DSL MEMO SERIES 2001-24
November 7, 2001
STATE OF WISCONSIN
Department of Health and Family Services
Division of Supportive Living
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
Sinikka McCabe, Administrator
Division of Supportive Living
This memo announces the availability of local match Brain Injury Waiver
slots and the availability of additional federal reimbursement. The
process for requesting, reporting and administering these slots is
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
- 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.
- 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
- 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
- Completes the Cost Share Worksheet (DSL-919) or CARES Form.
- Prints out the HSRS "Long-Term Support Client Registration" (L1)
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
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
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.
Regional Office Contact:
Assistant Area Administrators-Adult Services
Community Integration Specialist
Central Office Contact:
Bureau of Long Term Support
P. O. Box 7851
Madison, WI 53707-7851
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
Waiver (CARS Profile 506)
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