AB75: Bill Text

AB75,511,4 46.266 (1) (intro.) Notwithstanding s. 49.45 (6m) (ag) and except as provided in sub. (3), if before July 1, 1989, the federal health care financing administration or the department found a skilled nursing facility or intermediate care facility in this state that provides care to medical assistance recipients for which the facility receives reimbursement under s. 49.45 (6m) to be an institution for mental diseases, the department shall allocate funds from the appropriation account under s. 20.435 (7) (5) (be) for distribution under this section to a county department under s. 51.42 for the care, in the community or in a facility found to be an institution for mental diseases, of the following persons:

AB75, s. 856 Section 856. 46.268 (1) (intro.) of the statutes is amended to read:

AB75,511,9 46.268 (1) (intro.) Notwithstanding s. 49.45 (6m) (ag), from the appropriation account under s. 20.435 (7) (5) (be), the department shall distribute not more than $830,000 in each fiscal year in order to provide funding of community services for an eligible individual, if all of the following apply:

AB75, s. 857 Section 857. 46.275 (5m) of the statutes is repealed.

AB75, s. 858 Section 858. 46.281 (1n) (e) of the statutes is amended to read:

AB75,511,22 46.281 (1n) (e) Contract with a person to provide the advocacy services described under s. 16.009 (2) (p) 1. to 5. to actual or potential recipients of the family care benefit who are under age 60 or to their families or guardians. The department may not contract under this paragraph with a county or with a person who has a contract with the department to provide services under s. 46.283 (3) and (4) as a resource center or to administer the family care benefit as a care management organization. The contract under this paragraph shall include as a goal that the provider of advocacy services provide one advocate for every 2,500 3,500 individuals under age 60 who receive the family care benefit. The department shall allocate $190,000 for the contract under this paragraph in fiscal year 2007-08 and $525,000 in each subsequent fiscal year.

AB75, s. 859 Section 859. 46.281 (3) of the statutes is amended to read:

AB75,512,7 46.281 (3) Duty of the secretary. The secretary shall certify to each county, hospital, nursing home, community-based residential facility, adult family home, as defined in s. 50.01 (1) (a) or (b), 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 perform functional screenings and financial 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.

AB75, s. 860 Section 860. 46.283 (4) (e) of the statutes is amended to read:

AB75,512,14 46.283 (4) (e) 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, as defined in s. 50.01 (1) (a) or (b), and residential care apartment complexes in the area of the resource center.

AB75, s. 861 Section 861. 46.283 (4) (g) of the statutes is amended to read:

AB75,513,4 46.283 (4) (g) Perform a functional screening and a financial 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, as defined in s. 50.01 (1) (a) or (b), 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 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 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 perform a functional screening for a person seeking admission or about to be admitted for whom a functional screening was performed within the previous 6 months.

AB75, s. 862 Section 862. 46.284 (3m) of the statutes is created to read:

AB75,513,9 46.284 (3m) Permit required. A care management organization that is described under s. 600.01 (1) (b) 10. a., to which s. 600.01 (1) (b) 10. b. does not apply and that is certified under sub. (3) shall apply for a permit with the office of the commissioner of insurance under ch. 648.

AB75, s. 863 Section 863. 46.284 (4) (m) of the statutes is created to read:

AB75,513,12 46.284 (4) (m) Comply with any agreements under subch. V of ch. 111 relating to a provider, as defined in s. 46.2898 (1) (c), hired directly by an enrollee.

AB75, s. 864 Section 864. 46.286 (1) (a) (intro.) and 1. (intro.) of the statutes are consolidated, renumbered 46.286 (1) (a) (intro.) and amended to read:

AB75,513,18 46.286 (1) (a) Functional eligibility. (intro.) A person is functionally eligible if any of the following applies the person's level of care need, as determined by the department or its designee: 1. (intro.) The person's level of care need, is either of the following:

AB75, s. 865 Section 865. 46.286 (1) (a) 1. a. of the statutes is renumbered 46.286 (1) (a) 1m.

AB75, s. 866 Section 866. 46.286 (1) (a) 1. b. of the statutes is renumbered 46.286 (1) (a) 2m.

AB75, s. 867 Section 867. 46.286 (1) (a) 2. (intro.) of the statutes is repealed.

AB75, s. 868 Section 868. 46.286 (1) (a) 2. a. of the statutes is renumbered 46.286 (3) (b) 2. a.

AB75, s. 869 Section 869. 46.286 (1) (a) 2. b. of the statutes is renumbered 46.286 (3) (b) 2. b.

AB75, s. 870 Section 870. 46.286 (1) (a) 2. c. of the statutes is renumbered 46.286 (3) (b) 2. c.

AB75, s. 871 Section 871. 46.286 (1) (a) 2. d. of the statutes is renumbered 46.286 (3) (b) 2. d.

AB75, s. 872 Section 872. 46.286 (1) (a) 2. e. of the statutes is renumbered 46.286 (3) (b) 2. e.

AB75, s. 873 Section 873. 46.286 (1) (b) 1c. of the statutes is created to read:

AB75,514,9 46.286 (1) (b) 1c. In this paragraph, "medical assistance" does not include coverage of the benefits under s. 49.471 (11).

AB75, s. 874 Section 874. 46.286 (1) (b) 1m. of the statutes is renumbered 46.286 (1) (b) 2m. a.

AB75, s. 875 Section 875. 46.286 (1) (b) 3. of the statutes is renumbered 46.286 (1) (b) 2m. b.

AB75, s. 876 Section 876. 46.286 (1) (b) (intro.) (except 46.286 (1) (b) (title)) of the statutes is renumbered 46.286 (1) (b) 2m. (intro.).

AB75, s. 877 Section 877. 46.286 (3) (a) 4m. of the statutes is amended to read:

AB75,514,18 46.286 (3) (a) 4m. The person is financially eligible under sub. (1) (b) 1m. 2m. a., and fulfills any applicable cost-sharing requirements.

AB75, s. 878 Section 878. 46.286 (3) (b) 2. of the statutes is renumbered 46.286 (3) (b) 2. (intro.) and amended to read:

AB75,515,2 46.286 (3) (b) 2. (intro.) If the contract between the care management organization and the department is canceled or not renewed. If this circumstance occurs, the department shall assure that enrollees continue to receive needed services through another care management organization or through the medical assistance fee-for-service system or any of the following programs specified under sub. (1) (a) 2. a. to d.:

AB75, s. 879 Section 879. 46.286 (3) (c) of the statutes is amended to read:

AB75,515,10 46.286 (3) (c) Within each county and for each client group, par. (a) shall first apply on the effective date of a contract under which a care management organization accepts a per person per month payment to provide services under the family care benefit to eligible persons in that client group in the county. Within 24 36 months after this date, the department shall assure that sufficient capacity exists within one or more care management organizations to provide the family care benefit to all entitled persons in that client group in the county.

AB75, s. 880 Section 880. 46.288 (2) (intro.) of the statutes is amended to read:

AB75,515,17 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). The rules for determining functional eligibility under s. 46.286 (1) (a) 1. a. 1m. 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:

AB75, s. 881 Section 881. 46.288 (2) (a) of the statutes is repealed.

AB75, s. 882 Section 882. 46.288 (2) (b) of the statutes is repealed.

AB75, s. 883 Section 883. 46.288 (2) (c) of the statutes is repealed.

AB75, s. 884 Section 884. 46.2898 of the statutes is created to read:

AB75,515,22 46.2898 Quality home care. (1) Definitions. In this section:

AB75,515,23 (a) "Authority" means the Wisconsin Quality Home Care Authority.

AB75,515,24 (b) "Care management organization" has the meaning given in s. 46.2805 (1).

AB75,516,2 (c) "Provider" means an individual providing home care services who is not any of the following:

AB75,516,4 1. An employee of a home health agency, licensed under s. 50.49, who is hired through that home health agency.

AB75,516,6 2. An employee of a personal care provider agency who is hired through that personal care provider agency.

AB75,516,8 3. A health care provider, as defined in s. 146.997 (1) (d) acting in his or her professional capacity.

AB75,516,9 4. An employee of a company or agency providing supportive home care.

AB75,516,10 5. An employee of an independent living center, as defined in s. 46.96 (1) (ah).

AB75,516,12 6. An employee of a county agency or department under s. 46.215, 46.22, 46.23, 51.42, or 51.437.

AB75,516,21 (d) "Qualified provider" means a provider who meets the qualifications for payment through the Family Care Program under s. 46.286, the Program for All-Inclusive Care for the Elderly operated under 42 USC 1396u-4, an amendment to the state medical assistance plan under 42 USC 1396n (j), or a medical assistance waiver program operated under a waiver from the secretary of the U.S. department of health and human services under 42 USC 1396n (c) or 42 USC 1396n (b) and (c) and any qualification criteria established in the rules promulgated under sub. (7) and who the authority determines is eligible for placement on the registry maintained by the authority under s. 52.20 (1).

AB75,516,25 (2) County participation. (a) A county board of supervisors may require a county department under 46.215, 46.22, 46.23, 51.42, or 51.437 to follow procedures under this section and to pay providers in accordance with agreements under subch. V of ch. 111.

AB75,517,2 (b) If a county acts under par. (a), it shall notify the department and the authority of its action.

AB75,517,5 (3) Requirements for benefit. An adult individual who receives home care services and who meets all of the following criteria may receive a benefit for home care services only if he or she complies with sub. (5):

AB75,517,6 (a) The individual is a resident of one of the following:

AB75,517,7 1. A county that has acted under sub. (2) (a).

AB75,517,8 2. A county in which the Family Care Program under s. 46.286 is available.

AB75,517,10 3. A county in which the Program of All-Inclusive Care for the Elderly under 42 USC 1396u-4 is available.

AB75,517,13 4. A county in which the self-directed services option program under 42 USC 1396n (c) is available or in which a program operated under an amendment to the state medical assistance plan under 42 USC 1396n (j) is available.

AB75,517,15 (b) The individual self-directs all or part of his or her home care services and is the employer of record of a provider.

AB75,517,17 (c) The individual is eligible to receive a home care benefit under one of the following:

AB75,517,18 1. The Family Care Program under s. 46.286.

AB75,517,19 2. The Program of All-Inclusive Care for the Elderly, under 42 USC 1396u-4.

AB75,517,22 3. A program operated under a waiver from the secretary of the federal department of health and human services under 42 USC 1396n (c) or 42 USC 1396n (b) and (c) or the self-directed services option operated under 42 USC 1396n (c).

AB75,517,24 4. A program operated under an amendment to the state medical assistance plan under 42 USC 1396n (j).

AB75,518,4 (4) Duties of home care payors. Care management organizations, the state, and counties that pay for the provision of home care services to individuals shall inform the authority of the name, address, and telephone numbers of any provider hired by an individual receiving home care services.

AB75,518,6 (5) Duties of consumers: A recipient of home care services, as described under sub. (3), who hires a provider shall do all of the following:

AB75,518,10 (a) Hire only a provider who has been placed on the registry maintained by the authority under s. 52.20 (1) or a person whose name has been submitted to the authority under par. (b) and who the authority has determined is eligible for placement on the registry.

AB75,518,14 (b) If a potential provider has not been placed on the registry maintained by the authority under s. 52.20 (1), provide the name, address, and telephone number of the potential provider to the authority for evaluation of eligibility for the registry and for inclusion in the collective bargaining process under subch. V of ch. 111.

AB75,518,16 (c) Compensate providers in accordance with any collective bargaining agreement that applies to home care providers under subch. V of ch. 111.

AB75,518,18 (d) Inform the authority of the name, address, and telephone number of any provider that he or she fires.

AB75,518,21 (6) Providers. (a) A qualified provider providing home care services under this section shall be subject to the collective bargaining agreement that applies to home care providers under subch. V of ch. 111.

AB75,518,23 (b) A qualified provider may choose to be placed on the registry maintained by the authority under s. 52.20 (1).

AB75,519,2 (7) Department rule-making. The department may promulgate rules defining terms, including the term "home care services," establishing the qualification criteria that apply under sub. (1) (d), and establishing procedures for implementation of this section.

AB75,519,5 (8) Any withholding of medical assistance benefits by the department for failure of the benefit recipient to comply with s. 46.2898 (5) is subject to approval by the federal centers for medicare and medicaid services.

AB75, s. 885 Section 885. 46.29 (1) (intro.) of the statutes is amended to read:

AB75,519,10 46.29 (1) (intro.) From the appropriation account under s. 20.435 (6) (7) (a), the department shall allocate distribute at least $16,100 in each fiscal year for operation of the council on physical disabilities. The council on physical disabilities shall do all of the following:

AB75, s. 886 Section 886. 46.29 (1) (c) of the statutes is repealed.

AB75, s. 887 Section 887. 46.29 (1) (fm) of the statutes is repealed.

AB75, s. 888 Section 888. 46.295 (1) of the statutes is amended to read:

AB75,519,17 46.295 (1) The department may, on the request of any hearing-impaired person, city, village, town, or county or private agency, provide funds from the appropriation accounts under s. 20.435 (6) (7) (d) and (hs) and (7) (d) to reimburse interpreters for hearing-impaired persons for the provision of interpreter services.

AB75, s. 889 Section 889. 46.40 (2m) (a) of the statutes is amended to read:

AB75,519,22 46.40 (2m) (a) Prevention and treatment of substance abuse. For prevention and treatment of substance abuse under 42 USC 300x-21 to 300x-35, the department shall distribute not more than $13,975,500 in fiscal year 2009-10 and $9,735,700 in each fiscal year thereafter.

AB75, s. 890 Section 890. 46.40 (9) (d) of the statutes is renumbered 46.40 (9) (d) 1. (intro.) and amended to read:

AB75,520,3 46.40 (9) (d) 1. (intro.) The From the appropriation account under s. 20.435 (7) (b), the department may decrease a county's allocation under sub. (2) by the any of the following amounts:

AB75,520,5 a. The amount of any payment adjustments under s. 49.45 (52) made for that county from the appropriation account under s. 20.435 (7) (b).