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DSL Memo Series 2003-03

Replace DSL Memo 98-08

January 14, 2003

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

To:
Area Administrators/Assistant Area Administrators
Bureau Directors/Regional Field Operations Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Program Office Directors/Section Chiefs
Tribal Chairpersons/Human Services Facilitators

From: 
Sinikka McCabe, Administrator

Re: IMD CONTINUING PLACEMENT AND RELOCATION FUNDS

The purpose of this memo series is to provide updated information regarding IMD Continuing Placement and Relocation Funds.

Funding for Institutions for Mental Diseases (IMDs)

The legislature has appropriated $12,334,000 per year of the current biennium for IMD services. This funding level includes the dollars that are available for IMD OBRA/Special Relocations, IMD regular relocations, (i.e., when an IMD bed is closed and funds are available for eligible individuals in the community), and the per diem placement costs in an IMD with funding for the MA card replacement cost ($2.14/day for each approved IMD bed).

From this funding source for CY 2003, $3,066,580 will be awarded to eligible counties for IMD Continuing Placement and MA Card Costs, $830,000 will be awarded to counties for OBRA/Special Relocations, and $8,059,919 will be awarded to counties for IMD Regular Relocations. Attachment 1 lists the funding levels for the various counties eligible to receive IMD OBRA/Special Relocation and IMD Regular Relocation funds effective January 1, 2003. A State/County contract addendum for these counties will be issued within the next few weeks.

IMD Regular Relocation Fund – No change in policy in this area.

These funds are available when an IMD bed is closed and this funding is provided for an eligible person in the community. 1993 Wisconsin Act 16 increased the amount available for this type of relocation from 60 to 90 percent of the 1988 MA/IMD rate. In other words, a county is eligible for the same amount of GPR funds per day for the relocation as was available for the IMD bed, not including the MA card cost. This change is effective for all relocations in which a bed closed after January 1, 1993.

To access these relocation funds, the IMD facility must agree to close the bed. The county then must prepare an individualized treatment plan and budget following the instructions attached to this memo. This information should be submitted to Dan Zimmerman, Bureau of Community Mental Health, 1 West Wilson Street, Room 433, P.O. Box 7851, Madison, WI 53707-7851. The county must report costs monthly for the CARS Profile #559 on the DMT-862, CARS Expenditure Report form.

IMD OBRA/Special Relocation Fund Plan Requirements – No change in policy in this area.

Several years ago the Department of Health and Family Services (DHFS) was allocated $500,000 for IMD special relocations and $330,000 for OBRA relocations. No new funds are available and all funds in this area have been allocated. These funds were awarded to counties with the purpose to relocate persons with a mental illness from nursing homes and facilities declared to be IMDs to the community.

As noted in DSL 98-08, due to the high quality of IMD OBRA/Special Relocation plans and budgets that were submitted by the counties prior to CY 1995, the Division of Supportive Living (DSL) no longer requires counties to submit to BCMH an IMD or OBRA relocation plan for replacement individuals placed in the community from a nursing home setting or individuals who are already residing in the community.

Even though the plan submission is not required, it is important to keep in mind that these funds may be used by the county to pay for the cost of community-based care and services provided only to a person who: 1) has a mental illness; is between the ages of 22 and 65 at the time the person is relocated from an institution for mental diseases (IMD) or a Medicaid-certified nursing facility (NF); and 3) is income eligible for Medicaid. Also, the county must provide a match of 9.89% of the cost of community service as required by s. 46.268(3), Stats. The county must report costs monthly for the CARS Profile #571 on the DMT-862, CARS Expenditure Report form.

Redistribution of Vacant IMD Beds – Change in policy.

1993 Wisconsin Act 212 created the following language in s. 46.266(3):

The Department may redistribute funds for a vacant bed from one county to another county that is seeking to effect the placement of a person in an institution for mental diseases.

The process the Department has used for accomplishing this directive as it pertains to Trempealeau County Health Care Center has been confusing and difficult for both the Department and for counties. Since July 1, 1994, the policy has been:

If an IMD bed awarded to a county becomes vacant and remains vacant for 15 days, the Bureau of Community Mental Health (BCMH) may redistribute the funds for the vacant IMD bed to the next county on the waiting list. Staff at the IMD should notify the Bureau of Community Mental Health IMD Bed Coordinator when a vacancy occurs. The maintenance of the IMD bed waiting list is the responsibility of staff at the IMD. The waiting list policy of the facility should allow for equal access to all counties interested in utilizing the services of the facility. IMD staff should again notify the IMD Bed Coordinator at BCMH after the bed has been vacant for 15 days and indicate the county that is next on the waiting list with an eligible person to fill the bed. At that time, a State/County contract addendum will be issued to both counties indicating the change.

Sheboygan County Comprehensive Health Care Center closed in 2002. Of the remaining facilities (Trempealeau County Health Care Center, Milwaukee County Mental Health Complex – Rehab Central – IMD, and Dayton Residential Care Facility, which is a CBRF), only Trempealeau County Health Care Center admits persons from out-of-county. During the past several years, there have not been any beds that have been vacant for 15 or more days in any of these facilities. In order to maximize the use of State funds and provide equal access to all counties, the Department will permit Trempealeau County to immediately fill a vacant bed with the next person on the waiting list.

The aspect of the current policy that is most confusing for the counties is that the reimbursement rate for persons placed at Trempealeau County Health Care Center varies from $31.43 per day to $59.25 per day (the average rate is $48.55 per day). The rate a county would receive is dependent on the rate for the bed that was vacated.

In order to make the policy easier to understand and implement the Department will institute the following policy effective January 1, 2003.

Contracts with Milwaukee County for the placement of persons at Milwaukee County Mental Health Complex – Rehab Central – IMD and with Kenosha County for persons placed at Dayton Residential Care Facility, a CBRF, will remain the same. The daily rate each of these counties receives will remain the same. As a condition of receipt of these funds, the counties must:

1. Conduct or contract for an annual physical and mental evaluation to determine if the client funded under the contract continues to warrant the skilled or intermediate level of care provided by the IMD.
2. In conjunction with the IMD facility staff, prepare and have available an individualized treatment plan that is updated at least annually.
3. Comply with the Preadmission Screening and Resident Review requirements under 42 CFR 483 and corresponding policies issued by the Department. Note: Persons admitted to Dayton Residential Care Facility (licensed under HFS 83) or to the HFS 132 licensed only portion of Trempealeau County Health Care Center (76 beds) will be exempt from this requirement.
4. In order to claim funding for an individual admitted as a replacement for an original resident, the County must maintain proof that the person would be income eligible for medical assistance except for the fact that the facility to which she or he is being admitted is an IMD. The determination of income eligibility need not be processed through the County Department of Social Services but can be conducted by the receiving IMD or authorizing County Department of Community programs (51.42 authority).
5. Collect and enter all appropriate data into the Mental Health Module and the Consumer Status Data Set of the Human for each person residing in the IMD.
6. Report costs and other required data monthly for the CARS Profile #572 on the DMT-862, CARS Expenditure Report form and the DHCF-1104 Roster Claim form.

The Department will establish a contract with Trempealeau County Health Care Center to directly receive the funds. TCHCC is permitted to manage the waiting list for vacant beds in the facility without prior notice or approval from the Department. As a condition of receipt of these funds, the TCHCC had agreed to:

1. Conduct or contract for an annual physical and mental evaluation to determine if the client funded under the contract continues to warrant the skilled or intermediate level of care provided by the IMD.
2. Prepare and have available an individualized treatment plan that is updated at least annually.
3. Comply with the Preadmission Screening and Resident Review requirements under 42 CFR 483 and corresponding policies issued by the Department.
4. Provide a credit towards the monthly cost of care and treatment of each client admitted or retained to each county of responsibility for each client admitted or retained from the county responsibility in the amount of $55.37 per day times the number of days during the month that the client resided at TCHCC.
5. Establish an inter-county agreement for each client admitted or retained that ensures that the county of responsibility will provide all the following information:
1. The county of responsibility must maintain proof that the person would be income eligible for medical assistance except for the fact that the facility to which she or he is being admitted is an IMD. The determination of income eligibility need not be processed through the County Department of Social Services but can be conducted by the TCHCC staff or authorizing County Department of Community programs (51.42 authority).
2. The county of responsibility must collect and enter all appropriate data into the Mental Health Module and the Consumer Status Data Set of the Human for each person residing in the IMD.
6. Report costs and other required data monthly for the CARS Profile #572 on the DMT-862, CARS Expenditure Report form and the DHCF-1104 Roster Claim form.

Please refer any questions you may have regarding information contained in this memo to the contacts listed below.

REGIONAL OFFICE CONTACT:
Area Administrator

CENTRAL OFFICE CONTACT:
Dan Zimmerman
PASARR Contract Administrator
Bureau of Community Mental Health
1 West Wilson Street, Room 433
P. O. Box 7851
Madison, WI 53707-7851
(608) 266-7072
(608) 267-7793 - fax
zimmeds@dhfs.state.wi.us (E-mail address)

Attachments

Attachment 1

Profile #559 – Institution for Mental Diseases (IMD) – Regular Relocation Funds
	Agency #	Type	2003 Amount
CRAWFORD HSD	12	54	12,337
DOUGLAS DHS	16	54	97,791
LA CROSSE HSD	32	54	70,847
MIL. HSD	40	54	6,010,921
MILW AGING	40	58	530,113
ST CROIX HSD	55	54	114,712
TREMPEALEAU 51 BD	61	52	22,046
WINNEBAGO DSS	70	54	209,830
WOOD 51 BD	71	52	81,555
SHEBOYGAN HSD	59	54	909,767
TOTAL			8,059,919

Profile #571 – IMD OBRA/Special Relocation Funds
	Agency #	Type	2003 Amount
BARRON DSS	3	54	35,443
BROWN HSD	5	54	329,887
BURNETT HLTH/DSS/AGE	7	54	20,410
CRAWFORD HSD	12	54	33,545
DANE HSD	13	54	100,667
DOUGLAS DHS	16	54	29,711
DUNN HSD	17	54	10,257
EAU CLAIRE HSD	18	54	29,441
FRST/ONEIDA/VILAS 51 BD	21	52	12,045
GRANT IOWA 51 BD	22	52	1,566
LA CROSSE HSD	32	54	35,452
LANG/LINC/MARATHON 51 BD	34	52	38,445
MANITOWOC HSD	36	54	28,117
POLK DSS	48	54	23,641
PORTAGE HSD	49	54	28,426
SAWYER HSD	57	54	13,458
SHEBOYGAN HSD	59	54	20,622
WASHBURN DSS	65	54	16,218
WINNEBAGO DSS	70	54	12,045
MENOMINEE HSD	72	54	10,604
TOTAL			830,000

Profile #572 – IMD – Continuing Placement &Medical Assistance Card Replacement Funds
	Agency #	Type	2003 Amount
KENOSHA HSD	30	54	78,533
MILWAUKEE HSD	40	54	1,714,814
TREMPEALEAU 51 BD	61	52	1,273,233
TOTAL			3,066,580

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