DLTC Memo Series 2009-02

STATE OF WISCONSIN
Department of Health Services
Division of Long Term Care

DLTC Numbered Memo Series 2009-2
Date: February 17, 2009
Index Title: CIP II-Nursing Home Diversion Funding 2009

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: Fredi-Ellen Bove
Interim Administrator

Subject: CIP II-Nursing Home Diversion Funding 2009

Document Summary

Effective February 23, 2009, new CIP II - Nursing Home Diversion funds will be available to county and tribal CIP II agencies. Funding will be available to divert up to 150 eligible individuals who are at imminent risk of entering a nursing home. This memo provides updated information to counties on the anticipated allocation of these funds and describes the process to apply for these resources. CIP II agencies will have until April 24, 2009 to submit care plans to claim their allocated slots. Funding is available up to a maximum of $85 per day and cannot be supplemented by the county by blending other funds other than pure COP for non-waiver allowable costs.

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 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 February 10, 2009, 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 CIP II agencies to divert individuals who would otherwise enter a nursing home.

Diversion Policies

Most policies regarding the use of Nursing Home Diversion funding remain the same as described in DDES Memo Series 2006-07. Please review the policies to avoid delays in processing care plan approvals.

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 (F-20452) to determine if the person meets the criteria for high risk of nursing home entry and must submit the completed form with the care plan.

Participant Costs - Because this initiative must be cost neutral, the maximum waiver per diem for diversions under this funding is $85. The county or tribe cannot supplement this with other funds, except for pure COP to cover non-waiver allowable costs. 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.

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 and Oneida tribe, other than counties that are expected to implement Family Care on or before March 1, 2009, currently operating the CIP II program have been assigned at least one slot. Counties have until April 24, 2009 to identify the diversion candidate(s) and submit all required service plan materials to Kimberly Schindler in the Bureau of Long Term Support (BLTS - see address at end of memo). Slots not claimed by April 24, 2009 will be made available to other counties based on a randomly generated list of counties that have successfully claimed their initial slots. Agencies may submit care plans for use of their allocation of slots in advance of February 23, 2009, but no effective dates will be approved prior to that date. The attachment shows the planned allocations by county. Counties should not submit additional care plans in anticipation of unclaimed slots.

The following approval process for applications is the same as the process outlined in DDES Memo Series 2006-07, except that plans should be sent to Kimberly Schindler in BLTS:

1. A person in the community expresses an interest in receiving 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:
   1. The CBRF placement conditions are met;
   2. CBRF variance approval, if applicable, is obtained;
   3. CBRF maximum amount;
   4. RCAC maximum amount of waiver reimbursement;
   5. County contract criteria.
5. The county must submit the following items to BLTS to claim a diversion slot.
   1. The CIP II Diversion Cover Sheet (F-20415)-this cover sheet flags the plan for to ensure proper processing as a diversion and provides additional information needed by DHS.
   2. The individual's complete community care plan (where waiver costs do not exceed $85 per day); and
   3. The High Risk Worksheet (F-20452) which provides documentation that the individual meets the criteria for imminent entry into a nursing home.
6. BLTS will review the submitted documentation to assure cost neutrality and consistency among the long term care functional screen, assessment and the High Risk worksheet. If approved, BLTS will forward the application to The Management Group.
7. The Management Group will review the waiver application packet as it does for all applications and will issue a letter to the county indicating waiver approval with a copy to BLTS.
   

REGIONAL OFFICE CONTACT:         DES/Human Service Area Coordinators-LTS

CENTRAL OFFICE CONTACTS:

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

Attachments: Nursing Home Diversion Allocation by County
DDES Memo Series 2006-07
Criteria for High Risk of Nursing Home Admission-High Risk Worksheet (F-20452) CIP II Diversion Cover Sheet (F-20415)

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

ATTACHMENT

Initial Allocation of 2009 Diversion Funding
(expressed as slots)

* Excludes counties that have transitioned to Family Care and those transitioning to Family Care in March 2009.