46.277(2)
(2) Departmental powers and duties. The department may request a waiver 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 a skilled nursing facility or an intermediate care facility, in their communities by providing home or community-based services as part of medical assistance. The number of persons for whom the waiver is requested 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. If the department requests a waiver, it shall include all assurances required under
42 USC 1396n (c) (2) in its request. If the department receives this waiver, it may request one or more 3-year extensions of the waiver under
42 USC 1396n (c) and shall perform the following duties:
46.277(2)(a)
(a) 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 facilities certified as medical assistance providers.
46.277(2)(b)
(b) Fund home or community-based services provided by any county that meet the requirements of this section.
46.277(2)(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.
46.277(2)(d)
(d) Unless
s. 49.45 (37) applies, review and approve or disapprove each plan of care developed by the county department under
sub. (3).
46.277(2)(e)
(e) Review and approve or disapprove waiver requests under
sub. (3) (c), review and approve or disapprove requests for exceptions under
sub. (5) (d) 3. and provide technical assistance to a county that reaches or exceeds the annual allocation limit specified in
sub. (3) (c) in order to explore alternative methods of providing long-term community support services for persons who are in group living arrangements in that county.
46.277(3)(a)(a) Sections 46.27 (3) (b) and
46.275 (3) (a) and
(c) to
(e) apply to county participation in this program, except that services provided in the program shall substitute for care provided a person in a skilled nursing facility or intermediate care facility who meets the level of care requirements for medical assistance reimbursement to that facility rather than for care provided at a state center for the developmentally disabled. The number of persons who receive services provided by the program under this paragraph may not exceed the number of nursing home beds, other than beds specified in
sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.
46.277(3)(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.
46.277(3)(b)2.
2. Each county department participating in the 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 of nursing home beds, other than beds specified in
sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.
46.277(3)(c)
(c) Beginning on January 1, 1996, from the annual allocation to the county for the provision of long-term community support services under
sub. (5), annually establish a maximum total amount that may be encumbered in a calendar year for services for eligible individuals in community-based residential facilities.
46.277(3m)
(3m) Participation by a private nonprofit agency. A private nonprofit agency with which the department contracts for service under
sub. (5) (c) shall have the powers and duties under this section of a county department, as specified in
sub. (3) (a).
46.277(4)(a)(a) Any medical assistance recipient who meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or intermediate care facility is eligible to participate in the program, except that the number of participants may not exceed the number of nursing home beds, other than beds specified in
sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department. Such a recipient may apply, or any person may apply on behalf of such a recipient, for participation in the program.
Section 46.275 (4) (b) applies to participation in the program.
46.277(4)(b)
(b) To the extent authorized under
42 USC 1396n, if a person discontinues participation in the program, a medical assistance recipient may participate in the program in place of the participant who discontinues if that recipient meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or intermediate care facility, except that the number of participants may not exceed the number of nursing home beds, other than beds specified in
sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.
46.277(5)(b)
(b) Total funding to counties under the program may not exceed the amount approved in the waiver received under
sub. (2).
46.277(5)(c)
(c) The department may contract for services under this section with a private nonprofit agency.
Paragraphs (a) and
(b) apply to funding received by a private nonprofit agency under this subsection.
46.277(5)(d)1.1. In this paragraph, "physically disabled" means having a condition that affects one's physical functioning by limiting mobility or the ability to see or hear, that is the result of injury, disease or congenital deficiency and that significantly interferes with or limits at least one major life activity and the performance of one's major personal or social roles.
46.277(5)(d)1m.
1m. No county may use funds received under this section 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. 2.,
3., and
4. and
par. (e), one of the following applies:
46.277(5)(d)1m.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.
46.277(5)(d)1m.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.
46.277(5)(d)1n.
1n. A county may also use funds received under this section, subject to the limitations under
subds. 2.,
3., and
4. and
par. (e), 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: