This bill eliminates the sunset date for the wage-paying community service job program and expands the program, beginning on January 1, 2001, to allow all W-2 agencies to implement it for any individual that the W-2 agency determines is capable of working in an unsubsidized job but who, despite reasonable efforts, is unable to secure full-time unsubsidized employment. However, the bill caps the number of slots for the program at 2,500 statewide. Under the bill, a participant in a wage-paying community service job is disqualified from the state EITC with respect to any wages earned under the wage-paying community service job. Additionally, under the bill, the participant need not be engaged in unsubsidized employment to qualify for a wage-paying community service job. Finally, the bill allows a W-2 agency to require a participant in a wage-paying community service job to work in a community service job for not more than 30 hours per week and to participate in job search activities for not more than ten hours per week.
This bill requires a W-2 agency to assess the educational needs of an individual whom the W-2 agency proposes to place in unsubsidized employment or a trial job. Under the bill, if the W-2 agency determines that the individual needs basic education, such as courses leading to the granting of the equivalent of a high school diploma, and if the individual wishes to pursue the basic education, the W-2 agency must make basic education a part of an employability plan that the W-2 agency develops for the individual. The bill requires the W-2 agency to pay for the basic education services.
Under current law, with certain limited exceptions, a participant in the W-2 program may be required to work in a community service job for not more than 30 hours per week and to participate in education or training activities for not more than ten hours per week. If the W-2 agency requires fewer than 30 hours of work per week because the participant has part-time unsubsidized employment, the participant's grant amount may be reduced by an amount equal to the product of $5.15 and the difference between 30 and the number of hours that the participant is required to work. This bill specifies that if a W-2 agency places a person in a community service job for fewer than 30 hours per week because that person has part-time unsubsidized employment, the W-2 agency may reduce the monthly grant in accordance with a schedule developed by DWD.
Under current law, a child care subsidy is available to a parent or guardian of a child who is under the age of 13 if the parent or guardian meets certain income and asset limits and needs child care to participate in certain work-related activities, including employment skills training. If child care is needed in order to participate in employment skills training (which includes English as a second language courses, high school graduation equivalency courses and technical college courses), the parent or guardian must demonstrate that he or she has been employed in an unsubsidized job for at least nine consecutive months or that he or she is a participant in a W-2 employment position in order to receive a child care subsidy.
Under this bill, if a person wishes to receive a subsidy for child care that is needed in order to pursue basic education (such as English as a second language courses, high school graduation equivalency courses or literacy tutoring), that person must demonstrate that he or she is employed in unsubsidized employment (without regard to length of employment) or that he or she is a participant in a W-2 employment position. A person who wishes to receive a subsidy for child care that is needed in order for the person to participate in a course of study at a technical college, or to pursue education that provides an employment skill, must demonstrate that he or she has been working in unsubsidized employment for three months (and continues to be so employed) or that he or she is in a W-2 employment position. As under current law, the W-2 agency must determine that the basic, technical or other education would facilitate the person's efforts to obtain employment.
Under current law, a contract to operate as a W-2 agency must require that the W-2 agency provide, or contract with another person to provide, credit establishment and credit repair assistance to W-2 participants. Currently, DWD may allocate not more than $3,000,000 annually for credit assistance to W-2 recipients in the city of Milwaukee.
Under this bill, rather than requiring credit establishment and credit repair services, a W-2 agency contract must require that the W-2 agency provide, or contract with another to provide, budgeting and financial planning services. The bill eliminates the allocation for credit establishment and credit repair services offered to W-2 participants in the city of Milwaukee.
Current contracts between DWD and W-2 agencies require the agencies to offer follow-up services for 60 days after a W-2 participant moves from a W-2 employment position to unsubsidized employment. This bill permits a W-2 agency, subsequent to that follow-up period, to offer case management services, including the provision of employment skills training, English as a second language classes and basic education, to an individual who has moved from a W-2 employment position to unsubsidized employment, regardless of the individual's income or asset level.
Currently, in calculating a person's income for the purpose of determining financial eligibility for W-2 or for a W-2 child care subsidy, a W-2 agency must include child support payments received by the person on behalf of any child who is a member of that person's household. This bill removes child support payments from the income consideration. The bill also directs the W-2 agency to include in the calculation of income for W-2 child care eligibility net earnings and certain business-related expenses reported to the Internal Revenue Service for farm and self-employment income.
Medical assistance
Under current law, certain people are eligible for MA because of substantial medical needs that consume so much of their income as to qualify them as low-income. This category of MA recipients is commonly referred to as medically needy. Other people are eligible for MA by virtue of their receipt of other federal assistance, such as SSI. This category of MA recipients is commonly referred to as categorically needy.
This bill directs DHFS to seek federal approval and to request any necessary waivers to expand MA eligibility to disabled persons who would qualify for SSI but for excess income and assets. Under the bill, a disabled person whose family's income is less than 250% of the federal poverty line and whose assets do not exceed $20,000 is eligible to receive MA if the person pays a monthly premium and a one-time initial premium established by DHFS. The bill directs DHFS, however, to pay the monthly premium for a person who is eligible for this MA purchase plan and who is receiving services under COP. The bill also authorizes DHFS to pay for that person's one-time entry premium.
The bill also requires DHFS to evaluate how to coordinate the MA purchase plan with HIRSP, which provides major medical health insurance coverage for, among others, persons who are covered under medicare because they are disabled but for which persons who are eligible for MA are not eligible. DHFS is required, if necessary, to develop proposed legislation that coordinates the two programs and that addresses the provision of health care coverage for individuals who are eligible for both HIRSP and the MA purchase plan.
Under the current MA program, DHFS certifies persons or facilities that meet certain criteria as providers and pays for services and items that MA recipients receive from the certified providers. DHFS is authorized or required to enforce numerous sanctions, including decertification or suspension from the MA program, against providers who fail to comply with requirements under the program or to whom improper or erroneous payments or overpayments have been made. To implement these sanctions, DHFS must provide written notice, a fair hearing and a written decision.
This bill prohibits MA providers from submitting false claims for payment of services or items. The bill permits DHFS to assess forfeitures for violations of the prohibitions and to impose a surcharge on a forfeiture that is assessed.
The bill authorizes DHFS to require certain MA providers, as a condition of certification, to file with DHFS a surety bond, payable to DHFS, under terms and in an amount specified by DHFS, that would reasonably pay the amount of a recovery and DHFS's costs to pursue recovery of overpayments or to investigate and pursue allegations of false claims or statements.
The bill authorizes DHFS, if DHFS first makes specified findings, to prescribe MA provider certification criteria that limit the number of providers of particular services or that limit the amount of resources, including employes and equipment, that a certified provider may use to provide MA services and items.
The bill makes various changes relating to the procedures for the recovery by DHFS of improper or erroneous MA payments or overpayments.
The bill eliminates DHFS's general authority to suspend a provider, but authorizes DHFS, if certain criteria are met, to suspend certification for a provider pending a hearing on whether the provider must be decertified for violation of federal or state laws. The bill eliminates the right of notice, a fair hearing and a written decision for most sanctions against providers that DHFS may enforce, except for decertification from or restriction of a provider's participation in the MA program.
The bill authorizes DHFS to prescribe conditions of MA participation and reimbursement terms and to impose additional sanctions for noncompliance. The bill requires immediate access, upon request by DHFS, to provider records and specifies that a provider's failure to provide access constitutes grounds for decertification.
The bill changes provisions concerning liability for repayment of improper or erroneous payments or overpayments of a provider who sells or otherwise transfers ownership of his or her business. Under the bill, before such a sale or transfer may take place, the provider must notify DHFS of the impending sale and DHFS must inform the provider of the extent of liability, if any. If liability exists, the provider must so inform the prospective transferee of the extent of the liability and the liability attaches to both the provider and the transferee, with the sale or other transfer conditioned upon repayment. If the provider fails to inform the transferee, liability does not attach to the transferee. Repayment must be made prior to the sale or transfer and, if not done, the sale or transfer is void.
Currently, a person who disposes of assets for less than the fair market value in order to qualify for MA is ineligible for MA for a certain period. Current law specifies that a transfer of assets to an irrevocable annuity is a transfer that is below the fair market value if the amount of the transfer exceeds the expected benefit.
This bill provides that a transfer of an asset to an irrevocable annuity, or a transfer of an asset by promissory note or similar instrument, is a transfer for the fair market value of the asset if certain conditions are met.
Under current law, DHFS must recover from the estate of a deceased MA recipient the amount of MA paid on behalf of the recipient while the recipient was a resident in a nursing home or an inpatient in a medical institution and the amount of MA paid on behalf of the recipient for certain services received by the recipient after the recipient was over the age of 55. One mechanism for recovery is a claim filed against the estate, which may include a lien placed on the home of a recipient who is a nursing home resident and not expected to return home. Currently, a lien may only be for the amount of MA paid on behalf of the recipient while the recipient resides in a nursing home.
This bill expands the estate recovery program as follows:
1. In addition to obtaining a lien on the home of a nursing home resident who is not expected to return home, the bill directs DHFS to obtain a lien on the home of an inpatient in a hospital who is not expected to return home. The lien, in both cases, is for the amount of MA paid on behalf of that recipient that is generally recoverable, rather than only the amount paid while the recipient was in the nursing home (or hospital).
2. DHFS must recover expenditures for personal care services, which include assistance with meals, dressing, movement, bathing or other personal needs or maintenance.
Under current law, a court may reduce DHFS's claim in an estate by up to $3,000 to allow heirs and beneficiaries to retain certain personal property, including up to $1,000 in tangible personal property that is not used in trade, agriculture or other business. This bill allows a court to reduce DHFS's claim in an estate by up to $5,000, including $3,000 in tangible personal property that is not used in trade, agriculture or other business.
Under current law, payments to nursing homes for care provided to recipients of MA are determined under a payment system that considers specific allowable costs, under standards prescribed by DHFS. The standards for payment of allowable direct care costs, support service costs, heating fuel and utility costs and administrative and general costs of a nursing home may not be less than the median for such costs of a sample of all nursing homes. Payment for net property taxes or municipal services are required to be made on a range from actual costs to a maximum limit determined by DHFS. Payment for capital costs of a nursing home must be based on the home's replacement value, subject to DHFS limitations, except that DHFS may not reduce final capital payment by more than $3.50 per patient day and except that DHFS limitations do not apply to certain nursing homes that have high capital costs. DHFS must calculate a payment for a nursing home by applying specified standards and considering specified cost centers and allowable costs. Payments are based on cost reports from the nursing home's previous fiscal year.
This bill eliminates the requirement that DHFS base payment on information from cost reports from the nursing home's previous fiscal year. The bill also eliminates the requirement that the standards for payment by DHFS of allowable costs for direct care, support services, heating fuel and utilities, administration and general services be not less than the median for such costs for a sample of all nursing homes, although the bill still requires DHFS to consider a sampling of nursing homes in determining payment. The bill eliminates the limitation on the amount by which DHFS may reduce final capital costs payment of a nursing home. The bill revises the standard for payment for net property taxes or municipal services to limit the payment to actual previous costs, subject to a maximum determined by DHFS.
Under current federal law, with certain exceptions, states are permitted to require an individual who is eligible for MA to enroll in a managed care plan (generally a health maintenance organization, or HMO) rather than receiving services under the traditional fee-for-service system. Federal law prohibits states from requiring a child who is in foster care to enroll in a managed care plan as a condition of receiving MA.
This bill authorizes DHFS to request a waiver from the secretary of the federal department of health and human services to permit DHFS to require children in foster care to enroll in a managed care plan as a condition of receiving MA. If the waiver is granted and in effect, the bill permits DHFS to implement the waiver.
This bill requires DHFS to request a waiver from the secretary of the federal department of health and human services to permit DHFS to cover under MA clinical evaluation services for certain persons with HIV. The bill limits coverage to $500 per year per person.
Currently, DHFS must annually submit to JCF a report on nursing home bed utilization by MA recipients for the previous year. If the report indicates that the utilization has decreased, DHFS must include a proposal to transfer funds from the MA appropriation account to the COP appropriation account for expenditure for noninstitutional long-term support services.
This bill provides that the transfer of funds from MA to COP may not reduce the MA appropriation account balance below the amount necessary to ensure that the appropriation account will end the current fiscal year or the current fiscal biennium with a positive balance. The bill requires that DHFS's report to JCF include a discussion and detailed projection of the likely balances, expenditures, encumbrances and carry-over of currently appropriated amounts in the MA appropriation accounts.
Currently, MA recipients may obtain coverage for inpatient hospital services and outpatient services for treatment of alcohol or other drug abuse. This bill provides that MA recipients may receive, until July 1, 2003, residential treatment services for alcohol and other drug abuse, limited to 45 days of treatment services per treatment episode. The benefit may be provided only in a facility of fewer than 16 beds in a county, city, town or village that elects both to become certified as a provider of the services, or to contract with a certified provider to provide the services, and to pay the amount of the allowable charges for the services under the MA program that is not provided by the federal government.
