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In this subsection, “severely emotionally disturbed child” means an individual under 21 years of age who has emotional and behavioral problems that: 1. Are severe in degree; 2. Are expected to persist for at least one year; 3. Substantially interfere with the individual’s functioning in his or her family, school or community and with his or her ability to cope with the ordinary demands of life; and 4. Cause the individual to need services from 2 or more agencies or organizations that provide social services or services or treatment for mental health, juvenile justice, child welfare, special education or health.
Are severe in degree;
Are expected to persist for at least one year;
Substantially interfere with the individual’s functioning in his or her family, school or community and with his or her ability to cope with the ordinary demands of life; and
Cause the individual to need services from 2 or more agencies or organizations that provide social services or services or treatment for mental health, juvenile justice, child welfare, special education or health.
Except as provided under pars. (be), (bg), and (bj) and sub. (24), case management services under s. 49.46 (2) (b) 9. and (bm) are reimbursable under Medical Assistance only if provided to a Medical Assistance beneficiary who receives case management services from or through a certified case management provider in a county, city, village, or town that elects, under par. (b), to make the services available and who meets at least one of the following conditions: 1. Has a developmental disability, as defined under s. 51.01 (5) (a). 2. Has a serious and persistent mental illness. 3. Has Alzheimer’s disease, as defined under s. 46.87 (1) (a). 4. Is an alcoholic, as defined under s. 51.01 (1h). 5. Is drug dependent, as defined under s. 51.01 (8b). 6. Is physically disabled, as defined by the department. 7. Is a severely emotionally disturbed child. 8. Is age 65 or over. 9. Is a member of a family that has a child who is at risk of serious physical, mental or emotional dysfunction, as defined by the department. 10. Has HIV infection, as defined in s. 252.01 (2). 11. Is a child who is eligible for early intervention services under s. 51.44. 12. Is infected with tuberculosis. 13. Is a child with asthma. 14. Is a woman who is aged 45 to 64 and who is not a resident of a nursing home or otherwise receiving case management services under this paragraph.
Has a developmental disability, as defined under s. 51.01 (5) (a).
Has a serious and persistent mental illness.
Has Alzheimer’s disease, as defined under s. 46.87 (1) (a).
Is an alcoholic, as defined under s. 51.01 (1h).
Is drug dependent, as defined under s. 51.01 (8b).
Is physically disabled, as defined by the department.
Is a severely emotionally disturbed child.
Is age 65 or over.
Is a member of a family that has a child who is at risk of serious physical, mental or emotional dysfunction, as defined by the department.
Has HIV infection, as defined in s. 252.01 (2).
Is a child who is eligible for early intervention services under s. 51.44.
Is infected with tuberculosis.
Is a child with asthma.
Is a woman who is aged 45 to 64 and who is not a resident of a nursing home or otherwise receiving case management services under this paragraph.
A county, city, village, town or, in a county having a population of 750,000 or more, the department may elect to make case management services under this subsection available in the county, city, village or town to one or more of the categories of beneficiaries under par. (am) through the medical assistance program. A county, city, village, town or, in a county having a population of 750,000 or more, the department that elects to make the services available shall reimburse a case management provider for the amount of the allowable charges for those services under the medical assistance program that is not provided by the federal government.
A private nonprofit agency that is a certified case management provider may elect to provide case management services to medical assistance beneficiaries who have HIV infection, as defined in s. 252.01 (2). The amount of the allowable charges for those services under the medical assistance program that is not provided by the federal government shall be paid from the appropriation account under s. 20.435 (1) (am).
An independent living center, as defined in s. 46.96 (1) (ah), that is a certified case management provider and satisfies the criteria in s. 46.96 (3m) (a) 1. to 3. and (am) may elect to provide case management services to one or more of the categories of medical assistance beneficiaries specified under par. (am). The amount of allowable charges for the services under the medical assistance program that is not provided by the federal government shall be paid from nonfederal, public funds received by the independent living center from a county, city, village or town or from funds distributed as a grant under s. 46.96.
The department of corrections may elect to provide case management services under this subsection to persons who are under the supervision of that department under s. 938.183, 938.34 (4h), or 938.357 (3) or (4), who are Medical Assistance beneficiaries, and who meet one or more of the conditions specified in par. (am). The amount of the allowable charges for those services under the Medical Assistance program that is not provided by the federal government shall be paid from the appropriation account under s. 20.410 (3) (hm), (ho), or (hr).
Case management services under this subsection may not be provided to a person under par. (am) 7. unless any of the following is true: 1. A team of mental health experts appointed by the case management provider determines that the person is a severely emotionally disturbed child. The team shall consist of at least 3 members. The case management provider shall appoint at least one member of the team who is a licensed psychologist or a physician specializing in psychiatry. The case management provider shall appoint at least 2 members of the team who are members of the professions of school psychologist, school social worker, registered nurse, social worker, child care worker, occupational therapist or teacher of emotionally disturbed children. The case management provider shall appoint as a member of the team at least one person who personally participated in a psychological evaluation of the child. 2. Individuals who are designated by the coordinating committee have, or a service coordination agency has, determined under s. 46.56 (8) (d) that the person is a child, as defined in s. 46.56 (1) (bm), with emotional and behavioral disabilities.
A team of mental health experts appointed by the case management provider determines that the person is a severely emotionally disturbed child. The team shall consist of at least 3 members. The case management provider shall appoint at least one member of the team who is a licensed psychologist or a physician specializing in psychiatry. The case management provider shall appoint at least 2 members of the team who are members of the professions of school psychologist, school social worker, registered nurse, social worker, child care worker, occupational therapist or teacher of emotionally disturbed children. The case management provider shall appoint as a member of the team at least one person who personally participated in a psychological evaluation of the child.
Individuals who are designated by the coordinating committee have, or a service coordination agency has, determined under s. 46.56 (8) (d) that the person is a child, as defined in s. 46.56 (1) (bm), with emotional and behavioral disabilities.