The nursing facility Resource Allocation Program (RAP) was established under 1983 Wisconsin Act 27, which repealed and recreated Chapter 150, Wis. Stats. The RAP replaced the long term care section of the former Certificate of Need Program.
Under RAP, the Department of Health and Family Services (DHFS) is authorized to review and approve or disapprove the following:
Also, under s.150.31(1) of the statutes, the state has imposed a moratorium on the maximum number of nursing facility and FDD beds. The maximum number of nursing facility beds presently is 51,795 and for FDD beds is 3,704.
1997 AB 100/SB 77 Provision
The 1997-99 biennial budget would modify the RAP by: 1) Deleting the requirement that the total replacement of a nursing home be reviewed/approved by the DHFS; the review/approval process in this instance only would apply to the construction of a new nursing home; 2) Deleting a capital expenditure which is a renovation or replacement from the requirement that capital expenditures which exceed $1 million by or on behalf of a nursing home be reviewed/approved by the DHFS; and 3) Deleting an expenditure which is a renovation or replacement from the requirement that expenditures which exceed $600,000 for clinical equipment by or on behalf of a nursing home be reviewed/approved by the DHFS. In addition, the nursing home bed cap under s.150.31(1) Wis. Stats., would be decreased by the number of banked beds that ultimately are de-licensed under the bed banking program proposed under s.49.45(6m)(ap) of the biennial budget bill.
WAHSA Position: Support the modifications to the Chapter 150 RAP contained in AB 100/SB 77.
The RAP has never met its stated intent to contain nursing home growth and costs. Instead the program has become a bureaucratic nightmare which has increased costs to the Medicaid program rather than decreased costs.
The cost-per-bed limitation contained in HFS 122, the RAP rule, stifles creativity and perpetuates the 1960s nursing home model of "semi-private" ("semi-public" is more accurate) rooms and shared bathrooms.
Adoption of the AB 100/SB 77 RAP modifications will rectify these concerns by focusing the RAP process where it belongs: on significant capital expenditures for new construction or clinical equipment acquisitions which could result in substantial cost increases to the Medicaid program. WAHSA members urge your support for these modifications.
The Wisconsin Association of Homes and Services for the Aging (WAHSA) is a statewide membership organization of not-for-profit corporations principally serving the elderly and disabled. Membership is comprised of 187 religious, fraternal, private and governmental organizations which own, operate and/or sponsor 143 not-for-profit and 50 county-operated nursing homes, 23 facilities for the developmentally disabled, 56 community-based residential facilities, 10 licensed home health agencies, 91 independent living facilities, 40 adult day care programs and over 300 community service agencies which provide programs ranging from Alzheimerís support, child day care, hospice and homecare to Meals on Wheels. For more information, please contact the WAHSA staff at (608) 255-7060: John Sauer, Executive Director; Tom Ramsey, Director of Government Relations; Brian Schoeneck, Financial Services Director.