DDES INFO MEMO 2005-06
June 17, 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
Tribal Chairpersons
Facilities for the Developmentally Disabled
From:
Sinikka Santala, Division of Disability and Elder Services
Administrator
Mark Moody, Division of Health Care Financing
Administrator
Re:
ICF-MR Restructuring Initiative
Wisconsin's ICF-MR Restructuring Initiative is one of the long-term
programs advanced by the Doyle Administration that provides people with
developmental and physical disabilities and the frail elderly with the
opportunity to relocate from institutions into the community. We
appreciate the county support towards these community integration
initiatives. We also appreciate the willingness of counties to work with
the Department in identifying and resolving issues associated with these
initiatives.
Counties have raised legitimate concerns about the ICF-MR
Restructuring Initiative; many of which are focused on funding and the
adequacy of the rates the State would pay for people who relocate into
the community. We agree with counties that the initiative should not add
a burden to the county tax levy.
The ICF-MR Initiative was designed to allow funding that was used to
support people in institutions to follow a person into a more integrated
community setting. Based upon the cost of serving people under the CIP
1B program, we assumed that the funding available for institutional care
would be sufficient to support people either in an institution or in a
more integrated community setting.
Our original plan was to provide counties with benchmark rates for
people who relocate into the community. These benchmark rates were based
upon the cost to the state of serving people in an institutional
setting. Our assumption was that counties could use savings from care
plans that cost below the benchmark rates to support care plans that are
above the benchmark rates, or to support other people who are eligible
for the CIP 1B program. We also proposed to designate a "high cost
client fund" to support care plans that cost above the benchmark
rates. Based on feedback from counties, we have decided to modify the
method of funding community care plans. Our new approach will be to
fully fund the cost of community care plans for people who relocate into
the community under the ICF-MR Restructuring Initiative.
Rates for Community Care
Rather than providing counties with benchmark rates, the Department
will fund the cost of approved community care plans. While this means we
will fund care plans that exceed the previously identified
"benchmark rates", it also means that we will fund care plans
that are below the benchmark rates at the actual expected cost of the
care plan. We project that there is sufficient funding in the budget for
this initiative in the 2005-07 biennium to fully support the cost of
care plans for people who relocate during this period. To accomplish
this we need to assure that the community care plans are cost effective.
Community Integration staff from the Department will be working with
each county in the development of cost-effective care plans. We will
also be reviewing expenditures for each person who relocates to
determine the amount of ongoing funding that is needed to support him or
her in subsequent years. For example, some care plans include funding
for one time expenditures that do not need to be included in base
funding for future years.
Death of a Resident
We previously indicated that our intent was to allow the county to
use the funding that would have supported that person in the institution
who resided in an institution at the time of his or her death to either
fund new people that the court might place in the institution or to
support the cost of care of other people served under the CIP 1B
program. Because we will fund actual care plan costs, we will not be
providing funding related to the death of an institutional resident to
support people under the CIP 1B program. However, the funding will be
available to support new people in institutions should the court find
that the institution is the most integrated setting.
When an individual dies after being relocated to the community, and
was served in the community under this initiative, funding will remain
with the county to serve other people under the CIP 1B program. However,
when a person dies in the community the amount of funding that will be
built into the county's CIP 1B base will be the original benchmark rate.
We believe this is appropriate because the cost of care plans for people
who never resided in an institution are lower than the cost of care
plans for people who have relocated from an institution.
No Active Treatment Determinations
We understand that some counties may seek a no active treatment (NAT)
determination for people currently residing in institutions with a DD
level of care determination. In some cases the county may seek to have
such a person transfer to a nursing facility. If this occurs, the
funding that previously supported the person in an institution will be
needed to support them in a nursing facility. Therefore, no funding will
be available to transfer to the CIP 1B program if this occurs. However,
if the person who receives a no active treatment determination is
relocated to the community, funding will be provided to the county under
the CIP II program to support their community care costs. As with other
people served under the Initiative, we will support the cost of their
care plan under CIP II.
County Responsibility for the Cost of Institutional Care
The original plan under the ICF-MR Restructuring Initiative was to
charge counties for the state share of institutional costs if the days
of institutional care exceeded the county's base level (annualized level
of days based on the population in institutions on December 31, 2004).
We have decided to not implement this component of the initiative until
Calendar Year 2006. For Calendar Year 2005, the Department will pay
institutional providers from the budget provided for this initiative and
counties will not be charged if they exceed their base level of
institutional days. We will monitor institutional days and will provide
counties with reports to help them plan for assuming this responsibility
in Calendar Year 2006.
Cost of Preparing Community Care Plans
We hear the concern raised by counties regarding the cost that
counties are incurring in preparing community care plans for people
residing in institutions. We are working on developing a mechanism to
help defray this cost. We will continue to work with you and keep you
informed of our progress in this area.
We want to thank you again for your willingness to work with us to
make sure this initiative works for the people with developmental
disabilities, as well as for the counties and the state.
CONTACT INFORMATION:
Chuck Wilhelm, Director
Bureau of Long-Term Support
1 W. Wilson St., Rm. 418
Madison, WI 53703
wilheca@dhfs.state.wi.us
MEMO WEB SITE:
http://dhfs.wisconsin.gov/partners/local.htm
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