DLTC Memo Series 2008-03
Date: February 1, 2008
To: Listserv
For: Area Administrators / Human Services Area Coordinators
DLTC Bureau Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
County Waiver Contacts
Licensing Chiefs / Section Chiefs
Tribal Chairpersons / Human Services Facilitators
From: Sinikka Santala
Administrator
Subject: CIP II-Nursing Home Diversion Funding 2008
Document Summary
Effective on the date of this memo, counties may apply for new CIP II-
Nursing Home Diversion funds. Funding is now available to divert up to 150
eligible individuals who are at imminent risk of entering a nursing home.
This memo provides information to counties on the anticipated allocation
of these funds and reiterates the process to apply for these resources
from an earlier memo.
Introduction
The 2005 Wisconsin Act 355 made changes in the statutes to allow for
the expansion of relocations from nursing homes under the Community
Integration Program II (CIP II) to include persons who are diverted from
imminent entry into nursing homes. The eligibility criteria for these
diversion funds can be found in DDES Memo Series 2006-07. The statute
authorized the Department to provide an enhanced CIP II rate for up to 150
individuals who are diverted from imminent entry into a nursing home and
to request authorization for funding for additional diversions from the
Legislature's Joint Committee on Finance. On January 30, 2008, the
legislative Joint Finance Committee approved the Department's request to
serve 150 additional individuals. This document describes the process by
which the Department will make diversion funds available to counties to
divert individuals who would otherwise enter a nursing home.
Background
Since the authorization of the special Nursing Home Diversion funding
under Act 355, the Department has provided counties with funding for 300
persons who were at risk of entry into a nursing home. Previously, funding
was awarded on a first come, first served basis. Some counties with
limited staff resources have not been able to react quickly to the
announcement of diversion funds, while other counties have. As a result,
the distribution of funds has been uneven.
The short turn around time also presents a workload and coordination
challenge for the Department and for The Management Group (TMG). It is
difficult to predict when the diversion funds will be gone and this causes
frustration for counties in the process of developing care plans. The
Department has determined that a more orderly and equitable method of
distribution is appropriate and would alleviate some of these problems.
Summary of Policies from DDES Memo Series 2006-07
Most policies regarding the use of Nursing Home Diversion funding
remain the same as described in DDES Memo Series 2006-07. These policies
are summarized here.
Participant Eligibility -To be eligible for diversion funding, an
individual must meet all of the following criteria:
- Belong to a target group served by CIP II (elderly age 65 or
older and/or have a physical disability)
- Be functionally and financially eligible for the CIP II program;
- Reside or intend to reside in a community setting that is eligible
for CIP II;
- Meet high risk criteria for imminent entry into a nursing home;
- The costs of the person's Medicaid funded community care plan must
be no greater than the Medicaid costs the person would have incurred in
the nursing home. The care must be cost-neutral.
High Risk Criteria - Care managers must use the High Risk Worksheet
(DDE-452) to determine if the person meets the criteria for high risk of
nursing home entry.
Participant Costs - Because this initiative must be cost neutral, the
maximum waiver per diem for diversions under this funding is $85. The
Department does not have additional COP funding to cover room and board
costs for diversion participants.
Disposition of Funding When Person Leaves the Program - If an
individual funded under this initiative leaves the program permanently
(i.e., the person dies, moves into a nursing home permanently, leaves the
state or is no longer eligible), the funding will be returned to the
Department. The funding will be used for additional diversions not to
exceed the total number of authorized individuals to date.
Revised Diversion Funding Distribution Process
The Department is allocating potential slots based on a methodology
that takes into account the county population and county waiting list.
(See Attachment #1) All counties, other than counties that are expected to
implement Family Care on or before March 1, 2008, currently operating the
CIP II program have been assigned at least one slot. Counties that
implement Family Care in February or March (Sheboygan, Ozaukee and
Columbia) have not been targeted for diversion slots because they can
prioritize individuals at high risk of nursing home admission within their
waiting list for Family Care admission. Counties have up to 45 calendar
days from the effective date of this memo to identify the diversion
candidate(s) and submit all required service plan materials to TMG. Slots
not claimed within the 45 days will be made available to other counties
based on a randomly generated list of counties that have successfully
claimed their initial slots. The attachment shows the planned allocations
by county.
The following approval process for applications is the same as the
process outlined in DDES Memo Series 2006-07:
1. A person in the community expresses an interest in receiving their
long-term care services in the community in lieu of an imminent move to a
nursing home.
2. The county determines that the individual is both functionally and
financially eligible for CIP II, including the completion of a long-term
care functional screen and Medicaid eligibility determination.
3. The county determines that the person meets the high risk criteria.
4. The county determines that the person satisfies all other applicable
funding criteria, including:
a. The CBRF placement conditions are met;
b. CBRF variance approval, if applicable, is obtained;
c. CBRF maximum amount;
d. RCAC maximum amount of waiver reimbursement;
e. County contract criteria.
5. The county submits to The Management Group (TMG):
a. The individual's community care plan (where waiver costs do not exceed
$85 per day); and
b. The High Risk Worksheet (DDE-452) which provides documentation that the
individual meets the criteria for imminent entry into a nursing home.
6. TMG will review the waiver application packet as it does for all
applications. In addition, it will look for consistency among the long
term care functional screen, assessment and the High Risk worksheet. If
approved, TMG will forward the request to the Community Options Section in
the Bureau of Long-Term Support (BLTS).
7. BLTS reviews the submitted documentation to assure cost neutrality, and
if approved, will issue a letter indicating intent to award funding.
REGIONAL OFFICE CONTACT: DES/Human Service Area Coordinators-LTS
CENTRAL OFFICE CONTACTS:
Lisa Kelly
Bureau of Long-Term Support
P.O. Box 7851
Madison, WI 53707-7851
(608) 267-3659 phone
(608) 267-2913 fax
kellylm@dhfs.state.wi.us
Irene Anderson, COP/Waiver Supervisor
Bureau of Long-Term Support
P.O. Box 7851
Madison, WI 53707-7851
(608) 266-3884 phone
(608) 267-2913 fax
anderil@dhfs.state.wi.us
MEMO WEB SITE: http://dhfs.wisconsin.gov/dsl_info/
Attachments: Nursing Home Diversion
Allocation by County (Excel, 24 KB)
DDES Memo Series 2006-07
Criteria for High Risk of Nursing Home Admission-High Risk Worksheet (DDE-452)
(PDF 76 KB)
CIP II Diversion Cover Sheet (DDE-415)
(Word 55 KB)
cc: The Management Group (TMG)
Independent Living Center Directors
County/Tribal Aging Directors
Area Agency on Agency Executive Directors
Wisconsin Association of Homes and Services for the Aging, Inc.
Wisconsin Health Care Association
Wisconsin Assisted Living Association
Residential Services Association of Wisconsin
Board on Aging and Long Term Care
Coalition of Wisconsin Aging Groups
Disability Rights Wisconsin
Return
to Numbered Memos Index
|
