Wisconsin Legislature: DHS 68.06(2)(a)

2. Discontinues providing, purchasing, or making payments for goods and services under one or more categories listed in s. DHS 68.06 (2) (b).

3. Changes its waiting list policy.

4. Establishes a maximum payment of less than $4,000 in a calendar year for each person with dementia who is participating in the program.

5. Changes the agency it contracts with to provide goods and services under any of the categories listed under s. DHS 68.06 (2) (b).

(6) Notice to participants of changes. The administering agency shall notify each affected caregiver in writing of any change identified under sub. (5) (b) or (c) 2. or 5. at least 10 working days prior to implementing that change.

(7) Records and reports. The administering agency shall maintain program records and submit reports as required by the department.

History: Cr. Register, March, 1989, No. 399, eff. 4-1-89; am. (1), Register, October, 2000, No. 538, eff. 11-1-00; correction in (1) (b) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; CR 17-032: r. and recr. (1) to (3), am. (4), (5) (intro.), (a), (b), (c) (intro.), 1. to 4. Register June 2018 No. 750, eff. 7-1-18; correction in (2) (a) 3., (b), (5) made under s. 35.17, Stats., Register June 2018 No. 750.

DHS 68.05 Program budget requirement; county, tribal, or nonprofit agency.

(1) An administering agency shall annually prepare a budget for the program and shall submit the budget to the department each year by November 30. This budget shall be part of either the proposed budget required under s. 46.031, Stats., or the plan for older people required by the department and prepared by the county or tribal aging unit under s. 46.87 (3) (c) 4., Stats. The budget shall include at least, all the following information:

(a) The total amount of allocated funds anticipated for the program for the calendar year.

(b) The number of households anticipated to be enrolled and served for the calendar year.

(d) The method or methods for paying for goods and services under s. DHS 68.09.

(e) The maximum amount payable in a calendar year to or on behalf of any participating person with dementia, if that amount is less than $4,000.

(f) A brief description of any limitations on goods and services that are to be provided, purchased or contracted for.

(g) Brief descriptions of any new programs or expanded services.

(h) A summary of the waiting list policy.

(i) The name and phone number of the principal contact person at the county, tribal, or nonprofit agency for the program.

(2) The department may terminate an administering agency’s participation in the program if it determines that the information provided by the administering agency in the distinct budget is insufficient or inconsistent with the purposes and procedures of the program as defined in s. 46.87, Stats., and this chapter, or the agency does not submit the distinct budget by November 30.

(3) The administering agency’s contract with the department under s. 46.031 (2g) (a), Stats., shall include the name of the agency and the amount of the allocation for the contract year.

History: Cr. Register, March, 1989, No. 399, eff. 4-1-89; CR 17-032: am. (1), r. (2) Register June 2018 No. 750, eff. 7-1-18; renum. (1) to DHS 68.05 under s. 13.92 (4) (b) 1., Stats., Register June 2018 No. 750.

DHS 68.06 Allowable use of funds.

(1) Purposes. As permitted by s. 46.87 (5), Stats., the administering agency may use allocated funds for any of the following purposes:

(a) To pay for the cost of goods and services provided to or purchased for or by households and for limited transportation and supplemental services for a caregiver of a person living in a residential facility who is found eligible to participate in the program under s. DHS 68.07. The program may not be used to pay fees associated with the cost of permanent placement in an assisted living facility or other living arrangement that is not a CBRF or adult family home as defined under s. DHS 68.02.

(b) To contract with service providers to develop new programs or expand services.

(c) To provide outreach, that is, to search out persons in need of support by the program, or to provide activities designed to develop or enhance public awareness of dementia.

(d) To develop or assist support groups for persons with dementia and caregivers.

(e) To pay for program administration, except that no more than 10% of funds allocated for the program may be used for this purpose.

(2) Goods and services.

(a) A household or a person living in a residential facility who is participating in the program may not be restricted from purchasing goods and services listed under this subsection and identified under s. DHS 68.08 from providers who are located outside of the county to which application is made.

(b) The administering agency at the time of need determination under s. DHS 68.08 shall enumerate to households and individuals participating in the program the goods or services that may be purchased or provided to accomplish the purposes listed under sub. (1), which shall be limited to goods and services that can be provided under any of the following categories:

1. Adaptive equipment.

2. Adult day center services.

3. Advocacy and legal assistance.

4. Caregiver counseling and therapeutic resources.

5. Case management and service coordination.

6. Companion services.

7. Crisis intervention.

8. Daily living skills training.

9. Emergency housing and energy assistance.

10. Employment –related support services.

11. Health screening and accessibility.

12. Home-delivered meals for people with dementia and caregivers that are not Title III-C2 eligible.

13. Household chores.

14. In-home personal care.

15. Inpatient treatments not covered by the person’s primary health insurance.

16. Intake and assessment.

17. Interpreter services.

18. Outreach to individuals, groups or the community.

19. Protective placement or guardianship.

20. Recreation and social activities, including Memory Cafés and social events.

21. Respite, including short-term respite in a residential facility.

22. Support groups.

23. Transportation and.

24. Any other goods and services necessary to maintain the person with dementia as a member of the household.

(3) Administration. Administering agencies may use program funds to pay for the cost of administering the program only if the costs are incurred under one or both of the following categories:

(a) Training and development.

(b) Agency and systems management.

Note: For descriptions of the categories listed under subs.(2) and (3), write the Division of Disability and Elder Services, Bureau on Aging and Long-Term Care Resources, P.O. Box 7851, Madison, Wisconsin 53707.

(4) Non-Supplanting. Program funds may not be used to purchase goods and services that are otherwise covered by a person’s private health or long term care insurance, or be spent in place of other federal, state or local programs that would, in the absence of the Alzheimer’s and Dementia Family Caregiver Program, be available to the family.

History: Cr. Register, March, 1989, No. 399, eff. 4-1-89; CR 17-032: am. (1) (intro.), (a) to (d), r. and recr. (2) (b), am. (3) (a), cr. (4) Register June 2018 No. 750, eff. 7-1-18; correction in (2) (a), (b) (intro.) made under s. 13.92 (4) (b) 7., Stats., Register June 2018 No. 750.

DHS 68.07 Client eligibility. In accordance with s. 46.87 (5), Stats., the administering agency of each county or tribe shall determine the eligibility of each household that applies to participate in that county or tribe’s program by establishing that the household or person meets all of the following conditions:

(1) Diagnosis of condition. At least one member of the household or the person who lives in a residential facility has received a final, tentative or preliminary documented diagnosis of dementia from a physician or other qualified medical provider.

(2) residency. The person in the household who has dementia, or that person’s caregiver, meets one of the following conditions:

(a) Resides in the county or tribal service area.

(b) The person with dementia lives in a residential facility located in the county or tribal service area.

(3) Household income. The person with dementia and that person’s spouse are expected to have a joint income of no more than $48,000 for the 12-month period immediately following application for the program, except that in determining the income of a household with a joint gross income of more than $48,000, the administering agency shall subtract any expenses attributable to the dementia-related needs of the person with a dementia diagnosis or of the person’s caregiver. If the net income determined by subtracting dementia-related expenses for a household is $48,000 or less, the household shall be considered as having met the household income eligibility condition.

History: Cr. Register, March, 1989, No. 399, eff. 4-1-89; CR 17-032: am. Register June 2018 No. 750, eff. 7-1-18; correction in (2) (b) made under s. 35.17, Stats., Register June 2018 No. 750.

DHS 68.08 Determination of need. The amount paid or expended for each person diagnosed with dementia may not exceed $4,000 in any calendar year. For the purpose of calculating the funds to be paid to or expended for a household or individual participating in the program, the administering agency shall conduct a needs assessment to determine all of the following:

(1) The goods and services needed by the household to enable it to maintain the person with dementia as a member of the household.

(2) The goods and services reasonably needed by a person with dementia living in a residential facility that are not included in residential fees paid to the facility.

(3) The cost of each good and service that is needed.

History: Cr. Register, March, 1989, No. 399, eff. 4-1-89; corrections in (1) (c), (2) (a) and (b) made under s. 13.92 (4) (b) 7. Stats., Register November 2008 No. 635; CR 17-032: r. and recr. Register June 2018 No. 750, eff. 7-1-18.

DHS 68.09 Method of payment. The payment by an administering agency for goods and services shall be made using one or more of the following methods:

(1) Payment made to a service provider on behalf of the person with dementia or the person’s caregiver.

(2) Payment made to a service provider under contract with the administering agency to develop new programs or to expand services.

(3) Payment made to the household of a person with dementia pursuant to accounting requirements set forth by the administering agency.

(4) Payment made to a residential facility in which a person with dementia resides for the purchase of goods or services, or both, pursuant to accounting requirements set forth by the administering agency. Payments may not be made to cover the cost of goods or services that a residential facility is required to provide under a program, other than the Alzheimer’s family and caregiver support program.

History: Cr. Register, March, 1989, No. 399, eff. 4-1-89; CR 17-032: am. (1) to (4) Register June 2018 No. 750, eff. 7-1-18.

DHS 68.10 Hearing.

(1) Jurisdiction. Any household or individual participating in the program or caregiver may appeal the following actions by an administering agency:

(a) Denial of an application to participate in a program.

(b) The calculation of funds to be paid to or expended for a household or a person with dementia living in a residential facility and participating in the program.

(d) Change of provider of goods and services provided under this chapter.

(e) Change of method of payment for goods and services provided under this chapter.

(f) Change of the maximum amount payable in a calendar year to or on behalf of any participating person with dementia.

(2) Notification of appeal rights. At the time an administering agency takes any of the actions under sub. (1), it shall inform the household, individual participating in the program, any caregiver, and any guardian or protective payee, in writing, of the right to a hearing under this chapter and of the procedure for requesting a hearing.

(3) Request for hearing. A household or individual participating in the program or caregiver wishing to contest an action under sub. (1) shall file a written request for a hearing with the department of administration’s division of hearings and appeals within 45 days after the date of the action for which review is sought. A hearing request shall be considered filed on the date of receipt by the division of hearings and appeals.