46.2805(2)
(2) "Eligible person" means a person who meets all eligibility criteria under
s. 46.286 (1).
46.2805(3)
(3) "Enrollee" means a person who is enrolled in a care management organization.
46.2805(4)
(4) "Family care benefit" means financial assistance for long-term care and support items for an enrollee.
46.2805(6)
(6) "Family care district board" means the governing board of a family care district.
46.2805(7)
(7) "Functional and financial screen" means a screen prescribed by the department that is used to determine functional eligibility under
s. 46.286 (1) (a) and financial eligibility under
s. 46.286 (1) (b).
46.2805(7m)
(7m) "Local long-term care council" means a local long-term care council that is appointed under
s. 46.282 (2) (a).
46.2805(9)
(9) "Older person" means a person who is at least 65 years of age.
46.2805(10)
(10) "Resource center" means an entity that meets the standards for operation under
s. 46.283 (3) or, if under contract to provide a portion of the services specified under
s. 46.283 (3), meets the standards for operation with respect to those services.
46.2805(11)
(11) "Tribe or band" means a federally recognized American Indian tribe or band.
46.2805 History
History: 1999 a. 9,
185;
2003 a. 33.
46.281
46.281
Powers and duties of the department and the secretary; long-term care. 46.281(1)
(1)
Duties of the department. The department shall do all of the following:
46.281(1)(c)
(c) Request from the secretary of the federal department of health and human services any waivers of federal medicaid laws necessary to permit the use of federal moneys to provide the family care benefit to recipients of medical assistance. The department shall implement any waiver that is approved and that is consistent with
ss. 46.2805 to
46.2895. Regardless of whether a waiver is approved, the department may implement operation of resource centers, care management organizations and the family care benefit.
46.281(1)(d)1.
1. Establish, in geographic areas in which resides no more than 29% of the population that is eligible for the family care benefit, a pilot project under which the department may contract with a county, a family care district, a tribe or band, or the Great Lakes Inter-Tribal Council, Inc., or with any 2 or more of these entities under a joint application, to operate a resource center.
46.281(1)(d)2.
2. In geographic areas in which resides no more than 29% of the population that is eligible for the family care benefit, contract with counties or tribes or bands under a pilot project to demonstrate the ability of counties or tribes or bands to manage all long-term care programs and administer the family care benefit as care management organizations.
46.281(1)(e)
(e) After June 30, 2001, if the local long-term care council for the applicable area has developed the initial plan under
s. 46.282 (3) (a) 1., contract with entities specified under
par. (d) and, only if specifically authorized by the legislature and if the legislature appropriates necessary funding, contract as so authorized with one or more entities in addition to those specified in
par. (d) certified as meeting requirements under
s. 46.284 (3) for services of the entity as a care management organization and one or more entities for services specified under
s. 46.283 (3) and
(4).
46.281(1)(f)
(f) Prescribe and implement a per person monthly rate structure for costs of the family care benefit.
46.281(1)(g)
(g) In order to maintain continuous quality assurance and quality improvement for resource centers and care management organizations, do all of the following:
46.281(1)(g)1.
1. Prescribe by rule and by contract and enforce performance standards for operation of resource centers and care management organizations.
46.281(1)(g)2.
2. Use performance expectations that are related to outcomes for persons in contracting with care management organizations and resource centers.
46.281(1)(g)4.
4. Require that quality assurance and quality improvement efforts be included throughout the long-term care system specified in
ss. 46.2805 to
46.2895.
46.281(1)(g)5.
5. Ensure that reviews of the quality of management and service delivery of resource centers and care management organizations are conducted by external organizations and make information about specific review results available to the public.
46.281(1)(h)
(h) Require by contract that resource centers and care management organizations establish procedures under which an individual who applies for or receives the family care benefit may register a complaint or grievance and procedures for resolving complaints and grievances.
46.281(1)(i)
(i) Prescribe criteria to assign priority equitably on any necessary waiting lists for persons who are eligible for the family care benefit but who do not meet the criteria under
s. 46.286 (3).
46.281(2)
(2) Powers of the department. The department may develop risk-sharing arrangements in contracts with care management organizations, in accordance with applicable state laws and federal statutes and regulations.
46.281(3)
(3) Duty of the secretary. The secretary shall certify to each county, hospital, nursing home, community-based residential facility, adult family home and residential care apartment complex the date on which a resource center that serves the area of the county, hospital, nursing home, community-based residential facility, adult family home or residential care apartment complex is first available to provide a functional and financial screen. To facilitate phase-in of services of resource centers, the secretary may certify that the resource center is available for specified groups of eligible individuals or for specified facilities in the county.
46.281 History
History: 1999 a. 9;
2001 a. 103.
46.282
46.282
Councils on long-term care. 46.282(2)
(2)
Local long-term care councils; appointment; membership; terms; compensation and training; officers. 46.282(2)(a)(a)
Appointment by a county. In a county that participates in a pilot project under
s. 46.281 (1) (d) and before a county participates in the program under
ss. 46.2805 to
46.2895, the following shall be done:
46.282(2)(a)1.
1. The county board of supervisors of the county shall appoint a local long-term care council or the county boards of supervisors of 2 or more contiguous counties shall appoint a local long-term care council, except as follows:
46.282(2)(a)1.a.
a. In a county with a county executive or a county administrator, the county executive or county administrator shall appoint the local long-term care council, other than as provided in
subd. 1. b., subject to confirmation by the county board of supervisors.
46.282(2)(a)1.b.
b. If the lands of any tribe or band are located in the county or contiguous counties to be served by a local long-term care council, each tribe or band with these lands shall appoint at least one member of the local long-term care council.
46.282(2)(a)2.
2. A county board of supervisors or, in a county with a county executive or a county administrator, the county executive or county administrator shall appoint members of the local long-term care council who are required to be older persons or persons with physical or developmental disabilities or their immediate family members or other representatives from nominations that are submitted to the county board of supervisors or the county executive or county administrator by older persons or persons with physical or developmental disabilities or their immediate family members or other representatives and by local organizations that represent older persons or persons with physical or developmental disabilities.
46.282(2)(am)
(am)
Appointment by a tribe or band or council. If a tribe or band or the Great Lakes Inter-Tribal Council, Inc., intends to apply for a contract to operate a resource center or for certification as a care management organization, the tribe or band or the council shall, as a condition of the application or the certification, appoint a local long-term care council.
46.282(2)(b)1.1. A local long-term care council that serves a single-county area shall consist of 17 members, at least 9 of whom are older persons or persons with physical or developmental disabilities or their immediate family members or other representatives. The age or disability represented by these 9 members shall correspond to the proportion of numbers of persons, as determined by the department, receiving long-term care in this state who are aged 65 or older or have a physical or developmental disability. The total remaining 8 members shall consist of providers of long-term care services, persons residing in the county with recognized ability and demonstrated interest in long-term care and up to 3 members of the county board of supervisors or other elected officials.
46.282(2)(b)2.
2. A local long-term care council that serves an area of 2 or more contiguous counties shall consist of 23 members, at least 12 of whom are older persons or persons with physical or developmental disabilities or their immediate family members or other representatives. The age or disability represented by these 12 members shall correspond to the proportion of numbers of persons, as determined by the department, receiving long-term care in this state who are aged 65 or older or have a physical or developmental disability. The total remaining 11 members shall consist of all of the following:
46.282(2)(b)2.b.
b. Persons residing in the county with recognized ability and demonstrated interest in long-term care.
46.282(2)(b)2.c.
c. Either up to 4 members of the county boards of supervisors or other elected officials or, for a council that serves an area of more than 4 contiguous counties, up to one member of the county board of supervisors of the contiguous counties or up to one other elected official in each contiguous county area.
46.282(2)(b)3.
3. A local long-term care council that is appointed by a tribe or band or by the Great Lakes Inter-Tribal Council, Inc., shall consist of 21 members, at least 11 of whom are older persons or persons with physical or developmental disabilities or their family members or other representatives. The age or disability represented by these 11 members shall correspond to the proportion of numbers of persons, as determined by the department, receiving long-term care in this state who are aged 65 or older or have a physical or developmental disability. The total remaining 10 members shall consist of providers of long-term care services, persons residing in the county with recognized ability and demonstrated interest in long-term care, and up to 3 members of the governing board of the tribe or band or the Great Lakes Inter-Tribal Council, Inc., that appoints the local long-term care council.
46.282(2)(b)4.
4. Vacancies in membership in a local long-term care council shall be filled for the residue of the unexpired term in the manner that the original appointments are made. A local long-term care council member may be removed from office for the following reasons:
46.282(2)(b)4.a.
a. For cause, by a two-thirds vote of each county board of supervisors or governing body of a tribe or band participating in the appointment, on due notice in writing and hearing of the charges against the member.
46.282(2)(b)4.b.
b. If the member, when appointed, was a member of the county board of supervisors or was another elected official and was not reelected to that office, on due notice in writing.
46.282(2)(c)
(c)
Terms. The members of the local long-term care council appointed under
par. (a) shall serve 3-year terms. No member may serve more than 2 consecutive terms. Of the members first appointed under
par. (b) 1., 6 shall be appointed for 3 years; 6 shall be appointed for 4 years; and 5 shall be appointed for 5 years. Of the members first appointed under
par. (b) 2., 8 shall be appointed for 3 years; 8 shall be appointed for 4 years; and 7 shall be appointed for 5 years. Of the members appointed under
par. (b) 3., one-third shall be appointed for 3 years; one-third shall be appointed for 4 years; and one-third shall be appointed for 5 years.
46.282(2)(d)
(d)
Compensation and training. Members of the local long-term care council who are older persons, persons with physical or developmental disabilities, or the family members or other representatives of these persons shall receive compensation from the applicable county for reasonable expenses associated with membership participation. The county board of supervisors or, in the case of a member appointed by the governing body of a tribe or band or by the Great Lakes Inter-Tribal Council, Inc., the tribe or band or the Great Lakes Inter-Tribal Council, Inc., shall provide training to these members to enable them to participate effectively.
46.282(2)(e)
(e)
Officers. At the first meeting of a local long-term care council, members shall elect from their number a chairperson, a secretary and other officers as necessary. Vacancies in these offices shall be filled for the unexpired terms. The chairperson shall preside at all meetings when present and countersign all actions taken by the local long-term care council. In case of the absence of the chairperson for any meeting, the members present shall choose a temporary chairperson.
46.282(3)
(3) Local long-term care councils; powers and duties. 46.282(3)(a)(a) A local long-term care council shall do all of the following within the council's area:
46.282(3)(a)1.
1. Develop the initial plan for the structure of the county, multicounty or tribal resource center, and care management organization or organizations, including formulating recommendations to the county board or boards of supervisors and, in a county with a county executive or a county administrator, to the county executive or county administrator, to the governing body of the tribe or band or of the Great Lakes Inter-Tribal Council, Inc., if applicable, and to the department on all of the following:
46.282(3)(a)1.a.
a. Whether or not the county, counties, tribe or band, or Great Lakes Inter-Tribal Council, Inc., should exercise the right to apply under
s. 46.283 (1) for a contract to operate a resource center or to apply under
s. 46.284 (1) for a contract to operate a care management organization and how the operation should proceed.
46.282(3)(a)1.b.
b. Whether the county should create a family care district to operate a resource center or under a care management organization.
46.282(3)(a)1.c.
c. Whether local organizations other than the county should serve as alternatives or in addition to county-operated entities to operate a resource center or a care management organization and, if so, which organizations should be considered.
46.282(3)(a)1.d.
d. If applicable, how county-operated functions should interact with a resource center or care management organization that is operated by a tribe or band or by the Great Lakes Inter-Tribal Council, Inc.
46.282(3)(a)2.a.a. In the years 2000 and 2001, under criteria that the department prescribes, after consulting with the council on long-term care, evaluate the performance of the care management organization or organizations in the area of the local long-term care council and determine whether additional care management organizations are needed in the area and, if so, recommend this to the department.
46.282(3)(a)2.b.
b. In the year 2002 and thereafter, under criteria that the department prescribes, evaluate the performance of the care management organization or organizations in the area of the local long-term care council and determine whether additional care management organizations are needed in the area and, if so recommend this to the department.
46.282(3)(a)3.
3. Advise the department regarding applications for initial certification or certification renewal of care management organizations in the area of the local long-term care council, including providing recommendations for organizations applying for certification or recertification, and assist the department in reviewing and evaluating the applications.
46.282(3)(a)4.
4. Receive information about and monitor complaints from persons served by the care management organization in the area concerning whether the numbers of providers of long-term care services used by the care management organization are sufficient to ensure convenient and desirable consumer choice and provide recommendations under
subd. 3. to the department about this issue.
46.282(3)(a)5.
5. Review initial plans and existing provider networks of any care management organization in the area to assist the care management organization in developing a network of service providers that includes a sufficient number of accessible, convenient and desirable services.
46.282(3)(a)6.
6. Advise care management organizations about whether to offer optional acute and primary health care services and, if so, how these benefits should be offered.
46.282(3)(a)7.
7. Review the utilization of various types of long-term care services by care management organizations in the area.
46.282(3)(a)8.
8. Monitor the pattern of enrollments and disenrollments in local care management organizations.
46.282(3)(a)9.
9. Identify gaps in services, living arrangements and community resources and develop strategies to build local capacity to serve older persons and persons with physical or developmental disabilities, especially those with long-term care needs.
46.282(3)(a)10.
10. Perform long-range planning on policy for older persons and persons with physical or developmental disabilities.
46.282(3)(a)11.
11. Annually review interagency agreements between a resource center and care management organization or organizations and make recommendations, as appropriate, on the interaction between the resource center and the care management organization or organizations to assure coordination between or among them.
46.282(3)(a)12.
12. Annually review the number and types of complaints and grievances about the long-term care system by persons who receive or may receive care under the system, to determine if a need exists for system changes, and recommend system or other changes if appropriate.
46.282(3)(a)13.
13. Identify potential new sources of community resources and funding for needed services for older persons and persons with physical or developmental disabilities.
46.282(3)(a)14.
14. Support long-term care system improvements to improve services to older persons and persons with physical or developmental disabilities and their families.
46.282(3)(a)15.
15. Annually report to the department and, before July 1, 2001, to the long-term care council concerning significant achievements and problems in the local long-term care system.
46.282(3)(b)
(b) A local long-term care council may, within the local long-term care council's area, assume the duties of the county long-term community support planning committee as specified under
s. 46.27 (4).
46.282 History
History: 1999 a. 9;
2001 a. 103.
46.283
46.283
Resource centers. 46.283(1)(a)(a) After considering recommendations of the local long-term care council under
s. 46.282 (3) (a) 1., a county board of supervisors and, in a county with a county executive or a county administrator, the county executive or county administrator, may decide all of the following:
46.283(1)(a)1.
1. Whether to authorize one or more county departments under
s. 46.21,
46.215,
46.22 or
46.23 or an aging unit under
s. 46.82 (1) (a) 1. or
2. to apply to the department for a contract to operate a resource center and, if so, which to authorize and what client group to serve.
46.283(1)(a)2.
2. Whether to create a family care district to apply to the department for a contract to operate a resource center.
46.283(1)(b)
(b) After considering recommendations of the local long-term care council under
s. 46.282 (3) (a) 1., the governing body of a tribe or band or of the Great Lakes Inter-Tribal Council, Inc., may decide whether to authorize a tribal agency to apply to the department for a contract to operate a resource center for tribal members and, if so, which client group to serve.
46.283(1)(c)
(c) Under the requirements of
par. (a), a county board of supervisors may decide to apply to the department for a contract to operate a multicounty resource center in conjunction with the county board or boards of one or more other counties or a county-tribal resource center in conjunction with the governing body of a tribe or band or the Great Lakes Inter-Tribal Council, Inc.
46.283(1)(d)
(d) Under the requirements of
par. (b), the governing body of a tribe or band may decide to apply to the department for a contract to operate a resource center in conjunction with the governing body or governing bodies of one or more other tribes or bands or the Great Lakes Inter-Tribal Council, Inc., or with a county board of supervisors.
46.283(2)(a)(a) Before July 1,
2001, the department may contract only with a county, a family care district, the governing body of a tribe or band or the Great Lakes Inter-Tribal Council, Inc., or 2 or more of these entities under a joint application, to operate a resource center.
46.283(2)(b)
(b) After June 30, 2001, the department shall contract with the entities specified under
s. 46.281 (1) (d) 1. and may, in addition to contracting with these entities and subject to approval of necessary funding, contract to operate a resource center with counties, family care districts, or the governing body of a tribe or band or the Great Lakes Inter-Tribal Council, Inc., under a joint application of any of these, or with a private nonprofit organization if the department determines that the organization has no significant connection to an entity that operates a care management organization and if any of the following applies:
46.283(2)(b)1.
1. A county board of supervisors declines in writing to apply for a contract to operate a resource center.
