DLTC INFO MEMO 2008-02
STATE OF WISCONSIN
Department of Health and Family Services
Division of Long Term Care
DLTS Info Memo Series 2008-2
Date: February 21, 2008
To: Listserv
For: Area Administrators / Human Services Area Coordinators
County Department of Children and Family Services Directors
County Department of Community Program Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Mental Health Services Directors
County Departments of Social Services Directors
County Waiver Coordinators
County DD Coordinators
Tribal Chairpersons
Human Services Facilitators
From: Sinikka Santala
Administrator
Subject: Children's Long Term Support (CLTS) Allocation of New
Waiver Funds and High Cost One-Time Funding
I am pleased to inform you that we have significant new resources to
expand services to children with long-term support needs. This memo
provides information for the use of the new CLTS waiver funds which were
made available in the 2007-2009 biennial budget. This memo also discusses
the availability of the High Cost One Time Funding. The Division of
Long-Term Care (DLTC), the Autism Council and the CLTS Council continue to
address the needs of families who have children with long-term support
needs. The Department implemented the CLTS Waivers in 2004 to assist
counties in addressing these issues. The CLTS Waivers are authorized by
the Centers for Medicare and Medicaid Services (CMS) as statewide
programs.
Every county is required to implement all three CLTS Waivers, which
include children with developmental disabilities, mental health
disabilities, and physical disabilities. For children whose families
contact the county for long-term support services, the county must assess
the child's need for services under the CLTS Waivers when appropriate. The
county will create and maintain a waiting list of children found eligible
for the CLTS Waiver, but for whom funding is not available. All policies
regarding Medicaid Home and Community-Based Services Waiver waiting lists
may be found in the Medicaid Home and Community-Based Waiver Manual.
The 07-09 biennial budget bill provides $4.7 million All Funds (AF)/$2
million General Purpose Revenue (GPR) in Fiscal Year (FY) 08 and $4.8
million AF/$2 million GPR in FY09 to increase funding the CLTS Waivers.
These funds are allocated with the legislative expectation that waiting
lists for Children's Long-term Supports will be reduced.
I. Allocation of New Waiver Funds: Ongoing Funding
State Funded Waiver Slots
All 72 counties will be allocated funding equivalent to three slots at
a daily rate of $30.60, one for each target group (DD, PD, SED), which
equals annually to $33,507 All Funds (AF) for each county to serve new
children. This provides each county with a base of funding to address its
waiting list. The county must demonstrate that it provided services to at
least three new children. If the funding permits, a county may serve more
than three new children utilizing this new resource. The balance of the
new funding, approximately $2.5 million AF annually is allocated to
counties based on census data of county population under age 18 years (see
attached chart). The census-based distribution for the balance results in
47 counties receiving funding for at least one additional slot. The total
allocation of new funding has been added to each county's CLTS Waiver
contract profile under the State-County contract.
This funding distribution methodology also creates a statewide reserve
of 36 slots. These slots will be allocated on a first-come, first-serve
basis for counties once they have exhausted their allocation and
demonstrated that at least three children who were waiting are now
receiving services with the new funds. These funds are available to assist
counties to meet needs of children who are at high risk of institutional
placement or are in an institution such as intensive treatment programs at
State centers or at Mental Health institutes.
Limitations Regarding the Use of These Funds
1. Allocation
Counties that do not commit their allocation by August 31, 2008 will be
required to submit a justification to the Department including a plan on
how and a timeline for when they will utilize their allocation. The
Department will work with these counties to determine how much funding
will remain with the county and the timeline by which the funds will be
used. Those counties that are unable to allocate all the funds will
receive an adjusted allocation in the 2008 CLTS contract. The unused
funding will be reallocated to other counties or to contracted entities
that could fulfill the obligations not met by a county agency.
Any county not currently using all three CLTS Waivers will need to
develop a plan for implementing the Waivers. The Children's Services
Section staff will provide technical assistance as needed. Counties are
required to register children who meet the long-term support eligibility
requirements on the long-term support module within the Human Services
Reporting System (HSRS). Counties who do not currently report children
waiting in HSRS will need to submit a plan that outlines how they will
identify new eligible families and document that the children served with
this new funding were waiting for services.
2. Target Groups
Each county will receive one slot per target group (PD, DD, SED), which
is funded at $30.60 per day. If a county is unable to utilize a slot for a
specific target group, it can apply for a variance to use the slot for a
different target group. The variance must include a rationale which
includes:
- why a county is unable to serve children in all target groups
- how it is addressing the waitlist for all children
- technical assistance needed to address challenges in implementing a
specific waiver
3. Non-Supplanting
The requirements set forth in this memo are to assure that the full
amount of new funding is used to serve new children. The funds must not
supplant county or other funds currently utilized for children's long-term
support services. This non-supplanting expectation includes financial
commitments from county mental health, child protective services, juvenile
justice, as well as committed funding sources such as Community Options
Program (COP) and Family Support Program (FSP) funds. Counties must
maintain the level of funding for children's long-term supports based upon
calendar year 2007. Counties are not allowed to withdraw or decrease local
funding sources. If a county experienced extraordinary circumstances in
2007, the county should report these circumstances to the Children's
Services Specialist (CSS) and the Department will determine if a new base
will be permitted.
4. Disability Determination
A disability determination from the Disability Determination Bureau
(DDB) is required for all children accessing state-matched CLTS Waiver
slots.
5. Application Process
Counties need to follow the CLTS Waiver application process. If
counties have not implemented the CLTS Waivers please contact your
regional CSS for technical assistance (see attachment).
Children Transitioning into Adult Long-Term Support Services: One Time
Funding
Due to the delay in passage of the biennial budget bill, a portion of
the new CLTS funding must be utilized as one-time funding. If the full
$4.7 million AF for FY08 were spent on ongoing needs in the remaining five
months of FY08, there would not be sufficient funding in the following
year, FY09, to sustain these expenditures on an ongoing basis. For this
reason, the funding corresponding to the period July-December 2007,
equivalent to $2.35 million, must be treated as one-time funding. This
funding will be used for children transitioning into adult long-term
supports within one year. These funds are available for counties that are
coming on-line with Family Care in the 07-09 biennium. The children
eligible for this funding are defined as children on the long-term care
waitlist who are at least 17 years of age. These children must be expected
to meet adult long-term care eligibility standards and thus must be
expected to transition into Family Care. Counties that are not coming
on-line with Family Care in the 07-09 biennium and that have waitlists for
adult long-term care services, may use the one-time funding for children
who are CLTS waiver eligible and at least 21 years of age. The intent is
to assist them by providing some critical supports as they age out of
special education services in the school system and to meet needs that
they may have while waiting for funding to be available through the adult
service system. If a county can assure that funding will be available at
age 22 years thru Family Care, then a request for a waiver slot for a
period of one year or less will be appropriate.
Limitations regarding the use of these funds:
1. Application Process
Counties need to follow the CLTS Waiver application process. If
counties have not implemented the CLTS Waivers please contact your
regional CSS for technical assistance (see attachment).
2. Disability Determination
A disability determination from the Disability Determination Bureau
(DDB) is required for all children accessing state-matched CLTS Waiver
funding.
3. First-Come, First-Served
The funds will be available to counties on a first-come, first-served
basis. Each child will be allocated a slot in the amount of $30.60/day. If
a child has needs which would require services above the daily cost of
$30.60/day the county will need to get prior approval from their CSS
before submitting the plan to the Department.
The Department will be tracking the expenditure of these funds and will
notify all counties when the allocation has been exhausted.
