DDES INFO MEMO 2007-01
STATE OF WISCONSIN
Department of Health and Family Services
Division of Disability and Elder Services
DDES Info Memo Series 2006 - 21
Date: February 7, 2007
To: Listserv
For: DHFS Administrators
Area Administrators/Human Services Area Coordinators
DDES Bureau Directors, Office of Strategic Finance and Office of Quality
Assurance
County COP Coordinators
County Department of Community Program Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
County Child Welfare Directors
County Waiver Coordinators
County DD Coordinators
County MH Coordinators
Tribal Chairpersons
Human Services Facilitators
From: Sinikka Santala
Administrator
Subject: Realignment of Program Mission for Mental Health Institutes
and Centers for the Developmentally Disabled
Note: This informational memo is intended to give an update on DDES
decision at this time. Due to concerns raised by counties about the fiscal
impact of this proposal, DDES is re-analyzing fiscal issues. A numbered
memo will be issued once the fiscal impact on counties is fully
considered.
Introduction:
The Department of Health and Family Services and the Division of
Disability and Elder Services are committed to improving treatment
services for all people including those with developmental disabilities.
Quality care for these individuals and others involves treatment that is
appropriate, short-term, and coordinated with local resources to promote
successful reintegration as soon as possible into the community.
DHFS Centers for persons with developmental disabilities and mental
health institutes serve unique and often challenging client population.
These facilities and the staff working in our facilities are our most
valuable assets in providing high quality care and treatment for
individuals with mental illness and developmental disabilities.
In order to maintain high quality, viable services at our centers and
institutes, DDES will be implementing several actions to align the mission
and activities of WMHI, SWC, CWC, and NWC during the next several months.
We are committed to making those alignments with utmost care and respect
towards our patients, residents, their guardians, our staff, as well as
Wisconsin counties that purchase care from the institutes and centers.
These realignments impact WMHI in two important ways: WMHI mission will
focus on serving individuals with a primary diagnosis of mental illness.
It is also our intent to improve staffing capacity at WMHI to meet the
needs of the challenging population of people with mental illness it now
serves and will continue to serve in the future.
Our three developmental disability centers will further strengthen
their function to provide short term intensive treatment services for
individuals with developmental disabilities who live in community settings
but need short term active treatment. The strengthening and expansion of
the short term, intensive treatment program functions at SWC is also
consistent with the recently released recommendations of SWC
union/management task force on the future programs and mission of SWC.
The realignments that will be implemented:
To promote this goal, the Division of Disability and Elder Services is
announcing the transfer of treatment services from the Services for
Multiply Impaired Children (SMIC) Program and the Transitional Living
Center (TLC) Program at Winnebago Mental Health Institute to the Intensive
Treatment Programs (ITP) at Northern Wisconsin Center (NWC), Central
Wisconsin Center (CWC), and Southern Wisconsin Center (SWC). Currently,
the SMIC Program is located on the Sherman Hall 1 and 2 units at WMHI and
consists of 20 beds. The SMIC program primarily serves children and
adolescents (under 18 years of age) with a developmental disability and
whose behavior is considered difficult to manage in the community without
an intensive treatment intervention. The SMIC unit has also admitted and
treated children and adolescents with a diagnosis of autism and behavior
considered difficult to manage in the community. Currently, the TLC
Program is located on Sherman Hall 4 Unit at WMHI and consists of 14 beds.
The TLC Program is designed for individuals from the ages of 17 to 65 who
are dually diagnosed with a mental illness and a developmental disability
and exhibit extremely challenging behavior in the community or a less
secure setting.
WMHI will continue to provide psychiatric inpatient services for
children and adolescents who need hospitalization. The Admissions,
Treatment, and Recovery Unit (ATRU) which consists of 15 beds on Sherman
5, the Child, and Adolescent Psychiatric Services (CAPS) on Sherman Hall 8
which consists of 19 beds, and the Anchorage Program for adolescent
alcohol and other drug abuse treatment in Sherman Hall which consists of
15 beds will all continue to admit and treat patients. There are
approximately 800 admissions each year to these units for child and
adolescent services.
This transfer of services is not intended to be solely the transfer of
a particular program, in total, from one facility location to another.
