Amendment CSA1-SB40

SB40-CSA1,564,25 (a) Evaluate the performance of care management organizations and entities that operate a program described under s. 46.2805 (1) (a) or (b) in the committee's region with respect to responsiveness to recipients of their services, fostering choices for recipients, and other issues affecting recipients; and make recommendations based on the evaluation to the department and to the care management organizations and entities, as appropriate.

SB40-CSA1,565,3 (b) Evaluate the performance of resource centers operating in the committee's region and, as appropriate, make recommendations, concerning their performance to the department and the resource centers.

SB40-CSA1,565,6 (c) Monitor grievances and appeals made to care management organizations or entities that operate a program described under s. 46.2805 (1) (a) or (b) within the committee's region.

SB40-CSA1,565,7 (d) Review utilization of long-term care services in the committee's region.

SB40-CSA1,565,13 (f) Using information gathered under s. 46.283 (6) (b) 2. by governing boards of resources centers operating in the committee's region and other available information, identify any gaps in the availability of services, living arrangements, and community resources needed by older persons and persons with physical or developmental disabilities, and develop strategies to build capacity to provide those services, living arrangements, and community resources in the committee's region.

SB40-CSA1,565,16 (h) Annually report to the department regarding significant achievements and problems relating to the provision of long-term care services in the committee's region.

SB40-CSA1, s. 978 Section 978. 46.283 (1) (a) 2. of the statutes is amended to read:

SB40-CSA1,565,19 46.283 (1) (a) 2. Whether to create a family long-term care district to apply to the department for a contract to operate a resource center.

SB40-CSA1, s. 979 Section 979. 46.283 (2) (a) of the statutes is repealed.

SB40-CSA1, s. 980 Section 980. 46.283 (2) (b) of the statutes is renumbered 46.283 (2), and 46.283 (2) (intro.) and (b), as renumbered, are amended to read:

SB40-CSA1,566,5 46.283 (2) (intro.) After June 30, 2001, the The department may, if the applicable review conditions under s. 46.281 (1) (e) 2. are satisfied, contract to operate a resource center with counties, family long-term care districts, or the governing body of a tribe or band or the Great Lakes Inter-Tribal Council, Inc., under a joint application of any of these, or with a private nonprofit organization 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:

SB40-CSA1,566,7 (b) A county agency or a family long-term care district applies for a contract but fails to meet the standards specified in sub. (3).

SB40-CSA1, s. 981 Section 981. 46.283 (3) (h) of the statutes is repealed.

SB40-CSA1, s. 982 Section 982. 46.283 (3) (i) of the statutes is repealed.

SB40-CSA1, s. 983 Section 983. 46.283 (3) (k) of the statutes is amended to read:

SB40-CSA1,566,13 46.283 (3) (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 49.471, or the federal food stamp program under 7 USC 2011 to 2029.

SB40-CSA1, s. 984 Section 984. 46.283 (4) (e) of the statutes is amended to read:

SB40-CSA1,566,22 46.283 (4) (e) Within 6 months after the family care benefit is available to all eligible persons in the area of the resource center, provide 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.

SB40-CSA1, s. 985 Section 985. 46.283 (4) (f) of the statutes is amended to read:

SB40-CSA1,567,2 46.283 (4) (f) Provide Perform a functional screening and a financial screen to and cost-sharing screening for any resident, as specified in par. (e), who requests a screen screening and assist any resident who is eligible and chooses to enroll in a care management organization to do so.

SB40-CSA1, s. 986 Section 986. 46.283 (4) (g) of the statutes is amended to read:

SB40-CSA1,567,17 46.283 (4) (g) Provide Perform a functional screening and a financial screen to and cost-sharing screening for 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 and the person is determined by the resource center to have a condition that is expected to last at least 90 days that would require care, assistance, or supervision. A resource center may not require a financial screen and cost-sharing screening for a person seeking admission or about to be admitted on a private pay basis who waives the requirement for a financial screen and cost-sharing screening under this paragraph, unless the person is expected to become eligible for medical assistance within 6 months. A resource center need not provide perform a functional screen for screening for a person seeking admission or about to be admitted who has received a screen for whom a functional eligibility under s. 46.286 (1) (a) screening was performed within the previous 6 months.

SB40-CSA1, s. 987 Section 987. 46.283 (4) (j) of the statutes is created to read:

SB40-CSA1,567,21 46.283 (4) (j) Target any outreach, education, and prevention services it provides and any service development efforts it conducts on the basis of findings made by the governing board of the resource center under sub. (6) (b) 2. and 3.

SB40-CSA1, s. 989 Section 989. 46.283 (6) of the statutes is amended to read:

SB40-CSA1,567,25 46.283 (6) Governing board. (a) 1. A resource center shall have a governing board that reflects the ethnic and economic diversity of the geographic area served by the resource center.

SB40-CSA1,568,7 2. At least one-fourth of the members of the governing board shall be older persons or persons with physical or developmental disabilities individuals who belong to a client group served by the resource center or their family members, guardians, or other advocates. The proportion of these board members who belong to each client group, or their family members, guardians, or advocates, shall be the same, respectively, as the proportion of individuals in this state who receive services under s. 46.2805 to 46.2895 and belong to each client group.

SB40-CSA1, s. 990 Section 990. 46.283 (6) (a) 3. of the statutes is created to read:

SB40-CSA1,568,15 46.283 (6) (a) 3. An individual who has a financial interest in, or serves on the governing board of, a care management organization or an organization that administers a program described under s. 46.2805 (1) (a) or (b) or a managed care program under s. 49.45 for individuals who are eligible to receive supplemental security income under 42 USC 1381 to 1383c, which serves any geographic area also served by a resource center, and the individual's family members, may not serve as members of the governing board of the resource center.

SB40-CSA1, s. 991 Section 991. 46.283 (6) (b) of the statutes is created to read:

SB40-CSA1,568,18 46.283 (6) (b) The governing board of a resource center shall do all of the following:

SB40-CSA1,568,21 1. Determine the structure, policies, and procedures of, and oversee the operations of, the resource center. The operations of a resource center that is operated by a county are subject to the county's ordinances and budget.

SB40-CSA1,569,2 2. Annually gather information from consumers and providers of long-term care services and other interested persons concerning the adequacy of long-term care services offered in the area served by the resource center. The board shall provide well-advertised opportunities for persons to participate in the board's information gathering activities conducted under this subdivision.

SB40-CSA1,569,4 4. Report findings made under subds. 2. and 3. to the applicable regional long-term care advisory committee.

SB40-CSA1,569,7 5. Recommend strategies for building local capacity to serve older persons and persons with physical or developmental disabilities, as appropriate, to local elected officials, the regional long-term care advisory committee, or the department.

SB40-CSA1,569,9 7. Appoint members to the regional long-term care advisory committee, as provided under s. 46.2825 (1).

SB40-CSA1, s. 992 Section 992. 46.284 (1) (a) (intro.) of the statutes is amended to read:

SB40-CSA1,569,14 46.284 (1) (a) (intro.) After considering recommendations of the local long-term care council under s. 46.282 (3) (a) 1., 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:

SB40-CSA1, s. 993 Section 993. 46.284 (1) (a) 2. of the statutes is amended to read:

SB40-CSA1,569,17 46.284 (1) (a) 2. Whether to create a family long-term care district to apply to the department for a contract to operate a care management organization.

SB40-CSA1, s. 994 Section 994. 46.284 (2) (b) (intro.) of the statutes is repealed.

SB40-CSA1, s. 995 Section 995. 46.284 (2) (b) 1. of the statutes is repealed.

SB40-CSA1, s. 996 Section 996. 46.284 (2) (b) 2. of the statutes is repealed.

SB40-CSA1, s. 997 Section 997. 46.284 (2) (b) 3. of the statutes is renumbered 46.284 (2) (bm) and amended to read:

SB40-CSA1,570,8 46.284 (2) (bm) After December 31, 2003, the The department may contract with counties, family long-term 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 organization that has no significant connection to an entity that operates a resource center. Proposals for contracts under this subdivision shall be solicited under a competitive sealed proposal process under s. 16.75 (2m) and, after consulting with the local long-term care council for the county or counties, the department shall evaluate the proposals primarily as to the quality of care that is proposed to be provided, certify those applicants that meet the requirements specified in sub. (3) (a), select certified applicants for contract and contract with the selected applicants.

SB40-CSA1, s. 997m Section 997m. 46.284 (2) (c) of the statutes is created to read:

SB40-CSA1,570,22 46.284 (2) (c) The department shall require, as a term of any contract with a care management organization under this section, that the care management organization contract for the provision of services that are covered under the family care benefit with any community-based residential facility under s. 50.01 (1g), residential care apartment complex under s. 50.01 (1d), nursing home under s. 50.01 (3), intermediate care facility for the mentally retarded under s. 50.14 (1) (b), community rehabilitation program, home health agency under s. 50.49 (1) (a), provider of day services, or provider of personal care, as defined in s. 50.01 (4o), that agrees to accept the reimbursement rate that the care management organization pays under contract to similar providers for the same service and that satisfies any applicable quality of care, utilization, or other criteria that the care management organization requires of other providers with which it contracts to provide the same service.

SB40-CSA1, s. 998 Section 998. 46.284 (3) (a) of the statutes is amended to read:

SB40-CSA1,571,5 46.284 (3) (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. An application shall include comments about the applicant and recommendations about the application that are provided by the appropriate local long-term care council, as specified under s. 46.282 (3) (a) 3.

SB40-CSA1, s. 999 Section 999. 46.284 (5) (a) of the statutes is amended to read:

SB40-CSA1,571,13 46.284 (5) (a) From the appropriation accounts under s. 20.435 (4) (b), (g), (gp), (im), (o), and (w) and (7) (b) and, (bd), and (g), the department shall provide funding on a capitated payment basis for the provision of services under this section. Notwithstanding s. 46.036 (3) and (5m), a care management organization that is under contract with the department may expend the funds, consistent with this section, including providing payment, on a capitated basis, to providers of services under the family care benefit.

SB40-CSA1, s. 1000 Section 1000. 46.284 (6) of the statutes is amended to read:

SB40-CSA1,571,22 46.284 (6) Governing board. A care management organization shall have a governing board that reflects the ethnic and economic diversity of the geographic area served by the care management organization. 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 who are representative of the client group or groups whom the care management organization's enrollee organization is contracted to serve or those clients' family members, guardians, or other advocates.

SB40-CSA1, s. 1001 Section 1001. 46.285 (1) of the statutes is renumbered 46.285, and 46.285 (intro.), (1) and (2), as renumbered, are amended to read:

SB40-CSA1,572,6 46.285 Operation of resource center and care management organization. (intro.) In order to meet federal requirements and assure federal financial participation in funding of the family care benefit, a county, a tribe or band, a family long-term care district or an organization, including a private, nonprofit corporation, may not directly operate both a resource center and a care management organization, except as follows:

SB40-CSA1,572,10 (1) For an entity with which the department has contracted under s. 46.281 (1) (e) 1., 2005 stats., provision of the services specified under s. 46.283 (3) (b), (e), (f) and (g) shall be structurally separate from the provision of services of the care management organization by January 1, 2001.

SB40-CSA1,572,14 (2) The department may approve separation of the functions of a resource center from those of a care management organization by a means other than those specified in sub. (2) creating a long-term care district under s. 46.2895 to serve either as a resource center or as a care management organization.

SB40-CSA1, s. 1002 Section 1002. 46.285 (2) of the statutes is repealed.

SB40-CSA1, s. 1003 Section 1003. 46.286 (1) (intro.) of the statutes is amended to read:

SB40-CSA1,572,21 46.286 (1) Eligibility. (intro.) A person is eligible for, but not necessarily entitled to, the family care benefit if the person is at least 18 years of age; has a physical disability, as defined in s. 15.197 (4) (a) 2., or a developmental disability, as defined in s. 51.01 (5) (a), or degenerative brain disorder, as defined in s. 55.01 (1v) is a frail elder; and meets all of the following criteria:

SB40-CSA1, s. 1004 Section 1004. 46.286 (1) (a) 1. of the statutes is amended to read:

SB40-CSA1,572,24 46.286 (1) (a) 1. The person's functional capacity level of care need is at either of the following levels:

SB40-CSA1,573,3 a. The comprehensive nursing home level, if the person has a long-term or irreversible condition, expected to last at least 90 days or result in death within one year of the date of application, and requires ongoing care, assistance or supervision.

SB40-CSA1,573,7 b. The intermediate non-nursing home level, if the person has a condition that is expected to last at least 90 days or result in death within 12 months after the date of application, and is at risk of losing his or her independence or functional capacity unless he or she receives assistance from others.

SB40-CSA1, s. 1005 Section 1005. 46.286 (1) (b) (intro.) of the statutes is amended to read:

SB40-CSA1,573,10 46.286 (1) (b) Financial eligibility. (intro.) A person is financially eligible if all any of the following apply:

SB40-CSA1, s. 1006 Section 1006. 46.286 (1) (b) 1. (intro.) of the statutes is repealed.

SB40-CSA1, s. 1007 Section 1007. 46.286 (1) (b) 1. a. of the statutes is renumbered 46.286 (1) (b) 3. and amended to read:

SB40-CSA1,573,19 46.286 (1) (b) 3. The person was receiving the family care benefit on the effective date of this subdivision .... [revisor inserts date], the person would qualify for medical assistance except for financial or disability criteria, and the projected cost of the person's care plan, as calculated by the department or its designee, exceeds the person's gross monthly income, plus one-twelfth of his or her countable assets, less deductions and allowances permitted by rule by the department.

SB40-CSA1, s. 1008 Section 1008. 46.286 (1) (b) 1. b. and 2. of the statutes are consolidated, renumbered 46.286 (1) (b) 1m. and amended to read:

SB40-CSA1,573,25 46.286 (1) (b) 1m. The person is eligible under ch. 49 for medical assistance. 2. If subd. 1. b. applies, the person accepts medical assistance and, unless he or she is exempt from the acceptance under rules promulgated by the department, accepts medical assistance.

SB40-CSA1, s. 1009 Section 1009. 46.286 (3) (a) (intro.) of the statutes is amended to read:

SB40-CSA1,574,4 46.286 (3) (a) (intro.) Subject to pars. par. (c) and (d), a person is entitled to and may receive the family care benefit through enrollment in a care management organization if he or she all of the following apply:

SB40-CSA1,574,5 1m. The person is at least 18 years of age,.

SB40-CSA1,574,8 2m. The person has a physical disability, as defined in s. 15.197 (4) (a) 2., a developmental disability, as defined in s. 51.01 (5) (a), or degenerative brain disorder, as defined in s. 55.01 (1v), is a frail elder.

SB40-CSA1,574,10 4m. The person is financially eligible, under sub. (1) (b) 1m., and fulfills any applicable cost-sharing requirements and meets any of the following criteria:.

SB40-CSA1, s. 1010 Section 1010. 46.286 (3) (a) 1. of the statutes is repealed.

SB40-CSA1, s. 1011 Section 1011. 46.286 (3) (a) 2. of the statutes is repealed.

SB40-CSA1, s. 1012 Section 1012. 46.286 (3) (a) 3. of the statutes is repealed.

SB40-CSA1, s. 1013 Section 1013. 46.286 (3) (a) 3m. of the statutes is created to read:

SB40-CSA1,574,15 46.286 (3) (a) 3m. The person is functionally eligible under sub. (1) (a).

SB40-CSA1, s. 1014 Section 1014. 46.286 (3) (a) 4. of the statutes is repealed.

SB40-CSA1, s. 1015 Section 1015. 46.286 (3) (a) 6. of the statutes is repealed.

SB40-CSA1, s. 1016 Section 1016. 46.286 (3) (d) of the statutes is repealed.

SB40-CSA1, s. 1017 Section 1017. 46.286 (3m) of the statutes is repealed and recreated to read:

SB40-CSA1,574,21 46.286 (3m) Information about enrollees. The department shall obtain and share information about family care enrollees as provided in s. 49.475.

SB40-CSA1, s. 1018 Section 1018. 46.288 (2) (intro.) of the statutes is amended to read:

SB40-CSA1,575,4 46.288 (2) (intro.) Criteria and procedures for determining functional eligibility under s. 46.286 (1) (a), financial eligibility under s. 46.286 (1) (b), and cost sharing under s. 46.286 (2) (a) and entitlement under s. 46.286 (3). The rules for determining functional eligibility under s. 46.286 (1) (a) 1. a. shall be substantially similar to eligibility criteria for receipt of the long-term support community options program under s. 46.27. Rules under this subsection shall include definitions of the following terms applicable to s. 46.286:

SB40-CSA1, s. 1019 Section 1019. 46.289 (title) of the statutes is renumbered 46.2803 (title).