1999 Wisconsin Act 9

9,1056 Section 1056. 46.27 (10) (a) 1. of the statutes is amended to read:

46.27 (10) (a) 1. The department shall determine for each county participating in the pilot project under sub. (9) a funding level of state medical assistance expenditures to be received by the county. This level shall equal the amount that the department determines would otherwise be paid under s. 20.435 (5) (4) (b) because of increased utilization of nursing home services, as estimated by the department.

9,1057 Section 1057. 46.27 (11) (c) 3. of the statutes is amended to read:

46.27 (11) (c) 3. Medical assistance reimbursement for services a county, a private nonprofit agency or an aging unit with which the department contracts provides under this subsection shall be made from the appropriations under s. 20.435 (5) (4) (o) and (7) (b) and (bd).

9,1058 Section 1058. 46.27 (11) (c) 4. of the statutes is amended to read:

46.27 (11) (c) 4. The department may, from the appropriation under s. 20.435 (5) (4) (o), provide reimbursement for services provided under this subsection by counties that are in excess of the current average annual per person rate, as established by the department, and are less than or equal to the average amount approved in the waiver received under par. (am).

9,1059 Section 1059. 46.27 (11) (c) 5n. a. of the statutes is amended to read:

46.27 (11) (c) 5n. a. An assessment under sub. (6) has been completed for the person prior to the person's admission to the community-based residential facility, whether or not the person is a private pay admittee at the time of admission. except that a person seeking admission or about to be admitted on a private pay basis may waive the assessment, unless the person is expected to become eligible for medical assistance within 6 months of assessment. The county may waive this condition in accordance with guidelines established by the department. If the county waives this condition, the county must meet with the person or the person's guardian to discuss the cost-effectiveness of various service options.

9,1059g Section 1059g. 46.27 (11) (c) 5q. of the statutes is created to read:

46.27 (11) (c) 5q. No county department or aging unit may deny services to a person under subd. 5n. who refused to have an assessment completed as required under subd. 5n. a. before the effective date of this subdivision .... [revisor inserts date].

9,1060 Section 1060. 46.271 (2m) of the statutes is repealed.

9,1061 Section 1061. 46.275 (5) (a) of the statutes is amended to read:

46.275 (5) (a) Medical assistance reimbursement for services a county, or the department under sub. (3r), provides under this program is available from the appropriations under s. 20.435 (5) (4) (b) and (o). If 2 or more counties jointly contract to provide services under this program and the department approves the contract, medical assistance reimbursement is also available for services provided jointly by these counties.

9,1062 Section 1062. 46.275 (5) (c) of the statutes is amended to read:

46.275 (5) (c) The total allocation under s. 20.435 (5) (4) (b) and (o) to counties and to the department under sub. (3r) for services provided under this section may not exceed the amount approved by the federal department of health and human services. A county may use funds received under this section only to provide services to persons who meet the requirements under sub. (4) and may not use unexpended funds received under this section to serve other developmentally disabled persons residing in the county.

9,1063 Section 1063. 46.275 (5) (d) of the statutes is amended to read:

46.275 (5) (d) The department may, from the appropriation under s. 20.435 (5) (4) (o), provide reimbursement for services provided under this section by counties that are in excess of the current average annual per person rate, as established by the department, and are less than the average amount approved in the waiver received under sub. (2).

9,1064 Section 1064. 46.277 (5) (d) 1n. a. of the statutes is amended to read:

46.277 (5) (d) 1n. a. An assessment under s. 46.27 (6) has been completed for the person prior to the person's admission to the community-based residential facility, whether or not the person is a private pay admittee at the time of admission. except that a person seeking admission or about to be admitted on a private pay basis may waive the assessment, unless the person is expected to become eligible for medical assistance within 6 months of assessment. The county may waive this condition in accordance with guidelines established by the department. If the county waives this condition, the county must meet with the person or the person's guardian to discuss the cost-effectiveness of various service options.

