Register November 2008 No. 635
Chapter DHS 73
SELECTED FISCAL MANAGEMENT PROCEDURES AND STANDARDS UNDER THE COMMUNITY OPTIONS PROGRAM AND MEDICAL ASSISTANCE HOME AND COMMUNITY-BASED SERVICES WAIVER
DHS 73.01 Authority and purpose.
DHS 73.04 Assessment and case plan.
DHS 73.05 Reimbursement for community options program case plans.
DHS 73.06 Development of service agreements.
DHS 73.07 Determination of competence to receive service funds.
DHS 73.08 Supervisory review of payment decisions.
DHS 73.09 Documentation that services have been provided.
DHS 73.10 Individual hardship exceptions to limits on funding for CBRF care.
DHS 73.11 Criteria for determination of the infeasibility of in-home services.
Ch. DHS 73 Note
Note: Chapter HSS 73 was renumbered chapter HFS 73 under s. 13.93 (2m) (b) 1., Stats., and corrections were made under s. 13.93 (2m) (b) 6. and 7., Stats.,
Register, July, 2000, No. 535. Chapter HFS 73 was renumbered to chapter DHS 73 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats.,
Register November 2008 No. 635.
DHS 73.01
DHS 73.01
Authority and purpose. This chapter is promulgated under the authority of ss.
46.27 (2) (h) 2.,
(7) (cj) 3. b.,
(11) (c) 5n. b. and
(12),
46.277 (5) (d) 1n. b. and
(5r), and
227.11 (2) (a), Stats., to establish certain standards and procedures related to assessments, case plans, service agreements, participant payment of service providers and verification that services have been received for county administration of the community options program (COP) under s.
46.27, Stats., and county administration of home and community-based services waivers from medical assistance requirements that the department receives from the secretary of the U.S. department of health and human services under
42 USC 1396n (c), to establish conditions of hardship under which the department may grant exceptions in individual cases to limits on spending by counties for care provided in CBRFs and to establish criteria for county agency determination of the infeasibility of in-home services as a condition for paying for services provided to a program participant residing in a CBRF.
DHS 73.01 History
History: Cr.
Register, January, 1993, No. 445, eff. 2-1-93; emerg. am. eff. 1-1-96; am.
Register, May, 1996, No. 485, eff. 6-1-96;
CR 00-056: am.
Register August 2001 No. 548, eff. 9-1-01.
DHS 73.02
DHS 73.02
Applicability. This chapter applies to county departments designated under s.
46.27 (3) (b), Stats., to administer the community options program (COP), and to county departments and private non-profit agencies with which the department contracts to provide home and community-based services through a medical assistance waiver, and to vendors providing assessments, case plans or supportive home care services funded under s.
46.27 (7), Stats., or under a medical assistance waiver.
DHS 73.02 History
History: Cr.
Register, January, 1993, No. 445, eff. 2-1-93.
DHS 73.03
DHS 73.03
Definitions. In this chapter:
DHS 73.03(1)
(1) "Assessment" means a process for determining a person's functional abilities and disabilities and the person's need for and preferences in regard to medical and social long-term community support services.
DHS 73.03(2)
(2) "Case manager" means an employee of a county department or vendor agency responsible for locating, managing, coordinating and monitoring the services and informal community supports identified in a participant's case plan.
DHS 73.03(3)
(3) "Case plan" means a comprehensive community services plan specifying the types and amounts of services to be provided, the methods of service delivery and the coordination with informal community supports.
DHS 73.03(3m)
(3m) "CBRF" or "community-based residential facility" has the meaning specified in s.
50.01 (1g), Stats.
DHS 73.03(4)
(4) "COP" means the community options long-term support program under s.
46.27, Stats.
DHS 73.03(5)
(5) "County department" means a county department designated under s.
46.27 (3) (b), Stats., a county department established under s.
46.215,
46.22,
46.23,
51.42, or
51.437, Stats., which provides home and community-based services under a medical assistance waiver or a private non-profit agency designated by the department to provide services under a medical assistance waiver.
DHS 73.03(6)
(6) "Department" means the Wisconsin department of health services.
DHS 73.03(7)
(7) "Home and community-based services" means services that are provided under a medical assistance waiver as an alternative to institutional care.
DHS 73.03(8)
(8) "Household care" means household tasks and home maintenance activities that do not change the physical structure of the home, including shopping, meal preparation, cleaning, laundry, bed-making, simple home repairs, errands and seasonal chores.
DHS 73.03(8m)
(8m) "Initially applies for services" means applies for the first time for services in addition to an assessment or care plan under COP, the COP-waiver under s.
46.27 (11), Stats., or the community integration program under s.
46.277, Stats., and has not previously received the services.
DHS 73.03(9)
(9) "Medical assistance" means the assistance program operated by the department under ss.
49.43 to
49.497, Stats.
DHS 73.03(10)
(10) "Medical assistance waiver" means a waiver granted to the department by the secretary of the U.S. department of health and human services under
42 USC 1396n (c), authorizing the department to provide home and community-based services as part of the medical assistance program.
DHS 73.03(11)
(11) "Participant" means a person receiving an assessment, case plan or supportive home care services funded under s.
46.27 (7), Stats., or under a medical assistance waiver.
DHS 73.03(12)
(12) "Participant's representative" means a person designated in writing by the participant to act on behalf of the participant in making decisions about or directing the provision of services received by the participant.
DHS 73.03(13)
(13) "Primary caregiver" means the person providing the majority of unpaid, informal care to the participant.
DHS 73.03(15)
(15) "Respite care" means care and supervision to a participant in a homelike environment for purposes of giving the primary caregiver temporary relief, relieving the primary caregiver of the stress of giving continuous support.
DHS 73.03(16)
(16) "Service provider" means an individual employed to provide supportive home care services to a participant, whether that individual is employed by the participant, the participant's representative, a county department or a vendor agency.
DHS 73.03(17)
(17) "Supportive home care" means the provision of services except nursing care that are intended to maintain participants in independent or supervised living in the participant's own home or the home of the participant's friends or relatives, which help the participant meet his or her daily living needs, address the participant's needs for social contact, ensure the participant's well being, and reduce the likelihood that the participant will have to move to a nursing home or other alternate living arrangement.
DHS 73.03(17m)
(17m) "Terminally ill" means a medical prognosis that an individual's life expectancy is less than 12 months.
DHS 73.03(18)
(18) "Vendor agency" means an agency from which a county department purchases supportive home care services for participants.
DHS 73.03 History
History: Cr.
Register, January, 1993, No. 445, eff. 2-1-93; emerg. cr. (3m) and (8m), eff. 1-1-96; cr. (3m), (8m) and (17m),
Register, May, 1996, No. 485, eff. 6-1-96; correction in (6) made under s.
13.92 (4) (b) 6., Stats.,
Register November 2008 No. 635.
DHS 73.04
DHS 73.04
Assessment and case plan. DHS 73.04(1)
(1)
Assessment. Within the limits of state and federal funds, a county department shall carry out an assessment in accordance with s.
46.27 (5) (am) and
(6), Stats., of any person residing in a nursing home who wants to be assessed for eligibility to receive support services within the community rather than within the nursing home, any person seeking admission to or about to be admitted to a nursing home for whom community services represent an alternative to nursing home residence or any person whom the county department judges would otherwise require nursing home care in the absence of comprehensive community services. The assessment shall include a face-to-face discussion with the person or the person's guardian and any appropriate family members and caregivers. The assessment shall result in an outline of what would be required to enable the person to live at home or in a homelike setting integrated with the community and to meet the person's preferences for location, type and manner of services provided.
DHS 73.04(2)
(2) Case plan. The county department shall develop a case plan for non-institutional community services for a person who is assessed and for whom services are feasible, can be financed with available state and federal funds and are preferred to nursing home care by the person or the person's guardian. The case plan shall specify the types and amounts of services to be provided, the manner of service delivery and the assistance to be provided by informal community supports and shall incorporate the participant's preferences to the maximum extent possible.
DHS 73.04 History
History: Cr.
Register, January, 1993, No. 445, eff. 2-1-93; correction in (1) made under s. 13.93 (2m) (b) 7., Stats.,
Register August 2001 No. 548.
DHS 73.05
DHS 73.05
Reimbursement for community options program case plans. DHS 73.05(1)(a)(a) A county department may not be reimbursed for more than one case plan per community options program participant in a 12 month period, except when:
DHS 73.05(1)(a)1.
1. The initial case plan does not result in services funded under either the community options program or a medical assistance waiver;
DHS 73.05(1)(a)2.
2. A significant change in the participant's condition or life circumstances has occurred; and
DHS 73.05(1)(b)
(b) A county department may not be reimbursed for more than 2 case plans for any participant in a 12 month period.
DHS 73.05(2)
(2) Procedures. Each county department designated under s.
46.27 (3) (b), Stats., shall adopt fiscal management procedures to ensure that the requirements of
sub. (1) are met.
DHS 73.05(3)
(3) Requirements. All case plans submitted for reimbursement under s.
46.27 (6) (b), Stats., shall meet the requirements for case plans contained in the Community Options Program Guidelines and Procedures.
DHS 73.05 Note
Note: To obtain a copy of the Community Options Program Guidelines and Procedures, write the Bureau of Long Term Support, Division of Community Services, P.O. Box 7851, Madison, Wisconsin 53707-7851.
DHS 73.05 History
History: Cr.
Register, January, 1993, No. 445, eff. 2-1-93.
DHS 73.06
DHS 73.06
Development of service agreements.
