46.266(2)(a)4.
4. Funding for community care, for persons who were relocated by a county department to the community from an institution for mental diseases after December 31, 1992, may not exceed 60% of the daily medical assistance reimbursement rate under
s. 49.45 (6m) of the facility, if the requirement to close a bed under
sub. (8) (a) is waived by the department under
sub. (8) (b) or if
sub. (9) applies.
46.266(2)(a)5.
5. Funding for services in the community is not authorized under
s. 46.277 for the person or for a person receiving care under
s. 46.40 and for whom care under
s. 46.277 might be substituted.
46.266(2)(a)6.
6. If funding for treatment in institutions for mental diseases and for community care under this section is insufficient to reimburse all eligible costs, the department shall prorate the funds.
46.266(2)(a)7.
7. Funding under this paragraph shall be reduced by the amount of any funds provided as reimbursement to a skilled nursing facility or intermediate care facility under this paragraph after the date of a finding, if any, by the federal health care financing administration that the facility is no longer an institution for mental diseases and is eligible for reimbursement under
s. 49.45 (6m).
46.266(2)(a)8.
8. Funding under this paragraph requires compliance by an institution for mental diseases with the requirements under
s. 49.45 (6c).
46.266(2)(b)
(b) Funds, calculated according to a method specified by the department, equivalent to the state share of the average daily medical assistance payment for noninstitutional medical services for residents of skilled nursing facilities or intermediate care facilities found to be institutions for mental diseases whose care has been disallowed for federal financial participation.
46.266(3)
(3) The total number of beds in skilled nursing facilities or intermediate care facilities that are funded at any one time under
subs. (1) and
(2) may not exceed the number of beds available for the persons specified in
sub. (1) (a), minus the number of beds reduced under
sub. (8) (a), plus the number of beds added for persons who are specified under
sub. (1) (c) and
(d). The department may redistribute funds for a vacant bed from one county to another county that is seeking to effect the placement of a person in an institution for mental diseases.
46.266(4)
(4) The county department under
s. 51.42 to which funding shall be provided under
sub. (1) is one of the following:
46.266(4)(a)
(a) The county department in the county of residence of the person whose care in the facility has been disallowed for federal financial participation.
46.266(4)(b)
(b) If the department is unable to determine the county of residence under
par. (a), the county department of the county in which is located the facility where the person resided on the date of the finding by the federal health care financing administration or the department.
46.266(5)
(5) The board under
s. 51.42 (5) or, in a county with a county administrator or a county executive, the director under
s. 51.42 (6m) shall use funds provided under this section to contribute to the cost of the person's continued care in an institution for mental diseases or in the community.
46.266(6)
(6) No skilled nursing facility or intermediate care facility that has residents who are 21 to 64 years of age and have primary diagnoses of mental illness may receive funds under this section unless the skilled nursing facility or intermediate care facility has received distinct part or separate licensure under
s. 50.03 (1m).
46.266(7)
(7) The department is not required to decrease the statewide nursing home bed limit under
s. 150.31 to account for institution for mental diseases beds closed under this section and, notwithstanding
subch. II of ch. 150, may redistribute the institution for mental diseases beds made available by the provision of services under this section if the department promulgates rules establishing a method by which the beds will be redistributed.
46.266(8)(a)(a) Except as provided in
sub. (9), if a county department seeks to relocate a person from an institution for mental diseases to the community using funds provided under
sub. (1), the county department shall first obtain approval of the institution for mental diseases to terminate use of the bed occupied by the individual as part of a plan submitted by the institution for mental diseases and approved by the department.
46.266(8)(b)
(b) The department may waive the requirement under
par. (a) for relocations that are part of a plan submitted by the institution for mental diseases and approved by the department that the department expects will result in all of the following:
46.266(8)(b)1.
1. A finding by the federal health care financing administration that the nursing home is no longer an institution for mental diseases.
46.266(8)(b)2.
2. Licensure of the institution for mental diseases as a nursing home under
s. 50.03.
46.266(8)(b)3.
3. Certification by the department of the institution for mental diseases as a provider of medical assistance.
46.266(9)
(9) If approved by the department, an institution for mental diseases may, instead of closing a bed, agree to receive a permanent limitation on payment as a facility under
s. 49.45 (6m) for each person relocated under this section. The department shall promulgate rules to administer this subsection.
46.268
46.268
Relocation services for individuals with mental illness. 46.268(1)(1) Notwithstanding
s. 49.45 (6m) (ag), from the appropriation under
s. 20.435 (7) (be), the department shall distribute not more than $830,000 in each fiscal year in order to provide funding of community services for an eligible individual, if all of the following apply:
46.268(1)(b)
(b) Provision of services is not authorized under
s. 46.277 for the individual or for an individual receiving care under
s. 46.40 and for whom care under
s. 46.277 might be substituted.
46.268(1)(c)1.1. The amount of funds for an individual who was relocated by a county department to the community from a facility before January 1, 1993, does not exceed 60% of the daily medical assistance reimbursement rate of the facility under
s. 49.45 (6m).
46.268(1)(c)2.
2. The amount of funds for an individual who was relocated by a county department to the community from a facility after December 31, 1992, does not exceed 90% of the daily medical assistance reimbursement rate of the facility under
s. 49.45 (6m).
46.268(2)
(2) If an individual who is provided services under
sub. (1) discontinues service receipt, an individual may receive services in his or her place if that individual has mental illness, as defined in
s. 49.45 (6c) (a) 7., is otherwise eligible for medical assistance and is determined under
s. 49.45 (6c) (d) 1. to be in need of active treatment but not to require facility care.
46.268(3)
(3) County matching funds are required for allocations under
sub. (1). A county's required match equals 9.89% of the cost of community service.
46.27
46.27
Long-term support community options program. 46.27(1)(1)
Definitions. In this section:
46.27(1)(a)
(a) "Aging unit" means an aging unit director and necessary personnel, directed by a county commission on aging and organized as one of the following:
46.27(1)(a)1.
1. An agency of county government with the primary purpose of administering programs of services for older individuals of the county.
46.27(1)(a)2.
2. A unit, within a county department under
s. 46.215,
46.22 or
46.23, with the primary purpose of administering programs of services for older individuals of the county.
46.27(1)(ai)
(ai) "Community-based residential facility" means a facility that meets the definition in
s. 50.01 (1g) and that is licensed under
s. 50.03 (1).
46.27(1)(b)
(b) "Nursing home" means a facility that meets the definition in
s. 50.01 (3) and that is licensed under
s. 50.03 (1) and includes a state center for the developmentally disabled, the Wisconsin Veterans Home at King and the nursing care facility operated by the department of veterans affairs under
s. 45.385.
46.27(1)(bm)
(bm) "Private nonprofit agency" means a nonprofit corporation, as defined in
s. 181.0103 (17), which provides a program of all-inclusive care for persons aged 65 or older authorized under
42 USC 1395 to
1395ggg and which participates in the On Lok replication initiative.
46.27(1)(c)
(c) "Program" means the long-term support community options program.
46.27(1)(d)
(d) "Residence" means the voluntary concurrence of physical presence with intent to remain in a place of fixed habitation. Physical presence shall be prima facie evidence of intent to remain.
46.27(1)(dr)
(dr) "State-operated long-term care facility" means a state center for the developmentally disabled, the Wisconsin Veterans Home at King and the nursing care facility operated by the department of veterans affairs under
s. 45.385.
46.27(1)(e)
(e) "Voluntary" means according to a person's free choice, if competent, or by choice of a guardian, if incompetent.
46.27(2)
(2) Departmental duties. The department shall:
46.27(2)(c)
(c) Review and approve or disapprove the selection of a county department or aging unit under
sub. (3) (b) to administer the program.
46.27(2)(d)
(d) In consultation with representatives of counties, hospitals and nursing homes and with recipients of long-term community support services, develop guidelines for implementing the program and criteria for reviewing community options plans from counties participating in the program. The guidelines and criteria shall address cost-effectiveness, scope, feasibility and impact on the quality and appropriateness of health services and social services and shall provide counties with maximum flexibility to develop programs that address local needs.
46.27(2)(e)
(e) Review and approve or disapprove the community options plan of each county participating in the program.
46.27(2)(f)
(f) Evaluate the cost-effectiveness of the program, the ability of the program to provide alternatives to institutional care of persons and the reasons why any county department or aging unit administering the program finds that a community arrangement is not feasible under
sub. (6) (d).
46.27(2)(g)1.
1. Require that a county, by use of a form provided by the department or other appropriate procedure, ensure that persons receiving services under this section meet the eligibility requirements for the program.
46.27(2)(g)2.
2. Periodically monitor the implementation of the program.
46.27(2)(h)
(h) Promulgate all of the following as rules:
46.27(2)(h)1.
1. Adoption of a long-term community support service fee schedule as part of the uniform fee schedule under
s. 46.03 (18) that is substantially similar to the fee calculation schedule existing on January 1, 1985, that was developed as a part of the guidelines required under
par. (d).
46.27(2)(h)2.
2. Conditions of hardship under which the department may grant an exception to the requirement of
sub. (6r) (c).
46.27(2)(i)
(i) Review and approve or disapprove waiver requests under
sub. (3) (f), review and approve or disapprove requests for exceptions under
sub. (6r) (c) and provide technical assistance to a county that reaches or exceeds the annual allocation limit specified in
sub. (3) (f) in order to explore alternative methods of providing long-term community support services for persons who are in group living arrangements in that county.
46.27(2)(j)
(j) By January 1, 1997, develop a model contract for use by counties for purchase of long-term community support services for persons who reside in community-based residential facilities. The governor and the joint committee on finance shall approve the model contract before it is implemented.
46.27(2)(k)
(k) Review and approve or disapprove the terms of risk reserve escrow accounts created under
sub. (7) (fr) and approve or disapprove disbursements for administrative or staff costs from the risk reserve escrow accounts.
46.27(2m)
(2m) Reimbursement disallowances. The department may disallow reimbursement under this section for services provided to persons who do not meet the eligibility requirements.
46.27(3)
(3) Duties of participating counties. The county board of supervisors of any county participating in the program shall:
46.27(3)(a)
(a) Create an interagency long-term support planning committee, with the composition and the duties specified under
sub. (4).
46.27(3)(b)
(b) Designate one of the following, subject to departmental review and approval, to administer the program:
46.27(3)(b)5.
5. The departments under
subds. 1. and
2. jointly, if the county long-term support planning committee develops no more than one annual community options plan under
sub. (4).
46.27(3)(c)
(c) Develop procedures and phases for gradual implementation of this section in accordance with guidelines and criteria the department develops under
sub. (2) (d).
46.27(3)(cm)
(cm) Review and approve, disapprove or amend a community options plan to participate in the program, prior to submitting the plan to the department.
46.27(3)(d)
(d) Ensure that the program uses existing county resources and personnel to the greatest extent practicable and enhances the effectiveness of discharge planning from hospitals.
46.27(3)(e)
(e) Except as provided in
sub. (3g), after implementing the program for 12 months and within the limits of state and federal funds allocated under
sub. (7), provide noninstitutional community alternatives for a significant number of persons in each of the groups listed in
sub. (4) (a) 1. and eligible under
sub. (6). The department shall determine what constitutes a "significant number of persons" for each participating county, based on county size and on the statewide proportion of persons from each group receiving medical assistance in a nursing home, and, beginning on January 1, 1994, shall annually adjust each determination to reflect changes in the state population of eligible persons and to reflect purposes for which increased funds, if any, are appropriated by the legislature for the program. If a county fails to meet the "significant number of persons" requirement under this paragraph, all of the following apply:
46.27(3)(e)1.
1. For a county with an annual allocation for provision of long-term community support services under
sub. (7) (b) that exceeds $185,000, the department shall, unless the department finds that an emergency or unusual circumstance exists, designate a portion of the county's allocation for increased service in each calendar year that the county fails to meet the requirement, to one or more of the groups specified under
sub. (4) (a) 1. a. to
e.
46.27(3)(e)2.
2. For a county with an annual allocation for provision of long-term community support services under
sub. (7) (b) that is $185,000 or less, the department may designate a portion of the county's allocation for increased service in each calendar year that the county fails to meet the requirement, to one or more of the groups specified under
sub. (4) (a) 1. a. to
e.
46.27(3)(f)
(f) Beginning on January 1, 1996, from the annual allocation to the county for the provision of long-term community support services under
subs. (7) (b) and
(11), annually establish a maximum total amount that may be encumbered in a calendar year for services for eligible individuals in community-based residential facilities, unless the department waives the requirement under
sub. (2) (i) or approves a request for an exception under
sub. (6r) (c).
46.27(3)(h)
(h) Identify the service needs of persons with Alzheimer's disease and of their caregivers.
46.27(3g)
(3g) Waiver of requirements. The department may waive requirements under
sub. (3) (e) for a county if the county is able to demonstrate one of the following:
