46.272(10)
(10) Services; care management requirements. 46.272(10)(a)1.1. Within the limits of state and federal funds allocated under
sub. (13) and within the limits of fees collected, the department shall reimburse, if applicable, and the county department or private nonprofit agency shall provide long-term community support services to eligible children who have a disability.
46.272(10)(a)2.
2. The department may not reimburse and the county department or private nonprofit agency may not pay for room and board for children under the children's community options program.
46.272(10)(b)
(b) The department, after consulting with representatives of counties, hospitals, and individuals who receive services under the children's community options program under this section, shall do all of the following:
46.272(10)(b)1.
1. Establish minimum requirements for the provision of care management services, as defined by the department, including standards for care, times for performance of duties, and size of case loads.
46.272(10)(b)2.
2. Specify a reasonable schedule for phasing in the requirements established under
subd. 1.
46.272(10)(b)3.
3. Provide technical consultation and assistance to the administrator of the program with respect to the requirements established under
subd. 1.
46.272(10)(c)
(c) The department need not promulgate as rules under
ch. 227 the requirements under
par. (b) 1. or the schedule under
par. (b) 2.
46.272(11)
(11) Fiscal responsibility. Except as provided in
s. 51.40, and within the limitations under
sub. (13) (a) 2., the fiscal responsibility of a county for an assessment, unless the assessment is performed by an entity under a contract as specified under
s. 46.284 (2), case plan, or services provided to a child under this section is as follows:
46.272(11)(a)
(a) For a child seeking admission to or about to be admitted to an institutional setting, the county in which the child has residence is the county of fiscal responsibility.
46.272(11)(b)
(b) For a child residing in an institutional setting, except a state-operated long-term care facility, the county in which the institution is located is the county of fiscal responsibility.
46.272(11)(c)
(c) For a child living in an institutional setting, except a state-operated long-term care facility, whose legal residence is established in another county, the county in which the legal residence is established is the county of fiscal responsibility.
46.272(11)(d)
(d) For a child residing in a state-operated long-term care facility, or for a person protectively placed under
ch. 55, the county in which the child has residence before he or she enters the state-operated long-term care facility or is protectively placed is the county of fiscal responsibility.
46.272(12)
(12) Reimbursement disallowances. The department may disallow reimbursement under this section for services provided to children who do not meet the eligibility requirements for the children's community options program or any other eligibility requirements established by the department.
46.272(13)(a)(a) Subject to
pars. (b) and
(h), from the appropriation under
s. 20.435 (4) (bd), the department shall allocate funds to each county or private nonprofit agency with which the department contracts for all of the following purposes:
46.272(13)(a)1.
1. To pay assessment and case plan costs not otherwise paid by fee or under
s. 49.45 or
49.78 (2). The department shall reimburse multicounty consortia for the cost of assessing children eligible for medical assistance under
s. 49.46,
49.468,
49.47, or
49.471 (4) (a) as part of the administrative services of medical assistance, payable under
s. 49.45 (3) (a). Counties may use unspent funds allocated under this subdivision to pay the cost of long-term community support services and for a risk reserve under
par. (f).
46.272(13)(a)2.
2. To pay the cost of providing long-term community support services described under
sub. (7) (b) not otherwise paid under
s. 49.45 to children eligible for medical assistance under
s. 49.46,
49.47, or
49.471 (4) (a). The county department administering the program may spend funds received under this paragraph only in accordance with the case plan and service contract created for each child receiving long-term community support services. Counties may use unspent funds allocated under this subdivision from the appropriation under
s. 20.435 (4) (bd) for a risk reserve under
par. (f).
46.272(13)(b)2.
2. The department may not release funds under this subsection before approving the county's community options plan.
46.272(13)(b)3.
3. No county may use funds received under
par. (a) 2. to pay for long-term community support services provided to any child who resides in a nursing home, unless the department waives this restriction on use of funds and the services are provided in accordance with a discharge plan.
46.272(13)(b)4.
4. No county may use funds received under this section to purchase land or construct buildings.
46.272(13)(c)
(c) The department may release funds to counties acting jointly, if the counties sign a contract approved by the secretary that explains the plans for joint sponsorship.
46.272(13)(d)
(d) If the department determines that a county demonstrates a pattern of failure to serve clients whose cost of care significantly exceeds the average cost of care for children's long-term community support services provided under this section, the department may require that county to reserve a portion of funds allocated under this subsection for provision of service to those clients.
46.272(13)(e)
(e) The department shall, at the request of a county, carry forward up to 5 percent of the amount allocated under this subsection to the county for a calendar year if up to 5 percent of the amount so allocated has not been spent or encumbered by the county by December 31 of that year, for use by the county in the following calendar year, except that the amount carried forward shall be reduced by the amount of funds that the county has notified the department that the county wishes to place in a risk reserve under
par. (f). The department may transfer funds within
s. 20.435 (4) (bd) to accomplish this purpose. An allocation under this paragraph does not affect a county's base allocation under this subsection and shall lapse to the general fund unless expended within the calendar year to which the funds are carried forward. A county may not expend funds carried forward under this paragraph for administrative or staff costs, except administrative or staff costs that are associated with implementation of the waiver under
sub. (14) and approved by the department.
46.272(13)(f)1.1. Notwithstanding
s. 46.036 (3) and
(5m), a county may place in a risk reserve funds that are allocated under
par. (a) or
sub. (14) (b) 1. and are not expended or encumbered for services under this subsection or
sub. (14). The county shall notify the department of this decision and of the amount to be placed in the risk reserve. The county shall maintain the risk reserve in an interest-bearing escrow account with a financial institution, as defined in
s. 69.30 (1) (b), if the department has approved the terms of the escrow. All interest from the principal shall be reinvested in the escrow account.
46.272(13)(f)2.
2. The annual amount of a county's expenditure for a risk reserve, as specified in
subd. 1., may not exceed 10 percent of the county's most recent allocation under
par. (a) and
sub. (14) (b) 1. or $750,000, whichever is less. The total amount of the risk reserve, including interest, may not exceed 15 percent of the county's most recent allocation under this subsection.
46.272(13)(f)3.
3. A county may expend funds maintained in a risk reserve, as specified in
subd. 1., for any of the following purposes:
46.272(13)(f)3.a.
a. To defray costs of children's long-term community support services under this section.
46.272(13)(f)3.b.
b. If approved by the department, for administrative or staff costs under this section.
46.272(13)(f)4.
4. A county that maintains a risk reserve, as specified in
subd. 1., shall annually, on a form prescribed by the department, submit to the department a record of the status of the risk reserve, including revenues and disbursements.
46.272(13)(g)
(g) The department may carry forward to the next state fiscal year funds allocated under this subsection and not encumbered by counties by December 31 or carried forward under
par. (e). The department may transfer moneys within
s. 20.435 (4) (bd) to accomplish this purpose. An allocation under this paragraph shall not affect a county's base allocation for the program. The department may allocate these transferred moneys during the next fiscal year to counties for the improvement or expansion of long-term community support services for clients whose cost of care significantly exceeds the average cost of care provided under this section, including any of the following:
46.272(13)(g)1.
1. Specialized training for providers of services under this section.
46.272(13)(g)4.
4. Purchase of medical equipment or other specially adapted equipment.
46.272(13)(h)
(h) Funds allocated under this subsection may not be used to replace any other state and federal funds or any county funds that are currently being provided under any program to a family whose child is receiving services through the children's community options program.
46.272(14)(a)(a) The department may request a waiver from the federal department of health and human services authorizing the department to provide as part of the Medical Assistance program services for persons who are eligible for children's long-term support community options program services under
sub. (7) (b).
46.272(14)(b)1.1. Medical assistance reimbursement for services a county or a private nonprofit agency[, or] with which the department contracts provides under this subsection shall be made from the appropriations under
s. 20.435 (4) (bd) and
(o) and
(7) (b). Payments made under
sub. (13) (a) may be used as the state share for purposes of Medical Assistance reimbursement.
46.272 Note
NOTE: The text in brackets is unnecessary. Corrective legislation is pending.
46.272(14)(b)3.
3. The department may contract for services under this subsection with a county or a private nonprofit agency.
46.272(14)(b)4.
4. No county or private nonprofit agency 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.
46.272(14)(c)
(c) If a county department or private nonprofit agency providing services under this subsection is certified under
s. 49.45 (37) (a), the waiver under
s. 49.45 (37), if in effect, applies to plans of care for children receiving services under this subsection.
46.272(15)
(15) Right to hearing. A child 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 may not serve as the basis for a request under this subsection.
46.272 History
History: 2015 a. 55; s. 35.17 correction in (7) (e).
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.
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 employees affected by the program, including arrangements designed to preserve employee 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 or a tribal school, as defined in
s. 115.001 (15m).
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 protective placement or protective services under
s. 55.12.
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.
