Under current statutes, at least 24 hours before a woman may obtain a lawful
abortion, the attending physician, another physician or a person assisting the
attending physician must tell her certain information and must provide her with
written information that DHFS must publish and distribute. Among other things,
the material must state that it is unlawful for any person to coerce a woman to
undergo an abortion, and the physician or assistant must orally state that a woman
has a legal right to place her child in foster care or place the child with a relative for
adoption.
Under this bill, the materials must state that it is unlawful to perform an
abortion for which consent has been coerced. The attending physician, a person
assisting him or her or another physician must orally state that a woman has the
legal right to place her child in a foster home or treatment foster home for 6 months
or to petition a court for placement of the child in a foster home, treatment foster
home or group home or with a relative, or to place the child for adoption under a
process that involves court approval both of the voluntary termination of parental
rights and of the adoption.
Under current law, DHFS is permitted to charge a fee for the written materials
that it must publish and distribute and that must be provided to a woman at least
24 hours before she obtains a lawful abortion. The fee may not exceed the actual cost
of the preparation and distribution of those materials. County departments are
required to distribute the materials and may charge a fee not to exceed the actual cost
of preparation and distribution of the materials. This bill deletes authorization for
DHFS and for county departments to charge a fee for the materials.
Currently, under Karlin v. Foust, No. 96-C-0374-C, 1996 U.S. Dist. (W.D. Wis.
filed May 1, 1996), enforcement of the requirement to provide the materials and of
the requirement that the woman receive the materials at least 24 hours prior to
obtaining an abortion has been temporarily restrained.
Under current law, DHFS may impose daily forfeitures (civil monetary
penalties) on a C-BRF licensee who violates the laws relating to C-BRFs. Currently,
the C-BRF licensee must pay all forfeitures within 10 days after receipt of the notice
of assessment, or, if the forfeiture is contested, within 10 days after receipt of a final
administrative decision ordering payment, unless the decision is appealed and the
decision is stayed by a court order.
This bill permits a C-BRF licensee against whom a forfeiture has been assessed
to make alternative arrangements acceptable to DHFS for the payment of the
forfeiture. The bill requires DHFS not to continue a C-BRF license if, on the date
that the licensing fee is due, the C-BRF has any forfeitures that are due and have
not been paid.
Under current law, DHFS may establish a fee for each workshop or seminar
that it provides relating to the provision of services by C-BRFs and nursing homes.
This bill allows DHFS to establish a fee for each workshop or seminar that it provides
relating to the provision of services by assisted living facilities, adult family homes,
hospitals, home health agencies, rural medical centers and hospices.
Under current law, DHFS subsidizes continuation coverage premiums for
certain persons infected with human immunodeficiency virus (HIV). Continuation
coverage is coverage under an employer-provided group health insurance plan that
an employe, who would otherwise lose coverage because of a reduction in hours or
termination of employment, may continue upon payment of the applicable
premiums. To be eligible for premium subsidies, a person with an HIV infection must
be a state resident who has a family income that does not exceed 200% of the federal
poverty line, who is not eligible for medicare and who does not have insurance
coverage other than under the plan for which he or she is eligible for continuation
coverage or under a group or individual plan that offers a substantial reduction in
the covered services from the plan for which he or she is eligible for continuation
coverage. His or her employment must have been terminated, or his or her hours
must have been reduced, because of an illness or medical condition arising from or
related to the HIV infection. Premium subsidies for an eligible person may be paid
by DHFS until the person's continuation coverage ceases or until the expiration of
29 months after his or her continuation coverage began, whichever occurs first.
This bill expands eligibility for, and uses of, premium subsidies. A state
resident who has an HIV infection may be eligible for premium subsidies even if he
or she is eligible for medicare. The person's family income may not exceed 300% of
the federal poverty line, rather than 200%. However, if the person's family income
exceeds 200% of the federal poverty line, he or she must pay a portion of the premium
for the insurance coverage. The amount that the person pays is determined
according to a schedule established by DHFS, taking into consideration both income
level and family size. Premium subsidies are no longer limited to continuation
coverage. With the exceptions of medicare, medicare replacement policies and
long-term care insurance policies, premium subsidies may be paid for any health
insurance coverage, whether group or individual, that a person who fulfills all of the
other eligibility requirements has coverage under or is eligible for, including a
medicare supplement policy. The level of services covered under the policy does not
matter. In addition, premium subsidies may be paid for as the long as the person
remains eligible and has the coverage.
Under current law, the state registrar is required to accept for registration,
assign a date of acceptance, index and preserve original certificates of birth and
death, original marriage documents and original divorce reports. Numerous
provisions of the vital statistics laws require use of original vital records. Mutilating
or destroying an original birth or death certificate is punishable by a fine or up to 2
years imprisonment, or both.
This bill authorizes the state registrar to transfer to optical disk or electronic
format, in accordance with procedures and standards prescribed by the department
of administration, the paper originals of certificates of birth, death, divorce or
annulment, marriage documents, fetal death reports and related reports and to
destroy the originals of vital records that are transferred to optical disk or electronic
format. The bill also authorizes the state registrar to microfilm the paper originals
of these vital records, if so approved by the public records board. Lastly, the bill
provides that copies of vital records that have been converted to optical disk or
electronic format serve as the original vital records for purposes of the vital statistics
laws.
Under current law, DHFS may not approve for occupancy more than 22,516
hospital beds. Currently, a person may obligate for a capital expenditure, by or on
behalf of a hospital, to renovate or replace existing approved beds of the hospital or
to undertake new construction if the renovation, replacement or new construction
does not increase the approved bed capacity of the hospital. A person may also
obligate for a capital expenditure or implement services that increase the approved
bed capacity of a hospital if the capital expenditure or services are necessitated by
a transfer of beds from a public hospital that is operated by a county with a
population of 500,000 or more (Milwaukee County) to a private hospital and if the
resulting combined total number of approved beds in the 2 hospitals does not
increase. Currently, no person may transfer approved beds of a hospital to a facility
that is associated with the hospital.
This bill eliminates the cap on the number of hospital beds that DHFS may
approve. The bill also removes the bed capacity restrictions on capital expenditures
obligated by or on behalf of a hospital.
Under current law, DHFS must analyze occurrences, trends and patterns of
acute, communicable or chronic diseases, maternal and child health, injuries and
occupational and environmental hazards and distribute information based on these
analyses. This bill authorizes DHFS to charge reasonable fees for the analysis and
provision of health, occupational and environmental data.
Public assistance
Under current law, the department of industry, labor and job development
(DILJD) administers the food stamp employment and training program under which
certain food stamp recipients aged 18 to 60 may be required to work or participate
in job training. Currently, DILJD is authorized, to the extent permitted by federal
law or waiver, to distribute food stamp benefits based on the number of hours that
an individual participates in the work or training requirement, a method commonly
referred to as "pay-for-performance".
This bill expands the food stamp benefit distribution methods to include use of
not more than $300 of a household's food stamp benefit amount as a wage subsidy
to be paid to an employer of a member of the household who is employed by that
employer as a participant in a Wisconsin works (W-2) employment position. W-2
is this state's replacement program for the aid to families with dependent children
(AFDC) program. Participants in W-2 employment positions receive a cash benefit
based on work participation rather than family size, as under AFDC. The bill also
permits DILJD to distribute food stamp benefits as cash to households in which: 1)
a member has been employed in unsubsidized employment for at least 90 days, has
earned at least $350 per month for the last 90 days and continues to earn at least
$350 per month; or 2) a member is a participant in a W-2 employment position or
was a participant in a W-2 employment position but became ineligible solely because
of earnings. DILJD may not implement either of these methods of distribution,
however, until the secretary of administration reviews and approves a plan
submitted to DOA by DILJD detailing how DILJD will implement the distribution
methods and what the fiscal impact of those methods will be.
The bill also modifies the eligibility requirements under the food stamp
program. Under the bill, an individual is disqualified from the food stamp program
for noncompliance with the work requirements of the program. For the first
occurrence of noncompliance, the ineligibility period is one month; for the 2nd
occurrence, 3 months; and for the 3rd and subsequent occurrences, 6 months.
In addition, under the bill, in order to be eligible for food stamp benefits, a
person who is a custodial parent of a child who is under the age of 18 and who has
an absent parent, a person who is a noncustodial or putative parent of a child who
is under the age of 18 or a person who lives with and exercises parental control over
a child who is under the age of 18 and who has an absent parent must cooperate with
efforts to establish the paternity of the child and with efforts to secure any support
to which the person or child may have rights.
Finally, under the bill, DILJD must require an applicant for the food stamp
program to state in writing whether the applicant or any member of the applicant's
household has been convicted in any state or federal court of a felony that has as an
element possession, use or distribution of a controlled substance (dangerous drug).
A person who, after August 22, 1996, has been convicted of such a felony is ineligible
for food stamps and, in determining a household's eligibility for food stamps, the
needs of that person are not considered. However, the person's income and resources
are considered to be available to the household. The period of ineligibility or
disregard of the person's needs continues for at least 12 months, but must end after
12 months if the person submits to a test for drug use and the results of the test are
negative.
Under current law, a county department of social or human services is required
to certify eligibility for and issue food coupons to needy households, except that a W-2
agency (the agency with which DILJD contracts to administer W-2) is required to
certify eligibility for and issue food coupons to eligible participants in the W-2
program.
This bill requires a W-2 agency also to certify eligibility for and issue food
coupons to: 1) persons who may be required to participate in the food stamp
employment and training program; and 2) other persons who are under the age of
61 and who are not disabled.
Currently, certain offenses under the food stamp program are punishable by
fines or imprisonment or both. The maximum punishment for an offense involving
food coupons having a value of more than $100 is a fine of not more than $10,000 or
imprisonment for not more than 5 years or both. In addition, a court may suspend
a person who violates the food stamp provisions from participation in the food stamp
program for up to 18 months.
Under federal law, an offense involving food coupons having a value of $5,000
or more is punishable by a fine of not more than $250,000 or imprisonment for not
more than 20 years or both. Also, under federal law, a person who violates certain
provisions of the food stamp program must be suspended from the program for one
year for the first offense, 2 years for the 2nd offense and permanently for the 3rd
offense. Upon conviction of an offense under the federal law involving food coupons,
authorization cards or access devices having a value of $500 of more, the person must
be suspended from the program permanently. Additionally, under federal law, a
person who a court determines has traded a controlled substance for food coupons
must be suspended from the food stamp program for 2 years upon the first
determination and permanently upon a 2nd determination. A person who a court
determines has traded firearms, ammunition or explosives for food coupons must be
permanently suspended from the program.
In addition, under federal law, a person who is a fugitive felon is ineligible for
the food stamp program or for any program for which block grant moneys under the
federal temporary assistance for needy families (TANF) program are used. TANF is
the federal block grant program designed to replace AFDC. (W-2 is expected to be
funded in part by a TANF grant.) Federal law also requires a 10-year suspension
from the food stamp program for a person who is convicted of fraudulently misstating
or misrepresenting his or her identity or place of residence for the purpose of
obtaining simultaneous multiple food stamp benefits. Finally, federal law requires
a 10-year suspension from any TANF-funded program for a person who is convicted
of fraudulently misstating or misrepresenting his or her identity or place of residence
for the purpose of obtaining benefits in 2 or more states under the food stamp
program, the federal supplemental security income (SSI) program (a cash benefit
program for the aged, blind and disabled), the medical assistance program or any
program for which TANF moneys are used. The person's eligibility may be
reinstated, however, if the president of the United States pardons that person for the
conduct for which the person was suspended.
This bill modifies the W-2 and food stamp provisions to reflect the federal
requirements.
Under current law, a person who receives assistance under SSI or state
supplemental payments is ineligible for AFDC. The person may, however, apply for
AFDC on behalf of his or her dependent child. Currently, AFDC is due to expire 6
months after the date that DILJD specifies in the Wisconsin Administrative Register
as the statewide implementation date of W-2. A person who receives assistance
under SSI or state supplemental payments is ineligible to participate in the
employment component of W-2.
This bill requires DHFS to make a monthly payment of $77 to a recipient of SSI
or of state supplemental payments for each dependent child of that recipient if the
recipient is the custodial parent of that child. DHFS may not make the payment
unless: 1) the child meets the eligibility criteria for AFDC; and 2) the custodial
parent is ineligible for AFDC or W-2 solely because he or she receives SSI or state
supplemental payments. If a dependent child has 2 custodial parents, both custodial
parents must receive either SSI or state supplemental payments to be eligible for the
payment and only one payment per month may be made for any child. The $77
payment is unavailable for a child who receives SSI benefits, and a child on whose
behalf the $77 payment is made may not receive AFDC. Under the bill, a child for
whom the $77 payment is made is eligible for medical assistance (MA), under which
medical services are provided to low-income persons.
Under current law, DHFS administers the state supplemental food program for
women, infants and children, commonly referred to as WIC. Under WIC, DHFS
provides supplemental food, nutrition education and other services to eligible
low-income women, infants and children.
This bill authorizes DHFS to authorize grocery stores and pharmacies to accept
WIC drafts in exchange for certain food. Under the bill, DHFS may also contract for
alternative food distribution with entities other than grocery stores or pharmacies.
The bill provides that a person who violates rules promulgated by DHFS relating to
the WIC program may be subject to one of the following:
1. Denial of an application to be authorized as a WIC vendor or participant.
2. Suspension or termination of authorization as a WIC vendor.
3. Disqualification from WIC.
4. A forfeiture (civil monetary penalty) of not less than $10 nor more than
$1,000.
5. Repayment of cash or benefits.
In addition, the bill provides that a person who is found guilty of certain
violations of the WIC provisions may be subject to a fine of not more than $10,000
or imprisonment for not more than 2 years, or both, for the first offense, and a fine
of not more than $10,000 or imprisonment for not more than 5 years, or both, for a
2nd or subsequent offense.
Under current law, reimbursement for home health, personal care and
private-duty nursing services that are provided to a medical assistance recipient in
a month may not exceed 120% of the average monthly cost of nursing home care, as
determined by DHFS. The monthly limit does not apply to an MA recipient under
the age of 22 or a ventilator-dependent individual, or if DHFS determines that the
cost of providing an individual with nursing home care would exceed the cost of
providing the person with the home health, personal care or private-duty nursing
services.
This bill eliminates the monthly limit on reimbursement under MA for home
health, personal care and private-duty nursing services that are provided to an MA
recipient.
Under the current formula for state and federal payment for care received in
nursing homes and certain C-BRF's by MA recipients, DHFS may establish
minimum patient day occupancy standards for determining costs per patient day for
each of these facilities. DHFS determines payment by dividing the total allowable
facility costs by the actual adjusted patient days or patient days based on 91% of
occupancy, whichever is higher. Also under current law, the maximum number of
licensed nursing home beds statewide is 51,795, as adjusted under various criteria
by DHFS.
This bill permits nursing homes for which the bed occupancy rate is less than
91% to request DHFS to delicense a licensed bed. If DHFS approves the request,
DHFS may not include the bed in determining costs per patient day for the nursing
home. The nursing home may not sell or use a bed that is delicensed. Every 12
months after a bed is delicensed, DHFS must reduce the licensed bed capacity of the
nursing home by 10% of all the nursing home's delicensed beds or by 25% of one bed,
whichever is greater, and must also reduce the statewide maximum number of
licensed nursing home beds by this number. However, the nursing home retains the
right to resume use and licensure of a delicensed bed for 18 months after the facility
notifies DHFS that the facility intends to resume licensure of the bed, except that the
nursing home may not resume licensure of a bed or fraction of a bed for which the
licensed bed capacity of the nursing home has been reduced.
Under current law, DHFS may use state revenues under MA and federal
matching funds to reimburse the 3 state centers for the developmentally disabled for
the cost of services provided by the centers. Under a community integration
program, for each placement into a community of a person who is relocated from one
of the state centers, DHFS reduces this reimbursement by a specified amount and
community care for the person is paid for under MA. Currently, the reimbursement
reduction amount for the Central Wisconsin Center for the Developmentally
Disabled is $205 per day, the amount for the Northern Wisconsin Center for the
Developmentally Disabled is $199 per day and the amount for the Southern
Wisconsin Center for the Developmentally Disabled is $149 per day. This bill
changes the reimbursement reduction amounts for the Northern Wisconsin Center
for the Developmentally Disabled and the Southern Wisconsin Center for the
Developmentally Disabled to $174 per day.
Under current law, a county department of developmental disabilities services
authorizes all care of a developmentally disabled patient in a state facility, including
a state center for the developmentally disabled. Although the cost of care for the
majority of patients in a state center for the developmentally disabled is paid for
under MA, DHFS bills county departments of developmental disabilities services for
persons who are ineligible for MA and who lack other means of full payment, for
certain mentally ill persons who exhibit extremely aggressive and challenging
behaviors, and, at 10% of the MA rate, for a person placed in a state center who is
found under an independent professional review to be appropriate for community,
rather than institutional, care.
Under this bill, beginning January 1, 1998, county departments of
developmental disabilities services may be billed $184 per day for the care of a
patient of a state center who is found under an independent professional review to
be appropriate for community care. Also under the bill, beginning January 1, 1998,
if a county department of developmental disabilities services authorizes admission
to a state center for the developmentally disabled of a nonemergency new patient
whose care in the community would cost less than $184 per day, the county
department must reimburse the state center for the cost of that patient at the rate
of $184 per day.
Under current law, DHFS is required to file a claim against the estate of a
recipient of MA for the amount of MA paid on behalf of the recipient while the
recipient resided in a nursing home or while the recipient was an inpatient in a
medical institution and was required to contribute to the cost of care. DHFS must
also file a claim against the estate of a recipient of MA for certain MA services paid
on behalf of the recipient after the recipient attained the age of 55. Currently, DHFS
may collect the amount from, among other property of the decedent, funds of the
decedent that were held by the decedent immediately before death in a joint account
or a payable-on-death (P.O.D.) account. DHFS may collect from certain solely
owned property of the decedent by a transfer by affidavit process, rather than the
formal probate process, if the value of the solely owned property does not exceed
$10,000 and certain other conditions are met.
This bill authorizes DHFS to collect by affidavit signed by a DHFS
representative funds of a decedent that were held by the decedent immediately
before death in a joint account or a P.O.D. account, if all of the other conditions
allowing DHFS to collect by affidavit are met. The bill also authorizes DHFS to
establish a payment schedule, subject to reasonable interest, for heirs of an estate
who wish to satisfy a recovery claim without selling a nonliquid asset.
Under current law, DHFS, DILJD, a county or an elected tribal governing body
that provides certain public assistance benefits as a result of an injury, sickness or
death that creates a claim or cause of action on the part of the public assistance
recipient or beneficiary or the estate of the recipient or beneficiary against a 3rd
party must be joined by the plaintiff as a party to the claim or action. This is known
as subrogation and as a subrogated party, DHFS, DILJD, a county or an elected tribal
governing body may maintain an action or intervene in an action by the recipient,
beneficiary or estate against the 3rd party. Currently, a party that is joined based
on subrogation may do one of the following:
1. Participate in the prosecution of the action.
2. Agree to have his or her interests represented by the party who caused the
joinder.
3. Move for dismissal.
Current law also provides that a prevailing defendant is entitled to costs from
the plaintiffs, including subrogated plaintiffs who neither participated in the
prosecution of the action nor moved for dismissal.
This bill excludes DHFS and counties from liability for costs to prevailing
defendants in actions in which DHFS or a county is subrogated because of the
implication of MA payments if DHFS or the county does not participate in the
prosecution of the action.
Under the bill, DHFS need not take any affirmative action in order to have its
interests represented by the party causing the joinder. Regardless of whether DHFS
participates in prosecuting the claim, if the plaintiff prevails, the portion of the
proceeds of the claim that represents benefits paid under MA as a result of the
occurrence of injury, sickness or death for which the claim arose must be paid to
DHFS.
Under current law, an 18-year-old high school student who is ineligible for
AFDC solely because of his or her age is eligible for aid to 18-year-old students if he
or she meets certain conditions. The amount of aid paid to the person is equal to the
amount of aid to which that person would have been entitled under AFDC if he or
she were 17 years of age, except that if the person's family became ineligible for
AFDC on the person's 18th birthday the amount paid equals the amount of aid
granted to a single person under AFDC. This bill repeals the aid to 18-year-old
students program.
Under current law, DILJD may contract with a county to administer a work
experience and job training program for noncustodial parents who fail to pay child
support or to meet their children's needs for support because of unemployment or
underemployment. Currently, the program may include certain kinds of work
experience and job training, job orientation and job search activities. This bill limits
the permitted activities of the program to work experience and job search activities.
Under current law, DHFS determines, by use of a prospective payment formula
that is updated each fiscal year, the rates of payment for nursing homes and certain
C-BRFs that provide care to MA recipients. The current payment formula requires
DHFS to consider, in determining payments for individual facilities, costs for
allowable direct care, allowable support services, allowable fuel and utilities, net
property tax or allowable municipal services, allowable administrative and general
costs, allowable facility interest expenses and capital payment necessary for the
provision of service over time. For allowable direct care costs, DHFS must establish
standards for payment that are at least 110% of the median for direct care costs for
facilities that do not primarily serve the developmentally disabled and, for facilities
that primarily serve the developmentally disabled, standards for payment that are
at least 110% of the median for direct care costs for those facilities.
This bill revises the payment formula to limit an increase in payment, including
an increase resulting from adjustment of facility base rates and percentage increases
over facility base rates, in fiscal year 1997-98 to no more than 6.1% over that paid
in fiscal year 1996-97, or $50,975,000, whichever is less. The bill limits an increase
in this payment in fiscal year 1998-99 to no more than 3.5% over that paid in fiscal
year 1997-98, or $30,322,500, whichever is less, including an increase resulting from
adjustment of a percentage increase over facility base rates. The bill also clarifies
that this limited increase in payment is an aggregate increase for all nursing homes
and C-BRFs that are payable under the formula. Lastly, the bill changes the
standards for payment of allowable direct care costs; for facilities primarily serving
the developmentally disabled, the standards for payment are not less than the
median of direct care costs for a sample of all facilities in the state primarily serving
the developmentally disabled. For facilities that do not primarily serve the
developmentally disabled, the standards for payment are not less than the median
of direct care costs for a sample of all of those facilities in the state.
Under current law, certain nursing homes receive MA payments that are
supplemental to the payments established under the payment formula for all
facilities. Under one supplemental payment program, DHFS must distribute not
more than $20,000,000 in federal MA funds in each of fiscal years 1995-96 and
1996-97, plus any additional unanticipated federal MA funds that equal funds that
a county certifies were expended to operate a county facility and that are matched
by county funds. Under a 2nd supplemental payment program, DHFS must
distribute not more than $18,600,000 in federal MA funds in each fiscal year to
county, city, village or town nursing homes if the funds are matched by county, city,
village or town funds, if the county certifies to DHFS the amount of all county funds
expended in each calendar year to operate the facility and if certain other
requirements are met.
This bill consolidates the 2 programs of supplemental payments to nursing
homes and permits payment of county-matched funds of not more than $38,600,000
in each fiscal year.
Under current law, DILJD is directed to request a waiver from the secretary of
the federal department of health and human services to enable the state, by July 1,
1997, to cease making payments under AFDC to a nonlegally responsible relative on
behalf of a dependent child. Previously, AFDC payments to eligible nonlegally
responsible relatives could not cease unless a waiver was in effect.
Currently, under the federal Personal Responsibility and Work Opportunity
Reconciliation Act, a waiver is not necessary in order to cease making such
payments. This bill eliminates the requirement that DILJD request a waiver and
that a waiver be granted and in effect in order to end such payments. Under the bill,
a nonlegally responsible relative who is receiving AFDC payments on behalf of a
dependent child on the day on which this bill becomes law may not receive AFDC
payments after December 31, 1997, or the date of the first reinvestigation of the
person occurring after the day on which this bill becomes law, whichever occurs first.
A nonlegally responsible relative who is not receiving AFDC payments on the day on
which this bill becomes law may not receive any AFDC payments on or after that
date.
Current law requires a county department of human services or social services
(county department) to pay $215 per month to a relative of a child who is providing
care and maintenance for the child (kinship care) if certain conditions are met. This
bill makes a relative ineligible for kinship care payments if the child for whom the
relative is providing care and maintenance is already receiving federal SSI payments
or state supplemental payments to the child's SSI payments.
Under current law, DHFS or an entity to which DHFS has delegated authority
must annually review every resident of a nursing home or institution for mental
diseases who has a developmental disability or mental illness to determine if the
resident needs facility care or needs active treatment for the developmental
disability or mental illness. If the review determines that the resident does not need
facility care, no MA payment may be made for that resident's care and the resident
must be relocated unless he or she is determined to need active treatment for a
developmental disability or mental illness and he or she has continuously resided in
a nursing home or institution for mental diseases for at least 30 months before the
determination date. However, if the resident requires active treatment and has met
the continuous residency requirement, he or she may receive MA-paid active
treatment in the facility or in an alternative setting.
This bill eliminates the requirement for annual review of residents of a nursing
home and institution for mental diseases who have a developmental disability or
mental illness and, instead, requires review of those residents who have experienced
a significant change in physical or mental condition.
Currently, certain MA recipients may receive case management services that
are reimbursable under the MA program if the services are provided by a certified
case management provider in a county, city, village or town that elects to make the
services available and that reimburses the service provider for the amount of
allowable charges that are not paid from federal MA moneys.
This bill expands the eligibility for case management services under the MA
program, if provided by a certified provider in a county, city, village or town that
elects to provide the services, to include women who are aged 45 to 64 and who are
not residents of nursing homes or otherwise receiving case management services.
Currently, under a waiver of federal medicaid laws, state revenues and federal
medicaid moneys provide home or community-based care for persons who are
eligible for MA and who are diagnosed as developmentally disabled. These persons
are either relocated into the community from certain institutions other than a state
center for the developmentally disabled, or they receive care in intermediate care
facilities for the mentally retarded. The program providing this care is one of several
"community integration" programs and is commonly known as "CIP 1B".
This bill requires a county that owns a facility from which an individual is
relocated to the community under the "CIP 1B" program to submit to DHFS a plan
for delicensing a bed of the facility that is approved by DHFS in order to receive
funding for the individual's relocation under the "CIP 1B" program.
