SB21: Bill Text

SB21,649,16 (d) For a child residing in a state-operated long-term care facility, or for a person protectively placed under ch. 55, the county in which the child has residence before he or she enters the state-operated long-term care facility or is protectively placed is the county of fiscal responsibility.

SB21,649,20 (12) Reimbursement disallowances. The department may disallow reimbursement under this section for services provided to children who do not meet the eligibility requirements for the children's community options program or any other eligibility requirements established by the department.

SB21,649,24 (13) Funding. (a) Subject to pars. (b) and (h), from the appropriation under s. 20.435 (4) (bd), the department shall allocate funds to each county or private nonprofit agency with which the department contracts for all of the following purposes:

SB21,650,7 1. To pay assessment and case plan costs not otherwise paid by fee or under s. 49.45 or 49.78 (2). The department shall reimburse multicounty consortia for the cost of assessing children eligible for medical assistance under s. 49.46, 49.468, 49.47, or 49.471 (4) (a) as part of the administrative services of medical assistance, payable under s. 49.45 (3) (a). Counties may use unspent funds allocated under this subdivision to pay the cost of long-term community support services and for a risk reserve under par. (f).

SB21,650,15 2. To pay the cost of providing long-term community support services described under sub. (7) (b) not otherwise paid under s. 49.45 to children eligible for medical assistance under s. 49.46, 49.47, or 49.471 (4) (a). The county department administering the program may spend funds received under this paragraph only in accordance with the case plan and service contract created for each child receiving long-term community support services. Counties may use unspent funds allocated under this subdivision from the appropriation under s. 20.435 (4) (bd) for a risk reserve under par. (f).

SB21,650,16 (b) 1. Receipt of funds under this section is subject to s. 46.495 (2).

SB21,650,18 2. The department may not release funds under this subsection before approving the county's community options plan.

SB21,650,22 3. No county may use funds received under par. (a) 2. to pay for long-term community support services provided to any child who resides in a nursing home, unless the department waives this restriction on use of funds and the services are provided in accordance with a discharge plan.

SB21,650,24 4. No county may use funds received under this section to purchase land or construct buildings.

SB21,651,3 (c) The department may release funds to counties acting jointly, if the counties sign a contract approved by the secretary that explains the plans for joint sponsorship.

SB21,651,8 (d) If the department determines that a county demonstrates a pattern of failure to serve clients whose cost of care significantly exceeds the average cost of care for children's long-term community support services provided under this section, the department may require that county to reserve a portion of funds allocated under this subsection for provision of service to those clients.

SB21,651,22 (e) The department shall, at the request of a county, carry forward up to 5 percent of the amount allocated under this subsection to the county for a calendar year if up to 5 percent of the amount so allocated has not been spent or encumbered by the county by December 31 of that year, for use by the county in the following calendar year, except that the amount carried forward shall be reduced by the amount of funds that the county has notified the department that the county wishes to place in a risk reserve under par. (f). The department may transfer funds within s. 20.435 (4) (bd) to accomplish this purpose. An allocation under this paragraph does not affect a county's base allocation under this subsection and shall lapse to the general fund unless expended within the calendar year to which the funds are carried forward. A county may not expend funds carried forward under this paragraph for administrative or staff costs, except administrative or staff costs that are associated with implementation of the waiver under sub. (14) and approved by the department.

SB21,652,5 (f) 1. Notwithstanding s. 46.036 (3) and (5m), a county may place in a risk reserve funds that are allocated under par. (a) or sub. (14) (b) 1. and are not expended or encumbered for services under this subsection or sub. (14). The county shall notify the department of this decision and of the amount to be placed in the risk reserve. The county shall maintain the risk reserve in an interest-bearing escrow account with a financial institution, as defined in s. 69.30 (1) (b), if the department has approved the terms of the escrow. All interest from the principal shall be reinvested in the escrow account.

SB21,652,10 2. The annual amount of a county's expenditure for a risk reserve, as specified in subd. 1., may not exceed 10 percent of the county's most recent allocation under par. (a) and sub. (14) (b) 1. or $750,000, whichever is less. The total amount of the risk reserve, including interest, may not exceed 15 percent of the county's most recent allocation under this subsection.

