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.
46.275(4)(b)3.
3. The department determines that available home or community-based services are appropriate for that person.
46.275(4)(c)1.1. Except as provided in
subd. 2., if a resident of a state center for the developmentally disabled is relocated in order to receive home or community-based services under the program, the center may not accept a patient to fill the bed left vacant by the person leaving.
46.275(4)(c)2.
2. If a person who has been relocated from a state center for the developmentally disabled under this program seeks to return to the center within 365 days after relocating because the person or the county department administering the program, or the department under
sub. (3r), finds that the services available are inappropriate, the center shall accept the person as a patient to fill the bed that the person vacated. After this 365-day period, the person may only be readmitted into a bed not left vacant because of relocation under this section.
46.275(4)(f)
(f) To the extent provided in
42 USC 1396n, if a person who has been relocated from a state center for the developmentally disabled under this program discontinues participating in the program for any reason other than institutional placement, the department may reallocate on a case-by-case basis the funding within the relocating county to another medical assistance recipient who is developmentally disabled and who, but for this program, would require the level of care provided in a state center for the developmentally disabled.
46.275(5)(a)(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 (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.
46.275(5)(b)
(b) No county, or the department under
sub. (3r), may use funds received under this section to do any of the following:
46.275(5)(b)2.
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. or
51.423, as indicated in the county's budget or by actual expenditures.
46.275(5)(b)4.
4. Provide services, except respite care that is approved by the department, within a skilled nursing facility, intermediate care facility or intermediate care facility for the mentally retarded, including a state center for the developmentally disabled.
46.275(5)(b)5.
5. 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 the department approves the provision of services in a community-based residential facility or group home that has 5 to 8 beds.
46.275(5)(b)6.
6. Provide services to a recipient that are not specified in the recipient's written plan of care.
46.275(5)(c)
(c) The total allocation under
s. 20.435 (1) (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.
46.275(5)(d)
(d) The department may, from the appropriation under
s. 20.435 (1) (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).
46.275(5m)
(5m) Report. By March 1 of each year, the department shall submit a report to the joint committee on finance and to the chief clerk of each house of the legislature, for distribution to the appropriate standing committees under
s. 13.172 (3), describing the program's impact during the preceding calendar year on state employes, including the department's efforts to redeploy employes into vacant positions and the number of employes laid off.
46.275(6)
(6) Effective period. This section takes effect on the date approved by the secretary of the U.S. department of health and human services as the beginning date of the period of waiver received under
sub. (2). This section remains in effect for 3 years following that date and, if the secretary of the U.S. department of health and human services approves a waiver extension, shall continue an additional 3 years.
46.277
46.277
Community integration program for persons relocated or meeting reimbursable levels of care. 46.277(1)(1)
Legislative intent. The intent of the program under this section 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.
46.277(1m)(b)
(b) "Program" means the community integration program for which a waiver has been received under
sub. (2).
46.277(2)
(2) Departmental powers and duties. 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. 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:
46.277(2)(a)
(a) 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 facilities certified as medical assistance providers.
46.277(2)(b)
(b) Fund home or community-based services provided by any county that meet the requirements of this section.
46.277(2)(c)
(c) To the maximum extent possible, authorize the provision of services under this section to serve persons, except those institutionalized in a state center for the developmentally disabled, in noninstitutional settings and coordinate application of the review criterion under
s. 150.39 (5) with the services provided under this section.
46.277(2)(d)
(d) Unless
s. 49.45 (37) applies, review and approve or disapprove each plan of care developed by the county department under
sub. (3).
46.277(2)(e)
(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.
46.277(3)(a)(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.
46.277(3)(b)1.1. If the provision of services under this section results in a decrease in the statewide nursing home bed limit under
s. 150.31 (3), the facility affected by the decrease shall submit a plan for delicensing all or part of the facility that is approved by the department.
46.277(3)(b)2.
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.
46.277(3)(c)
(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.
46.277(3m)
(3m) Participation by a private nonprofit agency. A private nonprofit agency with which the department contracts for service under
sub. (5) (c) shall have the powers and duties under this section of a county department, as specified in
sub. (3) (a).
46.277(4)(a)(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.
46.277(4)(b)
(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.