Rather the current ITP programs at the three Centers will be enhanced to
include services for children and adolescents that will encourage
short-term active treatment to facilitate each individual's return to
his/her own community as quickly as possible. For individuals previously
referred and now admitted to SMIC at WMHI, a full array of options should
be considered starting with the county of residence and may also include
CWC and NWC. Individualized planning will be based on the goal of a
successful community oriented transition plan and supports, even when an
intermediate step involves a Center ITP.
The programmatic changes are intended for the TLC program as well.
However, the transfer of the SMIC program will occur at least one year
prior to the transfer of the TLC program to the Centers. This two stage
approach will provide time for planning and coordination among all parts
of the service delivery system. A future memo will describe in more detail
the TLC Program transfer to the Centers.
This initiative and program change will require the cooperation and
collaboration of different facilities, treatment staff, families,
guardians, patients, County Human Service Departments, County Community
Programs, County Social Service Departments, local law enforcement, and
local community organizations. This will be true for the transfer planning
and placement of residents currently on SMIC as well as for the future
admission, treatment, and discharge of individuals for the Intensive
Treatment Program. The same will be true for the transfer of the TLC
program. Admissions to an ITP will need to be planned and coordinated
across the system for children, adolescents, and adults with a
developmental disability and a behavioral health issue.
Impact on Counties:
For children and adolescents under the age of 22 who are appropriate
for admission, the current DDES proposal is that counties would become
responsible for the state match of federal Medicaid funding at an ITP.
Currently, counties are not financially responsible for the state share of
Medicaid reimbursement for children and adolescents with developmental
disabilities admitted to the SMIC program at WMHI. For adults, however,
counties would no longer be responsible for the full cost of care for
adults between the ages of 22 and 64 who were admitted previously to the
TLC program and now qualify for admission to one of the ITPs at the
Centers. For adults, as with children and adolescents, counties will only
be responsible for the state match of federal Medicaid funding at the
Center's ITP.
After a discussion with WCHSA on February 1, 2007 about this cost
proposal, we will conduct further analysis of this part of the proposal.
Further information will be provided about this once further analysis is
completed.
Impact on Clients:
The Centers, through the ITP, have developed programming that
specifically addresses the needs of individuals with developmental
disabilities at all ages. This focus results in the potential for a
shorter overall length of stay, by focusing specialized services to assist
the individual to attain the skills necessary for increased personal
independence, community integration and the coordination of services with
families, guardians, and community resources.
Target Dates:
After March 31, 2007 the SMIC Units will no longer accept voluntary or
involuntary admissions (i.e., emergency detentions and commitments).
Discharge planning for the current residents of SMIC has been started. The
SMIC Unit will close as of June 30, 2007. The ITP at NWC is available for
admissions immediately based on the criteria and process for admissions
presented below. For those children and adolescents who are on a waiting
list for admission to SMIC, staff from NWC and CWC will work with SMIC
staff, counties, guardians, and others to assess children and adolescents
for the most appropriate and available treatment setting. Most admissions
to SMIC occur on a voluntary basis and this will continue to be the case
at the ITPs. Further planning will be done to handle appropriately any
Emergency Detentions that do occur before and after the SMIC Unit Services
are transferred to the Centers.
The TLC Program will be transferred sometime in 2008. A separate memo
will be issued before that time to describe the transfer in more detail.
Admission Criteria for State Center Intensive Treatment Programs at
Northern Wisconsin Center Excel, Central Wisconsin Center Short Term
Assessment Program and Southern Wisconsin Center Intensive Treatment
Program:
Individuals eligible for Intensive Treatment Program (ITP) services are
children and adults with mental retardation who meet the diagnostic
eligibility criteria for residential services consistent with the
requirements of the Developmental Disabilities Medicaid Waiver and:
-
Whose preadmission assessment has
identified active treatment needs which cannot be adequately met
elsewhere due to significant maladaptive and inappropriate behaviors
which are due to social, psychological, psychiatric, and medical
factors and;
-
Whose preadmission assessment has
identified active treatment needs that can be met at an ITP and;
-
Whose need for active treatment can be
best met by decreasing the frequency of those behaviors which are
interfering with other active treatment needs and simultaneously
increasing those skills necessary to achieve functioning with as much
self determination and independence as possible, and preventing the
loss or regression of functioning and;
-
Consistent with the ICFMR standards,
individuals who need a program of active treatment that includes
aggressive, consistent implementation of a program of specialized and
generic training, treatment, and health services and;
-
Whose needs include acquiring the skills
essential for privacy and independence and includes, but is not
limited to: toilet training, personal hygiene, dental hygiene, self
feeding, bathing, dressing, grooming, communication of basic needs,
self-medication, use of medical devices and money management and;
-
Whose needs for medical services and
supports can be adequately met by the ITP.
ITP services are not for individuals who are able to function with
little supervision or in the absence of a program of continuous active
treatment or for persons who are generally able to independently take care
of most of their personal care needs, and effectively and appropriately
make known to others their basic needs and wants.
ITP services are not intended for emergency detentions under Chapter
51.
Note: Specific admission decisions will consider gender, age,
compatibility, and the availability of necessary programs and services
based on the preadmission assessment.
How to Initiate Admission to an ITP:
Referrals may be made to the following:
CWC
Joe Stoffels, STAP Coordinator
608-301-9244
Theresa Wright, STAP Social Worker
608-301-9233
NWC
Rebecca Graham, EXCEL Unit Director
715-723-5542 extension 5100
Admissions Coordinator
715-723-5542 extension 5115
Admissions will occur after a determination is made by a preadmission
assessment that the individual's needs could be met at an ITP and the
individual meets the criteria for admission.
Each admission to a Center ITP is for the purpose of helping the
individual attain increased personal independence and to successfully
transition to his/her own community. In order to accomplish this,
transition planning starts at the time of admission. The programmatic,
habilatative, and clinical emphasis at the ITP includes consideration of
where each individual will live, work, recreate, go to school, and receive
health care in the future. The typical length of stay is 90 days or less.
Transitional Planning for Current Residents of SMIC:
-
Each county and parent/guardian has been
notified. We intend to have a reasonable amount of time to engage in
planning activities for each person guardian/ward and responsible
county agency.
-
In the event that more detailed or
specific planning is needed, an interdisciplinary team meeting will be
scheduled. The team would include county staff, parents/guardians, the
child or adolescent, WMHII staff, NWC-ITP & CWC-ITP designees, and
others as appropriate. These meetings will be organized and led by the
WMHI team and held at WMHI.
Admissions to WMHI after June 30, 2007 and proposed ITP Charge to
Counties:
It is the intent of this policy and programmatic change to encourage
the placement of children and adolescents with a developmental disability
or autism, and behavioral challenges in the most appropriate treatment
setting that will encourage community integration. The SMIC program will
no longer operate by the end of June, 2007 and admissions to WMHI for this
target population, either on a voluntary or involuntary basis, will not be
appropriate. Any admission on an involuntary basis will lead to a
discharge as soon as possible after appropriate arrangements have been
made for the safety and treatment of the child or adolescent. It is our
intent that such transfers, either to alternative community settings or
one of the ITP's at the Centers will not be necessary. Our goal is to have
all admissions to one of the ITPs occur in a planned and coordinated
manner after assessing each child and adolescent for the most appropriate
short and long term treatment settings.
As is currently the case for ITP admissions to the Centers, a
responsible county will be charged the non-federal share of the ITP daily
rate. The ITP rate charged to a county equals the average daily rate of
the three Center ITP programs multiplied by the state or non-federal share
percentage available to Wisconsin for Medicaid reimbursement. For
additional information on the ITP rate, see DDES memo series 2006-12.
As was stated previously in this memo, based on concerns raised at WCHSA
meeting on February 1, the department is conducting further analysis on
this. We plan to involve counties in discussions before the final decision
is made.
WMHI CONTACT:
Joann O'Connor, Director
920-235-4910 extension 2550
BUREAU OF CENTER OPERATIONS and CWC CONTACT:
Theodore Bunck, Ph.D., Director
608-301-9229
NWC CONTACT:
Louise Ramseier, Director
715-723-5542 extension 4100
SWC CONTACT:
Jim Hutchinson, Director
262-878-2411
CENTRAL OFFICE CONTACT:
John Easterday, Associate Administrator
608-267-9391
Theodore Bunck, Ph.D., Director
608-301-9229
REGIONAL OFFICE CONTACT:
Area Administrators
MEMO WEB SITE: http://dhfs.wisconsin.gov/dsl_info/
Attachment: DDES
numbered memo 2006-12: Rate Information For Billing For Services
Provided By The Centers For Persons With Developmental Disabilities
cc: Wisconsin Council on Developmental Disabilities
Disability Rights of Wisconsin
Mental Health Council
Wisconsin Family Ties
Last Revised: October 24, 2008 |
