Amendment SSA1-AB133

AB133-SSA1,577,17 (1) "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:

AB133-SSA1,577,19 (a) A program of all-inclusive care for persons aged 65 or older authorized under 42 USC 1395 to 1395ggg.

AB133-SSA1,577,21 (b) A demonstration program known as the Wisconsin partnership program under a federal waiver authorized under 42 USC 1315.

AB133-SSA1,577,23 (2) "Eligible person" means a person who meets all eligibility criteria under s. 46.286 (1) or (1m).

AB133-SSA1,577,25 (3) "Enrollee" means a person who is enrolled in a care management organization.

AB133-SSA1,578,2 (4). "Family care benefit" means financial assistance for long-term care and support items for an enrollee.

AB133-SSA1,578,4 (5) "Family care district" means a special purpose district created under s. 46.2895 (1).

AB133-SSA1,578,6 (6) "Family care district board" means the governing board of a family care district.

AB133-SSA1,578,9 (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).

AB133-SSA1,578,11 (7m) "Local long-term care council" means a local long-term care council that is appointed under s. 46.282 (2) (a).

AB133-SSA1,578,12 (8) "Nonprofit organization" has the meaning given in s. 108.02 (19).

AB133-SSA1,578,13 (9) "Older person" means a person who is aged at least 65.

AB133-SSA1,578,16 (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.

AB133-SSA1,578,18 (11) "Tribe or band" means a federally recognized American Indian tribe or band.

AB133-SSA1, s. 1069 Section 1069. 46.281 of the statutes is created to read:

AB133-SSA1,578,22 46.281 Powers and duties of the department and the secretary; long-term care. (1) Duties of the department. The department shall do all of the following:

AB133-SSA1,579,2 (a) Provide training to members of the council on long-term care who are aged 65 or older or who have physical or developmental disabilities or their family members, guardians or other advocates, to enable these members to participate in the council's duties.

AB133-SSA1,579,5 (b) Provide information to the council on long-term care, including copies of reports submitted to the department by local long-term care councils, and seek recommendations of the council.

AB133-SSA1,579,12 (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.

AB133-SSA1,579,13 (d) Before July 1, 2001:

AB133-SSA1,579,18 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.

AB133-SSA1,579,23 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.

AB133-SSA1,580,6 (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).

AB133-SSA1,580,8 (f) Prescribe and implement a per person monthly rate structure for costs of the family care benefit.

AB133-SSA1,580,11 (g) In order to maintain continuous quality assurance and quality improvement for resource centers and care management organizations, do all of the following:

AB133-SSA1,580,13 1. Prescribe by rule and by contract and enforce performance standards for operation of resource centers and care management organizations.

AB133-SSA1,580,15 2. Use performance expectations that are related to outcomes for persons in contracting with care management organizations and resource centers.

AB133-SSA1,580,17 3. Conduct ongoing evaluations of the long-term care system specified in ss. 46.2805 to 46.2895.

AB133-SSA1,580,19 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.

AB133-SSA1,580,23 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.

AB133-SSA1,581,2 (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.

AB133-SSA1,581,5 (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).

AB133-SSA1,581,8 (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.

AB133-SSA1,581,16 (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.

AB133-SSA1, s. 1070 Section 1070. 46.281 (1) (a) of the statutes, as created by 1999 Wisconsin Act .... (this act), is repealed.

AB133-SSA1, s. 1071 Section 1071. 46.281 (1) (b) of the statutes, as created by 1999 Wisconsin Act .... (this act), is repealed.

AB133-SSA1, s. 1072 Section 1072. 46.282 of the statutes is created to read:

AB133-SSA1,581,23 46.282 Councils on long-term care. (1) Council on long-term care. The council on long-term care appointed under s. 15.197 (5) shall do all of the following:

AB133-SSA1,581,25 (a) Assist the department in developing broad policy issues related to long-term care services.

AB133-SSA1,582,3 (b) Assist the department in developing, implementing, coordinating and guiding long-term care services and systems, including by reviewing and making nonbinding recommendations to the department on all of the following:

AB133-SSA1,582,5 1. The department's standard contract provisions for resource centers and care management organizations.

AB133-SSA1,582,7 2. The family care benefit, including the per person rate structure for the benefit.

AB133-SSA1,582,8 3. The long-term support community options program under s. 46.27.

AB133-SSA1,582,9 4. The community integration programs under ss. 46.275, 46.277 and 46.278.

AB133-SSA1,582,11 5. Programs other than those under pars (c) and (d) that provide home and community-based services.

AB133-SSA1,582,12 6. The provision of medical assistance services under a fee-for-service system.

AB133-SSA1,582,14 (c) Monitor patterns of complaints, grievances and appeals related to long-term care in order to identify issues of statewide importance.

AB133-SSA1,582,15 (d) Monitor the numbers of persons on waiting lists.

AB133-SSA1,582,17 (e) Review patterns of utilization of various types of services by care management organizations.

AB133-SSA1,582,19 (f) Monitor the pattern of care management organization enrollments and disenrollments throughout the state.

AB133-SSA1,582,22 (g) Report annually to the legislature under s. 13.172 (2) and to the governor on the status, significant achievements and problems of resource centers, care management organizations and the family care benefit, including all of the following:

AB133-SSA1,582,23 1. Numbers of persons served.

AB133-SSA1,582,24 2. Costs of long-term care provided under the family care benefit.

AB133-SSA1,583,2 3. The number and service areas of resource centers and care management organizations.

AB133-SSA1,583,3 4. Waiting list information.

AB133-SSA1,583,5 5. Results of reviews of quality of services provided by resource centers and care management organizations.

AB133-SSA1,583,9 (2) Local long-term care councils; appointment; membership; terms; compensation and training; officers. (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:

AB133-SSA1,583,12 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:

AB133-SSA1,583,16 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.

AB133-SSA1,583,19 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.

AB133-SSA1,584,3 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.

AB133-SSA1,584,8 (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.

AB133-SSA1,584,18 (b) Membership. 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.

AB133-SSA1,585,2 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:

AB133-SSA1,585,3 a. Providers of long-term care services.

AB133-SSA1,585,5 b. Persons residing in the county with recognized ability and demonstrated interest in long-term care.

AB133-SSA1,585,9 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.

AB133-SSA1,585,20 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.

AB133-SSA1,585,24 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:

AB133-SSA1,586,3 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.

AB133-SSA1,586,6 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.

AB133-SSA1,586,14 (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.

AB133-SSA1,586,22 (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.

AB133-SSA1,587,3 (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.

AB133-SSA1,587,5 (3) Local long-term care councils; powers and duties. (a) A local long-term care council shall do all of the following within the council's area:

AB133-SSA1,587,12 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:

AB133-SSA1,587,16 a. Whether or not the county, counties, tribe or band or Great Lakes inter-tribal council, inc., should exercise its 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.

AB133-SSA1,587,18 b. Whether the county should create a family care district to operate a resource center or under a care management organization.

AB133-SSA1,587,22 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.

AB133-SSA1,587,25 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.

AB133-SSA1,588,5 2. 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.

AB133-SSA1,588,10 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.

AB133-SSA1,588,15 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.

AB133-SSA1,588,20 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.

AB133-SSA1,588,24 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.

AB133-SSA1,589,3 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.

AB133-SSA1,589,5 7. Review the utilization of various types of long-term care services by care management organizations in the area.

AB133-SSA1,589,7 8. Monitor the pattern of enrollments and disenrollments in local care management organizations.

AB133-SSA1,589,10 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.