DSL MEMO SERIES 2001-24

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

To:
Area Administrators/Assistant Area Administrators
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 Developmental Disabilities Contacts County Case Managers
County Waiver Contacts
County COP Contacts
Licensing Chiefs/Section Chiefs

From:
Sinikka McCabe, Administrator
Division of Supportive Living

Re: Availability and Administration of Local Match Brain Injury Waiver Slots

The 2001-2003 Biennial Budget created statutory language that included a provision that authorizes counties to access federal funds available through the Brain Injury Waiver (BIW) through the use of local match Brain Injury Waiver slots. These new local match slots are effective August 31, 2001 and can increase the capacity of counties to meet the needs of individuals with brain injury by providing approximately 60 percent federal matching dollars to fund community services. DHS will also be able to provide the federal match for any costs incurred by counties above the state matched per diem amounts as noted in Appendix J to the State-County Contract.

This memo describes the process for requesting and managing the new slots and related funding through the Bureau of Developmental Disabilities Services. This memo also serves as the administrative instructions until the Medicaid Home and Community-Based Waivers Manual, the Community Aides Reporting System Manual (CARS) and the Human Services Reporting System (HSRS) Handbook are updated to reflect these changes.

Use of Local Match Brain Injury Waiver Slots
Local match BIW slots can be used to serve people who meet the current definition of brain injury under s. 51.01 (2g), Stats.: 51.01 (2g) as noted below, and who meet Medicaid and Waiver eligibility criteria.

s. 51.01 (2g), Stats.: 51.01 (2g) (a) "Brain injury" means any injury to the brain, regardless of age at onset, whether mechanical or infectious in origin, including brain trauma, brain damage and traumatic head injury, the results of which are expected to continue indefinitely, which constitutes a substantial handicap to the individual, and which directly results in any two or more of the following:

1. Attention impairment
2. Cognition impairment
3. Language impairment
4. Memory impairment
5. Conduct disorder
6. Motor disorder
7. Any other neurological dysfunction
   (am) "Brain injury" includes any injury to the brain under par. (a) that is vascular in origin if received by a person prior to his or her attaining the age of 22 years.
   (b) "Brain injury" does not include alcoholism, Alzheimer’s disease as specified under s. 46.87 (1) (a) or the infirmities of aging as specified under s. 55.01 (3).

The BIW criteria further define the waiver eligible group as individuals who have quantifiable cognitive, behavioral or psychosocial dysfunction and that dysfunction, as compared with functional ability prior to the injury constitute a substantial handicap to the individual. The associated medical issues are quantifiably different in intensity from pre-injury status.

Currently state matched BIW slots are only available for individuals who received prior authorization for Medicaid reimbursement and are relocating from one of the four state approved brain injury rehabilitation units.

Local match BIW slots are available to individuals who meet the BIW eligibility criteria above and who are or have been relocated or diverted from an institutional setting, including a state mental health institution, IMD or brain injury rehabilitation unit.

Process to Request a Brain Injury Waiver Slot
The process the county uses to request a local match slot is as follows.
The county:

• Completes an assessment of the individual that describes the needs and preferences and has an explanation of the needed services and supports. This must be completed prior to the requested start date.
• Obtains a Level of Care rating (DOH 2256 and 2256a) with the signature of a physician or registered nurse within 90 days of the proposed start date. The Level of Care information must include information that substantiates the brain injury and provides documentation regarding the quantifiable difference in functional ability pre and post injury.
• Completes an Individual Service Plan (ISP) (DSL445) prior to the requested start date.
• Completes a narrative summary that includes the services listed in the ISP and how they are related to the needs and preferences of the individual as well as a comprehensive view of the person’s current situation and future plans.
• Completes the Cost Share Worksheet (DSL-919) or CARES Form.
• Prints out the HSRS "Long-Term Support Client Registration" (L1) screen.

The assessment, level of care, ISP, narrative summary, Cost Share or CARES and HSRS printout documentation must be sent to the regional community integration specialist assigned to the county, with a copy to the program assistant for the waivers in the Bureau of Developmental Disabilities Services.