High Cost One-Time Funds
A pool of high cost one-time funds is available, based on revenue from
the parental payment limit, formally the CLTS parental fee system. The
funding is being made available to allow counties to meet the needs of
children and families including:
- Assuring the child's health and safety
- Meeting the needs of the child/family as the result of an unexpected
event, emergency, or change in condition
- Completing home modifications
- Purchase of medical equipment or other specially adapted equipment
- Assisting with start up costs for a child returning home to their
parents home or to the home of another unpaid family member
Funds will be directed to exceptional expenses rather than routine
costs of care. County agencies will need to budget for routine costs from
existing allocations or other available sources of one-time funds to
address the needs of children. We continue to encourage counties to
establish risk reserves for these purposes. Counties are limited to
requesting items or services under a total cost of $2,000 or less (state
and federal match). Counties are also expected to request High Cost COP
funds for items with a total cost over $2,000 if this request is denied
the county may request CLTS One Time Funds.
Possibilities to consider before requesting CLTS One-Time Funding
include:
- Use county carryover for one-time expenses.
- Use funds collected through the parental liability system at the
local level.
- Establish a risk reserve to be used at the end of the year for
emergencies when money is especially tight.
- Other funding, such as Medicaid, Medicare, private insurance, DVR,
and funding made available by local civic groups, should be fully
explored.
- Use unexpended funding which may lapse at the end of the year.
Awards are reviewed and granted monthly. These will be based on the
criteria established and priority guidelines noted below.
Priorities for awards include:
1. High cost one-time needs due to an unexpected event or emergency.
- For a child to remain at home, home modifications are necessary.
- For a child to function as independently as possible, non-Medicaid
allowable medical or other specially adapted equipment is necessary.
- Essential equipment unexpectedly needs to be replaced.
- A child's condition deteriorates suddenly or unexpectedly resulting
in a sudden increase in costs.
- A caregiver dies or is suddenly unable to continue to provide care
resulting in a sudden increase in costs.
2. To assist with start-up costs for children returning to their
parents home or the home of another unpaid family member from another
living arrangement including a Foster Home, Wisconsin State Center, Child
Caring Center, or Mental Health Institution.
These one-time funding requests must be the funding of last resort.
Therefore, counties are expected to submit requests for funding after
receiving a denial from other potential funding sources including
Medicaid, Medicare, private insurance, DVR, High Cost COP, or the county
must document why these resources will not be a viable source of funding
to meet the child and family's needs. The request may require prior
approval from your Children's Services Specialist or Community Integration
Specialist for item/services as required in the HCBS Medicaid Waivers
Manual. All requests must have prior approval from the County/Agency
Supervisor.
Limitations Regarding the Use of These Funds
- The minimum request for an individual item or service should be for
$1,000 per individual item/service (state and federal funding).
- The maximum request for an individual item or project should be
$2,000, unless denied by High Cost COP funding process.
- All requests must be reviewed and approved by local County/Agency
Supervisor.
- Applicants should submit documentation that the Children's Services
Specialist has approved the request when necessary (ramps, fences,
home modifications over $2,000) and that Medicaid has denied Medicaid
allowable items. In some situations, agencies will be encouraged to
appeal Medicaid denials. Documentation for meeting the appropriate
standards must be maintained in participants' files.
- Funds may only be used for children who have been determined to meet
the eligibility requirements of the CLTS Waivers.
- Funds awarded must be matched through the appropriate CLTS Medicaid
Waiver.
- Funds will not be awarded that exceed the maximum benefit of a
service in the CLTS Medicaid Waiver.
- Funds will not be awarded to meet a long term support service that
may exceed the one time funding allocation.
Procedures
- A county Support and Service Coordinator submits the attached CLTS
One-Time Funding Request form with additional information as required
to the Children's Services Section.
- For qualifying requests, an award letter will be sent followed by an
amendment to the state-county contract using the appropriate CLTS
profile.
REGIONAL OFFICE CONTACT: Children's Services Specialist
CENTRAL OFFICE CONTACT: Katie Sepnieski
MEMO WEB SITE: http://www.dhs.wisconsin.gov/dsl_info/InfoMemos/DLTC/CY2008/index.htm
Attachments: CLTS Waiver funding
allocation chart
CSS regional map
Last Revised: July 12, 2010 |
