46.27(7g)(f)1.1. The department may recover amounts under this subsection for the provision of long-term community support services paid on and after January 1, 1996.
46.27(7g)(f)2.
2. The department may file a claim under
par. (c) only with respect to a client who dies after February 15, 1996.
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(7g)(h)
(h) The department may contract with or employ an attorney to probate estates to recover under this subsection the costs of care.
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 (4) (b) or
(w) 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) 1. and provided under
sub. (5) (b). Unless the department has contracted under
s. 46.281 (1) (d) with an entity other than the county department, 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 (4) (b) or
(w) 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 (4) (o) and
(7) (b) and
(bd).
46.27(11)(c)4.
4. The department may, from the appropriation under
s. 20.435 (4) (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)5m.
5m. No county may use funds received under this subsection to provide services to a person who does not live in his or her own home or apartment unless, subject to the limitations under
subds. 6.,
7. and
8., one of the following applies:
46.27(11)(c)5m.a.
a. The services are provided to the person in a community-based residential facility that entirely consists of independent apartments, each of which has an individual lockable independent entrance and exit and individual separate kitchen, bathroom, sleeping and living areas.
46.27(11)(c)5m.b.
b. The person suffers from Alzheimer's disease or related dementia and the services are provided to the person in a community-based residential facility that has a dementia care program.
46.27(11)(c)5n.
5n. A county may also use funds received under this subsection, subject to the limitations under
subds. 6.,
7. and
8., to provide services to a person who does not live in his or her own home or apartment if the services are provided to the person in a community-based residential facility and the county department or aging unit has determined that all of the following conditions have been met:
46.27(11)(c)5n.a.
a. An assessment under
sub. (6) has been completed for the person prior to the person's admission to the community-based residential facility, whether or not the person is a private pay admittee at the time of admission. The county may waive this condition in accordance with guidelines established by the department. If the county waives this condition, the county must meet with the person or the person's guardian to discuss the cost-effectiveness of various service options.
46.27(11)(c)5n.b.
b. The county department or aging unit documents that the option of in-home services has been discussed with the person, thoroughly evaluated and found to be infeasible, as determined by the county department or aging unit in accordance with rules promulgated by the department of health and family services.
46.27(11)(c)5n.c.
c. The county department or aging unit determines that the community-based residential facility is the person's preferred place of residence or is the setting preferred by the person's guardian.
46.27(11)(c)5n.d.
d. The county department or aging unit determines that the community-based residential facility provides a quality environment and quality care services.
46.27(11)(c)5n.e.
e. The county department or aging unit determines that placement in the community-based residential facility is cost-effective compared to other options, including home care and nursing home care.
46.27(11)(c)5p.a.a. Subject to the approval of the department, a county may establish and implement more restrictive conditions than those imposed under
subd. 5m. on the use of funds received under
sub. (7) (b) for the provision of services to a person in a community-based residential facility. A county that establishes more restrictive conditions under this
subd. 5p. a. shall include the conditions in its community options plan under
sub. (3) (cm).
46.27(11)(c)5p.b.
b. If the department determines that a county has engaged in a pattern of inappropriate use of funds received under
sub. (7) (b), the department may revoke its approval of the county's conditions established under
subd. 5p. a., if any, and may prohibit the county from using funds received under
sub. (7) (b) to provide services under
subd. 5n.
46.27(11)(c)6.a.a. No county, private nonprofit agency or aging unit may use funds received under this subsection to provide residential services in a group home, as defined in
s. 48.02 (7), that has more than 5 beds, unless the department approves the provision of services in a group home that has 6 to 8 beds.
46.27(11)(c)6.b.
b. No county, private nonprofit agency, or aging unit may use funds received under this subsection to provide residential services in a community-based residential facility, as defined in
s. 50.01 (1g), that has more than 20 beds, unless the requirements of
sub. (7) (cm) 1. a.,
b., or
c. are met.
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 residential care apartment complex, 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;
1997 a. 13,
27,
39,
79,
237;
1999 a. 9,
63;
2001 a. 16,
103.
46.27 Cross-reference
Cross Reference: See also ch.
HFS 73, Wis. adm. code.
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.
46.275
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 employees through redeployment of employees 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.
