DHS 10.22(4) (4) Independence from care management organization. To assure that persons receive long-term care counseling and eligibility determination services from the resource center in an environment that is free from conflict of interest, a resource center shall meet state and federal requirements for organizational independence from any care management organization.
DHS 10.22 Note Note: Before July 1, 2001, the Wisconsin legislature has authorized the department to contract only with a county, a family care district, the governing body of a tribe or band or the Great Lakes Inter-tribal Council, Inc., or with 2 or more of these entities under a joint application, to operate a Resource Center. After June 30, 2001, the department is authorized to contract with these same entities, 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: (1) A county board of supervisors declines in writing to apply for a contract to operate a Resource Center; or (2) A county agency or a family care district applies for a contract but fails to meet the standards for performance for Resource Centers specified in s. DHS 10.23. Certain functions of the Resource Center, such as eligibility determination, must be performed by public employees. Section 46.285, Stats., further requires that no entity may directly operate both a Resource Center and a CMO, except that a pilot Resource Center is required to be structurally separate from the provision of CMO services by January 1, 2001.
DHS 10.22 History History: Cr. Register, October, 2000, No. 538, eff. 11-1-00.
DHS 10.23 DHS 10.23 Standards for performance by resource centers.
DHS 10.23(1)(1)Compliance. An aging and disability resource center shall comply with all applicable statutes, all of the standards in this section and all requirements of its contract with the department.
DHS 10.23(2) (2) Services. A resource center shall ensure that the following services, meeting the standards specified, are available to its target population:
DHS 10.23(2)(a) (a) Information and referral services and other assistance. A resource center shall provide information, referral and assistance at hours that are convenient to the public and consistent with requirements of this chapter and its contract with the department, using a telephone number that is toll-free to all callers in its service area. The resource center shall be physically accessible and be able to provide information and assistance services in a private and confidential manner. The resource center shall be able to provide information and assistance services in a language that a person contacting the resource center can understand. Information and referral services include all of the following:
DHS 10.23(2)(a)1. 1. Current information on a wide variety of topics related to aging, physical and developmental disabilities, chronic illness and long-term care, as specified by the department and appropriate to the resource center's target population.
DHS 10.23(2)(a)2. 2. Referrals to and assistance in accessing an array of voluntary, purchased and public resources to help older people and people with disabilities secure needed services or benefits, live with dignity and security, and achieve maximum independence and quality of life. Referral and assistance includes all the following:
DHS 10.23(2)(a)2.a. a. Professional advice and counseling to assist consumers in identifying needs, capacities and personal preferences.
DHS 10.23(2)(a)2.b. b. Educating consumers regarding available service options and resources.
DHS 10.23(2)(a)2.c. c. Identifying service providers capable of meeting the person's needs.
DHS 10.23(2)(a)2.d. d. Actively assisting the consumer in accessing services when necessary.
DHS 10.23(2)(a)3. 3. Continued contact with people, as needed, to determine the outcomes of previous contacts and to offer additional assistance in locating or using services as necessary.
DHS 10.23(2)(b) (b) Advocacy. Advocacy on behalf of individuals and groups when needed services are not being adequately provided by an organization within the service delivery system.
DHS 10.23(2)(c) (c) Long-term care options counseling. The resource center shall provide members of its target population and their families or other representatives with professional counseling about options available to meet long-term care needs and about factors to consider in making long-term care decisions. The resource center shall offer this counseling to any person in its target population who is seeking or who the resource center determines appears to need long-term care services, and to his or her family members or other representatives if applicable. In making the offer, the resource center shall inform the person that participation in counseling is voluntary on the part of any individual. Information provided shall be timely, factual, thorough, accurate, unbiased and appropriate to the individual's needs and situation. The resource center shall conduct long-term care options counseling at a location preferred by and at a time convenient to the individual consumer. Long-term care options counseling shall inform and advise the person concerning all of the following:
DHS 10.23(2)(c)1. 1. The availability of any long-term care options open to the individual, including home care, community services, case management services, residential care and nursing home options.
DHS 10.23(2)(c)2. 2. Sources and methods of both public and private payment for long-term care services, including family care and the fee-for-service system.
