Amendment ASA1-AB100

AB100-ASA1,663,5 2. The person suffers from Alzheimer's disease or related dementia and the services are provided to the person in a community-based residential facility that has a dementia care program.

AB100-ASA1,663,8 3. The services are provided to the person in a community-based residential facility and the county department or aging unit has determined that all of the following conditions have been met:

AB100-ASA1,663,11 a. An assessment under sub. (6) has been completed for the person prior to the person's admission to the community-based residential facility, whether or not the person is a private pay admittee at the time of admission.

AB100-ASA1,663,15 b. The county department or aging unit documents that the option of in-home services has been discussed with the person, thoroughly evaluated and found to be infeasible, as determined by the county department or aging unit in accordance with rules promulgated by the department of health and family services.

AB100-ASA1,663,18 c. The county department or aging unit determines that the community-based residential facility is the person's preferred place of residence or is the setting preferred by the person's guardian.

AB100-ASA1,663,20 d. The county department or aging unit determines that the community-based residential facility provides a quality environment and quality care services.

AB100-ASA1,663,23 e. The county department or aging unit determines that placement in the community-based residential facility is cost-effective compared to other options, including home care and nursing home care.

AB100-ASA1,663,25 4. The services are provided to the person in a residential care apartment complex, as defined in s. 50.01 (1d).

AB100-ASA1,664,2 5. The services are provided to the person in an adult family home, as defined in s. 50.01 (1).

AB100-ASA1, s. 1459mf Section 1459mf. 46.27 (7) (ck) of the statutes is created to read:

AB100-ASA1,664,9 46.27 (7) (ck) 1. Subject to the approval of the department, a county may establish and implement more restrictive conditions than those imposed under par. (cj) on the use of funds received under par. (b) for the provision of services to a person in a community-based residential facility. A county that establishes more restrictive conditions under this paragraph shall include the conditions in its community options plan under sub. (3) (cm).

AB100-ASA1,664,14 2. If the department determines that a county has engaged in a pattern of inappropriate use of funds received under par. (b), the department may revoke its approval of the county's conditions established under subd. 1., if any, and may prohibit the county from using funds received under par. (b) to provide services under par. (cj) 3.

AB100-ASA1, s. 1460m Section 1460m. 46.27 (9) (a) of the statutes is amended to read:

AB100-ASA1,664,24 46.27 (9) (a) The department may select up to 5 counties that volunteer to participate in a pilot project under which they will receive certain funds allocated for long-term care. The department shall allocate a level of funds to these counties equal to the amount that would otherwise be paid under s. 20.435 (1) (5) (b) to nursing homes for providing care because of increased utilization of nursing home services, as estimated by the department. In estimating these levels, the department shall exclude any increased utilization of services provided by state centers any center for the developmentally disabled. The department shall calculate these amounts on a calendar year basis under sub. (10).

AB100-ASA1, s. 1134 Section 1134. 46.27 (9) (c) of the statutes is amended to read:

AB100-ASA1,665,6 46.27 (9) (c) All long-term community support services provided under this pilot project in lieu of nursing home care shall be consistent with those services described in the participating county's community options plan under sub. (4) (c) and provided under sub. (5) (b). Each Unless the department has contracted under s. 46.271 (2m) with an entity other than the county department, each county participating in the pilot project shall assess persons under sub. (6).

AB100-ASA1, s. 1135 Section 1135. 46.27 (10) (a) 1. of the statutes is amended to read:

AB100-ASA1,665,12 46.27 (10) (a) 1. The department shall determine for each county participating in the pilot project under sub. (9) a funding level of state medical assistance expenditures to be received by the county. This level shall equal the amount that the department determines would otherwise be paid under s. 20.435 (1) (5) (b) because of increased utilization of nursing home services, as estimated by the department.

AB100-ASA1, s. 1136 Section 1136. 46.27 (11) (c) 3. of the statutes is amended to read:

AB100-ASA1,665,17 46.27 (11) (c) 3. Medical assistance reimbursement for services a county, a private nonprofit agency or an aging unit with which the department contracts provides under this subsection shall be made from the appropriations under s. 20.435 (1) (5) (o) and (7) (b) and (bd).

AB100-ASA1, s. 1137 Section 1137. 46.27 (11) (c) 4. of the statutes is amended to read:

AB100-ASA1,665,23 46.27 (11) (c) 4. The department may, from the appropriation under s. 20.435 (1) (5) (o), provide reimbursement for services provided under this subsection by counties that are in excess of the current average annual per person rate, as established by the department, and are less than or equal to the average amount approved in the waiver received under par. (am).

AB100-ASA1, s. 1464g Section 1464g. 46.27 (11) (c) 5m. of the statutes is created to read:

AB100-ASA1,666,4 46.27 (11) (c) 5m. No county may use funds received under this subsection to provide services to a person who does not live in his or her own home or apartment unless, subject to the limitations under subds. 6., 7. and 8., one of the following applies:

AB100-ASA1,666,8 a. The services are provided to the person in a community-based residential facility that entirely consists of independent apartments, each of which has an individual lockable independent entrance and exit and individual separate kitchen, bathroom, sleeping and living areas.

AB100-ASA1,666,11 b. The person suffers from Alzheimer's disease or related dementia and the services are provided to the person in a community-based residential facility that has a dementia care program.

AB100-ASA1,666,13 c. The services are provided to the person in a residential care apartment complex, as defined in s. 50.01 (1d).

AB100-ASA1,666,15 d. The services are provided to the individual in an adult family home, as defined in s. 50.01 (1).

AB100-ASA1,666,16 e. Subdivision 5n. applies.

AB100-ASA1, s. 1464h Section 1464h. 46.27 (11) (c) 5n. of the statutes is created to read:

AB100-ASA1,666,22 46.27 (11) (c) 5n. A county may also use funds received under this subsection, subject to the limitations under subds. 6., 7. and 8., to provide services to a person who does not live in his or her own home or apartment if the services are provided to the person in a community-based residential facility and the county department or aging unit has determined that all of the following conditions have been met:

AB100-ASA1,666,25 a. An assessment under sub. (6) has been completed for the person prior to the person's admission to the community-based residential facility, whether or not the person is a private pay admittee at the time of admission.

AB100-ASA1,667,4 b. The county department or aging unit documents that the option of in-home services has been discussed with the person, thoroughly evaluated and found to be infeasible, as determined by the county department or aging unit in accordance with rules promulgated by the department of health and family services.

AB100-ASA1,667,7 c. The county department or aging unit determines that the community-based residential facility is the person's preferred place of residence or is the setting preferred by the person's guardian.

AB100-ASA1,667,9 d. The county department or aging unit determines that the community-based residential facility provides a quality environment and quality care services.

AB100-ASA1,667,12 e. The county department or aging unit determines that placement in the community-based residential facility is cost-effective compared to other options, including home care and nursing home care.

AB100-ASA1, s. 1464j Section 1464j. 46.27 (11) (c) 5p. of the statutes is created to read:

AB100-ASA1,667,19 46.27 (11) (c) 5p. a. Subject to the approval of the department, a county may establish and implement more restrictive conditions than those imposed under subd. 5m. on the use of funds received under par. (b) for the provision of services to a person in a community-based residential facility. A county that establishes more restrictive conditions under this paragraph shall include the conditions in its community options plan under sub. (3) (cm).

AB100-ASA1,667,24 b. If the department determines that a county has engaged in a pattern of inappropriate use of funds received under par. (b), the department may revoke its approval of the county's conditions established under subd. 1. a., if any, and may prohibit the county from using funds received under par. (b) to provide services under subd. 5n.