SB21,652,12 3. A county may expend funds maintained in a risk reserve, as specified in subd. 1., for any of the following purposes:

SB21,652,14 a. To defray costs of children's long-term community support services under this section.

SB21,652,16 b. If approved by the department, for administrative or staff costs under this section.

SB21,652,19 4. A county that maintains a risk reserve, as specified in subd. 1., shall annually, on a form prescribed by the department, submit to the department a record of the status of the risk reserve, including revenues and disbursements.

SB21,653,3 (g) The department may carry forward to the next state fiscal year funds allocated under this subsection and not encumbered by counties by December 31 or carried forward under par. (e). The department may transfer moneys within s. 20.435 (4) (bd) to accomplish this purpose. An allocation under this paragraph shall not affect a county's base allocation for the program. The department may allocate these transferred moneys during the next fiscal year to counties for the improvement or expansion of long-term community support services for clients whose cost of care significantly exceeds the average cost of care provided under this section, including any of the following:

SB21,653,4 1. Specialized training for providers of services under this section.

SB21,653,5 2. Start-up costs for developing needed services.

SB21,653,6 3. Home modifications.

SB21,653,7 4. Purchase of medical equipment or other specially adapted equipment.

SB21,653,11 (h) Funds allocated under this subsection may not be used to replace any other state and federal funds or any county funds that are currently being provided under any program to a family whose child is receiving services through the children's community options program.

SB21,653,16 (14) Medical assistance waiver. (a) The department may request a waiver from the federal department of health and human services authorizing the department to provide as part of the Medical Assistance program services for persons who are eligible for children's long-term support community options program services under sub. (7) (b).

SB21,653,21 (b) 1. Medical assistance reimbursement for services a county or a private nonprofit agency, or with which the department contracts provides under this subsection shall be made from the appropriations under s. 20.435 (4) (bd) and (o) and (7) (b). Payments made under sub. (13) (a) may be used as the state share for purposes of Medical Assistance reimbursement.

SB21,653,23 3. The department may contract for services under this subsection with a county or a private nonprofit agency.

SB21,654,2 4. No county or private nonprofit agency may use funds received under this subsection to provide residential services in a group home, as defined in s. 48.02 (7), that has more than 5 beds, unless the department approves the provision of services in a group home that has 6 to 8 beds.

SB21,654,5 (c) If a county department or private nonprofit agency providing services under this subsection is certified under s. 49.45 (37) (a), the waiver under s. 49.45 (37), if in effect, applies to plans of care for children receiving services under this subsection.

SB21,654,9 (15) Right to hearing. A child who is denied eligibility for services or whose services are reduced or terminated under this section may request a hearing from the department under s. 227.44, except that lack of adequate funding may not serve as the basis for a request under this subsection.

SB21,1536 Section 1536. 46.277 (5g) (b) of the statutes is renumbered 46.277 (5g) (b) (intro.) and amended to read:

SB21,654,15 46.277 (5g) (b) (intro.) This section does not apply to the delicensure of a bed of an institution for mental diseases of an individual who is aged 21 to 64, who has a primary diagnosis of mental illness and who otherwise meets any of the following requirements of s. 46.266 (1) (a), (b) or (c).:

SB21,1537 Section 1537. 46.277 (5g) (b) 1. and 2. of the statutes are created to read:

SB21,654,21 46.277 (5g) (b) 1. A person who resided in the facility on the date of the finding that a skilled nursing facility or intermediate care facility that provides care to Medical Assistance recipients to be an institution for mental diseases whose care in the facility is disallowed for federal financial participation under Medical Assistance.

SB21,655,2 2. A person who is aged 21 to 64, who has a primary diagnosis of mental illness, who would meet the level of care requirements for Medical Assistance reimbursement in a skilled nursing facility or intermediate care facility but for a finding that the facility is an institution for mental diseases, and for whom services would be provided in place of a person specified in subd. 1. who discontinues services.

