46.282(3)(a)1.
1. Develop the initial plan for the structure of the county, multicounty or tribal resource center and care management organization or organizations, including formulating recommendations to the county board or boards of supervisors and, in a county with a county executive or a county administrator, to the county executive or county administrator, to the governing body of the tribe or band or of the Great Lakes inter-tribal council, inc., if applicable, and to the department on all of the following:
46.282(3)(a)1.a.
a. Whether or not the county, counties, tribe or band or Great Lakes inter-tribal council, inc., should exercise its right to apply under
s. 46.283 (1) for a contract to operate a resource center or to apply under
s. 46.284 (1) for a contract to operate a care management organization and how the operation should proceed.
46.282(3)(a)1.b.
b. Whether the county should create a family care district to operate a resource center or under a care management organization.
46.282(3)(a)1.c.
c. Whether local organizations other than the county should serve as alternatives or in addition to county-operated entities to operate a resource center or a care management organization and, if so, which organizations should be considered.
46.282(3)(a)1.d.
d. If applicable, how county-operated functions should interact with a resource center or care management organization that is operated by a tribe or band or by the Great Lakes inter-tribal council, inc.
46.282(3)(a)2.a.a. In the years 2000 and 2001, under criteria that the department prescribes, after consulting with the council on long-term care, evaluate the performance of the care management organization or organizations in the area of the local long-term care council and determine whether additional care management organizations are needed in the area and, if so, recommend this to the department.
46.282(3)(a)2.b.
b. In the year 2002 and thereafter, under criteria that the department prescribes, evaluate the performance of the care management organization or organizations in the area of the local long-term care council and determine whether additional care management organizations are needed in the area and, if so recommend this to the department.
46.282(3)(a)3.
3. Advise the department regarding applications for initial certification or certification renewal of care management organizations in the area of the local long-term care council, including providing recommendations for organizations applying for certification or recertification, and assist the department in reviewing and evaluating the applications.
46.282(3)(a)4.
4. Receive information about and monitor complaints from persons served by the care management organization in the area concerning whether the numbers of providers of long-term care services used by the care management organization are sufficient to ensure convenient and desirable consumer choice and provide recommendations under
subd. 3. to the department about this issue.
46.282(3)(a)5.
5. Review initial plans and existing provider networks of any care management organization in the area to assist the care management organization in developing a network of service providers that includes a sufficient number of accessible, convenient and desirable services.
46.282(3)(a)6.
6. Advise care management organizations about whether to offer optional acute and primary health care services and, if so, how these benefits should be offered.
46.282(3)(a)7.
7. Review the utilization of various types of long-term care services by care management organizations in the area.
46.282(3)(a)8.
8. Monitor the pattern of enrollments and disenrollments in local care management organizations.
46.282(3)(a)9.
9. Identify gaps in services, living arrangements and community resources and develop strategies to build local capacity to serve older persons and persons with physical or developmental disabilities, especially those with long-term care needs.
46.282(3)(a)10.
10. Perform long-range planning on policy for older persons and persons with physical or developmental disabilities.
46.282(3)(a)11.
11. Annually review interagency agreements between a resource center and care management organization or organizations and make recommendations, as appropriate, on the interaction between the resource center and the care management organization or organizations to assure coordination between or among them.
46.282(3)(a)12.
12. Annually review the number and types of complaints and grievances about the long-term care system by persons who receive or may receive care under the system, to determine if a need exists for system changes, and recommend system or other changes if appropriate.
46.282(3)(a)13.
13. Identify potential new sources of community resources and funding for needed services for older persons and persons with physical or developmental disabilities.
46.282(3)(a)14.
14. Support long-term care system improvements to improve services to older persons and persons with physical or developmental disabilities and their families.
46.282(3)(a)15.
15. Annually report to the department and, before July 1, 2001, to the long-term care council concerning significant achievements and problems in the local long-term care system.
46.282(3)(b)
(b) A local long-term care council may, within the local long-term care council's area, assume the duties of the county long-term community support planning committee as specified under
s. 46.27 (4).
46.282 History
History: 1999 a. 9.
46.283
46.283
Resource centers. 46.283(1)(a)(a) After considering recommendations of the local long-term care council under
s. 46.282 (3) (a) 1., a county board of supervisors and, in a county with a county executive or a county administrator, the county executive or county administrator, may decide all of the following:
46.283(1)(a)1.
1. Whether to authorize one or more county departments under
s. 46.21,
46.215,
46.22 or
46.23 or an aging unit under
s. 46.82 (1) (a) 1. or
2. to apply to the department for a contract to operate a resource center and, if so, which to authorize and what client group to serve.
46.283(1)(a)2.
2. Whether to create a family care district to apply to the department for a contract to operate a resource center.
46.283(1)(b)
(b) After considering recommendations of the local long-term care council under
s. 46.282 (3) (a) 1., the governing body of a tribe or band or of the Great Lakes inter-tribal council, inc., may decide whether to authorize a tribal agency to apply to the department for a contract to operate a resource center for tribal members and, if so, which client group to serve.
46.283(1)(c)
(c) Under the requirements of
par. (a), a county board of supervisors may decide to apply to the department for a contract to operate a multicounty resource center in conjunction with the county board or boards of one or more other counties or a county-tribal resource center in conjunction with the governing body of a tribe or band or the Great Lakes inter-tribal council, inc.
46.283(1)(d)
(d) Under the requirements of
par. (b), the governing body of a tribe or band may decide to apply to the department for a contract to operate a resource center in conjunction with the governing body or governing bodies of one or more other tribes or bands or the Great Lakes inter-tribal council, inc., or with a county board of supervisors.
46.283(2)(a)(a) Before July 1,
2001, the department may contract only with a county, a family care district, the governing body of a tribe or band or the Great Lakes inter-tribal council, inc., or with 2 or more of these entities under a joint application, to operate a resource center.
46.283(2)(b)
(b) After June 30, 2001, the department shall contract with the entities specified under
s. 46.281 (1) (d) 1. and may, in addition to contracting with these entities and subject to approval of necessary funding, contract to operate a resource center with counties, family care districts, the governing body of a tribe or band or the Great Lakes inter-tribal council, inc., or 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:
46.283(2)(b)1.
1. A county board of supervisors declines in writing to apply for a contract to operate a resource center.
46.283(2)(b)2.
2. A county agency or a family care district applies for a contract but fails to meet the standards specified in
sub. (3).
46.283(3)
(3) Standards for operation. The department shall assure that at least all of the following are available to a person who contacts a resource center for service:
46.283(3)(a)
(a) Information and referral services and other assistance at hours that are convenient for the public.
46.283(3)(b)
(b) A determination of functional eligibility for the family care benefit.
46.283(3)(c)
(c) Within the limits of available funding, prevention and intervention services.
46.283(3)(d)
(d) Counseling concerning public and private benefits programs.
46.283(3)(e)
(e) A determination of financial eligibility and of the maximum amount of cost sharing required for a person who is seeking long-term care services, under standards prescribed by the department.
46.283(3)(f)
(f) Assistance to a person who is eligible for the family care benefit with respect to the person's choice of whether or not to enroll in a care management organization and, if so, which available care management organization would best meet his or her needs.
46.283(3)(g)
(g) Assistance in enrolling in a care management organization for persons who choose to enroll.
46.283(3)(h)
(h) Equitable assignment of priority on any necessary waiting lists, consistent with criteria prescribed by the department, for persons who are eligible for the family care benefit but who do not meet the criteria under
s. 46.286 (3).
46.283(3)(i)
(i) Assessment of risk for each person who is on a waiting list, as described in
par. (h), development with the person of an interim plan of care and assistance to the person in arranging for services.
46.283(3)(j)
(j) Transitional services to families whose children with physical or developmental disabilities are preparing to enter the adult service system.
46.283(4)
(4) Duties. A resource center shall do all of the following:
46.283(4)(a)
(a) Provide services within the entire geographic area prescribed for the resource center by the department.
46.283(4)(b)
(b) Submit to the department all reports and data required or requested by the department.
46.283(4)(c)
(c) Implement internal quality improvement and quality assurance processes that meet standards prescribed by the department.
46.283(4)(d)
(d) Cooperate with any review by an external advocacy organization.
46.283(4)(e)
(e) Within 6 months after the family care benefit is available to all eligible persons in the area of the resource center, provide information about the services of the resource center, including the services specified in
sub. (3) (d), about assessments under
s. 46.284 (4) (b) and care plans under
s. 46.284 (4) (c) and about the family care benefit to all older persons and persons with a physical disability who are residents of nursing homes, community-based residential facilities, adult family homes and residential care apartment complexes in the area of the resource center.
46.283(4)(f)
(f) Provide a functional and financial screen to any resident, as specified in
par. (e), who requests a screen and assist any resident who is eligible and chooses to enroll in a care management organization to do so.
46.283(4)(g)
(g) Provide a functional and financial screen to any person seeking admission to a nursing home, community-based residential facility, residential care apartment complex or adult family home if the secretary has certified that the resource center is available to the person and the facility and the person is determined by the resource center to have a condition that is expected to last at least 90 days that would require care, assistance or supervision. A resource center may not require a financial screen for a person seeking admission or about to be admitted on a private pay basis who waives the requirement for a financial screen under this paragraph, unless the person is expected to become eligible for medical assistance within 6 months. A resource center need not provide a functional screen for a person seeking admission or about to be admitted who has received a screen for functional eligibility under
s. 46.286 (1) (a) within the previous 6 months.
46.283(4)(h)
(h) Provide access to services under
s. 46.90 and
ch. 55 to a person who is eligible for the services, through cooperation with the county agency or agencies that provide the services.
46.283(4)(i)
(i) Assure that emergency calls to the resource center are responded to promptly, 24 hours per day.
46.283(5)
(5) Funding. From the appropriation accounts under
s. 20.435 (4) (b),
(bm) and
(pa) 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.
46.283(6)
(6) Governing board. A resource center shall have a governing board that reflects the ethnic and economic diversity of the geographic area served by the resource center. 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.
46.283(7)
(7) Confidentiality; exchange of information. No record, as defined in
s. 19.32 (2), of a resource center that contains personally identifiable information, as defined in
s. 19.62 (5), concerning an individual who receives services from the resource center may be disclosed by the resource center without the individual's informed consent, except as follows:
46.283(7)(b)
(b) Notwithstanding
ss. 48.78 (2) (a),
49.45 (4),
49.83,
51.30,
51.45 (14) (a),
55.06 (17) (c),
146.82,
252.11 (7),
253.07 (3) (c) and
938.78 (2) (a), a resource center acting under this section may exchange confidential information about a client, as defined in
s. 46.287 (1), without the informed consent of the client, under
s. 46.21 (2m) (c),
46.215 (1m),
46.22 (1) (dm),
46.23 (3) (e),
46.284 (7),
46.2895 (10),
51.42 (3) (e) or
51.437 (4r) (b) in the county of the resource center, if necessary to enable the resource center to perform its duties or to coordinate the delivery of services to the client.
46.283 History
History: 1999 a. 9.
46.284
46.284
Care management organizations. 46.284(1)(a)(a) After considering recommendations of the local long-term care council under
s. 46.282 (3) (a) 1., a county board of supervisors and, in a county with a county executive or a county administrator, the county executive or county administrator, may decide all of the following:
46.284(1)(a)1.
1. Whether to authorize one or more county departments under
s. 46.21,
46.215,
46.22 or
46.23 or an aging unit under
s. 46.82 (1) (a) 1. or
2. to apply to the department for a contract to operate a care management organization and, if so, which to authorize and what client group to serve.
46.284(1)(a)2.
2. Whether to create a family care district to apply to the department for a contract to operate a care management organization.
46.284(1)(b)
(b) The governing body of a tribe or band or of the Great Lakes inter-tribal council, inc., may decide whether to authorize a tribal agency to apply to the department for a contract to operate a care management organization for tribal members and, if so, which client group to serve.
46.284(1)(c)
(c) Under the requirements of
par. (a), a county board of supervisors may decide to apply to the department for a contract to operate a multicounty care management organization in conjunction with the county board or boards of one or more other counties or a county-tribal care management organization in conjunction with the governing body of a tribe or band or the Great Lakes inter-tribal council, inc.
46.284(1)(d)
(d) Under the requirements of
par. (b), the governing body of a tribe or band may decide to apply to the department for a contract to operate a care management organization in conjunction with the governing body or governing bodies of one or more other tribes or bands or the Great Lakes inter-tribal council, inc., or with a county board of supervisors.
46.284(2)(a)(a) The department may contract for operation of a care management organization only with an entity that is certified as meeting the requirements under
sub. (3). No entity may operate as a care management organization under the requirements of this section unless so certified and under contract with the department.
46.284(2)(b)
(b) Within each county, the department shall initially contract to operate a care management organization with the county or a family care district if the county elects to operate a care management organization and the care management organization meets the requirements of
sub. (3) and performance standards prescribed by the department. A county that contracts under this paragraph may operate the care management organization for all of the target groups or for a selected group or groups. With respect to contracts exclusively with counties to operate a care management organization, all of the following apply:
46.284(2)(b)1.
1. Before January 1,
2003, the department may not contract with an organization other than the county to operate a care management organization in the county unless any of the following applies:
46.284(2)(b)1.a.
a. The county and the local long-term care council agree in writing that at least one additional care management organization is necessary or desirable.
46.284(2)(b)1.b.
b. The governing body of a tribe or band or the Great Lakes inter-tribal council, inc., elects to operate a care management organization within the area and is certified under
sub. (3).
46.284(2)(b)2.
2. After December 31,
2002, and before January 1, 2004, the department may not contract with an organization other than the county to operate a care management organization in the county unless any of the following applies:
46.284(2)(b)2.b.
b. The county fails to meet requirements of
sub. (3) and performance standards prescribed by the department.
46.284(2)(b)2.c.
c. The county does not have the capacity to serve all county residents who are entitled to the family care benefit in the client group or groups that the county serves and cannot develop the capacity. If this
subd. 2. c. applies, the department may contract with an organization in addition to the county.
46.284(2)(b)3.
3. After December 31,
2003, the department may contract with counties, family care districts, the governing body of a tribe or band or the Great Lakes inter-tribal council, inc., or under a joint application of any of these, or with a private organization that has no significant connection to an entity that operates a resource center. Proposals for contracts under this subdivision shall be solicited under a competitive sealed proposal process under
s. 16.75 (2m) and, after consulting with the local long-term care council for the county or counties, the department shall evaluate the proposals primarily as to the quality of care that is proposed to be provided, certify those applicants that meet the requirements specified in
sub. (3) (a), select certified applicants for contract and contract with the selected applicants.
46.284(3)(a)(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.
46.284(3)(b)
(b) To be certified as a care management organization, an applicant shall demonstrate or ensure all of the following:
46.284(3)(b)1.
1. Adequate availability of providers with the expertise and ability to provide services that are responsive to the disabilities or conditions of all of the applicant's proposed enrollees and sufficient representation of programmatic philosophies and cultural orientations to accommodate a variety of enrollee preferences and needs.
46.284(3)(b)2.
2. Adequate availability of providers that can meet the preferences and needs of its proposed service recipients for services at various times, including evenings, weekends and, when applicable, on a 24-hour basis.
46.284(3)(b)3.
3. Adequate availability of providers that are able and willing to perform all of the tasks that are likely to be identified in proposed enrollees' service and care plans.
