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DDES Memo Series 2005-17

September 30, 2005

TO: 
Area Administrators/Human Services Area Coordinators
Bureau Directors/Section Chiefs
County Departments of Human Services Directors
County Department of Social Services Directors
County COP Coordinators
County Long Term Support Coordinators
County/Tribal Aging Unit Directors
Area Agency on Aging Executive Directors
Long-Term Support Planning Committee Chairpersons
Centers for Independent Living Executive Directors
Wisconsin Coalition for Advocacy
Wisconsin Board on Aging and Long Term Care
Bureau of Quality Assurance Regional Field Operations Directors
Wisconsin Association of Homes and Services for the Aging
Wisconsin Health Care Association
Wisconsin Nursing Home Social Workers Association

FROM: 
Sinikka Santala
Administrator

RE:  Community Relocation Initiative

DOCUMENT SUMMARY

Effective immediately counties may apply for CIP II – Community Relocation funding for eligible nursing home residents seeking to relocate.

The Department is pleased to announce the implementation of the Community Relocation Initiative. As part of his 2005-07 Biennial Budget, Governor Doyle included a proposal that would give elders and persons with physical disabilities the opportunity to relocate from nursing homes. People being cared for in nursing homes will have a choice -- to remain in that setting where they are comfortable and well cared for or move if their care needs can be met at home, in an apartment or in an assisted living setting. If Medicaid is currently paying for their nursing home care, then the home and community-based waiver may be available to provide needed help at home.

This Community Relocation Initiative is not only good for consumers, it is good for the state's budget. It is projected to save $9 million of public funds during the two-year budget period. These savings are possible because, on average, community care has been less costly than nursing home care, often because natural and community supports frequently can be built upon to help with some of the care that the person needs.

We believe that there are many people in nursing homes who want to take advantage of this opportunity. Thanks to the collaborative efforts of nursing home staff and county care managers, about 500 people have successfully relocated over the past two years. Yet there are more people who would like the opportunity to do so. This initiative will make that happen.

This document describes the community relocation initiative as authorized in the 2005-2007 Biennial Budget (2005 Act 25), conveys Department implementation policies related to the initiative and provides guidance to counties related to participation in the program.

Background

The Community Relocation Initiative will do the following:

• Modify and expand the current Community Integration Program II (CIP II) waiver for elders and people with physical disabilities, enabling the Department to provide enhanced funding above the standard CIP II waiver rate to reflect the actual cost of the waiver care plan.
• Provide an opportunity for eligible nursing home residents who wish to relocate to do so.
• Adopt a "money follows the person" principle.
• Provide permanent community-based waiver funding for each eligible person who relocates.
• Require that the total number of people served under the program statewide can not exceed the number of beds closed statewide. There is no requirement that the resident's bed or any other bed in the facility be closed under this program.
• Require that over the biennium the aggregated Medicaid costs of serving such individuals in the community under this initiative are less than what they would have been if those individuals had stayed in the nursing home.
• Provide counties with sufficient funding for the care plan costs of each individual who is relocated.

Participant Eligibility

Participation is strictly voluntary for individuals in nursing homes. To be eligible for relocation funding, an individual must be a nursing home resident who meets the following criteria:

• Person's nursing home care must be funded by Medicaid.
• Person must have long-term care needs that will last more than one year or have a terminal illness.
• Person is eligible for the CIP II home and community-based waiver, both functionally and financially.
• Person must need waiver-funded long-term care services in order to relocate.

Although the Department is not setting a strict length of nursing home stay requirement for persons who relocate, counties should carefully assess whether the person would be a long-term nursing home resident if it were not for the relocation initiative. Therefore, for persons in the nursing home for fewer than 100 days, counties will need to document that the stay is expected to be long-term based on the COP Guidelines (s. 404.A.1), the required assessment and functional screen. In addition, the person has a long term or irreversible illness or disability and without appropriate waiver funded services would be unable to leave the nursing home. Criteria to determine whether the stay is expected to be long term includes the need for assistance in one or a combination of the following: long-term health care needs, considerable limitations with activities of daily living, uncertain or insufficient caregiver assistance, cognitive impairments that would make community living without support unsafe and/or imminent loss of current community living arrangement. We recognize that there will be many questions about the specific definition of these terms and we will provide further clarification during the implementation to ensure consistent interpretation.

As savings are realized from low cost relocations, funds may be available for persons whose community costs exceed nursing home costs.

Funding Availability

The Department will determine whether sufficient funds are available within the relocation initiative "account" to cover all the expected Medicaid costs in the community (waiver services, Medicaid card services and administrative expenses) of a relocation candidate. If sufficient funds are available, the Department will provide the county with funds to cover the entire cost of the waiver care plan for the relocated individual. If the waiver care plan costs for an individual increase during the biennium, the county may request additional funds from the Department. If the Department determines that the increased costs are necessary for the individual's health and safety and if sufficient funds are available at the state level, the county may receive increased funding for the individual.

If a person relocated under this initiative is still on the CIP II waiver after 180 days and subsequently leaves the program permanently, the county will be eligible to use these CIP II-relocation funds for diversions of CIP II/COP-W eligible people on county waitlists who meet Department criteria for being at imminent risk of a long-term nursing home stay. (These criteria will be issued in a subsequent memo.) Leaving the program is defined as: the person dies, permanently returns to a nursing home, leaves the state or is no longer eligible. If the person stays on the program but moves to another county, the current COP Waiver policy will apply.

The funds supporting care plans for individuals who participate in CIP II for less than 180 days will be retained by the Department to fund individuals with high relocation costs, increases in care plans, one-time participant costs or individuals who return to nursing homes. In this way, the Department will be able to ensure that the program is managed within available funds.

Overview of Relocation Approval Process

The following summarizes the approval process for relocation applications.

• A person in the nursing home indicates an interest in receiving their long-term care services in the community.
• County determines whether the person meets eligibility criteria, assesses the person's needs, strengths and preferences and estimates the cost of a care plan.
• County submits a request for CIP II-Relocation funding, along with estimated care plan costs (Attachment) to the Community Options Section in the Department's Bureau of Long-Term Support (BLTS).
• BLTS determines whether the estimated community care plan and anticipated card costs can be supported within available funds while ensuring required savings.
• If sufficient funding is available, the Department will notify the county that they can proceed to complete the assessment and care plan within 60 days. The County submits the standard waiver documentation to The Management Group in accordance with current procedures and the Department issues the plan approval letter and notification of funding being awarded based on final care plan costs.
• If sufficient funding is not available, the county will be notified and the Department will place the person's estimate form in a pending file until sufficient relocation funds become available.

County COP Waiver agencies interested in making this opportunity available to nursing home residents are encouraged to initiate contact with interested individuals (especially those on the county waiver waiting list) to discuss service options.

During the month of October, seven regional forums will be held to facilitate local discussion and planning among nursing homes, counties and others for how best to identify and inform nursing home residents of this opportunity.

Effective immediately, the Department will accept preliminary care plan cost estimates and advise counties on funding availability.

REGIONAL CONTACT: 

Human Services Area Coordinators-LTS

CENTRAL OFFICE CONTACTS:

MEMO WEB SITE: 

http://www.dhs.wisconsin.gov/partners/local.htm

Attachment

DDE-2678 (PDF, 33 KB)

DDE-2678 (Word Fillable, 56 KB)

cc: 
Diane Waller

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