DLTC Numbered Memo 2011-06
DMHSAS Numbered Memo 2011-09
DLTC / DMHSAS Numbered Memo Series index page
State of Wisconsin
Department of Health Services
Division of Mental Health and Substance Abuse Services
Date: Nov. 10, 2011
DLTC Numbered Memo 2011-06
DMHSAS Numbered Memo 2011-09
Policy and Procedure for Assignment of Responsibility with Regard to Residency for People Participating in Adult
Long Term Care Programs in Wisconsin
Aging and Disability Resource Center Directors
Area Administrators/Human Service Area Coordinators
County Aging Units/Directors
County COP Contacts
County DD Coordinators
County Department of Developmental Disabilities Services Directors
County Department of Human Services Directors
County Department Income Maintenance Unit Directors
County Department of Social Services Directors
County Departments of Community Program Directors
County Elder Adults-at-Risk (Elder Abuse) Agency Contacts
County Waiver Contacts
DLTC Bureau Directors
DLTC Section Chiefs
Family Care Managed Care Organizations
IRIS Contract Agencies
Long Term Support Planning Committee Chairs
Pris Boroniec, DLTC Administrator
Linda A. Harris, Administrator, Division of Mental Health and Substance Abuse Services
Subject: Policy and Procedure for Assignment of
Responsibility with Regard to Residency for People Participating in Adult Long
Term Care Programs in Wisconsin.
This document establishes the policy and procedures for determining county of
residence when a person participating in a long term care program in Wisconsin
moves among counties within the state, including the role and responsibility of
long term care program entities (Managed Care Organizations, Waiver Agencies,
Independent Consultant Agency, Aging and Disability Resource Centers) regarding
the provision of services and funding. It is the intention of the Division of
Long Term Care (DLTC) that any person who receives long term care services
funded through any of its long term care programs be able to experience
continuity of care and freedom of choice when legally acceptable. The attached
instructions are applicable for all adult long term care programs in all
Wisconsin counties (i.e., Brain Injury Waiver, CIP Waivers, COP Waiver, Family
Care, Partnership, PACE and IRIS, as well as Aging and Disability Resource
The Department has previously provided direction to counties regarding
residency determination and the responsibility of long term care programs when a
person moves between counties in Wisconsin as it relates to long term care
programs and Family Care expansion in the following documents: OSF Memo May 23,
2002, DDES Memorandum January 2, 2007, and Managed Long Term Care Expansion
Planning Information #6 February 26, 2008. The release of this memo rescinds all
previous memos and information referenced above.
The Department of Health Services provides policy guidance on residency
determinations in DDES Memo 2007-01. The Residency Manual (available at: http://www.dhs.wisconsin.gov/dsl_info/NumberedMemos/DDES/CY2007/NMemo2007-01.htm)
is statutorily based and is the basis for decision and guidance of the policy
and procedures defined in this memo, and as such will remain in force after the
effective date of this memo.
Aging & Disability Resource Centers (ADRC): Aging and Disability
Resource Centers (ADRC's) under contract with the State and in agreement with
county and tribal governments provide accurate, unbiased information on all
programs related to aging or living with a disability.
Arrange or Make Placement: "Arranges for" means to perform
any action beyond providing basic information concerning the availability of
services, facilities, or programs in a county to an individual or the
County of Responsibility: The county responsible for the provision of
services under Chapter 46, 48, 51, 54, or 55 to an individual. The State
contracts require the ADRC, MCO, IRIS consultant agency (ICA), and county waiver
agencies to provide services to the residents of the counties in which they
operate as provided in State Statute.
Emergency/Emergent Services: Services determined necessary under
Chapter 51 and 55.
Income Maintenance Definition of Residency: The county in which the
person is physically located except when a person is placed by the county or
long term care agency. If the person is placed by the county or long term care
agency, the IM case remains with the county of residence and responsibility.
IRIS Consultant Agency (ICA): The IRIS Consultant Agency helps IRIS
participants with planning for goods, services, and supports.
Legal Residence/Residency: The voluntary concurrence of physical
presence with intent to remain in a place of fixed habitation. This is explained
in further detail in DDES Numbered Memo 2007-01 http://www.dhs.wisconsin.gov/dsl_info/NumberedMemos/DDES/CY2007/NMemo2007-01.htm.
Confusion has arisen in the use of the terms "move" and "change
in residency". Change in responsibility will occur when residency changes
not necessarily when a person moves. Change in residency does not always occur
when a person moves to another county or when the care plan requires the person
move to another county for specific services.
Long Term Care Program: All of the long term care programs
administered by DLTC including: Brain Injury Waiver, CIP Waivers, COP Waiver,
CLTS Waivers, Family Care, Partnership, PACE, and IRIS.
Managed Care Organization (MCO): An entity that the Department has
contracted with to provide the services within the benefit package to members.
These entities include Family Care, Partnership or PACE programs.
Natural Residential Setting: for the purposes of this policy, a person
living with others must:
- be paying a proportionate share of the household expenses, including food,
rent or mortgage, property taxes and utilities other than telephone; or
- have an ownership interest in or pay rent for his or her housing; or
- buy food separately or pay his or her share of food costs. (This
requirement does not apply to children under 18 residing with a parent or
people residing with a spouse.)
A residence is not qualified as a natural residential setting if it requires
certification as an Adult Family Home or licensure under Wisconsin Statutes
Chapters 48 or 50.
Permanent: Established by the person's stated intent to remain
voluntarily in a place of fixed habitation, with no stated conditions, as
further defined in the Residency Manual http://www.dhs.wisconsin.gov/dsl_info/NumberedMemos/DDES/CY2007/NMemo2007-01.htm
Person: Any member of an MCO, a customer of an ADRC, a participant of
the CIP/COP/BI/IRIS Waiver Program; this also includes guardian of the person.
Placed: Except for the provision of emergency services, if a county or
long term care program agency places or makes arrangements for placement of an
individual into a facility or residential setting; the originating county is the
person's county of residence. Placement of an individual in a facility or
residential setting outside the jurisdiction of the originating county does not
transfer the individual's legal residence to the county in which the facility or
residential setting is located.
Placed under Legal Authority: Admitted to a facility or living
arrangement by virtue of a protective placement, mental health commitment, or
consent of a court appointed guardian.
Plan of Care: The document established by the program or agency
responsible for an individual's care and treatment, for example the Individual
Service Plan, Member Centered Plan, or IRIS Support and Service Plan to which
the person or guardian has agreed and signed.
Temporary: Anything other than permanent; short term.
Voluntary: According to the person's free choice, if competent, or by
choice of a guardian if incompetent (the guardian's right to change residency is
limited by Chapter 51.40 (2) (f)).
Venue: The legally proper or most convenient place where a particular
case should be handled. Venue is not synonymous with either residency or
responsibility. Venue is retained by the court in which it has been established
unless a change of venue has been enacted. The court has its own rules about
requesting and approving a change of venue.
- A Wisconsin resident who is eligible for long term care programs may
enroll in the long term care programs available in his or her county of
- If a Wisconsin resident establishes residency permanently outside of
Wisconsin, he or she will not be eligible to continue in Wisconsin long term
care programs until he or she returns to Wisconsin and once again
establishes residency according to the State's definition. If a long term
care agency arranges for and makes placement for a person under an approved
plan of care in a living arrangement outside the State of Wisconsin to best
meet his or her needs, the county of residence does not change; the long
term care agency remains responsible for the care, oversight, and funding of
services. When a state or state-contracted agency makes the placement, the
state making the placement is the person's Medicaid residence.
- If a Wisconsin resident moves to a long term care facility or living
situation in another county in Wisconsin under a plan of care approved and
funded by the long term care agency, he or she remains a resident of the
county of which he or she was a resident prior to the placement; the long
term care agency retains responsibility to find and fund the delivery of all
necessary long term care services. The long term care agency continues to
provide care management and oversight of the services delivered to the
- When residency changes, or when a competent individual or a
court-appointed guardian of an individual in a natural residential setting
states voluntary intent to change residency, staff working to support people
in long-term care should work collaboratively and creatively to assure the
best possible continuity of care for the person. It is expected there will
be no lapse in coverage and all parties will act in good faith to transfer
responsibility in a timely manner. If services in the new county of
residence cannot start as soon as the person moves, the long-term care
program currently serving the individual should offer to extend enrollment
and funding temporarily after the move so there is no lapse in services to
- If a Wisconsin resident is enrolled in a long term care program and
voluntarily establishes residency in another county, the person has a right
to receive long term care program services that may be available in the new
county dependent on program eligibility.
- If a Wisconsin resident is temporarily out of the county or state in which
he is she is a resident (i.e., spends the winter in a warmer climate,
attends college, is in a hospital for treatment, is in a skilled nursing
facility for rehabilitation, is in a crisis bed waiting for a home or
apartment, is in a half-way house or homeless shelter), the person remains
the responsibility of the county in which he or she is a resident, not the
county where he or she is temporarily staying, except for emergency services
under Chapter 51 or 55 (i.e., mental health or adult protective services).
Guiding Principles and Best Practices
- Good care management practice means being aware of and discussing with
individuals their outcomes, desires, and intentions. This includes interest
in resources and opportunities outside the service area and potential
changes in residency. Therefore, agencies that provide good care management
should never be surprised by an individual making such a request. A long
term care agency should neither feel they can not enlist resources outside
of the service area nor be required to contract with services outside the
service area. The essence of care management is meeting outcomes in the most
effective and cost effective way.
- These policies and procedures are intended to support and facilitate open
communication and collaboration between all long term care agencies and
county agencies including, Aging & Disability Resource Centers (ADRC),
Managed Care Organizations (MCO), IRIS Consultant Agency (ICA), county
waiver agencies, Adult Protective Services (APS), Mental Health/Substance
Abuse program agencies, and Income Maintenance (IM).
- It is understood that a person's long term care agency may arrange and
make placement under an approved plan of care in an out of county treatment
facility or living situation in order to meet the persons specialized needs
for care. Such placement does not constitute change of residency, nor does
it shift primary responsibility for care to the county where such a placed
person now lives or to long term care programs operating in this county.
Persons living in natural residential settings are generally not
"placed" by an agency when they move, unless the move was
initiated by an agency to access particular community resource or service.
Voluntary moves, with respect to residency determination, are governed by
statute; which states:
49.001(8) "Voluntary" means according to a person's free choice,
if competent, or by choice of a guardian if incompetent.
Therefore, a guardian who has consulted with a long term care agency about
moving his/her ward for good cause, and who has made it clear that it is the
guardian's intent to simultaneously change location from a natural
residential setting to a natural residential setting and establish
residency, the guardian essentially provides consent to a voluntary move.
Thus, residency changes as if the person independently made the move per the
When the guardian's intent is to relocate their ward from any setting to a
facility setting in another county, this involves the commitment of funds
the guardian does not completely control. Consultation with the current
long-term care agency, and perhaps other agencies, is necessary. Such a move
will generally constitute "placement by an agency. Residency and
responsibility would, therefore remain unchanged in a facility to facility
move unless some other process was used to alter it (i.e. 51.40(2)(f), or a
SNF relocation with intended residency change discussed with the respective
counties and care organizations, etc.)
- The State contracts require the ADRC, MCO, ICA, and county waiver agencies
to provide services to the residents of the counties in the service area in
which they operate as stipulated in State Statute.
- When residency changes or a competent individual states voluntary intent
to change residency, staff working to support people in long term care
should work collaboratively and creatively to assure the best possible
continuity of care for the person. It is expected that, if a person informs
the long term care agency from which he or she is currently receiving
services of the intent to move with sufficient lead time prior to the move,
there will be no lapse in coverage of long term care services and all
parties will act in good faith to transfer responsibility of support and
services to another program in a timely manner. If services in the new
county of residence cannot start as soon as the person moves, the long term
care agency should offer to extend enrollment and funding temporarily after
the move so there is no lapse in services to the individual. It is the
responsibility of the person and/or their guardian to notify the long term
care agency of intent to change residency.
These are general procedures that apply to all instances when residency may
change or there is a question regarding long term care agency responsibility.
Specific programmatic procedures follow in the attachments.
- The long term care agency currently providing services shall notify the
person or guardian via handbook or manual that any person who is planning to
establish permanent residency in another county is responsible to provide
advance notice to the long term care agency so the care manager and/or ADRC
can meet with the person to discuss the consequences of the change in
residency and the possibilities for services in the new county. The person's
care manager shall periodically remind people of this responsibility, such
as at the time of care plan review.
- A person who participates in a long term care program is responsible to
inform the agency currently providing long term care services well in
advance of an intent to move so that agencies involved will have the
opportunity to attempt to ensure continuity of care. If the person fails to
provide appropriate advanced notification, the identified policies and
procedures should be followed as soon as becoming aware of the situation.
- A person who participates in the long term care program may have
emergency/crisis needs. In keeping with Wisconsin Statute 51.15, and unless
covered by an inter-county agreement, the county where the emergency need
occurs will be responsible for the immediate protection of the person. The
long term care agency and crisis response agencies shall coordinate care to
assure development of response plans to appropriately address emergent
needs. Once the emergency is resolved, the agencies with responsibility for
the person's care will provide any necessary follow up care and treatment.
- The long term care agency currently responsible for the person's services
and supports is expected to contact the county to which a person may move or
be placed to assure notification of appropriate county agencies occurs, as
well as the sharing of any existing behavior or crisis support plans.
- Any discussion of a potential move from one county to another must at a
timely point involve the Income Maintenance agency. It is the responsibility
of the long term care agency to ensure that Income Maintenance staff is
informed so that necessary transfers can occur and Medicaid eligibility is
- The Long Term Care Functional Screen (LTC FS) may be transferred between
long term care agencies with signed consent from the long term care program
participant or guardian.
- In transferring care to new agencies with appropriate release of
information, the totality of the person's care plan should be shared and
coordinated. In addition, any medical needs and primary care coordination
should be addressed.
The following summary will be used as guiding principles in residency
determinations under s. 51.40 and s. 49.001 (6) and (8). Detailed Information
can be found at:
- Court ordered commitment, protective placement or protective services.
If a person is under a court ordered commitment under Chapter 51 or a
protective placement or protective services under Chapter 55, the person
remains a resident of the county where he or she resided at the time the
initial commitment or initial order is made, even if treatment needs require
relocation to a service or facility in another county.
- Placement by a County Department
A county department placing or making arrangements for placement of the
person outside of the county of residence does not transfer the person's
legal residence to the county in which the placement occurs.
- Placement by a Long Term Care Program Agency
A long term care agency placing or making arrangements for placement of the
person outside of the county of residence under an approved plan of care
does not transfer the person's legal residence to the county in which the
- Persons in State Facilities (State Mental Health Institute, Center for
the Developmentally Disabled, Prison, or Facility Operated by DHS)
A person who is in a state facility is a resident of the county in which he
or she was a resident at the time of admission to the state facility.
- Persons in Nursing Facilities
- A person admitted to a nursing home prior to December 1, 2006, is a
resident of the county in which they are physically present, i.e., the
county in which the nursing home is located, unless another county
accepts the person as a resident or the person has established residence
in another county prior to entering the nursing home with the intent to
return to that county.
- A person who is voluntarily admitted to a nursing home after December
1, 2006, is a resident of the county in which they are physically
present, unless the person has established residence in another county
prior to entering the nursing home with the intent to return to that
county. A person admitted to a nursing home under Wisconsin Statute
50.04(2r) is a resident of the county that recommended the admission via
signature on the F-20822 form.
- A person admitted under Wisconsin Statue 50.04(2r) after December 1,
2006, is a resident of the county which approved the admission. This
applies to a nursing home that is not certified as a provider of medical
assistance or that is an ICF-MR or an institution for mental disease.
These facilities may not admit a resident who has a developmental
disability or who is both under age 65 and has mental illness unless the
county department of the person's county of residency has recommended
- Clarification of Guardian role in Residency Changes
The guardian may declare county of residence under the conditions
identified in State Statute and the residency manual.
- Persons living in natural residential settings are generally not
"placed" by an agency when they move, unless the move was
initiated by an agency to access particular community resource or
service. Voluntary moves, with respect to residency determination, are
governed by statute; which states:
49.001(8) "Voluntary" means according to a person's free
choice, if competent, or by choice of a guardian if incompetent.
- Therefore, a guardian who has consulted with a long term care agency
about moving his/her ward for good cause, and who has made it clear that
it is the guardian's intent to simultaneously change location from a
natural residential setting to a natural residential setting and
residency, the guardian essentially provides consent to a voluntary
move. Thus, residency changes as if the person independently made the
move per the above definition.
- When the guardian's intent is to relocate their ward from any setting
to a facility setting in another county, this involves the commitment of
funds the guardian does not completely control. Consultation with the
current long-term care agency, and perhaps other agencies, is necessary.
Such a move would generally constitute "placement by an
agency". Residency and responsibility would, therefore remain
unchanged in a facility to facility move unless some other process was
used to alter it (i.e. 51.40(2)(f), or a SNF relocation with intended
residency change discussed with the respective counties and care
Process for Requesting a Change in Residency
Vital to any seamless transfer of care is good communication practices with
persons and their guardians as well as partner agencies. The following process
is available to guide agencies on the legal aspects of a transfer, assuming the
policies, guiding principals, and best practices outlined in this memo have been
followed. Good information, informed consent, and collaboration between agencies
are critical. Significant conversation with the individual and between
responsible agencies should occur to explore the viability of a change in
residency before any process is initiated. Any request for a change in residency
or venue must be initiated by the person and/or guardian; the convenience or
costs to a long term care agency should never be motivation for such a request.
Voluntary moves initiated by guardians of wards in natural residential
settings (see guiding principals and #6 above) do not necessitate an order to
change venue. While it may be more convenient to change venue to the new county
of residence, a guardian's authority is not compromised by retaining venue in
the original court. Guardians should be encouraged to discuss these matters with
the court of jurisdiction to maximize efficiency and convenience in their future
communications and reporting.
1. Guardians request to declare county of residence
- As required under Wisconsin Statute 51.40(2)(f), the guardian must submit
to the current court of venue a written statement indicating the desire to
establish residency in a new county and requesting that the ward's residency
and court of venue be transferred to the court in that county.
- The court may approve or deny the guardian's request based upon their own
rules for evaluating the merits of cases.
- For the purpose of this policy, a court-approved request to change venue
and declare county of residence will change the county of residence and
responsibility, as well as eligibility for long term care program agencies
operating in the new county of residence.
2. For persons placed under legal authority
- A request for change of venue should be directed to the court that
currently has venue.
- When a request for change in venue is submitted, the county to which venue
is being requested must be notified and may object.
- For the purpose of this policy, a change of venue approved by the court
will change the county of residence and responsibility for long term care
program agencies. Counties should be aware of these requests and carefully
consider these decisions with the court.
3. For persons who are "placed by a county or long term care program
agency" (see definition above)
- Once placed by a county or long term care program agency under an approved
plan of care, a person may not independently change residency. To change
residency requires agreement between the current county of residence and the
county in which the person wants to establish residency.
- An individual wishing to make such a change should contact the ADRC or
local county agency in the county of residence. The ADRC or county agency
will assist in connecting the person with the appropriate county staff. The
counties will jointly discuss the request and reach an agreement.
- If the agreement is to accept the transfer, a date should be established
and communicated with all parties so a simultaneous transfer can occur for
all programs involved.
Requesting a Residency Determination
- Counties or long term support agencies may first attempt to resolve
residency disputes informally.
- Counties, long term care agencies, or ADRCs may contact their regional or
assigned quality specialist with questions, concerns, or issues regarding
residency as specified below:
- MCO staff should contact the contract coordinator or member care
- IRIS Consultant Agency should contact the IRIS Program Manager
- ADRC staff should contact the regional quality specialist
- Waiver agencies should contact the assigned quality specialist or DHS
- Area Administration
- When a regional or assigned quality staff receives a question or request
regarding residency Area Administration or the Designated Department
Residency contact will be consulted as needed.
- The person or an interested person on behalf of the person, or any county
agency or long term care program agency may make a request to the Department
for a formal residency determination.
- The county should indicate whether the request is for s. 51.40 or an
administrative residency determination, if known. The Department decision is
considered final. Should a person be dissatisfied with the decision they may
appeal to the circuit court. Directions on how to make this formal request
can be found at:
REGIONAL OFFICE CONTACT:
County Waiver Agencies: Area Administration Regional Coordinator
Aging and Disability Resource Centers: Regional Quality Specialist
Managed Care Organizations: Contract Specialist
CENTRAL OFFICE CONTACT: DHS Residency Coordinator - 608-267-4867
MEMO WEB SITE: http://www.dhs.wisconsin.gov/dsl_info/
Last Revised: November 15, 2011