Amendment ASA-AB150

AB150-ASA,771,5 46.27 (6) (a) 1. Within the limits of state and federal funds allocated under sub. (7) and within the limits of fees collected, an assessment shall be conducted for any person identified in sub. (5) (e) or who is seeking admission to or is about to be admitted to a nursing home. A fee may be charged, unless prohibited, for the assessment.

AB150-ASA, s. 2220k Section 2220k. 46.27 (6) (b) (intro.) of the statutes is amended to read:

AB150-ASA,771,9 46.27 (6) (b) (intro.) Within the limits of state and federal funds allocated under sub. (7) and within the limits of fees collected unless prohibited, a community services case plan shall be developed for any person with chronic disabilities:

AB150-ASA, s. 2220L Section 2220L. 46.27 (6) (c) of the statutes is created to read:

AB150-ASA,771,15 46.27 (6) (c) The amount of any fee charged for conduct of an assessment under par. (a) or for development of a case plan under par. (b) shall be in accordance with a sliding scale formula established by the department by rule under sub. (12) (c). A fee may not be charged if prohibited under 42 USC 1396 to 1396v or under regulations under 42 USC 1396 to 1396v.

AB150-ASA, s. 2221 Section 2221. 46.27 (6r) (a) of the statutes is amended to read:

AB150-ASA,771,25 46.27 (6r) (a) A person who is initially eligible for services under sub. (7) (b), for whom home and community-based services are available under sub. (11) or s. 46.275, 46.277 or 46.278 that require less total expenditure of state funds than do comparable services under sub. (7) (b) and who is eligible for and offered the home and community-based services under sub. (11) or s. 46.275, 46.277 or 46.278, but who declines the offer, except that a county may use funds received under sub. (7) (b) to pay for long-term community support services for the person for a period of up to 90 days during which an application for services under sub. (11) or s. 46.275, 46.277 or 46.278 for the person is processed.

AB150-ASA, s. 2222 Section 2222. 46.27 (6r) (c) of the statutes is created to read:

AB150-ASA,772,7 46.27 (6r) (c) A person who resides or intends to reside in a community-based residential facility and who is initially applying for long-term community support 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) (f), unless the department grants an exception to the requirement under this paragraph, under the conditions specified by rule, to avoid hardship to the person.

AB150-ASA, s. 2223c Section 2223c. 46.27 (6r) (e) of the statutes is created to read:

AB150-ASA,772,11 46.27 (6r) (e) A person who has not resided in this state for at least 180 consecutive days before applying for or receiving long-term community support services that are funded under sub. (7) (b).

AB150-ASA, s. 2223m Section 2223m. 46.27 (6u) (c) 2. of the statutes is amended to read:

AB150-ASA,772,18 46.27 (6u) (c) 2. For a person who is determined to be financially eligible under subd. 1. calculate, by use of the uniform fee system under s. 46.03 (18), the amount of cost sharing required for receipt of long-term community support services provided under sub. (5) (b). The county department or aging unit shall require payment by the person of at least 50% 100% of the amount calculated under this subdivision.

AB150-ASA, s. 2223t Section 2223t. 46.27 (7) (am) of the statutes is amended to read:

AB150-ASA,773,2 46.27 (7) (am) From the appropriation under s. 20.435 (7) (bd), the department shall allocate funds to each county or private nonprofit agency with which the department contracts to pay assessment and case plan costs under sub. (6) not otherwise paid by fee or under s. 46.032 or 49.45. The department shall reimburse counties for the cost of assessing persons eligible for medical assistance under s. 49.46, 49.468 or 49.47 as part of the administrative services of medical assistance, payable under s. 49.45 (3) (a). Counties may use unspent funds allocated under this paragraph to pay the cost of long-term community support services.