AB100-ASA1, s. 1138 Section 1138. 46.271 (1) of the statutes is renumbered 46.271 (1) (a), and 46.271 (1) (a) (intro.), as renumbered, is amended to read:

AB100-ASA1,668,8 46.271 (1) (a) (intro.) From the appropriation under s. 20.435 (7) (bd), the department shall award $100,000 in each fiscal year to applying county departments under s. 46.215, 46.22, 46.23, 51.42 or 51.437 or to an aging unit under the conditions specified in sub. (3) par. (c) to establish pilot projects for home and community-based long-term support services. Funds awarded to the pilot projects shall be used to do any of the following:

AB100-ASA1, s. 1139 Section 1139. 46.271 (2) of the statutes is renumbered 46.271 (1) (b), and 46.271 (1) (b) 1. and 2., as renumbered, are amended to read:

AB100-ASA1,668,12 46.271 (1) (b) 1. Solicit applications from county departments or aging units for the pilot projects under sub. (1) par. (a).

AB100-ASA1,668,16 2. Require that an applying county department or aging unit under par. (a) subd. 1. submit as part of the application specific plans for improving the coordination between hospitals and providers of home and community-based long-term support services.

AB100-ASA1, s. 1140 Section 1140. 46.271 (2m) of the statutes is created to read:

AB100-ASA1,668,20 46.271 (2m) (a) The department may establish, in geographic areas determined by the department, a pilot project under which the department may contract with a private or public entity to do all of the following:

AB100-ASA1,668,23 1. Serve as a clearinghouse of information for individuals who are interested in home or community-based long-term support services or institutional long-term care services.

AB100-ASA1,669,6 2. Perform assessments using the assessment method established by the department to determine an individual's functional abilities, disabilities, personal preferences and need for home or community-based long-term support services or institutional long-term care services. Each assessment shall include an investigation of long-term community support services that could serve as alternatives to institutional care in a nursing home or community-based residential facility. The assessment shall include an explanation of the potential community alternatives to the person being assessed and the person's family or guardian.

AB100-ASA1,669,8 3. Collect information specified by the department on the individuals served by the entity and provide that information to the department.

AB100-ASA1,669,13 (am) Residents of the geographic areas where a pilot project under this subsection is established shall receive an assessment by the entity contracted with under par. (a) (intro.) prior to entry into a nursing home or community-based residential facility or participation in the long-term support community options program under s. 46.27.

AB100-ASA1,669,16 (ap) The department may require that the results of a client's assessment under par. (a) 2. be submitted at the time that a provider submits a request for prior authorization for medical assistance services.

AB100-ASA1,669,20 (b) From the amounts carried forward under 1997 Wisconsin Act .... (this act), section 9123 (2), the department shall distribute funds to the entities with which the department contracts under par. (a) (intro.) for the performance of the functions specified under par. (a) 1. to 3.

AB100-ASA1,669,21 (c) Paragraphs (a) 2., (am) and (ap) do not apply to any of the following:

AB100-ASA1,669,23 1. Emergency admissions, as determined by a physician, but shall be applied within 10 days after the admission.

AB100-ASA1,670,2 2. A private pay patient seeking admission to or about to be admitted to a nursing home or community-based residential facility who is informed about the program but waives the assessment, unless the patient will be eligible for medical assistance within 6 months after the assessment.

AB100-ASA1,670,5 3. Persons seeking admission to or about to be admitted to the Wisconsin Veteran's Home at King who are informed about the pilot project but waive the assessment.

AB100-ASA1,670,7 4. Any person who is readmitted to a nursing home or community-based residential facility from a hospital within 6 months after being assessed.

AB100-ASA1,670,9 5. Current residents of a nursing home or community-based residential facility who are eligible for an assessment but who waive the assessment.

AB100-ASA1,670,11 6. A person who enters a nursing home or community-based residential facility for recuperative care.

AB100-ASA1,670,13 7. A person who enters a nursing home or community-based residential facility for respite care.

AB100-ASA1,670,17 8. A person who is admitted to a nursing home or community-based residential facility from another nursing home or community-based residential facility, unless the person requests an assessment and funds distributed for assessments under par. (b) are available to the entity.

AB100-ASA1, s. 1141 Section 1141. 46.271 (3) of the statutes is renumbered 46.271 (1) (c) and amended to read:

AB100-ASA1,670,22 46.271 (1) (c) The department may contract with an aging unit, as defined in s. 46.27 (1) (a), for administration of services under sub. (1) par. (a) if, by resolution, the county board of supervisors of that county so requests the department.

AB100-ASA1, s. 1468d Section 1468d. 46.275 (title) of the statutes is amended to read:

AB100-ASA1,670,25 46.275 (title) Community integration program for state center residents of state centers.

AB100-ASA1, s. 1468g Section 1468g. 46.275 (1) of the statutes is amended to read:

AB100-ASA1,671,7 46.275 (1) Legislative intent. The intent of the program under this section is to relocate persons from the residents of any state centers center for the developmentally disabled into appropriate community settings with the assistance of home and community-based services and with continuity of care. The intent of the program is also to minimize its impact on state employes through redeployment of employes into vacant positions.

AB100-ASA1, s. 1468m Section 1468m. 46.275 (1m) (b) of the statutes is amended to read:

AB100-ASA1,671,11 46.275 (1m) (b) "Program" means the community integration program for residents of any state centers center for the developmentally disabled, for which a waiver has been received under sub. (2).

AB100-ASA1, s. 1468p Section 1468p. 46.275 (2) (intro.) of the statutes is amended to read:

AB100-ASA1,671,23 46.275 (2) Departmental powers and duties. (intro.) 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 integrate medical assistance recipients who reside in state centers residents of any state center for the developmentally disabled who receive medical assistance into their communities by providing home and community-based services as part of the medical assistance program. 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:

AB100-ASA1, s. 1468r Section 1468r. 46.275 (2) (b) of the statutes is amended to read:

AB100-ASA1,672,3 46.275 (2) (b) Evaluate the effect of the program on medical assistance costs and on the program's ability to provide community care alternatives to institutional care in a state centers center for the developmentally disabled.

AB100-ASA1, s. 1142 Section 1142. 46.275 (5) (a) of the statutes is amended to read:

AB100-ASA1,672,10 46.275 (5) (a) 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) (5) (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.

AB100-ASA1, s. 1143 Section 1143. 46.275 (5) (c) of the statutes is amended to read:

AB100-ASA1,672,18 46.275 (5) (c) The total allocation under s. 20.435 (1) (5) (b) and (o) to counties and to the department under sub. (3r) for services provided under this section may not exceed the amount approved by the federal department of health and human services. A county may use funds received under this section only to provide services to persons who meet the requirements under sub. (4) and may not use unexpended funds received under this section to serve other developmentally disabled persons residing in the county.

AB100-ASA1, s. 1144 Section 1144. 46.275 (5) (d) of the statutes is amended to read:

AB100-ASA1,672,24 46.275 (5) (d) The department may, from the appropriation under s. 20.435 (1) (5) (o), provide reimbursement for services provided under this section by counties that are in excess of the current average annual per person rate, as established by the department, and are less than the average amount approved in the waiver received under sub. (2).

AB100-ASA1, s. 1471m Section 1471m. 46.277 (3) (c) of the statutes is amended to read:

AB100-ASA1,673,10 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.

AB100-ASA1, s. 1471p Section 1471p. 46.277 (5) (d) 1m. of the statutes is created to read:

AB100-ASA1,673,15 46.277 (5) (d) 1m. No county may use funds received under this section to provide services to a person who does not live in his or her own home or apartment unless, subject to the limitations under subds. 2. and 3. and par. (e), one of the following applies:

AB100-ASA1,673,19 a. The services are provided to the person in a community-based residential facility that entirely consists of independent apartments, each of which has an individual lockable independent entrance and exit and individual separate kitchen, bathroom, sleeping and living areas.

AB100-ASA1,673,22 b. The person suffers from Alzheimer's disease or related dementia and the services are provided to the person in a community-based residential facility that has a dementia care program.

AB100-ASA1,673,24 c. The services are provided to the person in a residential care apartment complex, as defined in s. 50.01 (1d).

AB100-ASA1,674,2 d. The services are provided to the individual in an adult family home, as defined in s. 50.01 (1).

AB100-ASA1,674,3 e. Subdivision 1n. applies.

AB100-ASA1, s. 1471q Section 1471q. 46.277 (5) (d) 1n. of the statutes is created to read: