AB150,873,2222 a. Sufficient responsiveness to individual resident needs.

AB150,873,2323 b. Maintenance of approved levels of quality of care.

AB150,873,2424 c. Cost effectiveness, in comparison with other feasible funding uses.

AB150,874,2

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1d. Sufficient consideration of care for facility residents with dementia or related
2conditions.

AB150,874,43 3. The department need not promulgate as rules under ch. 227 the standards
4required to be established under subd. 2.

AB150,874,75 4. This paragraph does not apply to individuals who are receiving services
6under this section that are funded under par. (b) and who are residing in
7community-based residential facilities with more than 8 beds on January 1, 1996.

AB150,874,139 46.27 (7m) Right to hearing. A person who is denied eligibility for services or
10whose services are reduced or terminated under this section may request a hearing
11from the department under s. 227.44, except that lack of adequate funding or a denial
12under sub. (6r) (a) or (d) may not serve as the basis for a request under this
13subsection.

AB150,874,2015 46.27 (11) (am) The department shall request a waiver from the secretary of
16the federal department of health and human services, under 42 USC 1396n (c),
17authorizing the department to provide as part of the medical assistance program,
18except as specified in sub. (11m), home and community-based services for persons
19who are eligible for long-term support community options program services under
20sub. (5) (b).

AB150,875,222 46.27 (11) (c) 7. A county may use funds received under this subsection to
23provide supportive, personal or nursing services, as defined in rules promulgated
24under s. 49.45 (2) (a) 23., to a person who resides in an assisted living facility, as
25defined in s. 50.01 (1d). Funding of the services may not exceed 85% of the statewide

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1rate for reimbursement under s. 49.45 (6m), as determined by the department under
2s. 49.45 (6m) (L).

AB150,875,84 46.27 (11) (c) 8. No county, private nonprofit agency or aging unit may use funds
5received under this subsection to provide services in any community-based
6residential facility unless the county, agency or aging unit uses as a service contract
7the model contract developed under sub. (2) (j) or a contract that includes all of the
8provisions of the model contract.

AB150,875,1910 46.27 (11) (cm) 1. The department shall request from the secretary of the
11federal department of health and human services an amendment to the waiver
12specified in par. (am) to allow the department to receive federal financial
13participation to continue to provide, notwithstanding sub. (11m), long-term
14community support services that substitute for the benefit under s. 49.46 (2) (a) 4.
15a. or (b) 6. a. to an individual who is eligible for medical assistance only under s. 49.47;
16who was receiving the services, provided as a medical assistance benefit, on January
171, 1996; and who has continued to receive those services or the services, provided as
18a medical assistance benefit, that are described in s. 46.275 (5g), 46.277 (5g) (c) or
1946.278 (6m) or specified in s. 49.46 (2) (a) 4. c. or (b) 6. a. since that date.

AB150,875,2220 2. If the waiver amendment under subd. 1. is granted and remains in effect, the
21department shall provide the services described in subd. 1. to individuals covered by
22the waiver amendment, notwithstanding sub. (11m).

AB150,876,52 46.27 (11m) Limitation. The department may not allocate funds to a county
3to provide long-term community support services that substitute for the benefit
4under s. 49.46 (2) (a) 4. a. or (b) 6. a. for persons who meet the condition specified
5under sub. (6r) (b) 1. but who are eligible for medical assistance only under s. 49.47.

AB150,876,87 46.275 (1m) (a) "Medical assistance" means aid provided under ss. 49.43 to
849.47 subch. IV of ch. 49, except s. 49.468.

AB150,876,2010 46.275 (2) Departmental powers and duties. (intro.) The department may
11request a waiver from the secretary of the U.S. federal department of health and
12human services, under 42 USC 1396n (c), authorizing the department to integrate
13medical assistance recipients who reside in state centers for the developmentally
14disabled into their communities by providing home and community-based services
15as part of the medical assistance program, except as provided in sub. (5g). If the
16department requests this waiver, it shall include all assurances required under 42
17USC 1396n (c) (2) in its request. If the department receives this waiver, at the end
18of the 3-year period during which the waiver remains in effect the department may
19request an additional 3-year extension of the waiver. If the department receives this
20waiver, it shall:

AB150,876,2522 46.275 (4) (a) Any Except as provided in sub. (5g), any medical assistance
23recipient living in a state center for the developmentally disabled is eligible to
24participate in the program. Such a recipient may apply, or any person may apply on
25behalf of such a recipient, for participation in the program.

AB150,877,72 46.275 (5) (a) Medical Except as provided in sub. (5g), medical assistance
3reimbursement for services a county, or the department under sub. (3r), provides
4under this program is available from the appropriations under s. 20.435 (1) (b) and
5(o). If 2 or more counties jointly contract to provide services under this program and
6the department approves the contract, medical assistance reimbursement is also
7available for services provided jointly by these counties.

AB150,877,139 46.275 (5) (b) 2. Reduce federal, state or county matching expenditures for
10long-term community support services provided to any person as part of this
11program from funds allocated under s. 46.495 (1) (d), 46.80 (5), 46.85 (3m) (b) 1. and
122., 49.52 (1) (d) or 51.423, as indicated in the county's budget or by actual
13expenditures.

AB150,877,2415 46.275 (5d) Waiver amendment. (a) The department shall request from the
16secretary of the federal department of health and human services an amendment to
17the waiver specified in sub. (2) to allow the department to receive federal financial
18participation to continue to provide, notwithstanding sub. (5g), home and
19community-based services that substitute for the benefit under s. 49.46 (2) (a) 4. a.
20or (b) 6. a. to an individual who is eligible for medical assistance only under s. 49.47;
21who was receiving the services, provided as a medical assistance benefit, on January
221, 1996; and who has continued to receive those services or the services, provided as
23a medical assistance benefit, that are described in s. 46.27 (11m), 46.277 (5g) (c) or
2446.278 (6m) or specified in s. 49.46 (2) (a) 4. c. or (b) 6. a. since that date.

AB150,878,3

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1(b) If the waiver amendment under par. (a) is granted and remains in effect,
2the department shall provide the services described in par. (a) to individuals covered
3by the waiver amendment, notwithstanding sub. (5g).

AB150,878,85 46.275 (5g) Limitation. The department may not provide under this section
6home and community-based services that substitute for the benefit under s. 49.46
7(2) (a) 4. a. or (b) 6. a. for persons who are eligible for medical assistance only under
8s. 49.47.

AB150,878,2110 46.277 (1) Legislative intent. The intent of the program under this section,
11except as provided in sub. (5g) (c), is to provide home or community-based care to
12serve in a noninstitutional community setting a person who meets eligibility
13requirements under 42 USC 1396n (c) and is relocated from an institution other than
14a state center for the developmentally disabled or meets the level of care
15requirements for medical assistance reimbursement in a skilled nursing facility or
16an intermediate care facility, except that the number of persons who receive home
17or community-based care under this section is not intended to exceed the number
18of nursing home beds that are delicensed as part of a plan submitted by the facility
19and approved by the department. The intent of the program is also that counties use
20all existing services for providing care under this section, including those services
21currently provided by counties.

AB150,879,2

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146.277 (1m) (a) "Medical assistance" means aid provided under ss. 49.43 to
249.47 subch. IV of ch. 49, except s. 49.468.

AB150,879,64 46.277 (1m) (b) "Program" means the community integration program for
5facilities certified as medical assistance providers, for which a waiver has been
6received under sub. (2).

AB150,879,208 46.277 (2) Departmental powers and duties. (intro.) The department may
9request a waiver from the secretary of the federal department of health and human
10services, under 42 USC 1396n (c), authorizing the department to serve medical
11assistance recipients, who meet the level of care requirements for medical assistance
12reimbursement in a skilled nursing facility or an intermediate care facility, in their
13communities by providing home or community-based services as part of medical
14assistance, except as provided in sub. (5g) (c). The number of persons for whom the
15waiver is requested may not exceed the number of nursing home beds that are
16delicensed as part of a plan submitted by the facility and approved by the
17department. If the department requests a waiver, it shall include all assurances
18required under 42 USC 1396n (c) (2) in its request. If the department receives this
19waiver, it may request one or more 3-year extensions of the waiver under 42 USC
201396n (c) and shall perform the following duties:

AB150,880,422 46.277 (2) (e) Review and approve or disapprove waiver requests under sub.
23(3) (c), review and approve or disapprove requests for exceptions under sub. (5) (d)

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13. and provide technical assistance to a county that reaches or exceeds the annual
2allocation limit specified in sub. (3) (c) in order to explore alternative methods of
3providing long-term community support services for persons who are in group living
4arrangements in that county.

AB150,880,146 46.277 (3) (a) Sections 46.27 (3) (b) and 46.275 (3) (a) and (c) to (e) apply to
7county participation in this program, except that services provided in the program
8shall substitute for care provided a person in a skilled nursing facility or
9intermediate care facility who meets the level of care requirements for medical
10assistance reimbursement to that facility rather than for care provided at a state
11center for the developmentally disabled. The number of persons who receive services
12provided by the program under this paragraph may not exceed the number of
13nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as
14part of a plan submitted by the facility and approved by the department.

AB150,880,2116 46.277 (3) (b) 2. Each county department participating in the program shall
17provide home or community-based care to persons eligible under this section, except
18that the number of persons who receive home or community-based care under this
19section may not exceed the number of nursing home beds, other than beds specified
20in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and
21approved by the department.

AB150,881,723 46.277 (3) (c) Beginning on January 1, 1996, from the annual allocation to the
24county for the provision of long-term community support services under sub. (5),
25annually establish a maximum total amount, not to exceed 25% of the annual

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1allocation, that may be encumbered in a calendar year for services for eligible
2individuals in community-based residential facilities. If the total amount that is
3encumbered for services for individuals in community-based residential facilities
4who are receiving services under sub. (5) on January 1, 1996, exceeds 25% of the
5county's annual allocation, a county may request a waiver of the requirement under
6this paragraph from the department. The department need not promulgate as rules
7under ch. 227 the standards for granting a waiver request under this paragraph.

AB150,881,169 46.277 (4) (a) Any medical assistance recipient who meets the level of care
10requirements for medical assistance reimbursement in a skilled nursing facility or
11intermediate care facility is eligible to participate in the program, except that the
12number of participants may not exceed the number of nursing home beds , other than
13beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the
14facility and approved by the department. Such a recipient may apply, or any person
15may apply on behalf of such a recipient, for participation in the program. Section
1646.275 (4) (b) applies to participation in the program.

AB150,882,219 46.277 (4) (a) Any medical assistance recipient who meets the level of care
20requirements for medical assistance reimbursement in a skilled nursing facility or
21intermediate care facility is eligible to participate in the program, except that the
22number of participants may not exceed the number of nursing home beds, other than
23beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the
24facility and approved by the department and except as provided in sub. (5g) (c). Such
25a recipient may apply, or any person may apply on behalf of such a recipient, for

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1participation in the program. Section 46.275 (4) (b) applies to participation in the
2program.

AB150,882,114 46.277 (4) (b) To the extent authorized under 42 USC 1396n, if a person
5discontinues participation in the program, a medical assistance recipient may
6participate in the program in place of the participant who discontinues if that
7recipient meets the level of care requirements for medical assistance reimbursement
8in a skilled nursing facility or intermediate care facility, except that the number of
9participants may not exceed the number of nursing home beds, other than beds
10specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility
11and approved by the department.

AB150,882,1913 46.277 (5) (d) 3. If subd. 2. a. or b. applies, no county may use funds received
14under this section to pay for services provided to a person who resides or intends to
15reside in a community-based residential facility and who is initially applying for the
16services, if the projected cost of services for the person, plus the cost of services for
17existing participants, would cause the county to exceed the limitation under sub. (3)
18(c). The department may grant an exception to the requirement under this
19subdivision, under the conditions specified by rule, to avoid hardship to the person.

AB150,883,321 46.277 (5) (e) A county may use funds received under this subsection to provide
22supportive, personal or nursing services, as defined in rules promulgated under s.
2349.45 (2) (a) 23., to a person who resides in an assisted living facility, as defined in

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1s. 50.01 (1d). Funding of the services may not exceed 85% of the statewide rate for
2reimbursement under s. 49.45 (6m), as determined by the department under s. 49.45
3(6m) (L).

AB150,883,145 46.277 (5d) Waiver amendment. (a) The department shall request from the
6secretary of the federal department of health and human services an amendment to
7the waiver specified in sub. (2) to allow the department to receive federal financial
8participation to continue to provide, notwithstanding sub. (5g) (c), home or
9community-based services that substitute for the benefit under s. 49.46 (2) (a) 4. a.
10or (b) 6. a. to an individual who is eligible for medical assistance only under s. 49.47;
11who was receiving the services, provided as a medical assistance benefit, on January
121, 1996; and who has continued to receive those services or the services, provided as
13a medical assistance benefit, that are described in s. 46.27 (11m), 46.275 (5g) or
1446.278 (6m) or specified in s. 49.46 (2) (a) 4. c. or (b) 6. a. since that date.

AB150,883,1715 (b) If the waiver amendment under par. (a) is granted and remains in effect,
16the department shall provide the services described in par. (a) to individuals covered
17by the waiver amendment, notwithstanding sub. (5g) (c).

AB150,883,1919 46.277 (5g) (title) Limitation Limitations on service.

AB150,884,222 46.277 (5g) (b) This section does not apply to the delicensure of a bed of an
23institution for mental diseases of an individual who is aged 21 to 64, who has a

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1primary diagnosis of mental illness and who otherwise meets the requirements of s.
246.266 (1) (a), (b) or (c).

AB150,884,64 46.277 (5g) (c) The department may not provide under this section home or
5community-based services that substitute for the benefit under s. 49.46 (2) (a) 4. a.
6or (b) 6. a. for persons who are eligible for medical assistance only under s. 49.47.

AB150,884,108 46.277 (5r) Rule making. The department shall promulgate rules that specify
9conditions of hardship under which the department may grant an exception to the
10requirement of sub. (5) (d) 3.

AB150,884,2212 46.278 (1) Legislative intent. The intent of the program under this section,
13except as provided in sub. (6m), is to provide home or community-based care to serve
14in a noninstitutional community setting a person who meets eligibility requirements
15under 42 USC 1396n (c) and who is diagnosed as developmentally disabled under the
16definition specified in s. 51.01 (5) and relocated from an institution other than a state
17center for the developmentally disabled or who meets the intermediate care facility
18for the mentally retarded level of care requirements for medical assistance
19reimbursement in an intermediate care facility for the mentally retarded and is
20ineligible for services under s. 46.275 or 46.277. The intent of the program is also that
21counties use all existing services for providing care under this section, including
22those services currently provided by counties.

AB150,885,2

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146.278 (1m) (b) "Medical assistance" means aid provided under ss. 49.43 to
249.47 subch. IV of ch. 49, except s. 49.468.

AB150,885,114 46.278 (2) (a) The department may request a waiver from the secretary of the
5federal department of health and human services, under 42 USC 1396n (c),
6authorizing the department to serve medical assistance recipients, who meet the
7level of care requirements for medical assistance reimbursement in an intermediate
8care facility for the mentally retarded, in their communities by providing home or
9community-based services as part of medical assistance, except as provided in sub.
10(6m). If the department requests a waiver, it shall include all assurances required
11under 42 USC 1396n (c) (2) in its request.

AB150,885,2013 46.278 (5) (a) Any medical assistance recipient who meets the level of care
14requirements for medical assistance reimbursement in an intermediate care facility
15for the mentally retarded and is ineligible for service under s. 46.275 or 46.277 is
16eligible to participate in the program, except that the number of participants may not
17exceed the number approved under the waiver received under sub. (3) and except
18that sub. (6m) applies. Such a recipient may apply, or any person may apply on behalf
19of such a recipient, for participation in the program. Section 46.275 (4) (b) applies
20to participation in the program.