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:
DHS 10.23(6)(e)1. 1. Develop and implement a written quality assurance and quality improvement plan designed to ensure and improve outcomes for its target population. The plan shall be approved by the department and shall include at least all of the following components:
DHS 10.23(6)(e)1.a. a. Identification of performance goals, specific to the needs of the resource center's customers, including any goals specified by the department.
DHS 10.23(6)(e)1.b. b. Identification of objective and measurable indicators of whether the identified goals are being achieved, including any indicators specified by the department.
DHS 10.23(6)(e)1.c. c. Identification of timelines within which goals will be achieved.
DHS 10.23(6)(e)1.d. d. Description of the process that the resource center will use to gather feedback from the resource center's customers and staff and other sources on the quality and effectiveness of the resource center's performance.
DHS 10.23(6)(e)1.e. e. Description of the process the resource center will use to monitor and act on the results and feedback received.
DHS 10.23(6)(e)1.f. f. A process for regularly updating the plan, including a description of the process the resource center will use for annually assessing the effectiveness of the quality assurance and quality improvement plan and the impact of its implementation on outcomes.
DHS 10.23(6)(e)2. 2. Measure resource center performance, using standard measures as required by its contract with the department, and report its findings on these measurements to the department.
DHS 10.23(6)(e)3. 3. Achieve minimum performance levels and performance improvement levels, as demonstrated by standardized measures agreed to in its contract with the department.
DHS 10.23(6)(e)4. 4. Initiate performance improvement projects that examine aspects of services related to improving resource center quality. These projects shall include all of the following:
DHS 10.23(6)(e)4.a. a. Measuring performance.
DHS 10.23(6)(e)4.b. b. Implementing system interventions.
DHS 10.23(6)(e)4.c. c. Evaluating the effectiveness of the interventions.
DHS 10.23(6)(e)4.d. d. Planning for sustained or increased improvement in performance based on the findings of the evaluation.
DHS 10.23(6)(e)5. 5. Comply with quality standards for services included in the resource center's contract with the department in all of the following areas:
DHS 10.23(6)(e)5.a. a. Timeliness and accuracy of the functional screen and financial eligibility and cost-sharing screen.
DHS 10.23(6)(e)5.b. b. Timely and accurate eligibility determination and enrollment procedures.
DHS 10.23(6)(e)5.c. c. Information and assistance services and long-term care options counseling.
DHS 10.23(6)(e)5.d. d. Protection of applicant rights.
DHS 10.23(6)(e)5.e. e. Effective processes for considering and acting on complaints and resolving grievances of applicants and other persons who use resource center services.
DHS 10.23(6)(e)5.f. f. Services to minority, rural and institutionalized populations.
DHS 10.23(6)(e)6. 6. Report all data required by the department related to standardized measures of performance, in the timeframes and format specified by the department.
DHS 10.23(6)(e)7. 7. Cooperate with the department in evaluating outcomes and in developing and implementing plans to sustain and improve performance.
DHS 10.23(6)(f) (f) Cooperation with external reviews. Cooperate with any review of resource center activities by the department, another state agency or the federal government.
DHS 10.23(7) (7) Confidentiality and exchange of information. No record, as defined in s. 19.32 (2), Stats., of a resource center that contains personally identifiable information, as defined in s. 19.62 (5), Stats., 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:
DHS 10.23(7)(a) (a) A resource center shall provide information as required to comply with s. 16.009 (2) (p) or 49.45 (4), Stats., or as necessary for the department to administer the family care program under ss. 46.2805 to 46.2895, Stats.
DHS 10.23(7)(b) (b) Notwithstanding ss. 48.78 (2) (a), 49.45 (4), 49.83, 51.30, 51.45 (14) (a), 55.22, 146.82, 252.11 (7), 253.07 (3) (c) and 938.78 (2) (a), Stats., and except as provided in sub. (2) (d) 2., a resource center may exchange confidential information about a client without the informed consent of the client, in the county of the resource center, if the exchange of information is necessary to enable the resource center to perform its duties or to coordinate the delivery of services to the client, as authorized 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), Stats.
DHS 10.23 History History: Cr. Register, October, 2000, No. 538, eff. 11-1-00; CR 04-040: am. (2) (d) 1., (3) (a) 2. (intro.) Register November 2004 No. 587, eff. 12-1-04; correction in (7) (b) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; EmR0834: emerg. am. (2) (d) 2., eff. 11-3-08; CR 08-109: am. (2) (d) 2. Register June 2009 No. 642, eff. 7-1-09; correction in (6) (b) made under s. 13.92 (4) (b) 6., Stats., Register November 2009 No. 647.
DHS 10.24 DHS 10.24 Department responsibilities for monitoring resource center quality and operations.
DHS 10.24(1)(1)Monitoring. The department shall monitor the performance and operations of the resource center in all of the following areas:
DHS 10.24(1)(a) (a) Providing information about long-term care options to persons who could benefit from the information and linking persons to needed services, including family care, when eligible.
DHS 10.24(1)(b) (b) Respecting individuals' rights and dignity and giving consumers a strong role in program and policy development.
DHS 10.24(1)(c) (c) Providing early intervention and prevention services.
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.