DHS 10.23(2)(c)3. 3. Factors to consider when choosing among the available programs, services and benefits, including cost, quality, outcomes, estate recovery and compatibility with the person's preferred lifestyle and residential setting.
DHS 10.23(2)(c)4. 4. Advantages and disadvantages of the various options in light of the individual's situation, values, capacities, knowledge and resources and the urgency of the individual's situation.
DHS 10.23(2)(c)5. 5. Opportunities and methods for maximizing independence and self-reliance, including the utilization of supports from family, friends and community.
DHS 10.23(2)(d) (d) Benefits counseling.
DHS 10.23(2)(d)1.1. The resource center shall ensure that people from its target populations have access to the services of a benefit specialist, including information about and assistance in applying for public and private benefits for which they may be eligible, assistance in preparing and filing grievances, appeals, requests for department review or fair hearing, and representation in grievance resolution and fair hearings.
DHS 10.23(2)(d)2. 2. Notwithstanding sub. (7) (b), a disability benefit specialist may not disclose information about a client without the informed consent of the client, unless required by law. A disability benefit specialist may also disclose information about a client without the informed consent of the client as permitted under s. 55.043 (1m) (br), Stats., if there is reasonable cause to believe that the adult at risk is at imminent risk of serious bodily harm, death, sexual assault, or significant property loss and is unable to make an informed judgment about whether to report the risk or if an adult at risk other than the subject of the report is at risk of serious bodily harm, death, sexual assault, or significant property loss inflicted by a suspected perpetrator.
DHS 10.23(2)(d)3. 3. When a benefit specialist represents a client in a matter in which a decision or action of the resource center is at issue, the resource center may not attempt to influence the benefit specialist's representation of the client.
DHS 10.23(2)(e) (e) Transitional services. A resource center that serves young adults shall coordinate with school districts, boards appointed under s. 51.437, Stats., county human services departments or departments of community programs to assist young adults with physical or developmental disabilities in making the transition from children's services to the adult long-term care system.
DHS 10.23(2)(f) (f) Prevention and early intervention. The resource center shall develop a prevention and early intervention plan based on department priorities established through contract and provide prevention and intervention services consistent with the plan and within the limits of available funding. The plan shall include how the resource center will do both of the following:
DHS 10.23(2)(f)1. 1. Educate communities in its area on prevention of disabling conditions.
DHS 10.23(2)(f)2. 2. Provide specific prevention advice and education to individuals in its target group, regardless of whether they are eligible for the family care benefit.
DHS 10.23(2)(g) (g) Emergency response. The resource center shall assure that emergency calls to the resource center are received 24 hours a day, seven days a week, responded to promptly and that people are connected promptly with the appropriate providers of emergency services.
DHS 10.23(2)(h) (h) Choice counseling. The resource center shall provide information and counseling to assist persons who are eligible for the family care benefit and their families or other representatives with respect to the person's choice of whether or not to enroll in a care management organization and, if so, which available care management organization would best meet his or her needs. Information provided under this paragraph shall include information about all of the following:
DHS 10.23(2)(h)1. 1. The availability of mechanisms for self-management of service funding under s. DHS 10.44 (2) (d) and (6), through which an enrollee may manage the funding for some or all of his or her own services under the family care benefit.
DHS 10.23(2)(h)2. 2. How to find additional assistance within or outside the resource center, a care management organization and the family care benefit.
DHS 10.23(2)(h)3. 3. Opportunities for enrollees in a CMO to do as much for themselves as possible and desired and for full participation in service planning and delivery.
DHS 10.23(2)(i) (i) Enrollment assistance. The resource center shall assist a person found eligible for the family care benefit and wishing to enroll in a care management organization to enroll in the care management organization of the person's choice.
DHS 10.23(2)(j) (j) Disenrollment counseling. The resource center shall provide information and counseling to assist persons in the process of voluntarily or involuntarily disenrolling from a care management organization, including all of the following:
DHS 10.23(2)(j)1. 1. Information about clients' rights and grievance procedures.
DHS 10.23(2)(j)2. 2. Advocacy resources available to assist the person in resolving complaints and grievances.
DHS 10.23(2)(j)3. 3. Service and program options available to the person if the disenrollment occurs.
DHS 10.23(2)(j)4. 4. Information about the availability of assistance with re-enrollment.
DHS 10.23(2)(k) (k) Waiting list management. The resource center shall manage, as directed by the department, any waiting lists that become necessary under s. DHS 10.36 (2) or (3).
DHS 10.23(3) (3) Access to family care and other benefits. If it is a county agency, the resource center shall provide to members of its target population access to the benefits under pars. (a) and (b) directly or through subcontract or other arrangement with the appropriate county agency. If it is not a county agency, the resource center shall have a departmentally approved memorandum of understanding with a county agency to which it will make referrals for access to these benefits. The memorandum of understanding shall clearly define the respective responsibilities of the two organizations, and how eligibility determination for the benefits under pars. (a) and (b) will be coordinated with other resource center functions for the convenience of members of the resource center's target population. Benefits to which the resource center shall provide access are all the following:
DHS 10.23(3)(a) (a) Family care.
DHS 10.23(3)(a)1.1. The requirements specified in s. DHS 10.31 shall govern application and determination of eligibility for the family care benefit.
DHS 10.23(3)(a)2. 2. A resource center shall offer a functional screening and a financial eligibility and cost-sharing screening to any individual over the age of 17 years and 9 months who appears to have a disability or condition requiring long-term care and who meets any of the following conditions:
DHS 10.23(3)(a)2.a. a. The person requests or is referred for the screens.
DHS 10.23(3)(a)2.b. b. The person is seeking access to the family care benefit.
DHS 10.23(3)(a)2.c. c. The person is seeking admission to a nursing home, community-based residential facility, adult family home, or residential care apartment complex, subject to the exceptions under ss. DHS 10.72 (4) and 10.73 (4) (a).
DHS 10.23(3)(a)3. 3. If a person accepts the offer, the resource center or the county agency shall provide the screens.
DHS 10.23(3)(b) (b) Medical assistance, SSI, state supplemental payments and food stamps. The resource center shall provide, directly or through referral, access to all of the following:
DHS 10.23(3)(b)1. 1. Medical assistance under s. 49.46, 49.468 or 49.47, Stats.
DHS 10.23(3)(b)2. 2. State supplemental payments under s. 49.77, Stats., to the federal supplemental security income (SSI) program under USC 1381 to 1383d, including the increased or “exceptional" payments (SSI-E) under s. 49.77 (3s), Stats.
DHS 10.23(3)(b)3. 3. The federal food stamp program under 7 USC 2011 to 2029.
DHS 10.23(4) (4) Elder abuse and adult protective services.
DHS 10.23(4)(a)(a) The resource center shall identify persons who may need elder abuse or adult protective services and shall provide or facilitate access to services for eligible individuals under s. 46.90 and chs. 51 and 55, Stats.
DHS 10.23(4)(b) (b) The resource center may provide elder abuse and adult protective services directly, if a county agency, or through cooperation with the local public agency or agencies that provide the services. If the resource center is not the county agency designated under s. 46.90 or ch. 55, Stats., it shall have a memorandum of understanding with the designated agency or agencies regarding how these services are to be coordinated. The memorandum shall specify staff contacts, hours of operation and referral processes and procedures.
DHS 10.23(5) (5) Staff qualifications. Persons providing resource center services, whether directly employed by the resource center or indirectly under subcontract or memorandum of understanding with another organization, shall have the following qualifications:
DHS 10.23(5)(a) (a) Persons answering the information and assistance telephone line shall be trained and knowledgeable about all of the following:
DHS 10.23(5)(a)1. 1. The mission, operations and referral policies of the resource center.
DHS 10.23(5)(a)2. 2. The target populations served and their needs.
DHS 10.23(5)(a)3. 3. Telephone etiquette and communication skills, including how to recognize and respond to special hearing or language needs.
DHS 10.23(5)(a)4. 4. How to recognize and handle emergencies.
DHS 10.23(5)(b) (b) Persons providing information and assistance services, long-term care options counseling, benefits counseling, the functional screen and financial eligibility and cost-sharing screen and choice counseling shall:
DHS 10.23(5)(b)1. 1. Be competent to provide these services to the resource center's target population.
DHS 10.23(5)(b)2. 2. Meet at least one of the following requirements for education and experience:
DHS 10.23(5)(b)2.a. a. Bachelor of arts or science degree, preferably in a health or human services related field, and at least one year of experience working with at least one of the resource center's target populations.
DHS 10.23(5)(b)2.b. b. Four years of post-secondary education and experience working with at least one of the target populations or an equivalent combination of education and experience, either in long-term support or a related human services field.
DHS 10.23(5)(b)2.c. c. Other experience, training or both, as approved by the department based on a plan for providing formal and on-the-job training to develop the required expertise.
DHS 10.23(5)(b)3. 3. Be knowledgeable about the range, quality and availability of long-term care services offered within the resource center's service area.
DHS 10.23(6) (6) Operational requirements. A resource center shall do all of the following:
DHS 10.23(6)(a) (a) Outreach and public education.
DHS 10.23(6)(a)1.1. Develop and implement an ongoing program of marketing and outreach to inform members of its target population and their families, community agencies, health professionals and service providers of the availability of resource center services.
DHS 10.23(6)(a)2. 2. Within 6 months after the family care benefit is available to all eligible persons in its service area, provide information about family care to persons who are members of a target population served by a CMO that operates in the county and who are residents of nursing homes, community-based residential facilities, adult family homes and residential care apartment complexes in the geographic area of the resource center. The information provided shall cover all of the following:
DHS 10.23(6)(a)2.a. a. The family care benefit, and the opportunities for enrollee choice within the benefit, including the opportunity for self-management of service funding under s. DHS 10.44 (2) (d) and (6).
DHS 10.23(6)(a)2.b. b. The services of the resource center, including information and assistance, benefits counseling, long-term care options counseling, advocacy assistance, the functional screen and financial eligibility and cost-sharing screen, and eligibility determination and enrollment in family care.
DHS 10.23(6)(a)2.c. c. The services of any available care management organization, including the comprehensive assessment and care plan.
DHS 10.23(6)(a)2.d. d. How to contact the resource center for assistance.
DHS 10.23(6)(a)2.e. e. The services of available advocacy services external to the resource center, including services under s. 16.009 (2) (p), Stats., and how to access these services.
DHS 10.23(6)(b) (b) Community needs identification. Implement a process for identifying unmet needs of its target population in the geographic area it serves. The process shall include input from the regional long-term care advisory committee, members of the target populations and their representatives, and local government and service agencies including the care management organization, if any. The process shall include a systematic review of the needs of populations residing in public and private long-term care facilities, members of minority groups and people in rural areas. A resource center shall target its outreach, education, prevention and service development efforts based on the results of the needs identification process.
DHS 10.23(6)(c) (c) Grievance and appeal processes. Implement a process for reviewing client complaints and resolving client grievances as required under s. DHS 10.53 (1).
DHS 10.23(6)(d) (d) Reporting and records.
DHS 10.23(6)(d)1.1. Except as provided in this par. and sub. (7), collect data about its operations as required by the department by contract. No data collection effort shall interfere with a person's right to receive information anonymously or require personally identifiable information unless the person has authorized the resource center to have or share that information.
DHS 10.23(6)(d)2. 2. Report information as the department determines necessary, including information needed for doing all of the following:
DHS 10.23(6)(d)2.a. a. Determining whether the resource center is meeting minimum quality standards and other requirements of its contract with the department.
DHS 10.23(6)(d)2.b. b. Determining the extent to which the resource center is improving its performance on measurable indicators identified by the resource center in its current quality improvement plan.
DHS 10.23(6)(d)2.c. c. Evaluating the effects of providing long-term care options counseling and choice counseling under this section.
DHS 10.23(6)(d)2.d. d. Evaluating the effects for enrollees and cost-effectiveness of providing the family care benefit.
DHS 10.23(6)(d)3. 3. Submit to the department all reports and data required or requested by the department, in the format and timeframe specified by the department.
DHS 10.23(6)(e) (e) Internal quality assurance and quality improvement. Implement an internal quality assurance and quality improvement program that meets the requirements of its contract with the department. As part of the program, the resource center shall do all of the following:
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.