Amendment SSA1-SB21

SB21-SSA1,481,14 (b) The department, after consulting with representatives of counties, hospitals, and individuals who receive services under the children's community options program under this section, shall do all of the following:

SB21-SSA1,481,17 1. Establish minimum requirements for the provision of care management services, as defined by the department, including standards for care, times for performance of duties, and size of case loads.

SB21-SSA1,481,19 2. Specify a reasonable schedule for phasing in the requirements established under subd. 1.

SB21-SSA1,481,21 3. Provide technical consultation and assistance to the administrator of the program with respect to the requirements established under subd. 1.

SB21-SSA1,481,23 (c) The department need not promulgate as rules under ch. 227 the requirements under par. (b) 1. or the schedule under par. (b) 2.

SB21-SSA1,482,3 (11) Fiscal responsibility. Except as provided in s. 51.40, and within the limitations under sub. (13) (a) 2., the fiscal responsibility of a county for an assessment, unless the assessment is performed by an entity under a contract as specified under s. 46.284 (2), case plan, or services provided to a child under this section is as follows:

SB21-SSA1,482,6 (a) For a child seeking admission to or about to be admitted to an institutional setting, the county in which the child has residence is the county of fiscal responsibility.

SB21-SSA1,482,9 (b) For a child residing in an institutional setting, except a state-operated long-term care facility, the county in which the institution is located is the county of fiscal responsibility.

SB21-SSA1,482,12 (c) For a child living in an institutional setting, except a state-operated long-term care facility, whose legal residence is established in another county, the county in which the legal residence is established is the county of fiscal responsibility.

SB21-SSA1,482,16 (d) For a child residing in a state-operated long-term care facility, or for a person protectively placed under ch. 55, the county in which the child has residence before he or she enters the state-operated long-term care facility or is protectively placed is the county of fiscal responsibility.

SB21-SSA1,482,20 (12) Reimbursement disallowances. The department may disallow reimbursement under this section for services provided to children who do not meet the eligibility requirements for the children's community options program or any other eligibility requirements established by the department.

SB21-SSA1,482,24 (13) Funding. (a) Subject to pars. (b) and (h), from the appropriation under s. 20.435 (4) (bd), the department shall allocate funds to each county or private nonprofit agency with which the department contracts for all of the following purposes:

SB21-SSA1,483,7 1. To pay assessment and case plan costs not otherwise paid by fee or under s. 49.45 or 49.78 (2). The department shall reimburse multicounty consortia for the cost of assessing children eligible for medical assistance under s. 49.46, 49.468, 49.47, or 49.471 (4) (a) as part of the administrative services of medical assistance, payable under s. 49.45 (3) (a). Counties may use unspent funds allocated under this subdivision to pay the cost of long-term community support services and for a risk reserve under par. (f).

SB21-SSA1,483,15 2. To pay the cost of providing long-term community support services described under sub. (7) (b) not otherwise paid under s. 49.45 to children eligible for medical assistance under s. 49.46, 49.47, or 49.471 (4) (a). The county department administering the program may spend funds received under this paragraph only in accordance with the case plan and service contract created for each child receiving long-term community support services. Counties may use unspent funds allocated under this subdivision from the appropriation under s. 20.435 (4) (bd) for a risk reserve under par. (f).

SB21-SSA1,483,16 (b) 1. Receipt of funds under this section is subject to s. 46.495 (2).

SB21-SSA1,483,18 2. The department may not release funds under this subsection before approving the county's community options plan.

SB21-SSA1,483,22 3. No county may use funds received under par. (a) 2. to pay for long-term community support services provided to any child who resides in a nursing home, unless the department waives this restriction on use of funds and the services are provided in accordance with a discharge plan.

SB21-SSA1,483,24 4. No county may use funds received under this section to purchase land or construct buildings.

SB21-SSA1,484,3 (c) The department may release funds to counties acting jointly, if the counties sign a contract approved by the secretary that explains the plans for joint sponsorship.

SB21-SSA1,484,8 (d) If the department determines that a county demonstrates a pattern of failure to serve clients whose cost of care significantly exceeds the average cost of care for children's long-term community support services provided under this section, the department may require that county to reserve a portion of funds allocated under this subsection for provision of service to those clients.

SB21-SSA1,484,22 (e) The department shall, at the request of a county, carry forward up to 5 percent of the amount allocated under this subsection to the county for a calendar year if up to 5 percent of the amount so allocated has not been spent or encumbered by the county by December 31 of that year, for use by the county in the following calendar year, except that the amount carried forward shall be reduced by the amount of funds that the county has notified the department that the county wishes to place in a risk reserve under par. (f). The department may transfer funds within s. 20.435 (4) (bd) to accomplish this purpose. An allocation under this paragraph does not affect a county's base allocation under this subsection and shall lapse to the general fund unless expended within the calendar year to which the funds are carried forward. A county may not expend funds carried forward under this paragraph for administrative or staff costs, except administrative or staff costs that are associated with implementation of the waiver under sub. (14) and approved by the department.

SB21-SSA1,485,5 (f) 1. Notwithstanding s. 46.036 (3) and (5m), a county may place in a risk reserve funds that are allocated under par. (a) or sub. (14) (b) 1. and are not expended or encumbered for services under this subsection or sub. (14). The county shall notify the department of this decision and of the amount to be placed in the risk reserve. The county shall maintain the risk reserve in an interest-bearing escrow account with a financial institution, as defined in s. 69.30 (1) (b), if the department has approved the terms of the escrow. All interest from the principal shall be reinvested in the escrow account.

SB21-SSA1,485,10 2. The annual amount of a county's expenditure for a risk reserve, as specified in subd. 1., may not exceed 10 percent of the county's most recent allocation under par. (a) and sub. (14) (b) 1. or $750,000, whichever is less. The total amount of the risk reserve, including interest, may not exceed 15 percent of the county's most recent allocation under this subsection.

SB21-SSA1,485,12 3. A county may expend funds maintained in a risk reserve, as specified in subd. 1., for any of the following purposes:

SB21-SSA1,485,14 a. To defray costs of children's long-term community support services under this section.

SB21-SSA1,485,16 b. If approved by the department, for administrative or staff costs under this section.

SB21-SSA1,485,19 4. A county that maintains a risk reserve, as specified in subd. 1., shall annually, on a form prescribed by the department, submit to the department a record of the status of the risk reserve, including revenues and disbursements.

SB21-SSA1,486,3 (g) The department may carry forward to the next state fiscal year funds allocated under this subsection and not encumbered by counties by December 31 or carried forward under par. (e). The department may transfer moneys within s. 20.435 (4) (bd) to accomplish this purpose. An allocation under this paragraph shall not affect a county's base allocation for the program. The department may allocate these transferred moneys during the next fiscal year to counties for the improvement or expansion of long-term community support services for clients whose cost of care significantly exceeds the average cost of care provided under this section, including any of the following:

SB21-SSA1,486,4 1. Specialized training for providers of services under this section.

SB21-SSA1,486,5 2. Start-up costs for developing needed services.

SB21-SSA1,486,6 3. Home modifications.

SB21-SSA1,486,7 4. Purchase of medical equipment or other specially adapted equipment.

SB21-SSA1,486,11 (h) Funds allocated under this subsection may not be used to replace any other state and federal funds or any county funds that are currently being provided under any program to a family whose child is receiving services through the children's community options program.

SB21-SSA1,486,16 (14) Medical assistance waiver. (a) The department may request a waiver from the federal department of health and human services authorizing the department to provide as part of the Medical Assistance program services for persons who are eligible for children's long-term support community options program services under sub. (7) (b).

SB21-SSA1,486,21 (b) 1. Medical assistance reimbursement for services a county or a private nonprofit agency, or with which the department contracts provides under this subsection shall be made from the appropriations under s. 20.435 (4) (bd) and (o) and (7) (b). Payments made under sub. (13) (a) may be used as the state share for purposes of Medical Assistance reimbursement.

SB21-SSA1,486,23 3. The department may contract for services under this subsection with a county or a private nonprofit agency.

SB21-SSA1,487,2 4. No county or private nonprofit agency may use funds received under this subsection to provide residential services in a group home, as defined in s. 48.02 (7), that has more than 5 beds, unless the department approves the provision of services in a group home that has 6 to 8 beds.

SB21-SSA1,487,5 (c) If a county department or private nonprofit agency providing services under this subsection is certified under s. 49.45 (37) (a), the waiver under s. 49.45 (37), if in effect, applies to plans of care for children receiving services under this subsection.

SB21-SSA1,487,9 (15) Right to hearing. A child who is denied eligibility for services or whose services are reduced or terminated under this section may request a hearing from the department under s. 227.44, except that lack of adequate funding may not serve as the basis for a request under this subsection.

SB21-SSA1,1536 Section 1536. 46.277 (5g) (b) of the statutes is renumbered 46.277 (5g) (b) (intro.) and amended to read:

SB21-SSA1,487,15 46.277 (5g) (b) (intro.) This section does not apply to the delicensure of a bed of an institution for mental diseases of an individual who is aged 21 to 64, who has a primary diagnosis of mental illness and who otherwise meets any of the following requirements of s. 46.266 (1) (a), (b) or (c).:

SB21-SSA1,1537 Section 1537. 46.277 (5g) (b) 1. and 2. of the statutes are created to read:

SB21-SSA1,487,21 46.277 (5g) (b) 1. A person who resided in the facility on the date of the finding that a skilled nursing facility or intermediate care facility that provides care to Medical Assistance recipients to be an institution for mental diseases whose care in the facility is disallowed for federal financial participation under Medical Assistance.

SB21-SSA1,488,2 2. A person who is aged 21 to 64, who has a primary diagnosis of mental illness, who would meet the level of care requirements for Medical Assistance reimbursement in a skilled nursing facility or intermediate care facility but for a finding that the facility is an institution for mental diseases, and for whom services would be provided in place of a person specified in subd. 1. who discontinues services.

SB21-SSA1,1542 Section 1542. 46.2803 (2) of the statutes is amended to read:

SB21-SSA1,488,11 46.2803 (2) Notwithstanding s. 46.27 (7), a county in which a care management organization is operating pursuant to a contract under s. 46.284 (2) or a county in which a program described under s. 46.2805 (1) (a) or (b) is administered may use funds appropriated under s. 20.435 (7) (4) (bd) and allocated to the county under s. 46.27 (7) to provide community mental health or substance abuse services and supports for persons with mental illness or persons in need of services or supports for substance abuse and to provide services under the Family Support Program under s. 46.985.

SB21-SSA1,1543 Section 1543 . 46.2803 (2) of the statutes, as affected by 2015 Wisconsin Act .... (this act), is amended to read:

SB21-SSA1,488,20 46.2803 (2) Notwithstanding s. 46.27 (7), a county in which a care management organization is operating pursuant to a contract under s. 46.284 (2) or a county in which a program described under s. 46.2805 (1) (a) or (b) is administered may use funds appropriated under s. 20.435 (4) (bd) and allocated to the county under s. 46.27 (7) to provide community mental health or substance abuse services and supports for persons with mental illness or persons in need of services or supports for substance abuse and to provide services under the Family Support Program under s. 46.985.

SB21-SSA1,1568 Section 1568. 46.281 (4) (d) of the statutes is amended to read:

SB21-SSA1,488,23 46.281 (4) (d) The department shall deposit payments made by counties under this subsection in the appropriation account under s. 20.435 (7) (g) (4) (h).

SB21-SSA1,1569b Section 1569b. 46.2825 (2) (i) of the statutes is created to read:

SB21-SSA1,489,2 46.2825 (2) (i) Review and assess the self-directed services option, as defined in s. 46.2899 (1).

SB21-SSA1,1586 Section 1586. 46.283 (5) of the statutes is amended to read:

SB21-SSA1,489,7 46.283 (5) Funding. From the appropriation accounts under s. 20.435 (4) (b), (bd), (bm), (gm), (pa), and (w) and (7) (b), (bd), and (md), the department may contract with organizations that meet standards under sub. (3) for performance of the duties under sub. (4) and shall distribute funds for services provided by resource centers.

SB21-SSA1,1603 Section 1603. 46.284 (5) (a) of the statutes is amended to read:

SB21-SSA1,489,15 46.284 (5) (a) From the appropriation accounts under s. 20.435 (4) (b), (bd), (g), (gm), (h), (im), (o), and (w) and (7) (b), (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.

SB21-SSA1,1618c Section 1618c. 46.2895 (4) (n) of the statutes is created to read:

SB21-SSA1,489,18 46.2895 (4) (n) In accordance with state law, operate a health maintenance organization.

SB21-SSA1,1621 Section 1621. 46.2896 of the statutes is created to read:

SB21-SSA1,489,20 46.2896 Counting promissory notes as assets. (1) In this section:

SB21-SSA1,489,24 (a) "Long-term care program" means the long-term care program under s. 46.27, 46.275, 46.277, 46.278, or 46.2785; the family care program providing the benefit under s. 46.286; the Family Care Partnership program; or the long-term care program defined in s. 46.2899 (1).

SB21-SSA1,490,4 (b) "Promissory note" means a written, unconditional agreement, given in return for goods, money loaned, or services rendered, under which one party promises to pay another party a specified sum of money at a specified time or on demand.

SB21-SSA1,490,7 (2) When determining or redetermining an individual's financial eligibility for a long-term care program, the department shall include a promissory note as a countable asset if all of the following apply:

SB21-SSA1,490,10 (a) The individual applying for or receiving benefits under the long-term care program or his or her spouse provided the goods, money loaned, or services rendered for the promissory note.

SB21-SSA1,490,12 (b) The promissory note was entered into or purchased on or after the effective date of this paragraph .... [LRB inserts date].

SB21-SSA1,490,14 (c) The promissory note is negotiable, assignable, and enforceable and does not contain any terms making it unmarketable.

SB21-SSA1,490,20 (3) A promissory note is presumed to be negotiable and its asset value is the outstanding principal balance at the time the individual applies for the long-term care program or at the time the individual's eligibility for the long-term care program is redetermined, unless the individual shows by credible evidence from a knowledgeable source that the note is nonnegotiable or has a different current market value, which will then be considered the asset value.

SB21-SSA1,1626 Section 1626. 46.29 (1) (intro.) of the statutes is amended to read:

SB21-SSA1,490,25 46.29 (1) (intro.) From the appropriation account under s. 20.435 (7) (4) (a), the department shall distribute at least $16,100 in each fiscal year for operation of the council on physical disabilities. The council on physical disabilities shall do all of the following:

SB21-SSA1,1627 Section 1627. 46.29 (3) (d) of the statutes is amended to read:

SB21-SSA1,491,3 46.29 (3) (d) The director of the office administrator of the division of state employment relations personnel management in the department of administration.

SB21-SSA1,1630 Section 1630. 46.295 (1) of the statutes is amended to read:

SB21-SSA1,491,8 46.295 (1) The department may, on the request of any hearing-impaired person, city, village, town, or county or private agency, provide funds from the appropriation accounts under s. 20.435 (4) (hs) and (7) (d) and (hs) to reimburse interpreters for hearing-impaired persons for the provision of interpreter services.

SB21-SSA1,1631 Section 1631. 46.40 (1) (a) of the statutes is amended to read:

SB21-SSA1,491,15 46.40 (1) (a) Within the limits of available federal funds and of the appropriations under s. 20.435 (7) (b) and (o), the department shall distribute funds for community social, mental health, developmental disabilities, and alcohol and other drug abuse services and for services under ss. 46.87, 46.985, and 51.421 to county departments under ss. 46.215, 46.22, 46.23, 51.42, and 51.437 and to county aging units, as provided in subs. (2), (2m), (8), and (7) to (9).

SB21-SSA1,1632 Section 1632. 46.40 (7) of the statutes is repealed.

SB21-SSA1,1633 Section 1633. 46.40 (7m) of the statutes is created to read:

SB21-SSA1,491,20 46.40 (7m) State community mental health allocation. For community mental health services, the department shall distribute not less than $24,348,700 in each fiscal year.

SB21-SSA1,1634 Section 1634. 46.40 (14m) of the statutes is amended to read:

SB21-SSA1,492,2 46.40 (14m) County community aids budgets. Before December 1 of each year, each county department under ss. 46.215, 46.22, 46.23, 51.42 and 51.437 and each tribal governing body shall submit to the department a proposed budget for the expenditure of funds allocated under this section or carried forward under s. 46.45 (3) (a). The proposed budget shall be submitted on a form developed by the department and approved by the department of administration.

SB21-SSA1,1635 Section 1635. 46.45 (3) (a) of the statutes is amended to read:

SB21-SSA1,492,16 46.45 (3) (a) Except as provided in par. (b), at the request of a county, tribal governing body, or private nonprofit organization, the department shall carry forward up to 3% of the total amount allocated to the county, tribal governing body, or nonprofit organization for a calendar year, not including the amount allocated to the county under s. 46.40 (7), which amount may be carried forward as provided in par. (c). All funds carried forward for a tribal governing body or nonprofit organization and all funds allocated under s. 46.40 (2m) carried forward for a county shall be used for the purpose for which the funds were originally allocated. Other funds carried forward under this paragraph may be used for any purpose under s. 20.435 (7) (b), except that a county may not use any funds carried forward under this paragraph for administrative or staff costs. An allocation of carried-forward funding under this paragraph does not affect a county's base allocations under s. 46.40 (2), (2m), (8), and (9).

SB21-SSA1,1636 Section 1636. 46.45 (3) (c) of the statutes is repealed.

SB21-SSA1,1637 Section 1637. 46.45 (6) (a) of the statutes is renumbered 46.45 (6) and amended to read:

SB21-SSA1,492,24 46.45 (6) The department may carry forward 10% of any funds specified in sub. (3) (a) that are not carried forward under sub. (3) (a) for emergencies, for justifiable unit services costs above planned levels, and for increased costs due to population shifts. An allocation of carried-forward funding under this paragraph does not affect a county's base allocations under s. 46.40 (2), (2m), (8), and (9).

SB21-SSA1,1638 Section 1638. 46.45 (6) (b) of the statutes is repealed.

SB21-SSA1,1639 Section 1639. 46.56 (3) (a) 4. of the statutes is repealed.

SB21-SSA1,1640 Section 1640. 46.56 (10) of the statutes is repealed.

SB21-SSA1,1644w Section 1644w. 46.96 (title) of the statutes is amended to read: