AB133-SSA1,602,87 2. The requirement that interest accruing to the risk reserve remain in the
8escrow account for the risk reserve.
AB133-SSA1,602,99 3. Limitations on the distribution of funds from the risk reserve.
AB133-SSA1,602,2010 4. The requirement that a care management organization place funds in a risk
11reserve and maintain the risk reserve in an interest-bearing escrow account with a
12financial institution, as defined in s. 69.30 (1) (b), or invest funds as specified in s.
1346.2895 (4) (j) 2. or 3. Moneys in the risk reserve or invested as specified in this
14subdivision may be expended only for the provision of services under this section.
15If a care management organization ceases participation under this section, the funds
16in the risk reserve or invested as specified in this subdivision, minus any
17contribution of moneys other than those specified in par. (c), shall be returned to the
18department. The department shall expend the moneys for the payment of
19outstanding debts to providers of family care benefit services and for the
20continuation of family care benefit services to enrollees.
AB133-SSA1,602,2321 (e) 1. Subject to subd. 2., a care management organization may enter into
22contracts with providers of family care benefit services and may limit profits of the
23providers under the contracts.
AB133-SSA1,603,224 2. The department shall review the contracts in subd. 1., including rates for the
25provision of service, to ensure that the contract terms protect services access by

1enrollees and financial viability of the care management organization, and may
2require contract revision.
AB133-SSA1,603,8 3(6) Governing board. A care management organization shall have a governing
4board that reflects the ethnic and economic diversity of the geographic area served
5by the care management organization. At least one-fourth of the members of the
6governing board shall be older persons or persons with physical or developmental
7disabilities or their family members, guardians or other advocates who are
8representative of the care management organization's enrollee.
AB133-SSA1,603,13 9(7) Confidentiality; exchange of information. No record, as defined in s. 19.32
10(2), of a care management organization that contains personally identifiable
11information, as defined in s. 19.62 (5), concerning an individual who receives services
12from the care management organization may be disclosed by the care management
13organization without the individual's informed consent, except as follows:
AB133-SSA1,603,1614 (a) A care management organization may provide information as required to
15comply with s. 16.009 (2) (p) or 49.45 (4) or as necessary for the department to
16administer the program under ss. 46.2805 to 46.2895.
AB133-SSA1,603,2417 (b) Notwithstanding ss. 48.78 (2) (a), 49.45 (4), 49.83, 51.30, 51.45 (14) (a), 55.06
18(17) (c), 146.82, 252.11 (7), 253.07 (3) (c) and 938.78 (2) (a), a care management
19organization acting under this section may exchange confidential information about
20a client, as defined in s. 46.287 (1), without the informed consent of the client, under
21s. 46.21 (2m) (c), 46.215 (1m), 46.22 (1) (dm), 46.23 (3) (e), 46.283 (7), 46.2895 (10),
2251.42 (3) (e) or 51.437 (4r) (b) in the county of the care management organization, if
23necessary to enable the care management organization to perform its duties or to
24coordinate the delivery of services to the client.
AB133-SSA1, s. 1077 25Section 1077. 46.285 of the statutes is created to read:
AB133-SSA1,604,6
146.285 Operation of resource center and care management
2organization.
(1) In order to meet federal requirements and assure federal
3financial participation in funding of the family care benefit, a county, a tribe or band,
4a family care district or an organization, including a private, nonprofit corporation,
5may not directly operate both a resource center and a care management
6organization, except as follows:
AB133-SSA1,604,107 (a) For a pilot project established under s. 46.281 (1) (d) 2., provision of the
8services specified under s. 46.283 (3) (b), (e), (f) and (g) shall be structurally separate
9from the provision of services of the care management organization by January 1,
102001.
AB133-SSA1,604,1311 (b) The department may approve separation of the functions of a resource
12center from those of a care management organization by a means other than those
13specified in sub. (2).
AB133-SSA1,604,15 14(2) Except as provided in sub. (1), all of the following apply to operation of both
15a resource center and a care management organization:
AB133-SSA1,604,1916 (a) 1. If a county board of supervisors and, if applicable, a county executive or
17a county administrator, elect to apply to the department for a contract to operate a
18resource center, the county board of supervisors may create a family care district to
19apply to the department for a contract to operate a care management organization.
