"Waiver program" means the Community Opportunities and Recovery Program for which a waiver has been requested under sub. (2)
and granted under 42 USC 1396n
(2) Waiver request.
The department may request a waiver from the secretary of the U.S. department of health and human services, under 42 USC 1396n
(c), authorizing the department to serve in their communities medical assistance recipients who meet eligibility requirements specified in sub. (4)
by providing them home or community-based services as part of the Medical Assistance program. If the department requests the waiver, it shall include all the assurances required under 42 USC 1396n
(c) (2) in the request. If the department receives the waiver, it may request an extension of the waiver under 42 USC 1396n
(3) Contract for administration.
If doing so is consistent with the waiver received by the department as specified in sub. (2)
, the department may contract with a county or a private agency to administer the waiver program. A private agency with which the department contracts shall have the powers and duties of a county under this section.
Any medical assistance recipient who has a serious mental illness and meets the level of care requirements under s. 49.45 (6m) (i)
for reimbursement of nursing home care under the Medical Assistance program is eligible to participate in the waiver program.
Medical assistance reimbursement for services a county or private agency contracts for or provides under the waiver program shall be made from the appropriation accounts under s. 20.435 (4) (b)
, and (o)
The department may, from the appropriation account under s. 20.435 (4) (o)
, reimburse a county for providing, or contracting to provide, services that cost more than the average annual per person rate established by the department, but less than the average amount approved by the federal government for the waiver program.
History: 2005 a. 25
; 2011 a. 32
Restrictions on placements and admissions to intermediate and nursing facilities. 46.279(1)(b)
"Intermediate facility" has the meaning given for an intermediate care facility for the mentally retarded under 42 USC 1396d
(d), other than a center for the developmentally disabled, as defined in s. 51.01 (3)
"Most integrated setting" means a setting that enables an individual to interact with persons without developmental disabilities to the fullest extent possible.
(2) Placements and admissions to intermediate facilities.
Except as provided in sub. (5)
, no person may protectively place or continue protective placement of an individual with a developmental disability in an intermediate facility and no intermediate facility may admit or continue service for such an individual unless, before the protective placement, continued placement following review under s. 55.18
, or admission and after having considered a plan developed under sub. (4)
, a court under s. 55.12
or 55.18 (1) (ar)
finds that protective placement in the intermediate facility is the most integrated setting that is appropriate to the needs of the individual or that the county of residence of the individual would not reasonably be able to provide community-based care in accordance with the plan within the limits of available state and federal funds and county funds required to be appropriated to match state funds, taking into account information presented by all affected parties. An intermediate facility to which an individual who has a developmental disability applies for admission shall, within 5 days after receiving the application, notify the county department that is participating in the program under s. 46.278
of the county of residence of the individual who is seeking admission concerning the application.
(3) Placements and admissions to nursing facilities.
Except as provided in sub. (5)
, if the department or an entity determines from a screening under s. 49.45 (6c) (b)
that an individual requires active treatment for developmental disability, no individual may be protectively placed in a nursing facility or have protective placement in a nursing facility continued following review under s. 55.18
, and no nursing facility may admit or continue service for the individual, unless the department or entity that conducts the screening determines that the individual's need for care cannot fully be met in an intermediate facility or under a plan under sub. (4)
or that the county of residence of the individual would not reasonably be able to provide community-based care in accordance with the plan within the limits of available state and federal funds and county funds required to be appropriated to match state funds.
(4) Plan for home or community-based care.
Except as provided in a contract specified in sub. (4m)
, a county department that participates in the program under s. 46.278
shall develop a plan for providing home or community-based care in a noninstitutional community setting to an individual who is a resident of that county, under any of the following circumstances:
Within 120 days after any determination made under s. 49.45 (6c) (c) 3.
that the level of care required by a resident that is provided by a facility could be provided in an intermediate facility or under a plan under this subsection.
Within 120 days after receiving written notice under sub. (2)
of an application.
Within 120 days after a proposal is made under s. 55.12 (6)
to provide protective placement to the individual in an intermediate facility or a nursing facility.
Within 120 days after receiving written notice under s. 55.18 (1) (ar)
of the protective placement of the individual in a nursing facility or an intermediate facility.
Within 90 days after extension of a temporary protective placement order by the court under s. 55.135 (5)
(4m) Contract for plan development.
The department shall contract with a public or private agency to develop a plan under sub. (4)
, and the county department is not required to develop such a plan, for an individual, as specified in the contract, to whom all of the following apply:
The individual resides in a county with a population of less than 100,000 in which are located at least 2 intermediate facilities that have licenses issued to private nonprofit organizations that are exempt from federal income tax under section 501
(a) of the Internal Revenue Code.
Placement for the individual is in, or proposed to be in, an intermediate facility specified under par. (a)
that has agreed to reduce its licensed bed capacity to an extent and according to a schedule acceptable to the facility and the department.
(4n) Contract for plan payment.
The department and the county specified in sub. (4m) (a)
shall negotiate a contract under which the department shall provide payment, from the appropriation account under s. 20.435 (4) (b)
, to implement a plan to provide care in a noninstitutional community setting to an individual who has established residence in the county in order to be admitted to an intermediate facility in the county. The contract may provide for the negotiation of a memorandum of understanding between the parties that identifies the relative functions and duties of the department and the county in implementing plans under sub. (4)
for residents of intermediate facilities in the county.
Revenue bonding for residential facilities. 46.28(1)(a)
"Authority" means the Wisconsin Housing and Economic Development Authority created under ch. 234
"Child with long-term care needs" means any of the following:
A juvenile adjudged delinquent for whom a case disposition is made under s. 938.34
A child found to be in need of protection or services for whom an order is made under s. 48.345
or a juvenile found to be in need of protection or services for whom an order is made under s. 938.345
"Chronically disabled" means any person who is alcoholic, developmentally disabled, drug dependent or mentally ill, as defined in s. 51.01 (1)
, or any person who is physically disabled.
"Elderly" means a person 60 years of age or older.
"Eligible individual" means an individual who is elderly or chronically disabled, a child with long-term care needs, a homeless individual or a victim of domestic abuse.
"Residential facility" means a living unit for eligible individuals that is developed by a sponsor and that is not physically connected to a nursing home or hospital except by common service units for laundry, kitchen or utility purposes and that may include buildings and grounds for activities related to residence, including congregate meal sites, socialization, physical rehabilitation facilities and child care facilities.
A tribal council or housing authority or any nonprofit entity created by a tribal council.
Any housing corporation, limited-profit or nonprofit entity.
Any other entity meeting criteria established by the authority and organized to provide housing for persons and families of low and moderate income.
An entity that is operated for profit and that is engaged in providing medical care or residential care or services, including all of the following:
NOTE: The cross-reference to s. 50.01 (6d) was changed from s. 50.01 (1d) by the legislative reference bureau under s. 13.92 (1) (bm) 2. to reflect the renumbering under s. 13.92 (1) (bm) 2. of s. 50.01 (1d).
"Victim of domestic abuse" means an individual who has encountered domestic abuse, as defined in s. 49.165 (1) (a)
The department may approve any residential facility for financing by the authority if it determines that the residential facility will help meet the housing needs of an eligible individual, based on factors that include:
The geographic location of the residential facility.
The population served by the residential facility.
The services offered by the residential facility.
The department may authorize the authority to issue revenue bonds under s. 234.61
to finance any residential facility it approves under sub. (2)
The department may charge sponsors for administrative costs and expenses it incurs in exercising its powers and duties under this section and under s. 234.61
In order to facilitate the transition to the long-term care system specified in ss. 46.2805
, within the limits of applicable federal statutes and regulations and if the secretary of health services finds it necessary, he or she may grant a county limited waivers to or exemptions from ss. 46.27 (3) (e) (intro.)
, (5) (d)
, (6) (a) 1.
and (b) (intro.)
, (6r) (c)
, (7) (b)
and (11) (c) 5m. (intro.)
and 46.277 (3) (a)
, (4) (a)
and (5) (d) 1m.
and rules promulgated under those provisions.
Notwithstanding s. 46.27 (7)
, a county in which a care management organization is operating pursuant to a contract under s. 46.284 (2)
or a county in which a program described under s. 46.2805 (1) (a)
is administered may use funds appropriated under 20.435 (7) (bd) and allocated to the county under s. 46.27 (7)
to provide community mental health or substance abuse services and supports for persons with mental illness or persons in need of services or supports for substance abuse and to provide services under the Family Support Program under s. 46.985
Client management of managed care long-term care benefit.
Under a managed care program for provision of long-term care services, the care manager shall provide, within guidelines established by the department, a mechanism by which an enrollee, beneficiary, or recipient of the program may arrange for, manage, and monitor his or her benefit directly or with the assistance of another person chosen by the enrollee, beneficiary, or recipient. The care manager shall provide each enrollee, beneficiary, or recipient with a form on which the enrollee, beneficiary, or recipient shall indicate whether he or she has been offered the option under this subsection and whether he or she has accepted or declined the option. If the enrollee, beneficiary, or recipient accepts the option, the care manager shall monitor the use by the enrollee, beneficiary, or recipient of a fixed budget for purchase of services or support items from any qualified provider, monitor the health and safety of the enrollee, beneficiary, or recipient, and provide assistance in management of the budget and services of the enrollee, beneficiary, or recipient at a level tailored to the need and desire of the enrollee, beneficiary, or recipient for the assistance.
History: 2005 a. 386
; 2007 a. 20
"Care management organization" means an entity that is certified as meeting the requirements for a care management organization under s. 46.284 (3)
and that has a contract under s. 46.284 (2)
. "Care management organization" does not mean an entity that contracts with the department to operate one of the following:
A demonstration program known as the Wisconsin partnership program under a federal waiver authorized under 42 USC 1315
"Eligible person" means a person who meets all eligibility criteria under s. 46.286 (1)
"Enrollee" means a person who is enrolled in a care management organization.
"Family care benefit" means financial assistance for long-term care and support items for an enrollee.
"Family member" means a spouse or an individual related by blood, marriage, or adoption within the 3rd degree of kinship as computed under s. 990.001 (16)
"Financial and cost-sharing screening" means a screening to determine financial eligibility under s. 46.286 (1) (b)
or the self-directed services option and cost-sharing under s. 46.286 (2)
using a uniform tool prescribed by the department.
"Frail elder" means an individual who is 65 years of age or older and has a physical disability or irreversible dementia that restricts the individual's ability to perform normal daily tasks or that threatens the capacity of the individual to live independently.
"Functional screening" means a screening to determine functional eligibility under s. 46.286 (1) (a)
or the self-directed services option using a uniform tool prescribed by the department.
"Long-term care district board" means the governing board of a long-term care district.
"Older person" means a person who is at least 65 years of age.
"Resource center" means an entity that meets the standards for operation under s. 46.283 (3)
or, if under contract to provide a portion of the services specified under s. 46.283 (3)
, meets the standards for operation with respect to those services.
"Self-directed services option" means the program that is operated under a waiver from the secretary of the federal department of health and human services under 42 USC 1396n
(c) in which an enrolled individual selects his or her own services and service providers.
"Tribe or band" means a federally recognized American Indian tribe or band.