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INFO MEMO 2007-13

STATE OF WISCONSIN
Department of Health and Family Services 
Division of Long Term Care 
Info Memo Series
Date: November 15, 2007

To: Listserv

For:  County Departments of Human Services Directors 
County Departments of Social Services Directors 
County 51 Coordinators 
County Fiscal Contacts 
County COP and Waiver Coordinators 
Human Services Area Coordinators 
Area Administrators
Community Integrations Specialists

From: Sinikka Santala, Administrator

Subject: LTC Fiscal Update Memo #3

This memo addresses the following:

  1. The Department of Health and Family Services' (DHS ) review and approval process for Community Options Program (COP) Exceptional Expense requests beginning CY 2008,
  2. Enrollment of new individuals in Home and Community Based Waivers (HCBWs) immediately prior to and during a county's transition to managed long-term care, and
  3. Development of community placements for individuals relocating from institutions (nursing homes, ICFs-MR, and State Centers) immediately prior to and during a county's transition to managed long-term care.

COP High Cost Funds - Submitting Requests for Review

DHS is centralizing review and approval of COP Exceptional Expense requests beginning in CY 2008. This change is to simplify state administration of these requests. As of January 1, 2008, all COP Exceptional Expense requests should be sent to Kimberly Schindler in the Community Options Section. COP Exceptional Expense requests will no longer be accepted in the Childrens Section or Developmental Disabilities Services Section.

Counties should use the approved request form when submitting a request. Before a COP High Cost request will be reviewed at DHS , the request must be approved by the County's Long Term care planning committee and, when applicable, the appropriate Community Integration Specialist, Children's Services Specialist or TMG Quality Assurance Consultant.

For more information on requesting COP Exceptional Expense funds, including information on how to obtain the required forms, please refer to the COP Information Memo #177 or contact the individuals listed below.

Enrolling New Individuals in HCBWs Immediately Prior to and During Managed Long-term Care Transition

A county may enroll new individuals into existing waiver slots up to the day the county begins its transition to managed care (transition to managed care begins the day current waiver participants begin enrolling in managed long term care). However the Department will stop approving new waiver slots 90 days prior to the managed care start date, to better manage transition. The Department will consider exceptions to the 90 day freeze for emergency situations. In addition, there is an exception for slots created for approved relocations under CRI, ICF-MR restructuring and/or CIP IA (state center relocations). An individual relocating from an institution may get a new waiver slot up to the day a county begins its transition to managed care. No new individuals may enroll in the adult HCBWs after the county begins its transition to managed care.

When developing a HCBW plan for an individual, a county anticipating managed long-term care transition must coordinate and communicate with the MCO planning to operate in the county. This will increase continuity of care and limit disruptions to the community living plan developed for the individual.

Development of Community Placements for Individuals Relocating from Institutions Immediately Prior to and During Managed Long-term Care Transition

The Department encourages counties planning a transition to managed long-term care to continue to assess, conduct person-centered plans and develop community placements for individuals residing in institutions (nursing homes, ICFs-MR and State Ceters). Counties may place these individuals in community settings and enroll them into the waivers up to the day the county begins its transition to managed care.

Counties anticipating a managed long-term care transition must coordinate and communicate with the MCO when developing a community placement for an individual relocating from an institution. As similarly noted above for other HCBW care plans developed during the period a county is planning it's managed long term care transition, coordination with the MCO will increase continuity of care and limit disruptions of the community living developed for the relocated individual.

Although no new individuals may enroll in HCBWs after a county begins its transition to managed long-term care, individuals relocating from nursing homes, ICFs-MR or State Centers during transition may enroll immediately in the MCO and do not count against a county's wait list enrollment limit. These individuals do not need to first be enrolled in a waiver placement to be prioritized for managed care enrollment.

We hope you find these changes helpful. If you have questions or concerns, please contact the following individuals:

REGIONAL OFFICE CONTACT:

CENTRAL OFFICE CONTACT:

MEMO WEB SITE: http://www.dhs.wisconsin.gov/dsl_info/ 

cc: Joyce Allen, DMHSAS 
Fredi Bove, DLTC 
John Easterday, DMHSAS 
Beth Wroblewski, BLTS 
Irene Anderson, BLTS 
Mike Linak, BLTS 
Sandy Blakeney, BLTS 
FMBS Team

Last Revised: September 13, 2010