AB133-SSA1,604,2320 2. If a county board of supervisors and, if applicable, a county executive or a
21county administrator, elect to apply to the department for a contract to operate a care
22management organization, the county board of supervisors may create a family care
23district to apply to the department to operate a resource center.
AB133-SSA1,605,324 (b) 1. If the governing body of a tribe or band elects to apply to the department
25for a contract directly to operate a resource center, tribal or band members may form

1a separate corporation to apply to the department for a contract to operate a care
2management organization. No members of the governing board of the corporation
3may be members of the tribal or band governing body.
AB133-SSA1,605,84 2. If the governing body of a tribe or band elects to apply to the department for
5a contract directly to operate a care management organization, tribal or band
6members may form a separate corporation to apply to the department for a contract
7to operate a resource center. No members of the governing board of the corporation
8may be members of the tribal or band governing body.
AB133-SSA1,605,139 (c) Any county or family care district that seeks to operate jointly with a tribe
10or band or tribal or band corporation a care management organization or resource
11center shall submit jointly with the tribe or band or tribal or band corporation an
12application to the department to operate the care management organization or
13resource center.
AB133-SSA1, s. 1078 14Section 1078. 46.286 of the statutes is created to read:
AB133-SSA1,605,19 1546.286 Family care benefit. (1) Eligibility. Except as provided in sub. (1m),
16a person is eligible for, but not necessarily entitled to, the family care benefit if the
17person is at least 18 years of age; has a physical disability, as defined in s. 15.197 (4)
18(a) 2., or infirmities of aging, as defined in s. 55.01 (3); and meets all of the following
19criteria:
AB133-SSA1,605,2120 (a) Functional eligibility. A person is functionally eligible if any of the following
21applies, as determined by the department or its designee:
AB133-SSA1,605,2222 1. The person's functional capacity is at either of the following levels:
AB133-SSA1,605,2523 a. The comprehensive level, if the person has a long-term or irreversible
24condition, expected to last at least 90 days or result in death within one year of the
25date of application, and requires ongoing care, assistance or supervision.
AB133-SSA1,606,4
1b. The intermediate level, if the person has a condition that is expected to last
2at least 90 days or result in death within 12 months after the date of application, and
3is at risk of losing his or her independence or functional capacity unless he or she
4receives assistance from others.
AB133-SSA1,606,105 2. The person has a condition that is expected to last at least 90 days or result
6in death within 12 months after the date of application and, on the date that the
7family care benefit became available in the person's county of residence, the person
8was a resident in a nursing home or had been receiving for at least 60 days, under
9a written plan of care, long-term care services, as specified by the department, which
10were funded under any of the following:
AB133-SSA1,606,1111 a. The long-term support community options program under s. 46.27.
AB133-SSA1,606,1312b. Home and community-based waiver programs under 42 USC 1396n (c),
13including community integration program under s. 46.275, 46.277 or 46.278.
AB133-SSA1,606,1414 c. The Alzheimer's family caregiver support program under s. 46.87.
AB133-SSA1,606,1615 d. Community aids under s. 46.40, if documented by the county under a method
16prescribed by the department.
AB133-SSA1,606,1817 e. County funding, if documented by the county under a method prescribed by
18the department.
AB133-SSA1,606,2019 (b) Financial eligibility. A person is financially eligible if all of the following
20apply:
AB133-SSA1,606,2221 1. As determined by the department or its designee, either of the following
22applies:
AB133-SSA1,607,223 a. The person would qualify for medical assistance except for financial or
24disability criteria, and the projected cost of the person's care plan, as calculated by
25the department or its designee, exceeds the person's gross monthly income, plus

1one-twelfth of his or her countable assets, less deductions and allowances permitted
2by rule by the department.
AB133-SSA1,607,33 b. The person is eligible under ch. 49 for medical assistance.
AB133-SSA1,607,54 2. If subd. 1. b. applies, the person accepts medical assistance unless he or she
5is exempt from the acceptance under rules promulgated by the department.
AB133-SSA1,607,10 6(1m) Eligibility exception. A person whose primary disabling condition is
7developmental disability is eligible for the family care benefit if the person is a
8resident of a county or is a member of a tribe or band that has operated, before July
91, 2001, a care management organization under s. 46.281 (1) (d) and meets all other
10eligibility criteria under this subsection.
AB133-SSA1,607,15 11(2) Cost sharing. (a) A person who is determined to be financially eligible
12under sub. (1) (b) shall contribute to the cost of his or her care an amount that is
13calculated by the department or its designee after subtracting from the person's
14gross income, plus one-twelfth of countable assets, the deductions and allowances
15permitted by the department by rule.
AB133-SSA1,607,1716 (b) Funds received under par. (a) shall be used by a care management
17organization to pay for services under the family care benefit.
AB133-SSA1,607,2118 (c) A person who is required to contribute to the cost of his or her care but who
19fails to make the required contributions is ineligible for the family care benefit unless
20he or she is exempt from the requirement under rules promulgated by the
21department.
AB133-SSA1,608,2 22(3) Entitlement. (a) Subject to pars. (c) and (d), a person is entitled to and may
23receive the family care benefit through enrollment in a care management
24organization if he or she meets the requirements of sub. (1) (intro.), is financially

1eligible, fulfills any applicable cost-sharing requirements and meets any of the
2following criteria:
AB133-SSA1,608,33 1. Is functionally eligible at the comprehensive level.
AB133-SSA1,608,54 2. Is functionally eligible at the intermediate level and is eligible under sub. (1)
5(b) 1. b.
AB133-SSA1,608,86 3. Is functionally eligible at the intermediate level and is determined by an
7agency under s. 46.90 (2) or specified in s. 55.05 (1t) to be in need of protective services
8under s. 55.05 or protective placement under s. 55.06.
AB133-SSA1,608,99 4. Is functionally eligible under sub. (1) (a) 2.
AB133-SSA1,608,1010 5. Is eligible under sub. (1m).
AB133-SSA1,608,1211 (b) An entitled individual who is enrolled in a care management organization
12may not be involuntarily disenrolled except as follows:
AB133-SSA1,608,1313 1. For cause, subject to the requirements of s. 46.284 (4) (a).
AB133-SSA1,608,1814 2. If the contract between the care management organization and the
15department is canceled or not renewed. If this circumstance occurs, the department
16shall assure that enrollees continue to receive needed services through another care
17management organization or through the medical assistance fee-for-service system
18or any of the programs specified under sub. (1) (a) 2. a. to d.
AB133-SSA1,608,2019 3. The department or its designee determines that the person no longer meets
20eligibility criteria under sub. (1).
AB133-SSA1,609,221 (c) Within each county and for each client group, par. (a) shall first apply on the
22effective date of a contract under which a care management organization accepts a
23per person per month payment to provide services under the family care benefit to
24eligible persons in that client group in the county. Within 24 months after this date,
25the department shall assure that sufficient capacity exists within one or more care

1management organizations to provide the family care benefit to all entitled persons
2in that client group in the county.
AB133-SSA1,609,53 (d) The department shall determine the date, which shall not be later than July
41, 2000, on which par. (a) shall first apply to persons who are not eligible for medical
5assistance under ch. 49.
AB133-SSA1,609,8 6(4) Divestment; rules. The department shall promulgate rules relating to
7prohibitions on divestment of assets of persons who receive the family care benefit,
8that are substantially similar to applicable provisions under s. 49.453.
AB133-SSA1,609,11 9(5) Treatment of trust amounts; rules. The department shall promulgate
10rules relating to treatment of trust amounts of persons who receive the family care
11benefit, that are substantially similar to applicable provisions under s. 49.454.
AB133-SSA1,609,16 12(6) Protection of income and resources of couple for maintenance of
13community spouse; rules.
The department shall promulgate rules relating to
14protection of income and resources of couples for the maintenance of the spouse in
15the community with regard to persons who receive the family care benefit, that are
16substantially similar to applicable provisions under s. 49.455.
AB133-SSA1,609,21 17(7) Recovery of family care benefit payments; rules. The department shall
18promulgate rules relating to the recovery from persons who receive the family care
19benefit, including by liens and from estates, of correctly and incorrectly paid family
20care benefits, that are substantially similar to applicable provisions under ss. 49.496
21and 49.497.
AB133-SSA1, s. 1079 22Section 1079. 46.287 of the statutes is created to read:
AB133-SSA1,609,24 2346.287 Hearings. (1) Definition. In this section, "client" means a person
24applying for eligibility for the family care benefit, an eligible person or an enrollee.
AB133-SSA1,610,6
1(2) Hearing. (a) 1. Except as provided in subd. 2., a client may contest any of
2the following applicable matters by filing, within 45 days of the failure of a resource
3center or care management organization to act on the contested matter within the
4time frames specified by rule by the department or within 45 days after receipt of
5notice of a decision in a contested matter, a written request for a hearing under s.
6227.44 to the division of hearings and appeals created under s. 15.103 (1):
AB133-SSA1,610,77 a. Denial of eligibility under s. 46.286 (1) or (1m).
AB133-SSA1,610,88 b. Determination of cost sharing under s. 46.286 (2).
AB133-SSA1,610,99 c. Denial of entitlement under s. 46.286 (3).
AB133-SSA1,610,1110 d. Failure to provide timely services and support items that are included in the
11plan of care.
AB133-SSA1,610,1212 e. Reduction of services or support items under the family care benefit.
AB133-SSA1,610,1613 f. Development of a plan of care that is unacceptable because the plan of care
14requires the enrollee to live in a place that is unacceptable to the enrollee or the plan
15of care provides care, treatment or support items that are insufficient to meet the
16enrollee's needs, are unnecessarily restrictive or are unwanted by the enrollee.
AB133-SSA1,610,1717 g. Termination of the family care benefit.
AB133-SSA1,610,1818 h. Imposition of ineligibility for the family care benefit under s. 46.286 (4).
AB133-SSA1,610,2019 i. Denial of eligibility or reduction of the amounts of the family care benefit
20under s. 46.286 (5).
AB133-SSA1,610,2221 j. Determinations similar to those specified under s. 49.455 (8) (a), made under
22s. 46.286 (6).
AB133-SSA1,610,2323 k. Recovery of family care benefit payments under s. 46.286 (7).
AB133-SSA1,611,3
12. An applicant for or recipient of medical assistance is not entitled to a hearing
2concerning the identical dispute or matter under both this section and 42 CFR
3431.200
to 431.246.
AB133-SSA1,611,104 (b) An enrollee may contest a decision, omission or action of a care management
5organization other than those specified in par. (a), or may contest the choice of service
6provider. In these instances, the enrollee shall first send a written request for review
7by the unit of the department that monitors care management organization
8contracts. This unit shall review and attempt to resolve the dispute. If the dispute
9is not resolved to the satisfaction of the enrollee, he or she may request a hearing
10under the procedures specified in par. (a) 1. (intro.).
AB133-SSA1,611,1411 (c) Information regarding the availability of advocacy services and notice of
12adverse actions taken and appeal rights shall be provided to a client by the resource
13center or care management organization in a form and manner that is prescribed by
14the department by rule.
AB133-SSA1, s. 1080 15Section 1080. 46.288 of the statutes is created to read:
AB133-SSA1,611,17 1646.288 Rule-making. The department shall promulgate as rules all of the
17following:
AB133-SSA1,611,20 18(1) Standards for performance by resource centers and for certification of care
19management organizations, including requirements for maintaining quality
20assurance and quality improvement.
AB133-SSA1,612,2 21(2) Criteria and procedures for determining functional eligibility under s.
2246.286 (1) (a), financial eligibility under s. 46.286 (1) (b), cost sharing under s. 46.286
23(2) (a) and entitlement under s. 46.286 (3). The rules for determining functional
24eligibility under s. 46.286 (1) (a) 1. a. shall be substantially similar to eligibility
25criteria for receipt of the long-term support community options program under s.

146.27. Rules under this subsection shall include definitions of the following terms
2applicable to s. 46.286:
AB133-SSA1,612,33 (a) "Primary disabling condition".
AB133-SSA1,612,44 (b) "Mental illness".
AB133-SSA1,612,55 (c) "Substance abuse".
AB133-SSA1,612,66 (d) "Long-term or irreversible".
AB133-SSA1,612,77 (e) "Requires ongoing care, assistance or supervision".
AB133-SSA1,612,98 (f) "Condition that is expected to last at least 90 days or result in death within
9one year".
AB133-SSA1,612,1010 (g) "At risk of losing independence or functional capacity".
AB133-SSA1,612,1111 (h) "Gross monthly income".
AB133-SSA1,612,1212 (i) "Deductions and allowances".
AB133-SSA1,612,1313 (j) "Countable assets".
AB133-SSA1,612,16 14(3) Procedures and standards for procedures for s. 46.287 (2), including time
15frames for action by a resource center or a care management organization on a
16contested matter.
AB133-SSA1, s. 1081 17Section 1081. 46.289 of the statutes is created to read:
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