AB150: Bill Text

AB150, s. 2221 Section 2221. 46.27 (6r) (a) of the statutes is amended to read:

AB150,871,9 46.27 (6r) (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 or 46.278 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 or 46.278, 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 or 46.278 for the person is processed.

AB150, s. 2222 Section 2222. 46.27 (6r) (c) of the statutes is created to read:

AB150,871,16 46.27 (6r) (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.

AB150, s. 2223 Section 2223. 46.27 (6r) (d) of the statutes is created to read:

AB150,871,18 46.27 (6r) (d) A person as specified in sub. (11m).

****Note: This is reconciled s. 46.27 (6r) (d). This section has been affected by a draft with the following LRB #: 0450/3.

AB150, s. 2224 Section 2224. 46.27 (7) (am) of the statutes is amended to read:

AB150,872,4 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 under s. 46.032 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.

AB150, s. 2225 Section 2225. 46.27 (7) (b) of the statutes, as affected by 1995 Wisconsin Act .... (this act), is amended to read:

AB150,872,18 46.27 (7) (b) From Except as specified in sub. (11m), from the appropriation under s. 20.435 (7) (bd), 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.

****Note: This is reconciled s. 46.27 (7) (b). This section has been affected by a draft with the following LRB #: 0448/2.

AB150, s. 2226 Section 2226. 46.27 (7) (b) 1m. of the statutes is renumbered 46.27 (7) (b).

AB150, s. 2227 Section 2227. 46.27 (7) (b) 2. of the statutes is renumbered 46.27 (7) (cg) and amended to read:

AB150,873,2 46.27 (7) (cg) No county may use funds received under this paragraph 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.

AB150, s. 2228 Section 2228. 46.27 (7) (c) 2. of the statutes is amended to read:

AB150,873,5 46.27 (7) (c) 2. Receipt of funds under this section is subject to s. 49.52 (2) 46.495 (2).

AB150, s. 2229 Section 2229. 46.27 (7) (cm) of the statutes is created to read:

AB150,873,10 46.27 (7) (cm) 1. 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, as defined in s. 50.01 (1g), that has more than 8 beds, unless one of the following applies:

AB150,873,12 a. The department approves the provision of services in a community-based residential facility that meets standards established under subd. 2.

AB150,873,17 b. The department approves the provision of services in a community-based residential facility that entirely consists of independent apartments, each of which has an individual lockable entrance and exit and individual separate kitchen, bathroom, sleeping and living areas, to individuals who are provided services under sub. (5) (b) and are physically disabled or are at least 65 years of age.

AB150,873,21 2. By January 1, 1996, the department shall establish standards for approvals made under subd. 1. a., including whether the proposed use of funds for residents at the community-based residential facility in question adequately provides for all of the following:

AB150,873,22 a. Sufficient responsiveness to individual resident needs.

AB150,873,23 b. Maintenance of approved levels of quality of care.

AB150,873,24 c. Cost effectiveness, in comparison with other feasible funding uses.

AB150,874,2 d. Sufficient consideration of care for facility residents with dementia or related conditions.

AB150,874,4 3. The department need not promulgate as rules under ch. 227 the standards required to be established under subd. 2.

AB150,874,7 4. This paragraph does not apply to individuals who are receiving services under this section that are funded under par. (b) and who are residing in community-based residential facilities with more than 8 beds on January 1, 1996.

AB150, s. 2230 Section 2230. 46.27 (7m) of the statutes is amended to read:

AB150,874,13 46.27 (7m) Right to hearing. A person who is denied eligibility for services or whose services are reduced or terminated under this section may request a hearing from the department under s. 227.44, except that lack of adequate funding or a denial under sub. (6r) (a) or (d) may not serve as the basis for a request under this subsection.

AB150, s. 2231 Section 2231. 46.27 (11) (am) of the statutes is amended to read:

AB150,874,20 46.27 (11) (am) The department shall request a waiver from the secretary of the federal department of health and human services, under 42 USC 1396n (c), authorizing the department to provide as part of the medical assistance program, except as specified in sub. (11m), home and community-based services for persons who are eligible for long-term support community options program services under sub. (5) (b).

AB150, s. 2232 Section 2232. 46.27 (11) (c) 7. of the statutes is created to read:

AB150,875,2 46.27 (11) (c) 7. A county may use funds received under this subsection to provide supportive, personal or nursing services, as defined in rules promulgated under s. 49.45 (2) (a) 23., to a person who resides in an assisted living facility, as defined in s. 50.01 (1d). Funding of the services may not exceed 85% of the statewide rate for reimbursement under s. 49.45 (6m), as determined by the department under s. 49.45 (6m) (L).

AB150, s. 2233 Section 2233. 46.27 (11) (c) 8. of the statutes is created to read:

AB150,875,8 46.27 (11) (c) 8. No county, private nonprofit agency or aging unit may use funds received under this subsection to provide services in any community-based residential facility unless the county, agency or aging unit uses as a service contract the model contract developed under sub. (2) (j) or a contract that includes all of the provisions of the model contract.

****Note: This is reconciled s. 46.27 (11) (c) 8. This Section has been affected by a draft with the following LRB number: -0453/2.

AB150, s. 2234 Section 2234. 46.27 (11) (cm) of the statutes is created to read:

AB150,875,19 46.27 (11) (cm) 1. The department shall request from the secretary of the federal department of health and human services an amendment to the waiver specified in par. (am) to allow the department to receive federal financial participation to continue to provide, notwithstanding sub. (11m), long-term community support services that substitute for the benefit under s. 49.46 (2) (a) 4. a. or (b) 6. a. to an individual who is eligible for medical assistance only under s. 49.47; who was receiving the services, provided as a medical assistance benefit, on January 1, 1996; and who has continued to receive those services or the services, provided as a medical assistance benefit, that are described in s. 46.275 (5g), 46.277 (5g) (c) or 46.278 (6m) or specified in s. 49.46 (2) (a) 4. c. or (b) 6. a. since that date.

AB150,875,22 2. If the waiver amendment under subd. 1. is granted and remains in effect, the department shall provide the services described in subd. 1. to individuals covered by the waiver amendment, notwithstanding sub. (11m).

****Note: This is reconciled s. 46.27 (11) (cm) 1. This section has been affected by a draft with the following LRB #: 0444/1.

AB150, s. 2235 Section 2235. 46.27 (11m) of the statutes is created to read:

AB150,876,5 46.27 (11m) Limitation. The department may not allocate funds to a county to provide long-term community support services that substitute for the benefit under s. 49.46 (2) (a) 4. a. or (b) 6. a. for persons who meet the condition specified under sub. (6r) (b) 1. but who are eligible for medical assistance only under s. 49.47.

AB150, s. 2236 Section 2236. 46.275 (1m) (a) of the statutes is amended to read:

AB150,876,8 46.275 (1m) (a) "Medical assistance" means aid provided under ss. 49.43 to 49.47 subch. IV of ch. 49, except s. 49.468.

AB150, s. 2237 Section 2237. 46.275 (2) (intro.) of the statutes is amended to read:

AB150,876,20 46.275 (2) Departmental powers and duties. (intro.) The department may request a waiver from the secretary of the U.S. federal department of health and human services, under 42 USC 1396n (c), authorizing the department to integrate medical assistance recipients who reside in state centers for the developmentally disabled into their communities by providing home and community-based services as part of the medical assistance program, except as provided in sub. (5g). If the department requests this waiver, it shall include all assurances required under 42 USC 1396n (c) (2) in its request. If the department receives this waiver, at the end of the 3-year period during which the waiver remains in effect the department may request an additional 3-year extension of the waiver. If the department receives this waiver, it shall:

AB150, s. 2238 Section 2238. 46.275 (4) (a) of the statutes is amended to read:

AB150,876,25 46.275 (4) (a) Any Except as provided in sub. (5g), any medical assistance recipient living in a state center for the developmentally disabled is eligible to participate in the program. Such a recipient may apply, or any person may apply on behalf of such a recipient, for participation in the program.

AB150, s. 2239 Section 2239. 46.275 (5) (a) of the statutes is amended to read:

AB150,877,7 46.275 (5) (a) Medical Except as provided in sub. (5g), medical assistance reimbursement for services a county, or the department under sub. (3r), provides under this program is available from the appropriations under s. 20.435 (1) (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.

AB150, s. 2240 Section 2240. 46.275 (5) (b) 2. of the statutes is amended to read:

AB150,877,13 46.275 (5) (b) 2. Reduce federal, state or county matching expenditures for long-term community support services provided to any person as part of this program from funds allocated under s. 46.495 (1) (d), 46.80 (5), 46.85 (3m) (b) 1. and 2., 49.52 (1) (d) or 51.423, as indicated in the county's budget or by actual expenditures.

AB150, s. 2241 Section 2241. 46.275 (5d) of the statutes is created to read:

AB150,877,24 46.275 (5d) Waiver amendment. (a) The department shall request from the secretary of the federal department of health and human services an amendment to the waiver specified in sub. (2) to allow the department to receive federal financial participation to continue to provide, notwithstanding sub. (5g), home and community-based services that substitute for the benefit under s. 49.46 (2) (a) 4. a. or (b) 6. a. to an individual who is eligible for medical assistance only under s. 49.47; who was receiving the services, provided as a medical assistance benefit, on January 1, 1996; and who has continued to receive those services or the services, provided as a medical assistance benefit, that are described in s. 46.27 (11m), 46.277 (5g) (c) or 46.278 (6m) or specified in s. 49.46 (2) (a) 4. c. or (b) 6. a. since that date.

AB150,878,3 (b) If the waiver amendment under par. (a) is granted and remains in effect, the department shall provide the services described in par. (a) to individuals covered by the waiver amendment, notwithstanding sub. (5g).

****Note: This is reconciled s. 46.275 (5d). This section has been affected by a draft with the following LRB #: 0444/1.

AB150, s. 2242 Section 2242. 46.275 (5g) of the statutes is created to read:

AB150,878,8 46.275 (5g) Limitation. The department may not provide under this section home and community-based services that substitute for the benefit under s. 49.46 (2) (a) 4. a. or (b) 6. a. for persons who are eligible for medical assistance only under s. 49.47.

AB150, s. 2243 Section 2243. 46.277 (1) of the statutes is amended to read:

AB150,878,21 46.277 (1) Legislative intent. The intent of the program under this section, except as provided in sub. (5g) (c), is to provide home or community-based care to serve in a noninstitutional community setting a person who meets eligibility requirements under 42 USC 1396n (c) and is relocated from an institution other than a state center for the developmentally disabled or meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or an intermediate care facility, except that the number of persons who receive home or community-based care under this section is not intended to exceed the number of nursing home beds that are delicensed as part of a plan submitted by the facility and approved by the department. The intent of the program is also that counties use all existing services for providing care under this section, including those services currently provided by counties.

****Note: This is reconciled s. 46.277 (1). This section has been affected by a draft with the following LRB #: 0444/1.

AB150, s. 2244 Section 2244. 46.277 (1m) (a) of the statutes is amended to read:

AB150,879,2 46.277 (1m) (a) "Medical assistance" means aid provided under ss. 49.43 to 49.47 subch. IV of ch. 49, except s. 49.468.

AB150, s. 2245 Section 2245. 46.277 (1m) (b) of the statutes is amended to read:

AB150,879,6 46.277 (1m) (b) "Program" means the community integration program for facilities certified as medical assistance providers, for which a waiver has been received under sub. (2).

AB150, s. 2246 Section 2246. 46.277 (2) (intro.) of the statutes is amended to read:

AB150,879,20 46.277 (2) Departmental powers and duties. (intro.) The department may request a waiver from the secretary of the federal department of health and human services, under 42 USC 1396n (c), authorizing the department to serve medical assistance recipients, who meet the level of care requirements for medical assistance reimbursement in a skilled nursing facility or an intermediate care facility, in their communities by providing home or community-based services as part of medical assistance, except as provided in sub. (5g) (c). The number of persons for whom the waiver is requested may not exceed the number of nursing home beds that are delicensed as part of a plan submitted by the facility and approved by the department. If the department requests a waiver, it shall include all assurances required under 42 USC 1396n (c) (2) in its request. If the department receives this waiver, it may request one or more 3-year extensions of the waiver under 42 USC 1396n (c) and shall perform the following duties:

****Note: This is reconciled s. 46.277 (2) (intro.). This section has been affected by a draft with the following LRB #: 0444/1.

AB150, s. 2247 Section 2247. 46.277 (2) (e) of the statutes is created to read:

AB150,880,4 46.277 (2) (e) Review and approve or disapprove waiver requests under sub. (3) (c), review and approve or disapprove requests for exceptions under sub. (5) (d) 3. and provide technical assistance to a county that reaches or exceeds the annual allocation limit specified in sub. (3) (c) in order to explore alternative methods of providing long-term community support services for persons who are in group living arrangements in that county.

AB150, s. 2248 Section 2248. 46.277 (3) (a) of the statutes is amended to read:

AB150,880,14 46.277 (3) (a) Sections 46.27 (3) (b) and 46.275 (3) (a) and (c) to (e) apply to county participation in this program, except that services provided in the program shall substitute for care provided a person in a skilled nursing facility or intermediate care facility who meets the level of care requirements for medical assistance reimbursement to that facility rather than for care provided at a state center for the developmentally disabled. The number of persons who receive services provided by the program under this paragraph may not exceed the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.

AB150, s. 2249 Section 2249. 46.277 (3) (b) 2. of the statutes is amended to read:

AB150,880,21 46.277 (3) (b) 2. Each county department participating in the program shall provide home or community-based care to persons eligible under this section, except that the number of persons who receive home or community-based care under this section may not exceed the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.

AB150, s. 2250 Section 2250. 46.277 (3) (c) of the statutes is created to read:

AB150,881,7 46.277 (3) (c) Beginning on January 1, 1996, from the annual allocation to the county for the provision of long-term community support services under sub. (5), annually establish a maximum total amount, not to exceed 25% of the annual allocation, that may be encumbered in a calendar year for services for eligible individuals in community-based residential facilities. If the total amount that is encumbered for services for individuals in community-based residential facilities who are receiving services under sub. (5) on January 1, 1996, exceeds 25% of the county's annual allocation, a county may request a waiver of the requirement under this paragraph from the department. The department need not promulgate as rules under ch. 227 the standards for granting a waiver request under this paragraph.

AB150, s. 2251 Section 2251. 46.277 (4) (a) of the statutes is amended to read:

AB150,881,16 46.277 (4) (a) Any medical assistance recipient who meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or intermediate care facility is eligible to participate in the program, except that the number of participants may not exceed the number of nursing home beds , other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department. Such a recipient may apply, or any person may apply on behalf of such a recipient, for participation in the program. Section 46.275 (4) (b) applies to participation in the program.

AB150, s. 2252 Section 2252 . 46.277 (4) (a) of the statutes, as affected by 1995 Wisconsin Act .... (this act), is amended to read:

AB150,882,2 46.277 (4) (a) Any medical assistance recipient who meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or intermediate care facility is eligible to participate in the program, except that the number of participants may not exceed the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department and except as provided in sub. (5g) (c). Such a recipient may apply, or any person may apply on behalf of such a recipient, for participation in the program. Section 46.275 (4) (b) applies to participation in the program.

****Note: This is reconciled s. 46.277 (4) (a). This section has been affected by a draft with the following LRB #: 0444/1.

AB150, s. 2253 Section 2253. 46.277 (4) (b) of the statutes is amended to read:

AB150,882,11 46.277 (4) (b) To the extent authorized under 42 USC 1396n, if a person discontinues participation in the program, a medical assistance recipient may participate in the program in place of the participant who discontinues if that recipient meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or intermediate care facility, except that the number of participants may not exceed the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.

AB150, s. 2254 Section 2254. 46.277 (5) (d) 3. of the statutes is created to read:

AB150,882,19 46.277 (5) (d) 3. If subd. 2. a. or b. applies, no county may use funds received under this section to pay for services provided to a person who resides or intends to reside in a community-based residential facility and who is initially applying for the 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) (c). The department may grant an exception to the requirement under this subdivision, under the conditions specified by rule, to avoid hardship to the person.

AB150, s. 2255 Section 2255. 46.277 (5) (e) of the statutes is created to read:

AB150,883,3 46.277 (5) (e) A county may use funds received under this subsection to provide supportive, personal or nursing services, as defined in rules promulgated under s. 49.45 (2) (a) 23., to a person who resides in an assisted living facility, as defined in s. 50.01 (1d). Funding of the services may not exceed 85% of the statewide rate for reimbursement under s. 49.45 (6m), as determined by the department under s. 49.45 (6m) (L).

AB150, s. 2256 Section 2256. 46.277 (5d) of the statutes is created to read: