46.27(7)(am)(am) From the appropriation under
s. 20.435 (7) (bd), the department shall allocate funds to each county or private nonprofit agency with which the department contracts to pay assessment and case plan costs under
sub. (6) not otherwise paid by fee or under
s. 49.45 or
49.78 (2). The department shall reimburse counties for the cost of assessing persons 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 paragraph to pay the cost of long-term community support services and for a risk reserve under
par. (fr).
46.27(7)(b)
(b) From the appropriations under
s. 20.435 (7) (bd) and
(im), the department shall allocate funds to each county to pay the cost of providing long-term community support services under
sub. (5) (b) not otherwise paid under
s. 49.45 to persons eligible for medical assistance under
s. 49.46,
49.47, or
49.471 (4) (a) or to persons whom the county department or aging unit administering the program finds likely to become medically indigent within 6 months by spending excess income or assets for medical or remedial care. The average per person reimbursement under this paragraph may not exceed the state share of the average per person payment rate the department expects under
s. 49.45 (6m). The county department or aging unit administering the program may spend funds received under this paragraph only in accordance with the case plan and service contract created for each person receiving long-term community support services. Counties may use unspent funds allocated under this paragraph from the appropriation under
s. 20.435 (7) (bd) for a risk reserve under
par. (fr).
46.27(7)(c)3.
3. The department may not release funds under this section before approving the county's community options plan.
46.27(7)(cg)
(cg) No county may use funds received under
par. (b) to pay for long-term community support services provided any person 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.
46.27(7)(cj)
(cj) No county may use funds received under
par. (b) to provide services to a person who does not live in his or her own home or apartment unless, subject to the limitations under
par. (cm), one of the following applies:
46.27(7)(cj)1.
1. 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(7)(cj)2.
2. 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(7)(cj)3.
3. 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(7)(cj)3.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(7)(cj)3.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(7)(cj)3.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(7)(cj)3.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(7)(ck)1.1. Subject to the approval of the department, a county may establish and implement more restrictive conditions than those imposed under
par. (cj) on the use of funds received under
par. (b) for the provision of services to a person in a community-based residential facility. A county that establishes more restrictive conditions under this subdivision shall include the conditions in its community options plan under
sub. (3) (cm).
46.27(7)(ck)2.
2. If the department determines that a county has engaged in a pattern of inappropriate use of funds received under
par. (b), the department may revoke its approval of the county's conditions established under
subd. 1., if any, and may prohibit the county from using funds received under
par. (b) to provide services under
par. (cj) 3.
46.27(7)(cm)1.1. Beginning on January 1, 1996, no county, private nonprofit agency or aging unit may use funds received under
par. (b) to provide services in any community-based residential facility that has more than 20 beds, unless one of the following applies:
46.27(7)(cm)1.a.
a. The department approves the provision of services in a community-based residential facility that is licensed on July 29, 1995, and that meets standards established under
subd. 2.
46.27(7)(cm)1.b.
b. The department approves the provision of services in a community-based residential facility that entirely consists of independent apartments, each of which has an individual lockable entrance and exit and individual separate kitchen, bathroom, sleeping and living areas, to individuals who are provided services under
sub. (5) (b) and are physically disabled or are at least 65 years of age.
46.27(7)(cm)1.c.
c. The department approves the provision of services in a community-based residential facility that is initially licensed after July 29, 1995, that is licensed for more than 20 beds and that meets standards established under
subd. 2.
46.27(7)(cm)2.
2. By January 1, 1996, the department shall establish standards for approvals made under
subd. 1. a., including whether the proposed use of funds for residents at the community-based residential facility in question adequately provides for all of the following:
46.27(7)(cm)2.c.
c. Cost effectiveness, in comparison with other feasible funding uses.
46.27(7)(cm)2.d.
d. Sufficient consideration of care for facility residents with dementia or related conditions.
46.27(7)(cm)3.
3. The department need not promulgate as rules under
ch. 227 the standards required to be established under
subd. 2.