Chapter DHS 73

DHS 73.06(2)(b)4. 4. The service provider’s rate of compensation; and

DHS 73.06(2)(b)5. 5. Verification and payment procedures to be followed consistent with s. DHS 73.09 (1) to (3).

DHS 73.06(3) (3) Exemptions. The service agreement between the participant or participant’s representative and service provider under sub. (2) (b) is not required when:

DHS 73.06(3)(a) (a) The services provided are limited to household care;

DHS 73.06(3)(b) (b) The services are provided by the spouse of the participant or by the parent of a minor participant; or

DHS 73.06(3)(c) (c) The services are for the purpose of providing respite care.

DHS 73.06(4) (4) County department or vendor agency employment of service provider.

DHS 73.06(4)(a) (a) If the service provider is employed by the county department or a vendor agency, there shall be either a single signed agreement among the participant or participant’s representative, the county department and, where applicable, the vendor agency, or separate signed agreements, one between the participant or participant’s representative and the county department and the other between the participant or participant’s representative and the vendor agency.

DHS 73.06(4)(b) (b) The agreement or agreements required under par. (a) shall contain at least the content specified in sub. (2) (a) 1. to 4. and (b), except that verification and payment procedures under sub. (2) (b) 5. and training arrangements under sub. (2) (b) 3. may be omitted if these do not directly involve the participant and are covered elsewhere either in written policy of the county department or in its contract with the vendor agency.

DHS 73.06 History History: Cr. Register, January, 1993, No. 445, eff. 2-1-93.

DHS 73.08 DHS 73.08 Supervisory review of payment decisions.

DHS 73.08(1) (1) The county department shall develop and implement written procedures for supervisory review of staff decisions regarding the competence of a participant to receive funds to pay a service provider and appropriateness of the levels of funds based upon the needs identified in the participant’s assessment and services authorized in the case plan for the participant.

DHS 73.08(2) (2) In conducting a review of a case in which a participant or participant’s representative receives funds, the supervisor shall examine:

DHS 73.08(2)(a) (a) The capability of the participant or participant’s representative to manage funds and act as employer of the service provider;

DHS 73.08(2)(b) (b) The adequacy of the funds provided compared to the level of need identified in the participant’s assessment; and

DHS 73.08(2)(c) (c) The adequacy of any training provided to the participant or the participant’s representative to enable the participant or participant’s representative to manage funds and serve as an employer.

DHS 73.08(3) (3) The supervisor’s review shall occur within 3 months after the initial disbursement of funds to a participant who receives funds for the first time on or after February 1, 1993 and within 9 months after February 1, 1993 for a participant who was receiving payments prior to February 1, 1993, and thereafter whenever there is a substantial change to the participant’s condition or need for services. Alternatively, the county department may conduct a supervisor’s review on a random sample of at least 10% of cases or 25 cases, whichever is greater, in which a participant receives funds. County departments with fewer that 25 cases shall review all cases. This review shall be completed within 12 months after February 1, 1993 and within every 12 months thereafter.

DHS 73.08(4) (4) A county department may contract with a third party for supervisory review under this section.

DHS 73.08 History History: Cr. Register, January, 1993, No. 445, eff. 2-1-93.

DHS 73.09 DHS 73.09 Documentation that services have been provided.

DHS 73.09(1) (1) If a participant or the participant’s representative employs a service provider, the county department shall verify the type and amount of service for which reimbursement is sought. A verification form developed and available from the county department shall either be submitted to the county department by the participant or participant’s representative or be reviewed by the case manager at the participant’s residence at least every 6 months.

DHS 73.09(2) (2) The completed verification form shall include the following information:

DHS 73.09(2)(a) (a) The type or types of services provided;

DHS 73.09(2)(b) (b) The number of hours of service provided in the past month or, if the service provider lives in the residence of the participant, the number of days of service provided in the past month;

DHS 73.09(2)(c) (c) The total dollar amount paid for the services;

DHS 73.09(2)(d) (d) The month in which the services were provided;

DHS 73.09(2)(e) (e) The dated signature of the participant or participant’s representative; and

DHS 73.09(2)(f) (f) The dated signature of the service provider.

DHS 73.09(3) (3) The county department may provide in the form under sub. (2) that the information in sub. (2) (b) does not have to be maintained or reported if:

DHS 73.09(3)(a) (a) The services provided are limited to household care;

DHS 73.09(3)(b) (b) The services are for the purpose of providing respite care; or

DHS 73.09(3)(c) (c) The services are provided by the spouse of the participant or by the parent of a minor participant.

DHS 73.09(4) (4) If a county department directly provides services or purchases services from a vendor agency, the county department and vendor agency, if any, shall establish procedures sufficient to document the amount of services provided to each participant each month.

DHS 73.09 History History: Cr. Register, January, 1993, No. 445, eff. 2-1-93.

DHS 73.10 DHS 73.10 Individual hardship exceptions to limits on funding for CBRF care.

DHS 73.10(1) (1) Limitation on funding. Each county shall annually establish limits on spending for services for persons who reside in CBRFs from the allocations received under s. 46.277 (5), Stats., for community long-term support services.

DHS 73.10(2) (2) Limitation on eligibility. If the projected cost of the services for an individual who is residing or intending to reside in a CBRF and initially applies for services to a county department would cause the county department to exceed a limit on spending for services provided to persons who reside in CBRFs under sub. (1), the individual is not eligible for those services using funds allocated under s. 46.277 (5), Stats.

DHS 73.10 History History: Emerg. cr. eff. 1-1-96; cr. Register, May, 1996, No. 485, eff. 6-1-96; CR 00-056: am. (1), Register August 2001 No. 548, eff. 9-1-01; CR 22-026: am. (1), (2), r. (3) Register May 2023 No. 809, eff. 6-1-23.

DHS 73.11 DHS 73.11 Criteria for determination of the infeasibility of in-home services.

DHS 73.11(1) (1) A county may use long-term support funds under s. 46.277, Stats., to provide services to a person residing in a CBRF if the county department or aging unit has determined that all 5 conditions under s. 46.277 (5) (d) 1n., Stats., have been met.

DHS 73.11 Note Note: The five conditions are: the completion of an assessment before the person’s admission; determination of the infeasibility of in-home care; determination that the CBRF is the person’s preferred residence; determination that the CBRF provides a quality environment and quality care services; and determination that the CBRF is cost-effective when compared to other residential options.

DHS 73.11(2) (2) To determine in-home care is infeasible, the county department or aging unit shall document in writing that all of the following have occurred:

DHS 73.11(2)(a) (a) A change has occurred in the individual’s condition, functioning, living situation or supports so that arrangements that were in place and adequate to maintain the individual’s health, safety and well-being are no longer sufficient to provide or ensure the provision of what the individual needs.

DHS 73.11 Note Note: Examples include, but are not limited to, when a spouse or other family member who has been a major caregiver dies or for some other reason can no longer provide care, or when there is a major change in the medical condition of a program participant such as a stroke or heart attack and there is need for more care and support but the additional funds or needed caregivers are for some reason not available.

DHS 73.11(2)(b) (b) Options for supporting the individual in his or her own home and community have been explored or attempted but have either failed or been found to be unavailable or not possible.

DHS 73.11 Note Note: Examples of efforts include, but are not limited to, other relatives, friends, neighbors or volunteers have been contacted; professional workers from a home health agency have been recruited and have attempted unsuccessfully to work with the individual in his or her home; and other options such as modifying the home and providing adaptations and aids to enable the individual to be more independent or obtaining nutritional services, adult day care and transportation are not available, feasible or cost-effective.

DHS 73.11 History History: CR 00-056: cr. Register August 2001 No. 548 eff. 9-1-01; CR 22-026: am. (1) Register May 2023 No. 809, eff. 6-1-23.