Under current law, dental services are provided to MA recipients on a fee-for-service basis or under some form of managed care, such as through enrollment by a recipient in a health maintenance organization that provides dental services. This bill increases the amount paid under the MA program for dental services providers who provide services on a fee-for-services basis.
Currently, DHFS annually may distribute no more than $2,256,000 of MA moneys as supplements to rural hospitals that, compared to other rural hospitals, have a high utilization of inpatient services by persons whose care is provided from governmental sources. This bill authorizes DHFS to distribute the supplements of MA moneys also to critical access hospitals. A critical access hospital is a hospital that DHFS determines meets specific federal medicaid requirements and has specific federal certification.
Under current law, at the request of DHFS, health insurers must provide information to enable DHFS to identify MA recipients who are eligible, or who would be eligible as dependents, for health insurance coverage. This bill authorizes DHFS to provide any information that it receives from a health insurer to DWD. The two departments must agree on procedures to safeguard the confidentiality of the information.
Currently, DHFS is authorized to provide enhanced reimbursement under CIP for a person who was relocated to the community from an intermediate care facility for the mentally retarded that closes. This bill additionally authorizes DHFS to provide enhanced reimbursement under CIP for a person who is relocated to the community from an intermediate care facility for the mentally retarded, or a distinct part of the facility, that has a DHFS-approved plan of closure and that intends to close within 12 months.
Children
Under current law, DHFS awards grants for various programs relating to youth alcohol and other drug abuse, adolescent pregnancy and other adolescent services. These programs include a neighborhood drug use and violence prevention program, a community alcohol and other drug abuse prevention program, a drug prevention program for Milwaukee public high school athletes, an adolescent self-sufficiency program, an adolescent pregnancy prevention program, an adolescent resource center in Milwaukee, a minority adolescent parenting skills program in Milwaukee and an adolescent choices project.
This bill eliminates all of these programs. The bill directs DHFS to award grants to public and private organizations operating in Milwaukee County; county departments of human services, social services, community programs or developmental disabilities services operating in counties other than Milwaukee County; and federally recognized American Indian tribes or bands in this state to provide programs to prevent and reduce the incidence of youth violence and other delinquent behavior, youth alcohol and other drug use and abuse, nonmarital pregnancy and child abuse and neglect; to increase the use of abstinence as a method of preventing nonmarital pregnancy; and to increase adolescent self-sufficiency by encouraging high school graduation, vocational preparedness, improved social and other interpersonal skills and responsible decision making. The bill requires DHFS to provide a set of benchmark indicators to measure the outcomes that are expected of a program receiving a grant and permits DHFS to renew a grant only if the recipient shows improvement on those indicators.
Under current law, an agency that is responsible for investigating reports of suspected or threatened child abuse or neglect must determine, within 60 days after receipt of such a report, whether abuse or neglect has occurred or is likely to occur. Currently, there is no procedure for appealing that determination. This bill provides that if such a determination contains a finding that a specific person has abused or neglected a child, that person may appeal that finding in accordance with procedures established by DHFS.
Under current law, an agency that is responsible for investigating reports of suspected or threatened child abuse or neglect must keep its records confidential and may disclose those records only under certain conditions. This bill permits such an agency, subject to standards established by DHFS, to disclose to the news media and the general public information from the agency's records in cases in which a child died or was placed in serious or critical condition as a result of abuse or neglect.
Under current federal law, each state that receives a grant under the federal Child Abuse Prevention and Treatment Act must establish not less than three child abuse and neglect citizen review panels to evaluate the extent to which local agencies responsible for providing child protective services are effectively discharging their responsibilities and must ensure that otherwise confidential child abuse and neglect records are made available to those panels. This bill permits a child abuse and neglect citizen review panel established by DHFS or a county department to have access to the otherwise confidential child abuse and neglect records of an agency responsible for child protection as necessary for the panel to carry out its functions.
Under current law, a person is eligible for a subsidy for child care for a child who is under the age of 13 if the person meets certain requirements. The person must be a parent or other primary caretaker of the child; the person must initially have a gross income at or below 165% of the federal poverty line; and the person's assets may not exceed $2,500 in combined equity value.
This bill expands eligibility for a child care subsidy beginning on January 1, 2000. Under the bill, the initial income limit is increased to 185% of the poverty line and the asset limit is eliminated. The bill also expands the subsidy to cover child care for disabled children who are under the age of 19.
