DSL MEMO SERIES 2000-05
ACTION MEMO

June 6, 2000

STATE OF WISCONSIN
Department of Health and Family Services
Division of Supportive Living

To:
Area Administrators/Assistant Area Administrators
Bureau Directors
County COP Contacts
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Waiver Contacts
County Departments of Social Services Directors
Long Term Support Planning Committee Chairpersons
Tribal Chairpersons/Human Services Facilitators

From:
Sinikka McCabe, Administrator
Division of Supportive Living

Re: Use of COP in CBRFs

Purpose

This memo notifies county agencies operating Community Option Programs (COP) of certain procedural changes relating to the use of COP for participants in Community Based Residential Facilities (CBRFs).

1. State Approved Variance To Use COP in CBRFs Over Eight Beds

Current Procedure. Currently agencies wishing to use COP in CBRFs larger than eight beds must submit a person specific request to the Department in accordance with the statutes (s. 46.27 (7)(cm)) and COP Guidelines (section 5.12 B.2). Regional Assistant Area Administrators review and approve the requests.

New Procedure. Consistent with Department interest in giving counties broader program management responsibility, a new procedure will enable counties to establish their own policy and procedure for review of CBRF size variance requests for elderly and persons with a physical disability. However, the statutes require the Department to approve the use of funds in CBRFs over eight beds. Therefore, instead of approving person specific requests, the Department will approve the county’s internal policy and procedure for reviewing and granting such variances. For persons with a developmental disability, current procedures for requesting and approving a size variance will continue to apply.

Implementation. Steps to implement this change are:

• County establishes its policy, which may vary based on target group or special needs. It should state under what circumstances, if any, the county will use larger facilities for an individual.
• County establishes its review and approval process, which includes documentation that COP Guidelines criteria have been met (5.12 B.2).
• The policy and procedure must be reviewed and approved by the Long Term Support Planning Committee and incorporated into the county’s COP Plan.
• Lead agencies are to submit to the Department (Regional Assistant Area Administrator and Bureau of Aging and Long Term Care Resources (BALTCR)) for approval their county policy and procedure. Area Administration will respond, consulting with BALTCR as needed.
• Once approved by the Department, the county may begin implementation.

All other requirements related to size limitations remain the same, except in Chippewa County.

Chippewa County Pilot. The budget bill included statutory provisions (s. 46.27 (7b)) which creates a pilot project in Chippewa County which allows COP funds to be used:

• In CBRFs up to and including 20 beds, without any size restriction and without the need for a Department approved variance.
• In CBRFs over 20 beds, if the Department approves the county lead agency’s person specific variance request.

Chippewa County must include a description of its pilot project in its COP Plan.

These changes will be incorporated into the next revision of the COP Guidelines.

2. Waiving the CBRF Pre-Admission Assessment

The budget bill (1999 Wisconsin Act 9) amended the COP and COP-Waiver statutes to allow waiving of the CBRF pre-admission assessment under certain conditions. After the Governor’s vetoes, the only change is the following addition for COP, COP-W and CIP II (s. 46.27 (7)(cj) 3.a.):

• The county may waive this condition [the pre-admission assessment] in accordance with guidelines established by the department. If the county waives this condition, the county must meet with the person or the person’s guardian to discuss the cost-effectiveness of various service options.

Intent. The intent of the pre-admission assessment is to provide information to consumers that enables them to make informed decisions about service choices and use of personal funds and that conveys the eligibility requirements for public programs. The new statutory language permits a county to substitute pre-admission consultation for an assessment.

Guidelines for waiving the Pre-Admission Assessment. The county must:

• Describe its pre-admission consultation process in its COP Plan, being sure it is consistent with the statute, i.e., county meets with the person, discusses options and their comparative costs.
  

• Describe how its pre-admission consultation process meets the intent of the pre-admission assessment.
  

• Describe who would receive the pre-admission consultation, e.g., short term admissions, respite, or emergency care, persons with personal resources to pay for more than 2-3 years of care.

Issues to Consider

Counties should be aware that COP assessment funds can only be used for the assessment, as described in the COP Guidelines and the county’s COP Plan. COP assessments funds may not be used for time spent in pre-admission consultation.

If an individual consumer refuses a pre-admission assessment, the person must be offered the pre-admission consultation. If the person also refuses that option and enters the CBRF, the person will not be eligible for COP or waiver funding in the future.

Whether the county does pre-admission assessments or consultation, it ought to have in place:

• Mechanisms for receiving referrals from CBRFs prior to any immediate admission and efforts to get providers to refer upon first contact with interested parties rather than at the time of admission.

• Efforts that periodically make public information available, so that consumers and their families can learn about service options before making decisions about where to live and receive services. This information should include explanations about CBRFs which do not qualify for COP or waiver funds (due to size, cost, or other local policies or contract specifications).

Process for Waiving the Pre-admission Assessment Requirement.

• The county establishes its policy and criteria for waiving the pre-admission assessment.
  
• The policy and criteria are approved by the local Long Term Support Planning Committee as part of the county’s COP Plan.
  

• The policy is submitted to the Department as an amendment to its COP Plan. Material is to be submitted to BALTCR (Susan Veleke) and to the assigned Regional Assistant Area Administrator, who will notify the county of approval. If this policy has been submitted as part of the 2000 COP Plan Update, no further action is needed.

ACTION SUMMARY:

1. CBRF Bed Size Variance Process: COP Lead agencies are to submit as an amendment to their COP Plan Update the local county policy and procedure for reviewing and granting variances to use COP funds in CBRFs over eight beds.

2. Waiving the Pre-admission Assessment (Optional): If a county chooses to implement a pre-admission consultation in lieu of the pre-admission assessment, submit policy and process as a COP Plan amendment.

REGIONAL OFFICE CONTACT:
Assistant Area Administrators

CENTRAL OFFICE CONTACT:
Janice Smith
Long Term Support Section Chief
Bureau of Aging and Long Term Care Resources
P. O. Box 7851
Madison, WI 53707-7851
(608) 266-7872
e-mail: SmithJA@wisconsin.gov