16.009(1)(a)
(a) "Beneficiary" means an individual who is eligible for coverage.
16.009(1)(ag)
(ag) "Board" means the board on aging and long-term care.
16.009(1)(ar)
(ar) "Client" means an individual who requests services of the office, or a resident on whose behalf a request is made.
16.009(1)(em)
(em) "Long-term care facility" includes any of the following:
16.009(1)(f)
(f) "Long-term care insurance" means insurance that provides coverage both for an extended stay in a nursing home and home health services for a person with a chronic condition. The insurance may also provide coverage for other services that assist the insured person in living outside a nursing home, including but not limited to adult day care and continuing care retirement communities.
16.009(1)(gm)
(gm) "Office" means the office of the long-term care ombudsman.
16.009(1)(i)
(i) "Program" means the long-term care ombudsman program.
16.009(1)(j)
(j) "Resident" means a person cared for or treated in a long-term care facility.
16.009(2)(a)
(a) Appoint an executive director within the classified service who shall employ staff within the classified service.
16.009(2)(b)
(b) Implement a long-term care ombudsman program, to do all of the following:
16.009(2)(b)1.
1. Investigate complaints from any person concerning improper conditions or treatment of aged or disabled persons who receive long-term care or concerning noncompliance with or improper administration of federal statutes or regulations or state statutes or rules related to long-term care for the aged or disabled.
16.009(2)(b)2.
2. Serve as mediator or advocate to resolve any problem or dispute relating to long-term care for the aged or disabled.
16.009(2)(d)
(d) Promote public education, planning and voluntary acts to resolve problems and improve conditions involving long-term care for the aged or disabled.
16.009(2)(e)
(e) Monitor the development and implementation of federal, state and local laws, regulations, rules, ordinances and policies that relate to long-term care facilities for the aged or disabled.
16.009(2)(em)
(em) Monitor, evaluate and make recommendations concerning long-term community support services received by clients of the long-term support community options program under
s. 46.27.
16.009(2)(f)
(f) As a result of information received while investigating complaints and resolving problems or disputes, publish material that assesses existing inadequacies in federal and state laws, regulations and rules concerning long-term care for the aged or disabled. The board shall initiate legislation as a means of correcting these inadequacies.
16.009(2)(g)
(g) Stimulate resident, client and provider participation in the development of programs and procedures involving resident rights and facility responsibilities, by establishing resident councils and by other means.
16.009(2)(h)
(h) Conduct statewide hearings on issues of concern to aged or disabled persons who are receiving or who may receive long-term care.
16.009(2)(i)
(i) Report annually to the governor and the chief clerk of each house of the legislature for distribution to the appropriate standing committees under
s. 13.172 (3). The report shall set forth the scope of the programs for providing long-term care for the aged or disabled developed in the state, findings regarding the state's activities in the field of long-term care for the aged and disabled, recommendations for a more effective and efficient total program and the actions taken by the agencies of the state to carry out the board's recommendations.
16.009(2)(j)
(j) Provide information and counseling to consumers regarding insurance policies available to supplement federal medicare insurance coverage, including long-term care insurance, and the eligibility requirements for medical assistance under
s. 49.46 (1),
49.468 or
49.47 (4). To implement this responsibility, the board shall provide training, educational materials and technical assistance to volunteer organizations and private businesses willing and able to provide insurance and medical assistance eligibility information and counseling, in order that these organizations and businesses may provide the information and counseling to consumers.
16.009(2)(k)
(k) After consulting with the department of regulation and licensing and obtaining from that department a listing of all practicing physicians in this state, by January 1, 1991, and annually thereafter, send an inquiry to each of those physicians as to whether he or she is a full-time physician who practices in this state and who treats beneficiaries of medicare Part B in this state. If the answer is affirmative, the inquiry shall be whether he or she voluntarily accepts, from each of his or her patients in this state who is a beneficiary and who had household income in the beneficiary's taxable year prior to the year in which treatment is received that did not exceed the maximum income allowed for claiming the homestead credit, as calculated under
s. 71.54 (1), assignment of the beneficiary's benefits for reimbursement for the provision of medical or other health service authorized under medicare Part B. The inquiry shall also be whether the physician does not require payment of any amount that is in excess of the reasonable charge, as determined by the federal health care financing administration through the insurance carrier for medicare Part B in this state, for the medicare Part B authorized medical or other health service that the physician renders to the beneficiaries in this state.
16.009(2)(L)
(L) From the information obtained in answer to the inquiry under
par. (k), provide to beneficiaries of medicare Part B in this state information with respect to those practicing physicians who voluntarily accept assignment of beneficiaries' benefits for reimbursement and do not require additional payment, as specified in
par. (k).
16.009(2)(m)
(m) Inquire of and obtain from the carrier for medicare Part B in this state, by January 1, 1991, and annually thereafter, information concerning the percentage of the claims in this state for payment of services covered by medicare Part B, for which full-time physicians who practice in this state voluntarily accept, from each of their patients in this state who is a medicare Part B beneficiary and who had household income in the beneficiary's taxable year prior to the year in which treatment is received that did not exceed the maximum income allowed for claiming the homestead credit, as calculated under
s. 71.54 (1), assignment of the beneficiary's benefits for reimbursement for the provision of medical or other health service authorized under medicare Part B.
16.009(2)(n)
(n) From the information obtained in answer to the inquiries under
pars. (k) and
(m), determine all of the following and, beginning July 1, 1991, and annually thereafter, submit a report to the chief clerk of each house of the legislature for distribution under
s. 13.172 (2) concerning:
16.009(2)(n)1.
1. Whether at least 80% of the full-time physicians who practice in this state and who treat beneficiaries of medicare Part B in this state voluntarily accept, from each of their patients in this state who is a beneficiary of medicare Part B and who had household income in the beneficiary's taxable year prior to the year in which treatment is received that did not exceed the maximum income allowed for claiming the homestead credit, as calculated under
s. 71.54 (1), assignment of the beneficiaries' benefits and do not require payment of any amount in excess of the reasonable charge. If the percentage determined under this subdivision is less than 80%, the board shall determine the applicable percentage.
16.009(2)(n)2.
2. Whether, for at least 80% of the claims specified in
par. (m) and at least 80% of the claims in this state for payment of services covered by medicare Part B, full-time physicians who practice in this state voluntarily accept assignment of the benefits of beneficiaries in this state and do not require payment of any amount in excess of the reasonable charge. If the percentage determined under this subdivision is less than 80%, the board shall determine the applicable percentage.
16.009(3)(a)
(a) Contract with any state agency to carry out the board's activities.
16.009(3)(bm)
(bm) Employ an attorney for provision of legal services in accordance with requirements of the long-term care ombudsman program under
42 USC 3027 (a) (12) and
42 USC 3058g (g).
16.009(4)(a)(a) The board shall operate the office in order to carry out the requirements of the long-term care ombudsman program under
42 USC 3027 (a) (12) (A) and
42 USC 3058f to
3058h. The executive director of the board shall serve as ombudsman under the office. The executive director of the board may delegate operation of the office to the staff employed under
sub. (2) (a), as designated representatives of the ombudsman.
16.009(4)(b)
(b) The ombudsman or his or her designated representative may have the following access to clients, residents and long-term care facilities:
16.009(4)(b)1.a.
a. At any time without notice, enter, and have immediate access to a client or resident in, a long-term care facility.
16.009(4)(b)1.b.
b. Communicate in private, without restriction, with a client or resident.
16.009(4)(b)1.c.
c. Except as provided in
subd. 1. d., have access to and review records that pertain to the care of the resident if the resident or his or her guardian has consented or if the resident has no guardian and is unable to consent.
16.009(4)(b)1.d.
d. With the consent of a resident or his or her legal counsel, have access to and review records that pertain to the care of the resident, as specified in
s. 49.498 (5) (e).
16.009(4)(b)1.e.
e. Have access to and review records of a long-term care facility as necessary to investigate a complaint if the resident's guardian refuses to consent; if the ombudsman or designated representative has reason to believe that the guardian is not acting in the best interests of the resident; and, for investigation only by a designated representative, if the designated representative obtains the approval of the ombudsman.
16.009(4)(b)1.f.
f. Have access to those administrative records, policies and documents of a long-term care facility to which the resident or public has access.
16.009(4)(b)1.g.
g. Have access to and, on request, be furnished copies of all licensing or certification records maintained by the department of health and family services with respect to regulation of a long-term care facility.
16.009(4)(b)2.
2. The ombudsman shall receive, upon request to a long-term care facility, the name, address and telephone number of the guardian, legal counsel or immediate family member of any resident.
16.009(4)(d)
(d) A long-term care facility or personnel of a long-term care facility that disclose information as authorized under this subsection are not liable for that disclosure.
16.009(4)(e)
(e) Information of the office relating to a client, complaints or investigations under the program may be disclosed only at the discretion of the ombudsman. The identity of a client or named witness or of a resident who is not a client may be revealed under this paragraph only if one of the following conditions is met:
16.009(4)(e)1.
1. Under written authorization by the client, witness or resident or his or her guardian, if any.
16.009(4)(e)2.
2. Under the lawful order of a court of competent jurisdiction.
16.009(5)(a)1.
1. Discharge or otherwise retaliate or discriminate against any person for contacting, providing information to or otherwise cooperating with any representative of the board.
16.009(5)(a)2.
2. Discharge or otherwise retaliate or discriminate against any person on whose behalf another person has contacted, provided information to or otherwise cooperated with any representative of the board.
16.009(5)(b)
(b) Any person who violates
par. (a) may be fined not more than $1,000 or imprisoned for not more than 6 months or both.
16.009(5)(c)2.
2. Any employe of a state agency who is discharged or otherwise retaliated or discriminated against in violation of
par. (a) may file a complaint with the personnel commission under
s. 230.45 (1) (j).
16.009(5)(d)
(d) Any employe of an employer not described in
par. (c) and who is discharged or otherwise retaliated or discriminated against in violation of
par. (a) may file a complaint with the department of workforce development under
s. 106.06 (5).
16.009(5)(e)
(e) Any person not described in
par. (c) or
(d) who is retaliated or discriminated against in violation of
par. (a) may commence an action in circuit court for damages incurred as a result of the violation.
16.0095
16.0095
Medicare upper limit consultant. The department shall hire a consultant, to be paid from the appropriation under
s. 20.435 (1) (bm), to determine and recommend to the the department of health and family services the aggregate payments that should be made for inpatient nursing home services under medical assistance under
subch. IV of ch. 49 such that the aggregate payments will not exceed the amount that is estimated to be the amount that would have been paid under the federal medicare program's payment principles. The consultant's recommendations to the department of health and family services shall be nonbinding.
16.0095 History
History: 1997 a. 27.
16.01
16.01
Women's council. 16.01(1)(1) In this section, "agency" means any office, department, agency, institution of higher education, association, society or other body in state government created or authorized to be created by the constitution or any law which is entitled to expend moneys appropriated by law, including the legislature and the courts, and any authority created under
ch. 231,
233 or
234.
16.01(2)(a)
(a) Identify the barriers that prevent women in this state from participating fully and equally in all aspects of life.
16.01(2)(b)
(b) Conduct statewide hearings on issues of concern to women.
16.01(2)(c)
(c) Review, monitor and advise all state agencies regarding the impact upon women of current and emerging state policies, procedures, practices, laws and administrative rules.
16.01(2)(d)
(d) Work closely with all state agencies, including the university of Wisconsin system and the technical college system, with the private sector and with groups concerned with women's issues to develop long-term solutions to women's economic and social inequality in this state.
16.01(2)(e)
(e) Recommend changes to the public and private sectors and initiate legislation to further women's economic and social equality and improve this state's tax base and economy.
16.01(2)(f)
(f) Disseminate information on the status of women in this state.
16.01(2)(g)
(g) Submit a biennial report on the women's council's activities to the governor and to the chief clerk of each house of the legislature, for distribution to the appropriate standing committees under
s. 13.172 (3).
16.01(3)
(3) All state agencies, including the university of Wisconsin system and the technical college system, shall fully cooperate with and assist the women's council. To that end, a representative of a state agency shall, upon request by the women's council:
16.01(3)(a)
(a) Provide information on program policies, procedures, practices and services affecting women.
16.01(3)(b)
(b) Present recommendations to the women's council.
16.01(3)(c)
(c) Attend meetings and provide staff assistance needed by the women's council.
16.01(3)(d)
(d) Inform the agency's appointing authority of issues concerning the women's council.
