Amendment SA2-AB56

AB56-SA2,11,19 20.435 (5) (ct) Mental health consultation program. The amounts in the schedule for developing a plan for a mental health consultation program under s. 51.441. No moneys may be encumbered under this paragraph after June 30, 2021.”.

AB56-SA2,11,20 62. Page 255, line 18: after that line insert:

AB56-SA2,11,21 “ Section 205c. 20.435 (5) (dg) of the statutes is created to read:

AB56-SA2,11,24 20.435 (5) (dg) Regional crisis stabilization facilities. The amounts in the schedule to provide grants to regional crisis stabilization facilities under s. 51.03 (7).”.

AB56-SA2,12,1 63. Page 265, line 17: delete that line and substitute:

AB56-SA2,12,2 “ Section 179b. 20.505 (8) (hm) 6e. of the statutes is repealed.”.

AB56-SA2,12,3 64. Page 279, line 8: after that line insert:

AB56-SA2,12,4 “ Section 318f. 20.940 of the statutes is repealed.” .

AB56-SA2,12,5 65. Page 292, line 25: after that line insert:

AB56-SA2,12,6 “ Section 414i. 40.51 (8) of the statutes is amended to read:

AB56-SA2,12,11 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.728, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.867, 632.87 (3) to (6), 632.885, 632.89, 632.895 (5m) and (8) to (17), and 632.896.

AB56-SA2,415i Section 415i. 40.51 (8m) of the statutes is amended to read:

AB56-SA2,12,16 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.728, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.867, 632.885, 632.89, and 632.895 (11) (8) and (10) to (17).”.

AB56-SA2,12,18 66. Page 295, line 23: delete the material beginning with that line and ending with page 304, line 9, and substitute:

AB56-SA2,12,19 “ Section 441b. 46.10 (16) of the statutes is amended to read:

AB56-SA2,13,6 46.10 (16) The department shall delegate to county departments under ss. 51.42 and 51.437 or the local providers of care and services meeting the standards established by the department under s. 46.036, the responsibilities vested in the department under this section for collection of patient fees for services other than those provided at state facilities, those provided to children that are reimbursed under a waiver under s. 46.27 (11), 46.275, 46.278, or 46.2785, or those provided under the disabled children's long-term support program if the county departments or providers meet the conditions that the department determines are appropriate. The department may delegate to county departments under ss. 51.42 and 51.437 the responsibilities vested in the department under this section for collection of patient fees for services provided at the state facilities if the necessary conditions are met.

AB56-SA2,442b Section 442b. 46.21 (2m) (b) 1. a. of the statutes is amended to read:

AB56-SA2,13,11 46.21 (2m) (b) 1. a. The powers and duties of the county departments under ss. 46.215, 51.42 and 51.437, including the administration of the long-term support community options program under s. 46.27, if the county department under s. 46.215 is designated as the administering agency under s. 46.27 (3) (b) 1.

AB56-SA2,443b Section 443b. 46.21 (2m) (b) 1. b. of the statutes is repealed.

AB56-SA2,444b Section 444b. 46.215 (1) (m) of the statutes is repealed.

AB56-SA2,445b Section 445b. 46.22 (1) (b) 1. e. of the statutes is repealed.

AB56-SA2,446b Section 446b. 46.23 (3) (bm) of the statutes is repealed.

AB56-SA2,447b Section 447b. 46.269 of the statutes is amended to read:

AB56-SA2,14,2 46.269 Determining financial eligibility for long-term care programs. To the extent approved by the federal government, the department or its designee shall exclude any assets accumulated in a person's independence account, as defined in s. 49.472 (1) (c), and any income or assets from retirement benefits earned or accumulated from income or employer contributions while employed and receiving state-funded benefits under s. 46.27 or medical assistance under s. 49.472 in determining financial eligibility and cost-sharing requirements, if any, for a long-term care program under s. 46.27, 46.275 , or 46.277, for the family care program that provides the benefit defined in s. 46.2805 (4), for the Family Care Partnership program, or for the self-directed services option, as defined in s. 46.2897 (1).

AB56-SA2,448b Section 448b. 46.27 of the statutes is repealed.

AB56-SA2,449b Section 449b. 46.271 (1) (c) of the statutes is amended to read:

AB56-SA2,14,7 46.271 (1) (c) The department may contract with an aging unit, as defined in s. 46.27 46.82 (1) (a), for administration of services under par. (a) if, by resolution, the county board of supervisors of that county so requests the department.

AB56-SA2,450b Section 450b. 46.275 (3) (e) of the statutes is repealed.

AB56-SA2,451b Section 451b. 46.275 (5) (b) 7. of the statutes is amended to read:

AB56-SA2,14,13 46.275 (5) (b) 7. Provide services in any community-based residential facility unless the county or department uses as a service contract the approved model contract developed under s. 46.27 (2) (j), 2017 stats., or a contract that includes all of the provisions of the approved model contract.

AB56-SA2,452b Section 452b. 46.277 (1m) (at) of the statutes is amended to read:

AB56-SA2,14,18 46.277 (1m) (at) “Private nonprofit agency" has the meaning specified in s. 46.27 (1) (bm) means a nonprofit corporation, as defined in s. 181.0103 (17), that provides a program of all-inclusive care for the elderly under 42 USC 1395eee or 1396u-4.

AB56-SA2,453b Section 453b. 46.277 (3) (a) of the statutes is amended to read:

AB56-SA2,15,3 46.277 (3) (a) Sections 46.27 (3) (b) and Section 46.275 (3) (a) and (c) to (e) apply applies to county participation in this program, except that services provided in the program shall substitute for care provided a person in a skilled nursing facility or intermediate care facility who meets the level of care requirements for medical assistance reimbursement to that facility rather than for care provided at a state center for the developmentally disabled. The number of persons who receive services provided by the program under this paragraph may not exceed the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.

AB56-SA2,454b Section 454b. 46.277 (5) (d) 2. (intro.) and b. of the statutes are consolidated, renumbered 46.277 (5) (d) 2. and amended to read:

AB56-SA2,15,13 46.277 (5) (d) 2. No county may use funds received under this section to provide residential services in any community-based residential facility, as defined in s. 50.01 (1g), unless one of the following applies: b. The the department approves the provision of services in a community-based residential facility that entirely consists of independent apartments, each of which has an individual lockable entrance and exit and individual separate kitchen, bathroom, sleeping and living areas, to individuals who are eligible under this section and are physically disabled or are at least 65 years of age.

AB56-SA2,455b Section 455b. 46.277 (5) (d) 2. a. of the statutes is repealed.

AB56-SA2,456b Section 456b. 46.277 (5) (d) 3. of the statutes is amended to read:

AB56-SA2,15,22 46.277 (5) (d) 3. If subd. 2. a. or b. applies, no county may use funds received under this section to pay for services provided to a person who resides or intends to reside in a community-based residential facility and who is initially applying for the services, if the projected cost of services for the person, plus the cost of services for existing participants, would cause the county to exceed the limitation under sub. (3) (c). The department may grant an exception to the requirement under this subdivision, under the conditions specified by rule, to avoid hardship to the person.

AB56-SA2,457b Section 457b. 46.277 (5) (f) of the statutes is amended to read:

AB56-SA2,16,3 46.277 (5) (f) No county or private nonprofit agency may use funds received under this subsection to provide services in any community-based residential facility unless the county or agency uses as a service contract the approved model contract developed under s. 46.27 (2) (j), 2017 stats., or a contract that includes all of the provisions of the approved model contract.

AB56-SA2,458b Section 458b. 46.278 (4) (a) of the statutes is amended to read:

AB56-SA2,16,12 46.278 (4) (a) Sections 46.27 (3) (b) and Section 46.275 (3) (a) and (c) to (e) apply applies to county participation in a program, except that services provided in the program shall substitute for care provided a person in an intermediate care facility for persons with an intellectual disability or in a brain injury rehabilitation facility who meets the intermediate care facility for persons with an intellectual disability or brain injury rehabilitation facility level of care requirements for medical assistance reimbursement to that facility rather than for care provided at a state center for the developmentally disabled.

AB56-SA2,459b Section 459b. 46.2803 of the statutes is repealed.

AB56-SA2,460b Section 460b. 46.2805 (1) (b) of the statutes is amended to read:

AB56-SA2,16,17 46.2805 (1) (b) A demonstration program known as the Wisconsin partnership Family Care Partnership program under a federal waiver authorized under 42 USC 1315 1396n.

AB56-SA2,461b Section 461b. 46.281 (1d) of the statutes is amended to read:

AB56-SA2,17,2 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 and the self-directed services option 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.

AB56-SA2,462b Section 462b. 46.281 (1n) (d) of the statutes is repealed.

AB56-SA2,463b Section 463b. 46.281 (3) of the statutes is repealed.

AB56-SA2,464b Section 464b. 46.2825 of the statutes is repealed.

AB56-SA2,465b Section 465b. 46.283 (3) (f) of the statutes is amended to read:

AB56-SA2,17,12 46.283 (3) (f) Assistance to a person who is eligible for the family care benefit with respect to the person's choice of whether or not to enroll in the self-directed services option, as defined in s. 46.2899 (1), a care management organization for the family care benefit or the Family Care Partnership program, or the program of all-inclusive care for the elderly and, if so, which available long-term care program or care management organization would best meet his or her needs.

AB56-SA2,466b Section 466b. 46.283 (4) (e) of the statutes is repealed.

AB56-SA2,467b Section 467b. 46.283 (4) (f) of the statutes is amended to read:

AB56-SA2,17,18 46.283 (4) (f) Perform a functional screening and a financial and cost-sharing screening for any resident, as specified in par. (e), 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.

AB56-SA2,468b Section 468b. 46.283 (6) (b) 7. of the statutes is repealed.

AB56-SA2,469b Section 469b. 46.283 (6) (b) 9. of the statutes is amended to read:

AB56-SA2,17,24 46.283 (6) (b) 9. Review the number and types of grievances and appeals concerning the long-term care system in the area served by related to the resource center, to determine if a need exists for system changes, and recommend system or other changes if appropriate.

AB56-SA2,470b Section 470b. 46.283 (6) (b) 10. of the statutes is repealed.

AB56-SA2,471b Section 471b. 46.285 (intro.) of the statutes is renumbered 46.285 and amended to read:

AB56-SA2,18,8 46.285 Operation of resource center and care management organization. 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 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:.

AB56-SA2,472b Section 472b. 46.285 (1) of the statutes is repealed.

AB56-SA2,473b Section 473b. 46.285 (2) of the statutes is repealed.

AB56-SA2,474b Section 474b. 46.286 (3) (b) 2. a. of the statutes is repealed.

AB56-SA2,475b Section 475b. 46.287 (2) (a) 1. (intro.) of the statutes is amended to read:

AB56-SA2,18,18 46.287 (2) (a) 1. (intro.) Except as provided in subd. 2., a client may contest any of the following applicable matters by filing, within 45 days of the failure of a resource center or care management organization county to act on the contested matter within the time frames specified by rule by the department or within 45 days after receipt of notice of a decision in a contested matter, a written request for a hearing under s. 227.44 to the division of hearings and appeals created under s. 15.103 (1):

AB56-SA2,476b Section 476b. 46.287 (2) (a) 1. d. of the statutes is renumbered 46.287 (2) (a) 1m. b.

AB56-SA2,477b Section 477b. 46.287 (2) (a) 1. e. of the statutes is repealed.

AB56-SA2,478b Section 478b. 46.287 (2) (a) 1. f. of the statutes is repealed.

AB56-SA2,479b Section 479b. 46.287 (2) (a) 1m. of the statutes is created to read:

AB56-SA2,19,5 46.287 (2) (a) 1m. Except as provided in subd. 2., a client may contest any of the following adverse benefit determinations by filing, within 90 days of the failure of a care management organization to act on a contested adverse benefit determination within the time frames specified by rule by the department or within 90 days after receipt of notice of a decision upholding the adverse benefit determination, a written request for a hearing under s. 227.44 to the division of hearings and appeals created under s. 15.103 (1):

AB56-SA2,19,9 a. Denial of functional eligibility under s. 46.286 (1) as a result of the care management organization's administration of the long-term care functional screen, including a change from a nursing home level of care to a non-nursing home level of care.

AB56-SA2,19,12 c. Denial or limited authorization of a requested service, including determinations based on type or level of service, requirements or medical necessity, appropriateness, setting, or effectiveness of a covered benefit.

AB56-SA2,19,15 d. Reduction, suspension, or termination of a previously authorized service, unless the service was only authorized for a limited amount or duration and that amount or duration has been completed.

AB56-SA2,19,16 e. Denial, in whole or in part, of payment for a service.

AB56-SA2,19,19 f. The failure of a care management organization to act within the time frames provided in 42 CFR 438.408 (b) (1) and (2) regarding the standard resolution of grievances and appeals.

AB56-SA2,19,22 g. Denial of an enrollee's request to dispute financial liability, including copayments, premiums, deductibles, coinsurance, other cost sharing, and other member financial liabilities.

AB56-SA2,19,25 h. Denial of an enrollee, who is a resident of a rural area with only one care management organization, to obtain services outside the care management organization's network of contracted providers.

AB56-SA2,20,6 i. Development of a plan of care that is unacceptable to the enrollee because the plan of care requires the enrollee to live in a place that is unacceptable to the enrollee; the plan of care does not provide sufficient care, treatment, or support to meet the enrollee's needs and support the enrollee's identified outcomes; or the plan of care requires the enrollee to accept care, treatment, or support that is unnecessarily restrictive or unwanted by the enrollee.

AB56-SA2,20,7 j. Involuntary disenrollment from the care management organization.

AB56-SA2,480b Section 480b. 46.287 (2) (b) of the statutes is amended to read:

AB56-SA2,20,17 46.287 (2) (b) An enrollee may contest a decision, omission or action of a care management organization other than those specified in par. (a), or may contest the choice of service provider. In these instances, the enrollee shall first send a written request for review by the unit of the department that monitors care management organization contracts. This unit shall review and attempt to resolve the dispute. 1m. by filing a grievance with the care management organization. If the dispute grievance is not resolved to the satisfaction of the enrollee, he or she may request a hearing under the procedures specified in par. (a) 1. (intro.) that the department review the decision of the care management organization.

AB56-SA2,481b Section 481b. 46.288 (2) (intro.) of the statutes is renumbered 46.288 (2) and amended to read:

AB56-SA2,20,25 46.288 (2) 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) 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:

AB56-SA2,482b Section 482b. 46.288 (2) (d) to (j) of the statutes are repealed.

AB56-SA2,483b Section 483b. 46.2896 (1) (a) of the statutes is amended to read:

AB56-SA2,21,6 46.2896 (1) (a) “Long-term care program" means the long-term care program under s. 46.27, 46.275, 46.277, 46.278, or 46.2785; the family care program providing the benefit under s. 46.286; the Family Care Partnership program; or the long-term care program defined in s. 46.2899 (1).”.

AB56-SA2,21,7 67. Page 304, line 10: delete lines 10 to 18 and substitute: