4. This paragraph does not apply to individuals who are receiving services under this section that are funded under par. (b) and who are residing in community-based residential facilities with more than 8 beds on January 1, 1996.
27,2229r
Section 2229r. 46.27 (7g) of the statutes is created to read:
46.27 (7g) Recovery of costs of care. (a) In this subsection:
1. “Client" means a person who receives or received long-term community support services that are funded under sub. (7).
2. “Disabled" has the meaning given in s. 49.468 (1) (a) 1.
3. “Home" means property in which a person has an ownership interest consisting of the person's dwelling and the land used and operated in connection with the dwelling.
(b) 1. Except as provided in subd. 2., the department may obtain a lien on a client's home if the client resides in a nursing home, community-based residential facility, adult family home or assisted living facility and cannot reasonably be expected to be discharged from the nursing home, community-based residential facility, adult family home or assisted living facility and return home. The lien is for the amount of long-term support community services paid on behalf of the client under sub. (7).
2. The department may not obtain a lien under this paragraph if any of the following persons lawfully reside in the home:
a. The client's spouse.
b. The client's child who is under age 21 or is disabled.
c. The client's sibling who has an ownership interest in the home and who has lived in the home continuously beginning at least 12 months before the client was admitted to the nursing home, community-based residential facility, adult family home or assisted living facility.
3. Before obtaining a lien on a client's home under this paragraph, the department shall do all of the following:
a. Notify the client in writing of its determination that the client cannot reasonably be expected to be discharged from the nursing home, community-based residential facility, adult family home or assisted living facility, its intent to impose a lien on the client's home and the client's right to a hearing on whether the requirements for the imposition of a lien are satisfied.
b. Provide the client with a hearing if he or she requests one.
4. The department shall obtain a lien under this paragraph by recording a lien claim in the office of the register of deeds of the county in which the home is located.
5. The department may not enforce a lien under this paragraph while the client lives unless the client sells the home and does not have a living child who is under age 21 or disabled or a living spouse.
6. The department may not enforce a lien under this paragraph after the death of the client as long as any of the following survive the client:
a. A spouse.
b. A child who is under age 21 or disabled.
c. A child of any age who resides in the home, if that child resided in the home for at least 24 months before the client was admitted to the nursing home, community-based residential facility, adult family home or assisted living facility and provided care to the client that delayed the client's admission to the nursing home, community-based residential facility, adult family home or assisted living facility.
d. A sibling who resides in the home, if the sibling resided in the home for at least 12 months before the client was admitted to the nursing home, community-based residential facility, adult family home or assisted living facility.
7. The department may enforce a lien imposed under this paragraph by foreclosure in the same manner as a mortgage on real property.
8. The department shall file a release of a lien imposed under this paragraph if the client is discharged from the nursing home, community-based residential facility, adult family home or assisted living facility and returns to live in the home.
(c) 1. Except as provided in subd. 4., the department shall file a claim against the estate of a client or against the estate of the surviving spouse of a client for the amount of long-term community support services funded under sub. (7) paid on behalf of the client after the client attained 55 years of age, unless already recovered by the department under this subsection.
2. The affidavit of a person designated by the secretary to administer this paragraph is evidence of the amount of the claim.
3. The court shall reduce the amount of a claim under subd. 1. by up to $3,000 if necessary to allow the client's heirs or the beneficiaries of the client's will to retain the following personal property:
a. The decedent's wearing apparel and jewelry held for personal use.
b. Household furniture, furnishings and appliances.
c. Other tangible personal property not used in trade, agriculture or other business, not to exceed $1,000 in value.
4. A claim under subd. 1. is not allowable if the decedent has a surviving child who is under age 21 or disabled or a surviving spouse.
5. If the department's claim is not allowable because of subd. 4. and the estate includes an interest in a home, the court exercising probate jurisdiction shall, in the final judgment, assign the interest in the home subject to a lien in favor of the department for the amount described in subd. 1. The personal representative shall record the final judgment as provided in s. 863.29.
6. The department may not enforce the lien under subd. 5. as long as any of the following survive the decedent:
a. A spouse.
b. A child who is under age 21 or disabled.
7. The department may enforce a lien under subd. 5. by foreclosure in the same manner as a mortgage on real property.
(d) The department may require the county department or aging unit selected to administer the program in each county to gather and provide the department with information needed to recover payment of long-term community support services under this subsection. The department shall pay to the county department or aging unit an amount equal to 5% of the recovery collected by the department relating to a beneficiary for whom the county department or aging unit made the last determination of eligibility for funding under sub. (7). A county department or aging unit may use funds received under this paragraph only to pay costs incurred under this paragraph and shall remit the remainder, if any, to the department for deposit in the appropriation account under s. 20.435 (7) (im). The department may withhold payments under this paragraph for failure to comply with the department's requirements under this paragraph. The department shall treat payments made under this paragraph as costs of administration of the program.
(e) From the appropriation under s. 20.435 (7) (im), the department shall pay the amount of the payments under par. (d) and shall spend the remainder of the funds recovered under this subsection for long-term community support services funded under sub. (7) (b) 1m.
(f) 1. The department may recover amounts under this subsection for the provision of long-term community support services paid on and after January 1, 1996.
2. The department may file a claim under par. (c) only with respect to a client who dies after February 15, 1996.
(g) The department shall promulgate rules establishing standards for determining whether the application of this subsection would work an undue hardship in individual cases. If the department determines that the application of this subsection would work an undue hardship in a particular case, the department shall waive application of this subsection in that case.
27,2231r
Section 2231r. 46.27 (11) (c) 3m. of the statutes is created to read:
46.27 (11) (c) 3m. Reimbursement under this paragraph for long-term community support services provided to a person
in a month may not exceed the average monthly cost of nursing home care, as determined by the department, except that this limitation does not apply to any of the following:
a. A person under the age of 22.
b. A ventilator-dependent person.
c. A person not specified under subd. 3m. a. or b., if the department determines that the cost of providing the person with nursing home care would exceed the cost of providing the person with care in the community. In making this determination, the department shall consider the
actual nursing home costs of that person and the extent to which costs under the medical assistance program for nursing home care would actually exceed the cost of providing the person with care in the community.
d. Any individual, if the department determines that nursing home care is not available for that individual.
e. Any individual, if the department determines that public funding is not available for the institutional care of that individual.
27,2232
Section 2232
. 46.27 (11) (c) 7. of the statutes is created to read:
46.27 (11) (c) 7. A county may use funds received under this subsection to provide supportive, personal or nursing services, as defined in rules promulgated under s. 49.45 (2) (a) 23., to a person who resides in a certified assisted living facility, as defined in s. 50.01 (1d). Funding of the services may not exceed 85% of the statewide medical assistance daily cost of nursing home care, as determined by the department.
27,2233
Section 2233
. 46.27 (11) (c) 8. of the statutes is created to read:
46.27 (11) (c) 8. No county, private nonprofit agency or aging unit may use funds received under this subsection to provide services in any community-based residential facility unless the county, agency or aging unit uses as a service contract the approved model contract developed under sub. (2) (j) or a contract that includes all of the provisions of the approved model contract.
27,2234m
Section 2234m. 46.27 (11g) of the statutes is created to read:
46.27 (11g) Report. Beginning January 1, 1997, and every January 1 thereafter, the department shall submit a report to the joint committee on finance and to the appropriate standing committees under s. 13.172 (3), summarizing the data collected for the state and for individual counties under the program in the calendar year ending immediately before the preceding calendar year.
27,2235g
Section 2235g. 46.27 (12) (c) of the statutes is created to read:
46.27 (12) (c) A sliding scale formula for a fee chargeable for conduct of an assessment under sub. (6) (a) or for development of a case plan under sub. (6) (b) that is based on the person's ability to pay, unless prohibited from payment under 42 USC 1396 to 1396v or under regulations under 42 USC 1396 to 1396v.
27,2236
Section 2236
. 46.275 (1m) (a) of the statutes is amended to read:
46.275 (1m) (a) “Medical assistance" means aid provided under ss. 49.43 to 49.47 subch. IV of ch. 49, except s. 49.468.
27,2240
Section 2240
. 46.275 (5) (b) 2. of the statutes is amended to read:
46.275 (5) (b) 2. Reduce federal, state or county matching expenditures for long-term community support services provided to any person as part of this program from funds allocated under s. 46.495 (1) (d), 46.80 (5), 46.85 (3m) (b) 1. and 2., 49.52 (1) (d) or 51.423, as indicated in the county's budget or by actual expenditures.
27,2244
Section 2244
. 46.277 (1m) (a) of the statutes is amended to read:
46.277 (1m) (a) “Medical assistance" means aid provided under ss. 49.43 to 49.47 subch. IV of ch. 49, except s. 49.468.
27,2245
Section 2245
. 46.277 (1m) (b) of the statutes is amended to read:
46.277 (1m) (b) “Program" means the community integration program for facilities certified as medical assistance providers, for which a waiver has been received under sub. (2).
