SB21: Bill Text

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SB21,1561 Section 1561. 46.281 (1g) (b) of the statutes is repealed.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

SB21,1568 Section 1568. 46.281 (4) (d) of the statutes is amended to read:

SB21,661,8 46.281 (4) (d) The department shall deposit payments made by counties under this subsection in the appropriation account under s. 20.435 (7) (g) (4) (h).

SB21,1569 Section 1569. 46.2825 of the statutes is repealed.

SB21,1570 Section 1570. 46.283 (title) of the statutes is amended to read:

SB21,661,11 46.283 (title) Resource centers; resource functions.

SB21,1571 Section 1571. 46.283 (1) (a) (intro.) and 1. of the statutes are consolidated, renumbered 46.283 (1) (a) and amended to read:

SB21,661,19 46.283 (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: 1. Whether whether to authorize one or more county departments under s. 46.21, 46.215, 46.22 or 46.23 or an aging unit under s. 46.82 (1) (a) 1., 2., or 3. to apply to the department for a contract to operate a resource center and, if so, which to authorize and what client group to serve.

SB21,1572 Section 1572. 46.283 (1) (a) 2. of the statutes is repealed.

SB21,1573 Section 1573. 46.283 (2) (intro.) of the statutes is renumbered 46.283 (2) and amended to read:

SB21,662,6 46.283 (2) Exclusive Resource center contract; contract for certain functions. The department may contract to operate a resource center with counties, 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 entity or 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:. The department may contract with an entity other than a resource center to perform certain functions of a resource center.

SB21,1574 Section 1574 . 46.283 (2) of the statutes, as affected by 2015 Wisconsin Act .... (this act), is amended to read:

SB21,662,16 46.283 (2) Resource center contract; contract for certain functions. The department may contract to operate a resource center with counties , 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 entity or nonprofit organization if the department determines that the organization has no significant connection to an entity that operates a care management organization. The department may contract with an entity other than a resource center to perform certain functions of a resource center.

SB21,1575 Section 1575. 46.283 (2) (a) of the statutes is repealed.

SB21,1576 Section 1576. 46.283 (2) (b) of the statutes is repealed.

SB21,1577 Section 1577. 46.283 (3) (title) of the statutes is repealed and recreated to read:

SB21,662,21 46.283 (3) (title) Resource function duties.

SB21,1578 Section 1578. 46.283 (3) (intro.) of the statutes is amended to read:

SB21,663,2 46.283 (3) (intro.) The department shall assure that at least all may in a contract with a resource center or other entity specify that the resource center or other entity provide any of the following are available to a person who contacts a resource center for service services or functions:

SB21,1579 Section 1579. 46.283 (3) (e) of the statutes is amended to read:

SB21,663,6 46.283 (3) (e) A determination of financial eligibility and of the maximum amount of cost sharing required for a person who is seeking long-term care services or the family care benefit, under standards prescribed by the department.

SB21,1580 Section 1580. 46.283 (4) (title) of the statutes is amended to read:

SB21,663,8 46.283 (4) (title) Duties; resource centers.

SB21,1581 Section 1581. 46.283 (4) (a) of the statutes is renumbered 46.283 (3) (L) and amended to read:

SB21,663,13 46.283 (3) (L) Provide Provision of services statewide or within the entire geographic area prescribed for the resource center or other entity by the department as specified in the contract.

SB21,1582 Section 1582. 46.283 (4) (e) of the statutes is renumbered 46.283 (3) (m) and amended to read:

SB21,663,25 46.283 (3) (m) Provide information Information about the services of the resource center or other entity, 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 and the self-directed services option to all older persons and adults with a physical or developmental 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 or other entity when the benefit under s. 46.286 first becomes available in the county where the nursing home, community-based residential facility, adult family home, or residential care apartment complex is located.

SB21,1583 Section 1583. 46.283 (4) (f) of the statutes is renumbered 46.283 (3) (n) and amended to read:

SB21,664,6 46.283 (3) (n) Perform Performance of a functional screening and a financial and cost-sharing screening for any resident, as specified in par. (e) (m), who requests a screening and assist any resident who is eligible and chooses to enroll in a care management organization or the self-directed services option to do so.

SB21,1584 Section 1584. 46.283 (4) (g) of the statutes is renumbered 46.283 (3) (o) and amended to read:

SB21,664,22 46.283 (3) (o) Perform Performance of 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, if the secretary has certified that the resource center or other entity is available to the person and the facility and the person is determined by the resource center or other entity to have a condition that is expected to last at least 90 days that would require care, assistance, or supervision. A resource center or other entity 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 or other entity 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.

SB21,1585 Section 1585. 46.283 (4) (j) of the statutes is repealed.

SB21,1586 Section 1586. 46.283 (5) of the statutes is amended to read:

SB21,665,5 46.283 (5) Funding. From the appropriation accounts under s. 20.435 (4) (b), (bd), (bm), (gm), (pa), and (w) and (7) (b), (bd), and (md), the department may contract with organizations that meet standards under sub. (3) for performance of the duties under sub. (4) (3) and shall distribute funds for services provided by resource centers and other entities.

SB21,1587 Section 1587. 46.283 (6) of the statutes is repealed.

SB21,1588 Section 1588. 46.283 (7) (intro.) of the statutes is amended to read:

SB21,665,12 46.283 (7) (intro.) No record, as defined in s. 19.32 (2), of a resource center or other contracted entity under sub. (2) that contains personally identifiable information, as defined in s. 19.62 (5), concerning an individual who receives services from the resource center may be disclosed by the resource center without the individual's informed consent, except as follows:

SB21,1589 Section 1589. 46.283 (7) (a) of the statutes is amended to read:

SB21,665,17 46.283 (7) (a) A resource center or other contracted entity under sub. (2) may provide information as required to comply with s. 16.009 (2) (p) or 49.45 (4) or as necessary for the department to administer the family care program under ss. 46.2805 to 46.2895.

SB21,1590 Section 1590. 46.283 (7) (b) of the statutes is amended to read:

SB21,666,2 46.283 (7) (b) Notwithstanding ss. 48.78 (2) (a), 49.45 (4), 49.83, 51.30, 51.45 (14) (a), 55.22 (3), 146.82, 252.11 (7), 253.07 (3) (c) and 938.78 (2) (a), a resource center or other contracted entity under sub. (2) acting under this section may exchange confidential information about a client, as defined in s. 46.287 (1), without the informed consent of the client, under s. 46.21 (2m) (c), 46.215 (1m), 46.22 (1) (dm), 46.23 (3) (e), 46.284 (7), 46.2895 (10), 51.42 (3) (e) or 51.437 (4r) (b) in the county operating area of the resource center or other entity, if necessary to enable the resource center or other entity to perform its duties or to coordinate the delivery of services to the client.

SB21,1591 Section 1591 . 46.283 (7) (b) of the statutes, as affected by 2015 Wisconsin Act .... (this act), is amended to read:

SB21,666,13 46.283 (7) (b) Notwithstanding ss. 48.78 (2) (a), 49.45 (4), 49.83, 51.30, 51.45 (14) (a), 55.22 (3), 146.82, 252.11 (7), 253.07 (3) (c) and 938.78 (2) (a), a resource center or other contracted entity under sub. (2) acting under this section may exchange confidential information about a client, as defined in s. 46.287 (1), without the informed consent of the client, under s. 46.21 (2m) (c), 46.215 (1m), 46.22 (1) (dm), 46.23 (3) (e), 46.284 (7), 46.2895 (10), 51.42 (3) (e) or 51.437 (4r) (b) in the operating area of the resource center or other entity, if necessary to enable the resource center or other entity to perform its duties or to coordinate the delivery of services to the client.

SB21,1592 Section 1592. 46.284 (1) (a) (intro.) and 1. of the statutes are consolidated, renumbered 46.284 (1) (a) and amended to read:

SB21,666,21 46.284 (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: 1. Whether whether to authorize one or more county departments under s. 46.21, 46.215, 46.22 or 46.23 or an aging unit under s. 46.82 (1) (a) 1. or 2. to apply to the department for a contract to operate a care management organization and, if so, which to authorize and what client group to serve.

SB21,1593 Section 1593. 46.284 (1) (a) 2. of the statutes is repealed.

SB21,1594 Section 1594. 46.284 (2) (a) of the statutes is amended to read:

SB21,667,3 46.284 (2) (a) The department may contract for operation of a care management organization only with an entity that is certified by the department as meeting the requirements under sub. (3). No entity may operate as a care management organization under the requirements of this section unless so certified and under contract with the department.

SB21,1595 Section 1595. 46.284 (2) (bm) of the statutes is amended to read:

SB21,667,16 46.284 (2) (bm) The department may contract with counties, 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 the department shall evaluate the proposals primarily as to the quality of care that is proposed to be provided, certify those The department may contract with any applicants that meet it certifies as meeting the requirements specified in sub. (3) (a), select certified applicants for contract and contract with the selected applicants. The department is not required to solicit proposals for contracts to be a care management organization under a competitive sealed proposal process.

SB21,1596 Section 1596 . 46.284 (2) (bm) of the statutes, as affected by 2015 Wisconsin Act .... (this act), is amended to read:

SB21,668,2 46.284 (2) (bm) The department may contract with counties, 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. The department may contract with any applicants that it certifies as meeting the requirements specified in sub. (3) (a). The department is not required to solicit proposals for contracts to be a care management organization under a competitive sealed proposal process.

SB21,1597 Section 1597. 46.284 (2) (c) of the statutes is repealed.

SB21,1598 Section 1598. 46.284 (2) (d) of the statutes is repealed.

SB21,1599 Section 1599. 46.284 (3) (b) 10. of the statutes is amended to read:

SB21,668,8 46.284 (3) (b) 10. Coverage statewide or for a geographic area specified by the department if the department grants the applicant an exception to statewide coverage.

SB21,1600 Section 1600. 46.284 (3) (b) 11. of the statutes is amended to read:

SB21,668,12 46.284 (3) (b) 11. The ability to develop strong linkages with systems and services that are not directly within the scope of the applicant's responsibility but that are important to the target group that it proposes to serve, including.

SB21,668,15 11m. If the department chooses to make primary and acute health care services part of the family care benefit, the ability to provide or provide access to primary and acute health care services under s. 49.46 (2) as determined by the department.

SB21,1601 Section 1601. 46.284 (3m) of the statutes is repealed.

SB21,1602 Section 1602. 46.284 (4) (e) of the statutes is amended to read:

SB21,669,4 46.284 (4) (e) Provide, within guidelines established by the department, a mechanism self-directed services option by which an enrollee may arrange for, manage, and monitor his or her family care benefit directly or with the assistance of another person chosen by the enrollee. The care management organization shall provide each enrollee with a form on which the enrollee shall indicate whether he or she has been offered the self-directed services option under this paragraph and whether he or she has accepted or declined the self-directed services option. If the enrollee accepts the option, the care management organization shall monitor the enrollee's use of a fixed budget for purchase of services or support items from any qualified provider, monitor the health and safety of the enrollee, and provide assistance in management of the enrollee's budget and services at a level tailored to the enrollee's need and desire for the assistance.

SB21,1603 Section 1603. 46.284 (5) (a) of the statutes is amended to read:

SB21,669,12 46.284 (5) (a) From the appropriation accounts under s. 20.435 (4) (b), (bd), (g), (gm), (h), (im), (o), and (w) and (7) (b), (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.

SB21,1604 Section 1604. 46.284 (5) (d) 4. of the statutes is amended to read:

SB21,669,24 46.284 (5) (d) 4. The requirement that a care management organization place funds in a risk reserve and maintain the risk reserve in an interest-bearing escrow account with a financial institution, as defined in s. 69.30 (1) (b) , or invest funds as specified in s. 46.2895 (4) (j) 2. or 3. Moneys in the risk reserve or invested as specified in this subdivision may be expended only for the provision of services under this section. If a care management organization ceases participation under this section, the funds in the risk reserve or invested as specified in this subdivision, minus any contribution of moneys other than those specified in par. (c), shall be returned to the department. The department shall expend the moneys for the payment of outstanding debts to providers of family care benefit services and for the continuation of family care benefit services to enrollees.

SB21,1605 Section 1605. 46.284 (6) of the statutes is amended to read:

SB21,670,6 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 representative of the client group or groups whom the care management organization is contracted to serve or those clients' enrollees or the enrollees' family members, guardians, or other advocates.

SB21,1606 Section 1606. 46.284 (7) (a) of the statutes is amended to read:

SB21,670,10 46.284 (7) (a) A care management organization may provide information as required to comply with s. 16.009 (2) (p) or 49.45 (4) or as necessary for the department to administer the family care program under ss. 46.2805 to 46.2895.