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;
1997 a. 13,
27,
39,
79,
237.
46.271
46.271
Long-term support pilot projects. 46.271(1)(a)(a) 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
par. (c) 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)1.
1. 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)(a)2.
2. 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(1)(b)
(b) The department shall do all of the following:
46.271(1)(b)1.
1. Solicit applications from county departments or aging units for the pilot projects under
par. (a).
46.271(1)(b)2.
2. Require that an applying county department or aging unit under
subd. 1. 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(1)(c)
(c) The department may contract with an aging unit, as defined in
s. 46.27 (1) (a), for administration of services under
par. (a) if, by resolution, the county board of supervisors of that county so requests the department.
46.271(2m)(a)(a) The department may establish, in geographic areas determined by the department, a pilot project under which the department may contract with a private or public entity to do all of the following:
46.271(2m)(a)1.
1. Serve as a clearinghouse of information for individuals who are interested in home or community-based long-term support services or institutional long-term care services.
46.271(2m)(a)2.
2. Perform assessments using the assessment method established by the department to determine an individual's functional abilities, disabilities, personal preferences and need for home or community-based long-term support services or institutional long-term care 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 or community-based residential facility. The assessment shall include an explanation of the potential community alternatives to the person being assessed and the person's family or guardian.
46.271(2m)(a)3.
3. Collect information specified by the department on the individuals served by the entity and provide that information to the department.
46.271(2m)(am)
(am) Residents of the geographic areas where a pilot project under this subsection is established shall receive an assessment by the entity contracted with under
par. (a) (intro.) prior to entry into a nursing home or community-based residential facility or participation in the long-term support community options program under
s. 46.27.
46.271(2m)(ap)
(ap) The department may require that the results of a client's assessment under
par. (a) 2. be submitted at the time that a provider submits a request for prior authorization for medical assistance services.
46.271(2m)(c)1.
1. Emergency admissions, as determined by a physician, but shall be applied within 10 days after the admission.
46.271(2m)(c)2.
2. A private pay patient seeking admission to or about to be admitted to a nursing home or community-based residential facility who is informed about the program but waives the assessment, unless the patient will be eligible for medical assistance within 6 months after the assessment.
46.271(2m)(c)3.
3. Persons seeking admission to or about to be admitted to the Wisconsin Veteran's Home at King who are informed about the pilot project but waive the assessment.
46.271(2m)(c)4.
4. Any person who is readmitted to a nursing home or community-based residential facility from a hospital within 6 months after being assessed.
46.271(2m)(c)5.
5. Current residents of a nursing home or community-based residential facility who are eligible for an assessment but who waive the assessment.
46.271(2m)(c)6.
6. A person who enters a nursing home or community-based residential facility for recuperative care.
46.271(2m)(c)7.
7. A person who enters a nursing home or community-based residential facility for respite care.
46.271(2m)(c)8.
8. A person who is admitted to a nursing home or community-based residential facility from another nursing home or community-based residential facility, unless the person requests an assessment and funds distributed for assessments under
par. (b) are available to the entity.
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 (5) (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)(b)7.
7. Provide services in any community-based residential facility unless the county or department uses as a service contract the approved model contract developed under
s. 46.27 (2) (j) or a contract that includes all of the provisions of the approved model contract.
