Amendment SSA1-SB40

SB40-SSA1,549,24 46.284 (3) (a) If an entity meets the requirements under par. (b) and applicable rules of the department and submits to the department an application for initial certification or certification renewal, the department shall certify that the entity meets the requirements for a care management organization. An application shall include comments about the applicant and recommendations about the application that are provided by the appropriate local long-term care council, as specified under s. 46.282 (3) (a) 3.

SB40-SSA1, s. 999 Section 999. 46.284 (5) (a) of the statutes is amended to read:

SB40-SSA1,550,7 46.284 (5) (a) From the appropriation accounts under s. 20.435 (4) (b), (g), (gp), (im), (o), and (w), and (xd) and (7) (b) and, (bd), and (g), the department shall provide funding on a capitated payment basis for the provision of services under this section. Notwithstanding s. 46.036 (3) and (5m), a care management organization that is under contract with the department may expend the funds, consistent with this section, including providing payment, on a capitated basis, to providers of services under the family care benefit.

SB40-SSA1, s. 1000 Section 1000. 46.284 (6) of the statutes is amended to read:

SB40-SSA1,550,16 46.284 (6) Governing board. A care management organization shall have a governing board that reflects the ethnic and economic diversity of the geographic area served by the care management organization. At least one-fourth of the members of the governing board shall be older persons or persons with physical or developmental disabilities or their family members, guardians or other advocates who are representative of the client group or groups whom the care management organization's enrollee organization is contracted to serve or those clients' family members, guardians, or other advocates.

SB40-SSA1, s. 1001 Section 1001. 46.285 (1) of the statutes is renumbered 46.285, and 46.285 (intro.), (1) and (2), as renumbered, are amended to read:

SB40-SSA1,550,23 46.285 (intro.) In order to meet federal requirements and assure federal financial participation in funding of the family care benefit, a county, a tribe or band, a family long-term care district or an organization, including a private, nonprofit corporation, may not directly operate both a resource center and a care management organization, except as follows:

SB40-SSA1,551,2 (1) For an entity with which the department has contracted under s. 46.281 (1) (e) 1., 2005 stats., 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.

SB40-SSA1,551,6 (2) The department may approve separation of the functions of a resource center from those of a care management organization by a means other than those specified in sub. (2) creating a long-term care district under s. 46.2895 to serve either as a resource center or a care management organization.

SB40-SSA1, s. 1002 Section 1002. 46.285 (2) of the statutes is repealed.

SB40-SSA1, s. 1003 Section 1003. 46.286 (1) (intro.) of the statutes is amended to read:

SB40-SSA1,551,13 46.286 (1) Eligibility. (intro.) A person is eligible for, but not necessarily entitled to, the family care benefit if the person is at least 18 years of age; has a physical disability, as defined in s. 15.197 (4) (a) 2., or a developmental disability, as defined in s. 51.01 (5) (a), or degenerative brain disorder, as defined in s. 55.01 (1v) is a frail elder; and meets all of the following criteria:

SB40-SSA1, s. 1004 Section 1004. 46.286 (1) (a) 1. of the statutes is amended to read:

SB40-SSA1,551,16 46.286 (1) (a) 1. The person's functional capacity level of care need is at either of the following levels:

SB40-SSA1,551,19 a. The comprehensive nursing home level, if the person has a long-term or irreversible condition, expected to last at least 90 days or result in death within one year of the date of application, and requires ongoing care, assistance or supervision.

SB40-SSA1,551,23 b. The intermediate non-nursing home level, if the person has a condition that is expected to last at least 90 days or result in death within 12 months after the date of application, and is at risk of losing his or her independence or functional capacity unless he or she receives assistance from others.

SB40-SSA1, s. 1005 Section 1005. 46.286 (1) (b) (intro.) of the statutes is amended to read:

SB40-SSA1,552,2 46.286 (1) (b) Financial eligibility. (intro.) A person is financially eligible if all any of the following apply:

SB40-SSA1, s. 1006 Section 1006. 46.286 (1) (b) 1. (intro.) of the statutes is repealed.

SB40-SSA1, s. 1007 Section 1007. 46.286 (1) (b) 1. a. of the statutes is renumbered 46.286 (1) (b) 3. and amended to read:

SB40-SSA1,552,11 46.286 (1) (b) 3. The person was receiving the family care benefit on the effective date of this subdivision .... [revisor inserts date], the person would qualify for medical assistance except for financial or disability criteria, and the projected cost of the person's care plan, as calculated by the department or its designee, exceeds the person's gross monthly income, plus one-twelfth of his or her countable assets, less deductions and allowances permitted by rule by the department.

SB40-SSA1, s. 1008 Section 1008. 46.286 (1) (b) 1. b. and 2. of the statutes are consolidated, renumbered 46.286 (1) (b) 1m. and amended to read:

SB40-SSA1,552,17 46.286 (1) (b) 1m. The person is eligible under ch. 49 for medical assistance. 2. If subd. 1. b. applies, the person accepts medical assistance and, unless he or she is exempt from the acceptance under rules promulgated by the department, accepts medical assistance.

SB40-SSA1, s. 1009 Section 1009. 46.286 (3) (a) (intro.) of the statutes is amended to read:

SB40-SSA1,552,21 46.286 (3) (a) (intro.) Subject to pars. par. (c) and (d), a person is entitled to and may receive the family care benefit through enrollment in a care management organization if he or she all of the following apply:

SB40-SSA1,552,22 1m. The person is at least 18 years of age,.

SB40-SSA1,552,25 2m. The person has a physical disability, as defined in s. 15.197 (4) (a) 2., a developmental disability, as defined in s. 51.01 (5) (a), or degenerative brain disorder, as defined in s. 55.01 (1v), is a frail elder.

SB40-SSA1,553,2 4m. The person is financially eligible, under sub. (1) (b) 1m., and fulfills any applicable cost-sharing requirements and meets any of the following criteria:.

SB40-SSA1, s. 1010 Section 1010. 46.286 (3) (a) 1. of the statutes is repealed.

SB40-SSA1, s. 1011 Section 1011. 46.286 (3) (a) 2. of the statutes is repealed.

SB40-SSA1, s. 1012 Section 1012. 46.286 (3) (a) 3. of the statutes is repealed.

SB40-SSA1, s. 1013 Section 1013. 46.286 (3) (a) 3m. of the statutes is created to read:

SB40-SSA1,553,7 46.286 (3) (a) 3m. The person is functionally eligible under sub. (1) (a).

SB40-SSA1, s. 1014 Section 1014. 46.286 (3) (a) 4. of the statutes is repealed.

SB40-SSA1, s. 1015 Section 1015. 46.286 (3) (a) 6. of the statutes is repealed.

SB40-SSA1, s. 1016 Section 1016. 46.286 (3) (d) of the statutes is repealed.

SB40-SSA1, s. 1017 Section 1017. 46.286 (3m) of the statutes is repealed and recreated to read:

SB40-SSA1,553,13 46.286 (3m) Information about enrollees. The department shall obtain and share information about family care enrollees as provided in s. 49.475.

SB40-SSA1, s. 1018 Section 1018. 46.288 (2) (intro.) of the statutes is amended to read:

SB40-SSA1,553,21 46.288 (2) (intro.) Criteria and procedures for determining functional eligibility under s. 46.286 (1) (a), financial eligibility under s. 46.286 (1) (b), and cost sharing under s. 46.286 (2) (a) and entitlement under s. 46.286 (3). The rules for determining functional eligibility under s. 46.286 (1) (a) 1. a. shall be substantially similar to eligibility criteria for receipt of the long-term support community options program under s. 46.27. Rules under this subsection shall include definitions of the following terms applicable to s. 46.286:

SB40-SSA1, s. 1019 Section 1019. 46.289 (title) of the statutes is renumbered 46.2803 (title).

SB40-SSA1, s. 1020 Section 1020. 46.289 of the statutes is renumbered 46.2803 (1).

SB40-SSA1, s. 1021 Section 1021. 46.2895 (title) of the statutes is amended to read:

SB40-SSA1,553,25 46.2895 (title) Family Long-term care district.

SB40-SSA1, s. 1022 Section 1022. 46.2895 (1) (a) (intro.) of the statutes is amended to read:

SB40-SSA1,554,8 46.2895 (1) Creation. (a) (intro.) A county board of supervisors, a tribe or band, or any combination of counties or tribes or bands, may create a special purpose district that is termed a "family long-term care district", that is a local unit of government, that is separate and distinct from, and independent of, the state and the county or tribe or band that created it, and that has the powers and duties specified in this section, if the each county board or tribe or band that participates in creating the district does all of the following:

SB40-SSA1, s. 1023 Section 1023. 46.2895 (1) (a) 1. a. of the statutes is amended to read:

SB40-SSA1,554,11 46.2895 (1) (a) 1. a. Declares the need for establishing the family long-term care district.

SB40-SSA1, s. 1024 Section 1024. 46.2895 (1) (a) 1. b. of the statutes is amended to read:

SB40-SSA1,554,16 46.2895 (1) (a) 1. b. Specifies the family long-term care district's primary purpose, which shall be to operate, under contract with the department, either a resource center under s. 46.283 or, a care management organization under s. 46.284, but not both, or a program described under s. 46.2805 (1) (a) or (b).

SB40-SSA1, s. 1025 Section 1025. 46.2895 (1) (a) 1. c. of the statutes is created to read:

SB40-SSA1,554,21 46.2895 (1) (a) 1. c. Specifies the number of individuals who shall be appointed as members of the long-term care district board, the length of their terms, and, if the long-term care district is created by more than one county or tribe or band, how many members shall be appointed by each county or tribe or band.

SB40-SSA1, s. 1026 Section 1026. 46.2895 (1) (b) of the statutes is repealed.

SB40-SSA1, s. 1027 Section 1027. 46.2895 (1) (c) of the statutes is created to read:

SB40-SSA1,555,3 46.2895 (1) (c) A long-term care district may not operate a care management organization under s. 46.284 or a program described under s. 46.2805 (1) (a) or (b) if the district operates a resource center under s. 46.283.

SB40-SSA1, s. 1028 Section 1028. 46.2895 (1) (d) of the statutes is created to read:

SB40-SSA1,555,6 46.2895 (1) (d) A county or tribe or band may create more than one long-term care district.

SB40-SSA1, s. 1029 Section 1029. 46.2895 (1) (e) of the statutes is created to read:

SB40-SSA1,555,13 46.2895 (1) (e) A long-term care district may change its primary purpose specified under par. (a) 1. b. if all the counties or tribes or bands that created the district and that have not withdrawn or been removed from the district under sub. (14), adopt a resolution approving the change in primary purpose and if the change in purpose does not violate par. (c) or any provision of a contract between the department and the district.

SB40-SSA1, s. 1030 Section 1030. 46.2895 (2) of the statutes is amended to read:

SB40-SSA1,555,19 46.2895 (2) Jurisdiction. A family long-term care district's jurisdiction is the geographical area of the county or counties of the county board or boards of supervisors who that created the family long-term care district and the geographic area of the reservation of, or lands held in trust for, any tribe or band that created the long-term care district.

SB40-SSA1, s. 1031 Section 1031. 46.2895 (3) (title) of the statutes is amended to read:

SB40-SSA1,555,21 46.2895 (3) (title) Family Long-term care district board.

SB40-SSA1, s. 1032 Section 1032. 46.2895 (3) (a) 1. of the statutes is renumbered 46.2895 (3) (a) and amended to read:

SB40-SSA1,556,3 46.2895 (3) (a) The county board of supervisors of a county or, in a county with a county administrator or county executive, the county administrator or county executive shall appoint the members of the family long-term care district board, which is the governing board of a family care district under sub. (1) (a) members whom the county is allotted, by resolutions adopted under sub. (1) (a) 1. c., to appoint.

SB40-SSA1, s. 1033 Section 1033. 46.2895 (3) (a) 2. of the statutes is repealed.

SB40-SSA1, s. 1034 Section 1034. 46.2895 (3) (b) 1. of the statutes is amended to read:

SB40-SSA1,556,11 46.2895 (3) (b) 1. The family care district board appointed under par. (a) 1. shall consist of 15 persons who are residents of the area of jurisdiction of the family care district. At least one-fourth of the members of a long-term care district board shall be representative of the client group or groups whom it is the family long-term care district's primary purpose to serve or those clients' family members, guardians, or other advocates.

SB40-SSA1, s. 1035 Section 1035. 46.2895 (3) (b) 2. of the statutes is repealed.

SB40-SSA1, s. 1036 Section 1036. 46.2895 (3) (b) 3. of the statutes is amended to read:

SB40-SSA1,556,18 46.2895 (3) (b) 3. Membership of the family a long-term care district board under subd. 1. or 2. shall reflect the ethnic and economic diversity of in the area of jurisdiction of the family long-term care district. Up to one-fourth of the members of the board may be elected or appointed officials or employees of the county or counties that created the family care district.

SB40-SSA1,556,21 4. No member of the a long-term care district board may have a private financial interest in or profit directly or indirectly from any contract or other business of the family long-term care district.

SB40-SSA1, s. 1037 Section 1037. 46.2895 (3) (b) 5. of the statutes is created to read:

SB40-SSA1,556,24 46.2895 (3) (b) 5. Only individuals who reside within the jurisdiction of a long-term care district may serve as members of the long-term care district board.

SB40-SSA1, s. 1038 Section 1038. 46.2895 (3) (c) of the statutes is repealed.

SB40-SSA1, s. 1039 Section 1039. 46.2895 (3) (d) of the statutes is amended to read:

SB40-SSA1,557,9 46.2895 (3) (d) As soon as possible after the appointment of the initial members of the family long-term care district board, the board shall organize for the transaction of business and elect a chairperson and other necessary officers. Each chairperson shall be elected by the board from time to time for the term of that chairperson's office as a member of the board or for the term of 3 years, whichever is shorter, and shall be eligible for reelection. A majority of the board shall constitute a quorum. The Unless specified otherwise in a bylaw adopted by the board, the board may act based on the affirmative vote of a majority of a quorum.

SB40-SSA1, s. 1040 Section 1040. 46.2895 (4) (intro.) of the statutes is amended to read:

SB40-SSA1,557,14 46.2895 (4) Powers. (intro.) Subject to sub. (1) (a) 1. b. (c), a family long-term care district has all the powers necessary or convenient to carry out the purposes and provisions of ss. 46.2805 to 46.2895. In addition to all these powers, a family long-term care district may do all of the following:

SB40-SSA1, s. 1041 Section 1041. 46.2895 (4) (b) of the statutes is amended to read:

SB40-SSA1,557,19 46.2895 (4) (b) Adopt bylaws and policies and procedures for the regulation of its affairs and the conduct of its business. The bylaws, policies and procedures shall be consistent with ss. 46.2805 to 46.2895 and, if the family long-term care district contracts with the department under par. (d) or (dm), with the terms of that contract.

SB40-SSA1, s. 1042 Section 1042. 46.2895 (4) (dm) of the statutes is created to read:

SB40-SSA1,557,23 46.2895 (4) (dm) Subject to sub. (1) (c), enter into a contract with the department to operate a program described under s. 46.2805 (1) (a) or (b) and provide services related to the contracted services.

SB40-SSA1, s. 1043 Section 1043. 46.2895 (4) (g) of the statutes is amended to read:

SB40-SSA1,558,5 46.2895 (4) (g) Subject to sub. (8), employ any agent, employee, or special adviser that the family long-term care district finds necessary, fix and regulate his or her compensation and provide, either directly or subject to an agreement under s. 66.0301 as a participant in a benefit plan of another governmental entity, any employee benefits, including an employee pension plan.

SB40-SSA1, s. 1044 Section 1044. 46.2895 (4) (h) of the statutes is amended to read:

SB40-SSA1,558,8 46.2895 (4) (h) Mortgage, pledge or otherwise encumber the family long-term care district's property or funds.

SB40-SSA1, s. 1045 Section 1045. 46.2895 (4) (k) of the statutes is amended to read:

SB40-SSA1,558,12 46.2895 (4) (k) Create a risk reserve or other special reserve as the family long-term care district board desires or as the department requires under the contract with the department that is specified under par. (d).