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 |