9,1065 Section 1065. 46.278 (6) (d) of the statutes is amended to read:

46.278 (6) (d) If a county makes available nonfederal funds equal to the state share of service costs under the waiver received under sub. (3), the department may, from the appropriation under s. 20.435 (5) (4) (o), provide reimbursement for services that the county provides under this section to persons who are in addition to those who may be served under this section with funds from the appropriation under s. 20.435 (5) (4) (b).

9,1066 Section 1066. 46.278 (6) (e) of the statutes is renumbered 46.278 (6) (e) 1. (intro.) and amended to read:

46.278 (6) (e) 1. (intro.) The department may provide enhanced reimbursement for services under the program for an individual who was relocated to the community by a county department from an one of the following:

a. An intermediate care facility for the mentally retarded that closes under s. 50.03 (14).

2. a. The enhanced reimbursement rate under this paragraph subd. 1. a. and b. shall be determined under a formula that is developed by the department.

9,1067 Section 1067. 46.278 (6) (e) 1. b. of the statutes is created to read:

46.278 (6) (e) 1. b. An intermediate care facility for the mentally retarded or a distinct part thereof that has a plan of closure approved by the department and that intends to close within 12 months.

9,1067b Section 1067b. 46.278 (6) (e) 1. c. of the statutes is created to read:

46.278 (6) (e) 1. c. An intermediate care facility for the mentally retarded that has a plan of closure or significant reduction in capacity approved by the department and that intends to close or significantly reduce its capacity within 60 months.

9,1067c Section 1067c. 46.278 (6) (e) 2. b. of the statutes is created to read:

46.278 (6) (e) 2. b. The enhanced reimbursement rate under subd. 1. c. shall be 90% of the enhanced reimbursement rate under this subd. 2. a.

9,1068 Section 1068. 46.2805 of the statutes is created to read:

46.2805 Definitions; long-term care. In ss. 46.2805 to 46.2895:

(1) "Care management organization" means 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:

(a) A program of all-inclusive care for persons aged 65 or older authorized under 42 USC 1395 to 1395ggg.

(b) A demonstration program known as the Wisconsin partnership program under a federal waiver authorized under 42 USC 1315.

(2) "Eligible person" means a person who meets all eligibility criteria under s. 46.286 (1) or (1m).

(3) "Enrollee" means a person who is enrolled in a care management organization.

(4). "Family care benefit" means financial assistance for long-term care and support items for an enrollee.

(5) "Family care district" means a special purpose district created under s. 46.2895 (1).

(6) "Family care district board" means the governing board of a family care district.

(7) "Functional and financial screen" means a screen prescribed by the department that is used to determine functional eligibility under s. 46.286 (1) (a) and financial eligibility under s. 46.286 (1) (b).

(7m) "Local long-term care council" means a local long-term care council that is appointed under s. 46.282 (2) (a).

(8) "Nonprofit organization" has the meaning given in s. 108.02 (19).

(9) "Older person" means a person who is aged at least 65.

(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.

(11) "Tribe or band" means a federally recognized American Indian tribe or band.

9,1069 Section 1069. 46.281 of the statutes is created to read:

46.281 Powers and duties of the department and the secretary; long-term care. (1) Duties of the department. The department shall do all of the following:

(a) Provide training to members of the council on long-term care who are aged 65 or older or who have physical or developmental disabilities or their family members, guardians or other advocates, to enable these members to participate in the council's duties.

(b) Provide information to the council on long-term care, including copies of reports submitted to the department by local long-term care councils, and seek recommendations of the council.

(c) 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. Regardless of whether a waiver is approved, the department may implement operation of resource centers, care management organizations and the family care benefit.

(d) Before July 1, 2001:

1. Establish, in geographic areas in which resides no more than 29% of the population that is eligible for the family care benefit, a pilot project under which the department may contract with a county, a family care district, a tribe or band or the Great Lakes inter-tribal council, inc., or with any 2 or more of these entities under a joint application, to operate a resource center.

2. In geographic areas in which resides no more than 29% of the population that is eligible for the family care benefit, contract with counties or tribes or bands under a pilot project to demonstrate the ability of counties or tribes or bands to manage all long-term care programs and administer the family care benefit as care management organizations.

(e) After June 30, 2001, if the local long-term care council for the applicable area has developed the initial plan under s. 46.282 (3) (a) 1., contract with entities specified under par. (d) and, only if specifically authorized by the legislature and if the legislature appropriates necessary funding, contract as so authorized with one or more entities in addition to those specified in par. (d) certified as meeting requirements under s. 46.284 (3) for services of the entity as a care management organization and one or more entities for services specified under s. 46.283 (3) and (4).

(f) Prescribe and implement a per person monthly rate structure for costs of the family care benefit.

(g) In order to maintain continuous quality assurance and quality improvement for resource centers and care management organizations, do all of the following:

1. Prescribe by rule and by contract and enforce performance standards for operation of resource centers and care management organizations.

2. Use performance expectations that are related to outcomes for persons in contracting with care management organizations and resource centers.

3. Conduct ongoing evaluations of the long-term care system specified in ss. 46.2805 to 46.2895.

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.

5. Ensure that reviews of the quality of management and service delivery of resource centers and care management organizations are conducted by external organizations and make information about specific review results available to the public.

(h) Require by contract that resource centers and care management organizations establish procedures under which an individual who applies for or receives the family care benefit may register a complaint or grievance and procedures for resolving complaints and grievances.

(i) Prescribe criteria to assign priority equitably on any necessary waiting lists for persons who are eligible for the family care benefit but who do not meet the criteria under s. 46.286 (3).

(2) Powers of the department. The department may develop risk-sharing arrangements in contracts with care management organizations, in accordance with applicable state laws and federal statutes and regulations.

(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 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 provide a functional and financial screen. To facilitate phase-in of services of resource centers, the secretary may certify that the resource center is available for specified groups of eligible individuals or for specified facilities in the county.

9,1070 Section 1070. 46.281 (1) (a) of the statutes, as created by 1999 Wisconsin Act .... (this act), is repealed.

9,1071 Section 1071. 46.281 (1) (b) of the statutes, as created by 1999 Wisconsin Act .... (this act), is repealed.

9,1072 Section 1072. 46.282 of the statutes is created to read:

46.282 Councils on long-term care. (1) Council on long-term care. The council on long-term care appointed under s. 15.197 (5) shall do all of the following:

(a) Assist the department in developing broad policy issues related to long-term care services.

(b) Assist the department in developing, implementing, coordinating and guiding long-term care services and systems, including by reviewing and making nonbinding recommendations to the department on all of the following:

1. The department's standard contract provisions for resource centers and care management organizations.

2. The family care benefit, including the per person rate structure for the benefit.

3. The long-term support community options program under s. 46.27.

4. The community integration programs under ss. 46.275, 46.277 and 46.278.

5. Programs other than those under pars (c) and (d) that provide home and community-based services.

6. The provision of medical assistance services under a fee-for-service system.

(c) Monitor patterns of complaints, grievances and appeals related to long-term care in order to identify issues of statewide importance.

(d) Monitor the numbers of persons on waiting lists.

(e) Review patterns of utilization of various types of services by care management organizations.

(f) Monitor the pattern of care management organization enrollments and disenrollments throughout the state.

(g) Report annually to the legislature under s. 13.172 (2) and to the governor on the status, significant achievements and problems of resource centers, care management organizations and the family care benefit, including all of the following:

1. Numbers of persons served.

2. Costs of long-term care provided under the family care benefit.

3. The number and service areas of resource centers and care management organizations.

4. Waiting list information.

5. Results of reviews of quality of services provided by resource centers and care management organizations.