DDES INFO MEMO 2005-03
March 18, 2005
To:
Area Administrators/ Human Services Area Coordinators
Bureau Directors
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
Facilities for the Developmentally Disabled
FROM:
Sinikka Santala, Administrator
Division of Disability and Elder Services
Mark Moody, Administrator
Division of Health Care Financing
RE:
ICF-MR Restructuring Initiative
The Department is very pleased to be working in partnership with
counties to implement the ICF-MR initiative. This initiative builds on
Wisconsin's long-standing and strong commitment to improve access to
community-based care for individuals with disabilities. The initiative
will further the important goal of reforming the long-term care system
in a way that realigns long-term care resources to respond to consumer
choices and achieve improved system cost-effectiveness.
The purpose of this letter is to describe the financial policies and
procedures that will be used for the
ICF-MR Restructuring Initiative. The Department has designed the
financing of this initiative to achieve the following goals:
- Create incentives for cost-effective care plans to stimulate the
maximum number of relocations of institutional residents into more
integrated community-based settings.
- Encourage counties and providers to act promptly to move people to
settings that meet the needs and reflect the preferences of
individuals.
- For ICFs-MR that will be closing, facilitate expeditious and
orderly closings.
At the state level, we must stay within our budgeted funds. For this
reason we intend to administer the funding provided for 1) institutional
placements; 2) community placements; and 3) facility downsizing
agreements as one program and one integrated budget.
Institutional Placements
Department staff have worked with counties and institutional
providers and have identified about 1,500 people who will be affected by
this initiative. The Department will determine an institutional
allotment for each county based upon the number of people the county had
in institutions on December 21, 2004, and the cost of care in the
institutions. If a resident remains in the institution, we will deduct
the cost of the institutional care from the institutional allotment.
However, if a county incurs days of care in excess of their
institutional allotment, the county will be responsible for paying the
non-federal share of these expenditures.
Facility Phase Down Payments
Some funding will be made available for phase down payments when
facilities close. These payments will be made to institutions to assure
an orderly and appropriate transition of people from the institutions
into the community. The Department will be negotiating phase down
agreements with institutions. Counties will be involved in discussions
about the appropriate length of phase down agreements.
Community Placements
Benchmark Levels
The Department is establishing "benchmark" reimbursement rates
by level of care. These benchmark levels are:
$ 140 per day for people at the DD1A and DD1B levels of care.
$ 124 per day for people at the DD2 level of care.
$ 82 per day for people at the DD3 level of care.
State High-Cost Fund
The Department will maintain and administer an ICF-MR relocation
"high-cost fund". This fund will be composed of funding for
new CIP IB placements provided in the budget bill and other savings
generated under the initiative.
Payments to Counties
The Department will be reviewing with the county the proposed care plan
for each relocation and will be working with the county to design care
plans that meet a client's needs and reflect the client's preferences in
a cost-effective manner.
A county will receive the benchmark reimbursement rate for any
relocation with a care plan that costs less than the benchmark level.
For individuals whose care plan cost is greater than the benchmark
level, a county may request from the Department high-cost fund
supplementary funding above the benchmark level to cover the full cost
of the care plan. The Department will review the request, including the
care plan, and will provide additional funding:
- if it is justified,
- if county savings from previous relocations in which the care plan
cost was less than the benchmark level are insufficient to cover the
higher cost, and
- if funding is available in the high cost fund.
Priority will be given to plans for people relocating from
institutions in the process of closing.
The funding provided to counties for community placements will be
available to support allowable expenditures under the CIP 1B program.
Therefore, any funding provided to counties under this initiative that
is not used to support those people who were relocated is available to
support other allowable expenditures under the CIP 1B program.
Legal Issues
The initiative contains new legal procedures that the county and
court must follow to assure that people with developmental disabilities
live in the most integrated setting. We have provided information to
counties and will be providing training to Guardians Ad Litem and the
Courts on these new procedures.
We recognize and appreciate the critical role counties will play in
this initiative. We look forward to the prospect of working together to
advance this significant long-term care reform initiative.
CONTACT INFORMATION:
Chuck Wilhelm, Director
Bureau of Developmental Disability Services
1 W. Wilson St., Rm. 418
Madison, WI 53703
608-266-8402
Wilheca@dhfs.state.wi.us
MEMO WEB SITE:
http://dhfs.wisconsin.gov/partners/local.htm
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