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.
46.277(5)(b)
(b) Total funding to counties under the program may not exceed the amount approved in the waiver received under
sub. (2).
46.277(5)(c)
(c) The department may contract for services under this section with a private nonprofit agency.
Paragraphs (a) and
(b) apply to funding received by a private nonprofit agency under this subsection.
46.277(5)(d)1.1. In this paragraph, "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.
46.277(5)(d)2.
2. No county may use funds received under this section 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:
46.277(5)(d)2.a.
a. The department approves the provision of services in a community-based residential facility or group home that has 5 to 8 beds.
46.277(5)(d)2.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 section and are physically disabled or are at least 65 years of age.
46.277(5)(d)3.
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.
46.277(5)(e)
(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 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.
46.277(5g)(a)(a) The number of persons served under this section 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.
46.277(5g)(b)
(b) This section does not apply to the delicensure of a bed of an institution for mental diseases of an individual who is aged 21 to 64, who has a primary diagnosis of mental illness and who otherwise meets the requirements of
s. 46.266 (1) (a),
(b) or
(c).
46.277(5m)
(5m) Report. By October 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 cost and quality of services used under the program and the extent to which existing services have been used under the program in the preceding calendar year.
46.277(5r)
(5r) Rule making. The department shall promulgate rules that specify conditions of hardship under which the department may grant an exception to the requirement of
sub. (5) (d) 3.
46.277(6)
(6) Effective period. The effective date provisions of
s. 46.275 (6) apply to this section.
46.278
46.278
Community integration program for persons with mental retardation. 46.278(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 who is diagnosed as developmentally disabled under the definition specified in
s. 51.01 (5) and relocated from an institution other than a state center for the developmentally disabled or who meets the intermediate care facility for the mentally retarded level of care requirements for medical assistance reimbursement in an intermediate care facility for the mentally retarded and is ineligible for services under
s. 46.275 or
46.277. 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.
46.278(1m)(ag)
(ag) "Family consortium" means a group composed of relatives, or of relatives and the guardian, of an individual with developmental disability who together provide services for the individual in a home that is an extension of a relative's or the guardian's home.
46.278(1m)(c)
(c) "Program" means the community integration program for facilities certified as medical assistance providers, for which a waiver has been received under
sub. (3).
46.278(2)
(2) Departmental powers and duties. 46.278(2)(a)(a) 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 an intermediate care facility for the mentally retarded, in their communities by providing home or community-based services as part of medical assistance. If the department requests a waiver, it shall include all assurances required under
42 USC 1396n (c) (2) in its request.
46.278(3)
(3) Waiver; extension; duties. If the department receives a waiver requested under
sub. (2) (a), it may request a 3-year extension of the waiver under
42 USC 1396n (c) and shall perform the following duties:
46.278(3)(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.
46.278(3)(b)
(b) Fund home or community-based services provided by any county that meet the requirements of this section.
46.278(3)(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.
46.278(4)(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 an intermediate care facility for the mentally retarded who meets the intermediate care facility for the mentally retarded level of care requirements for medical assistance reimbursement to that facility rather than for care provided at a state center for the developmentally disabled.
46.278(4)(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.
46.278(4)(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 that are approved under the waiver received under
sub. (3).
46.278(5)(a)(a) Any medical assistance recipient who meets the level of care requirements for medical assistance reimbursement in an intermediate care facility for the mentally retarded and is ineligible for service under
s. 46.275 or
46.277 is eligible to participate in the program, except that the number of participants may not exceed the number approved under the waiver received under
sub. (3). 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.
46.278(5)(am)
(am) One individual who is eligible under
par. (a) may, beginning January 1, 1992, participate in the program through services provided by a family consortium that is formed before January 1, 1991, and is approved by the department.
46.278(5)(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 intermediate care facility for the mentally retarded level of care requirements for medical assistance reimbursement in an intermediate care facility for the mentally retarded, except that the number of participants concurrently served may not exceed the number approved under the waiver received under
sub. (3).
46.278(6)(b)
(b) Total funding to counties for relocating each person under the program may not exceed the amount approved in the waiver received under
sub. (3).
46.278(6)(c)
(c) Funding may be provided under the program for services of a family consortium.
46.278(6)(d)
(d) If a county makes available nonfederal funds equal to the state share of service costs under the waiver received under
sub. (3), the department may, from the appropriation under
s. 20.435 (1) (o), provide reimbursement for services that the county provides under this section to persons who are in addition to those who may be served under this section with funds from the appropriation under
s. 20.435 (1) (b).
46.278(6)(e)
(e) The department may provide enhanced reimbursement for services under the program for an individual who was relocated to the community by a county department from an intermediate care facility for the mentally retarded that closes under
s. 50.03 (14). The enhanced reimbursement rate under this paragraph shall be determined under a formula that is developed by the department.
46.278(7)
(7) Report. By July 1 of each year, the department shall submit 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), a report describing the cost and quality of services used under the program and the extent to which existing services have been used under the program in the preceding calendar year.
46.278(8)
(8) Effective period. Except as provided under
sub. (2), this section takes effect on the date approved by the secretary of the federal department of health and human services as the beginning date of the period of waiver received under
sub. (3). This section remains in effect for 3 years following that date and, if the secretary of the federal department of health and human services approves a waiver extension, shall continue an additional 3 years.
46.28
46.28
Revenue bonding for residential facilities. 46.28(1)(a)
(a) "Authority" means the Wisconsin housing and economic development authority created under
ch. 234.
46.28(1)(am)
(am) "Child with long-term care needs" means any of the following:
