Section 10.33. Conditions of functional eligibility.

 

(1)   Definitions. In this section:

(a) "Appropriately" means suitable in terms of time and place.

(b) "Long-term or irreversible condition" means a physical or cognitive impairment that is expected to last for more than 90 days or result in death within one year.

(c) "Requires ongoing care, assistance or supervision" means a person cannot safely or appropriately perform one or more ADLs or IADLs, as is evidenced by findings from functional screening.

(d) "Safely" means without significant risk of harm to oneself or others.

(2)   Determination of functional eligibility.

(a) Determination. Functional eligibility for the family care benefit shall be determined pursuant to s. 46.286 (1) , Stats., and this chapter, using a uniform functional screening prescribed by the department. To have functional eligibility for the family care benefit, the functional eligibility condition under par. (b) shall be met and, except as provided under sub. (3) , the functional capacity level under par. (c) or (d) shall be met.

(b) Long-term condition. The person shall have a long-term or irreversible condition.

(c) Comprehensive functional capacity level. A person is functionally eligible at the comprehensive level if the person requires ongoing care, assistance or supervision from another person, as is evidenced by any of the following findings from application of the functional screening:

1. The person cannot safely or appropriately perform 3 or more activities of daily living.

2. The person cannot safely or appropriately perform 2 or more ADLs and one or more instrumental activities of daily living.

3. The person cannot safely or appropriately perform 5 or more IADLs.

4. The person cannot safely or appropriately perform one or more ADL and 3 or more IADLs and has cognitive impairment.

5. The person cannot safely or appropriately perform 4 or more IADLs and has cognitive impairment.

6. The person has a complicating condition that limits the person's ability to independently meet his or her needs as evidenced by meeting both of the following conditions:

a. The person requires frequent medical or social intervention to safely maintain an acceptable health or developmental status; or requires frequent changes in service due to intermittent or unpredictable changes in his or her condition; or requires a range of medical or social interventions due to a multiplicity of conditions.

b. The person has a developmental disability that requires specialized services; or has impaired cognition exhibited by memory deficits or disorientation to person, place or time; or has impaired decision making ability exhibited by wandering, physical abuse of self or others, self neglect or resistance to needed care.

(d) Intermediate functional capacity level . A person is functionally eligible at the intermediate level if the person is at risk of losing his or her independence or functional capacity unless he or she receives assistance from others, as is evidenced by a finding from application of the functional screening that the person needs assistance to safely or appropriately perform either of the following:

1. One or more ADL.

2. One or more of the following critical IADLs:

a. Management of medications and treatments.

b. Meal preparation and nutrition.

c. Money management.

(3)   Grandfathering. If a person does not meet either of the functional capacity levels under sub. (2) (c) or (d) , the department shall deem the person functionally eligible for the family care benefit if all of the following apply:

(a) The person has a long-term or irreversible condition.

(b) The person is in need of services included in the family care benefit.

(c) On the date that the family care benefit became available in the county of the person's residence, he or she was a resident in a nursing home or had been receiving for at least 60 days, under a written plan of care, long-term care services that were funded under any of the following:

1. The long-term support community options program under s. 46.27 , Stats.

2. Any home and community-based waiver program under 42 USC 1396n (c), including the community integration program under s. 46.275 , 46.277 or 46.278 , Stats.

3. The Alzheimer's family caregiver support program under s. 46.87 , Stats.

4. Community aids under s. 46.40 , Stats., if documented by the county under a method prescribed by the department.

5. County funding, if documented under a method prescribed by the department.

History: Cr. Register, October, 2000, No. 538 , eff. 11-1-00; CR 04-040 : am. (1) (c) and (2) (a), (c) and (d) Register November 2004 No. 587 , eff. 12-1-04.