Administrator
Re: Community Integration Program 1B (CIP 1B) Funding for People
Relocated From County Owned Facilities
This memo provides information regarding a statutory change included in
the 1997-99 Biennial Budget. Statutory language authorizing CIP 1B is
found in Chapter 46.278. A new section was added to this statute effective
October 14, 1997 which reads:
Section 1473. 46.278 (6)(f) of the statutes is created
to read: 46.278 (6)(f) If a county owns the institution or
intermediate care facility for the mentally retarded from which an
individual is relocated to the community under this section, in order
to receive funding under the program, the county shall submit a plan
for delicensing a bed of the institution or intermediate care facility
for the mentally retarded that is approved by the department.
Implementation Date
The implementation date is the date of this Info Memo. Any county
having made CIP 1B relocations (applicable to this statute) on or after
10/14/97 to the date of this Info Memo has 90 days from the date of this
memo to submit a bed delicensure plan to the Department (pages 2 and 3
describe the implementation process).
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Document Summary
This memo describes a statutory change affecting county owned
institutions and county human services agencies. The memo includes
the implementation process for delicensing a nursing home bed or
ICF-MR bed in order to obtain CIP 1B funding for a resident of that
county who relocates to the community.
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Background
The number of persons with developmental disabilities residing in
Wisconsin nursing homes and ICFs-MR remains at twice the national average.
Each year the Wisconsin Legislature allocates funds for a limited number
of CIP 1B relocation slots to assist individuals to move from these
facilities to community settings. Unlike the CIP 1A program, where a bed
must close in one of the State DD Centers each time a person moves to a
community setting, non-state operated nursing homes and ICFs-MR have been
able to admit new persons to vacated beds. Expanding community capacity
without a concomitant reduction in institutional capacity results in an
overall increase in Medicaid expenditures as overall long-term support
system capacity expands by an amount equal to the new CIP 1B slots.
The purpose of the new statute is to initiate a transfer of resources
from institutions to the community. This is accomplished by encouraging
county human services agencies and county institutional providers to work
together to reduce the number of institutional beds used for persons with
developmental disabilities in publicly owned facilities. The statute is
applicable only to county owned facilities. The statute does not apply to
privately operated nursing homes or ICFs-MR. Counties will thus be
operating in a manner similar to the Department when it closes DD Center
beds by transferring capacity from institutions to the community.
Under What Circumstances Must a County Close an Institutional Bed?
If a county owns a nursing home or ICF-MR and plans to use CIP 1B
funding to relocate a person for whom that county has responsibility,
a plan for a bed to be delicensed from the facility must be submitted to
the Department for approval per the process described below.
If the person’s county of responsibility is different than the county
which owns the facility, a plan for the bed closure is not
required, and CIP 1B funding, if available, may follow the person to the
community.
When a person from the community enters a facility for short term care
or for a rehabilitative stay of up to 90 days with an intent to return to
a community placement, the facility does not need to close a bed when the
person leaves. Such a person may also be eligible to obtain a locally
matched CIP 1B diversion slot, depending upon program and funding
eligibility as determined by the county.
Bed closure is not required for current CIP 1B participants who enter a
facility. In such cases, the county may either maintain or reserve that
person’s CIP 1B slot for the person to return to upon discharge or can
replace that slot with another at their discretion.
Process for Implementing s. 46.278 (6)(f)
Counties must take the following actions to obtain a CIP 1B slot for a
county resident relocated from the nursing home or ICF-MR owned by that
county.
1. Submit a letter signed jointly by an authorized representative of
the county human services agency contracting with the Department for CIP
1B funds and the administrator of the county owned nursing home or ICF-MR,
as applicable, to:
Bureau Director, DSL/BDDS, P.O. Box 7851, Madison, WI 53707-7851.
Include in the letter:
a. the name of the person(s) being relocated for whom CIP 1B funding is
needed;
b. the name and license number of the institution from which the
person(s) is/are being relocated;
c. the anticipated date (start date) the person(s) will be relocated to
the community with CIP 1B funds;
d. a statement acknowledging that the human services agency and the
facility are aware that the delicensed bed will no longer be available to
the facility after the effective date approved by the Department;
e. the planned date of bed closure. In order for the county to receive
a state funded CIP 1B slot the bed must close on the date the person
relocates to the community*; and
f. if the bed closure will be a nursing facility bed instead of an
ICF-MR bed, the county agency administering CIP II must also sign a
statement agreeing to the conversion of the closed bed to CIP 1B instead
of CIP II as would normally occur for a nursing facility bed closure.
* If the facility needs additional time to plan for an orderly
reduction in bed capacity and associated revenue reductions, the facility
may request an extension by describing how this orderly bed reduction will
occur. The extension may not be greater than six months from the date the
person relocates to the community. CIP 1B funding during the extension
period can be secured through a county matched CIP 1B diversion slot or
through a state matched CIP 1B diversion slot (if available). Planning for
the extension will require coordination and cooperation between the county
human services agency and the facility to determine such details as slot
availability and local funding match source availability. The extension
period slot will return to the state when the bed closes at which time the
county will be given a permanent state funded CIP 1B slot. If the bed is
not closed by the approved date, the use of the CIP 1B slot will be
rescinded and the county will repay all state match costs associated with
that slot from the relocation date.
Department Review
The Department will review the county’s plan to delicense the bed and
will approve the request in writing if the criteria in 1. a.-f. above are
met. If the criteria are not met the Department will return the request to
the county indicating what elements of the plan are not complete. CIP 1B
relocation funding is not available to the county until an approved plan
is received by the Department. When the person’s CIP 1B service plan
packet is submitted to the Bureau of Developmental Disabilities Services (BDDS)
Community Integration Specialist assigned to the county, the county human
services agency must attach a copy of the Department’s approval letter.
Amending the Facility License
Prior to the Department approved bed closure date, the facility shall
follow the existing process for delicensing beds by writing:
Provider
Regulation and Quality Improvement Section
Bureau of Quality Assurance (BQA)
P.O. Box 309
Madison, WI 53701
BQA will review the information and, as
appropriate, issue an amended facility license.A facility which does not close a bed by the approved date may be
subject to the equivalent delicensing of any vacant beds.
CENTRAL OFFICE CONTACT:
Tom Swant, Community Integration Specialist
Division of Supportive Living
Bureau of Developmental Disabilities Services
1 West Wilson Street
P.O. Box 7851
Madison, WI 53707-7851
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