SECTION 8. 46.277 (5) (bm) of the statutes is created to read:
46.277 (5) (bm) 1. Funding to a county for an individual who is relocated from a nursing home under sub. (3r) shall be no more than the per-person, per-day payment rate at the individual's level-of-care requirement for the nursing home under s. 49.45 (6m), indexed annually by the percentage of any annual nursing home average rate increase under s. 49.45 (6m), minus the amount that is obtained by subtracting the average annual costs for allowable charges under s. 49.46 (2) (a) and (b) payable on behalf of individuals in nursing homes from the average annual costs per medical assistance recipient for the allowable charges payable on behalf of individuals who are relocated into communities from nursing homes.
2. Notwithstanding the limitation on payment to a county under subd. 1., funding to a county for an individual who is relocated from a nursing home under sub. (3r) may include, in addition to the amount specified in subd. 1., an amount not to exceed the sum obtained by subtracting the total of all payments made for home or community-based services for nursing home residents relocated under sub. (3r) (c) from the amount available under subd. 1.
3. If a county department fails to complete a needs and costs-based assessment and offer home or community-based services under this section to a nursing home resident within the time period specified in sub. (3r) (a), the county shall pay the nonfederal share of Medical Assistance for his or her nursing home care unless the nursing home resident refused participation or the needs and costs-based assessment determined that participation was not feasible.
4. Funding to a county is available under subd. 1. or 2. only during the period in which a relocated individual continues to receive home or community-based care.
SECTION 9. 46.278 (1m) (bg) of the statutes is created to read:
46.278 (1m) (bg) "Nursing home" means a nursing home, as defined in s. 50.01 (3), that is certified as a provider of medical assistance, other than an intermediate care facility for the mentally retarded.
SECTION 10. 46.278 (3) (b) of the statutes is amended to read:
46.278 (3) (b) Fund Except as provided in subs. (4g) and (6) (bm), fund home or community-based services provided by any county that meet the requirements of this section.
SECTION 11. 46.278 (4g) of the statutes is created to read:
46.278 (4g) RELOCATION OF NURSING HOME RESIDENTS. (a) In a county that is participating in the program, for each nursing home resident who has applied for participation and has been found eligible under sub. (5), but is not participating in the program and who indicates that he or she prefers to receive services in the community, rather than in the nursing home, the participating county department shall initiate a needs and costs-based assessment before the resident has resided in the nursing home for 90 continuous days or before the cost of the resident's nursing home care has been paid under Medical Assistance for 30 days, whichever is longer. The county department shall complete the needs and costs-based assessment within 90 days after initiating the assessment.
(b) After completion of the needs and costs-based assessment, the county department shall contact the department regarding available funding.
(c) If the department determines that costs for home or community-based services for the nursing home resident, as determined under the needs and costs-based assessment, are equal to or less than the amount specified under sub. (6) (bm) 1., the county department shall offer and, if accepted, provide home or community-based services under this section to the nursing home resident, if the cost of the resident's nursing home care has been paid under Medical Assistance for at least 30 days.
(d) If the department determines that costs for home or community-based services for the nursing home resident, as determined under the needs and costs-based assessment, exceed the amount specified under sub. (6) (bm) 1., the department may ascertain whether additional funding, as specified under sub. (6) (bm) 2., is available. If additional funding is available and if the cost of the resident's nursing home care has been paid under Medical Assistance for at least 30 days, the county department shall offer and, if accepted, provide home or community-based services under this section to the nursing home resident.
SECTION 12. 46.278 (6) (am) of the statutes is created to read:
46.278 (6) (am) From the appropriation under s. 20.435 (4) (w), the department may provide reimbursement to a county for administrative activities by the county to relocate a nursing home resident under sub. (4g).
SECTION 13. 46.278 (6) (b) of the statutes is amended to read:
46.278 (6) (b) Total Except as provided in subs. (4g) and (6) (bm), total funding to counties for relocating each person under a program may not exceed the amount approved in the waiver received under sub. (3).
SECTION 14. 46.278 (6) (bm) of the statutes is created to read:
46.278 (6) (bm) 1. Funding to a county for an individual who is relocated from a nursing home under sub. (4g) shall be no more than the per-person, per-day payment rate at the individual's level-of-care requirement for the nursing home under s. 49.45 (6m), indexed annually by the percentage of any annual nursing home average rate increase under s. 49.45 (6m), minus the amount that is obtained by subtracting the average annual costs for allowable charges under s. 49.46 (2) (a) and (b) payable on behalf of individuals in nursing homes from the average annual costs for the allowable charges payable on behalf of individuals who are relocated into communities from nursing homes.
2. Notwithstanding the limitation on payment to a county under subd. 1., funding to a county for an individual who is relocated from a nursing home under sub. (4g) may include, in addition to the amount specified in subd. 1., an amount not to exceed the sum obtained by subtracting the total of all payments made for home or community-based services for nursing home residents relocated under sub. (4g) (c) from the amount available under subd. 1.
3. If a county department fails to complete a needs and costs-based assessment and offer home or community-based services under this section to a nursing home resident within the time period specified in sub. (4g) (a), the county shall pay the nonfederal share of Medical Assistance for his or her nursing home care unless the nursing home resident refused participation or the needs and costs-based assessment determined that participation was not feasible.
4. Funding to a county is available under subd. 1. or 2. only during the period in which a relocated individual continues to receive home or community-based care.
SECTION 15. 46.278 (6) (f) of the statutes is repealed.
SECTION 9424. Effective dates; health and family services.
(1) NURSING HOME RESIDENT RELOCATION; FUNDING. The treatment of sections 20.435 (4) (w) (by SECTION 1), 46.277 (2) (b) and (5) (am), (b), and (bm) 1. and 2., and 46.278 (3) (b) and (6) (am), (b), (bm) 1. and 2., and (f) of the statutes takes effect on January 1, 2004.
(2) NURSING HOME RESIDENT RELOCATION; REQUIREMENTS. The treatment of sections 46.277 (1m) (ak), (3) (c), (3r), and (5) (bm) 3. and 4. and 46.278 (1m) (bg), (4g), and (6) (bm) 3. and 4. of the statutes takes effect on June 1, 2004.
(End)
LRB-0209LRB-0209/2
DAK:kjf/cjs/cmh:pg
2003 - 2004 LEGISLATURE
DOA:......Blaine - BB0048 Restrict admissions to ICF-MRs and nursing homes; increase access to community-based services
For 2003-05 Budget -- Not Ready For Introduction
2003 BILL
AN ACT ...; relating to: restricting protective placements and admissions to intermediate and nursing facilities.
Analysis by the Legislative Reference Bureau
health and human services
Mental illness and developmental disabilities
Under current law, persons who apply for admission to nursing homes, state centers for the developmentally disabled, or institutions for mental diseases, including persons who are found by a court to be in need of protective services and are protectively placed, must be screened to determine if they have developmental disability or mental illness. If so determined, they must also be screened to determine if they need facility care and active treatment for developmental disability or mental illness. Residents of these facilities who have developmental disability or mental illness and have had significant changes in their physical or mental conditions must also be screened to determine if they need facility care or active treatment. Persons who are not in need of facility care must be relocated for other care and reimbursement, depending on the severity of their disabilities and their financial resources.
Currently, counties must provide the portion of the Medical Assistance (MA) program payment that is not provided by the federal government for services to individuals in state centers for the developmentally disabled who are also mentally ill and exhibit extremely aggressive and challenging behaviors. Under one of the community integration programs, persons with developmental disabilities who are eligible for MA and who formerly resided in, or were diverted from, state centers for the developmentally disabled or other institutions, are provided services in community settings that are reimbursed by state and federal funds, or by county and federal funds, under MA. Under this program, a county that owns the institution from which a person is relocated into the community must receive approval from DHFS of a plan for delicensing a bed of the institution, in order for the county to obtain reimbursement for the person's community care.
This bill, beginning January 1, 2004, places restrictions on protective placements and admissions of persons with developmental disabilities to intermediate facilities and nursing facilities, as defined in the bill. Within 90 days after receiving written notice of the prospective placement or admission of a person with developmental disabilities in an intermediate facility, a county department of social services, human services, developmental disabilities services, or community programs must develop a plan for providing home or community-based care to the person in a noninstitutional setting. The person may not be placed in or admitted to the intermediate facility unless a board of social services, human services, community programs, or developmental disabilities services finds that placement in the community under such a plan is not in the person's best interests, or the person or his or her guardian rejects the plan. Also, a person who has been screened and found to require active treatment for developmental disability may not be placed in or admitted to a nursing facility unless it is determined that his or her need for care cannot be met in an intermediate facility or under a plan for home or community care. These restrictions first apply on April 1, 2004.
The bill changes the screening process for residents of state centers for the developmentally disabled who have been determined to need facility care and active treatment for developmental disability, to require that they be further screened to determine whether the level of care that they require that is provided by the facility could be provided safely in an intermediate facility or under a plan for home or community care.
Beginning January 1, 2004, the bill prohibits payment of the federal portion of MA for services for an individual in a state center for the developmentally disabled who is also mentally ill and exhibits extremely aggressive and challenging behaviors, unless the person receiving the services has been protectively placed in the state center or is placed there for emergency purposes or as a temporary placement. The bill requires that counties pay the portion of MA payment that is not provided by the federal government for services to persons with developmental disabilities in an intermediate care facility for the mentally retarded and, if they have been determined to need facility care, for services in a nursing facility; however, no payment of the federal portion of MA for services to these persons may be made unless the person was placed in or admitted to the facility after the placing board considered a plan for home or community care and rejected the plan or found it would not meet the person's needs. The requirements and limitations first apply to services provided and payment made on April 1, 2004.
The bill changes laws relating to protective placement of persons who are found incompetent, to require that the court notify the appropriate county department to develop a plan for home or community care, for a person about to be protectively placed, and that the person be placed in a noninstitutional community setting under the plan unless there is an affirmative finding by the court that placement for home or community care would not be in the person's best interests.
For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 46.279 of the statutes is created to read:
46.279 Restrictions on placements and admissions to intermediate and nursing facilities. (1) DEFINITIONS. In this section:
(a) "Developmental disability" has the meaning given in s. 51.01 (5) (a).
(b) "Intermediate facility" means an intermediate care facility for the mentally retarded, as defined in 42 USC 1396d (d), other than a center for the developmentally disabled, as defined in s. 51.01 (3).
(c) "Nursing facility" has the meaning given under 42 USC 1369r (a).
(2) PLACEMENTS AND ADMISSIONS TO INTERMEDIATE FACILITIES. Except as provided in sub. (5), no person may place an individual with a developmental disability in an intermediate facility and no intermediate facility may admit such an individual unless, before the placement or admission, a court under s. 55.06 (9) (a) or (10) (a) 2. finds that placement under a plan that was developed under sub. (4) is not in the individual's best interests. An intermediate facility to which an individual who has a developmental disability applies for admission shall, within 5 days after receiving the application, notify the county department that is participating in the program under s. 46.278 of the county of residence of the individual who is seeking admission concerning the application.
(3) PLACEMENTS AND ADMISSIONS TO NURSING FACILITIES. Except as provided in sub. (5), if the department or an entity determines from a screening under s. 49.45 (6c) (b) that an individual requires active treatment for developmental disability, no individual may be placed in a nursing facility, and no nursing facility may admit the individual, unless it is determined from the screening that the individual's need for care cannot fully be met in an intermediate facility or under a plan under sub. (4).
(4) PLAN FOR HOME OR COMMUNITY-BASED CARE. A county department that participates in the program under s. 46.278 shall develop a plan for providing home or community-based care to an individual in a noninstitutional community setting under any of the following circumstances:
(a) Within 90 days after any determination made under s. 49.45 (6c) (c) 3. that the level of care required by a resident that is provided by a facility could be provided in an intermediate facility or under a plan under this subsection.
(b) Within 90 days after receiving written notice under sub. (2) of an application.
(c) Within 90 days after a proposal is made under s. 55.06 (9) (a) to place the individual in an intermediate facility or a nursing facility.
(d) Within 90 days after receiving written notice under s. 55.06 (10) (a) 2. of the placement of the individual in a nursing facility or an intermediate facility.
(e) Within 60 days after extension of a temporary placement order by the court under s. 55.06 (11) (c).
(5) EXCEPTIONS. Subsections (2) and (3) do not apply to an emergency placement under s. 55.06 (11) (a) or to a temporary placement under s. 55.06 (11) (c) or (12).
SECTION 2. 49.45 (6c) (a) 6m. of the statutes is created to read:
49.45 (6c) (a) 6m. "Intermediate facility" has the meaning given in s. 46.279 (1) (a).
SECTION 3. 49.45 (6c) (b) of the statutes is amended to read:
49.45 (6c) (b) Preadmission screening. Except as provided in par. (e), beginning on August 9, 1989, every individual who applies for admission to a facility or to an institution for mental diseases shall be screened to determine if the individual has developmental disability or mental illness. Beginning on August 9, 1989, the The department or an entity to which the department has delegated authority shall screen every individual who has been identified as having a developmental disability or mental illness to determine if the individual needs facility care. If the individual is determined to need facility care, the department or an entity to which the department has delegated authority shall also assess the individual to determine if he or she requires active treatment for developmental disability or active treatment for mental illness. If the department or entity determines that the individual requires active treatment for developmental disability, the department or entity shall determine whether the level of care required by the individual that is provided by a facility could be provided safely in an intermediate facility or under a plan that is developed under s. 46.279 (4).
SECTION 4. 49.45 (6c) (c) (intro.) of the statutes is amended to read:
49.45 (6c) (c) Resident review. (intro.) Except as provided in par. (e), the department or an entity to which the department has delegated authority shall review every resident of a facility or institution for mental diseases who has a developmental disability or mental illness and who has experienced a significant change in his or her physical or mental condition to determine if any all of the following applies:
SECTION 5. 49.45 (6c) (c) 1. of the statutes is amended to read:
49.45 (6c) (c) 1. The Whether the resident needs facility care.
SECTION 6. 49.45 (6c) (c) 2. of the statutes is amended to read:
49.45 (6c) (c) 2. The Whether the resident requires active treatment for developmental disability or active treatment for mental illness.
SECTION 7. 49.45 (6c) (c) 3. of the statutes is created to read:
49.45 (6c) (c) 3. If the department or entity determines under subd. 1. that the resident needs facility care and under subd. 2. that the resident requires active treatment for developmental disability, whether the level of care required by the resident that is provided by a facility could be provided safely in an intermediate facility or under a plan that is developed under s. 46.279 (4).
SECTION 8. 49.45 (30m) of the statutes is renumbered 49.45 (30m) (a) (intro.) and amended to read:
49.45 (30m) (a) (intro.) A county shall provide the portion of the payment that is not provided by the federal government for all of the following services under s. 51.06 (1m) (d) to individuals with developmental disability who are eligible for medical assistance that is not provided by the federal government.:
SECTION 9. 49.45 (30m) (a) 1. of the statutes is created to read:
49.45 (30m) (a) 1. Services under s. 51.06 (1m) (d).
SECTION 10. 49.45 (30m) (a) 2. of the statutes is created to read:
49.45 (30m) (a) 2. Services in an intermediate care facility for the mentally retarded, as defined in s. 46.278 (1m) (am), other than a state center for the developmentally disabled.
SECTION 11. 49.45 (30m) (a) 3. of the statutes is created to read:
49.45 (30m) (a) 3. Services for which payment is permitted under sub. (6c) (d) 2. that are provided in a nursing facility, as defined in s. 46.279 (1) (c).
SECTION 12. 49.45 (30m) (b) of the statutes is created to read:
49.45 (30m) (b) No payment under this section may be made for services specified under par. (a) unless the individual who receives the services is protectively placed under s. 55.06 (9) (a) or is placed under an emergency placement under s. 55.06 (11) (a) or a temporary placement under s. 55.06 (11) (c).
SECTION 13. 49.45 (30m) (c) of the statutes is created to read:
49.45 (30m) (c) No payment under this section may be made for services specified under par. (a) 2. or 3. that are provided to an individual who was placed in or admitted to an intermediate facility, as defined in s. 46.279 (1) (b), or nursing facility, as defined in s. 46.279 (1) (c), unless one of the following applies:
1. Any placement or admission that is made after March 31, 2004, complied with the requirements of s. 46.279.
2. For an individual who was protectively placed under ch. 55 at any time, any annual review that is conducted under s. 55.06 (10) (a) 1. after March 31, 2004, complies with the requirements of s. 55.06 (10) (a) 2.
SECTION 14. 49.46 (2) (a) 4. c. of the statutes is amended to read:
49.46 (2) (a) 4. c. Skilled nursing home services other than in an institution for mental diseases, except as limited under s. 49.45 (6c) and (30m) (b) and (c).
SECTION 15. 49.46 (2) (b) 6. a. of the statutes is amended to read:
49.46 (2) (b) 6. a. Intermediate care facility services other than in an institution for mental diseases, except as limited under s. 49.45 (30m) (b) and (c).