AB150-ASA, s. 2224 Section 2224. 46.27 (7) (am) of the statutes, as affected by 1995 Wisconsin Act .... (this act), is amended to read:

AB150-ASA,773,12 46.27 (7) (am) From the appropriation under s. 20.435 (7) (bd), the department shall allocate funds to each county or private nonprofit agency with which the department contracts to pay assessment and case plan costs under sub. (6) not otherwise paid by fee or under s. 46.032 49.33 (2) or 49.45. The department shall reimburse counties for the cost of assessing persons eligible for medical assistance under s. 49.46, 49.468 or 49.47 as part of the administrative services of medical assistance, payable under s. 49.45 (3) (a). Counties may use unspent funds allocated under this paragraph to pay the cost of long-term community support services.

AB150-ASA, s. 2226m Section 2226m. 46.27 (7) (b) 1m. of the statutes is amended to read:

AB150-ASA,773,25 46.27 (7) (b) 1m. From the appropriation appropriations under s. 20.435 (7) (bd) and (im), the department shall allocate funds to each county to pay the cost of providing long-term community support services under sub. (5) (b) not otherwise paid under s. 49.45 to persons eligible for medical assistance under s. 49.46 or 49.47 or to persons whom the county department or aging unit administering the program finds likely to become medically indigent within 6 months by spending excess income or assets for medical or remedial care. The average per person reimbursement under this paragraph may not exceed the state share of the average per person payment rate the department expects under s. 49.45 (6m). The county department or aging unit administering the program may spend funds received under this paragraph only in accordance with the case plan and service contract created for each person receiving long-term community support services.

AB150-ASA, s. 2226n Section 2226n. 46.27 (7) (b) 1r. of the statutes is created to read:

AB150-ASA,774,5 46.27 (7) (b) 1r. 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:

AB150-ASA,774,6 a. A person under the age of 22.

AB150-ASA,774,7 b. A ventilator-dependent person.

AB150-ASA,774,14 c. A person not specified under subd. 1r. 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 publicly funded costs or, if the person is ineligible for medical assistance under s. 49.46, 49.468 or 49.47, private costs for nursing home care would actually exceed the cost of providing the person with care in the community.

AB150-ASA,774,16 d. Any individual, if the department determines that nursing home care is not available for that individual.

AB150-ASA,774,18 e. Any individual, if the department determines that public funding is not available for the institutional care of that individual.

AB150-ASA, s. 2227 Section 2227. 46.27 (7) (b) 2. of the statutes is renumbered 46.27 (7) (cg) and amended to read:

AB150-ASA,774,24 46.27 (7) (cg) No county may use funds received under this paragraph par. (b) to pay for long-term community support services provided any person who resides in a nursing home, unless the department waives this restriction on use of funds and the services are provided in accordance with a discharge plan.

AB150-ASA, s. 2228 Section 2228. 46.27 (7) (c) 2. of the statutes is amended to read:

AB150-ASA,775,2 46.27 (7) (c) 2. Receipt of funds under this section is subject to s. 49.52 (2) 46.495 (2).

AB150-ASA, s. 2229 Section 2229. 46.27 (7) (cm) of the statutes is created to read:

AB150-ASA,775,7 46.27 (7) (cm) 1. Beginning on January 1, 1996, no county, private nonprofit agency or aging unit may use funds received under par. (b) to provide services in any community-based residential facility, as defined in s. 50.01 (1g), that has more than 8 beds, unless one of the following applies:

AB150-ASA,775,10 a. The department approves the provision of services in a community-based residential facility that has no more than 16 beds and that meets standards established under subd. 2.

AB150-ASA,775,15 b. The department approves the provision of services in a community-based residential facility that entirely consists of independent apartments, each of which has an individual lockable entrance and exit and individual separate kitchen, bathroom, sleeping and living areas, to individuals who are provided services under sub. (5) (b) and are physically disabled or are at least 65 years of age.

AB150-ASA,775,19 2. By January 1, 1996, the department shall establish standards for approvals made under subd. 1. a., including whether the proposed use of funds for residents at the community-based residential facility in question adequately provides for all of the following:

AB150-ASA,775,20 a. Sufficient responsiveness to individual resident needs.

