46.27(7)(fr)3.d.
d. If approved by the department, for administrative or staff costs under this section.
46.27(7)(fr)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.
46.27(7)(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.
(fm). 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 planning and implementation of resource centers under s.
46.283 or care management organizations under s.
46.284 and 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:
46.27(7)(g)1.
1. Specialized training for providers of services under this section.
46.27(7)(g)4.
4. Purchase of medical equipment or other specially adapted equipment.
46.27(7g)(a)1.
1. “Client" means a person who receives or received long-term community support services that are funded under sub.
(7).
46.27(7g)(a)1m.
1m. “Decedent" means a deceased client or a deceased nonclient surviving spouse, whichever is applicable.
46.27(7g)(a)3.
3. “Home" means property in which a person has an ownership interest consisting of the person's dwelling and the land used and operated in connection with the dwelling.
46.27(7g)(a)4.
4. “Nonclient surviving spouse" means any person who was married to a client while the client was receiving services for which the cost may be recovered under par.
(c) 1. and who survived the client.
46.27(7g)(a)5.
5. “Property of a decedent" means all real and personal property to which the client held any legal title or in which the client had any legal interest immediately before death, to the extent of that title or interest, including assets transferred to a survivor, heir, or assignee through joint tenancy, tenancy in common, survivorship, life estate, revocable trust, or any other arrangement, excluding an irrevocable trust.
46.27(7g)(c)1.1. Except as provided in subd.
4., the department shall file a claim against the estate of a client, and against the estate of a nonclient surviving spouse, for the amount of long-term community support services funded under sub.
(7) paid on behalf of the client after the client attained 55 years of age, unless already recovered by the department under this subsection.
46.27(7g)(c)2.
2. The affidavit of a person designated by the secretary to administer this paragraph is evidence of the amount of the claim.
46.27(7g)(c)2m.a.a. Property that is subject to the department's claim under subd.
1. in the estate of a client or in the estate of a nonclient surviving spouse is all property of a decedent that is included in the estate.
46.27(7g)(c)2m.b.
b. There is a presumption, consistent with s.
766.31, which may be rebutted, that all property in the estate of the nonclient surviving spouse was marital property held with the client and that 100 percent of the property in the estate of the nonclient surviving spouse is subject to the department's claim under subd.
1. 46.27(7g)(c)3.
3. The court shall reduce the amount of a claim under subd.
1. by up to the amount specified in s.
861.33 (2) if necessary to allow the decedent's heirs or the beneficiaries of the decedent's will to retain the following personal property:
46.27(7g)(c)3.a.
a. The decedent's wearing apparel and jewelry held for personal use.
46.27(7g)(c)3.c.
c. Other tangible personal property not used in trade, agriculture or other business, not to exceed in value the amount specified in s.
861.33 (1) (a) 4. 46.27(7g)(c)4.
4. A claim under subd.
1. is not allowable if the decedent has a surviving child who is under age 21 or disabled or a surviving spouse.
46.27(7g)(c)5.a.a. If the department's claim is not allowable because of subd.
4. and the estate includes an interest in real property, including a home, the court exercising probate jurisdiction shall, in the final judgment or summary findings and order, assign the interest in the real property subject to a lien in favor of the department for the amount described in subd.
1. The personal representative or petitioner for summary settlement or summary assignment of the estate shall record the final judgment as provided in s.
863.29,
867.01 (3) (h), or
867.02 (2) (h).
46.27(7g)(c)5.b.
b. If the department's claim is not allowable because of subd.
4., the estate includes an interest in real property, including a home, and the personal representative closes the estate by sworn statement under s.
865.16, the personal representative shall stipulate in the statement that the real property is assigned subject to a lien in favor of the department for the amount described in subd.
1. The personal representative shall record the statement in the same manner as described in s.
863.29, as if the statement were a final judgment.
46.27(7g)(c)6.
6. The department may not enforce a lien under subd.
5. as long as any of the following survive the decedent:
46.27(7g)(c)6m.
6m. All of the following apply to a lien under subd.
5. that the department may not enforce because of subd.
6.:
46.27(7g)(c)6m.a.
a. If the decedent's surviving spouse or child who is under age 21 or disabled refinances a mortgage on the real property, the lien is subordinate to the new encumbrance.
46.27(7g)(c)7.
7. The department may enforce a lien under subd.
5. by foreclosure in the same manner as a mortgage on real property.
46.27(7g)(d)
(d) The department may require the county department or aging unit selected to administer the program in each county to gather and provide the department with information needed to recover payment of long-term community support services under this subsection. The department shall pay to the county department or aging unit an amount equal to 5 percent of the recovery collected by the department relating to a beneficiary for whom the county department or aging unit made the last determination of eligibility for funding under sub.
(7). A county department or aging unit may use funds received under this paragraph only to pay costs incurred under this paragraph and shall remit the remainder, if any, to the department for deposit in the appropriation account under s.
20.435 (4) (im). The department may withhold payments under this paragraph for failure to comply with the department's requirements under this paragraph. The department shall treat payments made under this paragraph as costs of administration of the program.
46.27(7g)(e)
(e) From the appropriation under s.
20.435 (4) (im), the department shall pay the amount of the payments under par.
(d) and shall spend the remainder of the funds recovered under this subsection for long-term community support services funded under sub.
(7) (b).
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),
(gm), 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.
46.284 (2) 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),
(gm), 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)(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) (bd) and
(o) and
(7) (b).
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.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 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 (6d). Funding of the services may not exceed 85 percent 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.