Slot Allocation and Management
State-matched BIW slots that become vacant continue to revert to the Bureau where they are reassigned to qualified applicants who have applications on file. Local match slot numbers terminate when vacated. However, counties can obtain new slots by utilizing the process described in the previous section. The Bureau does not anticipate slot capacity issues with the BIW as there are a sufficient number of approved slots from the federal Centers for Medicare and Medicaid Services (CMS).

Fiscal and Client Reporting Conditions

HUMAN SERVICES REPORTING SYSTEM (HSRS) REQUIREMENTS: A new code ‘B’ will be added to field 26 (LTS Code) for reporting BIW locally matched slots. Identifying a funding source (field 27) for the local match will also be required for the BIW locally matched slots. All other reporting requirements will remain the same as outlined in the current HSRS Handbook. The county’s HSRS reporting of BIW and any matching funds used for services provided shall include the federal and local shares of all claims for all services covered by the BIW provided to eligible participants. The county shall also report all units of service provided as a result of all funds reported on all other required reporting elements contained in the section of the HSRS Handbook covering the MA Waivers Module. Reports to HSRS shall be submitted to the Department monthly on the Long Term Support Module of HSRS in accordance with the instructions contained in the HSRS Handbook, and applicable DSL Numbered Memos.

COMMUNITY AIDS REPORTING SYSTEM (CARS): CARS Profile 507, (BIW Federal) will be established for payment of the federal portion of the local match slot and overage on state matched BIW slots. Brain Injury Waiver "regular" slots use state GPR funds to match the federal share of MA.

Reimbursement will be based on the average daily claims that must be less than or equal to the current state per diem rate for program participants. Any costs exceeding the state per diem rate should not be reported on the current BIW (506) Profile, but on the BIW Federal (507) and selected local match lines. If the average daily claim for program participants equals less than the state per diem rate, any unused funds will be applied to the BIW Federal lines (local match slots) to provide MA match during the year-end contract reconciliation. Funding for either type of slot may be used to reimburse the county agency for costs they incur if the costs are included in a valid claim submitted for an eligible BIW program participant and associated administrative costs. See Attachment A for examples of the reporting outlined in this memo.

An addendum to the State/County contract will provide adjustments to the Community Aids Reporting System for counties with contracts in CY2001 as well as for counties receiving the new BIW locally matched slots.

If you have questions regarding this information or would like to request additional assistance, please contact the regional Community Integration Specialist assigned to your county, or Ken Golden at 608/266-1520, email goldekt@wisconsin.gov . Fiscal and contract questions should be directed to Christine Pomerening at 608/267-8933, e-mail pomerca@wisconsin.gov .

Regional Office Contact:
Assistant Area Administrators-Adult Services
Community Integration Specialist

Central Office Contact:
Ken Golden
Bureau of Developmental Disabilities Services
P. O. Box 7851
Madison, WI 53707-7851
Phone: 608-266-1520
Fax: 608-261-6752
e-mail: goldekt@wisconsin.gov

Christy Pomerening
Bureau of Developmental Disabilities Services
P. O. Box 7851
Madison, WI 53707-7851
Phone: 608-267-8933
Fax: 608-261-6752
e-mail: pomerca@wisconsin.gov

cc:
DCTF
DHCF
DMT
DSL-HSRS
ARC Wisconsin Disability Association
Brain Injury Association
Clearview Nursing Home, Juneau Brain-Injury Unit
Lakeview Hospital, Waterford-Neurobehavioral or Coma Programs
Mendota Mental Health Institute
Milwaukee Mental Health Center - IMD
St. Mary's Nursing Home-Milwaukee Brain Injury Unit
Sheboygan County Comprehensive Care Center-IMD
Trempealeau County Health Care Center-IMD
Tribal Chairpersons/Human Services Facilitators
WI Coalition of Advocacy
Winnebago Mental Health Institute
Wisconsin Council on Developmental Disabilities

Attachment:
Brain Injury Waiver (CARS Profile 506)

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