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, 1996, 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.
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 model contract developed under sub. (2) (j) or a contract that includes all of the provisions of the 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 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 2223. 46.27 (6r) (d) of the statutes is created to read:
46.27 (6r) (d) A person as specified in sub. (11m).
****NOTE: This is reconciled s. 46.27 (6r) (d). This section has been affected by a draft with the following LRB #: 0450/3.
SECTION 2224. 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 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 2225. 46.27 (7) (b) of the statutes, as affected by 1995 Wisconsin Act .... (this act), is amended to read:
46.27 (7) (b) From Except as specified in sub. (11m), from the appropriation under s. 20.435 (7) (bd), 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.
****NOTE: This is reconciled s. 46.27 (7) (b). This section has been affected by a draft with the following LRB #: 0448/2.
SECTION 2226. 46.27 (7) (b) 1m. of the statutes is renumbered 46.27 (7) (b).
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, as defined in s. 50.01 (1g), 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 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 2230. 46.27 (7m) of the statutes is amended to read:
46.27 (7m) RIGHT TO HEARING. A person who is denied eligibility for services or whose services are reduced or terminated under this section may request a hearing from the department under s. 227.44, except that lack of adequate funding or a denial under sub. (6r) (a) or (d) may not serve as the basis for a request under this subsection.
SECTION 2231. 46.27 (11) (am) of the statutes is amended to read:
46.27 (11) (am) The department shall request a waiver from the secretary of the federal department of health and human services, under 42 USC 1396n (c), authorizing the department to provide as part of the medical assistance program, except as specified in sub. (11m), home and community-based services for persons who are eligible for long-term support community options program services under sub. (5) (b).
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 an assisted living facility, as defined in s. 50.01 (1d). Funding of the services may not exceed 85% of the statewide rate for reimbursement under s. 49.45 (6m), as determined by the department under s. 49.45 (6m) (L).
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 model contract developed under sub. (2) (j) or a contract that includes all of the provisions of the model contract.
****NOTE: This is reconciled s. 46.27 (11) (c) 8. This SECTION has been affected by a draft with the following LRB number: -0453/2.
SECTION 2234. 46.27 (11) (cm) of the statutes is created to read:
46.27 (11) (cm) 1. The department shall request from the secretary of the federal department of health and human services an amendment to the waiver specified in par. (am) to allow the department to receive federal financial participation to continue to provide, notwithstanding sub. (11m), long-term community support services that substitute for the benefit under s. 49.46 (2) (a) 4. a. or (b) 6. a. to an individual who is eligible for medical assistance only under s. 49.47; who was receiving the services, provided as a medical assistance benefit, on January 1, 1996; and who has continued to receive those services or the services, provided as a medical assistance benefit, that are described in s. 46.275 (5g), 46.277 (5g) (c) or 46.278 (6m) or specified in s. 49.46 (2) (a) 4. c. or (b) 6. a. since that date.
2. If the waiver amendment under subd. 1. is granted and remains in effect, the department shall provide the services described in subd. 1. to individuals covered by the waiver amendment, notwithstanding sub. (11m).
****NOTE: This is reconciled s. 46.27 (11) (cm) 1. This section has been affected by a draft with the following LRB #: 0444/1.
SECTION 2235. 46.27 (11m) of the statutes is created to read:
46.27 (11m) LIMITATION. The department may not allocate funds to a county to provide long-term community support services that substitute for the benefit under s. 49.46 (2) (a) 4. a. or (b) 6. a. for persons who meet the condition specified under sub. (6r) (b) 1. but who are eligible for medical assistance only under s. 49.47.
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.
SECTION 2237. 46.275 (2) (intro.) of the statutes is amended to read:
46.275 (2) DEPARTMENTAL POWERS AND DUTIES. (intro.) The department may request a waiver from the secretary of the U.S. federal department of health and human services, under 42 USC 1396n (c), authorizing the department to integrate medical assistance recipients who reside in state centers for the developmentally disabled into their communities by providing home and community-based services as part of the medical assistance program, except as provided in sub. (5g). If the department requests this waiver, it shall include all assurances required under 42 USC 1396n (c) (2) in its request. If the department receives this waiver, at the end of the 3-year period during which the waiver remains in effect the department may request an additional 3-year extension of the waiver. If the department receives this waiver, it shall:
SECTION 2238. 46.275 (4) (a) of the statutes is amended to read:
46.275 (4) (a) Any Except as provided in sub. (5g), any medical assistance recipient living in a state center for the developmentally disabled is eligible to participate in the program. Such a recipient may apply, or any person may apply on behalf of such a recipient, for participation in the program.
SECTION 2239. 46.275 (5) (a) of the statutes is amended to read:
46.275 (5) (a) Medical Except as provided in sub. (5g), medical assistance reimbursement for services a county, or the department under sub. (3r), provides under this program is available from the appropriations under s. 20.435 (1) (b) and (o). If 2 or more counties jointly contract to provide services under this program and the department approves the contract, medical assistance reimbursement is also available for services provided jointly by these counties.
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.
SECTION 2241. 46.275 (5d) of the statutes is created to read:
46.275 (5d) WAIVER AMENDMENT. (a) The department shall request from the secretary of the federal department of health and human services an amendment to the waiver specified in sub. (2) to allow the department to receive federal financial participation to continue to provide, notwithstanding sub. (5g), home and community-based services that substitute for the benefit under s. 49.46 (2) (a) 4. a. or (b) 6. a. to an individual who is eligible for medical assistance only under s. 49.47; who was receiving the services, provided as a medical assistance benefit, on January 1, 1996; and who has continued to receive those services or the services, provided as a medical assistance benefit, that are described in s. 46.27 (11m), 46.277 (5g) (c) or 46.278 (6m) or specified in s. 49.46 (2) (a) 4. c. or (b) 6. a. since that date.
(b) If the waiver amendment under par. (a) is granted and remains in effect, the department shall provide the services described in par. (a) to individuals covered by the waiver amendment, notwithstanding sub. (5g).
****NOTE: This is reconciled s. 46.275 (5d). This section has been affected by a draft with the following LRB #: 0444/1.
SECTION 2242. 46.275 (5g) of the statutes is created to read:
46.275 (5g) LIMITATION. The department may not provide under this section home and community-based services that substitute for the benefit under s. 49.46 (2) (a) 4. a. or (b) 6. a. for persons who are eligible for medical assistance only under s. 49.47.
SECTION 2243. 46.277 (1) of the statutes is amended to read:
46.277 (1) LEGISLATIVE INTENT. The intent of the program under this section, except as provided in sub. (5g) (c), is to provide home or community-based care to serve in a noninstitutional community setting a person who meets eligibility requirements under 42 USC 1396n (c) and is relocated from an institution other than a state center for the developmentally disabled or meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or an intermediate care facility, except that the number of persons who receive home or community-based care under this section is not intended to exceed the number of nursing home beds that are delicensed as part of a plan submitted by the facility and approved by the department. The intent of the program is also that counties use all existing services for providing care under this section, including those services currently provided by counties.
****NOTE: This is reconciled s. 46.277 (1). This section has been affected by a draft with the following LRB #: 0444/1.
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.
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).
SECTION 2246. 46.277 (2) (intro.) of the statutes is amended to read:
46.277 (2) DEPARTMENTAL POWERS AND DUTIES. (intro.) The department may request a waiver from the secretary of the federal department of health and human services, under 42 USC 1396n (c), authorizing the department to serve medical assistance recipients, who meet the level of care requirements for medical assistance reimbursement in a skilled nursing facility or an intermediate care facility, in their communities by providing home or community-based services as part of medical assistance, except as provided in sub. (5g) (c). The number of persons for whom the waiver is requested may not exceed the number of nursing home beds that are delicensed as part of a plan submitted by the facility and approved by the department. If the department requests a waiver, it shall include all assurances required under 42 USC 1396n (c) (2) in its request. If the department receives this waiver, it may request one or more 3-year extensions of the waiver under 42 USC 1396n (c) and shall perform the following duties:
****NOTE: This is reconciled s. 46.277 (2) (intro.). This section has been affected by a draft with the following LRB #: 0444/1.
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.
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.
SECTION 2249. 46.277 (3) (b) 2. of the statutes is amended to read:
