Section 10.31. Application and eligibility determination.

 

(1)   Definition. In this section, "agency" means any county agency, or any resource center that is not a county agency, that is responsible for all or part of determination of functional, financial, and other conditions of eligibility for the family care benefit.

(2)   General requirement. Application for the family care benefit shall be made and reviewed in accordance with the provisions of this chapter.

(3)   Access to information. The agency shall provide information to persons inquiring about or applying for the family care benefit as required under s. DHS 10.23 (2) (c) and (h) .

(4)   Application.

(a) Making application . Any person may apply for a family care benefit on a form prescribed by the department and available from a resource center. Application shall be made to the agency serving the county, tribe or family care district in which the person resides. Application may not be made to an agency in a county or tribe in which the family care benefit is not available.

(b) Signing the application . The applicant or the applicant's legal guardian, authorized representative or, where the applicant is incapacitated, someone acting responsibly for the applicant, shall sign each application form in the presence of a representative of the agency. The signatures of 2 witnesses are required when the applicant signs the application with a mark.

(5)   Verification of information. An application for the family care benefit shall be denied when the applicant or enrollee is able to produce required verifications but refuses or fails to do so. If the applicant or enrollee is not able to produce verifications or requires assistance to do so, the agency taking the application may not deny assistance but shall proceed immediately to assist the person to secure necessary verifications.

(6)   Eligibility determination.

(a) Decision date . Except as provided in par. (b) , as soon as practicable, but not later than 30 days from the date the agency receives an application that includes at least the applicant's name, address, unless the applicant is homeless, and signature, the agency shall determine the applicant's eligibility and cost sharing requirements for the family care benefit, using a functional screening and a financial eligibility and cost-sharing screening prescribed by the department. If the applicant is a family care spouse, the agency shall notify both spouses in accordance with the requirements of s. 49.455 (7) , Stats.

(b) Notice . The agency shall notify the applicant in writing of its determination. If a delay in processing the application occurs because of a delay in securing necessary information, the agency shall notify the applicant in writing that there is a delay in processing the application, specify the reason for the delay, and inform the applicant of his or her right to appeal the delay by requesting a fair hearing under s. DHS 10.55 .

(7)   Enrollment. The agency shall complete and transmit, as directed by the department, all enrollment forms and materials required to enroll persons who are eligible and who choose to enroll in a care management organization.

(8)   Fraud. When the agency director or designee has reason to believe that an applicant or enrollee, or the representative of an applicant or enrollee, has committed fraud, the agency director or designee shall refer the case to the district attorney.

History: Cr. Register, October, 2000, No. 538 , eff. 11-1-00; CR 04-040 : am. (6) (a) Register November 2004 No. 587 , eff. 12-1-04.

Note

This provision allows anyone acting responsibly for a person who is incapacitated to begin the application process for financial assistance with the costs of long-term care services. Other decisions regarding receipt of health or long-term care services, including placement in a long-term care facility, require consent of the individual or authorization by a person or court with the specific authority to make treatment or placement decisions. Microsoft Windows NT 6.1.7601 Service Pack 1