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DDES Memo Series 2006-08

Date: May 2, 2006

To: Area Administrators / Human Services Area Coordinators
DDES 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
Licensing Chiefs / Section Chiefs
Tribal Chairpersons / Human Services Facilitators
County Long-Term Care Coordinators

From: Sinikka Santala
Administrator

Subject: Using CIP II Funds Generated by Community Relocations for Diversions

Document Summary

This memo describes the parameters within which counties can use CIP II Community Relocation Initiative funding for diversions when a person relocated to the community under the Community Relocation Initiative no longer needs his/her CIP II funding.

On September 30, 2005, the Department announced the implementation of the Community Relocation Initiative that was part of the 2005-2007 Biennial Budget. In that numbered memo (DDES Memo Series 2005-17), the Department indicated that, if a person permanently left the program after being out of the nursing home for at least 180 days, the county would be eligible to use these CIP-II relocation funds for a diversion(s). To be eligible for these diversion funds, a person would be required to meet certain risk criteria to be defined by the Department in addition to meeting the usual functional and financial eligibility criteria for CIP II. Since the first individuals were relocated in September, the Department expects that counties will soon have an opportunity to use these freed up funds for diversions. This memo defines that criteria and lays out the process for using relocation funds for diversions.

Background

The Community Relocation Initiative allows for the Medicaid funds being used to support a person in a nursing home to be available to support the person in the community under the CIP II waiver. The candidate for relocation must choose the relocation option, be eligible for CIP II and need the support of the waiver to relocate to the community (see DDES Memo Series 2005-17 for complete eligibility requirements).

If a person relocated under this initiative remains in the community for at least 180 days and subsequently leaves the CIP II program permanently (dies, returns to the nursing home for a permanent stay, loses eligibility, etc.), the county serving that individual may be eligible to use the funds to divert other persons from entering a nursing home. In order to target the diversion funds to people likely to enter a nursing home in the immediate future, the Department will require counties to identify individuals who are at high risk of a long-term nursing home stay before being able to use diversion funding.

Criteria

The Department reviewed national studies, analyzed Wisconsin data and consulted with county long-term support coordinators and staff to develop the criteria for determining high risk. Factors that were identified are:

  • Meeting an intensive skilled nursing (ISN) level of care;
  • Facing imminent loss of current living arrangement;
  • Having a fragile or insufficient informal caregiver arrangement;
  • Having a terminal illness;
  • Having multiple other factors that are associated with nursing home entry (DDE-452, PDF, 78 KB).

The attached High Risk Worksheet (DDE-452) (PDF, 78 KB) was developed by the Department for use by counties to assess persons on their waitlist for risk. A copy of the worksheet must be included in the care plan packet submitted for waiver approval before using diversion funds.

Process

When the relocated individual has left the CIP II-Community Relocation program permanently after at least 180 days in the program, the county should review persons on their waitlist against the criteria listed on the worksheet. Counties should integrate the use of the criteria into their current waitlist process. When an individual or individuals are identified who meet the high risk criteria and can be served within the funds available, the county develops a care plan(s). The county notifies the Department via fax of the name of the person leaving the program and name(s) of the person or persons to be served as diversions. At the same time, the county will submit the care plan to The Management Group as usual along with the High Risk Worksheet (DDE-452) (PDF, 78 KB). The Management Group will review the care plan and forward the approved care plan to the Department for preparation of the letter acknowledging the replacement.

Counties are not required to provide estimates and get pre-approval for diversions as they are with relocations. The county may use some or all of the funds available from the person who permanently left the program for a diversion, but agencies should be aware that additional funds will not be available from the Department. If the amount available exceeds that needed by the diverted individual, the county may use the funds to divert a second individual or, if funds are insufficient to support an adequate care plan for any eligible high risk individual identified by the county, the county may use the funds to cover cost increases for other CIP II-Community Relocation participants (relocations or diversions). The funds will not be released by the Department until the county identifies a use in accordance with this memo. Unexpended funds cannot be carried over into the next contract year.

Funding example:

  • Mrs. G is relocated from a nursing home and then dies after being in the community for 9 months. Her care plan cost was $75 per day.
  • Mr. H is on the waitlist, meets the high risk diversion criteria and has a care plan cost of $56 per day.
  • This leaves $19 per day. No high risk individual on the waiting list can be served for $19 per day.
  • The county uses the $19 to fund increased costs for Ms. X who was relocated 6 months ago and now has additional needs.
  • At the end of the biennium, the $75 becomes part of the county base and can be used as needed within CIP II when the current relocation participants are no longer on the program.

Numbered memo 2006-07 was released on April 25, 2006 to implement 2005 Wisconsin Act 355. That act provides diversion funding for 150 individuals who are at high risk of nursing home placement. The risk criteria for that initiative are identical to the criteria to be used for CIP II Community Relocation funds that are available for diversions when a person leaves the program. Counties should use available diversion funds under the Community Relocation Initiative first before applying for funding under Act 355.

REGIONAL OFFICE CONTACT: OSF/Human Service Area Coordinators

CENTRAL OFFICE CONTACT: 

Kevin Lafky
Community Options Section
Bureau of Long-Term Support
P.O. Box 7851
Madison, WI 53707-7851
Phone: (608) 266-7754
Fax: 608-267-2913
lafktke@wisconsin.gov

MEMO WEB SITE: http://www.dhs.wisconsin.gov/partners/local.htm

Attachment: http://www.dhs.wisconsin.gov/forms1/f2/f20452.pdf(PDF, 78 KB)

cc: The Management Group (TMG)
Independent Living Center Directors
County/Tribal Aging Directors
Area Agency on Aging 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

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Last Revised: September 13, 2010