DLTC Numbered Memo 2011-01
STATE OF WISCONSIN
Department of Health Services
Division of Long Term Care
DLTC Numbered Memo Series 2011-01
Date: February 25, 2011
Index Title: Setting an MCO enrollment date for relocation from ICFs-MR
For: Aging and Disability Resource Centers
Managed Care Organizations
IRIS consultant Agency
From: Fredi Bove
Deputy Division Administrator
Subject: Setting an MCO enrollment date for people relocating from
private intermediate care facilities for mental retardation (ICFs-MR) or
State Operated ICFs-MR before a Family Care/IRIS county is at entitlement.
The purpose of this memo is to establish the policy that guides ADRC
and MCO action when a resident or guardian of a resident of an ICF-MR or
State Center requests to relocate in counties with a waiting list for long
term support services while the county is in transition from legacy
waivers to Family Care Managed Care Waivers before a Family Care/IRIS
county is at entitlement. This memo does not apply to relocations
necessitated by a facility closure or downsizing, which follows the Wis.
Stat. Chapter 50 protocols established by the Department.
A basic premise of Wisconsin's community-based long term care programs
since their inception has been to foster consumer choice of living
arrangement. The Community Integration Program 1A began in 1981 to support
relocations of individuals with developmental disabilities from the three
State Centers for the Developmentally Disabled to community settings. The
ICF-MR Restructuring Initiative was authorized in the 2003-05 biennial
budget bill and became effective on January 1, 2005. Since January 1,
2005, 725 people have moved out of ICFs-MR to homes in the community and
another 150 moved from long-term beds at State Centers.
Family Care further improved the system by eliminating artificial barriers
of setting by combining institutional and community based funding to
support people wherever they chose or needed to live by including ICF-MR
care within the Family Care and Partnership benefit package.
In addition, the Supreme Court Olmstead decision stated that residents in
institutions be given the same opportunity for community care as community
dwelling individuals in need of long term care. Further, the federal
government expected that where there were waiting lists, people in
institutions would be served at the same pace as those not in the
institution. These principles are the basis for this policy regarding
ICF-MR relocations in Family Care, Partnership and IRIS.
This memo applies to the discharge of any and all ICF-MR or State Center
residents in long term care unit seeking enrollment into Family Care
Managed Care or IRIS while the county is in transition from the Legacy
Waivers with the following:
- The person is functionally eligible for his/her preferred program;
- The person is the legal responsibility of a county currently being
served by Family Care, Partnership and IRIS;
- The person is not currently enrolled in Family Care or Partnership
(and has never been in the past)
- The person may or may not be on the ADRC's wait list.
Residents of ICFs-MR including State Centers seeking to enroll in Family
Care or Partnership will be enrolled in the program of their choice no
later than six (6) months from the date of their enrollment counseling
session with the Aging and Disability Resource Center (ADRC). This policy
is specific to counties that are not at full entitlement. (If the county
is at full entitlement then the person can enroll into Family Care Managed
Care and IRIS immediately due to full entitlement status). In the event
that there is an ADRC wait list for services in the transition county, the
six months from the time of the ADRC referral prevails and the person will
not be placed on the ADRC wait list.
Sometimes for new members in Family Care, Partnership and IRIS community
living options need to be developed, because:
- Mental health, medical or behavioral issues make finding a suitable
provider tailored for the individual challenging,
- Intensive training of direct care staff and development of
comprehensive back up plans prior to placement in the community is
- Housing modifications such as ramps, bathroom modifications etc.
need to be installed,
- Guardians who live out of the area, or even out of state, means that
negotiating care plans and completing paperwork may take a longer
period of time.
When an ICF-MR resident who meets the above criteria comes to the
attention of the ADRC, the ADRC will confirm financial eligibility,
determine functional eligibility, and provide enrollment counseling. When
the person selects a benefit package (Family Care, Partnership, PACE) and
a Managed Care Organization (MCO), the ADRC will discuss with the consumer
various factors that contribute to selecting an appropriate enrollment
date for that individual. These factors might include the person's
readiness to relocate (e.g., the person's medical condition is
sufficiently stable); and, the financial implications of any date chosen
(e.g., cost share).
The ADRC will indicate to the consumer that the MCO enrollment date will
be six months from the date of the consumer/ADRC consultation (unless the
MCO has chosen a shorter timeframe as a general policy). This advance
notice is intended to give the MCO some time to prepare for the relocation
before having to assume the cost of the ICF-MR care.
The ADRC will complete the enrollment form including the enrollment date.
The ADRC notifies the MCO immediately of the new enrollee, the enrollment
date and any other information helpful to relocation planning. Also, the
ADRC is to notify OFCE (send secure email to DHSOFCE@dhs.wisconsin.gov)
that an ICF-MR resident intends to become a member and relocate, the
planned enrollment date and the facility where the person is residing.
If the ICF-MR resident prefers to relocate sooner, and if the MCO can
arrange an earlier relocation date, the MCO will notify the individual and
the ADRC, and the ADRC will revise the date on the enrollment form and
re-submit the form to the local income maintenance agency or CAPO,
whichever is processing the enrollment.
If the individual selects IRIS as his/her program choice, the standard
IRIS referral process applies. In addition, the ADRC is to notify the
Division's IRIS program manager of each ICF-MR resident referred to the
IRIS Consultant Agency (ICA). The person will be able to relocate once
their IRIS service plan is approved. IRIS is a home and community based
waiver and cannot support a resident while in an institution.
When an MCO accepts an enrollment date six months from referral, the MCO
is expected to contact the consumer as soon as possible to begin
relocation planning. At a minimum, the MCO must have an initial in-person
meeting with the resident within two weeks after the referral date. All
other requirements for MCO activity remain the same as outlined in the MCO
This policy and procedure is to be implemented no later than March 15,
The provisions contained in this numbered memo will be incorporated into
subsequent contracts for MCOs and ADRCs.
REGIONAL OFFICE CONTACT:
ADRCs - Contact ORCD Regional Quality Specialist
MCOs - Contact OFCE Contract Coordinator
MEMO WEB SITE: http://www.dhs.wisconsin.gov/dsl_info/
cc: Area Administrators / Human Services Area Coordinators
Area Agencies on Aging
County Aging Unit Directors
County COP Coordinators
County Department of Community Program Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
County Waiver Coordinators
County DD Coordinators
Independent Living Centers
Human Services Facilitators
Last Revised: March 08, 2011