STATE OF WISCONSIN
Department of Health Services
DLTC Numbered Memo Series 2009-06
Division of Long Term Care
Date May 5, 2009
Index Title: Maximum COP-W/CIP-II Service Reimbursement for Persons in RCACs Starting January 1, 2009

Replaces DDES 2007-22

To: Listserv
For: Area Administrators/Human Services Area Coordinators
Bureau Directors/Office Directors
County CIP II/COP Waiver Coordinators
County Community Options Program Coordinators
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
DLTC Section Chiefs
Tribal Chairpersons/Human Services Facilitators

From: Fredi-Ellen Bove, Interim Administrator

Subject: Maximum COP-W/CIP II Service Reimbursement for Persons in RCACs Starting January 1, 2009

Document Summary

This memo increases the maximum COP-W/CIP-II service reimbursement for persons in RCACs to $88.31 beginning January 1, 2009.

Supportive, personal and nursing services provided to Medicaid Waiver recipients residing in a certified residential care apartment complex (RCAC) continue to qualify for reimbursement under the COP-W and CIP II programs, at an amount not to exceed 85 percent of the statewide average daily cost of Medical Assistance reimbursement for nursing home care. (s.46.27 (11) (c) 7 and S.46.277 (5) (e), Wis. Stats.) This amount has been re-determined.

As a result of this redetermination, the maximum funding limit that can be reimbursed for services in a RCAC has changed from $88.22 per day to $88.31 per day effective January 1, 2009. This statutorily established reimbursement imposes a ceiling on the total cost of supportive, personal and nursing services that can be paid for by the Waiver for RCAC services for a person residing in a certified RCAC. This maximum funding limit does not include the amounts counties can report for case management or the seven percent administrative costs.

The maximum RCAC funding limit should not be considered a facility rate. The amount of reimbursement the RCAC receives is the payment amount negotiated and contracted by the county with a particular facility for a particular individual according to the individual's service needs.

Questions related to Medicaid waiver funding for this service can be directed to The Management Group (TMG) quality assurance consultants, or persons listed below.

REGIONAL OFFICE CONTACT:

Human Services Area Coordinators-LTS


CENTRAL OFFICE CONTACT:

Kimberly Schindler, COP-W Quality Assurance Specialist
P.O. Box 7851
Madison, WI 53707-7851

Kimberly.Schindler@dhs.wisconsin.gov (608) 266-1345


MEMO WEB SITE:

http://www.dhs.wisconsin.gov/dsl_info