SB21,1538 Section 1538. 46.28 (1) (a) of the statutes is amended to read:

SB21,655,5 46.28 (1) (a) "Authority" means the Forward Wisconsin Housing and Economic Development Authority created under ch. 234 235.

SB21,1539 Section 1539. 46.28 (3) of the statutes is amended to read:

SB21,655,8 46.28 (3) The department may authorize the authority to issue revenue bonds under s. 234.61 235.61 to finance any residential facility it approves under sub. (2).

SB21,1540 Section 1540. 46.28 (4) of the statutes is amended to read:

SB21,655,12 46.28 (4) The department may charge sponsors for administrative costs and expenses it incurs in exercising its powers and duties under this section and under s. 234.61 235.61.

SB21,1541 Section 1541. 46.2803 (1) of the statutes is amended to read:

SB21,655,21 46.2803 (1) In order to facilitate the transition to the long-term care system specified in ss. family care program as defined in s. 46.2805 to 46.2895 (4m), within the limits of applicable federal statutes and regulations and if the secretary of health services finds it necessary, he or she may grant a county limited waivers to or exemptions from ss. 46.27 (3) (e) (intro.), 1. and 2. and (f), (5) (d) and (e), (6) (a) 1., 2. and 3. and (b) (intro.), 1. and 2., (6r) (c), (7) (b), (cj) and (cm) and (11) (c) 5m. (intro.) and 6. and 46.277 (3) (a), (4) (a) and (5) (d) 1m., 1n. and 2. and rules promulgated under those provisions.

SB21,1542 Section 1542. 46.2803 (2) of the statutes is amended to read:

SB21,656,5 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) (4k) or (b) (9m) is administered may use funds appropriated under s. 20.435 (7) (4) (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.

SB21,1543 Section 1543 . 46.2803 (2) of the statutes, as affected by 2015 Wisconsin Act .... (this act), is amended to read:

SB21,656,14 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 (4k) or (9m) is administered may use funds appropriated under s. 20.435 (4) (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.

SB21,1544 Section 1544. 46.2804 of the statutes is repealed.

SB21,1545 Section 1545. 46.2805 (intro.) of the statutes is amended to read:

SB21,656,18 46.2805 Definitions; long-term care. (intro.) In ss. 46.2805 to 46.2895 46.288:

SB21,1546 Section 1546. 46.2805 (1) (intro.) of the statutes is amended to read:

SB21,656,21 46.2805 (1) (intro.) "Care management organization" means all of the following:

SB21,657,2 (cm) Before January 1, 2017, or the date specified in 2015 Wisconsin Act .... (this act), section 9118 (9), whichever is later, an entity that is certified as meeting the requirements for a care management organization under s. 46.284 (3) and that has a contract under s. 46.284 (2). "Care management organization" does not mean an entity that contracts with the department to operate one of the following:

SB21,1547 Section 1547. 46.2805 (1) (a) of the statutes is repealed.

SB21,1548 Section 1548. 46.2805 (1) (b) of the statutes is repealed.

SB21,1549 Section 1549. 46.2805 (1) (dm) of the statutes is created to read:

SB21,657,10 46.2805 (1) (dm) Beginning on January 1, 2017, or the date specified in 2015 Wisconsin Act .... (this act), section 9118 (9 ), whichever is later, an insurer that is licensed and in compliance with the applicable provisions of chs. 600 to 646, that is certified as meeting the requirements for a care management organization under s. 46.284 (3), and that has a contract under s. 46.284 (2).

SB21,1550 Section 1550. 46.2805 (4) of the statutes is amended to read:

SB21,657,15 46.2805 (4) "Family care benefit" means financial assistance for long-term care and support items for an enrollee and any financial assistance, as specified by the department, for primary and acute health care services under s. 49.46 (2) for an enrollee.

SB21,1551 Section 1551. 46.2805 (4k) of the statutes is created to read:

SB21,657,19 46.2805 (4k) "Family Care Partnership Program" means an integrated health and long-term care program operated under an amendment to the state Medical Assistance plan under 42 USC 1396u-2 and a waiver under 42 USC 1396n (c).

SB21,1552 Section 1552. 46.2805 (4m) of the statutes is created to read:

SB21,657,22 46.2805 (4m) "Family care program" means the program under s. 46.2805 to 46.2895 that provides the family care benefit.

SB21,1553 Section 1553. 46.2805 (4m) of the statutes, as created by 2015 Wisconsin Act .... (this act), is amended to read:

SB21,658,2 46.2805 (4m) "Family care program" means the program under s. 46.2805 to 46.2895 46.288 that provides the family care benefit.

SB21,1554 Section 1554. 46.2805 (7r) of the statutes is repealed.

SB21,1555 Section 1555. 46.2805 (7u) of the statutes is repealed.

SB21,1556 Section 1556. 46.2805 (9m) of the statutes is created to read:

SB21,658,8 46.2805 (9m) "Program of all-inclusive care for the elderly" means an integrated health and long-term care program operated under 42 USC 1395eee or 1396u-4.

SB21,1557 Section 1557. 46.2805 (10) of the statutes is amended to read:

SB21,658,13 46.2805 (10) "Resource center" means an entity that meets the standards for operation under s. 46.283 (3) or, if under contract to provide a portion of the services specified under s. 46.283 (3), meets the standards for operation with respect to those services, and fulfills the duties under s. 46.283 (4).

SB21,1558 Section 1558. 46.2805 (10m) of the statutes is amended to read:

SB21,658,18 46.2805 (10m) "Self-directed services option" means the option in the family care program that is operated under a waiver from the secretary of the federal department of health and human services under 42 USC 1396n (c) in which an enrolled individual selects his or her own services and service providers.

SB21,1559 Section 1559. 46.281 (1d) of the statutes is amended to read:

SB21,659,2 46.281 (1d) Waiver 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 46.288. Regardless of whether a waiver is approved, the department may implement operation of resource centers, care management organizations, and the family care benefit.

SB21,1560 Section 1560. 46.281 (1g) (a) of the statutes is renumbered 46.281 (1g) and amended to read:

SB21,659,10 46.281 (1g) Contracting for resource centers and care management organizations. Subject to par. (b), the The department may contract with entities or resource centers as provided under s. 46.283 (2) to provide any of 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.

SB21,1561 Section 1561. 46.281 (1g) (b) of the statutes is repealed.

SB21,1562 Section 1562. 46.281 (1n) (b) 3. of the statutes is amended to read:

SB21,659,20 46.281 (1n) (b) 3. Conduct ongoing evaluations of managed care programs for provision of long-term care services that are funded by medical assistance, as defined in s. 46.278 (1m) (b), as to client access to services, the availability of client choice of living and service options, quality of care, and cost-effectiveness. In evaluating the availability of client choice, the department shall evaluate the opportunity for a client to arrange for, manage, and monitor his or her family care benefit directly or with assistance, self-directed services option as specified in s. 46.284 (4) (e).

SB21,1563 Section 1563. 46.281 (1n) (b) 4. of the statutes is amended to read:

SB21,659,24 46.281 (1n) (b) 4. Require that quality assurance and quality improvement efforts be included throughout the long-term care system specified in ss. 46.2805 to 46.2895 family care program.

SB21,1564 Section 1564. 46.281 (1n) (d) of the statutes is repealed.

SB21,1565 Section 1565. 46.281 (1n) (e) of the statutes is amended to read:

SB21,660,11 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 other entity 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 individuals under age 60 who receive the family care benefit or who participates in the self-directed services option.

SB21,1566 Section 1566. 46.281 (3) of the statutes is amended to read:

SB21,660,22 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 or other entity under contract under s. 46.283 (2) 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 or other entity is available for specified groups of eligible individuals or for specified facilities in the county.

SB21,1567 Section 1567. 46.281 (4) (c) of the statutes is amended to read:

SB21,661,5 46.281 (4) (c) Each county in which the department has a contract with an entity to administer the family care benefit, and in which the department had such a contract before January 1, 2006, shall annually either pay the department or agree to reduce the community aids distribution to the county under s. 46.40 (2) by the amount that the county paid the department, or by which the county's community aids distribution was reduced, in calendar year 2006 to fund the family care program under ss. 46.2805 to 46.2895.