“Most integrated setting" means a setting that enables an individual to interact with persons without developmental disabilities to the fullest extent possible.
(2) Placements and admissions to intermediate facilities.
Except as provided in sub. (5)
, no person may protectively place or continue protective placement of an individual with a developmental disability in an intermediate facility and no intermediate facility may admit or continue service for such an individual unless, before the protective placement, continued placement following review under s. 55.18
, or admission and after having considered a plan developed under sub. (4)
, a court under s. 55.12
or 55.18 (1) (ar)
finds that protective placement in the intermediate facility is the most integrated setting that is appropriate to the needs of the individual or that the county of residence of the individual would not reasonably be able to provide community-based care in accordance with the plan within the limits of available state and federal funds and county funds required to be appropriated to match state funds, taking into account information presented by all affected parties. An intermediate facility to which an individual who has a developmental disability applies for admission shall, within 5 days after receiving the application, notify the county department that is participating in the program under s. 46.278
of the county of residence of the individual who is seeking admission concerning the application.
(3) Placements and admissions to nursing facilities.
Except as provided in sub. (5)
, if the department or an entity determines from a screening under s. 49.45 (6c) (b)
that an individual requires active treatment for developmental disability, no individual may be protectively placed in a nursing facility or have protective placement in a nursing facility continued following review under s. 55.18
, and no nursing facility may admit or continue service for the individual, unless the department or entity that conducts the screening determines that the individual's need for care cannot fully be met in an intermediate facility or under a plan under sub. (4)
or that the county of residence of the individual would not reasonably be able to provide community-based care in accordance with the plan within the limits of available state and federal funds and county funds required to be appropriated to match state funds.
(4) Plan for home or community-based care.
Except as provided in a contract specified in sub. (4m)
, a county department that participates in the program under s. 46.278
shall develop a plan for providing home or community-based care in a noninstitutional community setting to an individual who is a resident of that county, under any of the following circumstances:
Within 120 days after any determination made under s. 49.45 (6c) (c) 3.
that the level of care required by a resident that is provided by a facility could be provided in an intermediate facility or under a plan under this subsection.
Within 120 days after receiving written notice under sub. (2)
of an application.
Within 120 days after a proposal is made under s. 55.12 (6)
to provide protective placement to the individual in an intermediate facility or a nursing facility.
Within 120 days after receiving written notice under s. 55.18 (1) (ar)
of the protective placement of the individual in a nursing facility or an intermediate facility.
Within 90 days after extension of a temporary protective placement order by the court under s. 55.135 (5)
(4m) Contract for plan development.
The department shall contract with a public or private agency to develop a plan under sub. (4)
, and the county department is not required to develop such a plan, for an individual, as specified in the contract, to whom all of the following apply:
The individual resides in a county with a population of less than 100,000 in which are located at least 2 intermediate facilities that have licenses issued to private nonprofit organizations that are exempt from federal income tax under section 501
(a) of the Internal Revenue Code.
Placement for the individual is in, or proposed to be in, an intermediate facility specified under par. (a)
that has agreed to reduce its licensed bed capacity to an extent and according to a schedule acceptable to the facility and the department.
(4n) Contract for plan payment.
The department and the county specified in sub. (4m) (a)
shall negotiate a contract under which the department shall provide payment, from the appropriation account under s. 20.435 (4) (b)
, to implement a plan to provide care in a noninstitutional community setting to an individual who has established residence in the county in order to be admitted to an intermediate facility in the county. The contract may provide for the negotiation of a memorandum of understanding between the parties that identifies the relative functions and duties of the department and the county in implementing plans under sub. (4)
for residents of intermediate facilities in the county.
Revenue bonding for residential facilities. 46.28(1)(a)
“Authority" means the Wisconsin Housing and Economic Development Authority created under ch. 234
“Child with long-term care needs" means any of the following:
A juvenile adjudged delinquent for whom a case disposition is made under s. 938.34
A child found to be in need of protection or services for whom an order is made under s. 48.345
or a juvenile found to be in need of protection or services for whom an order is made under s. 938.345
“Chronically disabled" means any person who is alcoholic, developmentally disabled, drug dependent, or mentally ill, as defined in s. 51.01 (1)
, and (13)
, or any person who is physically disabled.
“Elderly" means a person 60 years of age or older.
“Eligible individual" means an individual who is elderly or chronically disabled, a child with long-term care needs, a homeless individual or a victim of domestic abuse.
“Residential facility" means a living unit for eligible individuals that is developed by a sponsor and that is not physically connected to a nursing home or hospital except by common service units for laundry, kitchen or utility purposes and that may include buildings and grounds for activities related to residence, including congregate meal sites, socialization, physical rehabilitation facilities and child care facilities.
A tribal council or housing authority or any nonprofit entity created by a tribal council.
Any housing corporation, limited-profit or nonprofit entity.
Any other entity meeting criteria established by the authority and organized to provide housing for persons and families of low and moderate income.
An entity that is operated for profit and that is engaged in providing medical care or residential care or services, including all of the following:
“Victim of domestic abuse" means an individual who has encountered domestic abuse, as defined in s. 49.165 (1) (a)
The department may approve any residential facility for financing by the authority if it determines that the residential facility will help meet the housing needs of an eligible individual, based on factors that include:
The geographic location of the residential facility.
The population served by the residential facility.
The services offered by the residential facility.
The department may authorize the authority to issue revenue bonds under s. 234.61
to finance any residential facility it approves under sub. (2)
The department may charge sponsors for administrative costs and expenses it incurs in exercising its powers and duties under this section and under s. 234.61
Client management of managed care long-term care benefit.
Under a managed care program for provision of long-term care services, the care manager shall provide, within guidelines established by the department, a mechanism by which an enrollee, beneficiary, or recipient of the program may arrange for, manage, and monitor his or her benefit directly or with the assistance of another person chosen by the enrollee, beneficiary, or recipient. The care manager shall provide each enrollee, beneficiary, or recipient with a form on which the enrollee, beneficiary, or recipient shall indicate whether he or she has been offered the option under this subsection and whether he or she has accepted or declined the option. If the enrollee, beneficiary, or recipient accepts the option, the care manager shall monitor the use by the enrollee, beneficiary, or recipient of a fixed budget for purchase of services or support items from any qualified provider, monitor the health and safety of the enrollee, beneficiary, or recipient, and provide assistance in management of the budget and services of the enrollee, beneficiary, or recipient at a level tailored to the need and desire of the enrollee, beneficiary, or recipient for the assistance.
History: 2005 a. 386
; 2007 a. 20
“Care management organization" means an entity that is certified as meeting the requirements for a care management organization under s. 46.284 (3)
and that has a contract under s. 46.284 (2)
. “Care management organization" does not mean an entity that contracts with the department to operate one of the following:
A demonstration program known as the Family Care Partnership program under a federal waiver authorized under 42 USC 1396n
“Eligible person" means a person who meets all eligibility criteria under s. 46.286 (1)
“Enrollee" means a person who is enrolled in a care management organization.
“Family care benefit" means financial assistance for long-term care and support items for an enrollee.
“Family member" means a spouse or an individual related by blood, marriage, or adoption within the 3rd degree of kinship as computed under s. 990.001 (16)
“Financial and cost-sharing screening" means a screening to determine financial eligibility under s. 46.286 (1) (b)
or the self-directed services option and cost-sharing under s. 46.286 (2)
using a uniform tool prescribed by the department.
“Frail elder" means an individual who is 65 years of age or older and has a physical disability or irreversible dementia that restricts the individual's ability to perform normal daily tasks or that threatens the capacity of the individual to live independently.
“Functional screening" means a screening to determine functional eligibility under s. 46.286 (1) (a)
or the self-directed services option using a uniform tool prescribed by the department.
“Long-term care district board" means the governing board of a long-term care district.
“Older person" means a person who is at least 65 years of age.
“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.
“Self-directed services option" means the program that is operated under a waiver from the secretary of the federal department of health and human services under 42 USC 1396n
(c) in which an enrolled individual selects his or her own services and service providers.
“Tribe or band" means a federally recognized American Indian tribe or band.
Powers and duties of the department, secretary, and counties; long-term care. 46.281(1d)(1d)
The department shall 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 and the self-directed services option to recipients of medical assistance. The department shall implement any waiver that is approved and that is consistent with ss. 46.2805
. Regardless of whether a waiver is approved, the department may implement operation of resource centers, care management organizations, and the family care benefit.
(1g) Contracting for resource centers and care management organizations. 46.281(1g)(a)
Subject to par. (b)
, the department may contract with entities as provided under s. 46.283 (2)
to provide the services under s. 46.283 (3)
as resource centers in any geographic area in the state, and may contract with entities as provided under s. 46.284 (2)
to administer the family care benefit as care management organizations in any geographic area in the state.
If the department proposes to contract with entities to administer the family care benefit in geographic areas in which, in the aggregate, resides more than 29 percent of the state population that is eligible for the family care benefit, the department shall first submit to the joint committee on finance in writing the proposed contract for the approval of the committee. The submission shall include the contract proposal; and an estimate of the fiscal impact of the proposed addition that demonstrates that the addition will be cost neutral, including startup, transitional, and ongoing operational costs and any proposed county contribution. The submission shall also include, for each county affected by the proposal, documentation that the county consents to administration of the family care benefit in the county, the amount of the county's payment or reduction in community aids under s. 46.281 (4)
, and a proposal by the county for using any savings in county expenditures on long-term care that result from administration of the family care benefit in the county. The department may enter into the proposed contract only if the committee approves the proposed contract. The procedures under s. 13.10
do not apply to this paragraph.
(1k) Worker's compensation coverage.
An individual who is performing services for a person receiving the Family Care benefit, or benefits under Family Care Partnership, on a self-directed basis and who does not otherwise have worker's compensation coverage for those services is considered to be an employee of the entity that is providing financial management services for that person.
(1n) Other duties of the department.
The department shall do all of the following:
Prescribe and implement a per person monthly rate structure for costs of the family care benefit.
In order to maintain continuous quality assurance and quality improvement for resource centers and care management organizations, do all of the following:
Prescribe by rule and by contract and enforce performance standards for operation of resource centers and care management organizations.
Use performance expectations that are related to outcomes for persons in contracting with care management organizations and resource centers.
Conduct ongoing evaluations of managed care programs for provision of long-term care services that are funded by medical assistance, as defined in s. 46.278 (1m) (b)
, as to client access to services, the availability of client choice of living and service options, quality of care, and cost-effectiveness. In evaluating the availability of client choice, the department shall evaluate the opportunity for a client to arrange for, manage, and monitor his or her family care benefit directly or with assistance, as specified in s. 46.284 (4) (e)
Require that quality assurance and quality improvement efforts be included throughout the long-term care system specified in ss. 46.2805
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.
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.
Contract with a person to provide the advocacy services described under s. 16.009 (2) (p) 1.
to actual or potential recipients of the family care benefit who are under age 60 or to their families or guardians. The department may not contract under this paragraph with a county or with a person who has a contract with the department to provide services under s. 46.283 (3)
as a resource center or to administer the family care benefit as a care management organization. The contract under this paragraph shall include as a goal that the provider of advocacy services provide one advocate for every 2,500 individuals under age 60 who receive the family care benefit or who participates in the self-directed services option.
From the appropriation under s. 20.435 (7) (b)
, provide $75,000 annually to Grant County to provide, with respect to issues concerning family care benefits, liaison services between the county and a managed care organization and advocacy services on behalf of the county.