DSL Memo Series
Supercedes DSL 2000-05 Ė In Part
Replaces DSL 2002-02
January 2, 2003
STATE OF WISCONSIN
Department of Health and Family Services
Division of Supportive Living
Assistant Area Administrators
COP County Contacts
Community Based Residential Facilities
County Departments of Community Programs Directors
County Department of Developmental Disabilities Services Directors
County Department of Human Services Directors
County Department of Social Services Directors
County Waiver Contacts
Long Term Support Planning Committee Chairs
Re: USE OF COP/COP-W/CIP-II IN CBRFs
This memo summarizes statutory changes and provides implementation
provisions related to facility size effective January 1, 2003 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
Summary of Changes
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needed and therefore the language has been repealed.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 HFS 73.10 that require an individual to have a diagnosis of a
- 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:
A pre-admission assessment or consultation has been completed
prior to the personís admission to the CBRF, regardless of the
individualís ability to pay;
- The option of in-home services has been thoroughly explored and
- The CBRF is the individualís preferred residence;
- The CBRF provides a quality environment and quality care
- The CBRF is cost-effective compared to other options.
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 HFS 73.11 (Attachment #3). Therefore all
of the above criteria can now be implemented.
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,
County Policies for use of COP-Regular funds in CBRFs with up to
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.
Use of COP-Regular, COP-W, CIP-II in CBRFs above 20 beds
with Department approval
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. This section will outline the policy related to the use of
funding in CBRFs with more than 20 beds effective January 1, 2003.
- Policy Content:
COP funds and COP-W/CIP-II Medicaid home and community based waiver
funds cannot be used in CBRFs with more than 20 beds unless one of the
- 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 of the facility
and therefore a variance is not required.
- The Department has approved a variance, requested by the county
COP lead agency, to provide waiver funding for a specific facility.
The variance request has documented how the facility design,
environment and programming mitigate the effects of living in a large
Rationale for the New Policy
Community Options and the Medicaid home and community based waivers
are home-care programs, created to provide an alternative to
institutional care. As CBRFs get larger, they are more likely to operate
like or feel like an institution (i.e., building safety and design
standards that must be met are more institutional, privacy may be
reduced, schedules and routines are designed around staffing patterns
rather than resident preferences, etc.)
However, the Department recognizes that some large CBRFs have
designed their facilities and programming to be consumer focused,
respectful of the individual, offer privacy and autonomy, and meet needs
individually or in small familiar groups. Therefore, if the county lead
agency can document that a facility has compensated for the effects of
large scale congregate living, the Department will grant a variance.
To arrive at this policy, the Department sought input from an
advisory group made up of county employees, provider agencies, aging and
disability advocates and Department staff. This group developed a
recommendation, which was then shared with county agencies, and other
advisory groups. The final policy is a collaboration of the various
perspectives received from these groups.
Implementation of the New Policy
- Variance requests shall be reviewed and approved by the countyís
Long Term Support Planning Committee prior to submission to the
Department. Ideally, members of the committee will visit the
facility before approving the variance request.
- Lead agencies are to submit requests for variances to use
COP/COP-W/CIP-II funding in CBRFs with more than 20 beds to the
Bureau of Aging and Long Term Care Resources (BALTCR) and Regional
Assistant Area Administrator-Adult Services. BALTCR will respond to
the request within fifteen working days of receipt, consulting with
Area Administration as needed.
- Counties wishing to seek variances for particular facilities
within or out of county shall describe all of the following in the
- How the facility design and programming are such that the
facility is non-institutional.
- A description of the CBRFís efforts to provide services in a
manner that enhances resident dignity, independence, privacy and
choice, and that mitigate the effects of large, congregate living
- Documentation provided by the CBRF that it can accommodate the
special needs of individuals with an irreversible dementia such as
Alzheimerís disease, if the variance is requested for a facility
that provides services to this target group.
- As described in the COP Guidelines under Chapter II (2.04(M)6.),
lead agencies are not required to contract with or seek a variance
to purchase services from any CBRF for which a size variance is
- Department approved person specific variances are no longer
necessary. However, in order to place individuals in CBRFs of any
size, including CBRFs with more than 20 beds using COP/COP-W/CIP-II
funding, the five conditions on CBRF funding must be met for each
individual. Policies and implementation highlights can be found in Attachment
#2 of this memo.
- Individuals with developmental disabilities who are funded with
CIP 1A/1B Medicaid home and community based waiver funding are not
affected by this policy change. A variance continues to be required
to fund CBRFs with more than four and up to eight beds for residents
with developmental disabilities with CIP1A/1B funds.
- Please note that Medicaid does not allow personal care (MAPC) in
CBRFs with more than 20 beds (HFS 107.112 (4)) even if the
COP/COP-W/CIP-II funding variance is granted to the facility.
- County agencies or their designees may not certify recipients of
Supplemental Security Income for the Exceptional Expense Supplement
(SSI-E) if they are residing in CBRFs with more than 20 beds even if
the COP/COP-W/CIP-II funding variance is granted to the facility.
- Where an individual variance request has been granted for the use
of COP-Regular in CBRFs with more than 20 beds, another variance is
Final policies and procedures found in this memo and its attachments
will be incorporated into the COP Guidelines and the Medicaid-Waivers
Manual in 2003.
REGIONAL OFFICE CONTACT:
Assistant Area Administrators-Adult Services
CENTRAL OFFICE CONTACT:
Long Term Support Residential Policy Specialist
Bureau of Aging and Long Term Care Resources
P.O. Box 7851
Madison, WI 53707-7851
- Statutory changes to use of COP-Regular, COP-W, CIP-II in
- Policies and guidelines implementing five statutory conditions for
the use of COP-Regular, COP-W, CIP-II funding in CBRFs.
- HFS 73.11: Criteria for determination of the infeasibility of
Area Agencies on Aging
Board on Aging and Long Term Care
COP/LTS Statewide Advisory Committee
County/Tribal Aging Units
DSL Bureau Directors
DSL Section Chiefs
DSL/BQA Regional Field Operations Directors
Independent Living Centers
The Management Group
Tribal Chairpersons/Human Services Facilitators
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