46.27 (4) (c) 8. If a pilot project under s. 46.271 (2m) 46.281 (1) (d) is established in the county, a description of how the activities of the pilot project relate to and are coordinated with the county's proposed program.
9,1039
Section
1039. 46.27 (5) (am) of the statutes is amended to read:
46.27 (5) (am) Organize assessment activities specified in sub. (6). The county department or aging unit shall utilize persons for each assessment who can determine the needs of the person being assessed and who know the availability within the county of services alternative to placement in a nursing home. If any hospital patient is referred to a nursing home for admission, these persons shall work with the hospital discharge planner in performing the activities specified in sub. (6). The county department or aging unit shall coordinate the involvement of representatives from the county departments under ss. 46.215, 46.22, 51.42 and 51.437, health service providers and the county commission on aging in the assessment activities specified in sub. (6), as well as the person being assessed and members of the person's family or the person's guardian. This paragraph does not apply to a county department or aging unit in a county where a pilot project under s. 46.271 (2m) 46.281 (1) (d) is established.
9,1040
Section
1040. 46.27 (6) (a) 3. of the statutes is amended to read:
46.27 (6) (a) 3. In each participating county, except in counties where a pilot project under s. 46.271 (2m) 46.281 (1) (d) is established, assessments shall be conducted for those persons and in accordance with the procedures described in the county's community options plan. The county may elect to establish assessment priorities for persons in target groups identified by the county in its plan regarding gradual implementation. If a person who is already admitted to a nursing home requests an assessment and if funds allocated for assessments under sub. (7) (am) are available, the county shall conduct the assessment.
9,1041
Section
1041. 46.27 (6g) (intro.) of the statutes is amended to read:
46.27 (6g) Fiscal responsibility. (intro.) Except as provided in s. 51.40, and within the limitations under sub. (7) (b), the fiscal responsibility of a county for an assessment, unless the assessment is performed by an entity under s. 46.271 (2m) 46.281 (1) (d), case plan or services provided to a person under this section is as follows:
9,1041m
Section 1041m. 46.27 (6r) (f) of the statutes is created to read:
46.27 (6r) (f) A person who has attained the age of 18 but has not attained the age of 65 unless that person is engaged in gainful employment or participating in a program that is certified by the department to provide health and employment services that are aimed at helping the individual achieve employment goals. The department may waive this paragraph for any individual for whom its application would cause undue hardship.
9,1042
Section
1042. 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 100% of the amount calculated under this subdivision, unless the person is a recipient of medical assistance under s. 49.472. If the person is a recipient of medical assistance under s. 49.472, the county department or aging unit may not require any payment from the person under this subdivision.
9,1043
Section
1043. 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. 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 and for a risk reserve under par. (fr).
9,1044
Section
1044. 46.27 (7) (b) of the statutes is amended to read:
46.27 (7) (b) 1m. From the 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. Counties may use unspent funds allocated under this paragraph from the appropriation under s. 20.435 (7) (bd) for a risk reserve under par. (fr).
9,1045
Section
1045. 46.27 (7) (cj) 3. a. of the statutes is amended to read:
46.27 (7) (cj) 3. 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. except that a person seeking admission or about to be admitted on a private pay basis may waive the assessment, unless the person is expected to become eligible for medical assistance within 6 months of assessment. The county may waive this condition in accordance with guidelines established by the department. If the county waives this condition, the county must meet with the person or the person's guardian to discuss the cost-effectiveness of various service options.
9,1045d
Section 1045d. 46.27 (7) (ck) 1. of the statutes is amended to read:
46.27 (7) (ck) 1. Subject to the approval of the department, and except as provided in sub. (7b) (a), 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 subdivision shall include the conditions in its community options plan under sub. (3) (cm).
9,1045g
Section 1045g. 46.27 (7) (cL) of the statutes is created to read:
46.27 (7) (cL) No county department or aging unit may deny services to a person under par. (cj) who refused to have an assessment completed as required under par. (cj) 3. a. before the effective date of this paragraph .... [revisor inserts date].
9,1045k
Section 1045k. 46.27 (7) (cm) 1. (intro.) of the statutes is amended to read:
46.27 (7) (cm) 1. (intro.) Beginning
Except as provided sub. (7b), 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:
9,1046
Section
1046. 46.27 (7) (fm) of the statutes is amended to read:
46.27 (7) (fm) The department shall, at the request of a county, carry forward up to 10% of the amount allocated under this subsection to the county for a calendar year if up to 10% of the amount so allocated has not been spent or encumbered by the county by December 31 of that year, for use by the county in the following calendar year, except that the amount carried forward shall be reduced by the amount of funds that the county has notified the department that the county wishes to place in a risk reserve under par. (fr). The department may transfer funds within s. 20.435 (7) (bd) to accomplish this purpose. An allocation under this paragraph does not affect a county's base allocation under this subsection and shall lapse to the general fund unless expended within the calendar year to which the funds are carried forward. A county may not expend funds carried forward under this paragraph for administrative or staff costs, except administrative or staff costs that are associated with implementation of the waiver under sub. (11) and approved by the department.
9,1047
Section
1047. 46.27 (7) (fr) of the statutes is created to read:
46.27 (7) (fr) 1. Notwithstanding s. 46.036 (3) and (5m), a county may place in a risk reserve funds that are allocated under par. (am) or (b) or sub. (11) (c) 3. and are not expended or encumbered for services under this subsection or sub. (11). The county shall notify the department of this decision and of the amount to be placed in the risk reserve. The county shall maintain the risk reserve in an interest-bearing escrow account with a financial institution, as defined in s. 69.30 (1) (b), if the department has approved the terms of the escrow. All interest from the principal shall be reinvested in the escrow account.
2. The annual amount of a county's expenditure for a risk reserve, as specified in subd. 1., may not exceed 10% of the county's most recent allocation under pars. (am) and (b) and sub. (11) (c) 3. or $750,000, whichever is less. The total amount of the risk reserve, including interest, may not exceed 15% of the county's most recent allocation under this subsection.
3. A county may expend funds maintained in a risk reserve, as specified in subd. 1., for any of the following purposes:
a. To defray costs of long-term community support services under this section.
b. To meet requirements under any contract that the county has with the department to operate a care management organization under s. 46.284.
c. If approved by a resolution of the county board of supervisors, to transfer funds to a family care district.
d. If approved by the department, for administrative or staff costs under this section.
4. A county that maintains a risk reserve, as specified in subd. 1., shall annually, on a form prescribed by the department, submit to the department a record of the status of the risk reserve, including revenues and disbursements.
9,1048
Section
1048. 46.27 (7) (g) (intro.) of the statutes is amended to read:
46.27 (7) (g) (intro.) The department may carry forward to the next state fiscal year up to $500,000 of funds allocated under this subsection and not encumbered by counties by December 31 or carried forward under par. (fm). The department may transfer moneys within s. 20.435 (7) (bd) to accomplish this purpose. An allocation under this paragraph shall not affect a county's base allocation for the program. The department may allocate these transferred moneys during the next fiscal year to counties for planning and implementation of resource centers under s. 46.283 or care management organizations under s. 46.284 and for the improvement or expansion of long-term community support services for clients whose cost of care significantly exceeds the average cost of care provided under this section, including any of the following:
9,1048m
Section 1048m. 46.27 (7b) of the statutes is created to read:
46.27 (7b) Pilot program in Chippewa County. The department shall establish a pilot project in Chippewa County to effect all of the following:
(a) Notwithstanding the maximum total amount established by Chippewa County under sub. (3) (f), Chippewa County may not deny services under this section to an eligible individual who resides in a community-based residential facility when the individual becomes eligible, solely because the maximum total amount has been reached.
(b) In making a determination under sub. (7) (cj) 3. e. regarding the cost-effectiveness of a placement in a community-based residential facility, Chippewa County shall consider all state and federal funds needed for all options considered.
(c) Chippewa County, or a private nonprofit agency or aging unit in Chippewa County, may use funds received under sub. (7) (b) to provide services in any community-based residential facility that has 20 or fewer beds notwithstanding sub. (7) (cm) 1. Subsection (7) (cm) 1. applies in Chippewa County, however, with respect to the use of funds received under sub. (7) (b) to provide services in any community-based residential facility that has more than 20 beds.
9,1049
Section
1049. 46.27 (7g) (c) 3. (intro.) of the statutes is amended to read:
46.27 (7g) (c) 3. (intro.) The court shall reduce the amount of a claim under subd. 1. by up to $3,000
the amount specified in s. 861.33 (2) if necessary to allow the client's heirs or the beneficiaries of the client's will to retain the following personal property:
9,1050
Section
1050. 46.27 (7g) (c) 3. c. of the statutes is amended to read:
46.27 (7g) (c) 3. c. Other tangible personal property not used in trade, agriculture or other business, not to exceed $1,000 in value the amount specified in s. 861.33 (1) (a) 4.
9,1051
Section
1051. 46.27 (7g) (c) 5. of the statutes is renumbered 46.27 (7g) (c) 5. a. and amended to read:
46.27 (7g) (c) 5. a. If the department's claim is not allowable because of subd. 4. and the estate includes an interest in a home, the court exercising probate jurisdiction shall, in the final judgment or summary findings and order, assign the interest in the home subject to a lien in favor of the department for the amount described in subd. 1. The personal representative or petitioner for summary settlement or summary assignment of the estate shall record the final judgment as provided in s. 863.29, 867.01 (3) (h) or 867.02 (2) (h).
9,1052
Section
1052. 46.27 (7g) (c) 5. b. of the statutes is created to read:
46.27 (7g) (c) 5. b. If the department's claim is not allowable because of subd. 4., the estate includes an interest in a home and the personal representative closes the estate by sworn statement under s. 865.16, the personal representative shall stipulate in the statement that the home is assigned subject to a lien in favor of the department for the amount described in subd. 1. The personal representative shall record the statement in the same manner as described in s. 863.29, as if the statement were a final judgment.
9,1053
Section
1053. 46.27 (7g) (h) of the statutes is created to read:
46.27 (7g) (h) The department may contract with or employ an attorney to probate estates to recover under this subsection the costs of care.
9,1054
Section
1054. 46.27 (9) (a) of the statutes is amended to read:
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 (5) (4) (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 for the developmentally disabled. The department shall calculate these amounts on a calendar year basis under sub. (10).
9,1055
Section
1055. 46.27 (9) (c) of the statutes is amended to read:
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) 1. and provided under sub. (5) (b). Unless the department has contracted under s. 46.271 (2m) 46.281 (1) (d) with an entity other than the county department, each county participating in the pilot project shall assess persons under sub. (6).
9,1056
Section
1056. 46.27 (10) (a) 1. of the statutes is amended to read:
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 (5) (4) (b) because of increased utilization of nursing home services, as estimated by the department.
9,1057
Section
1057. 46.27 (11) (c) 3. of the statutes is amended to read:
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 (5) (4) (o) and (7) (b) and (bd).
9,1058
Section
1058. 46.27 (11) (c) 4. of the statutes is amended to read:
46.27 (11) (c) 4. The department may, from the appropriation under s. 20.435 (5) (4) (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).
9,1059
Section
1059. 46.27 (11) (c) 5n. a. of the statutes is amended to read:
46.27 (11) (c) 5n. 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. except that a person seeking admission or about to be admitted on a private pay basis may waive the assessment, unless the person is expected to become eligible for medical assistance within 6 months of assessment. The county may waive this condition in accordance with guidelines established by the department. If the county waives this condition, the county must meet with the person or the person's guardian to discuss the cost-effectiveness of various service options.
9,1059g
Section 1059g. 46.27 (11) (c) 5q. of the statutes is created to read:
46.27 (11) (c) 5q. No county department or aging unit may deny services to a person under subd. 5n. who refused to have an assessment completed as required under subd. 5n. a. before the effective date of this subdivision .... [revisor inserts date].
9,1060
Section
1060. 46.271 (2m) of the statutes is repealed.
9,1061
Section
1061. 46.275 (5) (a) of the statutes is amended to read:
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 (5) (4) (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.
9,1062
Section
1062. 46.275 (5) (c) of the statutes is amended to read:
46.275 (5) (c) The total allocation under s. 20.435
(5) (4) (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.
9,1063
Section
1063. 46.275 (5) (d) of the statutes is amended to read:
46.275 (5) (d) The department may, from the appropriation under s. 20.435 (5) (4) (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).
9,1064
Section
1064. 46.277 (5) (d) 1n. a. of the statutes is amended to read:
46.277 (5) (d) 1n. a. An assessment under s. 46.27 (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. except that a person seeking admission or about to be admitted on a private pay basis may waive the assessment, unless the person is expected to become eligible for medical assistance within 6 months of assessment. The county may waive this condition in accordance with guidelines established by the department. If the county waives this condition, the county must meet with the person or the person's guardian to discuss the cost-effectiveness of various service options.
9,1065
Section
1065. 46.278 (6) (d) of the statutes is amended to read:
46.278 (6) (d) If a county makes available nonfederal funds equal to the state share of service costs under the waiver received under sub. (3), the department may, from the appropriation under s. 20.435 (5) (4) (o), provide reimbursement for services that the county provides under this section to persons who are in addition to those who may be served under this section with funds from the appropriation under s. 20.435 (5) (4) (b).
9,1066
Section
1066. 46.278 (6) (e) of the statutes is renumbered 46.278 (6) (e) 1. (intro.) and amended to read:
46.278 (6) (e) 1. (intro.) The department may provide enhanced reimbursement for services under the program for an individual who was relocated to the community by a county department from an one of the following:
a. An intermediate care facility for the mentally retarded that closes under s. 50.03 (14).
2. a. The enhanced reimbursement rate under this paragraph subd. 1. a. and b. shall be determined under a formula that is developed by the department.
9,1067
Section
1067. 46.278 (6) (e) 1. b. of the statutes is created to read:
46.278 (6) (e) 1. b. An intermediate care facility for the mentally retarded or a distinct part thereof that has a plan of closure approved by the department and that intends to close within 12 months.
9,1067b
Section 1067b. 46.278 (6) (e) 1. c. of the statutes is created to read:
46.278 (6) (e) 1. c. An intermediate care facility for the mentally retarded that has a plan of closure or significant reduction in capacity approved by the department and that intends to close or significantly reduce its capacity within 60 months.
9,1067c
Section 1067c. 46.278 (6) (e) 2. b. of the statutes is created to read:
46.278 (6) (e) 2. b. The enhanced reimbursement rate under subd. 1. c. shall be 90% of the enhanced reimbursement rate under this subd. 2. a.
9,1068
Section
1068. 46.2805 of the statutes is created to read:
46.2805 Definitions; long-term care. In ss. 46.2805 to 46.2895:
(1) "Care management organization" means an entity that is certified as meeting the requirements for a care management organization under s. 46.284 (3) and that has a contract under s. 46.284 (2). "Care management organization" does not mean an entity that contracts with the department to operate one of the following:
