AB133-SSA1,592,99 (b) A determination of functional eligibility for the family care benefit.
AB133-SSA1,592,1010 (c) Within the limits of available funding, prevention and intervention services.
AB133-SSA1,592,1111 (d) Counseling concerning public and private benefits programs.
AB133-SSA1,592,1412 (e) A determination of financial eligibility and of the maximum amount of cost
13sharing required for a person who is seeking long-term care services, under
14standards prescribed by the department.
AB133-SSA1,592,1815 (f) Assistance to a person who is eligible for the family care benefit with respect
16to the person's choice of whether or not to enroll in a care management organization
17and, if so, which available care management organization would best meet his or her
18needs.
AB133-SSA1,592,2019 (g) Assistance in enrolling in a care management organization for persons who
20choose to enroll.
AB133-SSA1,592,2321 (h) Equitable assignment of priority on any necessary waiting lists, consistent
22with criteria prescribed by the department, for persons who are eligible for the family
23care benefit but who do not meet the criteria under s. 46.286 (3).
AB133-SSA1,593,3
1(i) Assessment of risk for each person who is on a waiting list, as described in
2par. (h), development with the person of an interim plan of care and assistance to the
3person in arranging for services.
AB133-SSA1,593,54 (j) Transitional services to families whose children with physical or
5developmental disabilities are preparing to enter the adult service system.
AB133-SSA1,593,86 (k) A determination of eligibility for state supplemental payments under s.
749.77, medical assistance under s. 49.46, 49.468 or 49.47 or the federal food stamp
8program under 7 USC 2011 to 2029.
AB133-SSA1,593,9 9(4) Duties. A resource center shall do all of the following:
AB133-SSA1,593,1110 (a) Provide services within the entire geographic area prescribed for the
11resource center by the department.
AB133-SSA1,593,1312 (b) Submit to the department all reports and data required or requested by the
13department.
AB133-SSA1,593,1514 (c) Implement internal quality improvement and quality assurance processes
15that meet standards prescribed by the department.
AB133-SSA1,593,1616 (d) Cooperate with any review by an external advocacy organization.
AB133-SSA1,593,2317 (e) Within 6 months after the family care benefit is available to all eligible
18persons in the area of the resource center, provide information about the services of
19the resource center, including the services specified in sub. (3) (d), about assessments
20under s. 46.284 (4) (b) and care plans under s. 46.284 (4) (c) and about the family care
21benefit to all older persons and persons with a physical disability who are residents
22of nursing homes, community-based residential facilities, adult family homes and
23residential care apartment complexes in the area of the resource center.
AB133-SSA1,594,3
1(f) Provide a functional and financial screen to any resident, as specified in par.
2(e), who requests a screen and assist any resident who is eligible and chooses to enroll
3in a care management organization to do so.
AB133-SSA1,594,94 (g) Provide a functional and financial screen to any person seeking admission
5to a nursing home, community-based residential facility, residential care apartment
6complex or adult family home if the secretary has certified that the resource center
7is available to the person and the facility and the person is determined by the
8resource center to have a condition that is expected to last at least 90 days that would
9require care, assistance or supervision.
AB133-SSA1,594,1210 (h) Provide access to services under s. 46.90 and ch. 55 to a person who is
11eligible for the services, through cooperation with the county agency or agencies that
12provide the services.
AB133-SSA1,594,1413 (i) Assure that emergency calls to the resource center are responded to
14promptly, 24 hours per day.
AB133-SSA1,594,18 15(5) Funding. From the appropriation accounts under s. 20.435 (4) (b), (bm) and
16(pa) and (7) (b), (bd) and (md), the department may contract with organizations that
17meet standards under sub. (3) for performance of the duties under sub. (4) and shall
18distribute funds for services provided by resource centers.
AB133-SSA1,594,23 19(6) Governing board. A resource center shall have a governing board that
20reflects the ethnic and economic diversity of the geographic area served by the
21resource center. At least one-fourth of the members of the governing board shall be
22older persons or persons with physical or developmental disabilities or their family
23members, guardians or other advocates.
AB133-SSA1,595,3 24(7) Confidentiality; exchange of information. No record, as defined in s. 19.32
25(2), of a resource center that contains personally identifiable information, as defined

1in s. 19.62 (5), concerning an individual who receives services from the resource
2center may be disclosed by the resource center without the individual's informed
3consent, except as follows:
AB133-SSA1,595,64 (a) A resource center may provide information as required to comply with s.
516.009 (2) (p) or 49.45 (4) or as necessary for the department to administer the
6program under ss. 46.2805 to 46.2895.
AB133-SSA1,595,137 (b) Notwithstanding ss. 48.78 (2) (a), 49.45 (4), 49.83, 51.30, 51.45 (14) (a), 55.06
8(17) (c), 146.82, 252.11 (7), 253.07 (3) (c) and 938.78 (2) (a), a resource center acting
9under this section may exchange confidential information about a client, as defined
10in s. 46.287 (1), without the informed consent of the client, under s. 46.21 (2m) (c),
1146.215 (1m), 46.22 (1) (dm), 46.23 (3) (e), 46.284 (7), 46.2895 (10), 51.42 (3) (e) or
1251.437 (4r) (b) in the county of the resource center, if necessary to enable the resource
13center to perform its duties or to coordinate the delivery of services to the client.
AB133-SSA1, s. 1075 14Section 1075. 46.284 of the statutes is created to read:
AB133-SSA1,595,19 1546.284 Care management organizations. (1) Application for contract.
16(a) After considering recommendations of the local long-term care council under s.
1746.282 (3) (a) 1., a county board of supervisors and, in a county with a county
18executive or a county administrator, the county executive or county administrator,
19may decide all of the following:
AB133-SSA1,595,2320 1. Whether to authorize one or more county departments under s. 46.21,
2146.215, 46.22 or 46.23 or an aging unit under s. 46.82 (1) (a) 1. or 2. to apply to the
22department for a contract to operate a care management organization and, if so,
23which to authorize and what client group to serve.
AB133-SSA1,595,2524 2. Whether to create a family care district to apply to the department for a
25contract to operate a care management organization.
AB133-SSA1,596,4
1(b) The governing body of a tribe or band or of the Great Lakes inter-tribal
2council, inc., may decide whether to authorize a tribal agency to apply to the
3department for a contract to operate a care management organization for tribal
4members and, if so, which client group to serve.
AB133-SSA1,596,95 (c) Under the requirements of par. (a), a county board of supervisors may decide
6to apply to the department for a contract to operate a multicounty care management
7organization in conjunction with the county board or boards of one or more other
8counties or a county-tribal care management organization in conjunction with the
9governing body of a tribe or band or the Great Lakes inter-tribal council, inc.
AB133-SSA1,596,1410 (d) Under the requirements of par. (b), the governing body of a tribe or band may
11decide to apply to the department for a contract to operate a care management
12organization in conjunction with the governing body or governing bodies of one or
13more other tribes or bands or the Great Lakes inter-tribal council, inc., or with a
14county board of supervisors.
AB133-SSA1,596,19 15(2) Contracts. (a) The department may contract for operation of a care
16management organization only with an entity that is certified as meeting the
17requirements under sub. (3). No entity may operate as a care management
18organization under the requirements of this section unless so certified and under
19contract with the department.
AB133-SSA1,597,220 (b) Within each county, the department shall initially contract to operate a care
21management organization with the county or a family care district if the county
22elects to operate a care management organization and the care management
23organization meets the requirements of sub. (3) and performance standards
24prescribed by the department. A county that contracts under this paragraph may
25operate the care management organization for all of the target groups or for a

1selected group or groups. With respect to contracts exclusively with counties to
2operate a care management organization, all of the following apply:
AB133-SSA1,597,53 1. Before January 1, 2003, the department may not contract with an
4organization other than the county to operate a care management organization in
5the county unless any of the following applies:
AB133-SSA1,597,76 a. The county and the local long-term care council agree in writing that at least
7one additional care management organization is necessary or desirable.
AB133-SSA1,597,108 b. The governing body of a tribe or band or the Great Lakes inter-tribal council,
9inc., elects to operate a care management organization within the area and is
10certified under sub. (3).
AB133-SSA1,597,1311 2. After December 31, 2002, and before January 1, 2004, the department may
12not contract with an organization other than the county to operate a care
13management organization in the county unless any of the following applies:
AB133-SSA1,597,1414 a. Subdivision 1. a. or b. applies.
AB133-SSA1,597,1615 b. The county fails to meet requirements of sub. (3) and performance standards
16prescribed by the department.
AB133-SSA1,597,2017 c. The county does not have the capacity to serve all county residents who are
18entitled to the family care benefit in the client group or groups that the county serves
19and cannot develop the capacity. If this subd. 2. c. applies, the department may
20contract with an organization in addition to the county.
AB133-SSA1,598,521 3. After December 31, 2003, the department may contract with counties, family
22care districts, the governing body of a tribe or band or the Great Lakes inter-tribal
23council, inc., or under a joint application of any of these, or with a private nonprofit
24organization that has no significant connection to an entity that operates a resource
25center. Proposals for contracts under this subdivision shall be solicited under a

1competitive sealed proposal process under s. 16.75 (2m) and, after consulting with
2the local long-term care council for the county or counties, the department shall
3evaluate the proposals primarily as to the quality of care that is proposed to be
4provided, certify those applicants that meet the requirements specified in sub. (3) (a),
5select certified applicants for contract and contract with the selected applicants.
AB133-SSA1,598,12 6(3) Certification; requirements. (a) If an entity meets the requirements
7under par. (b) and applicable rules of the department and submits to the department
8an application for initial certification or certification renewal, the department shall
9certify that the entity meets the requirements for a care management organization.
10An application shall include comments about the applicant and recommendations
11about the application that are provided by the appropriate local long-term care
12council, as specified under s. 46.282 (3) (a) 3.
AB133-SSA1,598,1413 (b) To be certified as a care management organization, an applicant shall
14demonstrate or ensure all of the following:
AB133-SSA1,598,1815 1. Adequate availability of providers with the expertise and ability to provide
16services that are responsive to the disabilities or conditions of all of the applicant's
17proposed enrollees and sufficient representation of programmatic philosophies and
18cultural orientations to accommodate a variety of enrollee preferences and needs.
AB133-SSA1,598,2119 2. Adequate availability of providers that can meet the preferences and needs
20of its proposed service recipients for services at various times, including evenings,
21weekends and, when applicable, on a 24-hour basis.
AB133-SSA1,598,2422 3. Adequate availability of providers that are able and willing to perform all
23of the tasks that are likely to be identified in proposed enrollees' service and care
24plans.
AB133-SSA1,599,2
14. Adequate availability of residential and day services that are geographically
2accessible to proposed enrollees' homes, families or friends.
AB133-SSA1,599,43 5. Adequate supported living arrangements of the types and sizes that meet
4proposed enrollees' preference and needs.
AB133-SSA1,599,75 6. Expertise in determining and meeting the needs of every target population
6that the applicant proposes to serve and connections to the appropriate service
7providers.
AB133-SSA1,599,88 7. Thorough knowledge of local long-term care and other community resources.
AB133-SSA1,599,119 8. The ability to manage and deliver, either directly or through subcontracts
10or partnerships with other organizations, the full range of benefits to be included in
11the monthly payment amount.
AB133-SSA1,599,1312 9. Thorough knowledge of methods for maximizing informal caregivers and
13community resources and integrating them into a service or care plan.
AB133-SSA1,599,1414 10. Coverage for a geographic area specified by the department.
AB133-SSA1,599,1815 11. The ability to develop strong linkages with systems and services that are
16not directly within the scope of the applicant's responsibility but that are important
17to the target group that it proposes to serve, including primary and acute health care
18services.
AB133-SSA1,599,2019 12. Adequate and competent staffing by qualified personnel to perform all of
20the functions that the applicant proposes to undertake.
AB133-SSA1,599,22 21(4) Duties. A care management organization shall, in addition to meeting all
22contract requirements, do all of the following:
AB133-SSA1,600,523 (a) Accept requested enrollment of any person who is entitled to the family care
24benefit and of any person who is eligible for the family care benefit and for whom
25funding is available. No care management organization may disenroll any enrollee,

1except under circumstances specified by the department by contract. No care
2management organization may encourage any enrollee to disenroll in order to obtain
3long-term care services under the medical assistance fee-for-service system. No
4involuntary disenrollment is effective unless the department has reviewed and
5approved it.
AB133-SSA1,600,86 (b) Conduct a comprehensive assessment for each enrollee, including an
7in-person interview with the enrollee, using a standard format developed by the
8department.
AB133-SSA1,600,119 (c) With the enrollee and the enrollee's family or guardian, if appropriate,
10develop a comprehensive care plan that reflects the enrollee's values and
11preferences.
AB133-SSA1,600,1312 (d) Provide or contract for the provision of necessary services and monitor the
13provided or contracted services.
AB133-SSA1,600,2114 (e) Provide, within guidelines established by the department, a mechanism by
15which an enrollee may arrange for, manage and monitor his or her family care benefit
16directly or with the assistance of another person chosen by the enrollee. The care
17management organization shall monitor the enrollee's use of a fixed budget for
18purchase of services or support items from any qualified provider, monitor the health
19and safety of the enrollee and provide assistance in management of the enrollee's
20budget and services at a level tailored to the enrollee's need and desire for the
21assistance.
AB133-SSA1,600,2322 (f) Provide, on a fee-for-service basis, case management services to persons
23who are functionally eligible but not financially eligible for the family care benefit.
AB133-SSA1,600,2524 (g) Meet all performance standards required by the federal government or
25promulgated by the department by rule.
AB133-SSA1,601,2
1(h) Submit to the department reports and data required or requested by the
2department.
AB133-SSA1,601,43 (i) Implement internal quality improvement and assurance processes that
4meet standards prescribed by the department by rule.
AB133-SSA1,601,55 (j) Cooperate with external quality assurance reviews.
AB133-SSA1,601,66 (k) Meet departmental requirements for protection of solvency.
AB133-SSA1,601,87 (L) Annually submit to the department an independent financial audit that
8meets federal requirements.
AB133-SSA1,601,15 9(5) Funding and risk-sharing. (a) From the appropriation accounts under s.
1020.435 (4) (b), (g) and (o) and (7) (b) and (bd), the department shall provide funding
11on a capitated payment basis for the provision of services under this section.
12Notwithstanding s. 46.036 (3) and (5m), a care management organization that is
13under contract with the department may expend the funds, consistent with this
14section, including providing payment, on a capitated basis, to providers of services
15under the family care benefit.
AB133-SSA1,601,2016 (b) If the expenditures by a care management organization under par. (a)
17exceed payments received from the department under par. (a), as determined by the
18department by contract, the department may share the loss with the care
19management organization, within the limits prescribed under the contract with the
20department.
AB133-SSA1,601,2521 (c) If the payments received from the department under par. (a) exceed the
22expenditures by a care management organization under par. (a), as determined by
23the department by contract, the care management organization may retain a portion
24of the excess payments, within the limits prescribed under the contract with the
25department, and shall return the remainder to the department.
AB133-SSA1,602,3
1(d) The department may, by contract, impose solvency protections that the
2department determines are reasonable and necessary to retain federal financial
3participation. These protections may include all of the following:
AB133-SSA1,602,64 1. The requirement that a care management organization segregate a risk
5reserve from other funds of the care management organization or the authorizing
6body for the care management organization.
AB133-SSA1,602,87 2. The requirement that interest accruing to the risk reserve remain in the
8escrow account for the risk reserve.
AB133-SSA1,602,99 3. Limitations on the distribution of funds from the risk reserve.
AB133-SSA1,602,2010 4. The requirement that a care management organization place funds in a risk
11reserve and maintain the risk reserve in an interest-bearing escrow account with a
12financial institution, as defined in s. 69.30 (1) (b), or invest funds as specified in s.
1346.2895 (4) (j) 2. or 3. Moneys in the risk reserve or invested as specified in this
14subdivision may be expended only for the provision of services under this section.
15If a care management organization ceases participation under this section, the funds
16in the risk reserve or invested as specified in this subdivision, minus any
17contribution of moneys other than those specified in par. (c), shall be returned to the
18department. The department shall expend the moneys for the payment of
19outstanding debts to providers of family care benefit services and for the
20continuation of family care benefit services to enrollees.
AB133-SSA1,602,2321 (e) 1. Subject to subd. 2., a care management organization may enter into
22contracts with providers of family care benefit services and may limit profits of the
23providers under the contracts.
AB133-SSA1,603,224 2. The department shall review the contracts in subd. 1., including rates for the
25provision of service, to ensure that the contract terms protect services access by

1enrollees and financial viability of the care management organization, and may
2require contract revision.
AB133-SSA1,603,8 3(6) Governing board. A care management organization shall have a governing
4board that reflects the ethnic and economic diversity of the geographic area served
5by the care management organization. At least one-fourth of the members of the
6governing board shall be older persons or persons with physical or developmental
7disabilities or their family members, guardians or other advocates who are
8representative of the care management organization's enrollee.
AB133-SSA1,603,13 9(7) Confidentiality; exchange of information. No record, as defined in s. 19.32
10(2), of a care management organization that contains personally identifiable
11information, as defined in s. 19.62 (5), concerning an individual who receives services
12from the care management organization may be disclosed by the care management
13organization without the individual's informed consent, except as follows:
AB133-SSA1,603,1614 (a) A care management organization may provide information as required to
15comply with s. 16.009 (2) (p) or 49.45 (4) or as necessary for the department to
16administer the program under ss. 46.2805 to 46.2895.
AB133-SSA1,603,2417 (b) Notwithstanding ss. 48.78 (2) (a), 49.45 (4), 49.83, 51.30, 51.45 (14) (a), 55.06
18(17) (c), 146.82, 252.11 (7), 253.07 (3) (c) and 938.78 (2) (a), a care management
19organization acting under this section may exchange confidential information about
20a client, as defined in s. 46.287 (1), without the informed consent of the client, under
21s. 46.21 (2m) (c), 46.215 (1m), 46.22 (1) (dm), 46.23 (3) (e), 46.283 (7), 46.2895 (10),
2251.42 (3) (e) or 51.437 (4r) (b) in the county of the care management organization, if
23necessary to enable the care management organization to perform its duties or to
24coordinate the delivery of services to the client.
AB133-SSA1, s. 1077 25Section 1077. 46.285 of the statutes is created to read:
AB133-SSA1,604,6
146.285 Operation of resource center and care management
2organization.
(1) In order to meet federal requirements and assure federal
3financial participation in funding of the family care benefit, a county, a tribe or band,
4a family care district or an organization, including a private, nonprofit corporation,
5may not directly operate both a resource center and a care management
6organization, except as follows:
AB133-SSA1,604,107 (a) For a pilot project established under s. 46.281 (1) (d) 2., provision of the
8services specified under s. 46.283 (3) (b), (e), (f) and (g) shall be structurally separate
9from the provision of services of the care management organization by January 1,
102001.
AB133-SSA1,604,1311 (b) The department may approve separation of the functions of a resource
12center from those of a care management organization by a means other than those
13specified in sub. (2).
AB133-SSA1,604,15 14(2) Except as provided in sub. (1), all of the following apply to operation of both
15a resource center and a care management organization:
AB133-SSA1,604,1916 (a) 1. If a county board of supervisors and, if applicable, a county executive or
17a county administrator, elect to apply to the department for a contract to operate a
18resource center, the county board of supervisors may create a family care district to
19apply to the department for a contract to operate a care management organization.
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