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STATE OF WISCONSIN
Department of Health Services
DLTC Numbered Memo Series 2009-07
Division of Long Term Care
Date May 14, 2009
Index Title:
New Preadmission Requirements Use of COP/COP-W/CIP II in CBRFS
Supersedes DSL Memo Series
2002-25, in part. (The First of
The Five Conditions for Use of
Funds in CBRFs is Repealed.)
To: Listserv
For: Aging and Disability Resource Center Directors
Area Administrators
Human Service Area Coordinators
County COP Contacts
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
Human Service Area Coordinators
Long Term Support Planning Committee Chairs
Tribal Chairpersons/Human Service Facilitators
DLTC Bureau Directors
DLTC Section Chiefs
From: Fredi-Ellen Bove
Interim Administrator
Subject: Use of COP/COP-W/CIP II Funding in Community Based Residential
Facilities (CBRFs)
Document Summary
2007 Wisconsin Act 20 (the 2007 - 2009 state budget bill) included
significant changes to the pre-admission requirements for the use of COP, CIP II
and COP-W in Community Based Residential Facilities. The changes include the
repeal of the first of the "five conditions" that must be met prior to
CBRF admission in order to use COP, CIP II or COP-W funds (Chapters 46.27 (7) (cj)
3 (a) and 46.277(5) (e) (1n. a.) The budget bill also amended Chapter 50
directing the Department to establish requirements for facility operators,
mandating the referral of prospective residents to the appropriate local county
waiver agency or ADRC (Chapter 50.02(2) (d) 1.), as applicable. The legislation
further required that the Department provide direction as to the agency response
to the referral from the CBRF. This memo will address the changes made to the
CBRF preadmission requirements as they apply to COP, CIP II and COP-Waiver
agencies and local ADRCs. The memo outlines the new requirements and timelines
that must be followed as a result of these statutory changes. The changes
discussed below do not apply to the Family Care, IRIS, CIP 1A/1B or BIW
programs.
This memo focuses on local agency responsibilities under the revised
statutes. More specific instructions for CBRF operators as to the new
requirements under Chapter 50 will be communicated to facility operators by the
Division of Quality Assurance. Aging and Disability Resource Centers will
receive additional direction via an upcoming Resource Centered bulletin from the
Office for Resource Center Development.
- Previous Statutory Conditions for the Use of COP, CIP II or COP-W in
CBRFs
Criteria established in 1997 and included in s. 46.27 (7) (cj) 3. (a.)
outlined five conditions to be met prior to the use of COP, CIP II or COP-W
funds for CBRF admissions. It was the intent of these provisions to assure
that the Community Options Program and Medicaid Waiver funds were primarily
employed to support and maintain persons in their own homes. The criteria
sought to assure that prospective CBRF residents were fully informed of all
community based services available prior to making a decision to enter a
CBRF.
The previous criteria included the following five conditions:
1. A pre-admission assessment or consultation has been completed prior to
the person's admission to the CBRF, regardless of the individual's ability
to pay;
2. The option of in-home services has been thoroughly explored and
determined to be infeasible;
3. The CBRF is the person's preferred residence;
4. The CBRF provides a quality environment and quality care services
5. The CBRF is cost effective compared to other options
While the intent of the law was to assure all other feasible options were
explored prior to a decision to move to a CBRF, the preadmission
assessment/consultation (PAC) requirement had the practical effect of
negatively impacting residents who may not have received the consultation.
Persons who independently chose to move to a CBRF and who had not received
the PAC were subsequently ineligible to receive COP or waiver funds in their
chosen living arrangement.
- New Statutory Requirements
The 2007 - 2009 state budget bill (2007 Wisconsin Act 20), repealed the
first of the five conditions requiring the PAC. The repeal means that the
PAC is no longer required before COP, CIP II or COP-W funding may be used.
However, the other four conditions remain. This means that the waiver
agencies must continue to document that those four criteria have been met
before COP, CIP II or COP-W funding for CBRF services may be used.
In addition, the legislation amended Chapter 50 introducing new requirements
to the admission practices of the affected CBRFs and also amended Chapter 46
impacting the operations of county waiver agencies and ADRCs, as applicable.
Further, the legislation directed the Department to establish requirements
for CBRF operators to meet in the referral of prospective residents to local
agencies/ADRCs, as well as time frames within which the local agencies must
respond to such referrals.
CBRF Operator Responsibilities: The new conditions require
that when CBRF operators first provide written information about the
facility to a prospective resident who is at least 65 years of age or has a
developmental or physical disability and whose disability or condition is
expected to last at least 90 days, the facility operator is required to make
a referral to the county human service agency that administers the
COP/waiver programs or to the appropriate ADRC. (See s. 50.035 (4n).) While
requiring the referral of most prospective residents, the statute exempts
certain individuals. Persons who are seeking admission for respite and
persons who are members of a care management organization are not required
to be referred. All other prospective residents should be referred to the
county waiver agency/ADRC.
To meet the new requirements, CBRF operators must make a referral using
the DQA F-62493 form (See Attachment 1 below) to the local county waiver
agency or to the ADRC, located in or serving the person's county of
residence, as applicable. The form contains facility information and
individual contact information. The form also offers the opportunity for the
prospective resident to "opt out" of any agency or ADRC follow-up
contacts. This means that while facilities must make a referral and
designated agencies must accept and respond, prospective residents may
choose to decline a follow up contact from the agency/ADRC. In cases where
the prospective resident has indicated they wish to "opt out" of
the agency/ADRC follow up contact, the CBRF must still send the referral.
In counties with operating ADRCs, the facility operator should also include
ADRC contact information in the facility information provided to prospective
residents (See Attachment 2 below.) Finally, facilities are required to
establish and maintain a record of all PAC referral forms completed.
County Waiver Agency/ADRC Responsibilities: In counties where
there is a County Department of Human Services or another county department
providing COP and Medicaid waiver services and there is no operating ADRC,
the county waiver agency is responsible for accepting and responding to the
CBRF pre-admission referrals. In counties where both an existing
waiver agency providing COP, CIP II or COP-Waiver services and an ADRC are
concurrently operating, the county waiver agency and the ADRC must designate
which agency will accept and respond to the required CBRF referrals. It is a
local decision as to which agency is most appropriate to respond to facility
referrals and provide the required counseling. The designated agency must
inform all facilities within its service area of this designation and supply
written local contact information (e.g., a pamphlet, fact sheet, etc.) to
facility operators to provide to prospective residents.
Note: In counties where managed care is available, the ADRC is
responsible for accepting and responding to the CBRF referrals.
Agencies are reminded that while CBRFs must refer most prospective
residents, these persons have the option to request that they not receive a
follow up contact. If the prospective resident does not "opt
out" of the agency/ADRC follow up, the designated agency must contact
the prospective resident within five business days. The initial
follow up contact must be direct, by telephone or in person and may not
solely consist of a letter or e-mail sent to the prospective resident. The
content of this contact shall include an offer of counseling, as required
under s. 46.27(5) (j)) or Article IV (D) (3), ADRC contract, respectively.
The counseling provided shall consist of Long-Term Care Options Counseling,
the content of which will inform and advise the person concerning all of the
following:
- The availability of any long-term care options open to the
individual, including home care, community services, case management
services, residential care and nursing home options.
- Sources and methods of both private and public payment for long-term
care services including COP, CIP II/COP-W and, where available, managed
care, and the IRIS waiver program.
- Factors to consider when choosing among available programs, services
and benefits, including cost, quality, outcomes, estate recovery and
compatibility with the person's preferred lifestyle and residential
setting.
- Advantages and disadvantages of the various options in light of the
individual's situation, values, capacities, knowledge and resources and
the urgency of the individual's situation.
- Opportunities and methods for maximizing independence and
self-reliance, including the utilization of supports from family,
friends and the community.
While the designated county waiver agency or ADRC must make the offer of
options counseling within the prescribed five business day time frame, when
contacted, the prospective resident may decline the offer. If the offer of
options counseling is accepted, the agency should then meet with the person,
at a location preferred by and at a time convenient to the prospective
resident within ten business days. The ten day time line may be
extended if the prospective resident requests such a delay.
In the event the designated agency is unable to make a direct contact with
the prospective resident within the initial five working day time frame, the
agency must send a written offer of options counseling to the person. If
there is no response to the agency's written offer after 20 calendar days,
the county waiver agency/ADRC should document the post-referral contact
attempt. Documentation of all referrals received and all contacts
made/attempted in response to CBRF referrals should be maintained by the
agency.
Current Program Participants and Repeat Referrals:
If the prospective resident referred by the facility operator is currently a
waiver program participant and the waiver agency is not assisting in the
admission, the local waiver agency should contact the participant and
address his/her decision to explore CBRF admission. Should such an admission
be pursued, the agency is reminded that it must assure that the preadmission
criteria under s. 46.27(cj) are met before COP, CIP II or COP-W funds may be
used.
There may be persons who contact more than one facility over a period of
time which may trigger multiple referrals to the designated agency. If the
prospective resident referred by a CBRF has been referred to the designated
agency/ADRC for counseling at any time in the previous six months and the
appropriate, required follow up has occurred, the agency need not make
another follow up contact unless the prospective resident requests it.
- Summarizing the New Preadmission Requirements:
While significant changes to the law were made as a result of the passage of
the 2007-2009 Budget Bill, the overall intent remains unchanged. By
establishing conditions that must be met prior to CBRF admission, the
legislature has reaffirmed that the community-based long-term care programs
are intended to provide funding for services for persons to remain in their
own homes. The conditions placed on CBRFs requiring notice to local waiver
agencies or ADRCs and the subsequent response required are intended to
assure that prospective CBRF residents receive all of the information
necessary to make an informed decision.
Changes to the preadmission and referral requirements - in brief:
· The first of the "five conditions" has been repealed.
· The remaining four conditions must continue to be met and
documented before COP, CIP II or COP-W funds may be used for CBRF services.
· Local waiver agencies and ADRCs must designate which agency is to
receive the preadmission referrals and notify CBRFs in their service area of
the designation.
· CBRF operators must refer prospective residents who are not
exempted to the designated local agency when they provide written
information to these person(s).
· The designated local county waiver agency or ADRC must respond to
the CBRF referral and within five business days, contact prospective
residents who have not "opted out" to offer counseling.
· The prospective resident may decline the offer.
· If the offer of counseling is accepted, the agency/ADRC should
meet with the prospective CBRF resident within ten calendar days.
· Agencies should maintain documentation of all referrals received
and all follow up contacts made/attempted in response to facility referrals.
- Medicaid Waiver Manual Update
Direction to waiver agencies to implement the policies described in this
memo will be incorporated into the Medicaid Waiver Manual in 2009. See
Chapter 5 of the manual for additional information and instruction as to the
requirements related to the use of funds in substitute care settings.
REGIONAL OFFICE CONTACT:
Human Service Area Coordinators
CENTRAL OFFICE CONTACTS:
Kevin Lafky, Community Options Section
Bureau of Long Term Support
P.O. Box 7851
Madison, WI 53707-7851
Phone 608 266-7754
kevin.lafky@wisconsin.gov
Carrie Molke, Office for Resource Center Development
Bureau of Aging and Disability Resources
P.O. Box 7851
Madison, WI 53707-7851
Phone 608 267-5267
carrie.molke@wisconsin.gov
Attachment 1: DQA PAC Referral http://www.dhs.wisconsin.gov/forms1/F6/F62493.doc
Attachment 2: PAC Information Brochure http://www.dhs.wisconsin.gov/ltcare/adrc/professionals/programsservices/pac.htm
cc: Area Agencies on Aging
Board on Aging and Long Term care
COP/LTS Statewide Advisory Committee
County/Tribal Aging Units
DQA Administrator
DQA Bureau of Assisted Living Director
DQA Regional Field Operations Supervisors
Disability Rights Wisconsin
Independent Living Centers
Residential Services Association of Wisconsin
The Management Group (TMG)
Wisconsin County Human Services Association (WCHSA)
Wisconsin Assisted Living Association (WALA)
Wisconsin Association of Homes for the Aging
Wisconsin Health Care Association
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