2007 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
health and human services
Other health and human services
Currently, DHFS administers Family Care, a long-term care program for people who are at least 18 years of age, have a physical or developmental disability or a degenerative brain disorder, and satisfy financial eligibility criteria. Under Family Care, DHFS contracts with care management organizations to provide a flexible long-term care benefit called the family care benefit for a capitated payment rate. Also under Family Care, DHFS contracts with resource centers to provide information and referral services pertaining to long-term care and to assess financial and functional eligibility for the family care benefit, among other services. Five counties currently have both care management organizations and resource centers. An additional four counties have only resource centers.
This bill makes the following changes to Family Care:
1. DHFS currently has authority to make the family care benefit available in areas of the state in which, in the aggregate, not more than 29 percent of the population that is eligible for the family care benefit resides. Subject to the approval of the Joint Committee on Finance, DHFS may expand availability of the family care benefit to additional areas of the state, (areas in which up to 50 percent of the population eligible for the family care benefit resides). To apply for the committee's approval for expansion, DHFS must provide the committee a copy of any proposed new contract with a care management organization and information demonstrating that the expansion is cost-neutral. The bill authorizes DHFS to make the family care benefit available anywhere in the state and eliminates the requirement that DHFS obtain the approval of the Joint Committee on Finance to expand availability of the family care benefit
2. Currently, DHFS must obtain legislative approval to enter into a contract for a care management organization with an entity other than a county, family care district, Indian tribe or band, or the Great Lakes Inter-Tribal Council, Inc. Further, DHFS may not contract for a care management organization to serve an area unless the local long-term care council for the area has developed an initial plan for Family Care. The bill eliminates these two limitations on contracting for care management organizations.
3. Currently, DHFS may not enter into new contracts for resource centers without the approval of the Joint Committee on Finance. The bill eliminates the requirement that DHFS obtain the committee's approval for new contracts for resource centers.
4. Under current law, one of the qualifying conditions for the family care benefit is that a person has a degenerative brain disorder. The bill provides instead that a person may be eligible for the family care benefit if he or she is a "frail elder," which is defined as a person who is 65 years of age or older and has a physical disability or irreversible dementia that restricts the individual's ability to perform normal daily tasks or that threatens the capacity of the individual to live independently.
5. Currently, a person may be functionally eligible for the family care benefit at one of two levels, comprehensive or intermediate. The bill changes the two levels to nursing home level of care and non-nursing home level of care.
6. Currently, local long-term care councils, which are responsible for advising counties or tribes on whether to apply to participate in Family Care and, if so, how Family Care should be administered in the county or for the tribe, must include members who are older people, people with physical or developmental disabilities, or their family members. The bill defines a family member as spouse or individual related by blood, marriage, or adoption within the third degree of kinship.
7. Currently, a resource center must notify residents of certain long-term care residential facilities in the area served by the resource center who are potentially eligible for the family care benefit of the services that the resource center provides. A resource center must provide this information within six months after the family care benefit is available in the area. The bill eliminates the six-month deadline for providing the information.
8. Currently, a care management organization need not be licensed as a home health agency. The bill provides that an entity with which a care management organization contracts to provide home health services under Family Care need not be licensed as a home health agency for purposes of providing the contracted services.
9. Resource centers currently perform a functional and financial screening to determine a person's eligibility for the family care benefit. The bill specifies that the functional and financial screenings are separate screenings, and includes an assessment of a person's ability to pay for part of the family care benefit as part of the financial screening.
10. Currently, for those counties that have care management organizations, DHFS may allocate up to 21.3 percent of a county's basic community aids allocation to fund the services of the county's resource center and care management organization. The bill changes the percentage of the county's basic community aids allocation that DHFS may allocate for this purpose to an amount agreed to by DHFS and the county.
The bill also makes changes that affect programs other than Family Care. Currently DHFS administers the GPR-funded Community Options Program to provide community-based services to supplement services available under long-term care MA waiver programs or to serve certain persons not eligible for the waiver programs. DHFS also administers the Family Support Program to provide services to families of children who are disabled to assist the families in caring for the children at home. Additionally, several counties administer the Wisconsin Partnership Program or the Program for All-Inclusive Care for the Elderly (PACE), capitated payment rate programs to provide both acute health and long-term care services to elderly people or people with physical disabilities who are eligible for nursing home care. The bill provides that counties in which the family care benefit is available or in which the Wisconsin Partnership Program or PACE is operated may use their Community Options Program funding to provide mental health or substance abuse services or to provide services under the Family Support Program.
Current law also requires that DHFS obtain approval from the Joint Committee on Finance before expanding use of capitated rate payment programs to provide long-term care services. The bill eliminates this requirement.
For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 20.435 (7) (bd) of the statutes is amended to read:
20.435 (7) (bd) Community options program; pilot projects; family care benefit Long-term care programs. The amounts in the schedule for assessments, case planning, services, administration and risk reserve escrow accounts under s. 46.27, for pilot projects under s. 46.271 (1), to fund services provided by resource centers under s. 46.283 (5), for services under the family care benefit under s. 46.284 (5), for services and supports under s. 46.2803 (2), and for the payment of premiums under s. 49.472 (5). If the department transfers funds to this appropriation from the appropriation account under sub. (4) (b), the amounts in the schedule for the fiscal year for which the transfer is made are increased by the amount of the transfer for the purposes specified in s. 49.45 (6v). Notwithstanding ss. 20.001 (3) (a) and 20.002 (1), the department may under this paragraph transfer moneys between fiscal years. Except for moneys authorized for transfer under this appropriation or under s. 46.27 (7) (fm) or (g), all moneys under this appropriation that are allocated under s. 46.27 and are not spent or encumbered by counties or by the department by December 31 of each year shall lapse to the general fund on the succeeding January 1 unless transferred to the next calendar year by the joint committee on finance.
****NOTE: This SECTION involves a change in an appropriation that must be reflected in the revised schedule in s. 20.005, stats.
SECTION 2. 20.435 (7) (g) of the statutes is created to read:
20.435 (7) (g) Long-term care; county contributions. All moneys received from counties as contributions to the family care program under s. 46.2805 to 46.2895, the Pace program described under s. 46.2805 (1) (a), and the Wisconsin Partnership Program described under s. 46.2805 (1) (b), to fund services under the family care benefit under s. 46.284 (5) and services under the Pace and Wisconsin Partnership programs.
****NOTE: This SECTION involves a change in an appropriation that must be reflected in the revised schedule in s. 20.005, stats.
SECTION 3. 46.27 (4) (c) 8. of the statutes is amended to read:
46.27 (4) (c) 8. If a contract with an entity under s. 46.281 (1) (e) 1. 46.284 (2) is established in the county, a description of how the activities of the entity relate to and are coordinated with the county's proposed program.
SECTION 4. 46.27 (5) (am) of the statutes is amended to read:
46.27 (5) (am) Organize assessment activities specified in sub. (6). The county department or aging unit shall utilize persons for each assessment who can determine the needs of the person being assessed and who know the availability within the county of services alternative to placement in a nursing home. If any hospital patient is referred to a nursing home for admission, these persons shall work with the hospital discharge planner in performing the activities specified in sub. (6). The county department or aging unit shall coordinate the involvement of representatives from the county departments under ss. 46.215, 46.22, 51.42 and 51.437, health service providers and the county commission on aging in the assessment activities specified in sub. (6), as well as the person being assessed and members of the person's family or the person's guardian. This paragraph does not apply to a county department or aging unit in a county in which the department has contracted with an entity under s. 46.281 (1) (e) 1 46.284 (2).
SECTION 5. 46.27 (6) (a) 3. of the statutes is amended to read:
46.27 (6) (a) 3. In each participating county, except in counties in which the department has contracted with an entity under s. 46.281 (1) (e) 1. 46.284 (2), assessments shall be conducted for those persons and in accordance with the procedures described in the county's community options plan. The county may elect to establish assessment priorities for persons in target groups identified by the county in its plan regarding gradual implementation. If a person who is already admitted to a nursing home requests an assessment and if funds allocated for assessments under sub. (7) (am) are available, the county shall conduct the assessment.
SECTION 6. 46.27 (6g) (intro.) of the statutes is amended to read:
46.27 (6g) FISCAL RESPONSIBILITY. (intro.) Except as provided in s. 51.40, and within the limitations under sub. (7) (b), the fiscal responsibility of a county for an assessment, unless the assessment is performed by an entity under a contract as specified under s. 46.281 (1) (e) 1. 46.284 (2), case plan, or services provided to a person under this section is as follows:
SECTION 7. 46.27 (9) (c) of the statutes is amended to read:
46.27 (9) (c) All long-term community support services provided under this pilot project in lieu of nursing home care shall be consistent with those services described in the participating county's community options plan under sub. (4) (c) 1. and provided under sub. (5) (b). Unless the department has contracted under s. 46.281 (1) (e) 1. 46.284 (2) with an entity other than the county department, each county participating in the pilot project shall assess persons under sub. (6).
SECTION 8. 46.2803 (2) of the statutes is created to read:
46.2803 (2) Notwithstanding s. 46.27 (7), a county in which a care management organization is operating pursuant to a contract under s. 46.284 (2) or a county in which a program described under s. 46.2805 (1) (a) or (b) is administered may use funds appropriated under 20.435 (7) (bd) and allocated to the county under s. 46.27 (7) to provide community mental health or substance abuse services and supports for persons with mental illness or persons in need of services or supports for substance abuse and to provide services under the Family Support Program under s. 46.985.
SECTION 9. 46.2804 (title) of the statutes is amended to read:
46.2804 (title) Managed care programs for Client management of managed care long-term care services benefit.
SECTION 10. 46.2804 (1) of the statutes is repealed.
SECTION 11. 46.2804 (2) of the statutes is renumbered 46.2804.
SECTION 12. 46.2805 (6m) of the statutes is created to read:
46.2805 (6m) "Family member" means a spouse or an individual related by blood, marriage, or adoption within the 3rd degree of kinship as computed under s. 990.001 (16).
SECTION 13. 46.2805 (6r) of the statutes is created to read:
46.2805 (6r) "Financial and cost-sharing screening" means a screening to determine financial eligibility under s. 46.286 (1) (b) and cost-sharing under s. 46.286 (2) using a uniform tool prescribed by the department.
SECTION 14. 46.2805 (6v) of the statutes is created to read:
46.2805 (6v) "Frail elder" means an individual who is 65 years of age or older and has a physical disability or irreversible dementia that restricts the individual's ability to perform normal daily tasks or that threatens the capacity of the individual to live independently.
SECTION 15. 46.2805 (7) of the statutes is amended to read:
46.2805 (7) "Functional and financial screen screening" means a screen prescribed by the department that is used screening to determine functional eligibility under s. 46.286 (1) (a) and financial eligibility under s. 46.286 (1) (b) using a uniform tool prescribed by the department.
SECTION 16. 46.281 (1) (intro.) of the statutes is renumbered 46.281 (1n) (intro.), and 46.281 (1n) (title), as renumbered, is amended to read:
46.281 (1n) (title) DUTIES OTHER DUTIES OF THE DEPARTMENT.
SECTION 17. 46.281 (1) (c) of the statutes is renumbered 46.281 (1d) and amended to read:
46.281 (1d) WAIVER REQUEST. Request The department shall 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.
SECTION 18. 46.281 (1) (d) of the statutes is repealed.
****NOTE: This is reconciled s. 46.281 (1) (d). This SECTION has been affected by drafts with the following LRB numbers: 0330 and 1524.
SECTION 19. 46.281 (1) (e) of the statutes is repealed.
****NOTE: This is reconciled s. 46.281 (1) (e). This SECTION has been affected by drafts with the following LRB numbers: 0330 and 1562.
SECTION 20. 46.281 (1) (f) of the statutes is renumbered 46.281 (1n) (a).
SECTION 21. 46.281 (1) (g) of the statutes is renumbered 46.281 (1n) (b).
SECTION 22. 46.281 (1) (h) of the statutes is renumbered 46.281 (1n) (c).
SECTION 23. 46.281 (1g) of the statutes is created to read:
46.281 (1g) CONTRACTING FOR RESOURCE CENTERS AND CARE MANAGEMENT ORGANIZATIONS. The department may contract with entities as provided under s. 46.283 (2) to provide the services under s. 46.283 (3) and (4) as resource centers in any geographic area in the state, and may contract with entities as provided under s. 46.284 (2) to administer the family care benefit as care management organizations in any geographic area in the state.
SECTION 24. 46.281 (2) (title) of the statutes is amended to read:
46.281 (2) (title) POWERS OTHER POWERS OF THE DEPARTMENT.
SECTION 25. 46.281 (3) of the statutes is amended to read:
46.281 (3) DUTY OF THE SECRETARY. The secretary shall certify to each county, hospital, 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, hospital, nursing home, community-based residential facility, adult family home or residential care apartment complex is first available to provide a perform functional screenings and financial screen and cost-sharing screenings. 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 26. 46.283 (2) (a) of the statutes is repealed.
****NOTE: This is reconciled s. 46.283 (2) (a). This SECTION has been affected by drafts with the following LRB numbers: 0330 and 1524.
SECTION 27. 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:
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:
(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).
****NOTE: This is reconciled s. 46.283 (2) (b) (intro.) and 2. This SECTION has been affected by drafts with the following LRB numbers: 0330 and 1524.
SECTION 28. 46.283 (4) (e) of the statutes is amended to read:
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.
SECTION 29. 46.283 (4) (f) of the statutes is amended to read:
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.
SECTION 30. 46.283 (4) (g) of the statutes is amended to read:
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.
SECTION 31. 46.284 (2) (b) (intro.) of the statutes is repealed.
****NOTE: This is reconciled s. 46.284. (2) (b) (intro.). This SECTION has been affected by drafts with the following LRB numbers: 0330 and 1524.
SECTION 32. 46.284 (2) (b) 1. of the statutes is repealed.
****NOTE: This is reconciled s. 46.284 (2) (b) 1. This SECTION has been affected by drafts with the following LRB numbers: 0330 and 1562.
SECTION 33. 46.284 (2) (b) 2. of the statutes is repealed.
SECTION 34. 46.284 (2) (b) 3. of the statutes is renumbered 46.284 (2) (bm) and amended to read:
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.
****NOTE: This is reconciled s. 46.284. (2) (b) 3. This SECTION has been affected by drafts with the following LRB numbers: 0330, 1524, and 1562.
SECTION 35. 46.286 (1) (intro.) of the statutes is amended to read:
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:
SECTION 36. 46.286 (1) (a) 1. of the statutes is amended to read:
46.286 (1) (a) 1. The person's functional capacity level of care need is at either of the following levels:
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.
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.
SECTION 37. 46.289 (title) of the statutes is renumbered 46.2803 (title).
SECTION 38. 46.289 of the statutes is renumbered 46.2803 (1).
SECTION 39. 46.40 (9) (a) (intro.) of the statutes is amended to read:
