DDES INFO MEMO 2006-18
STATE OF WISCONSIN
Department of Health and Family Services
Division of Disability and Elder Services
Date: October 12, 2006, 2006
Index Title: Clarification of Timeframes for Discharge Dates for State
Center Intensive Treatment Programs
Supersedes DDES Info Memo 2005-08
To: Listserv
For: Area Administrators/Human Services Area Coordinators
County Department of Community Program Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Section Chiefs/Licensing Chiefs
County Tribal Chairpersons/Human Services Facilitators
County DD and LTC Coordinators
DD Center Directors
From: Sinikka Santala
Administrator
Subject: Clarification of Timeframes for Surcharge Discharge Date for
State Center Intensive Treatment Programs
Background
As of January 1, 2006, DHS
began billing counties the progressive
surcharge for all individuals served in the ITP programs who remain past
their mutually agreed upon discharge date.
Wisconsin continues to be at the forefront of national efforts to
provide people with developmental disabilities opportunities to live in
the community, rather than institutional settings. Occasionally, some
individuals may require short-term, intensive psychiatric, psychological,
and/or behavioral supports in order to remain healthy and safe in the
community. Such supports are provided by Wisconsin's Intensive Treatment
Programs (ITPs) operated at the State Centers for People with
Developmental Disabilities.
Individuals eligible for Intensive Treatment Program (ITP) services are
children and adults with a diagnosis of mental retardation* and who are
currently eligible for services funded under the Medicaid Waiver, and meet
all of the following criteria:
- Whose preadmission assessment has identified active treatment needs
that cannot be adequately met in a more integrated setting due to
significant maladaptive and inappropriate behavior which are due to a
combination of social, psychological, psychiatric, and medical
factors;
- Whose need for active treatment can be best met by decreasing the
frequency of those behaviors that are interfering with other active
treatment needs and simultaneously increasing those skills necessary
to achieve functioning with as much self determination and
independence as possible, and preventing the loss or regression of
functioning;
- Consistent with the ICF/MR standards, individuals who need a program
of active treatment that includes aggressive, consistent
implementation of a program of specialized and generic training,
treatment, and health services;
- Whose needs include acquiring the skills essential for privacy and
independence, including but not limited to, toilet training, personal
hygiene, dental hygiene, self feeding, bathing, dressing, grooming,
communication of basic needs, self-medication, use of medical devices
and money management; and
- Whose needs for medical services and supports can be adequately met
by the ITP.
ITP services are not for individuals who are able to function with
little supervision, or in the absence of a program of continuous active
treatment, or for persons who are generally able to independently take
care of most of their personal care needs, and can effectively and
appropriately make known to others their basic needs and wants.
Under s. 51.437(4rm)(c)2m of the Wisconsin Statutes, county departments
of developmental disabilities services are responsible for the non-federal
share of costs for services provided to Medicaid-eligible individuals in
the ITP programs.
The 2003-05 State budget act (2003 WI Act 33) modified the ITP
program's authorizing legislation in the following ways:
- Admission to the ITP programs can only occur if the Department of
Health and Family Services (DHS
) determines that a licensed bed and
other necessary resources are available, and only if DHS
and the
county of residence agree on a maximum discharge date for the
individual.
- A progressive surcharge was established under which counties can be
assessed an additional 10% of the county ITP charge during the first
six months after the maximum discharge date. The surcharge increases
by 10% during each six-month period thereafter.
Clarification of Timeframes for Discharge Dates
In order to determine a mutually agreed upon (anticipated) discharge
date, the county, guardian, and ITP team may need to assess the individual
to determine the scope of psychiatric and psychological needs and/or
related services that would be provided at the ITP. Active treatment and
assessment results are the basis of determining the purpose of the
admission and the agreed upon discharge date. Typically assessments are
part of the preadmission process. When the admission is determined to be
more urgent and there is mutual agreement that the individual meets the
ITP admission criteria, this assessment must be concluded within two weeks
of the day of admission and a discharge date established by that time. The
length of the admission is a maximum of 28 days to complete the
treatment/intervention process. All discharge dates will be set at 28 days
or less from the day of admission.
The discharge date set at admission may be adjusted by mutual agreement
when clinical and habilitative needs dictate the course of treatment.
Under these circumstances, a discharge date may be set at up to 90 days
from the original date of admission.
ITP admissions are short term and all assessments and treatments must
be completed within 90 days. In rare instances, with clinical
justification, a limited further extension of the discharge date may be
requested from the Division Administrator or designee. In no case will an
extension be granted that leads to long-term care at a State Center for
People with Developmental Disabilities.
As always, thank you for all you do for persons with disabilities in
Wisconsin.
*Mental retardation is a
disability characterized by significant limitations in both intellectual
functioning and in adaptive behavior as expressed in conceptual, social,
and practical adaptive skills. This
disability originates before age 18.
CENTRAL OFFICE CONTACT:
Michael Hughes, Budget and Policy Manager
DDES Office of Operations
P.O.Box 7850
Madison, WI 53707-7850
(608) 267-2254, hughemr@wisconsin.gov
MEMO WEB SITE: http://www.dhs.wisconsin.gov/dsl_info/
cc: Disability Rights/Wisconsin
Last Revised: September 13, 2010 |
