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 (this act), is repealed.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 (this act), is repealed.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.
(c) The long-term support community options program under s. 46.27.
(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.
(c) The number and service areas of resource centers and care management organizations.
(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.
(c) Within the limits of available funding, prevention and intervention services.
(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.
(f) Provide a functional and financial screen to any resident, as specified in par. (e), who requests a screen and assist any resident who is eligible and chooses to enroll in a care management organization to do so.
(g) Provide a functional and financial screen to any person seeking admission to a nursing home, community-based residential facility, residential care apartment complex or adult family home if the secretary has certified that the resource center is available to the person and the facility.
(h) Provide access to services under s. 46.90 and ch. 55 to a person who is eligible for the services, through cooperation with the county agency or agencies that provide the services.
(i) Assure that emergency calls to the resource center are responded to promptly, 24 hours per day.
(5) FUNDING. From the appropriation accounts under s. 20.435 (4) (bm) and (pa) and (7) (b), (bd) and (md), the department may contract with organizations that meet standards under sub. (3) for performance of the duties under sub. (4) and shall distribute funds for services provided by resource centers.
(6) GOVERNING BOARD. A resource center shall have a governing board that reflects the ethnic and economic diversity of the geographic area served by the resource center. At least one-fourth of the members of the governing board shall be older persons or persons with physical or developmental disabilities or their family members, guardians or other advocates.
(7) EXCHANGE OF INFORMATION. Notwithstanding 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 resource center 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), 46.284 (7), 46.2895 (10), 51.42 (3) (e) or 51.437 (4r) (b) in the county of the resource center, if necessary to enable the resource center to perform its duties or to coordinate the delivery of services to the client.
****NOTE: The numbering of s. 20.435 (4) (bm) and (pa) is dependent on the renumbering of s. 20.435 (1) (bm) and (p) in LRB-0028. If LRB-0028 is not included in the budget bill, these cross-references must be renumbered.
SECTION 1075. 46.284 of the statutes is created to read:
46.284 Care management organizations. (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 care management organization 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 care management organization.
(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 care management organization 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 care management organization in conjunction with the county board or boards of one or more other counties or a county-tribal care management organization 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 care management organization 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) CONTRACTS. (a) The department may contract for operation of a care management organization only with an entity that is certified as meeting the requirements under sub. (3). No entity may operate as a care management organization under the requirements of this section unless so certified and under contract with the department.
(b) Within each county, the department shall initially contract to operate a care management organization with the county or a family care district if the county elects to operate a care management organization and the care management organization meets the requirements of sub. (3) and performance standards prescribed by the department. A county that contracts under this paragraph may operate the care management organization for all of the target groups or for a selected group or groups. During the first 24 months in which the county has a contract under which it accepts a per person per month payment for each enrollee in the care management organization, the department may not contract with another organization to operate a care management organization in the county unless any of the following applies:
1. The county agrees in writing that at least one additional care management organization is necessary or desirable.
2. The county does not have the capacity to serve all county residents who are entitled to the family care benefit in the client group or groups that the county serves and cannot develop the capacity.
3. The governing body of a tribe or band or the Great Lakes inter-tribal council, inc., elects to operate a care management organization within the area and is certified under sub. (3).
(c) For contracts following the initial contracts specified in par. (b), the department shall, after consulting with the council on long-term care, prescribe criteria to determine the number of care management organizations that are necessary for operation in a county. Under these criteria, the department shall solicit applications, certify those applicants that meet the requirements specified in sub. (3) (a), select certified applicants for contract and contract with the selected applicants.
(3) CERTIFICATION; REQUIREMENTS. (a) If an entity meets the requirements under par. (b) and applicable rules of the department and submits to the department an application for initial certification or certification renewal, the department shall certify that the entity meets the requirements for a care management organization.
(b) To be certified as a care management organization, an applicant shall demonstrate or ensure all of the following:
1. Adequate availability of providers with the expertise and ability to provide services that are responsive to the disabilities or conditions of all of the applicant's proposed enrollees and sufficient representation of programmatic philosophies and cultural orientations to accommodate a variety of enrollee preferences and needs.
2. Adequate availability of providers that can meet the preferences and needs of its proposed service recipients for services at various times, including evenings, weekends and, when applicable, on a 24-hour basis.
3. Adequate availability of providers that are able and willing to perform all of the tasks that are likely to be identified in proposed enrollees' service and care plans.
4. Adequate availability of residential and day services that are geographically accessible to proposed enrollees' homes, families or friends.
5. Adequate supported living arrangements of the types and sizes that meet proposed enrollees' preference and needs.
6. Expertise in determining and meeting the needs of every target population that the applicant proposes to serve and connections to the appropriate service providers.
7. Thorough knowledge of local long-term care and other community resources.
8. The ability to manage and deliver, either directly or through subcontracts or partnerships with other organizations, the full range of benefits to be included in the monthly payment amount.
