46.28(1)(cg)
(cg) "Eligible individual" means an individual who is elderly or chronically disabled, a child with long-term care needs, a homeless individual or a victim of domestic abuse.
46.28(1)(d)
(d) "Residential facility" means a living unit for eligible individuals that is developed by a sponsor and that is not physically connected to a nursing home or hospital except by common service units for laundry, kitchen or utility purposes and that may include buildings and grounds for activities related to residence, including congregate meal sites, socialization, physical rehabilitation facilities and child care facilities.
46.28(1)(e)2.
2. A tribal council or housing authority or any nonprofit entity created by a tribal council.
46.28(1)(e)7.
7. Any housing corporation, limited-profit or nonprofit entity.
46.28(1)(e)8.
8. Any other entity meeting criteria established by the authority and organized to provide housing for persons and families of low and moderate income.
46.28(1)(e)9.
9. An entity that is operated for profit and that is engaged in providing medical care or residential care or services, including all of the following:
46.28(1)(f)
(f) "Victim of domestic abuse" means an individual who has encountered domestic abuse, as defined in
s. 49.165 (1) (a).
46.28(2)
(2) The department may approve any residential facility for financing by the authority if it determines that the residential facility will help meet the housing needs of an eligible individual, based on factors that include:
46.28(2)(a)
(a) The geographic location of the residential facility.
46.28(2)(b)
(b) The population served by the residential facility.
46.28(2)(c)
(c) The services offered by the residential facility.
46.28(3)
(3) The department may authorize the authority to issue revenue bonds under
s. 234.61 to finance any residential facility it approves under
sub. (2).
46.28(4)
(4) The department may charge sponsors for administrative costs and expenses it incurs in exercising its powers and duties under this section and under
s. 234.61.
46.2803(1)(1) 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 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.
46.2803(2)
(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 20.435 (7) (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.
46.2804
46.2804
Client management of managed care long-term care benefit. Under a managed care program for provision of long-term care services, the care manager shall provide, within guidelines established by the department, a mechanism by which an enrollee, beneficiary, or recipient of the program may arrange for, manage, and monitor his or her benefit directly or with the assistance of another person chosen by the enrollee, beneficiary, or recipient. The care manager shall provide each enrollee, beneficiary, or recipient with a form on which the enrollee, beneficiary, or recipient shall indicate whether he or she has been offered the option under this subsection and whether he or she has accepted or declined the option. If the enrollee, beneficiary, or recipient accepts the option, the care manager shall monitor the use by the enrollee, beneficiary, or recipient of a fixed budget for purchase of services or support items from any qualified provider, monitor the health and safety of the enrollee, beneficiary, or recipient, and provide assistance in management of the budget and services of the enrollee, beneficiary, or recipient at a level tailored to the need and desire of the enrollee, beneficiary, or recipient for the assistance.
46.2804 History
History: 2005 a. 386;
2007 a. 20.
46.2805(1)
(1) "Care management organization" means an entity that is certified as meeting the requirements for a care management organization under
s. 46.284 (3) and that has a contract under
s. 46.284 (2). "Care management organization" does not mean an entity that contracts with the department to operate one of the following:
46.2805(1)(b)
(b) A demonstration program known as the Wisconsin partnership program under a federal waiver authorized under
42 USC 1315.
46.2805(2)
(2) "Eligible person" means a person who meets all eligibility criteria under
s. 46.286 (1).
46.2805(3)
(3) "Enrollee" means a person who is enrolled in a care management organization.
46.2805(4)
(4) "Family care benefit" means financial assistance for long-term care and support items for an enrollee.
46.2805(6m)
(6m) "Family member" means a spouse or an individual related by blood, marriage, or adoption within the 3rd degree of kinship as computed under
s. 990.001 (16).
46.2805(6r)
(6r) "Financial and cost-sharing screening" means a screening to determine financial eligibility under
s. 46.286 (1) (b) or the self-directed services option and cost-sharing under
s. 46.286 (2) using a uniform tool prescribed by the department.
46.2805(6v)
(6v) "Frail elder" means an individual who is 65 years of age or older and has a physical disability or irreversible dementia that restricts the individual's ability to perform normal daily tasks or that threatens the capacity of the individual to live independently.
46.2805(7)
(7) "Functional screening" means a screening to determine functional eligibility under
s. 46.286 (1) (a) or the self-directed services option using a uniform tool prescribed by the department.
46.2805(7u)
(7u) "Long-term care district board" means the governing board of a long-term care district.
46.2805(9)
(9) "Older person" means a person who is at least 65 years of age.
46.2805(10)
(10) "Resource center" means an entity that meets the standards for operation under
s. 46.283 (3) or, if under contract to provide a portion of the services specified under
s. 46.283 (3), meets the standards for operation with respect to those services.
