Amendment ASA2-AB1110

AB1110-ASA2, s. 6 Section 6. 46.2804 of the statutes is created to read:

AB1110-ASA2,5,21 46.2804 Managed care programs for long-term care services. (1) If the department intends to expand its use of capitation payments under managed care programs for provision of long-term care services over the number of capitated payments made on behalf of individuals enrolled in these managed care programs under 2005 Wisconsin Act 25, the department shall first notify the joint committee on finance in writing of the proposed expansion. Unless the proposed expansion is a part of a biennial budget bill, the joint committee on finance shall, within 14 working days after the date of the department's notification, schedule a meeting under s. 13.10 to approve, modify, or disapprove the proposed expansion. The department may make the expansion only as approved or modified by the joint committee on finance.

AB1110-ASA2,6,11 (2) Under a managed care program for provision of long-term care services, the care manager shall provide, within guidelines established by the department, a mechanism by which an enrollee, beneficiary, or recipient of the program may arrange for, manage, and monitor his or her benefit directly or with the assistance of another person chosen by the enrollee, beneficiary, or recipient. The care manager shall provide each enrollee, beneficiary, or recipient with a form on which the enrollee, beneficiary, or recipient shall indicate whether he or she has been offered the option under this subsection and whether he or she has accepted or declined the option. If the enrollee, beneficiary, or recipient accepts the option, the care manager shall monitor the use by the enrollee, beneficiary, or recipient of a fixed budget for purchase of services or support items from any qualified provider, monitor the health and safety of the enrollee, beneficiary, or recipient, and provide assistance in management of the budget and services of the enrollee, beneficiary, or recipient at a level tailored to the need and desire of the enrollee, beneficiary, or recipient for the assistance.

AB1110-ASA2, s. 7 Section 7. 46.281 (1) (d) (intro.) of the statutes is repealed.

AB1110-ASA2, s. 8 Section 8. 46.281 (1) (d) 1. of the statutes is repealed.

AB1110-ASA2, s. 9 Section 9. 46.281 (1) (d) 2. of the statutes is renumbered 46.281 (1) (d) and amended to read:

AB1110-ASA2,7,16 46.281 (1) (d) In geographic areas in which, in the aggregate, resides no more than 29% 29 percent of the state 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 a county, a family care district, a tribe or band, the Great Lakes Inter-Tribal Council, Inc., or with 2 or more of these entities to manage all long-term care programs and administer the family care benefit as care management organizations. If the department proposes to contract with these entities to administer care management organizations in geographic areas in which, in the aggregate, resides more than 29 percent but less than 50 percent of the state population that is eligible for the family care benefit, the department shall first notify the joint committee on finance in writing of the proposed contract. The notification shall include the contract proposal; and an estimate of the fiscal impact of the proposed addition that demonstrates that the addition will be cost neutral, including startup, transitional, and ongoing operational costs and any proposed county contribution. If the cochairpersons of the committee do not notify the department within 14 working days after the date of the department's notification that the committee has scheduled a meeting for the purpose of reviewing the proposed contract, the department may enter into the proposed contract. If within 14 days after the date of the department's notification the cochairpersons of the committee notify the department that the committee has scheduled a meeting for the purpose of reviewing the proposed contract, the department may enter into the proposed contract only upon approval of the committee. The department may contract with these entities to administer care management organizations in geographic areas in which, in the aggregate, resides 50 percent or more of the state population that is eligible for the family care benefit only if specifically authorized by the legislature and if the legislature appropriates necessary funding.

AB1110-ASA2, s. 10 Section 10. 46.281 (1) (e) (intro.) of the statutes, as affected by 2005 Wisconsin Act 25, is repealed.

AB1110-ASA2, s. 11 Section 11. 46.281 (1) (e) 1. of the statutes, as affected by 2005 Wisconsin Act 25, is amended to read:

AB1110-ASA2,8,2 46.281 (1) (e) 1. If Subject to the requirements of par. (d), 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 may, 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.

AB1110-ASA2, s. 12 Section 12. 46.281 (1) (e) 2. of the statutes, as created by 2005 Wisconsin Act 25, is amended to read:

AB1110-ASA2,8,17 46.281 (1) (e) 2. Contract with entities specified under par. (d) and may contract with other entities for the provision of services under s. 46.283 (3) and (4), except that after July 27, 2005, the department shall notify the joint committee on finance in writing of any proposed contract with an entity that did not have a contract to provide services under s. 46.283 (3) and (4) before July 27, 2005. If the cochairpersons of the committee do not notify the department within 14 working days after the date of the department's notification that the committee has scheduled a meeting for the purpose of reviewing the proposed contract, the department may enter into the proposed contract. If within 14 working days after the date of the department's notification the cochairpersons of the committee notify the department that the committee has scheduled a meeting for the purpose of reviewing the proposed contract, the department may enter into the proposed contract only upon approval of the committee.

AB1110-ASA2, s. 13 Section 13. 46.281 (1) (g) 3. of the statutes is amended to read:

AB1110-ASA2,9,2 46.281 (1) (g) 3. Conduct ongoing evaluations of the long-term care system specified in ss. 46.2805 to 46.2895 managed care programs for provision of long-term care services that are funded by medical assistance, as defined in s. 46.278 (1m) (b), as to client access to services, the availability of client choice of living and service options, quality of care, and cost-effectiveness. In evaluating the availability of client choice, the department shall evaluate the opportunity for a client to arrange for, manage, and monitor his or her family care benefit directly or with assistance, as specified in s. 46.284 (4) (e).

AB1110-ASA2, s. 14 Section 14. 46.282 (2) (a) (intro.) of the statutes is amended to read:

AB1110-ASA2,9,7 46.282 (2) (a) Appointment by a county. (intro.) In a county that participates in a pilot project in which the department has a contract under s. 46.281 (1) (d) (e) and before a county participates in the program under ss. 46.2805 to 46.2895, the following shall be done:

AB1110-ASA2, s. 15 Section 15. 46.283 (2) (b) (intro.) of the statutes, as affected by 2005 Wisconsin Act 25, is amended to read:

AB1110-ASA2,9,18 46.283 (2) (b) (intro.) After June 30, 2001, the department shall contract with the entities specified under s. 46.281 (1) (d) 1. and may, if the applicable review conditions under s. 48.281 (1) (e) 2. s. 46.281 (1) (e) 2. are satisfied, in addition to contracting with these entities, contract to operate a resource center with counties, family care districts, or the governing body of a tribe or band or the Great Lakes Inter-Tribal Council, Inc., under a joint application of any of these, 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:

AB1110-ASA2, s. 16 Section 16. 46.284 (4) (e) of the statutes is amended to read:

AB1110-ASA2,9,25 46.284 (4) (e) Provide, within guidelines established by the department, a mechanism by which an enrollee may arrange for, manage, and monitor his or her family care benefit directly or with the assistance of another person chosen by the enrollee. The care management organization shall provide each enrollee with a form on which the enrollee shall indicate whether he or she has been offered the option under this paragraph and whether he or she has accepted or declined the option. If the enrollee accepts the option, the care management organization shall monitor the enrollee's use of a fixed budget for purchase of services or support items from any qualified provider, monitor the health and safety of the enrollee, and provide assistance in management of the enrollee's budget and services at a level tailored to the enrollee's need and desire for the assistance.

AB1110-ASA2, s. 17 Section 17. 46.285 (1) (a) of the statutes is amended to read:

AB1110-ASA2,10,10 46.285 (1) (a) For a pilot project established an entity with which the department has contracted under s. 46.281 (1) (d) 2. (e) 1., provision of the services specified under s. 46.283 (3) (b), (e), (f) and (g) shall be structurally separate from the provision of services of the care management organization by January 1, 2001.

AB1110-ASA2, s. 18 Section 18. 49.45 (3) (ag) of the statutes is amended to read:

AB1110-ASA2,10,14 49.45 (3) (ag) Reimbursement shall be made to each entity contracted with under s. 46.281 (1) (d) (e) for functional screens performed under s. 46.281 (1) (d) by the entity.

AB1110-ASA2, s. 19 Section 19. Nonstatutory provisions.

AB1110-ASA2,10,17 (1) Increased payments for nursing homes providing Family Care benefit services.

AB1110-ASA2,10,18 (a) In this subsection:

AB1110-ASA2,10,20 1. "Care management organization" has the meaning given in section 46.2805 (1) of the statutes.

AB1110-ASA2,10,21 2. "Facility" has the meaning given in section 49.45 (6m) (a) 3. of the statutes.

AB1110-ASA2,10,23 3. "Family Care benefit" has the meaning given in section 46.2805 (4) of the statutes.

AB1110-ASA2,10,25 4. "Medical Assistance" has the meaning given in section 46.278 (1m) (b) of the statutes.

AB1110-ASA2,11,3 (b) Care management organizations shall provide increased funding for reimbursement for care provided by facilities for recipients of Medical Assistance as a Family Care benefit, in amounts that proportionately reflect all of the following:

AB1110-ASA2,11,5 1. For fiscal year 2005-06, the nursing home reimbursement supplement authorized under 2005 Wisconsin Act 211, Section 1 (4d).

AB1110-ASA2,11,7 2. For fiscal year 2006-07, the nursing home reimbursement rate increase authorized under 2005 Wisconsin Act 211, Section 1 (4c).

AB1110-ASA2,11,8 (End)