Wisconsin Legislature: LRB-2079/1

46.278 (6) (e) 1. b. An intermediate care facility for the mentally retarded or a distinct part thereof that has a plan of closure approved by the department and that intends to close within 12 months.

SECTION 1068. 46.2805 of the statutes is created to read:

46.2805 Definitions; long-term care. In ss. 46.2805 to 46.2895:

(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:

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

(b) A demonstration program known as the Wisconsin partnership program under a federal waiver authorized under 42 USC 1315.

(2) "Eligible person" means a person who meets all eligibility criteria under s. 46.286 (1) or (1m).

(3) "Enrollee" means a person who is enrolled in a care management organization.

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

(5) "Family care district" means a special purpose district created under s. 46.2895 (1).

(6) "Family care district board" means the governing board of a family care district.

(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).

(8) "Nonprofit organization" has the meaning given in s. 108.02 (19).

(9) "Older person" means a person who is aged at least 65.

(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.

(11) "Tribe or band" means a federally recognized American Indian tribe or band.

SECTION 1069. 46.281 of the statutes is created to read:

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:

(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.

(b) Provide information to the council on long-term care and seek recommendations of the council.

(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.

(d) Before July 1, 2001:

1. Establish, in geographic areas determined by the department, 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.

2. 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.

(e) After June 30, 2001, contract with one or more entities 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).

(f) Prescribe and implement a per person monthly rate structure for costs of the family care benefit.

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

1. Prescribe by rule and by contract and enforce performance standards for operation of resource centers and care management organizations.

2. Use performance expectations that are related to outcomes for persons in contracting with care management organizations and resource centers.

3. Conduct ongoing evaluations of the long-term care system specified in ss. 46.2805 to 46.2895.

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.

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.

(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.

(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).

(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.

(3) DUTY OF THE SECRETARY. The secretary shall certify to each county, 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, 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.

SECTION 1070. 46.281 (1) (a) of the statutes, as created by 1999 Wisconsin Act .... (this act), is repealed.

SECTION 1071. 46.281 (1) (b) of the statutes, as created by 1999 Wisconsin Act .... (this act), is repealed.

SECTION 1072. 46.282 of the statutes is created to read:

46.282 Council on long-term care. The council on long-term care appointed under s. 15.197 (5) shall do all of the following:

(1) Assist the department in developing broad policy issues related to long-term care services.

(2) 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:

(a) The department's standard contract provisions for resource centers and care management organizations.

(b) The family care benefit, including the per person rate structure for the benefit.

(d) The community integration programs under ss. 46.275, 46.277 and 46.278.

(e) Programs other than those under pars (c) and (d) that provide home and community-based services.

(f) The provision of medical assistance services under a fee-for-service system.

(3) Monitor patterns of complaints, grievances and appeals related to long-term care in order to identify issues of statewide importance.

(4) Monitor the numbers of persons on waiting lists.

(5) Review patterns of utilization of various types of services by care management organizations.

(6) Monitor the pattern of care management organization enrollments and disenrollments throughout the state.

(7) 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:

(a) Numbers of persons served.

(b) Costs of long-term care provided under the family care benefit.

(d) Waiting list information.

(e) Results of reviews of quality of services provided by resource centers and care management organizations.

SECTION 1073. 46.282 of the statutes, as created by 1999 Wisconsin Act .... (this act), is repealed.

SECTION 1074. 46.283 of the statutes is created to read:

46.283 Resource centers. (1) APPLICATION FOR CONTRACT. (a) 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:

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.

2. Whether to create a family care district to apply to the department for a contract to operate a resource center.

(b) 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.

(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.

(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.

(2) EXCLUSIVE CONTRACT. (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 with 2 or more of these entities under a joint application, to operate a resource center.

(b) After June 30, 2001, the department may contract with a private nonprofit organization to operate a resource center 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:

1. A county board of supervisors declines in writing to apply for a contract to operate a resource center.

2. A county agency or a family care district applies for a contract but fails to meet the standards specified in sub. (3).

(c) After the period specified in par. (a), the department may contract to operate a resource center with counties, family care districts, the governing body of a tribe or band or the Great Lakes inter-tribal council, inc., or under a joint application of any of these, or with a private nonprofit organization that is entirely separate from an entity that operates a care management organization.

(3) STANDARDS FOR OPERATION. The department shall assure that at least all of the following are available to a person who contacts a resource center for service:

(a) Information and referral services and other assistance at hours that are convenient for the public.

(b) A determination of functional eligibility for the family care benefit.

(d) Counseling concerning public and private benefits programs.

(e) A determination of financial eligibility and of the maximum amount of cost sharing required for a person who is seeking long-term care services, under standards prescribed by the department.

(f) Assistance to a person who is eligible for the family care benefit with respect to the person's choice of whether or not to enroll in a care management organization and, if so, which available care management organization would best meet his or her needs.

(g) Assistance in enrolling in a care management organization for persons who choose to enroll.

(h) Equitable assignment of priority on any necessary waiting lists, consistent with criteria prescribed by the department, for persons who are eligible for the family care benefit but who do not meet the criteria under s. 46.286 (3).

(i) Assessment of risk for each person who is on a waiting list, as described in par. (h), development with the person of an interim plan of care and assistance to the person in arranging for services.

(j) Transitional services to families whose children with physical or developmental disabilities are preparing to enter the adult service system.

(k) A determination of eligibility for state supplemental payments under s. 49.77, medical assistance under s. 49.46, 49.468 or 49.47 or the federal food stamp program under 7 USC 2011 to 2029.

(4) DUTIES. A resource center shall do all of the following:

(a) Provide services within the entire geographic area prescribed for the resource center by the department.

(b) Submit to the department all reports and data required or requested by the department.

(c) Implement internal quality improvement and quality assurance processes that meet standards prescribed by the department.

(d) Cooperate with any review by an external advocacy organization.

(e) Within 6 months after the family care benefit is available to all eligible persons in the area of the resource center, provide information about the services of the resource center, including the services specified in sub. (3) (d), about assessments under s. 46.284 (4) (b) and care plans under s. 46.284 (4) (c) and about the family care benefit to all older persons and persons with a physical disability who are residents of nursing homes, community-based residential facilities, adult family homes and residential care apartment complexes in the area of the resource center.