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DSL Memo Series 2002-25

Supercedes DSL 2000-05 – In Part
Replaces DSL 2002-02

January 2, 2003

STATE OF WISCONSIN
Department of Health and Family Services
Division of Supportive Living

To:
Area Administrators
Assistant Area Administrators
COP County Contacts
Community Based Residential Facilities
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
Long Term Support Planning Committee Chairs

From: 
Sinikka McCabe, Administrator

Re: USE OF COP/COP-W/CIP-II IN CBRFs

DOCUMENT SUMMARY

This memo summarizes statutory changes and provides implementation provisions related to facility size effective January 1, 2003 and conditions under which COP, COP-W and CIP II can be used in CBRFs. The memo requires that the five criteria for use of COP and COP Waiver funds in CBRFs be met when placing new individuals in CBRFs as of May 1, 2002.

The 2001-03 budget bill (2001 Act 16) made changes in the statutes (Attachment #1) related to the use of Community Options Program (COP-Regular), Community Options Program-Waiver (COP-W) and Community Integration Program II (CIP-II) funds in a Community Based Residential Facility (CBRF). This memo will summarize the statutory changes and provide implementation highlights. In addition, this memo details in Attachment #2 the policies that implement four statutory conditions, in addition to the pre-admission assessment requirement, for the use of COP-Regular, COP-W, and CIP-II in CBRFs. These conditions include: the infeasibility of in-home care, quality, cost-effectiveness, and preference.

  1. Summary of Changes

    2. Facility Size

    The new language authorizes counties to use COP-Regular, COP-W and CIP II funds to support residential services for individuals residing in licensed CBRFs with up to and including 20 beds without Department approval, and in facilities larger than 20 beds with Department approval. As a result of these changes, the Chippewa County Pilot is no longer needed and therefore the language has been repealed.

    Note: COP-W and CIP-II are waiver funds that are used to support people with physical disabilities and people who are elderly. The waiver allowable CBRF size changes, therefore, do not apply to participants who have a developmental disability, have a mental illness, or have long- term care needs due to alcohol or other drug abuse.

    County Established Maximum Total Amount of Funds Used for CBRF Care

    The new statutory language reiterates the ability of the Department to waive and/or approve a request for an exception when a county is at or over the established maximum amount of funds. The Department may waive or approve an exception in accordance with hardship conditions established under HFS 73.10 that require an individual to have a diagnosis of a terminal illness.

  2. Implementation Highlights

    1. Waiver Mandate
      2.

      Effective September 1, 2001, CBRFs with a licensed capacity up to and including 20 beds may now be waiver allowable settings for people who have a physical disability or who are elderly. In addition, CBRFs with more than 20 beds may be waiver allowable settings if the facility was licensed prior to July 29, 1995, or an individual resided in the CBRF prior to January 1, 1996. As found in the COP Guidelines (Chapter II, 2.04 L.), and the Medicaid-Waivers Manual (Chapter I, 1.04), COP-W and CIP II Medicaid Waiver funds must be used in lieu of COP-Regular funds to provide services to an individual whenever a service is waiver allowable. Residents residing in medium or large CBRFs PRIOR TO September 1, 2001, who were receiving COP-Regular funding, who are elderly or have a physical disability, must be screened for waiver eligibility and, if found eligible, they must be converted to the waiver for waiver allowable services.

    2. Human Services Reporting System
      3.

      The HSRS Long-Term Support Module Card and handbook material will be updated for 2002 to accommodate these changes.

    3. Five Criteria for the use of COP-Regular, COP-W, CIP-II funding in any size CBRF

      4. The Community Options Programs are home-care programs intended to provide assistance and support to individuals so that they can continue to live at home. Certain criteria were established and placed in statute in 1997 that outlined requirements for use of COP, COP-W and CIP-II funding in an out-of-home residential setting such as a CBRF. These conditions were created to ensure that the limited home-care funds are used in a manner that is consistent with the purpose of the program. These conditions include:

      • 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;
      • The option of in-home services has been thoroughly explored and determined infeasible;
      • The CBRF is the individual’s preferred residence;
      • The CBRF provides a quality environment and quality care services;
      • The CBRF is cost-effective compared to other options.

      Of the five conditions listed above, only the pre-admission assessment or consultation requirement has been implemented. The other four conditions were not fully implemented pending promulgation of an administrative rule that defined the method for determining when home care is "infeasible." This rule has been promulgated effective September 1, 2001 under HFS 73.11 (Attachment #3). Therefore all of the above criteria can now be implemented.

      The implementation policies and guidelines for these conditions can be found in Attachment #2. These statutory provisions must be met when placing new individuals in CBRFs of any size as of May 1, 2002.

    4. County Policies for use of COP-Regular funds in CBRFs with up to 20 beds
      5.

      The CBRF variance approval process as described in DSL numbered memo series 2000-05 is no longer required. This process permitted counties to establish their own policy and procedure for approving variance requests for the use of COP-Regular funding in CBRFs with over eight and up to 20 beds. These policies required Department approval. Counties no longer need Department approval for use of COP-Regular, COP-W, or CIP-II funding in CBRFs up to and including 20 beds.

    5. Use of COP-Regular, COP-W, CIP-II in CBRFs above 20 beds with Department approval
      6.

      The new statutory language allows for the use of COP-Regular, COP-W, and CIP-II funding in CBRFs with more than 20 beds with Department approval. This section will outline the policy related to the use of funding in CBRFs with more than 20 beds effective January 1, 2003.

      1. Policy Content:

        2. COP funds and COP-W/CIP-II Medicaid home and community based waiver funds cannot be used in CBRFs with more than 20 beds unless one of the following applies:

        1. The facility consists entirely of independent apartments. Definitions related to independent apartment CBRFs can be found in the Medicaid-Waivers Manual under Appendix Z. Meeting criteria for independent apartments constitutes Department approval of the facility and therefore a variance is not required.
        2. The Department has approved a variance, requested by the county COP lead agency, to provide waiver funding for a specific facility. The variance request has documented how the facility design, environment and programming mitigate the effects of living in a large congregate setting.

      2. Rationale for the New Policy

        3.

        Community Options and the Medicaid home and community based waivers are home-care programs, created to provide an alternative to institutional care. As CBRFs get larger, they are more likely to operate like or feel like an institution (i.e., building safety and design standards that must be met are more institutional, privacy may be reduced, schedules and routines are designed around staffing patterns rather than resident preferences, etc.)

        However, the Department recognizes that some large CBRFs have designed their facilities and programming to be consumer focused, respectful of the individual, offer privacy and autonomy, and meet needs individually or in small familiar groups. Therefore, if the county lead agency can document that a facility has compensated for the effects of large scale congregate living, the Department will grant a variance.

        To arrive at this policy, the Department sought input from an advisory group made up of county employees, provider agencies, aging and disability advocates and Department staff. This group developed a recommendation, which was then shared with county agencies, and other advisory groups. The final policy is a collaboration of the various perspectives received from these groups.

      3. Implementation of the New Policy

        4.
        1. Variance requests shall be reviewed and approved by the county’s Long Term Support Planning Committee prior to submission to the Department. Ideally, members of the committee will visit the facility before approving the variance request.
        2. Lead agencies are to submit requests for variances to use COP/COP-W/CIP-II funding in CBRFs with more than 20 beds to the Bureau of Aging and Long Term Care Resources (BALTCR) and Regional Assistant Area Administrator-Adult Services. BALTCR will respond to the request within fifteen working days of receipt, consulting with Area Administration as needed.
        3. Counties wishing to seek variances for particular facilities within or out of county shall describe all of the following in the variance request:
          1. How the facility design and programming are such that the facility is non-institutional.
          2. A description of the CBRF’s efforts to provide services in a manner that enhances resident dignity, independence, privacy and choice, and that mitigate the effects of large, congregate living buildings.
          3. Documentation provided by the CBRF that it can accommodate the special needs of individuals with an irreversible dementia such as Alzheimer’s disease, if the variance is requested for a facility that provides services to this target group.
        4. As described in the COP Guidelines under Chapter II (2.04(M)6.), lead agencies are not required to contract with or seek a variance to purchase services from any CBRF for which a size variance is required.
        5. Department approved person specific variances are no longer necessary. However, in order to place individuals in CBRFs of any size, including CBRFs with more than 20 beds using COP/COP-W/CIP-II funding, the five conditions on CBRF funding must be met for each individual. Policies and implementation highlights can be found in Attachment #2 of this memo.
        6. Individuals with developmental disabilities who are funded with CIP 1A/1B Medicaid home and community based waiver funding are not affected by this policy change. A variance continues to be required to fund CBRFs with more than four and up to eight beds for residents with developmental disabilities with CIP1A/1B funds.
        7. Please note that Medicaid does not allow personal care (MAPC) in CBRFs with more than 20 beds (HFS 107.112 (4)) even if the COP/COP-W/CIP-II funding variance is granted to the facility.
        8. County agencies or their designees may not certify recipients of Supplemental Security Income for the Exceptional Expense Supplement (SSI-E) if they are residing in CBRFs with more than 20 beds even if the COP/COP-W/CIP-II funding variance is granted to the facility.
        9. Where an individual variance request has been granted for the use of COP-Regular in CBRFs with more than 20 beds, another variance is not required.

    6. Manual Update

      7. Final policies and procedures found in this memo and its attachments will be incorporated into the COP Guidelines and the Medicaid-Waivers Manual in 2003.

      REGIONAL OFFICE CONTACT:
      Assistant Area Administrators-Adult Services

      CENTRAL OFFICE CONTACT:
      Carrie Molke
      Long Term Support Residential Policy Specialist
      Bureau of Aging and Long Term Care Resources
      P.O. Box 7851
      Madison, WI 53707-7851
      (608) 267-5267
      molkeca@dhfs.state.wi.us

      Attachments:

      1. Statutory changes to use of COP-Regular, COP-W, CIP-II in CBRFs.
      2. Policies and guidelines implementing five statutory conditions for the use of COP-Regular, COP-W, CIP-II funding in CBRFs.
      3. HFS 73.11: Criteria for determination of the infeasibility of in-home services.

        4. cc:
        Area Agencies on Aging
        Board on Aging and Long Term Care
        COP/LTS Statewide Advisory Committee
        County/Tribal Aging Units
        DSL Bureau Directors
        DSL Section Chiefs
        DSL/BQA Regional Field Operations Directors
        Independent Living Centers
        The Management Group
        Tribal Chairpersons/Human Services Facilitators

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