• We have taken members’ concerns and frustrations over the survey and enforcement process to the Governor’s office and to the Department of Health Services (DHS) Secretary’s office, and they are listening. DHS has presented to us a series of reform measures. We have provided input and have also proposed additional measures that we took from our reform legislation. To date, DHS has agreed to three very significant reforms:
  • The Division of Quality Assurance (DQA), the state’s survey agency, will make every effort to ensure that compliance verification re-visits and complaint visits will not occur simultaneously;
  • In applying remedies for non-compliance, DQA committed to exploring a policy to establish a progressive enforcement process starting with the least onerous penalty depending on a facility’s operational track record and where allowed under federal law and regulation; and
  • A facility’s administrator or DON will have the opportunity to provide the facility’s perspective and to provide additional information at the start of a DQA internal meeting to determine whether an immediate jeopardy deficiency shall be assessed against the facility following a survey.

WHCA/WiCAL will continue to discuss with DHS/DQA additional reform ideas but the immediate task is to ensure that the three above priorities are implemented as soon as possible.

2024 – Our goals for the year ahead:

Our goals for the year ahead are very clear and straightforward. They are also very labor intensive. They include:

• Ensuring that our facilities receive the historic Medicaid payment increases in the manner intended by the State Legislature and Governor Evers;
• Seeking additional administrative modifications to the payment methodology that will streamline, clarify, and simplify the methodology;
• Successfully concluding the federal/ARPA component of our WisCaregiver Careers grant and seeking additional grant and other funding opportunities to favorably position our member nursing facilities to retain the great staff they have and to successfully attract additional qualified and engaged staff;
• Continuing to expedite and enhance the NHA licensure process for mid-career long term care professionals who wish to obtain their NHA license;
• Working with DHS/DQA to implement the three survey and enforcement priorities discussed above and to continue discussion to further enhance the process for our facilities, your staffs and the residents you so ably serve; and
• Closely monitoring and, where necessary, scrutinizing Managed Care Organization (MCO) practices to ensure that nursing facility providers are paid fairly for the crucial services they provide.

Along with our policy goals, 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. 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.

Finally and importantly, I must talk about the importance of the political campaign and fundraising process, WHCA/WiCAL’s success to date and our 2024 goals: 

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 $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 continued to be active in raising funds in 2023 and will once again look to be a major player in 2024 especially given the recent Wisconsin Supreme Court decision directing that a new state legislative district map be developed for the November 2024 elections.

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. 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 2025-2027 state budget cycle.

During the first quarter of 2024, we will be communicating with every member to ask you to participate in our political giving campaign either by making a corporate contribution if you represent a for-profit corporation or partnership and/or by making an individual contribution to our Political Action Committee. Thank you in advance for your kind consideration of this request.

Please do not hesitate to contact me with any questions that you may have regarding this document and/or if we can assist you in any way in the daily operation of your facility. On behalf of my WHCA/WiCAL staff colleagues, it is a great honor and privilege to serve you!

Sincerely,

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