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 submit to the joint committee on finance in writing the proposed contract for the approval of the committee. The submission 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 submission 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. The department may enter into the proposed contract only if the committee approves the proposed contract. The procedures under
s. 13.10 do not apply to this paragraph.
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, 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.
46.2825(2)(d)
(d) Review utilization of long-term care services in the committee's region.
46.2825(2)(e)
(e) Monitor enrollments and disenrollments in care management organizations that provide services in the committee's region.
46.2825(2)(f)
(f) Using information gathered under
s. 46.283 (6) (b) 2. by governing boards of resources centers operating in the committee's region and other available information, identify any gaps in the availability of services, living arrangements, and community resources needed by older persons and persons with physical or developmental disabilities, and develop strategies to build capacity to provide those services, living arrangements, and community resources in the committee's region.
46.2825(2)(g)
(g) Perform long-range planning on long-term care policy for individuals belonging to the client groups served by the resource center.
46.2825(2)(h)
(h) Annually report to the department regarding significant achievements and problems relating to the provision of long-term care services in the committee's region.
46.2825 History
History: 2007 a. 20 ss.
968,
970,
977.
46.283
46.283
Resource centers. 46.283(1)(a)(a) 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.,
2., or
3. 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 long-term care district to apply to the department for a contract to operate a resource center.
46.283(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 resource center for tribal members and, if so, which client group to serve.
46.283(1)(c)
(c) 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) 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)
(2) Exclusive contract. The department may contract to operate a resource center with counties, long-term care districts, or the governing body of a tribe or band or the Great Lakes Inter-Tribal Council, Inc., 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)(a)
(a) A county board of supervisors declines in writing to apply for a contract to operate a resource center.
46.283(2)(b)
(b) A county agency or a long-term 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.
