46.269
46.269
Determining financial eligibility for long-term care programs. To the extent approved by the federal government, the department or its designee shall exclude any assets accumulated in a person's independence account, as defined in s.
49.472 (1) (c), and any income or assets from retirement benefits earned or accumulated from income or employer contributions while employed and receiving state-funded benefits under s.
46.27 or medical assistance under s.
49.472 in determining financial eligibility and cost-sharing requirements, if any, for a long-term care program under s.
46.27,
46.275, or
46.277, for the family care program that provides the benefit defined in s.
46.2805 (4), for the Family Care Partnership program, or for the self-directed services option, as defined in s.
46.2897 (1).
46.269 History
History: 2017 a. 59.
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 and a Wisconsin veterans home operated by the department of veterans affairs under s.
45.50.
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 and a Wisconsin veterans home operated by the department of veterans affairs under s.
45.50.
46.27(1)(e)
(e) “Voluntary" means according to an individual's free choice, if competent, or by choice of his or her guardian, if the individual is adjudicated 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:
46.27(3g)(a)
(a) That the county has disproportionately lengthy waiting lists for services under sub.
(7) or under sub.
(11) for one or more of the groups listed in sub.
(4) (a) 1. 46.27(3g)(b)
(b) That demographic or other data indicate that the county's population is significantly at variance with the statewide proportion of persons from each group listed in sub.
(4) (a) 1. receiving medical assistance in a nursing home.
46.27(3m)
(3m) Powers and duties of a private nonprofit agency. A private nonprofit agency with which the department contracts for service under sub.
(11) (c) 5. shall have the powers and duties under this section of a county department designated under sub.
(3) (b) to administer the program.
46.27(4)(a)
(a) The county board of supervisors shall select the county long-term support planning committee, which shall include at a minimum the following members:
46.27(4)(a)1.
1. At least 5 persons receiving long-term community support services, each of whom represents one of the following groups:
46.27(4)(a)6.
6. One representative of the county commission on aging.
46.27(4)(am)
(am) If the governing board of a resource center assumes under s.
46.283 (6) (b) 10. the duties of the county long-term support planning committee under this subsection, the county long-term support planning committee for the county is dissolved.
46.27(4)(c)
(c) The planning committee shall develop, or, if the governing board of a resource center has under s.
46.283 (6) (b) 10. assumed the duties of the planning committee, the governing board of the resource center shall recommend a community options plan for participation in the program. The plan shall include:
46.27(4)(c)1.
1. A description of the county's proposed program, including the estimated numbers of persons to be assessed and the procedures to be used in performing assessments.
46.27(4)(c)2.
2. A description of the services available and the services to be developed or expanded as alternatives to institutional care under this program.
46.27(4)(c)3.
3. A description of the procedures to be used to coordinate the program with other county agencies, hospitals, nursing homes and providers of community support services.
46.27(4)(c)5.
5. A description of the method to be used by the committee or, if the governing board of a resource center has under s.
46.283 (6) (b) 10. assumed the duties of the planning committee, the governing board of the resource center to monitor the implementation of the program.
46.27(4)(c)6.
6. A description of outreach procedures to be used to ensure that significant numbers of people from each group listed in sub.
(3) (e) will be served by the program.
46.27(4)(c)7.
7. A description of services and programs to be provided to meet the needs of persons with Alzheimer's disease.
46.27(4)(c)8.
8. If a contract with an entity under s.
46.284 (2) is established in the county, a description of how the activities of the entity relate to and are coordinated with the county's proposed program.
46.27(5)
(5) County department or aging unit duties. The county department or aging unit selected to administer the program shall:
46.27(5)(am)
(am) Organize assessment activities specified in sub.
(6). The county department or aging unit shall utilize persons for each assessment who can determine the needs of the person being assessed and who know the availability within the county of services alternative to placement in a nursing home. If any hospital patient is referred to a nursing home for admission, these persons shall work with the hospital discharge planner in performing the activities specified in sub.
(6). The county department or aging unit shall coordinate the involvement of representatives from the county departments under ss.
46.215,
46.22,
51.42 and
51.437, health service providers and the county commission on aging in the assessment activities specified in sub.
(6), as well as the person being assessed and members of the person's family or the person's guardian. This paragraph does not apply to a county department or aging unit in a county in which the department has contracted with an entity under s.
46.284 (2).
46.27(5)(b)
(b) Within the limits of state and federal funds allocated under sub.
(7), arrange service contracts under s.
46.036 and ensure the provision of necessary long-term community support services for each person who meets the criteria specified in sub.
(6) (b). No county department or aging unit may use funds allocated under sub.
(7) (b) to provide services in any community-based residential facility unless the county department 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(5)(c)
(c) Within the limits of state and federal funds allocated under sub.
(7), provide for ongoing care management services in accordance with the requirements established under sub.
(6d) (a) 1., periodic case plan review and follow-up services for any person receiving long-term community support services under sub.
(6) (b).
46.27(5)(d)
(d) Determine, under sub.
(6u), the cost-sharing obligations, if any, for all persons who meet the criteria specified in sub.
(6) (b) and are applying for or receiving long-term community support services that are funded under sub.
(7) or
(11).
46.27(5)(e)
(e) Within the limits of state and federal funds allocated under sub.
(7) and in accordance with the county's plan for gradual implementation and the requirements under sub.
(6) (a) 3., apply the program to any person residing in a nursing home who wants to be assessed and to receive long-term community support services, and coordinate the program with the protective services system under ch.
55.
