DHS 68.06(2)(b)15.15. Inpatient treatments not covered by the person’s primary health insurance. DHS 68.06(2)(b)20.20. Recreation and social activities, including Memory Cafés and social events. DHS 68.06(2)(b)24.24. Any other goods and services necessary to maintain the person with dementia as a member of the household. DHS 68.06(3)(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: DHS 68.06 NoteNote: 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.
DHS 68.06(4)(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. DHS 68.06 HistoryHistory: 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 68.07DHS 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: DHS 68.07(1)(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. DHS 68.07(2)(2) residency. The person in the household who has dementia, or that person’s caregiver, meets one of the following conditions: DHS 68.07(2)(b)(b) The person with dementia lives in a residential facility located in the county or tribal service area. DHS 68.07(3)(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. DHS 68.07 HistoryHistory: 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 68.08DHS 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: DHS 68.08(1)(1) The goods and services needed by the household to enable it to maintain the person with dementia as a member of the household. DHS 68.08(2)(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. DHS 68.08(3)(3) The cost of each good and service that is needed. DHS 68.08 HistoryHistory: 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 68.09DHS 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: DHS 68.09(1)(1) Payment made to a service provider on behalf of the person with dementia or the person’s caregiver. DHS 68.09(2)(2) Payment made to a service provider under contract with the administering agency to develop new programs or to expand services. DHS 68.09(3)(3) Payment made to the household of a person with dementia pursuant to accounting requirements set forth by the administering agency. DHS 68.09(4)(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. DHS 68.09 HistoryHistory: 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(1)(1) Jurisdiction. Any household or individual participating in the program or caregiver may appeal the following actions by an administering agency: DHS 68.10(1)(b)(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. DHS 68.10(1)(c)(c) Reduction, suspension, limitation or termination of goods and services provided under this chapter. DHS 68.10(1)(d)(d) Change of provider of goods and services provided under this chapter. DHS 68.10(1)(e)(e) Change of method of payment for goods and services provided under this chapter. DHS 68.10(1)(f)(f) Change of the maximum amount payable in a calendar year to or on behalf of any participating person with dementia. DHS 68.10(2)(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. DHS 68.10(3)(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. DHS 68.10 NoteNote: The mailing address of the Office of Administrative Hearings is P.O. Box 7875, Madison, Wisconsin 53707-7875.
DHS 68.10(4)(4) Arrangements for a hearing. In response to a request for a hearing under this section, the director of the office of administrative hearings shall appoint a hearing examiner, set a date for the hearing and notify the parties at least 10 days before the hearing of the date, time and place of the hearing and of the procedures to be followed. DHS 68.10 HistoryHistory: Cr. Register, March, 1989, No. 399, eff. 4-1-89; CR 17-032: am. (1) (a) to (f) Register June 2018 No. 750, eff. 7-1-18. DHS 68.11DHS 68.11 Exceptions to requirements. The department may grant an exception to an administering agency of any requirement made of the administering agency under this chapter, except a requirement under s. DHS 68.03 or 68.10 (2), if the department is convinced that an alternative to the requirement meets the intent of and is in compliance with s. 46.87, Stats. The department shall respond in writing to a written request for an exception within 30 days after receiving the request. DHS 68.11 HistoryHistory: Cr. Register, March, 1989, No. 399, eff. 4-1-89.
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