Funding paperwork needed when a person or their housemate dies or is temporarily in a non-billable setting

To capture all possible waiver revenue, Dane County has developed a reporting process for individuals whose housemates are not living at home due to hospitalization, nursing home stays, jail, center assessments and evaluations or death. Historically, Dane County has either continued to pay for the individual’s services while in the non-community setting, or, in the case of death, has paid for 14 days after their date of death. As a result, the county has not collected any revenue for increased support costs an individual may experience while their housemate temporarily resides in a non-billable setting. Beginning in , the following applies.

Lapse Reports:
“Lapses” in community living are reported to Dane County monthly by Support Broker Agencies using a “Lapse Report”, submitted with 610 billing. Lapse reports get e-mailed to the identified county clerical staff with a CC: to the SDS Coordinator. The comment section of the lapse report should list the names of a person’s housemate(s) or state “live alone” or “AFH”.

Exception Expense Requests (EERs) when person has housemate:

A person dies:

Support Broker ends the person’s entire SDS rate effective the date of death. The SDS Coordinator will generate a 14-day vocational support EER, for the full amount of the deceased person’s vocational service rate. The SDS Coordinator will also generate a 14-day supported living EER, for the surviving housemate, for the full amount of the deceased person’s residential service rate.

On day 15, the surviving housemate’s County Manager can approve an EER not to exceed 90 days or ⅔ of the deceased person’s supported living rate. No SDS meeting is required. EERs in excess of ⅔ of the deceased person’s residential service rate and/or 90 days require SDS Meeting approval. The Support Broker of the surviving housemate completes the EER needed while a person identifies a new housemate or living arrangement.

A person goes to a non-community setting (for example, hospital, nursing home, etc.) for 7 days or less:
No reduction in person’s rate. No Support Broker paperwork required.
  • Example: Earl J. goes to the hospital emergency room and is admitted for 2 days then returns home – No change in funding. This is repeat of sentence above.
A person goes to a non-community setting for 8-30 days:

The SDS Coordinator will generate 2 EERs—one for the person in a non-community setting for a -⅔ (reduction) of their residential service rate and one for the roommate for &frac2/3; (increase based on the non-community person’s residential service rate). This will not change the total SDS funds that Supported Living Providers receive for the household. No Support Broker paperwork required.

  • Example: Earl J. returns to the hospital 2 months later and remains in the hospital 7 days and is then moved to a nursing home for 14 days of rehab. Earl J is in non-community settings for 21 days. Earl J’s monthly SDS payment is $3,000. The SDS Coordinator will generate an EER for Earl J, for ($2,000) and an EER for his roommate, Ray T. for $2,000—all prorated for the 21 days. Supported living provider will receive monthly SDS payment of $3,000. $1,000 for Earl J; $2,000 for Earl’s housemate.
A person goes to a non-community setting for 31 days or more:

The person in a non-community setting’s supported living rate is discontinued. Any existing supported living or vocational EERs will also end. The person’s Support Broker sends an e-mail to Fiscal Assistance, MA Waiver Unit, DCDHS Accountant, SDS Coordinator, County Manager and the housemate’s Support Broker. E-mail should include:

  1. Name of the person in non-billable setting.
  2. Date admitted to non-billable setting.
  3. Date supported living rate ends (day 30).
  4. Anticipated discharge date.
  5. Name of their housemate.

The housemate who remains at home will have a +⅔ EER. The Support Broker for the person who continues to reside at home completes the EER. The County Manager will provide the Support Broker with the EER amount and term, and will also send an e-mail authorization approving the EER. This applies when the plan is for the person to return to their home. It is not a vacancy rate.

  • Example: Beulah S. goes to the hospital emergency room for psychiatric problems, but is moved to Mendota Mental Health. She stays at Mendota for 45 days before returning home. Her monthly SDS payment is $4,500. The SDS Coordinator generates an EER for Beulah for ($3,000) and an EER for her roommate, Lily Lou, for $3,000. These EERs cover days 1-30. After day 31, Beulah’s entire SDS payment will stop, but Lily Lou’s EER for $3,000/month will continue until Beulah returns home on day 45. Broker completes EER. Funding to supported living providers for days 31-45 will be reduced by ⅓ of Beulah’s SDS rate.

Exceptional Expense Reports (EERs) When Person Lives Alone:

A person dies:
Support Broker ends the person’s entire SDS rate effective the date of death. SDS Coordinator completes paperwork to ensure supported living and vocational providers get paid for an additional 14 days. No Support Broker paperwork required.
A person goes to a non-community setting (for example, hospital, nursing home, etc.) for 1-30 days:
This situation continues to be fully funded. No Support Broker paperwork required.
A person goes to a non-community setting for 31 days or more:
The Support Broker will need to individually negotiate a negative EER to reflect reduced support costs while person is away from their home.

The SDS Coordinator generates all lapse EERs for 8-30 days based on the Lapse Reports submitted with each Support Broker Agency’s monthly 610 report. The SDS Accountant will sign the EER; the original EER will go to Fiscal Assistance and copies are made for the Support Broker, Residential Provider and County Manager.

This process applies only to individuals in the SDS program and not to contracted AFHs or those in the AFH program. When submitting their monthly Lapse Report to Dane County, it is requested that Support Broker Agency Directors include the SDS Coordinator on the CC: line of their Lapse Report e-mail.