Wisconsin Department of Health Services
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DSL Memo Series 2002-02April 5, 2002 STATE OF WISCONSIN To: From: Re: Use of COP/COP-W/CIP-II in CBRFs (Supercedes DSL Memo Series 2000-05 – In Part) DOCUMENT SUMMARY This memo summarizes statutory changes and provides implementation provisions related to facility size and conditions under which COP, COP-W and CIP II can be used in CBRFs. The memo requires that the five criteria for use of COP and COP Waiver funds in CBRFs be met when placing new individuals in CBRFs as of May 1, 2002. The 2001-03 budget bill (2001 Act 16) made changes in the statutes (Attachment #1) related to the use of Community Options Program (COP-Regular), Community Options Program-Waiver (COP-W) and Community Integration Program II (CIP-II) funds in a Community Based Residential Facility (CBRF). This memo will summarize the statutory changes and provide implementation highlights. In addition, this memo details in Attachment #2 the policies that implement four statutory conditions, in addition to the pre-admission assessment requirement, for the use of COP-Regular, COP-W, and CIP-II in CBRFs. These conditions include: the infeasibility of in-home care, quality, cost-effectiveness, and preference. I. Summary of Changes Facility Size The new language authorizes counties to use COP-Regular, COP-W and CIP II funds to support residential services for individuals residing in licensed CBRFs with up to and including 20 beds without Department approval, and in facilities larger than 20 beds with Department approval. As a result of these changes, the Chippewa County Pilot is no longer needed and therefore the language has been repealed. Note: COP-W and CIP-II are waiver funds that are used to support people with physical disabilities and people who are elderly. The waiver allowable CBRF size changes, therefore, do not apply to participants who have a developmental disability, have a mental illness, or have long- term care needs due to alcohol or other drug abuse. County Established Maximum Total Amount of Funds Used for CBRF Care The new statutory language reiterates the ability of the Department to waive and/or approve a request for an exception when a county is at
or over the established maximum amount of funds. The Department may waive or approve an exception in accordance with hardship conditions established
under II. Implementation Highlights Waiver Mandate Effective September 1, 2001, CBRFs with a licensed capacity up to and including 20 beds may now be waiver allowable settings for people who have a physical disability or who are elderly. In addition, CBRFs with more than 20 beds may be waiver allowable settings if the facility was licensed prior to July 29, 1995, or an individual resided in the CBRF prior to January 1, 1996. As found in the COP Guidelines (Chapter II, 2.04 L.), and the Medicaid-Waivers Manual (Chapter I, 1.04), COP-W and CIP II Medicaid Waiver funds must be used in lieu of COP-Regular funds to provide services to an individual whenever a service is waiver allowable. Residents residing in medium or large CBRFs PRIOR TO September 1, 2001, who were receiving COP-Regular funding, who are elderly or have a physical disability, must be screened for waiver eligibility and, if found eligible, they must be converted to the waiver for waiver allowable services. Human Services Reporting System The HSRS Long-Term Support Module Card and handbook material will be updated for 2002 to accommodate these changes. Five Criteria for the use of COP-Regular, COP-W, CIP-II funding in any size CBRF The Community Options Programs are home-care programs intended to provide assistance and support to individuals so that they can continue to live at home. Certain criteria were established and placed in statute in 1997 that outlined requirements for use of COP, COP-W and CIP-II funding in an out-of-home residential setting such as a CBRF. These conditions were created to ensure that the limited home-care funds are used in a manner that is consistent with the purpose of the program. These conditions include:
Of the five conditions listed above, only the pre-admission assessment or consultation requirement has been implemented. The other four conditions
were not fully implemented pending promulgation of an administrative rule that defined the method for determining when home care is "infeasible."
This rule has been promulgated effective September 1, 2001 under The implementation policies and guidelines for these conditions can be found in Attachment #2. These statutory provisions must be met when placing new individuals in CBRFs of any size as of May 1, 2002. D. County Policies for use of COP-Regular funds in CBRFs with up to 20 beds The CBRF variance approval process as described in DSL numbered memo series 2000-05 is no longer required. This process permitted counties to establish their own policy and procedure for approving variance requests for the use of COP-Regular funding in CBRFs with over eight and up to 20 beds. These policies required Department approval. Counties no longer need Department approval for use of COP-Regular, COP-W, or CIP-II funding in CBRFs up to and including 20 beds. E. Use of COP-Regular, COP-W, CIP-II in CBRFs above 20 beds The new statutory language allows for the use of COP-Regular, COP-W, and CIP-II funding in CBRFs with more than 20 beds with Department approval. As a temporary policy, to use COP-W & CIP-II in large CBRFs, the Department has adopted the existing COP-Regular criteria. In addition, exceptional circumstances may be considered. As a result, use of these funds in CBRFs with more than 20 beds may be allowable when one of the following applies: The facility consists entirely of independent apartments. Definitions related to independent apartment CBRFs can be found in the Medicaid-Waivers Manual under Appendix Z. Meeting criteria for independent apartments constitutes Department approval and person specific approval is not required. The facility was licensed prior to July 29, 1995 and the five criteria discussed above in C. are met. A person specific variance must be
sought and approval granted. The individual resided in the facility prior to January 1, 1996 and the conditions discussed in C. above, excluding the pre-admission assessment condition, are met. A person specific variance must be sought and approval granted. Note: the pre-admission assessment condition was not effective in 1995 (or prior to 1995) when the person would have been admitted, therefore PAA is not required for these residents. Exceptional circumstances exist for an elderly person and when all of the criteria discussed in C. above are met. No variance will
be granted at this time for an individual with Alzheimer’s disease or another dementia, a developmental disability, a physical disability, a
mental illness, or long-term care needs due to alcohol or other drug abuse. Circumstances may be considered exceptional when:
These temporary guidelines are in effect until further notice. The Department will develop a revised policy for the use of these funds in CBRFs above 20 beds during 2002. A workgroup of county staff, advocates, and residential providers will assist the Department in developing a revised policy. NOTE: Medicaid does not cover personal care (MAPC) in CBRFs with more than 20 beds (HFS 107.12 (4)).
Lead agencies are to submit to the Bureau of Aging and Long Term Care Resources (BALTCR) and Regional Assistant Area Administrator-Adult Services a request for a variance to use COP-Regular, COP-W, or CIP-II in CBRFs with more than 20 beds. BALTCR will respond to the request within fifteen working days of receipt, consulting with Area Administration as needed. Consistent with the COP Guidelines, the variance request shall include all of the following: Documentation that all of the five conditions discussed in C. above have been met; A statement of the individual’s diagnosis, or population group, or other description of the individual’s long-term care needs; A general description of the CBRF where the person will reside including: a) the CBRF’s name and address, licensed capacity and class; b) a copy of the CBRF’s program statement/description, c) a description of the CBRF’s efforts to provide services in a manner that enhances resident dignity, independence, privacy, and choice that mitigate the negative effect of large, congregate living environments; and If the variance is requested under Section E, 2-3 for a participant who has an irreversible dementia such as Alzheimer’s disease, documentation provided by the CBRF that it can accommodate the special needs of the participant through: a) smaller, self-contained units and the facility environment, and b) special programmatic features and individualized programming, and c) specific staffing and staff training to deal with persons with dementia in large numbers. Lead agencies are not required to contract with or seek a variance to purchase services from any CBRF for which a size variance is required. Where an individual variance request has been granted for the use of COP-Regular in CBRFs with more than 20 beds, another variance is not required. G. Manual Update Final policies and procedures found in this memo and its attachments will be incorporated into the COP Guidelines and the Medicaid-Waivers Manual in 2002. Informational Sessions The Department will hold an informational session to discuss the policies referenced in this memo. The session will be held on May 15, 2002, from 10:00 a.m. to 12:00 p.m. This will be an Educational Teleconference Network (ETN) training. Please check the Department’s website at www.DHS .state.wi.us/aging/training.htm for more detailed information. REGIONAL OFFICE CONTACT: CENTRAL OFFICE CONTACT: Attachments: 1. Statutory changes to use of COP-Regular, COP-W, CIP-II in CBRFs. 3. HFS 73.11: Criteria for determination of the infeasibility of in-home services. cc: |