Under current law, DWD must award grants for the start-up or expansion of child care services and must attempt to award these grants to head start agencies, employers that provide or wish to provide child care services for their employes, family day care centers, group day care centers and day care programs for the children of student parents. A person who is awarded a child care start-up or expansion grant must contribute matching funds equal to 25% of the amount awarded and may not use any grant moneys to purchase or improve land or to purchase, construct or permanently improve, other than minor remodeling, any building or facility.
This bill requires DWD to award low-interest loans for the start-up or expansion of child care services. Under the bill, the same requirements that apply to the awarding of child care start-up or expansion grants, other than the matching funds requirement, apply to the awarding of child care start-up or expansion low-interest loans. The bill also requires DWD to attempt to award child care start-up and expansion grants and low-interest loans to organizations that provide child care for sick children and to child care providers that employ participants or former participants in a W-2 employment position.
Under current law, if a W-2 agency determines that a person is eligible for a child care subsidy, the W-2 agency must refer that person to the county department. The county department determines, in accordance with a schedule developed by DWD, the amount of the person's copayment for child care; provides a child care subsidy, either in the form of a voucher or a direct payment to the child care provider; and helps the person identify available and appropriate child care. The county department also sets maximum reimbursement rates for child care providers and certifies certain child care providers. Finally, under current law, a county department is responsible for conducting a background investigation of child care providers prior to certifying them.
This bill permits DWD to require a county department, a tribal governing body or a W-2 agency to administer the child care subsidy program, except that in Milwaukee County, DWD must require a W-2 agency to administer the child care subsidy program in that county. Under the bill, whichever entity administers the program is responsible for determining the copayment amount, providing the subsidy, conducting background investigations on and certifying child care providers and identifying available and appropriate child care for subsidy recipients. County departments, however, retain the responsibility for setting maximum reimbursement rates for child care providers.
Under current law, DHFS may not license a person to operate a foster home, treatment foster home, group home, shelter care facility, child welfare agency or day care center; a county department or a child welfare agency may not license a person to operate a foster home or treatment foster home; a county department may not certify a person as a day care provider; and a school board may not contract with a person to operate a day care program if the person has been convicted of or has pending a charge for a serious crime, as defined by DHFS by rule; has abused or neglected a client or a child; has misappropriated client property; or is not sufficiently credentialed to provide adequate client care. In addition, such a licensed, certified or contracting entity may not hire or contract with such a person if the person is expected to have access to the entity's clients and may not permit such a person to reside at the entity as a nonclient. Such a person may, however, subject to certain exceptions, demonstrate that he or she has been rehabilitated. At the time of initial licensure, certification, hiring, contracting or residence and every four years after that, DHFS, a county department, a child welfare agency or a school board must obtain, with respect to an operator or nonclient resident of an entity, and an entity must obtain, with respect to an employe or contractor who has or is expected to have access to the entity's clients, certain personal background information, including information obtained from a criminal history search. DHFS, a county department, a child welfare agency or a school board may charge a fee for obtaining this background information about an operator or nonclient resident of an entity.
This bill changes the type of interaction with clients that an employe or contractor must have to require a background investigation of the employe or contractor and to prohibit the employe or contractor from being hired by or from contracting with an entity. The bill, rather than requiring an investigation of an employe or contractor who has or is expected to have access to a client, instead requires an investigation of an employe or contractor who provides or is expected to provide to clients direct care that is more intensive than negligible in quantity or quality or in the amount of time required to provide the care. The bill also permits DHFS, a county department, a child welfare agency, a W-2 agency or a school board to charge a fee for the cost of providing background information to an entity about an employe or contractor and to charge a fee to a person for the cost of determining whether the person has been rehabilitated.
Under current law, a foster home may provide care and maintenance for no more than four children unless all of the children are siblings. This bill permits a foster home to provide care and maintenance for no more than four children or, if necessary to enable a sibling group to remain together, for no more than six children or, if DHFS promulgates rules permitting a different number of children, for the number of children permitted under those rules.
Under current law, subject to certain exceptions, DHFS, a county department or a licensed child welfare agency (collectively "agency") may not make available for inspection or disclose the contents of any record kept or information received about an individual in the care or legal custody of the agency except by order of the court assigned to exercise jurisdiction under the children's code (juvenile court). Current law, however, is silent as to the confidentiality of records kept and information received relating to a foster parent, treatment foster parent or family-operated group home parent (substitute care parent).
This bill prohibits an agency from making available for inspection or disclosing the contents of any record kept or information received relating to a substitute care parent or a family member of a substitute care parent without first receiving the written permission of the substitute care parent, except by order of the juvenile court. The bill does not prohibit an agency from disclosing information in confidence to another social welfare agency, from disclosing the contents of a record as permitted under the child abuse and neglect reporting law, from disclosing to the child's parent, guardian or legal custodian the name and address of the substitute care parent or from including the location of the child's placement in the child's permanency plan.
Current law appropriates to DHFS certain general purpose revenues (GPR) and federal revenues for foster care and for adoption assistance payments to parents who adopt children with special needs. This bill expands the purposes for which GPR and federal foster care and adoption services moneys are appropriated to DHFS to include the cost of contracting with private adoption agencies to provide adoption services for children with special needs who are under the guardianship of DHFS.
Under current law, in Milwaukee County, DHFS is required to provide the juvenile court with services necessary for investigating and supervising child welfare cases under the children's code and the county board of supervisors is required to provide the juvenile court with services necessary for investigating and supervising cases under the juvenile justice code. Child welfare cases under the children's code include cases in which a child is alleged to have been abused or neglected or otherwise to be in need of protection or services under the children's code. Cases under the juvenile justice code include cases in which a juvenile is alleged to be delinquent, in violation of a civil law or ordinance or in need of protection or services under the juvenile justice code, that is, habitually truant from home or school, uncontrollable or a school dropout. The chief judge of the judicial administrative district covering Milwaukee County must formulate written judicial policy governing intake and juvenile court services for matters under the children's code and the juvenile justice code.
This bill prohibits the chief judge from directing DHFS to provide intake and juvenile court services in cases in which the referral information indicates that the juvenile should be referred to the juvenile court under the juvenile justice code, unless that information indicates that the juvenile should also be referred to the juvenile court under the children's code. The bill also requires the chief judge to direct DHFS and Milwaukee County to coordinate the provision of services in cases in which a DHFS intake worker determines that jurisdiction exists under the juvenile justice code instead of or in addition to the children's code and in cases in which a Milwaukee County intake worker determines that jurisdiction exists under the children's code instead of or in addition to the juvenile justice code.
Health
Under current law, DHFS must administer a health care program (known as badger care) to provide health care coverage to low-income (generally defined as having an income at or below 185% of the federal poverty line) children and their parents if the children reside with their parents.
This bill expands the badger care program to cover any child under the age of 19 who meets financial and other eligibility requirements, regardless of whether the child resides with his or her parents. The bill also requires DHFS to lower the maximum income level for initial eligibility for badger care if funding for badger care is insufficient to accommodate the projected enrollment in badger care and requires DHFS to raise the income limit to up to 185% of the federal poverty line if, after having lowered the income level, funding for badger care becomes sufficient to cover projected enrollment of persons at the higher income level.
Currently, the health insurance risk-sharing plan (HIRSP) provides major medical health insurance coverage for persons who are covered under medicare because they are disabled, persons who have tested positive for human immunodeficiency virus (HIV) and persons who have been refused coverage, or coverage at an affordable price, in the private health insurance market because of their mental or physical health condition. Also eligible for coverage are persons (called eligible individuals) who do not currently have health insurance coverage, but who were covered under certain types of health insurance coverage for at least 18 months in the past. HIRSP offers its enrollees who are not eligible for medicare an annual choice of coverage option. Responsibility for administering HIRSP is split between DHFS and the HIRSP board of governors (board).
This bill makes various changes to HIRSP. Except for an eligible individual, a person who is at least 65 years of age is not eligible for HIRSP coverage. The bill provides that a person who has HIRSP coverage on the date on which he or she attains age 65 does not lose eligibility for coverage because of his or her age.
With certain exceptions, current law provides that a person for whom a premium, deductible or coinsurance amount is paid by any governmental agency is not eligible for HIRSP coverage. The bill provides that a person who receives a reimbursement from DHFS for the cost of drugs for the treatment of HIV infection and for the treatment of acquired immunodeficiency syndrome (AIDS) is not ineligible for HIRSP coverage by reason of the reimbursement.
With certain exceptions, current law sets the deductible for coverage under HIRSP at $1,000. HIRSP pays 80% of covered costs exceeding the deductible. After a covered person has paid $2,000 in costs, including the deductible, in a calendar year, the bill directs HIRSP to pay 100% of the covered costs for the remainder of the calendar year. If more than one member of a family has HIRSP coverage, HIRSP pays 100% of covered costs after the family has paid $4,000 in costs. The bill specifies these values for covered persons not eligible for medicare who choose the other coverage option that HIRSP offers. Under the other coverage option, the deductible is $2,500. HIRSP pays 100% of the covered costs after a covered person has paid $3,500 in costs in a calendar year. For a family with more than one covered person, HIRSP pays 100% of covered costs after the family has paid $7,000 in costs.
Finally, the bill transfers to DHFS some of the board's responsibilities, such as establishing procedures for hearing grievances and collecting assessments from insurers, and requires the board to advise DHFS with respect to those responsibilities.
Under current law, DHFS may not license, certify, issue a certificate of approval to or register a person to operate an adult treatment facility or organization or to provide adult treatment services if DHFS knows that the person has been convicted of or has pending a charge for a serious crime; has been found to have abused or neglected a facility client or misappropriated client money; has abused or neglected a child; or is not sufficiently credentialed to provide adequate client care. In addition, an adult treatment facility or organization or a person providing services may not hire such a person if that person may have access to clients and an adult treatment facility may not allow him or her to reside as a nonclient at the facility. The prohibitions do not apply if the person demonstrates to DHFS that he or she has been rehabilitated, unless the person has been convicted of certain offenses. DHFS must obtain specific personal background information, including that obtained from criminal history searches, about persons applying to operate adult treatment facilities or organizations or applying to provide adult treatment services. In addition, DHFS must obtain the information every four years for all persons licensed to operate such facilities or organizations or to provide such services and for nonclient facility residents and may charge a fee for conducting those personal background information checks. Every adult treatment facility or organization and every person who provides adult treatment services must obtain the same types of information about prospective employes or contractors, and every adult treatment facility must obtain such information about persons who seek to reside as nonclients in the facilities. The information must be obtained every four years for employes or contractors.
This bill authorizes DHFS to conduct background investigations on behalf of adult treatment facilities and organizations and persons who provide adult treatment services and to charge a fee for doing so. Additionally, the bill authorizes DHFS to charge persons a fee for the costs incurred by DHFS under requests to demonstrate that the persons have been rehabilitated.
The bill changes the type of interaction with clients that a prospective employe or a prospective contractor must have in order to require a background investigation of the employe or contractor and to prohibit the employe or contractor from being hired by or from contracting with adult treatment facilities, organizations or services. The bill, rather than requiring investigation of a person who has or is expected to have access to the clients of the facility, organization or service, instead requires investigation of a person who provides to the clients or is expected to provide to the clients, direct care that is more intensive than negligible in quantity or quality or in the amount of time required to provide the care. Restrictions on nonclient residents at the facility, organization or service are unchanged by the bill.
Under current law, DHFS administers the birth and developmental outcome monitoring program (BDOMP). Under that program, a report must be made to DHFS by a physician or nurse who diagnoses or confirms a suspected diagnosis that a child under the age of six has a condition resulting from a low birth weight, a chronic condition possibly requiring long-term care, a birth defect or a developmental disability or other severe disability. DHFS must develop and implement a system for the collection, updating and analysis of the information reported and to disseminate the information.
This bill eliminates BDOMP. Instead, the bill requires physicians, hospitals, certain clinics and clinical laboratories to report birth defects identified in children under the age of two to DHFS. The bill requires DHFS to establish and maintain a registry that documents the diagnosis of a birth defect in a child under the age of two. As under current law, personally identifying information that is contained in the reports made to DHFS is confidential and, with certain exceptions, may not be released to any person. Finally, the bill creates a council on birth defect prevention and surveillance to advise DHFS regarding the registry and rules related to reporting.
Under current law, DHFS licenses and otherwise regulates emergency medical technicians and ambulance service providers. DHFS may charge a reasonable fee for licensure. This bill authorizes DHFS to impose forfeitures on ambulance service providers for violation of laws that prescribe conditions for licensure and for operation of ambulances. The bill clarifies that DHFS may charge a fee for the renewal of licenses for emergency medical technicians and ambulance service providers and authorizes DHFS to charge fees for untimely license renewal. DHFS must promulgate rules to establish the amounts for assessments of the forfeitures, fees for license renewal and late renewal fees.
This bill does all of the following with respect to tuberculosis:
1. Requires that laboratories that perform primary culture for mycobacteria also perform organism identification for mycobacterium tuberculosis and conduct antimicrobial drug susceptibility tests on the mycobacterium tuberculosis bacteria. The results of that test must be reported to DHFS.
2. Creates a process by which a person with infectious tuberculosis or with a suspected case of tuberculosis may be confined pending a hearing if the confinement is to be longer than 72 hours.
3. Permits local health departments to request from DHFS certification to establish and maintain a public health dispensary.
This bill provides that DHFS may use moneys derived from Indian gaming compacts to fund grants for cooperative American Indian health projects.
Under current law, DHFS must base fees for renewal of home health agency licenses on the annual net income, as determined by DHFS, of each home health agency seeking license renewal. This bill eliminates annual net income of home health agencies as a basis for establishing fees for home health agency license renewal, thus permitting DHFS to base fees on any criterion.
Mental illness and developmental disabilities
Under current law, a person who is believed to be mentally ill and a proper subject for treatment and who evidences certain acts, omissions or other behavior that indicate that he or she satisfies at least one of five standards of dangerousness may be detained on an emergency basis and transported to and detained and treated in a mental health treatment facility. A petition signed by three others may be brought against the detained person alleging that the detained person is mentally ill, is a proper subject for treatment and is dangerous because he or she meets a standard for involuntary civil commitment. If such a petition is filed with a court, the subject of the petition must be given a hearing to determine if there is probable cause to support the petition's allegations. If a court finds probable cause, a final hearing on commitment must be held. If, at the hearing, the person is again found to satisfy one of the standards of dangerousness he or she may be involuntarily committed to the care and custody of a county department of community programs for appropriate treatment.
Currently, one of the five standards of dangerousness for involuntary civil commitment terminates on December 1, 2001. That standard, known as the fifth standard, requires that a person, because of mental illness, either evidences the incapability of expressing an understanding of the advantages and disadvantages of and alternatives to accepting a particular medication or treatment after these have been explained to him or her or evidences substantial incapability of applying an understanding of those advantages, disadvantages and alternatives to his or her mental illness in order to make an informed choice as to whether to accept or refuse medication or treatment. The person also must evidence a substantial probability, as demonstrated by both his or her treatment history and recent acts or omissions, that he or she needs care or treatment to prevent further disability or deterioration. Lastly, the person must evidence a substantial probability that he or she will, if left untreated, lack services necessary for his or her health or safety and suffer mental, emotional or physical harm that will result in either the loss of his or her ability to function independently in the community or the loss of cognitive or volitional control over his or her thoughts or actions.
This bill eliminates the December 1, 2002, termination of the fifth standard for emergency detention and involuntary civil commitment of persons with mental illness.
Currently, if a person is found to be a proper subject for treatment and is found to satisfy at least one of the five standards of dangerousness, the person may initially be committed for treatment for a period not to exceed six months. In addition, a commitment order may be extended after an evaluation of the person. Each consecutive commitment order extension may be for a period not to exceed 12 months.
An inmate of a jail, house of correction or prison may be subject to an involuntary commitment proceeding based on a petition described above. However, there is an alternative petition that may be used to begin an involuntary commitment proceeding against an inmate. This alternative petition must allege all of the following: 1) that the inmate is mentally ill, is a proper subject for treatment and is in need of treatment; 2) that the inmate has been fully informed about, and has had the opportunity to discuss, his or her treatment needs and the mental health services available to him or her; and 3) that appropriate less restrictive forms of treatment have been attempted and have been unsuccessful. If an inmate is committed based on an alternative petition, the total period that the inmate may be committed may not exceed 180 days in any 365-day period.
This bill extends the period for which an inmate of a state prison may be committed based on an alternative petition to a period not to exceed one year. The bill does not change the current time limits on the commitment of an inmate of a jail or house of correction based on an alternative petition.
Current law provides a procedure for involuntarily committing sexually violent persons to DHFS for control, care and treatment. A sexually violent person is a person who has been convicted of certain sexually violent offenses and who is dangerous because he or she suffers from a mental disorder that makes it substantially probable that the person will engage in acts of sexual violence.
Under current law, when a person is found to be a sexually violent person the person must be committed to the custody of DHFS. The court that commits the person must specify whether the person is to be placed in institutional care or on supervised release in the community, and DHFS must arrange for control, care and treatment of the person in the least restrictive manner consistent with the requirements of the person and in accordance with the court's commitment order.
