Amendment ASA1-AB133

AB133-ASA1,609,24 46.287 Hearings. (1) Definition. In this section, "client" means a person applying for eligibility for the family care benefit, an eligible person or an enrollee.

AB133-ASA1,610,6 (2) Hearing. (a) 1. Except as provided in subd. 2., a client may contest any of the following applicable matters by filing, within 45 days of the failure of a resource center or care management organization to act on the contested matter within the time frames specified by rule by the department or within 45 days after receipt of notice of a decision in a contested matter, a written request for a hearing under s. 227.44 to the division of hearings and appeals created under s. 15.103 (1):

AB133-ASA1,610,7 a. Denial of eligibility under s. 46.286 (1) or (1m).

AB133-ASA1,610,8 b. Determination of cost sharing under s. 46.286 (2).

AB133-ASA1,610,9 c. Denial of entitlement under s. 46.286 (3).

AB133-ASA1,610,11 d. Failure to provide timely services and support items that are included in the plan of care.

AB133-ASA1,610,12 e. Reduction of services or support items under the family care benefit.

AB133-ASA1,610,16 f. Development of a plan of care that is unacceptable because the plan of care requires the enrollee to live in a place that is unacceptable to the enrollee or the plan of care provides care, treatment or support items that are insufficient to meet the enrollee's needs, are unnecessarily restrictive or are unwanted by the enrollee.

AB133-ASA1,610,17 g. Termination of the family care benefit.

AB133-ASA1,610,18 h. Imposition of ineligibility for the family care benefit under s. 46.286 (4).

AB133-ASA1,610,20 i. Denial of eligibility or reduction of the amounts of the family care benefit under s. 46.286 (5).

AB133-ASA1,610,22 j. Determinations similar to those specified under s. 49.455 (8) (a), made under s. 46.286 (6).

AB133-ASA1,610,23 k. Recovery of family care benefit payments under s. 46.286 (7).

AB133-ASA1,611,3 2. An applicant for or recipient of medical assistance is not entitled to a hearing concerning the identical dispute or matter under both this section and 42 CFR 431.200 to 431.246.

AB133-ASA1,611,10 (b) An enrollee may contest a decision, omission or action of a care management organization other than those specified in par. (a), or may contest the choice of service provider. In these instances, the enrollee shall first send a written request for review by the unit of the department that monitors care management organization contracts. This unit shall review and attempt to resolve the dispute. If the dispute is not resolved to the satisfaction of the enrollee, he or she may request a hearing under the procedures specified in par. (a) 1. (intro.).

AB133-ASA1,611,14 (c) Information regarding the availability of advocacy services and notice of adverse actions taken and appeal rights shall be provided to a client by the resource center or care management organization in a form and manner that is prescribed by the department by rule.

AB133-ASA1, s. 1080 Section 1080. 46.288 of the statutes is created to read:

AB133-ASA1,611,17 46.288 Rule-making. The department shall promulgate as rules all of the following:

AB133-ASA1,611,20 (1) Standards for performance by resource centers and for certification of care management organizations, including requirements for maintaining quality assurance and quality improvement.

AB133-ASA1,612,2 (2) Criteria and procedures for determining functional eligibility under s. 46.286 (1) (a), financial eligibility under s. 46.286 (1) (b), cost sharing under s. 46.286 (2) (a) and entitlement under s. 46.286 (3). The rules for determining functional eligibility under s. 46.286 (1) (a) 1. a. shall be substantially similar to eligibility criteria for receipt of the long-term support community options program under s. 46.27. Rules under this subsection shall include definitions of the following terms applicable to s. 46.286:

AB133-ASA1,612,3 (a) "Primary disabling condition".

AB133-ASA1,612,4 (b) "Mental illness".

AB133-ASA1,612,5 (c) "Substance abuse".

AB133-ASA1,612,6 (d) "Long-term or irreversible".

AB133-ASA1,612,7 (e) "Requires ongoing care, assistance or supervision".

AB133-ASA1,612,9 (f) "Condition that is expected to last at least 90 days or result in death within one year".

AB133-ASA1,612,10 (g) "At risk of losing independence or functional capacity".

AB133-ASA1,612,11 (h) "Gross monthly income".

AB133-ASA1,612,12 (i) "Deductions and allowances".

AB133-ASA1,612,13 (j) "Countable assets".

AB133-ASA1,612,16 (3) Procedures and standards for procedures for s. 46.287 (2), including time frames for action by a resource center or a care management organization on a contested matter.

AB133-ASA1, s. 1081 Section 1081. 46.289 of the statutes is created to read:

AB133-ASA1,612,24 46.289 Transition. In order to facilitate the transition to the long-term care system specified in ss. 46.2805 to 46.2895, within the limits of applicable federal statutes and regulations and if the secretary of health and family services finds it necessary, he or she may grant a county limited waivers to or exemptions from ss. 46.27 (3) (e) (intro.), 1. and 2. and (f), (5) (d) and (e), (6) (a) 1., 2. and 3. and (b) (intro.), 1. and 2., (6r) (c), (7) (b), (cj) and (cm) and (11) (c) 5m. (intro.) and 6. and 46.277 (3) (a), (4) (a) and (5) (d) 1m., 1n. and 2. and rules promulgated under those provisions.

AB133-ASA1, s. 1082 Section 1082. 46.2895 of the statutes is created to read:

AB133-ASA1,613,6 46.2895 Family care district. (1) Creation. (a) After considering recommendations of the local long-term care council under s. 46.282 (3) (a) 1., a county board of supervisors may create a special purpose district that is termed a "family care district", that is a local unit of government, that is separate and distinct from, and independent of, the state and the county, and that has the powers and duties specified in this section, if the county board does all of the following:

AB133-ASA1,613,7 1. Adopts an enabling resolution that does all of the following:

AB133-ASA1,613,8 a. Declares the need for establishing the family care district.

AB133-ASA1,613,11 b. Specifies the family care district's primary purpose, which shall be to operate, under contract with the department, either a resource center under s. 46.283 or a care management organization under s. 46.284, but not both.

AB133-ASA1,613,13 2. Files copies of the enabling resolution with the secretary of administration, the secretary of health and family services and the secretary of revenue.

AB133-ASA1,613,17 (b) The county boards of supervisors of 2 or more counties may together create a family care district with the attributes specified in par. (a) (intro.) on a multicounty basis within the counties if the county boards of supervisors comply with the requirements of par. (a) 1. and 2.

AB133-ASA1,613,20 (2) Jurisdiction. A family care district's jurisdiction is the geographical area of the county or counties of the county board or boards of supervisors who created the family care district.

AB133-ASA1,613,25 (3) Family care district board. (a) 1. The county board of supervisors of a county or, in a county with a county administrator or county executive, the county administrator or county executive shall appoint the members of the family care district board, which is the governing board of a family care district under sub. (1) (a).

AB133-ASA1,614,5 2. The county boards of supervisors of 2 or more counties shall appoint the members of the family care district board, which is the governing board of the family care district under sub. (1) (b). Each county board shall appoint members in the same proportion that the county's population represents to the total population of all of the counties that constitute the jurisdiction of the family care district.

AB133-ASA1,614,10 (b) 1. The family care district board appointed under par. (a) 1. shall consist of 15 persons who are residents of the area of jurisdiction of the family care district. At least one-fourth of the members shall be representative of the client group or groups whom it is the family care district's primary purpose to serve or those clients' family members, guardians or other advocates.

AB133-ASA1,614,16 2. The family care district board appointed under par. (a) 2. shall consist of an odd number of members that is at least 15 but not more than 21 persons, all of whom are residents of the area of jurisdiction of the family care district. At least one-fourth of the members shall be representative of the client group or groups whom it is the family care district's primary purpose to serve or those clients' family members, guardians or other advocates.

AB133-ASA1,614,22 3. Membership of the family care district board under subd. 1. or 2. shall reflect the ethnic and economic diversity of the area of jurisdiction of the family care district. Up to one-fourth of the members of the board may be elected or appointed officials or employes of the county or counties that created the family care district. No member of the board may have a private financial interest in or profit directly or indirectly from any contract or other business of the family care district.

AB133-ASA1,615,3 (c) The members of the family care district board appointed under par. (a) shall serve 3-year terms. No member may serve more than 2 consecutive terms. Of the members first appointed, 5 shall be appointed for 3 years; 5 shall be appointed for 4 years; and 5 or, in the case of a board appointed under par. (b) 2., the remainder, shall be appointed for 5 years. A member shall serve until his or her successor is appointed, unless removed for cause under s. 17.13.

AB133-ASA1,615,10 (d) As soon as possible after the appointment of the initial members of the family care district board, the board shall organize for the transaction of business and elect a chairperson and other necessary officers. Each chairperson shall be elected by the board from time to time for the term of that chairperson's office as a member of the board or for the term of 3 years, whichever is shorter, and shall be eligible for reelection. A majority of the board shall constitute a quorum. The board may act based on the affirmative vote of a majority of a quorum.

AB133-ASA1,615,14 (4) Powers. Subject to sub. (1) (a) 1. b., a family care district has all the powers necessary or convenient to carry out the purposes and provisions of ss. 46.2805 to 46.2895. In addition to all these powers, a family care district may do all of the following:

AB133-ASA1,615,15 (a) Adopt and alter, at pleasure, an official seal.

AB133-ASA1,615,19 (b) Adopt bylaws and policies and procedures for the regulation of its affairs and the conduct of its business. The bylaws, policies and procedures shall be consistent with ss. 46.2085 to 46.2895 and, if the family care district contracts with the department under par. (d), with the terms of that contract.

AB133-ASA1,615,20 (c) Sue and be sued.

AB133-ASA1,615,24 (d) Negotiate and enter into leases or contracts, including a contract with the department to operate either a resource center or a portion of its functions under s. 46.283 or a care management organization under s. 46.284, but not both a resource center or its functions and a care management organization.

AB133-ASA1,616,3 (e) Provide services related to services available under the family care benefit, to older persons and persons with disabilities, in addition to the services funded under the contract with the department that is specified under par. (d).

AB133-ASA1,616,5 (f) Acquire, construct, equip, maintain, improve or manage a resource center under s. 46.283 or a care management organization under s. 46.284, but not both.

AB133-ASA1,616,10 (g) Subject to sub. (8), employ any agent, employe or special adviser that the family care district finds necessary, fix and regulate his or her compensation and provide, either directly or subject to an agreement under s. 66.30 as a participant in a benefit plan of another governmental entity, any employe benefits, including an employe pension plan.

AB133-ASA1,616,12 (h) Mortgage, pledge or otherwise encumber the family care district's property or funds.

AB133-ASA1,616,14 (i) Buy, sell or lease property, including real estate, and maintain or dispose of the property.

AB133-ASA1,616,16 (j) Invest any funds not required for immediate disbursement in any of the following:

AB133-ASA1,616,18 1. An interest-bearing escrow account with a financial institution, as defined in s. 69.30 (1) (b).

AB133-ASA1,616,20 2. Time deposits in any financial institution, as defined in s. 69.30 (1) (b), if the time deposits mature in not more than 2 years.

AB133-ASA1,616,23 3. Bonds or securities issued or guaranteed as to principal and interest by the federal government or by a commission, board or other instrumentality of the federal government.

AB133-ASA1,617,3 (k) Create a risk reserve or other special reserve as the family care district board desires or as the department requires under the contract with the department that is specified under par. (d).

AB133-ASA1,617,7 (L) Accept aid, including loans, to accomplish the purpose of the family care district from any local, state or federal governmental agency or accept gifts, loans, grants or bequests from individuals or entities, if the conditions under which the aid, loan, gift, grant or bequest is furnished are not in conflict with this section.

AB133-ASA1,617,9 (m) Make and execute other instruments necessary or convenient to exercise the powers of the family care district.

AB133-ASA1,617,11 (5) Limitation on powers. A family care district may not issue bonds or levy a tax or assessment.

AB133-ASA1,617,12 (6) Duties. The family care district board shall do all of the following:

AB133-ASA1,617,13 (a) Appoint a director, who shall hold office at the pleasure of the board.

AB133-ASA1,617,15 (b) Subject to sub. (8), develop and implement a personnel structure and other employment policies for employes of the family care district.

AB133-ASA1,617,17 (c) Assure compliance with the terms of any contract with the department under sub. (4) (d).

AB133-ASA1,617,19 (d) Establish a fiscal operating year and annually adopt a budget for the family care district.

AB133-ASA1,617,20 (e) Contract for any legal services required for the family care district.

AB133-ASA1,617,25 (f) Subject to sub. (8), procure liability insurance covering its officers, employes and agents, insurance against any loss in connection with its property and other assets and other necessary insurance; establish and administer a plan of self-insurance; or, subject to an agreement under s. 66.30, participate in a governmental plan of insurance or self-insurance.

AB133-ASA1,618,2 (7) Director; duties. The director appointed under sub. (6) (a) shall do all of the following:

AB133-ASA1,618,5 (a) Manage the property and business of the family care district and manage the employes of the district, subject to the general control of the family care district board.

AB133-ASA1,618,7 (b) Comply with the bylaws and direct enforcement of all policies and procedures adopted by the family care district board.

AB133-ASA1,618,9 (c) Perform duties in addition to those specified in pars. (a) and (b) as are prescribed by the family care district board.

AB133-ASA1,618,11 (8) Employment and employe benefits of certain employes. (a) A family care district board shall do all of the following:

AB133-ASA1,618,23 1. If the family care district offers employment to any individual who was previously employed by the county, who while employed by the county performed duties relating to the same or a substantially similar function for which the individual is offered employment by the district and whose wages, hours and conditions of employment were established in a collective bargaining agreement with the county under subch. IV of ch. 111 that is in effect on the date that the individual commences employment with the district, with respect to that individual, abide by the terms of the collective bargaining agreement concerning the individual's compensation and benefits until the time of the expiration of that collective bargaining agreement or adoption of a collective bargaining agreement with the district under subch. IV of ch. 111 covering the individual as an employe of the district, whichever occurs first.

AB133-ASA1,619,7 2. If the family care district offers employment to any individual who was previously employed by the county and who while employed by the county performed duties relating to the same or a substantially similar function for which the individual is offered employment by the district, but whose wages, hours and conditions of employment were not established in a collective bargaining agreement with the county under subch. IV of ch. 111 that is in effect on the date the individual commences employment with the district, with respect to that individual, initially provide that individual the same compensation and benefits that he or she received while employed by the county.

AB133-ASA1,619,14 3. If the family care district offers employment to any individual who was previously employed by the county and who while employed by the county performed duties relating to the same or a substantially similar function for which the individual is offered employment by the district, with respect to that individual, recognize all years of service with the county for any benefit provided or program operated by the district for which an employe's years of service may affect the provision of the benefit or the operation of the program.

AB133-ASA1,619,19 4. If the county has not established its own retirement system for county employes, adopt a resolution that the family care district be included within the provisions of the Wisconsin retirement system under s. 40.21 (1). In this resolution, the family care district shall agree to recognize 100% of the prior creditable service of its employes earned by the employes while employed by the district.

AB133-ASA1,619,21 (b) The county board of supervisors of the area of jurisdiction of the family care district shall do all of the following:

AB133-ASA1,619,24 1. If the county has established its own retirement system for county employes, provide that family care district employes are eligible to participate in the county retirement system.

AB133-ASA1,620,4 2. Provide that, subject to the terms of any applicable collective bargaining agreement as provided in par. (a) 1., family care district employes are eligible to receive health care coverage under any county health insurance plan that is offered to county employes.

AB133-ASA1,620,9 3. Provide that, subject to the terms of any applicable collective bargaining agreement as provided in par. (a) 1., family care district employes are eligible to participate in any deferred compensation or other benefit plan offered by the county to county employes, including disability and long-term care insurance coverage and income continuation insurance coverage.

AB133-ASA1,620,14 (9) Confidentiality of records. No record, as defined in s. 19.32 (2), of a family care district that contains personally identifiable information, as defined in s. 19.62 (5), concerning an individual who receives services from the family care district may be disclosed by the family care district without the individual's informed consent, except as required to comply with s. 16.009 (2) (p) or 49.45 (4).

AB133-ASA1,620,22 (10) Exchange of information. Notwithstanding sub. (9) and ss. 48.78 (2) (a), 49.45 (4), 49.83, 51.30, 51.45 (14) (a), 55.06 (17) (c), 146.82, 252.11 (7), 253.07 (3) (c) and 938.78 (2) (a), a family care district acting under this section may exchange confidential information about a client, as defined in s. 46.287 (1), without the informed consent of the client, under s. 46.21 (2m) (c), 46.215 (1m), 46.22 (1) (dm), 46.23 (3) (e), 46.283 (7), 46.284 (7), 51.42 (3) (e) or 51.437 (4r) (b) in the jurisdiction of the family care district, if necessary to enable the family care district to perform its duties or to coordinate the delivery of services to the client.

AB133-ASA1,620,25 (11) Obligations and debts not those of county. The obligations and debts of the family care district are not the obligations or debts of the county that created the family care district.