46.2805(10m)
(10m) "Self-directed services option" means the program that is operated under a waiver from the secretary of the federal department of health and human services under
42 USC 1396n (c) in which an enrolled individual selects his or her own services and service providers.
46.2805(11)
(11) "Tribe or band" means a federally recognized American Indian tribe or band.
46.281
46.281
Powers and duties of the department, secretary, and counties; long-term care. 46.281(1d)
(1d)
Waiver request. The department shall request from the secretary of the federal department of health and human services any waivers of federal medicaid laws necessary to permit the use of federal moneys to provide the family care benefit to recipients of medical assistance. The department shall implement any waiver that is approved and that is consistent with
ss. 46.2805 to
46.2895. Regardless of whether a waiver is approved, the department may implement operation of resource centers, care management organizations, and the family care benefit.
46.281(1g)
(1g) Contracting for resource centers and care management organizations. 46.281(1g)(a)(a) Subject to
par. (b), the department may contract with entities as provided under
s. 46.283 (2) to provide the services under
s. 46.283 (3) and
(4) as resource centers in any geographic area in the state, and may contract with entities as provided under
s. 46.284 (2) to administer the family care benefit as care management organizations in any geographic area in the state.
46.281(1g)(b)
(b) If the department proposes to contract with entities to administer the family care benefit in geographic areas in which, in the aggregate, resides more than 29 percent of the state population that is eligible for the family care benefit, the department shall first notify the joint committee on finance in writing of the proposed contract. The notification shall include the contract proposal; and an estimate of the fiscal impact of the proposed addition that demonstrates that the addition will be cost neutral, including startup, transitional, and ongoing operational costs and any proposed county contribution. The notification shall also include, for each county affected by the proposal, documentation that the county consents to administration of the family care benefit in the county, the amount of the county's payment or reduction in community aids under
s. 46.281 (4), and a proposal by the county for using any savings in county expenditures on long-term care that result from administration of the family care benefit in the county. If the cochairpersons of the committee do not notify the department within 14 working days after the date of the department's notification that the committee has scheduled a meeting for the purpose of reviewing the proposed contract, the department may enter into the proposed contract. If within 14 working days after the date of the department's notification the cochairpersons of the committee notify the department that the committee has scheduled a meeting for the purpose of reviewing the proposed contract, the department may enter into the proposed contract only if the committee approves the proposed contract or if the committee fails to act on the proposed contract within 59 working days after the date of the department's notification.
46.281(1n)
(1n) Other duties of the department. The department shall do all of the following:
46.281(1n)(a)
(a) Prescribe and implement a per person monthly rate structure for costs of the family care benefit.
46.281(1n)(b)
(b) In order to maintain continuous quality assurance and quality improvement for resource centers and care management organizations, do all of the following:
46.281(1n)(b)1.
1. Prescribe by rule and by contract and enforce performance standards for operation of resource centers and care management organizations.
46.281(1n)(b)2.
2. Use performance expectations that are related to outcomes for persons in contracting with care management organizations and resource centers.
46.281(1n)(b)3.
3. Conduct ongoing evaluations of managed care programs for provision of long-term care services that are funded by medical assistance, as defined in
s. 46.278 (1m) (b), as to client access to services, the availability of client choice of living and service options, quality of care, and cost-effectiveness. In evaluating the availability of client choice, the department shall evaluate the opportunity for a client to arrange for, manage, and monitor his or her family care benefit directly or with assistance, as specified in
s. 46.284 (4) (e).
46.281(1n)(b)4.
4. Require that quality assurance and quality improvement efforts be included throughout the long-term care system specified in
ss. 46.2805 to
46.2895.
46.281(1n)(b)5.
5. Ensure that reviews of the quality of management and service delivery of resource centers and care management organizations are conducted by external organizations and make information about specific review results available to the public.
46.281(1n)(c)
(c) Require by contract that resource centers and care management organizations establish procedures under which an individual who applies for or receives the family care benefit may register a complaint or grievance and procedures for resolving complaints and grievances.
46.281(1n)(d)1.1. Establish regions for long-term care advisory committees under
s. 46.2825, periodically review the boundaries of the regions, and, as appropriate, revise the boundaries.
46.281(1n)(d)2.
2. Specify the number of members that each governing board of a resource center shall appoint to a regional long-term care advisory committee. The total number of committee members shall not exceed 25, and the department shall allot committee membership equally among the governing boards of resource centers operating within the boundaries of the regional long-term care advisory committee.
46.281(1n)(d)3.
3. Provide information and staff assistance to assist regional long-term care advisory committees in performing the duties under
s. 46.2825 (2).
46.281(1n)(e)
(e) Contract with a person to provide the advocacy services described under
s. 16.009 (2) (p) 1. to
5. to actual or potential recipients of the family care benefit who are under age 60 or to their families or guardians. The department may not contract under this paragraph with a county or with a person who has a contract with the department to provide services under
s. 46.283 (3) and
(4) as a resource center or to administer the family care benefit as a care management organization. The contract under this paragraph shall include as a goal that the provider of advocacy services provide one advocate for every 2,500 individuals under age 60 who receive the family care benefit or who participates in the self-directed services option.
46.281(1n)(f)
(f) From the appropriation under
s. 20.435 (7) (b), provide $75,000 annually to Grant County to provide, with respect to issues concerning family care benefits, liaison services between the county and a managed care organization and advocacy services on behalf of the county.
46.281(2)
(2) Other powers of the department. The department may develop risk-sharing arrangements in contracts with care management organizations, in accordance with applicable state laws and federal statutes and regulations.
46.281(3)
(3) Duty of the secretary. The secretary shall certify to each county, hospital, nursing home, community-based residential facility, adult family home, as defined in
s. 50.01 (1) (a) or
(b), and residential care apartment complex the date on which a resource center that serves the area of the county, hospital, nursing home, community-based residential facility, adult family home, or residential care apartment complex is first available to perform functional screenings and financial and cost-sharing screenings. To facilitate phase-in of services of resource centers, the secretary may certify that the resource center is available for specified groups of eligible individuals or for specified facilities in the county.
46.281(4)(a)(a) In this subsection, "base amount" means the amount that a county expended in calendar year 2006, as determined by the department, to provide long-term care services to individuals who would have been eligible for the family care benefit in calendar year 2006 if the family care benefit had been available to residents of the county.
46.281(4)(b)
(b) Except as provided in
par. (c), each county in which the department has a contract with an entity to administer the family care benefit shall in each year of the contract either pay the department the following amount or agree to reduce the community aids distribution to the county under
s. 46.40 (2) by the following amount:
46.281(4)(b)1.
1. If the base amount for the county is less than or equal to 22 percent of the calendar year 2006 community aids distribution to the county under
s. 46.40 (2), the base amount.
46.281(4)(b)2.
2. If the base amount for the county is greater than 22 percent of the calendar year 2006 community aids distribution to the county under
s. 46.40 (2), the following amounts in the following years:
46.281(4)(b)2.a.
a. For the first year that the department contracts for administration of the family care benefit in the county, the base amount for the county.
46.281(4)(b)2.b.
b. For the 2nd, 3rd, and 4th years that the department contracts for administration of the family care benefit in the county, the amount from the previous year minus 25 percent of the difference between the base amount for the county and 22 percent of the calendar year 2006 community aids distribution to the county under
s. 46.40 (2).
46.281(4)(b)2.c.
c. For the 5th year and each subsequent year that the department contracts for administration of the family care benefit in the county, 22 percent of the calendar year 2006 community aids distribution to the county under
s. 46.40 (2).
46.281(4)(c)
(c) Each county in which the department has a contract with an entity to administer the family care benefit, and in which the department had such a contract before January 1, 2006, shall annually either pay the department or agree to reduce the community aids distribution to the county under
s. 46.40 (2) by the amount that the county paid the department, or by which the county's community aids distribution was reduced, in calendar year 2006 to fund the program under
ss. 46.2805 to
46.2895.
46.281(4)(d)
(d) The department shall deposit payments made by counties under this subsection in the appropriation account under
s. 20.435 (7) (g).
46.2825
46.2825
Regional long-term care advisory committees. 46.2825(1)(1)
Creation. The governing board of each resource center operating in a region established by the department under
s. 46.281 (1n) (d) 1. shall appoint the number of its members that is specified by the department under
s. 46.281 (1n) (d) 2. to a regional long-term care advisory committee. At least 50 percent of the persons a resource center board appoints to a regional long-term care advisory committee shall be older persons or persons with a physical or developmental disability or their family members, guardians, or other advocates.
46.2825(2)
(2) Duties. A regional long-term care advisory committee shall do all of the following:
46.2825(2)(a)
(a) Evaluate the performance of care management organizations and entities that operate a program described under
s. 46.2805 (1) (a) or
(b) in the committee's region with respect to responsiveness to recipients of their services, fostering choices for recipients, and other issues affecting recipients; and make recommendations based on the evaluation to the department and to the care management organizations and entities, as appropriate.
46.2825(2)(b)
(b) Evaluate the performance of resource centers operating in the committee's region and, as appropriate, make recommendations, concerning their performance to the department and the resource centers.
46.2825(2)(c)
(c) Monitor grievances and appeals made to care management organizations or entities that operate a program described under
s. 46.2805 (1) (a) or
(b) within the committee's region.