27,2247
Section 2247
. 46.277 (2) (e) of the statutes is created to read:
46.277 (2) (e) Review and approve or disapprove waiver requests under sub. (3) (c), review and approve or disapprove requests for exceptions under sub. (5) (d) 3. and provide technical assistance to a county that reaches or exceeds the annual allocation limit specified in sub. (3) (c) in order to explore alternative methods of providing long-term community support services for persons who are in group living arrangements in that county.
27,2248
Section 2248
. 46.277 (3) (a) of the statutes is amended to read:
46.277 (3) (a) Sections 46.27 (3) (b) and 46.275 (3) (a) and (c) to (e) apply to county participation in this program, except that services provided in the program shall substitute for care provided a person in a skilled nursing facility or intermediate care facility who meets the level of care requirements for medical assistance reimbursement to that facility rather than for care provided at a state center for the developmentally disabled. The number of persons who receive services provided by the program under this paragraph may not exceed the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.
27,2249
Section 2249
. 46.277 (3) (b) 2. of the statutes is amended to read:
46.277 (3) (b) 2. Each county department participating in the program shall provide home or community-based care to persons eligible under this section, except that the number of persons who receive home or community-based care under this section may not exceed the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.
27,2250
Section 2250
. 46.277 (3) (c) of the statutes is created to read:
46.277 (3) (c) Beginning on January 1, 1996, from the annual allocation to the county for the provision of long-term community support services under sub. (5), annually establish a maximum total amount, not to exceed 25% of the annual allocation, that may be encumbered in a calendar year for services for eligible individuals in community-based residential facilities. If the total amount that is encumbered for services for individuals in community-based residential facilities who are receiving services under sub. (5) on January 1, 1996, exceeds 25% of the county's annual allocation, a county may request a waiver of the requirement under this paragraph from the department. The department need not promulgate as rules under ch. 227 the standards for granting a waiver request under this paragraph.
27,2251
Section 2251
. 46.277 (4) (a) of the statutes is amended to read:
46.277 (4) (a) Any medical assistance recipient who meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or intermediate care facility is eligible to participate in the program, except that the number of participants may not exceed the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department. Such a recipient may apply, or any person may apply on behalf of such a recipient, for participation in the program. Section 46.275 (4) (b) applies to participation in the program.
27,2253
Section 2253
. 46.277 (4) (b) of the statutes is amended to read:
46.277 (4) (b) To the extent authorized under 42 USC 1396n, if a person discontinues participation in the program, a medical assistance recipient may participate in the program in place of the participant who discontinues if that recipient meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or intermediate care facility, except that the number of participants may not exceed the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.
27,2254
Section 2254
. 46.277 (5) (d) 3. of the statutes is created to read:
46.277 (5) (d) 3. If subd. 2. a. or b. applies, no county may use funds received under this section to pay for services provided to a person who resides or intends to reside in a community-based residential facility and who is initially applying for the services, if the projected cost of services for the person, plus the cost of services for existing participants, would cause the county to exceed the limitation under sub. (3) (c). The department may grant an exception to the requirement under this subdivision, under the conditions specified by rule, to avoid hardship to the person.
27,2255
Section 2255
. 46.277 (5) (e) of the statutes is created to read:
46.277 (5) (e) A county may use funds received under this subsection to provide supportive, personal or nursing services, as defined in rules promulgated under s. 49.45 (2) (a) 23., to a person who resides in a certified assisted living facility, as defined in s. 50.01 (1d). Funding of the services may not exceed 85% of the statewide medical assistance daily cost of nursing home care, as determined by the department.
27,2257
Section 2257
. 46.277 (5g) (title) of the statutes is amended to read:
46.277 (5g) (title) Limitation Limitations on service.
27,2258
Section 2258
. 46.277 (5g) of the statutes is renumbered 46.277 (5g) (a).
27,2259
Section 2259
. 46.277 (5g) (b) of the statutes is created to read:
46.277 (5g) (b) This section does not apply to the delicensure of a bed of an institution for mental diseases of an individual who is aged 21 to 64, who has a primary diagnosis of mental illness and who otherwise meets the requirements of s. 46.266 (1) (a), (b) or (c).
27,2261
Section 2261
. 46.277 (5r) of the statutes is created to read:
46.277 (5r) Rule making. The department shall promulgate rules that specify conditions of hardship under which the department may grant an exception to the requirement of sub. (5) (d) 3.
27,2263
Section 2263
. 46.278 (1m) (b) of the statutes is amended to read:
46.278 (1m) (b) “Medical assistance" means aid provided under ss. 49.43 to 49.47 subch. IV of ch. 49, except s. 49.468.
27,2266
Section 2266
. 46.278 (6) (e) of the statutes is created to read:
