46.287(2)(a)1.f.
f. Development of a plan of care that is unacceptable because the plan of care requires the enrollee to live in a place that is unacceptable to the enrollee or the plan of care provides care, treatment or support items that are insufficient to meet the enrollee's needs, are unnecessarily restrictive or are unwanted by the enrollee.
46.287(2)(a)2.
2. An applicant for or recipient of medical assistance is not entitled to a hearing concerning the identical dispute or matter under both this section and
42 CFR 431.200 to
431.246.
46.287(2)(b)
(b) An enrollee may contest a decision, omission or action of a care management organization other than those specified in
par. (a), or may contest the choice of service provider. In these instances, the enrollee shall first send a written request for review by the unit of the department that monitors care management organization contracts. This unit shall review and attempt to resolve the dispute. If the dispute is not resolved to the satisfaction of the enrollee, he or she may request a hearing under the procedures specified in
par. (a) 1. (intro.).
46.287(2)(c)
(c) Information regarding the availability of advocacy services and notice of adverse actions taken and appeal rights shall be provided to a client by the resource center or care management organization in a form and manner that is prescribed by the department by rule.
46.287 History
History: 1999 a. 9;
2003 a. 33.
46.288
46.288
Rule-making. The department shall promulgate as rules all of the following:
46.288(1)
(1) Standards for performance by resource centers and for certification of care management organizations, including requirements for maintaining quality assurance and quality improvement.
46.288(2)
(2) Criteria and procedures for determining functional eligibility under
s. 46.286 (1) (a), financial eligibility under
s. 46.286 (1) (b), 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:
46.288(2)(e)
(e) "Requires ongoing care, assistance or supervision".
46.288(2)(f)
(f) "Condition that is expected to last at least 90 days or result in death within one year".
46.288(2)(g)
(g) "At risk of losing independence or functional capacity".
46.288(3)
(3) Procedures and standards for procedures for
s. 46.287 (2), including time frames for action by a resource center or a care management organization on a contested matter.
46.288 History
History: 1999 a. 9.
46.289
46.289
Transition. In order to facilitate the transition to the long-term care system specified in
ss. 46.2805 to
46.2895, within the limits of applicable federal statutes and regulations and if the secretary of health and family services finds it necessary, he or she may grant a county limited waivers to or exemptions from
ss. 46.27 (3) (e) (intro.),
1. and
2. and
(f),
(5) (d) and
(e),
(6) (a) 1.,
2. and
3. and
(b) (intro.),
1. and
2.,
(6r) (c),
(7) (b),
(cj) and
(cm) and
(11) (c) 5m. (intro.) and
6. and
46.277 (3) (a),
(4) (a) and
(5) (d) 1m.,
1n. and
2. and rules promulgated under those provisions.
46.289 History
History: 1999 a. 9.
46.2895
46.2895
Family care district. 46.2895(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 may create a special purpose district that is termed a "family care district", that is a local unit of government, that is separate and distinct from, and independent of, the state and the county, and that has the powers and duties specified in this section, if the county board does all of the following:
46.2895(1)(a)1.
1. Adopts an enabling resolution that does all of the following:
46.2895(1)(a)1.b.
b. Specifies the family 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.
46.2895(1)(a)2.
2. Files copies of the enabling resolution with the secretary of administration, the secretary of health and family services and the secretary of revenue.
46.2895(1)(b)
(b) The county boards of supervisors of 2 or more counties may together create a family care district with the attributes specified in
par. (a) (intro.) on a multicounty basis within the counties if the county boards of supervisors comply with the requirements of
par. (a) 1. and
2.
46.2895(2)
(2) Jurisdiction. A family care district's jurisdiction is the geographical area of the county or counties of the county board or boards of supervisors who created the family care district.
46.2895(3)(a)1.1. 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 care district board, which is the governing board of a family care district under
sub. (1) (a).
46.2895(3)(a)2.
2. The county boards of supervisors of 2 or more counties shall appoint the members of the family care district board, which is the governing board of the family care district under
sub. (1) (b). Each county board shall appoint members in the same proportion that the county's population represents to the total population of all of the counties that constitute the jurisdiction of the family care district.
46.2895(3)(b)1.1. 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 shall be representative of the client group or groups whom it is the family care district's primary purpose to serve or those clients' family members, guardians or other advocates.
46.2895(3)(b)2.
2. The family care district board appointed under
par. (a) 2. shall consist of an odd number of members that is at least 15 but not more than 21 persons, all of whom are residents of the area of jurisdiction of the family care district. At least one-fourth of the members shall be representative of the client group or groups whom it is the family care district's primary purpose to serve or those clients' family members, guardians or other advocates.
46.2895(3)(b)3.
3. Membership of the family care district board under
subd. 1. or
2. shall reflect the ethnic and economic diversity of the area of jurisdiction of the family 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. No member of the board may have a private financial interest in or profit directly or indirectly from any contract or other business of the family care district.
46.2895(3)(c)
(c) The members of the family care district board appointed under
par. (a) shall serve 3-year terms. No member may serve more than 2 consecutive terms. Of the members first appointed, 5 shall be appointed for 3 years; 5 shall be appointed for 4 years; and 5 or, in the case of a board appointed under
par. (b) 2., the remainder, shall be appointed for 5 years. A member shall serve until his or her successor is appointed, unless removed for cause under
s. 17.13.
46.2895(3)(d)
(d) As soon as possible after the appointment of the initial members of the family 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 board may act based on the affirmative vote of a majority of a quorum.
46.2895(4)
(4) Powers. Subject to
sub. (1) (a) 1. b., a family 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 care district may do all of the following:
46.2895(4)(a)
(a) Adopt and alter, at pleasure, an official seal.
46.2895(4)(b)
(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 care district contracts with the department under
par. (d), with the terms of that contract.
46.2895(4)(d)
(d) Negotiate and enter into leases or contracts, including a contract with the department to operate either a resource center or a portion of its functions under
s. 46.283 or a care management organization under
s. 46.284, but not both a resource center or its functions and a care management organization.
46.2895(4)(e)
(e) Provide services related to services available under the family care benefit, to older persons and persons with disabilities, in addition to the services funded under the contract with the department that is specified under
par. (d).
46.2895(4)(f)
(f) Acquire, construct, equip, maintain, improve or manage a resource center under
s. 46.283 or a care management organization under
s. 46.284, but not both.
46.2895(4)(g)
(g) Subject to
sub. (8), employ any agent, employee, or special adviser that the family 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.
46.2895(4)(h)
(h) Mortgage, pledge or otherwise encumber the family care district's property or funds.
46.2895(4)(i)
(i) Buy, sell or lease property, including real estate, and maintain or dispose of the property.
46.2895(4)(j)
(j) Invest any funds not required for immediate disbursement in any of the following:
46.2895(4)(j)2.
2. Time deposits in any financial institution, as defined in
s. 69.30 (1) (b), if the time deposits mature in not more than 2 years.
46.2895(4)(j)3.
3. Bonds or securities issued or guaranteed as to principal and interest by the federal government or by a commission, board or other instrumentality of the federal government.
46.2895(4)(k)
(k) Create a risk reserve or other special reserve as the family care district board desires or as the department requires under the contract with the department that is specified under
par. (d).
46.2895(4)(L)
(L) Accept aid, including loans, to accomplish the purpose of the family care district from any local, state or federal governmental agency or accept gifts, loans, grants or bequests from individuals or entities, if the conditions under which the aid, loan, gift, grant or bequest is furnished are not in conflict with this section.
46.2895(4)(m)
(m) Make and execute other instruments necessary or convenient to exercise the powers of the family care district.
46.2895(5)
(5) Limitation on powers. A family care district may not issue bonds or levy a tax or assessment.
46.2895(6)
(6) Duties. The family care district board shall do all of the following:
46.2895(6)(a)
(a) Appoint a director, who shall hold office at the pleasure of the board.
46.2895(6)(b)
(b) Subject to
sub. (8), develop and implement a personnel structure and other employment policies for employees of the family care district.
46.2895(6)(c)
(c) Assure compliance with the terms of any contract with the department under
sub. (4) (d).
46.2895(6)(d)
(d) Establish a fiscal operating year and annually adopt a budget for the family care district.
46.2895(6)(e)
(e) Contract for any legal services required for the family care district.
46.2895(6)(f)
(f) Subject to
sub. (8), procure liability insurance covering its officers, employees, and agents, insurance against any loss in connection with its property and other assets and other necessary insurance; establish and administer a plan of self-insurance; or, subject to an agreement under
s. 66.0301, participate in a governmental plan of insurance or self-insurance.
46.2895(7)
(7) Director; duties. The director appointed under
sub. (6) (a) shall do all of the following:
46.2895(7)(a)
(a) Manage the property and business of the family care district and manage the employees of the district, subject to the general control of the family care district board.
46.2895(7)(b)
(b) Comply with the bylaws and direct enforcement of all policies and procedures adopted by the family care district board.
46.2895(7)(c)
(c) Perform duties in addition to those specified in
pars. (a) and
(b) as are prescribed by the family care district board.
46.2895(8)
(8) Employment and employee benefits of certain employees. 46.2895(8)(a)(a) A family care district board shall do all of the following:
46.2895(8)(a)1.
1. If the family care district offers employment to any individual who was previously employed by the county, who while employed by the county performed duties relating to the same or a substantially similar function for which the individual is offered employment by the district and whose wages, hours and conditions of employment were established in a collective bargaining agreement with the county under
subch. IV of ch. 111 that is in effect on the date that the individual commences employment with the district, with respect to that individual, abide by the terms of the collective bargaining agreement concerning the individual's compensation and benefits until the time of the expiration of that collective bargaining agreement or adoption of a collective bargaining agreement with the district under
subch. IV of ch. 111 covering the individual as an employee of the district, whichever occurs first.
46.2895(8)(a)2.
2. If the family care district offers employment to any individual who was previously employed by the county and who while employed by the county performed duties relating to the same or a substantially similar function for which the individual is offered employment by the district, but whose wages, hours and conditions of employment were not established in a collective bargaining agreement with the county under
subch. IV of ch. 111 that is in effect on the date the individual commences employment with the district, with respect to that individual, initially provide that individual the same compensation and benefits that he or she received while employed by the county.
46.2895(8)(a)3.
3. If the family care district offers employment to any individual who was previously employed by the county and who while employed by the county performed duties relating to the same or a substantially similar function for which the individual is offered employment by the district, with respect to that individual, recognize all years of service with the county for any benefit provided or program operated by the district for which an employee's years of service may affect the provision of the benefit or the operation of the program.
46.2895(8)(a)4.
4. If the county has not established its own retirement system for county employees, adopt a resolution that the family care district be included within the provisions of the Wisconsin retirement system under
s. 40.21 (1). In this resolution, the family care district shall agree to recognize 100% of the prior creditable service of its employees earned by the employees while employed by the district.
46.2895(8)(b)
(b) The county board of supervisors of the area of jurisdiction of the family care district shall do all of the following:
46.2895(8)(b)1.
1. If the county has established its own retirement system for county employees, provide that family care district employees are eligible to participate in the county retirement system.
46.2895(8)(b)2.
2. Provide that, subject to the terms of any applicable collective bargaining agreement as provided in
par. (a) 1., family care district employees are eligible to receive health care coverage under any county health insurance plan that is offered to county employees.
46.2895(8)(b)3.
3. Provide that, subject to the terms of any applicable collective bargaining agreement as provided in
par. (a) 1., family care district employees are eligible to participate in any deferred compensation or other benefit plan offered by the county to county employees, including disability and long-term care insurance coverage and income continuation insurance coverage.
46.2895(9)
(9) Confidentiality of records. No record, as defined in
s. 19.32 (2), of a family care district that contains personally identifiable information, as defined in
s. 19.62 (5), concerning an individual who receives services from the family care district may be disclosed by the family care district without the individual's informed consent, except as required to comply with
s. 16.009 (2) (p) or
49.45 (4).
46.2895(10)
(10) Exchange of information. Notwithstanding
sub. (9) and
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 family care district 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),
46.283 (7),
46.284 (7),
51.42 (3) (e) or
51.437 (4r) (b) in the jurisdiction of the family care district, if necessary to enable the family care district to perform its duties or to coordinate the delivery of services to the client.
46.2895(11)
(11) Obligations and debts not those of county. The obligations and debts of the family care district are not the obligations or debts of the county that created the family care district.
46.2895(12)
(12) Assistance to family care district. From moneys in the county treasury that are not appropriated to some other purpose, the county board of supervisors under
sub. (1) (a) or the county boards of supervisors under
sub. (1) (b) may appropriate moneys to the family care district as a gift or may lend moneys to the family care district.
