46.27(4)(c)
(c) The planning committee shall develop, or, if the governing board of a resource center has under s.
46.283 (6) (b) 10. assumed the duties of the planning committee, the governing board of the resource center shall recommend a community options plan for participation in the program. The plan shall include:
46.27(4)(c)1.
1. A description of the county's proposed program, including the estimated numbers of persons to be assessed and the procedures to be used in performing assessments.
46.27(4)(c)2.
2. A description of the services available and the services to be developed or expanded as alternatives to institutional care under this program.
46.27(4)(c)3.
3. A description of the procedures to be used to coordinate the program with other county agencies, hospitals, nursing homes and providers of community support services.
46.27(4)(c)5.
5. A description of the method to be used by the committee or, if the governing board of a resource center has under s.
46.283 (6) (b) 10. assumed the duties of the planning committee, the governing board of the resource center to monitor the implementation of the program.
46.27(4)(c)6.
6. A description of outreach procedures to be used to ensure that significant numbers of people from each group listed in sub.
(3) (e) will be served by the program.
46.27(4)(c)7.
7. A description of services and programs to be provided to meet the needs of persons with Alzheimer's disease.
46.27(4)(c)8.
8. If a contract with an entity under s.
46.284 (2) is established in the county, a description of how the activities of the entity relate to and are coordinated with the county's proposed program.
46.27(5)
(5) County department or aging unit duties. The county department or aging unit selected to administer the program shall:
46.27(5)(am)
(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 in which the department has contracted with an entity under s.
46.284 (2).
46.27(5)(b)
(b) Within the limits of state and federal funds allocated under sub.
(7), arrange service contracts under s.
46.036 and ensure the provision of necessary long-term community support services for each person who meets the criteria specified in sub.
(6) (b). No county department or aging unit may use funds allocated under sub.
(7) (b) to provide services in any community-based residential facility unless the county department or aging unit uses as a service contract the approved model contract developed under sub.
(2) (j) or a contract that includes all of the provisions of the approved model contract.
46.27(5)(c)
(c) Within the limits of state and federal funds allocated under sub.
(7), provide for ongoing care management services in accordance with the requirements established under sub.
(6d) (a) 1., periodic case plan review and follow-up services for any person receiving long-term community support services under sub.
(6) (b).
46.27(5)(d)
(d) Determine, under sub.
(6u), the cost-sharing obligations, if any, for all persons who meet the criteria specified in sub.
(6) (b) and are applying for or receiving long-term community support services that are funded under sub.
(7) or
(11).
46.27(5)(e)
(e) Within the limits of state and federal funds allocated under sub.
(7) and in accordance with the county's plan for gradual implementation and the requirements under sub.
(6) (a) 3., apply the program to any person residing in a nursing home who wants to be assessed and to receive long-term community support services, and coordinate the program with the protective services system under ch.
55.
46.27(5)(h)
(h) Within the limits of state and federal funds allocated under sub.
(7) and in accordance with the county's plan for gradual implementation, apply the program to any person who has been diagnosed by a physician as having Alzheimer's disease, who meets the level of care requirements under sub.
(6r) (b) 4. and who wants to be assessed and to receive long-term community support services.
46.27(5)(i)
(i) In instances in which an individual receives direct funding for long-term community support services under par.
(b), serve directly as a fiscal agent or contract with a fiscal intermediary to serve as a fiscal agent for that individual for the purposes of performing the responsibilities and protecting the interests of the individual under the unemployment insurance law. The county department or aging unit may elect to act as a fiscal agent or contract with a fiscal intermediary to serve as a fiscal agent for an individual who is provided long-term support services under s.
46.275,
46.277,
46.278,
46.2785,
46.495,
51.42, or
51.437. The fiscal agent under this paragraph is responsible for remitting any federal unemployment compensation taxes or state unemployment insurance contributions owed by the individual, including any interest and penalties which are owed by the individual; for serving as the representative of the individual in any investigation, meeting, hearing, or appeal involving ch.
108 or the federal Unemployment Tax Act,
26 USC 3301 to
3311, in which the individual is a party; and for receiving, reviewing, completing, and returning all forms, reports, and other documents required under ch.
108 or the federal Unemployment Tax Act on behalf of the individual. An individual may make an informed, knowing, and voluntary election to waive the right to a fiscal agent under this paragraph. The waiver may be as to all or any portion of the fiscal agent's responsibilities. The waiver may be rescinded in whole or in part at any time.
46.27(5)(j)
(j) Within the time period specified by the department, offer counseling, that is specified by the department, concerning public and private benefit programs to prospective residents of community-based residential facilities who are referred to the county department or aging unit under s.
50.035 (4n).
46.27(5m)
(5m) Worker's compensation coverage. An individual who is performing services for a person receiving long-term care benefits under this section on a self-directed basis and who does not otherwise have worker's compensation coverage for those services is considered to be an employee of the entity that is providing financial management services for that person.
46.27(6)(a)1.1. Within the limits of state and federal funds allocated under sub.
(7) and within the limits of fees collected, an assessment shall be conducted for any person identified in sub.
(5) (e) or who is seeking admission to or is about to be admitted to a nursing home. A fee may be charged, unless prohibited, for the assessment.
46.27(6)(a)1m.
1m. Each assessment shall determine the person's functional abilities, disabilities and need for medical and social long-term community support 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. The assessment shall include an explanation of the potential community alternatives to the person being assessed and the person's family or guardian.
46.27(6)(a)2.a.
a. Any person or facility that is excluded because of gradual implementation of the program under sub.
(3) (c).
46.27(6)(a)2.b.
b. Emergency admissions, as determined by a physician, but shall be applied within 10 days of admission.
46.27(6)(a)2.c.
c. Private pay patients seeking admission to or about to be admitted to a facility under subd.
1. who are informed about the program but waive the assessment, unless the patient will be eligible for medical assistance within 6 months of assessment.
46.27(6)(a)2.cm.
cm. Persons under subd.
1. seeking admission to or about to be admitted to a Wisconsin veterans home operated by the department of veterans affairs under s.
45.50 who are informed about the program but waive the assessment.
46.27(6)(a)2.d.
d. Any person who is readmitted to a nursing home from a hospital within 6 months after being assessed.
46.27(6)(a)2.e.
e. Current residents of a nursing home who are eligible for an assessment under sub.
(5) (e) and subd.
3., but who waive the assessment.
46.27(6)(a)2.f.
f. A person who enters a nursing home for recuperative care.
46.27(6)(a)2.h.
h. A person who is admitted to a nursing home from another nursing home, unless the person requests an assessment and funds allocated for assessments under sub.
(7) (am) are available to the county.
46.27(6)(a)3.
3. In each participating county, except in counties in which the department has contracted with an entity under s.
46.284 (2), 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.
46.27(6)(b)
(b) Within the limits of state and federal funds allocated under sub.
(7) and within the limits of fees collected unless prohibited, a community services case plan shall be developed for any person with chronic disabilities:
46.27(6)(b)2.
2. For whom noninstitutional community services are feasible, financially viable and preferred by the person or the person's guardian. In this subdivision, noninstitutional community services are financially viable if they can be financed by state or federal funds allocated under sub.
(7).
46.27(6)(c)
(c) The amount of any fee charged for conduct of an assessment under par.
(a) or for development of a case plan under par.
(b) shall be in accordance with a sliding scale formula established by the department by rule under sub.
(12) (c). A fee may not be charged if prohibited under
42 USC 1396 to
1396v or under regulations under
42 USC 1396 to
1396v.
46.27(6)(d)
(d) If the county, through an assessment, determines that a community arrangement is not feasible, the county department or aging unit administering the program shall explain the reasons to the person and his or her family or guardian. The county department or aging unit administering the program shall maintain records sufficient to provide the county long-term support planning committee and the department with a periodic review of the reasons community arrangements were not feasible in order to assist future program planning.
46.27(6)(e)
(e) The department shall encourage counties to use public health nurses who meet the requirements of s.
250.06 (1) to conduct assessments under this subsection.
46.27(6d)(a)
(a) The department, after consulting with representatives of counties, hospitals, and individuals who receive services under this section, shall do all of the following:
46.27(6d)(a)1.
1. Establish minimum requirements for the provision of care management services, as defined by the department, including standards for care, times for performance of duties, and size of caseloads.
46.27(6d)(a)2.
2. Specify a reasonable schedule for phasing in the requirements established under subd.
1. 46.27(6d)(a)3.
3. Provide technical consultation and assistance to the administrator of the program, as designated under sub.
(3) (b), with respect to the requirements established under subd.
1. 46.27(6d)(b)
(b) The department need not promulgate as rules under ch.
227 the requirements under par.
(a) 1. or the schedule under par.
(a) 2. 46.27(6g)
(6g) Fiscal responsibility. 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 a contract as specified under s.
46.284 (2), case plan, or services provided to a person under this section is as follows:
46.27(6g)(a)
(a) For a person seeking admission to or about to be admitted to a nursing home, the county in which the person has residence is the county of fiscal responsibility.
46.27(6g)(b)
(b) For a person residing in a nursing home, except a state-operated long-term care facility, the county in which the nursing home is located is the county of fiscal responsibility.
46.27(6g)(c)
(c) For a person living in a nursing home, except a state-operated long-term care facility, whose legal residence is established in another county, the county in which the legal residence is established is the county of fiscal responsibility.
46.27(6g)(d)
(d) For a person residing in a state-operated long-term care facility, or for a person protectively placed under ch.
55, the county in which the person has residence before he or she enters the state-operated long-term care facility or is protectively placed is the county of fiscal responsibility.
46.27(6r)
(6r) Eligibility. No county may use funds received under sub.
(7) (b) to pay for long-term community support services provided to any of the following:
46.27(6r)(a)
(a) A person who is initially eligible for services under sub.
(7) (b), for whom home and community-based services are available under sub.
(11) or s.
46.275,
46.277,
46.278, or
46.2785 that require less total expenditure of state funds than do comparable services under sub.
(7) (b) and who is eligible for and offered the home and community-based services under sub.
(11) or s.
46.275,
46.277,
46.278, or
46.2785, but who declines the offer, except that a county may use funds received under sub.
(7) (b) to pay for long-term community support services for the person for a period of up to 90 days during which an application for services under sub.
(11) or s.
46.275,
46.277,
46.278, or
46.2785 for the person is processed.
46.27(6r)(b)
(b) A person who initially receives services under this section after December 31, 1985, unless one of the following applies:
46.27(6r)(b)1.
1. The person meets the level of care requirements under s.
49.45 (6m) (i) for reimbursement of nursing home care under the medical assistance program.
46.27(6r)(b)1m.
1m. The person meets the requirements under any of the following for receipt of care in an institution for mental diseases:
46.27(6r)(b)1m.a.
a. A person who resided in the facility on the date of the finding that a skilled nursing facility or intermediate care facility that provides care to Medical Assistance recipients is an institution for mental diseases whose care in the facility is disallowed for federal financial participation under Medical Assistance.
46.27(6r)(b)1m.b.
b. A person who is aged 21 to 64, who has a primary diagnosis of mental illness, who would meet the level of care requirements for Medical Assistance reimbursement in a skilled nursing facility or intermediate care facility but for a finding that the facility is an institution for mental diseases, and for whom services would be provided in place of a person specified in subd.
1m. a. who discontinues services.
46.27(6r)(b)2.
2. The person has serious and persistent mental illness, as defined under s.
51.01 (14t), affecting mental health to the extent that long-term or repeated hospitalization is likely unless the person receives long-term community support services.
46.27(6r)(b)3.
3. The person receives medical assistance, resides in a nursing home immediately prior to receiving services under this section and is identified through the inspection of patient care under
42 USC 1396a (a) (31) as a person for whom community care is appropriate.
46.27(6r)(b)4.
4. The person has been diagnosed by a physician as having Alzheimer's disease and requires a level of care equivalent to either of the following:
46.27(6r)(b)4.a.
a. Noninstitutional personal care, including personal assistance, supervision and protection, and periodic medical services and consultation with a registered nurse, or periodic observation and consultation for physical, emotional, social or restorative needs, but not regular nursing care.
46.27(6r)(b)4.b.
b. Care, including social services and activity therapy, in a residential facility under the daily supervision of a licensed nurse with consultation from a registered nurse at least 4 hours per week.
46.27(6r)(c)
(c) A person who resides or intends to reside in a community-based residential facility and who is initially applying for long-term community support services, if the projected cost of services for the person, plus the cost of services for existing participants, would cause the county to exceed the limitation under sub.
(3) (f), unless the department grants an exception to the requirement under this paragraph, under the conditions specified by rule, to avoid hardship to the person.
46.27(6r)(e)
(e) A person who has not resided in this state for at least 180 consecutive days before applying for or receiving long-term community support services that are funded under sub.
(7) (b).
46.27(6r)(f)
(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.
46.27(6u)
(6u) Financial eligibility and cost-sharing requirements. 46.27(6u)(b)
(b) The county department or aging unit selected to administer the program shall require all persons applying for long-term community support services that are funded under sub.
(7) or
(11) and, annually, all persons receiving the services to provide the following information:
46.27(6u)(b)1.
1. For persons applying for or receiving services under sub.
(7), a declaration of assets, on a form prescribed by the department. The declaration shall include any assets that the person applying for or receiving the services, or his or her spouse, has, after August 12, 1993, transferred to another for less than fair market value at any time within the 36-month period, or with respect to payments from a trust or portions of a trust that would be treated as assets transferred by an individual under s.
49.454 (2) (c) or
(3) (b), within the 60-month period, immediately before the date of the declaration.
46.27(6u)(b)2.
2. For persons applying for or receiving services under sub.
(11), a declaration of income, on a form prescribed by the department.
46.27(6u)(c)
(c) From the information obtained under par.
(b), the county department or aging unit shall:
46.27(6u)(c)1.
1. Determine the financial eligibility of the applicant or recipient of services to receive assistance for long-term community support services under the program. A person is financially eligible under this subdivision if he or she is one of the following:
46.27(6u)(c)1.b.
b. A person whom the county department or aging unit finds is likely to become medically indigent within 6 months by spending excess assets for medical or remedial care.
46.27(6u)(c)2.
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 percent 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.
46.27(6u)(c)3.
3. Bill persons not determined under subd.
1. to be financially eligible for the full cost of long-term community support services received.
46.27(6u)(c)4.
4. Use funds received under subds.
2. and
3. to pay for long-term community support services for persons who are eligible under sub.
(6) (b).
46.27(6u)(d)
(d) In determining financial eligibility under par.
(c) 1. and in calculating the amount under par.
(c) 2., the county department or aging unit shall include as the assets for any person, except those persons who are eligible for medical assistance under s.
49.46,
49.468,
49.47, or
49.471 (4) (a), any portion of assets that the person or the person's spouse has, after August 12, 1993, transferred to another as specified in par.
(b), unless one of the following conditions applies:
46.27(6u)(d)2.
2. The county department or aging unit determines that undue hardship would result to the person or to his or her family from a denial of financial eligibility or from including all or a portion of a transferred asset in the calculation of the amount of cost sharing required.
46.27(7)(am)
(am) From the appropriation under s.
20.435 (4) (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.
49.45 or
49.78 (2). The department shall reimburse multicounty consortia for the cost of assessing persons eligible for medical assistance under s.
49.46,
49.468,
49.47, or
49.471 (4) (a) 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).
46.27(7)(b)
(b) From the appropriations under s.
20.435 (4) (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,
49.47, or
49.471 (4) (a) 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 (4) (bd) for a risk reserve under par.
(fr).
46.27(7)(c)3.
3. The department may not release funds under this section before approving the county's community options plan.
46.27(7)(cg)
(cg) No county may use funds received under par.
(b) to pay for long-term community support services provided any person who resides in a nursing home, unless the department waives this restriction on use of funds and the services are provided in accordance with a discharge plan.
46.27(7)(cj)
(cj) No county may use funds received under par.
(b) to provide services to a person who does not live in his or her own home or apartment unless, subject to the limitations under par.
(cm), one of the following applies:
