46.277(5)(f)
(f) No county or private nonprofit agency may use funds received under this subsection to provide services in any community-based residential facility unless the county or agency 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.
46.277(5)(g)1.1. The department may provide enhanced reimbursement for services provided under this section to an individual who, on or after July 27, 2005, is relocated to the community from a nursing home by a county department or to an individual who meets the level of care requirements for Medical Assistance reimbursement in a skilled nursing facility or an intermediate care facility and is diverted from imminent entry into a nursing home. Except as provided in
subd. 3., the number of individuals served under this paragraph may not exceed the number of nursing home beds that are delicensed as part of plans submitted by nursing homes and approved by the department, and the number of individuals diverted from imminent entry into a nursing home may not exceed 150.
46.277(5)(g)2.
2. The department shall develop and utilize a formula to determine the enhanced reimbursement rate for services provided under
subd. 1. The department shall also develop and utilize criteria for determining imminent entry into a nursing home under
subd. 1. that shall include an imminent loss of current living arrangements and an imminent risk of a long-term nursing home stay. The department need not promulgate as rules under
ch. 227 the criteria required to be developed and utilized under this subdivision.
46.277(5)(g)3.
3. If it is likely that the number of individuals for whom an enhanced reimbursement for services is provided under
subd. 1. and who are diverted from imminent entry into nursing homes will exceed 150, the department may submit a request to the joint committee on finance for approval to provide enhanced reimbursement for services provided under
subd. 1. for diversion from imminent entry into nursing homes for a number of individuals in excess of 150. Notwithstanding
s. 13.101 (3) (a), the committee is not required to find that an emergency exists. If the cochairpersons of the committee do not notify the secretary within 14 working days after the date of the department's submittal that the committee intends to schedule a meeting to review the request, approval of the request is granted. If, within 14 working days after the date of the department's request submittal, the cochairpersons of the committee notify the secretary that the committee intends to schedule a meeting to review the request, the request may be granted only as approved by the committee.
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.
46.277 Cross-reference
Cross Reference: See also ch.
HFS 73, Wis. adm. code.
46.278
46.278
Community integration program and brain injury waiver program for persons with developmental disabilities. 46.278(1)(1)
Legislative intent. The intent of the programs 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 or a brain injury rehabilitation facility level of care requirements for medical assistance reimbursement in an intermediate care facility for the mentally retarded or brain injury rehabilitation facility 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)(a)
(a) "Brain injury rehabilitation facility" means a nursing facility or hospital designated as a facility for brain injury rehabilitation by the department under the approved state medicaid plan.
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 or the brain injury waiver 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 one or more waivers 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 or in a brain injury rehabilitation facility, 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 each 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 a program, except that services provided in the program shall substitute for care provided a person in an intermediate care facility for the mentally retarded or brain injury rehabilitation facility who meets the intermediate care facility for the mentally retarded or brain injury rehabilitation facility 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 a 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 an applicable 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 or in a brain injury rehabilitation facility and is ineligible for service under
s. 46.275 or
46.277 is eligible to participate in a program, except that persons eligible for the brain injury waiver program must meet the definition of brain injury under
s. 51.01 (2g), and 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 a program.
Section 46.275 (4) (b) applies to participation in a 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 a program, a medical assistance recipient may participate in a program in place of the participant who discontinues if that recipient meets the requirements under
par. (a).
46.278(6)(b)
(b) Total funding to counties for relocating each person under a program may not exceed the amount approved in the waiver received under
sub. (3).
46.278(6)(c)
(c) Funding may be provided under a 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 a waiver received under
sub. (3), the department may, from the appropriation under
s. 20.435 (4) (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 (4) (b) or
(w).
46.278(6)(e)1.1. The department may provide enhanced reimbursement for services under the community integration program for an individual who was relocated to the community by a county department from one of the following:
46.278(6)(e)1.b.
b. An intermediate care facility for the mentally retarded or a distinct part thereof that has a plan of closure approved by the department and that intends to close within 12 months.
46.278(6)(e)1.c.
c. An intermediate care facility for the mentally retarded that has a plan of closure or significant reduction in capacity approved by the department and that intends to close or significantly reduce its capacity within 60 months.
46.278(6)(e)2.a.a. The enhanced reimbursement rate under
subd. 1. a. and
b. shall be determined under a formula that is developed by the department.
46.278(6)(e)2.b.
b. The enhanced reimbursement rate under
subd. 1. c. shall be 90% of the enhanced reimbursement rate under this
subd. 2. a.
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.
46.2785
46.2785
Community Opportunities and Recovery Program. 46.2785(1)(c)
(c) "Waiver program" means the Community Opportunities and Recovery Program for which a waiver has been requested under
sub. (2) and granted under
42 USC 1396n (c).
46.2785(2)
(2) Waiver request. 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 serve in their communities medical assistance recipients who meet eligibility requirements specified in
sub. (4) by providing them home or community-based services as part of the Medical Assistance program. If the department requests the waiver, it shall include all the assurances required under
42 USC 1396n (c) (2) in the request. If the department receives the waiver, it may request an extension of the waiver under
42 USC 1396n (c).
46.2785(3)
(3) Contract for administration. If doing so is consistent with the waiver received by the department as specified in
sub. (2), the department may contract with a county or a private agency to administer the waiver program. A private agency with which the department contracts shall have the powers and duties of a county under this section.
46.2785(4)
(4) Eligibility. Any medical assistance recipient who has a serious mental illness and meets the level of care requirements under
s. 49.45 (6m) (i) for reimbursement of nursing home care under the Medical Assistance program is eligible to participate in the waiver program.
46.2785(5)(a)(a) Medical assistance reimbursement for services a county or private agency contracts for or provides under the waiver program shall be made from the appropriation accounts under
s. 20.435 (4) (b) and
(o).
46.2785(5)(b)
(b) The department may, from the appropriation account under
s. 20.435 (4) (o), reimburse a county for providing, or contracting to provide, services that cost more than the average annual per person rate established by the department, but less than the average amount approved by the federal government for the waiver program.
46.2785 History
History: 2005 a. 25.
46.279
46.279
Restrictions on placements and admissions to intermediate and nursing facilities. 46.279(1)(b)
(b) "Intermediate facility" means an intermediate care facility for the mentally retarded, as defined in
42 USC 1396d (d), other than a center for the developmentally disabled, as defined in
s. 51.01 (3).
46.279(1)(bm)
(bm) "Most integrated setting" means a setting that enables an individual to interact with persons without developmental disabilities to the fullest extent possible.
46.279(2)
(2) Placements and admissions to intermediate facilities. Except as provided in
sub. (5), no person may protectively place or continue protective placement of an individual with a developmental disability in an intermediate facility and no intermediate facility may admit or continue service for such an individual unless, before the protective placement, continued placement following review under
s. 55.18, or admission and after having considered a plan developed under
sub. (4), a court under
s. 55.12 or
55.18 (1) (ar) finds that protective placement in the intermediate facility is the most integrated setting that is appropriate to the needs of the individual or that the county of residence of the individual would not reasonably be able to provide community-based care in accordance with the plan within the limits of available state and federal funds and county funds required to be appropriated to match state funds, taking into account information presented by all affected parties. An intermediate facility to which an individual who has a developmental disability applies for admission shall, within 5 days after receiving the application, notify the county department that is participating in the program under
s. 46.278 of the county of residence of the individual who is seeking admission concerning the application.
46.279(3)
(3) Placements and admissions to nursing facilities. Except as provided in
sub. (5), if the department or an entity determines from a screening under
s. 49.45 (6c) (b) that an individual requires active treatment for developmental disability, no individual may be protectively placed in a nursing facility or have protective placement in a nursing facility continued following review under
s. 55.18, and no nursing facility may admit or continue service for the individual, unless the department or entity that conducts the screening determines that the individual's need for care cannot fully be met in an intermediate facility or under a plan under
sub. (4) or that the county of residence of the individual would not reasonably be able to provide community-based care in accordance with the plan within the limits of available state and federal funds and county funds required to be appropriated to match state funds.
46.279(4)
(4) Plan for home or community-based care. Except as provided in a contract specified in
sub. (4m), a county department that participates in the program under
s. 46.278 shall develop a plan for providing home or community-based care in a noninstitutional community setting to an individual who is a resident of that county, under any of the following circumstances:
46.279(4)(a)
(a) Within 120 days after any determination made under
s. 49.45 (6c) (c) 3. that the level of care required by a resident that is provided by a facility could be provided in an intermediate facility or under a plan under this subsection.
46.279(4)(b)
(b) Within 120 days after receiving written notice under
sub. (2) of an application.
46.279(4)(c)
(c) Within 120 days after a proposal is made under
s. 55.12 (6) to provide protective placement to the individual in an intermediate facility or a nursing facility.
46.279(4)(d)
(d) Within 120 days after receiving written notice under
s. 55.18 (1) (ar) of the protective placement of the individual in a nursing facility or an intermediate facility.
46.279(4)(e)
(e) Within 90 days after extension of a temporary protective placement order by the court under
s. 55.135 (5).
46.279(4m)
(4m) Contract for plan development. The department shall contract with a public or private agency to develop a plan under
sub. (4), and the county department is not required to develop such a plan, for an individual, as specified in the contract, to whom all of the following apply:
46.279(4m)(a)
(a) The individual resides in a county with a population of less than 100,000 in which are located at least 2 intermediate facilities that have licenses issued to private nonprofit organizations that are exempt from federal income tax under section
501 (a) of the Internal Revenue Code.
46.279(4m)(b)
(b) Placement for the individual is in, or proposed to be in, an intermediate facility specified under
par. (a) that has agreed to reduce its licensed bed capacity to an extent and according to a schedule acceptable to the facility and the department.
46.279(4n)
(4n) Contract for plan payment. The department and the county specified in
sub. (4m) (a) shall negotiate a contract under which the department shall provide payment, from the appropriation account under
s. 20.435 (4) (b), to implement a plan to provide care in a noninstitutional community setting to an individual who has established residence in the county in order to be admitted to an intermediate facility in the county. The contract may provide for the negotiation of a memorandum of understanding between the parties that identifies the relative functions and duties of the department and the county in implementing plans under
sub. (4) for residents of intermediate facilities in the county.
46.279 History
History: 2003 a. 33;
2005 a. 25,
47,
253,
264.
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:
