SECTION 2209r. 46.265 (3) of the statutes is repealed.
SECTION 2209w. 46.27 (1) (ai) of the statutes is created to read:
46.27 (1) (ai) "Community-based residential facility" means a facility that meets the definition in s. 50.01 (1g) and that is licensed under s. 50.03 (1).
SECTION 2210. 46.27 (2) (d) of the statutes is amended to read:
46.27 (2) (d) In consultation with representatives of counties, hospitals and nursing homes and with recipients of long-term community support services, develop guidelines for implementing the program and criteria for reviewing community options plans from counties participating in the program. The guidelines and criteria shall address cost-effectiveness, scope, feasibility and impact on the quality and appropriateness of health services and social services and shall provide counties with maximum flexibility to develop programs that address local needs.
SECTION 2211. 46.27 (2) (h) of the statutes is renumbered 46.27 (2) (h) (intro.) and amended to read:
46.27 (2) (h) (intro.) Promulgate all of the following as rules to adopt:
1. Adoption of a long-term community support service fee schedule as part of the uniform fee schedule under s. 46.03 (18) that is substantially similar to the fee calculation schedule existing on January 1, 1985, that was developed as a part of the guidelines required under par. (d).
SECTION 2212. 46.27 (2) (h) 2. of the statutes is created to read:
46.27 (2) (h) 2. Conditions of hardship under which the department may grant an exception to the requirement of sub. (6r) (c).
SECTION 2213. 46.27 (2) (i) of the statutes is created to read:
46.27 (2) (i) Review and approve or disapprove waiver requests under sub. (3) (f), review and approve or disapprove requests for exceptions under sub. (6r) (c) and provide technical assistance to a county that reaches or exceeds the annual allocation limit specified in sub. (3) (f) in order to explore alternative methods of providing long-term community support services for persons who are in group living arrangements in that county.
SECTION 2214. 46.27 (2) (j) of the statutes is created to read:
46.27 (2) (j) By January 1, 1997, develop a model contract for use by counties for purchase of long-term community support services for persons who reside in community-based residential facilities. The governor and the joint committee on finance shall approve the model contract before it is implemented.
SECTION 2215. 46.27 (3) (e) 1. of the statutes is amended to read:
46.27 (3) (e) 1. For a county with an annual allocation for provision of long-term community support services under sub. (7) (b) 1m. that exceeds $185,000, the department shall, unless the department finds that an emergency or unusual circumstance exists, designate a portion of the county's allocation for increased service in each calendar year that the county fails to meet the requirement, to one or more of the groups specified under sub. (4) (a) 1. a. to e.
SECTION 2216. 46.27 (3) (e) 2. of the statutes is amended to read:
46.27 (3) (e) 2. For a county with an annual allocation for provision of long-term community support services under sub. (7) (b) 1m. that is $185,000 or less, the department may designate a portion of the county's allocation for increased service in each calendar year that the county fails to meet the requirement, to one or more of the groups specified under sub. (4) (a) 1. a. to e.
SECTION 2217. 46.27 (3) (f) of the statutes is created to read:
46.27 (3) (f) Beginning on January 1, 1996, from the annual allocation to the county for the provision of long-term community support services under subs. (7) (b) and (11), 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. (7) (b) 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.
SECTION 2218. 46.27 (4) (c) 4. of the statutes is amended to read:
46.27 (4) (c) 4. A description of the method to be used to coordinate the use of funds received under this program with the use of other funds allocated to the county under ss. 46.495 (1) (d), 46.80 (5), and 46.85 (3m) (b) 1. and 2. and 49.52 (1) (d) and to county departments under s. 51.423.
SECTION 2219. 46.27 (5) (b) of the statutes is amended to read:
46.27 (5) (b) Within the limits of state and federal funds allocated under sub. (7), arrange service contracts under s. 46.036 and ensure the provision of necessary long-term community support services for each person who meets the criteria specified in sub. (6) (b). No county department or aging unit may use funds allocated under sub. (7) (b) to provide services in any community-based residential facility unless the county department 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.
SECTION 2220. 46.27 (5) (i) of the statutes is amended to read:
46.27 (5) (i) In the instances in which an individual who is provided long-term community support services under par. (b) for which the individual receives direct funding, serve directly as a fiscal agent or contract with a fiscal intermediary to serve as a fiscal agent for that individual for the purposes of performing the responsibilities and protecting the interests of the individual under the unemployment compensation law. The county department or aging unit may elect to act as a fiscal agent or contract with a fiscal intermediary to serve as a fiscal agent for an individual who is provided long-term support services under s. 46.275, 46.277, 46.278, 49.52, 46.495, 51.42 or 51.437. The fiscal agent under this paragraph is responsible for remitting any federal unemployment compensation taxes or state unemployment compensation contributions owed by the individual, including any interest and penalties which are owed by the individual; for serving as the representative of the individual in any investigation, meeting, hearing or appeal involving ch. 108 or the federal unemployment tax act (26 USC 3301 to 3311) in which the individual is a party; and for receiving, reviewing, completing and returning all forms, reports and other documents required under ch. 108 or the federal unemployment tax act on behalf of the individual. An individual may make an informed, knowing and voluntary election to waive the right to a fiscal agent. The waiver may be as to all or any portion of the fiscal agent's responsibilities. The waiver may be rescinded in whole or in part at any time.
SECTION 2220j. 46.27 (6) (a) 1. of the statutes is amended to read:
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.
SECTION 2220k. 46.27 (6) (b) (intro.) of the statutes is amended to read:
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:
SECTION 2220L. 46.27 (6) (c) of the statutes is created to read:
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.
SECTION 2221. 46.27 (6r) (a) of the statutes is amended to read:
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.
SECTION 2222. 46.27 (6r) (c) of the statutes is created to read:
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.
SECTION 2223c. 46.27 (6r) (e) of the statutes is created to read:
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).
SECTION 2223m. 46.27 (6u) (c) 2. of the statutes is amended to read:
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.
SECTION 2223t. 46.27 (7) (am) of the statutes is amended to read:
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.
SECTION 2224. 46.27 (7) (am) of the statutes, as affected by 1995 Wisconsin Act .... (this act), is amended to read:
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.
SECTION 2226m. 46.27 (7) (b) 1m. of the statutes is amended to read:
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.
SECTION 2226n. 46.27 (7) (b) 1r. of the statutes is created to read:
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:
a. A person under the age of 22.
b. A ventilator-dependent person.
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.
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.
SECTION 2227. 46.27 (7) (b) 2. of the statutes is renumbered 46.27 (7) (cg) and amended to read:
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.
SECTION 2228. 46.27 (7) (c) 2. of the statutes is amended to read:
46.27 (7) (c) 2. Receipt of funds under this section is subject to s. 49.52 (2) 46.495 (2).
SECTION 2229. 46.27 (7) (cm) of the statutes is created to read:
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 that has more than 8 beds, unless one of the following applies:
a. The department approves the provision of services in a community-based residential facility that is licensed on the effective date of this subd. 1. a. .... [revisor inserts date], and that meets standards established under subd. 2.
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.
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:
a. Sufficient responsiveness to individual resident needs.
b. Maintenance of approved levels of quality of care.
c. Cost effectiveness, in comparison with other feasible funding uses.
d. Sufficient consideration of care for facility residents with dementia or related conditions.
3. The department need not promulgate as rules under ch. 227 the standards required to be established under subd. 2.
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.
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.
