Opportunities for enrollees in a CMO to do as much for themselves as possible and desired and for full participation in service planning and delivery.
The resource center shall assist a person found eligible for the family care benefit and wishing to enroll in a care management organization to enroll in the care management organization of the person's choice.
The resource center shall provide information and counseling to assist persons in the process of voluntarily or involuntarily disenrolling from a care management organization, including all of the following:
Advocacy resources available to assist the person in resolving complaints and grievances.
Service and program options available to the person if the disenrollment occurs.
Information about the availability of assistance with re-enrollment.
Waiting list management.
The resource center shall manage, as directed by the department, any waiting lists that become necessary under s. DHS 10.36 (2)
(3) Access to family care and other benefits.
If it is a county agency, the resource center shall provide to members of its target population access to the benefits under pars. (a)
directly or through subcontract or other arrangement with the appropriate county agency. If it is not a county agency, the resource center shall have a departmentally approved memorandum of understanding with a county agency to which it will make referrals for access to these benefits. The memorandum of understanding shall clearly define the respective responsibilities of the two organizations, and how eligibility determination for the benefits under pars. (a)
will be coordinated with other resource center functions for the convenience of members of the resource center's target population. Benefits to which the resource center shall provide access are all the following:
The requirements specified in s. DHS 10.31
shall govern application and determination of eligibility for the family care benefit.
A resource center shall offer a functional screening and a financial eligibility and cost-sharing screening to any individual over the age of 17 years and 9 months who appears to have a disability or condition requiring long-term care and who meets any of the following conditions:
The person is seeking admission to a nursing home, community-based residential facility, adult family home, or residential care apartment complex, subject to the exceptions under ss. DHS 10.72 (4)
and 10.73 (4) (a)
If a person accepts the offer, the resource center or the county agency shall provide the screens.
Medical assistance, SSI, state supplemental payments and food stamps.
The resource center shall provide, directly or through referral, access to all of the following:
State supplemental payments under s. 49.77
, Stats., to the federal supplemental security income (SSI) program under USC 1381 to 1383d, including the increased or "exceptional" payments (SSI-E) under s. 49.77 (3s)
The resource center shall identify persons who may need elder abuse or adult protective services and shall provide or facilitate access to services for eligible individuals under s. 46.90
and chs. 51
The resource center may provide elder abuse and adult protective services directly, if a county agency, or through cooperation with the local public agency or agencies that provide the services. If the resource center is not the county agency designated under s. 46.90
or ch. 55
, Stats., it shall have a memorandum of understanding with the designated agency or agencies regarding how these services are to be coordinated. The memorandum shall specify staff contacts, hours of operation and referral processes and procedures.
(5) Staff qualifications.
Persons providing resource center services, whether directly employed by the resource center or indirectly under subcontract or memorandum of understanding with another organization, shall have the following qualifications:
Persons answering the information and assistance telephone line shall be trained and knowledgeable about all of the following:
The mission, operations and referral policies of the resource center.
Telephone etiquette and communication skills, including how to recognize and respond to special hearing or language needs.
Persons providing information and assistance services, long-term care options counseling, benefits counseling, the functional screen and financial eligibility and cost-sharing screen and choice counseling shall:
Be competent to provide these services to the resource center's target population.
Meet at least one of the following requirements for education and experience:
Bachelor of arts or science degree, preferably in a health or human services related field, and at least one year of experience working with at least one of the resource center's target populations.
Four years of post-secondary education and experience working with at least one of the target populations or an equivalent combination of education and experience, either in long-term support or a related human services field.
Other experience, training or both, as approved by the department based on a plan for providing formal and on-the-job training to develop the required expertise.
Be knowledgeable about the range, quality and availability of long-term care services offered within the resource center's service area.
(6) Operational requirements.
A resource center shall do all of the following:
Develop and implement an ongoing program of marketing and outreach to inform members of its target population and their families, community agencies, health professionals and service providers of the availability of resource center services.
Within 6 months after the family care benefit is available to all eligible persons in its service area, provide information about family care to persons who are members of a target population served by a CMO that operates in the county and who are residents of nursing homes, community-based residential facilities, adult family homes and residential care apartment complexes in the geographic area of the resource center. The information provided shall cover all of the following:
The family care benefit, and the opportunities for enrollee choice within the benefit, including the opportunity for self-management of service funding under s. DHS 10.44 (2) (d)
The services of the resource center, including information and assistance, benefits counseling, long-term care options counseling, advocacy assistance, the functional screen and financial eligibility and cost-sharing screen, and eligibility determination and enrollment in family care.
The services of any available care management organization, including the comprehensive assessment and care plan.
The services of available advocacy services external to the resource center, including services under s. 16.009 (2) (p)
, Stats., and how to access these services.
Community needs identification.
Implement a process for identifying unmet needs of its target population in the geographic area it serves. The process shall include input from the regional long-term care advisory committee, members of the target populations and their representatives, and local government and service agencies including the care management organization, if any. The process shall include a systematic review of the needs of populations residing in public and private long-term care facilities, members of minority groups and people in rural areas. A resource center shall target its outreach, education, prevention and service development efforts based on the results of the needs identification process.
Grievance and appeal processes.
Implement a process for reviewing client complaints and resolving client grievances as required under s. DHS 10.53 (1)
Except as provided in this par. and sub. (7)
, collect data about its operations as required by the department by contract. No data collection effort shall interfere with a person's right to receive information anonymously or require personally identifiable information unless the person has authorized the resource center to have or share that information.
Report information as the department determines necessary, including information needed for doing all of the following:
Determining whether the resource center is meeting minimum quality standards and other requirements of its contract with the department.
Determining the extent to which the resource center is improving its performance on measurable indicators identified by the resource center in its current quality improvement plan.
Evaluating the effects of providing long-term care options counseling and choice counseling under this section.
Evaluating the effects for enrollees and cost-effectiveness of providing the family care benefit.
Submit to the department all reports and data required or requested by the department, in the format and timeframe specified by the department.
Internal quality assurance and quality improvement.
Implement an internal quality assurance and quality improvement program that meets the requirements of its contract with the department. As part of the program, the resource center shall do all of the following:
Develop and implement a written quality assurance and quality improvement plan designed to ensure and improve outcomes for its target population. The plan shall be approved by the department and shall include at least all of the following components:
Identification of performance goals, specific to the needs of the resource center's customers, including any goals specified by the department.
Identification of objective and measurable indicators of whether the identified goals are being achieved, including any indicators specified by the department.
Description of the process that the resource center will use to gather feedback from the resource center's customers and staff and other sources on the quality and effectiveness of the resource center's performance.
Description of the process the resource center will use to monitor and act on the results and feedback received.
A process for regularly updating the plan, including a description of the process the resource center will use for annually assessing the effectiveness of the quality assurance and quality improvement plan and the impact of its implementation on outcomes.
Measure resource center performance, using standard measures as required by its contract with the department, and report its findings on these measurements to the department.
Achieve minimum performance levels and performance improvement levels, as demonstrated by standardized measures agreed to in its contract with the department.
Initiate performance improvement projects that examine aspects of services related to improving resource center quality. These projects shall include all of the following:
Planning for sustained or increased improvement in performance based on the findings of the evaluation.
Comply with quality standards for services included in the resource center's contract with the department in all of the following areas:
Timeliness and accuracy of the functional screen and financial eligibility and cost-sharing screen.
Timely and accurate eligibility determination and enrollment procedures.
Information and assistance services and long-term care options counseling.
Effective processes for considering and acting on complaints and resolving grievances of applicants and other persons who use resource center services.
Report all data required by the department related to standardized measures of performance, in the timeframes and format specified by the department.
Cooperate with the department in evaluating outcomes and in developing and implementing plans to sustain and improve performance.
Cooperation with external reviews.
Cooperate with any review of resource center activities by the department, another state agency or the federal government.
(7) Confidentiality and exchange of information.
No record, as defined in s. 19.32 (2)
, Stats., of a resource center that contains personally identifiable information, as defined in s. 19.62 (5)
, Stats., concerning an individual who receives services from the resource center may be disclosed by the resource center without the individual's informed consent, except as follows:
Notwithstanding ss. 48.78 (2) (a)
, 49.45 (4)
, 51.45 (14) (a)
, 252.11 (7)
, 253.07 (3) (c)
and 938.78 (2) (a)
, Stats., and except as provided in sub. (2) (d) 2.
, a resource center may exchange confidential information about a client without the informed consent of the client, in the county of the resource center, if the exchange of information is necessary to enable the resource center to perform its duties or to coordinate the delivery of services to the client, as authorized under s. 46.21 (2m) (c)
, 46.215 (1m)
, 46.22 (1) (dm)
, 46.23 (3) (e)
, 46.284 (7)
, 46.2895 (10)
, 51.42 (3) (e)
or 51.437 (4r) (b)
DHS 10.23 History
Cr. Register, October, 2000, No. 538
, eff. 11-1-00; CR 04-040
: am. (2) (d) 1., (3) (a) 2. (intro.) Register November 2004 No. 587
, eff. 12-1-04; correction in (7) (b) made under s. 13.92 (4) (b) 7.
, Stats., Register November 2008 No. 635
: emerg. am. (2) (d) 2., eff. 11-3-08; CR 08-109
: am. (2) (d) 2. Register June 2009 No. 642
, eff. 7-1-09; correction in (6) (b) made under s. 13.92 (4) (b) 6.
, Stats., Register November 2009 No. 647
Department responsibilities for monitoring resource center quality and operations. DHS 10.24(1)
The department shall monitor the performance and operations of the resource center in all of the following areas:
Providing information about long-term care options to persons who could benefit from the information and linking persons to needed services, including family care, when eligible.
Respecting individuals' rights and dignity and giving consumers a strong role in program and policy development.