AB150-ASA,775,21 b. Maintenance of approved levels of quality of care.

AB150-ASA,775,22 c. Cost effectiveness, in comparison with other feasible funding uses.

AB150-ASA,775,24 d. Sufficient consideration of care for facility residents with dementia or related conditions.

AB150-ASA,776,2 3. The department need not promulgate as rules under ch. 227 the standards required to be established under subd. 2.

AB150-ASA,776,5 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.

AB150-ASA, s. 2229r Section 2229r. 46.27 (7g) of the statutes is created to read:

AB150-ASA,776,7 46.27 (7g) Recovery of costs of care. (a) In this subsection:

AB150-ASA,776,9 1. "Client" means a person who receives or received long-term community support services that are funded under sub. (7).

AB150-ASA,776,10 2. "Disabled" has the meaning given in s. 49.468 (1) (a) 1.

AB150-ASA,776,13 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.

AB150-ASA,776,20 (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).

AB150-ASA,776,22 2. The department may not obtain a lien under this paragraph if any of the following persons lawfully reside in the home:

AB150-ASA,776,23 a. The client's spouse.

AB150-ASA,776,24 b. The client's child who is under age 21 or is disabled.

AB150-ASA,777,4 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.

AB150-ASA,777,6 3. Before obtaining a lien on a client's home under this paragraph, the department shall do all of the following:

AB150-ASA,777,11 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.

AB150-ASA,777,12 b. Provide the client with a hearing if he or she requests one.

AB150-ASA,777,14 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.

AB150-ASA,777,17 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.

AB150-ASA,777,19 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:

AB150-ASA,777,20 a. A spouse.

AB150-ASA,777,21 b. A child who is under age 21 or disabled.

AB150-ASA,778,2 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.

AB150-ASA,778,5 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.

AB150-ASA,778,7 7. The department may enforce a lien imposed under this paragraph by foreclosure in the same manner as a mortgage on real property.

AB150-ASA,778,10 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.

AB150-ASA,778,15 (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.

AB150-ASA,778,17 2. The affidavit of a person designated by the secretary to administer this paragraph is evidence of the amount of the claim.

AB150-ASA,778,20 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:

AB150-ASA,778,21 a. The decedent's wearing apparel and jewelry held for personal use.

AB150-ASA,778,22 b. Household furniture, furnishings and appliances.

AB150-ASA,778,24 c. Other tangible personal property not used in trade, agriculture or other business, not to exceed $1,000 in value.

AB150-ASA,779,2 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.

AB150-ASA,779,7 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.

AB150-ASA,779,9 6. The department may not enforce the lien under subd. 5. as long as any of the following survive the decedent:

AB150-ASA,779,10 a. A spouse.

AB150-ASA,779,11 b. A child who is under age 21 or disabled.

AB150-ASA,779,13 7. The department may enforce a lien under subd. 5. by foreclosure in the same manner as a mortgage on real property.

AB150-ASA,780,2 (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.

AB150-ASA,780,6 (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.

AB150-ASA,780,9 (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.

AB150-ASA,780,11 2. The department may file a claim under par. (c) only with respect to a client who dies after February 15, 1996.

AB150-ASA,780,16 (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.

AB150-ASA, s. 2231r Section 2231r. 46.27 (11) (c) 3m. of the statutes is created to read:

AB150-ASA,780,21 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:

AB150-ASA,780,22 a. A person under the age of 22.

AB150-ASA,780,23 b. A ventilator-dependent person.

AB150-ASA,781,4 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.

AB150-ASA,781,6 d. Any individual, if the department determines that nursing home care is not available for that individual.

AB150-ASA,781,8 e. Any individual, if the department determines that public funding is not available for the institutional care of that individual.

AB150-ASA, s. 2232 Section 2232. 46.27 (11) (c) 7. of the statutes is created to read: