NEW RICHMOND -- “We are pleased to announce that we have received notice from the Wisconsin Department of Health Services that the Centers for Medicare & Medicaid Services has determined that the information submitted by DHS for the heightened scrutiny review is sufficient to demonstrate that both Orchard View Terrace and Kitty Rhoades Memorial Memory Care Center settings will overcome any institutional presumption and meet all of the Home and Community Based Services settings criteria. We are relieved and very excited to finally be able to accept residents that need the Home and Community Based Waiver," said Sandy Hackenmueller, St. Croix County Health & Rehab Center administrator.

It has been a long and challenging road for Hackenmueller, but she welcomed the CSM decision and is ready to begin admitting new clients.

“Our facility has many people to thank for the continued support they have given to all our programs," Hackenmueller said. "We are happy to finally be able to progress in our mission to support citizens in the county as the need arises."

Since the $20 million state-of-the-art facility had opened its doors -- first to a new 50-bed skilled nursing facility in November 2016 and, seven months later in July 2017, to Orchard View Terrace a 48-bed assisted living facility and Kitty Rhoades Memory Care Center, a 10-bed memory care facility -- both Orchard View and Kitty Rhoades have only been able to accept private-pay clients. Only a fraction of their available beds were filled. Before clients dependent on Medicaid funding could use either facility, the facilities needed to be approved by CMS through a process called heightened scrutiny.

The Home and Community-Based Services Settings Rule of 2014 ( defines the qualities of settings that are eligible for reimbursement for Medicaid home and community-based services. In the most general sense, the rule is intended to enable people to receive services in their homes and keep them out of institutional care facilities.

The particular tenant of the settings rule that prevented Orchard View and Kitty Rhoades from initially accepting Medicaid reimbursement clients excluded institutions located on the grounds of, or adjacent to, a public institution.

According to communications specialist Elizabeth Goodsitt, DHS corresponded with CMS repeatedly throughout the heightened scrutiny process answering additional questions and providing more information on five separate occasions after St. Croix County’s initial evidentiary package was submitted in September 2018.

“DHS did send the additional information CMS asked for. That happened on Oct. 25, 2019. DHS received additional questions from CMS on November 12, 2019, and responded to those questions on Nov. 14. On Dec. 3, 2019, DHS confirmed with CMS that it did not need any additional information from us. In total, DHS has responded to five requests for information from CMS since St. Croix County Health and Rehab Center’s initial application,” Goodsitt said.

Success at last

All of the diligence on behalf of SCHRC and DHS paid off last month. In a letter dated Jan. 9, 2020, Ralph Lollar, director of Division of Long Term Services and Supports for CSM, notified Jim Jones, the director of Medicaid at DHS, that the information sufficiently demonstrated that both Orchard View Terrace and Kitty Rhoades Memorial Memory Care Center meet all of the Home and Community Based Services settings criteria, clearing them to receive Medicaid reimbursement.

The decision handed down for Orchard View and Kitty Rhoades could have a significant impact on as many as 100 other institutions in line to go through the heightened scrutiny process, according to Goodsitt.

Continuing a legacy of compassion

County Supervisor Dan Hansen believes this hard-earned approval will finally allow the county to fulfill its obligation to residents and continue its legacy of compassion.

“We never envisioned that this would have taken so long. There were two referendums. The people of St. Croix County said that they wanted to have a nursing home which would honor Medicaid. That would be something that they could depend upon. Now the people’s will can be fulfilled. It’s very important to me that we offer quality care for people who don’t have the means to go to a private facility.

"We’re continuing the spirit of the St. Croix County Health Center from its inception. We have a long tradition of caring for our own that we are now able to continue. With this license, we will be able to continue serving people who are truly in need. That was the intent of building this facility,” Hansen said.