Section 46.278. Community integration program and brain injury waiver program for persons with developmental disabilities.

 

(1)   Legislative intent. The intent of the programs under this section is to provide home or community-based care to serve in a noninstitutional community setting a person who meets eligibility requirements under 42 USC 1396n (c) and who is diagnosed as developmentally disabled under the definition specified in s. 51.01 (5) and relocated from an institution other than a state center for the developmentally disabled or who meets the intermediate care facility for persons with an intellectual disability or brain injury rehabilitation facility level of care requirements for medical assistance reimbursement in an intermediate care facility for persons with an intellectual disability or a brain injury rehabilitation facility and is ineligible for services under s. 46.275 or 46.277 . The intent of the program is also that counties use all existing services for providing care under this section, including those services currently provided by counties.

(1m)   Definitions. In this section:

(a) “Brain injury rehabilitation facility" means a nursing facility or hospital designated as a facility for brain injury rehabilitation by the department under the approved state medicaid plan.

(ag) “Family consortium" means a group composed of relatives, or of relatives and the guardian, of an individual with developmental disability who together provide services for the individual in a home that is an extension of a relative's or the guardian's home.

(am) “Intermediate care facility for persons with an intellectual disability" has the meaning given for “intermediate care facility for the mentally retarded" under 42 USC 1396d (d).

(b) “Medical assistance" means aid provided under subch. IV of ch. 49 , except ss. 49.468 and 49.471 .

(c) “Program" means the community integration program or the brain injury waiver program, for facilities certified as medical assistance providers, for which a waiver has been received under sub. (3) .

(2)   Departmental powers and duties.

(a) The department may request one or more waivers 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 an intermediate care facility for persons with an intellectual disability or in a brain injury rehabilitation facility, in their communities by providing home or community-based services as part of medical assistance. If the department requests a waiver, it shall include all assurances required under 42 USC 1396n (c) (2) in its request.

(b) Section 49.45 (37) applies to this subsection.

(3)   Waiver; extension; duties. If the department receives a waiver requested under sub. (2) (a) , it may request a 3-year extension of the waiver under 42 USC 1396n (c) and shall perform the following duties:

(a) Evaluate the effect of each 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.

(b) Fund home or community-based services provided by any county that meet the requirements of this section.

(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.

(4)   County participation.

(a) Sections 46.27 (3) (b) and 46.275 (3) (a) and (c) to (e) apply to county participation in a program, except that services provided in the program shall substitute for care provided a person in an intermediate care facility for persons with an intellectual disability or in a brain injury rehabilitation facility who meets the intermediate care facility for persons with an intellectual disability or brain injury rehabilitation facility level of care requirements for medical assistance reimbursement to that facility rather than for care provided at a state center for the developmentally disabled.

(b)

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.

2. Each county department participating in a 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 that are approved under an applicable waiver received under sub. (3) .

(5)   Eligibility of residents.

(a) Any medical assistance recipient who meets the level of care requirements for medical assistance reimbursement in an intermediate care facility for persons with an intellectual disability or in a brain injury rehabilitation facility and is ineligible for service under s. 46.275 or 46.277 is eligible to participate in a program, except that persons eligible for the brain injury waiver program must meet the definition of brain injury under s. 51.01 (2g) , and except that the number of participants may not exceed the number approved under the waiver received under sub. (3) . Such a recipient may apply, or any person may apply on behalf of such a recipient, for participation in a program. Section 46.275 (4) (b) applies to participation in a program.

(am) One individual who is eligible under par. (a) may, beginning January 1, 1992, participate in the program through services provided by a family consortium that is formed before January 1, 1991, and is approved by the department.

(b) To the extent authorized under 42 USC 1396n , if a person discontinues participation in a program, a medical assistance recipient may participate in a program in place of the participant who discontinues if that recipient meets the requirements under par. (a) .

(6)   Funding.

(a) The provisions of s. 46.275 (5) (a) , (b) and (d) apply to funding received by counties under the programs.

(b) Total funding to counties for relocating each person under a program may not exceed the amount approved in the waiver received under sub. (3) .

(c) Funding may be provided under a program for services of a family consortium.

(d) If a county makes available nonfederal funds equal to the state share of service costs under a waiver received under sub. (3) , the department may, from the appropriation under s. 20.435 (4) (o) , provide reimbursement for services that the county provides under this section to persons who are in addition to those who may be served under this section with funds from the appropriation accounts under s. 20.435 (4) (b) , (gm) , or (w) .

(e)

1. The department may provide enhanced reimbursement for services under the community integration program for an individual who was relocated to the community by a county department from one of the following:

a. An intermediate care facility for persons with an intellectual disability that closes under s. 50.03 (14) .

b. An intermediate care facility for persons with an intellectual disability or a distinct part thereof that has a plan of closure approved by the department and that intends to close within 12 months.

c. An intermediate care facility for persons with an intellectual disability that has a plan of closure or significant reduction in capacity approved by the department and that intends to close or significantly reduce its capacity within 60 months.

2.

a. The enhanced reimbursement rate under subd. 1. a. and b. shall be determined under a formula that is developed by the department.

b. The enhanced reimbursement rate under subd. 1. c. shall be 90 percent of the enhanced reimbursement rate under subd. 2. a.

(7)   Report. By July 1 of each year, the department shall submit to the joint committee on finance and to the chief clerk of each house of the legislature, for distribution to the appropriate standing committees under s. 13.172 (3) , a report describing the cost and quality of services used under the program and the extent to which existing services have been used under the program in the preceding calendar year.

(8)   Effective period. Except as provided under sub. (2) , this section takes effect on the date approved by the secretary of the federal department of health and human services as the beginning date of the period of waiver received under sub. (3) . This section remains in effect for 3 years following that date and, if the secretary of the federal department of health and human services approves a waiver extension, shall continue an additional 3 years.

1987 a. 27 , 186 ; 1989 a. 31 ; 1991 a. 269 ; 1993 a. 16 ; 1995 a. 27 ; 1997 a. 27 ; 1999 a. 9 ; 2001 a. 16 ; 2003 a. 33 ; 2007 a. 153 ; 2011 a. 32 , 126 ; 2013 a. 173 s. 33 .