46.27(7g)(g)
(g) The department shall promulgate rules establishing standards for determining whether the application of this subsection would work an undue hardship in individual cases. If the department determines that the application of this subsection would work an undue hardship in a particular case, the department shall waive application of this subsection in that case.
46.27(7m)
(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) may not serve as the basis for a request under this subsection.
46.27(8)
(8) County participation. Every county shall participate in and implement the program.
46.27(9)
(9) Pilot project allocating the cost of nursing home utilization increases to counties. 46.27(9)(a)(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 (1) (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).
46.27(9)(b)
(b) The department may only select counties to participate in this pilot project and receive these funds that have been part of the long-term support community options program since January 1, 1983. County participation in this pilot project shall be for periods beginning either January 1, 1984, or January 1, 1985.
46.27(9)(c)
(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) and provided under
sub. (5) (b). Each county participating in the pilot project shall assess persons under
sub. (6).
46.27(10)(a)1.1. 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 (1) (b) because of increased utilization of nursing home services, as estimated by the department.
46.27(10)(a)2.
2. The department shall transfer or credit to the participating county the amount calculated under
subd. 1. for 1984 or for the first 6 months of 1985, depending on the date the county begins participating in the pilot project. The county shall use these funds to provide long-term care to medical assistance recipients covered by its community options plan, either in the form of nursing home care financed under
par. (b) or in the form of long-term community support services. The county may use extra funds available under this paragraph after it provides this long-term care for other long-term community support services under its community options plan.
46.27(10)(b)
(b) Each county participating in the pilot project is liable for the entire nonfederal share of medical assistance costs related to increased utilization of nursing homes that are located in the county.
46.27(10)(c)
(c) The department's method of determining each county's base level of funding, the transfer or credit of funds and the department's specification of county financial liability under the pilot project are subject to the approval of the joint committee on finance.
46.27(11)(a)(a) In this subsection, "physically disabled" means having a condition that affects one's physical functioning by limiting mobility or the ability to see or hear, that is the result of injury, disease or congenital deficiency and that significantly interferes with or limits at least one major life activity and the performance of one's major personal or social roles.
46.27(11)(am)
(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 home and community-based services for persons who are eligible for long-term support community options program services under
sub. (5) (b).
46.27(11)(b)
(b) The department shall include all assurances required under
42 USC 1396n (c) in the implementation of the waiver.
46.27(11)(c)
(c) The following conditions apply under the waiver:
46.27(11)(c)1.
1. At the end of the 3-year period during which the waiver remains in effect the department may request a 3-year extension of the waiver.
46.27(11)(c)2.
2. The department shall annually submit to the secretary of the federal department of health and human services information showing the effect of the program on the type and amount of medical assistance provided and on the health and welfare of program participants.
46.27(11)(c)3.
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 (1) (o) and
(7) (b) and
(bd).
46.27(11)(c)3m.
3m. Reimbursement under this paragraph for long-term community support services provided to a person may not exceed the average monthly cost of nursing home care, as determined by the department, except that this limitation does not apply to any of the following:
46.27(11)(c)3m.c.
c. A person not specified under
subd. 3m. a. or
b., if the department determines that the cost of providing the person with nursing home care would exceed the cost of providing the person with care in the community. In making this determination, the department shall consider the nursing home costs of that person and the extent to which costs under the medical assistance program for nursing home care would actually exceed the cost of providing the person with care in the community.
46.27(11)(c)3m.d.
d. Any individual, if the department determines that nursing home care is not available for that individual.
46.27(11)(c)3m.e.
e. Any individual, if the department determines that public funding is not available for the institutional care of that individual.
46.27(11)(c)4.
4. The department may, from the appropriation under
s. 20.435 (1) (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).
46.27(11)(c)5.
5. The department may contract for services under this subsection with a county, a private nonprofit agency or, if a county board of supervisors by resolution so requests the department, an aging unit.
46.27(11)(c)6.
6. No county, private nonprofit agency or aging unit may use funds received under this subsection to provide residential services in any community-based residential facility, as defined in
s. 50.01 (1g), or group home, as defined in
s. 48.02 (7), that has more than 4 beds, unless one of the following applies:
46.27(11)(c)6.a.
a. The department approves the provision of services in a community-based residential facility or group home that has 5 to 8 beds.
46.27(11)(c)6.b.
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 eligible under this subsection and are physically disabled or are at least 65 years of age.
46.27(11)(c)7.
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 a certified assisted living facility, as defined in
s. 50.01 (1d). Funding of the services may not exceed 85% of the statewide medical assistance daily cost of nursing home care, as determined by the department.
46.27(11)(c)8.
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 approved model contract developed under
sub. (2) (j) or a contract that includes all of the provisions of the approved model contract.
46.27(11g)
(11g) Report. Beginning January 1, 1997, and every January 1 thereafter, the department shall submit a report to the joint committee on finance and to the appropriate standing committees under
s. 13.172 (3), summarizing the data collected for the state and for individual counties under the program in the calendar year ending immediately before the preceding calendar year.
46.27(12)
(12) Rules. The department shall promulgate rules establishing the following:
46.27(12)(a)
(a) Fiscal management procedures required to be implemented by counties in administering the program under this section, as follows:
46.27(12)(a)1.
1. A simple contract between the community options program client and the service provider for that client.
46.27(12)(a)2.
2. A method for documenting the amount of service provided to enable verification of the appropriateness of payment.
46.27(12)(a)3.
3. Guidelines for determining whether a potential community options program client is competent to receive community options program funds directly or if an action should be brought for a determination of competency and the appointment of a guardian.
46.27(12)(a)4.
4. Supervisory review of community options program client payment decisions.
46.27(12)(b)
(b) Standards to ensure that only a single payment is made by the department for an initial community options case plan conducted by a county.
46.27(12)(c)
(c) A sliding scale formula for a fee chargeable for conduct of an assessment under
sub. (6) (a) or for development of a case plan under
sub. (6) (b) that is based on the person's ability to pay, unless prohibited from payment under
42 USC 1396 to
1396v or under regulations under
42 USC 1396 to
1396v.
46.27 History
History: 1981 c. 20;
1983 a. 27;
1983 a. 189 s.
329 (5);
1983 a. 192,
239;
1985 a. 29 ss.
876s to
896am,
3200 (56);
1985 a. 120,
176;
1987 a. 27,
399;
1989 a. 31,
77,
336,
359;
1991 a. 32,
39,
235,
274;
1993 a. 16,
27,
437;
1995 a. 27.
46.271
46.271
Long-term support pilot projects. 46.271(1)
(1) From the appropriation under
s. 20.435 (7) (bd), the department shall award $100,000 in each fiscal year to applying county departments under
s. 46.215,
46.22,
46.23,
51.42 or
51.437 or to an aging unit under the conditions specified in
sub. (3) to establish pilot projects for home and community-based long-term support services. Funds awarded to the pilot projects shall be used to do any of the following:
46.271(1)(a)
(a) Provide administration for projects that serve individuals who are discharged from hospitals and meet one of the eligibility requirements under
s. 46.27 (6r) (b) 1. to
4.
46.271(1)(b)
(b) Promote the development of a system of home and community-based long-term support services that is easily accessible to individuals who are eligible for and potentially need these services.
46.271(2)
(2) The department shall do all of the following:
46.271(2)(a)
(a) Solicit applications from county departments or aging units for the pilot projects under
sub. (1).
46.271(2)(b)
(b) Require that an applying county department or aging unit under
par. (a) submit as part of the application specific plans for improving the coordination between hospitals and providers of home and community-based long-term support services.
46.271(3)
(3) The department may contract with an aging unit, as defined in
s. 46.27 (1) (a), for administration of services under
sub. (1) if, by resolution, the county board of supervisors of that county so requests the department.
46.275
46.275
Community integration program for residents of state centers. 46.275(1)(1)
Legislative intent. The intent of the program under this section is to relocate persons from the state centers for the developmentally disabled into appropriate community settings with the assistance of home and community-based services and with continuity of care. The intent of the program is also to minimize its impact on state employes through redeployment of employes into vacant positions.
46.275(1m)(b)
(b) "Program" means the community integration program for residents of state centers for the developmentally disabled, for which a waiver has been received under
sub. (2).
46.275(2)
(2) Departmental powers and duties. The department may request a waiver from the secretary of the U.S. 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. 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:
46.275(2)(a)
(a) Annually submit to the secretary of the U.S. department of health and human services information showing the effect of the program on medical assistance costs and on the health and welfare of program participants.
46.275(2)(b)
(b) Evaluate the effect of the program on medical assistance costs and on the program's ability to provide community care alternatives to institutional care in state centers for the developmentally disabled.
46.275(2)(c)
(c) Fund home or community-based services provided by any county or by the department that meet the requirements of this section.
46.275(2)(e)
(e) Submit to the governor and to the chief clerk of each house of the legislature, for distribution to appropriate legislative standing committees under
s. 13.172 (3), annual progress reports on the program plus any other information requested.
46.275(3)(a)(a) Any county may participate in the program, if it meets the conditions specified in this subsection and the requirements established by the department, including requirements concerning the qualifications and levels of staff for home or community-based service providers.
46.275(3)(b)
(b) The board of supervisors of any county that participates in the program shall designate one of the following county departments to administer the program, subject to departmental review and approval:
46.275(3)(c)
(c) Any county participating in the program shall inform the persons eligible for program services under
sub. (4) that home and community-based services are available, at their choosing, in place of institutional care. Services provided under this section shall meet the following conditions:
46.275(3)(c)1.
1. The services substitute for care provided at a state center for the developmentally disabled.
46.275(3)(c)2.
2. The services are provided to each recipient under a written plan of care designed for that recipient and, unless
s. 49.45 (37) applies, approved by the department.
46.275(3)(d)
(d) Any county participating in the program shall provide case management services, including the responsibility for locating, coordinating and monitoring all services and informal supports needed by eligible persons and their families.
46.275(3)(e)
(e) Any county participating in the program shall protect the health and welfare of persons receiving program services and shall coordinate the program to the greatest extent practicable with the long-term support community options program under
s. 46.27.
46.275(3g)
(3g) Duties of the department. The department shall provide fair and equitable arrangements to protect the interests of all state employes affected by the program, including arrangements designed to preserve employe rights and benefits.
46.275(3r)(a)(a) The department may, without county participation under
sub. (3) or county reimbursement under
sub. (5) (a), relocate a person eligible for program services under
sub. (4) from a state center for the developmentally disabled into a community setting in any of the following situations:
46.275(3r)(a)1.
1. The person's county of residence when the person entered the state center for the developmentally disabled cannot be determined with reasonable certainty.
46.275(3r)(a)2.
2. The person's county of residence when the person entered the state center for the developmentally disabled is not participating, under
sub. (3), in the program.
46.275(3r)(a)3.
3. The person will be relocated into the home of the person's parent or guardian and will be receiving state monitoring of the relocation and services provided by a public or private school.
46.275(3r)(b)
(b) If the department relocates a person under this subsection, it shall comply with the requirements imposed on counties under
sub. (3) (c) to
(e).
46.275(3r)(c)
(c) Prior to relocating a person under this subsection, the department shall ensure delivery of any necessary education, habilitation, vocational, medical and therapy services through contracting with community-based service providers. If any service is not available, the department may provide it directly.
46.275(4)(a)(a) 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.
46.275(4)(b)
(b) The department in conjunction with the county shall review any application for participation in the program as to eligibility and the appropriateness of planned services. The county department administering the program for the county in which the medical assistance recipient resides shall review any application for participation in the program as to eligibility, except applications for relocation under
sub. (3r). No person may participate in the program unless all of the following occur:
46.275(4)(b)1.
1. Consent for participation is given either by the person's parent, guardian or legal custodian, if the person is under age 18, or by the person or the person's guardian, if the person is age 18 or over, except that this subdivision does not limit the authority of the circuit court to enter, change, revise or extend a dispositional order under
subch. VI of ch. 48 or
subch. VI of ch. 938 or to order a placement under
s. 55.06.
46.275(4)(b)2.
2. The county, or the department under
sub. (3r), agrees to provide services to the person.
