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SB21,643,1712 2. Persons from the service area representing the county department under s.
1346.23, 51.42, or 51.437 and the county department under s. 46.215 or 46.22, school
14districts, and local health departments, as defined in s. 250.01 (4). At least one of the
15committee members selected under this subdivision shall be a person providing
16community social services to children with disabilities who are eligible for the
17program.
SB21,643,1918 3. Persons in the service area who provide social or educational services to
19children who have disabilities other than the providers specified in subd. 2.
SB21,643,2120 (b) Cooperate with the committee appointed under par. (a) to prepare a
21program plan. The program plan shall include all of the following:
SB21,643,2222 1. A description of the proposed program.
SB21,643,2323 2. The estimated number of families that will be assessed and served.
SB21,643,2524 3. A list of specific groups, if any, that will be given priority for available
25funding.
SB21,644,3
14. A description of the outreach procedures that will be used to ensure that the
2program will be made available to children with physical, emotional, and mental
3impairments.
SB21,644,44 5. The procedures that will be used to determine family needs.
SB21,644,75 6. A description of the methods that will be used for the development and
6monitoring of service plans and for coordinating the provision of services and goods
7to participating families.
SB21,644,98 7. A description of the methods that will be used to promote the creation of
9informal support and advocacy systems for families.
SB21,644,1110 8. A description of the method that will be used to monitor the children's
11community options program.
SB21,644,1612 (c) Submit the proposed program plan to the county board of supervisors in each
13county in the service area for review. After approval by the county board of
14supervisors in each county in which families are eligible to participate in the
15program, the county department shall submit the proposed program plan to the
16department.
SB21,644,1917 (d) Administer the program or contract with a human service agency in the
18service area to administer the program within the limits of state and federal funds
19under subs. (13) and (14).
SB21,644,2420 (e) In conjunction with the county department under s. 46.215 or 46.22, if any,
21in the service area and with the administering agency, if it is not the county
22department under s. 46.23, 51.42, or 51.437, coordinate the administration of the
23program with the administration of other publicly funded programs that serve
24children who have disabilities.
SB21,644,2525 (f) Submit all information and reports required by the department.
SB21,645,4
1(5) Powers and duties of a private nonprofit agency. A private nonprofit
2agency with which the department contracts for service under sub. (14) (b) 3. shall
3have the powers and duties under this section of a county department designated to
4administer the program.
SB21,645,5 5(6) Duties of administering agencies. Each administering agency shall:
SB21,645,66 (a) Cooperate in the development of the program plan under sub. (4) (b).
SB21,645,87 (b) Provide information about the program and other programs for children
8who have disabilities to families in the service area.
SB21,645,99 (c) Implement the program in accordance with the program plan.
SB21,645,1110 (d) Designate one of its employees as the coordinator for each participating
11family.
SB21,645,13 12(7) County department duties. The county department selected to administer
13the children's community options program shall:
SB21,645,2114 (a) Organize assessment activities specified in par. (f) and sub. (8). The county
15department shall utilize persons for each assessment who can determine the needs
16of the child being assessed and who know the availability within the county of
17services. The county department shall coordinate the involvement of
18representatives from the county departments under ss. 46.215, 46.22, 51.42 and
1951.437, and health service providers in the assessment activities specified in sub. (8),
20as well as the child being assessed and members of the child's family or the child's
21guardian.
SB21,645,2522 (b) Within the limits of state and federal funds allocated under sub. (13),
23arrange service contracts under s. 46.036 and ensure the provision of necessary
24long-term community support services for each child who meets the criteria for
25services under the children's community options program.
SB21,646,5
1(c) Within the limits of state and federal funds allocated under sub. (13),
2provide for ongoing care management services in accordance with the requirements
3established under sub. (10) (b) 1., periodic case plan review and follow-up services
4for any child receiving community support services under the children's community
5options program.
SB21,646,86 (d) Determine, under sub. (9), the fee, if any, for all families or guardians of
7children who meet the criteria to receive services and are applying for or receiving
8children's community support services that are funded under sub. (13) or (14).
SB21,647,29 (e) In the instances in which a child who is provided community support
10services under this section for which the child or his or her parent or guardian
11receives direct funding, serve directly as a fiscal agent or contract with a fiscal
12intermediary to serve as a fiscal agent for that child for the purposes of performing
13the responsibilities and protecting the interests of the individual under the
14unemployment insurance law. The county department may elect to act as a fiscal
15agent or contract with a fiscal intermediary to serve as a fiscal agent for a child who
16is provided long-term community support services under s. 46.275, 46.277, 46.278,
1746.2785, 46.495, 51.42, or 51.437. The fiscal agent under this paragraph is
18responsible for remitting any federal unemployment compensation taxes or state
19unemployment insurance contributions owed by the child, including any interest
20and penalties which are owed by the child; for serving as the representative of the
21child in any investigation, meeting, hearing or appeal involving ch. 108 or the federal
22unemployment tax act (26 USC 3301 to 3311) in which the child is a party; and for
23receiving, reviewing, completing and returning all forms, reports and other
24documents required under ch. 108 or the federal unemployment tax act on behalf of
25the child. A child may make an informed, knowing and voluntary election to waive

1the right to a fiscal agent. The waiver may be as to all or any portion of the fiscal
2agent's responsibilities. The waiver may be rescinded in whole or in part at any time.
SB21,647,43 (f) Develop assessments and care plans according to uniform criteria
4established by the department for children in all long-term care programs.
SB21,647,7 5(8) Assessments. Within the limits of state and federal funds allocated under
6sub. (13) and within the limits of fees collected, an assessment shall be conducted for
7any child with a disability who is seeking services in the program.
SB21,647,12 8(9) Financial eligibility and fees. (a) The department shall create a sliding
9scale formula for a fee chargeable for conduct of an assessment under sub. (8), for
10development of a case plan, and for children's long-term community support services
11that is based on the child's ability to pay, unless prohibited from payment under the
12federal Medicaid law.
SB21,647,1613 (b) The county department selected to administer the program shall require all
14children or their parents or guardians applying for children's long-term community
15support services at the time of application and all children receiving the services that
16are funded under sub. (13) or (14) annually to provide the following information:
SB21,647,1717 1. A declaration of income, on a form prescribed by the department.
SB21,647,2018 2. A declaration of costs paid annually for care and services related to the
19special needs or disability of the child for whom the application is made or services
20are provided.
SB21,647,2521 (c) From the information obtained under par. (b), the county department shall
22determine the amount of the fee for receipt of children's long-term community
23support services under this section. The county department shall require payment
24by the child or parent or guardian of the child of 100 percent of the amount calculated
25under this paragraph.
SB21,648,3
1(d) The county department shall used funds received under par (c) to pay for
2long-term community support services for children who are eligible for services
3under the children's community options program.
SB21,648,8 4(10) Services; care management requirements. (a) 1. Within the limits of state
5and federal funds allocated under sub. (13) and within the limits of fees collected, the
6department shall reimburse, if applicable, and the county department or private
7nonprofit agency shall provide long-term community support services to eligible
8children who have a disability.
SB21,648,119 2. The department may not reimburse and the county department or private
10nonprofit agency may not pay for room and board for children under the children's
11community options program.
SB21,648,1412 (b) The department, after consulting with representatives of counties,
13hospitals, and individuals who receive services under the children's community
14options program under this section, shall do all of the following:
SB21,648,1715 1. Establish minimum requirements for the provision of care management
16services, as defined by the department, including standards for care, times for
17performance of duties, and size of case loads.
SB21,648,1918 2. Specify a reasonable schedule for phasing in the requirements established
19under subd. 1.
SB21,648,2120 3. Provide technical consultation and assistance to the administrator of the
21program with respect to the requirements established under subd. 1.
SB21,648,2322 (c) The department need not promulgate as rules under ch. 227 the
23requirements under par. (b) 1. or the schedule under par. (b) 2.
SB21,649,3 24(11) Fiscal responsibility. Except as provided in s. 51.40, and within the
25limitations under sub. (13) (a) 2., the fiscal responsibility of a county for an

1assessment, unless the assessment is performed by an entity under a contract as
2specified under s. 46.284 (2), case plan, or services provided to a child under this
3section is as follows:
SB21,649,64 (a) For a child seeking admission to or about to be admitted to an institutional
5setting, the county in which the child has residence is the county of fiscal
6responsibility.
SB21,649,97 (b) For a child residing in an institutional setting, except a state-operated
8long-term care facility, the county in which the institution is located is the county
9of fiscal responsibility.
SB21,649,1210 (c) For a child living in an institutional setting, except a state-operated
11long-term care facility, whose legal residence is established in another county, the
12county in which the legal residence is established is the county of fiscal responsibility.
SB21,649,1613 (d) For a child residing in a state-operated long-term care facility, or for a
14person protectively placed under ch. 55, the county in which the child has residence
15before he or she enters the state-operated long-term care facility or is protectively
16placed is the county of fiscal responsibility.
SB21,649,20 17(12) Reimbursement disallowances. The department may disallow
18reimbursement under this section for services provided to children who do not meet
19the eligibility requirements for the children's community options program or any
20other eligibility requirements established by the department.
SB21,649,24 21(13) Funding. (a) Subject to pars. (b) and (h), from the appropriation under
22s. 20.435 (4) (bd), the department shall allocate funds to each county or private
23nonprofit agency with which the department contracts for all of the following
24purposes:
SB21,650,7
11. To pay assessment and case plan costs not otherwise paid by fee or under s.
249.45 or 49.78 (2). The department shall reimburse multicounty consortia for the
3cost of assessing children eligible for medical assistance under s. 49.46, 49.468,
449.47, or 49.471 (4) (a) as part of the administrative services of medical assistance,
5payable under s. 49.45 (3) (a). Counties may use unspent funds allocated under this
6subdivision to pay the cost of long-term community support services and for a risk
7reserve under par. (f).
SB21,650,158 2. To pay the cost of providing long-term community support services described
9under sub. (7) (b) not otherwise paid under s. 49.45 to children eligible for medical
10assistance under s. 49.46, 49.47, or 49.471 (4) (a). The county department
11administering the program may spend funds received under this paragraph only in
12accordance with the case plan and service contract created for each child receiving
13long-term community support services. Counties may use unspent funds allocated
14under this subdivision from the appropriation under s. 20.435 (4) (bd) for a risk
15reserve under par. (f).
SB21,650,1616 (b) 1. Receipt of funds under this section is subject to s. 46.495 (2).
SB21,650,1817 2. The department may not release funds under this subsection before
18approving the county's community options plan.
SB21,650,2219 3. No county may use funds received under par. (a) 2. to pay for long-term
20community support services provided to any child who resides in a nursing home,
21unless the department waives this restriction on use of funds and the services are
22provided in accordance with a discharge plan.
SB21,650,2423 4. No county may use funds received under this section to purchase land or
24construct buildings.
SB21,651,3
1(c) The department may release funds to counties acting jointly, if the counties
2sign a contract approved by the secretary that explains the plans for joint
3sponsorship.
SB21,651,84 (d) If the department determines that a county demonstrates a pattern of
5failure to serve clients whose cost of care significantly exceeds the average cost of care
6for children's long-term community support services provided under this section, the
7department may require that county to reserve a portion of funds allocated under
8this subsection for provision of service to those clients.
SB21,651,229 (e) The department shall, at the request of a county, carry forward up to 5
10percent of the amount allocated under this subsection to the county for a calendar
11year if up to 5 percent of the amount so allocated has not been spent or encumbered
12by the county by December 31 of that year, for use by the county in the following
13calendar year, except that the amount carried forward shall be reduced by the
14amount of funds that the county has notified the department that the county wishes
15to place in a risk reserve under par. (f). The department may transfer funds within
16s. 20.435 (4) (bd) to accomplish this purpose. An allocation under this paragraph does
17not affect a county's base allocation under this subsection and shall lapse to the
18general fund unless expended within the calendar year to which the funds are
19carried forward. A county may not expend funds carried forward under this
20paragraph for administrative or staff costs, except administrative or staff costs that
21are associated with implementation of the waiver under sub. (14) and approved by
22the department.
SB21,652,523 (f) 1. Notwithstanding s. 46.036 (3) and (5m), a county may place in a risk
24reserve funds that are allocated under par. (a) or sub. (14) (b) 1. and are not expended
25or encumbered for services under this subsection or sub. (14). The county shall notify

1the department of this decision and of the amount to be placed in the risk reserve.
2The county shall maintain the risk reserve in an interest-bearing escrow account
3with a financial institution, as defined in s. 69.30 (1) (b), if the department has
4approved the terms of the escrow. All interest from the principal shall be reinvested
5in the escrow account.
SB21,652,106 2. The annual amount of a county's expenditure for a risk reserve, as specified
7in subd. 1., may not exceed 10 percent of the county's most recent allocation under
8par. (a) and sub. (14) (b) 1. or $750,000, whichever is less. The total amount of the
9risk reserve, including interest, may not exceed 15 percent of the county's most recent
10allocation under this subsection.
SB21,652,1211 3. A county may expend funds maintained in a risk reserve, as specified in subd.
121., for any of the following purposes:
SB21,652,1413 a. To defray costs of children's long-term community support services under
14this section.
SB21,652,1615 b. If approved by the department, for administrative or staff costs under this
16section.
SB21,652,1917 4. A county that maintains a risk reserve, as specified in subd. 1., shall
18annually, on a form prescribed by the department, submit to the department a record
19of the status of the risk reserve, including revenues and disbursements.
SB21,653,320 (g) The department may carry forward to the next state fiscal year funds
21allocated under this subsection and not encumbered by counties by December 31 or
22carried forward under par. (e). The department may transfer moneys within s.
2320.435 (4) (bd) to accomplish this purpose. An allocation under this paragraph shall
24not affect a county's base allocation for the program. The department may allocate
25these transferred moneys during the next fiscal year to counties for the improvement

1or expansion of long-term community support services for clients whose cost of care
2significantly exceeds the average cost of care provided under this section, including
3any of the following:
SB21,653,44 1. Specialized training for providers of services under this section.
SB21,653,55 2. Start-up costs for developing needed services.
SB21,653,66 3. Home modifications.
SB21,653,77 4. Purchase of medical equipment or other specially adapted equipment.
SB21,653,118 (h) Funds allocated under this subsection may not be used to replace any other
9state and federal funds or any county funds that are currently being provided under
10any program to a family whose child is receiving services through the children's
11community options program.
SB21,653,16 12(14) Medical assistance waiver. (a) The department may request a waiver
13from the federal department of health and human services authorizing the
14department to provide as part of the Medical Assistance program services for persons
15who are eligible for children's long-term support community options program
16services under sub. (7) (b).
SB21,653,2117 (b) 1. Medical assistance reimbursement for services a county or a private
18nonprofit agency, or with which the department contracts provides under this
19subsection shall be made from the appropriations under s. 20.435 (4) (bd) and (o) and
20(7) (b). Payments made under sub. (13) (a) may be used as the state share for
21purposes of Medical Assistance reimbursement.
SB21,653,2322 3. The department may contract for services under this subsection with a
23county or a private nonprofit agency.
SB21,654,224 4. No county or private nonprofit agency may use funds received under this
25subsection to provide residential services in a group home, as defined in s. 48.02 (7),

1that has more than 5 beds, unless the department approves the provision of services
2in a group home that has 6 to 8 beds.
SB21,654,53 (c) If a county department or private nonprofit agency providing services under
4this subsection is certified under s. 49.45 (37) (a), the waiver under s. 49.45 (37), if
5in effect, applies to plans of care for children receiving services under this subsection.
SB21,654,9 6(15) Right to hearing. A child who is denied eligibility for services or whose
7services are reduced or terminated under this section may request a hearing from the
8department under s. 227.44, except that lack of adequate funding may not serve as
9the basis for a request under this subsection.
SB21,1536 10Section 1536. 46.277 (5g) (b) of the statutes is renumbered 46.277 (5g) (b)
11(intro.) and amended to read:
SB21,654,1512 46.277 (5g) (b) (intro.) This section does not apply to the delicensure of a bed
13of an institution for mental diseases of an individual who is aged 21 to 64, who has
14a primary diagnosis of mental illness and who otherwise meets any of the following
15requirements of s. 46.266 (1) (a), (b) or (c).:
SB21,1537 16Section 1537. 46.277 (5g) (b) 1. and 2. of the statutes are created to read:
SB21,654,2117 46.277 (5g) (b) 1. A person who resided in the facility on the date of the finding
18that a skilled nursing facility or intermediate care facility that provides care to
19Medical Assistance recipients to be an institution for mental diseases whose care in
20the facility is disallowed for federal financial participation under Medical
21Assistance.
SB21,655,222 2. A person who is aged 21 to 64, who has a primary diagnosis of mental illness,
23who would meet the level of care requirements for Medical Assistance
24reimbursement in a skilled nursing facility or intermediate care facility but for a

1finding that the facility is an institution for mental diseases, and for whom services
2would be provided in place of a person specified in subd. 1. who discontinues services.
SB21,1538 3Section 1538. 46.28 (1) (a) of the statutes is amended to read:
SB21,655,54 46.28 (1) (a) "Authority" means the Forward Wisconsin Housing and Economic
5Development Authority created under ch. 234 235.
SB21,1539 6Section 1539. 46.28 (3) of the statutes is amended to read:
SB21,655,87 46.28 (3) The department may authorize the authority to issue revenue bonds
8under s. 234.61 235.61 to finance any residential facility it approves under sub. (2).
SB21,1540 9Section 1540. 46.28 (4) of the statutes is amended to read:
SB21,655,1210 46.28 (4) The department may charge sponsors for administrative costs and
11expenses it incurs in exercising its powers and duties under this section and under
12s. 234.61 235.61.
SB21,1541 13Section 1541. 46.2803 (1) of the statutes is amended to read:
SB21,655,2114 46.2803 (1) In order to facilitate the transition to the long-term care system
15specified in ss.
family care program as defined in s. 46.2805 to 46.2895 (4m), within
16the limits of applicable federal statutes and regulations and if the secretary of health
17services finds it necessary, he or she may grant a county limited waivers to or
18exemptions from ss. 46.27 (3) (e) (intro.), 1. and 2. and (f), (5) (d) and (e), (6) (a) 1., 2.
19and 3. and (b) (intro.), 1. and 2., (6r) (c), (7) (b), (cj) and (cm) and (11) (c) 5m. (intro.)
20and 6. and 46.277 (3) (a), (4) (a) and (5) (d) 1m., 1n. and 2. and rules promulgated
21under those provisions.
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