(a) 1m. Except as provided in subd. 2., a client may contest any of 23
the following adverse benefit determinations by filing, within 90 days of the failure 24
of a care management organization to act on a contested adverse benefit 25
determination within the time frames specified by rule by the department or within
90 days after receipt of notice of a decision upholding the adverse benefit 2
determination, a written request for a hearing under s. 227.44 to the division of 3
hearings and appeals created under s. 15.103 (1):
a. Denial of functional eligibility under s. 46.286 (1) as a result of the care 5
management organization's administration of the long-term care functional screen, 6
including a change from a nursing home level of care to a non-nursing home level 7
c. Denial or limited authorization of a requested service, including 9
determinations based on type or level of service, requirements or medical necessity, 10
appropriateness, setting, or effectiveness of a covered benefit.
d. Reduction, suspension, or termination of a previously authorized service, 12
unless the service was only authorized for a limited amount or duration and that 13
amount or duration has been completed.
e. Denial, in whole or in part, of payment for a service.
f. The failure of a care management organization to act within the time frames 16
provided in 42 CFR 438.408
(b) (1) and (2) regarding the standard resolution of 17
grievances and appeals.
g. Denial of an enrollee's request to dispute financial liability, including 19
copayments, premiums, deductibles, coinsurance, other cost sharing, and other 20
member financial liabilities.
h. Denial of an enrollee, who is a resident of a rural area with only one care 22
management organization, to obtain services outside the care management 23
organization's network of contracted providers.
i. Development of a plan of care that is unacceptable to the enrollee because the 25
plan of care requires the enrollee to live in a place that is unacceptable to the enrollee;
the plan of care does not provide sufficient care, treatment, or support to meet the 2
enrollee's needs and support the enrollee's identified outcomes; or the plan of care 3
requires the enrollee to accept care, treatment, or support that is unnecessarily 4
restrictive or unwanted by the enrollee.
j. Involuntary disenrollment from the care management organization.
46.287 (2) (b) of the statutes is amended to read:
(b) An enrollee may contest a decision, omission or action of a care 8
management organization other than those specified in par. (a), or may contest the
9choice of service provider. In these instances, the enrollee shall first send a written
10request for review by the unit of the department that monitors care management
11organization contracts. This unit shall review and attempt to resolve the dispute.
121m. by filing a grievance with the care management organization.
If the dispute 13grievance
is not resolved to the satisfaction of the enrollee, he or she may request
14a hearing under the procedures specified in par. (a) 1. (intro.) that the department
15review the decision of the care management organization
46.288 (2) (intro.) of the statutes is renumbered 46.288 (2) and 17
amended to read:
Criteria and procedures for determining functional eligibility under 19
s. 46.286 (1) (a), financial eligibility under s. 46.286 (1) (b), and cost sharing under 20
s. 46.286 (2) (a). The rules for determining functional eligibility under s. 46.286 (1)
21(a) 1m. shall be substantially similar to eligibility criteria for receipt of the long-term
22support community options program under s. 46.27. Rules under this subsection
23shall include definitions of the following terms applicable to s. 46.286:
46.288 (2) (d) to (j) of the statutes are repealed.
46.2896 (1) (a) of the statutes is amended to read:
(a) “Long-term care program" means the long-term care program 2
under s. 46.27,
46.275, 46.277, 46.278, or 46.2785; the family care program providing 3
the benefit under s. 46.286; the Family Care Partnership program; or the long-term 4
care program defined in s. 46.2899 (1).
46.536 of the statutes is amended to read:
646.536 Mobile crisis team Crisis program enhancement grants.
the appropriation under s. 20.435 (5) (cf), the department shall award grants in the 8
total amount of $250,000 in each fiscal biennium to counties or regions comprised of 9
multiple counties to establish certified or enhance
crisis programs that create mental
10health mobile crisis teams
to serve individuals having mental health
crises in rural 11
areas. The department shall award a grant under this section in an amount equal 12
to one-half the amount of money the county or region provides to establish certified 13or enhance
crisis programs that create mobile crisis teams
46.82 (3) (a) 13. of the statutes is repealed.
46.854 of the statutes is created to read:
1646.854 Healthy aging grant program.
From the appropriation under s. 17
20.435 (1) (bk), the department shall award in each fiscal year a grant of $250,000 18
to an entity that conducts programs in healthy aging.
46.995 (4) of the statutes is created to read:
The department shall ensure that any child who is eligible and who 21
applies for the disabled children's long-term support program that is operating 22
under a waiver of federal law receives services under the disabled children's 23
long-term support program that is operating under a waiver of federal law.
47.07 of the statutes is created to read:
147.07 Project SEARCH.
The department shall allocate for each fiscal 2
year at least $250,000 from the appropriation under s. 20.445 (1) (b) for contracts 3
entered into under this section.
The department may enter into contracts to provide services to persons with 5
disabilities under the Project SEARCH program operated by the Cincinnati 6
Children's Hospital or its successor organization.
48.02 (1d) of the statutes is amended to read:
“Adult" means a person who is 18 years of age or older, except that
9for purposes of investigating or prosecuting a person who is alleged to have violated
10any state or federal criminal law or any civil law or municipal ordinance, “
11means a person who has attained 17 years of age
48.02 (2) of the statutes is amended to read:
“Child," when used without further qualification, means a person who 14
is less than 18 years of age, except that for purposes of investigating or prosecuting
15a person who is alleged to have violated a state or federal criminal law or any civil
16law or municipal ordinance, “child" does not include a person who has attained 17
17years of age
48.02 (14m) of the statutes is created to read:
“Qualifying residential family-based treatment facility” means a 20
certified residential family-based alcohol or drug abuse treatment facility that 21
meets all of the following criteria:
(a) The treatment facility provides, as part of the treatment for substance 23
abuse, parenting skills training, parent education, and individual and family 24
(b) The substance abuse treatment, parenting skills training, parent 2
education, and individual and family counseling is provided under an organizational 3
structure and treatment framework that involves understanding, recognizing, and 4
responding to the effects of all types of trauma and in accordance with recognized 5
principles of a trauma-informed approach and trauma-specific interventions to 6
address the consequences of trauma and facilitate healing.
48.13 of the statutes is amended to read:
848.13 Jurisdiction over children alleged to be in need of protection or
Except as provided in s. 48.028 (3), the court has exclusive original 10
jurisdiction over a child alleged to be in need of protection or services which can be 11
ordered by the court, and if one of the following applies
12(1) Who The child
is without a parent or guardian;.
13(2) Who The child
has been abandoned;.
14(2m) Whose The child's
parent has relinquished custody of the child under s. 15
16(3) Who The child
has been the victim of abuse, as defined in s. 48.02 (1) (a) or 17
(b) to (g), including injury that is self-inflicted or inflicted by another;.
18(3m) Who The child
is at substantial risk of becoming the victim of abuse, as 19
defined in s. 48.02 (1) (a) or (b) to (g), including injury that is self-inflicted or inflicted 20
by another, based on reliable and credible information that another child in the home 21
has been the victim of such abuse;.
22(4) Whose The child's
parent or guardian signs the petition requesting 23
jurisdiction under this subsection and is unable or needs assistance to care for or 24
provide necessary special treatment or care for the child;.
1(4m) Whose The child's
guardian is unable or needs assistance to care for or 2
provide necessary special treatment or care for the child, but is unwilling or unable 3
to sign the petition requesting jurisdiction under this subsection
4(5) Who The child
has been placed for care or adoption in violation of law
5(8) Who The child
is receiving inadequate care during the period of time a 6
parent is missing, incarcerated, hospitalized or institutionalized
7(9) Who The child
is at least age 12, signs the petition requesting jurisdiction 8
under this subsection and is in need of special treatment or care which the parent, 9
guardian or legal custodian is unwilling, neglecting, unable or needs assistance to 10
11(10) Whose The child's
parent, guardian or legal custodian neglects, refuses or 12
is unable for reasons other than poverty to provide necessary care, food, clothing, 13
medical or dental care or shelter so as to seriously endanger the physical health of 14
15(10m) Whose The child's
parent, guardian or legal custodian is at substantial 16
risk of neglecting, refusing or being unable for reasons other than poverty to provide 17
necessary care, food, clothing, medical or dental care or shelter so as to endanger 18
seriously the physical health of the child, based on reliable and credible information 19
that the child's parent, guardian or legal custodian has neglected, refused or been 20
unable for reasons other than poverty to provide necessary care, food, clothing, 21
medical or dental care or shelter so as to endanger seriously the physical health of 22
another child in the home;.
23(11) Who The child
is suffering emotional damage for which the parent, 24
guardian or legal custodian has neglected, refused or been unable and is neglecting,
refusing or unable, for reasons other than poverty, to obtain necessary treatment or 2
to take necessary steps to ameliorate the symptoms;
3(11m) Who The child
is suffering from an alcohol and other drug abuse 4
impairment, exhibited to a severe degree, for which the parent, guardian or legal 5
custodian is neglecting, refusing or unable to provide treatment
6(13) Who The child
has not been immunized as required by s. 252.04 and not 7
exempted under s. 252.04 (3).
48.13 (14) of the statutes is created to read:
The child's parent is residing in a qualifying residential 10
family-based treatment facility, signs the petition requesting jurisdiction under this 11
subsection, and, with the department's consent, requests that the child reside with 12
him or her at the qualifying residential family-based treatment facility.
48.207 (1) (L) of the statutes is created to read:
(L) With a parent in a qualifying residential family-based treatment 15
facility if the child's permanency plan includes a recommendation for such a 16
placement under s. 48.38 (4) (em) before the placement is made and the parent 17
consents to the placement.
48.345 (3) (c) of the statutes is amended to read:
(c) A foster home licensed under s. 48.62, a group home licensed 20
under s. 48.625, a foster home, group home, or similar facility regulated in another
the home of a guardian under s. 48.977 (2).
48.345 (3) (cm) of the statutes is amended to read:
(cm) A group home described in s. 48.625 (1m) or a similar facility
24regulated in another state,
if the child is at least 12 years of age, is a custodial parent,
as defined in s. 49.141 (1) (b), or an expectant mother, is receiving inadequate care, 2
and is in need of a safe and structured living arrangement.
48.345 (3) (d) of the statutes is amended to read:
(d) A residential treatment care
center for children and youth 5
operated by a child welfare agency licensed under s. 48.60, or a similar facility
6regulated in another state
48.345 (3) (e) of the statutes is created to read:
(e) With a parent in a qualifying residential family-based treatment 9
facility, or a similar facility regulated in another state, if the child's permanency plan 10
includes a recommendation for such a placement under s. 48.38 (4) (em) before the 11
placement is made.
48.38 (2) (intro.) of the statutes is amended to read:
48.38 (2) Permanency plan required.
(intro.) Except as provided in sub. (3), 14
for each child living in a foster home, group home, residential care center for children 15
and youth, juvenile detention facility, shelter care facility,
16family-based treatment facility with a parent,
or supervised independent living 17
arrangement, the agency that placed the child or arranged the placement or the 18
agency assigned primary responsibility for providing services to the child under s. 19
48.355 (2) (b) 6g. shall prepare a written permanency plan, if any of the following 20
conditions exists, and, for each child living in the home of a guardian or a relative 21
other than a parent, that agency shall prepare a written permanency plan, if any of 22
the conditions specified in pars. (a) to (e) exists:
48.38 (2) (d) of the statutes is amended to read:
(d) The child was placed under a voluntary agreement between the 2
agency and the child's parent under s. 48.63 (1) (a) or (bm)
or (5) (b) or under a 3
voluntary transition-to-independent-living agreement under s. 48.366 (3).
48.38 (4) (em) of the statutes is created to read:
(em) A recommendation regarding placement with a parent in a 6
qualifying residential family-based treatment facility.
Subchapter IX (title) of chapter 48 [precedes 48.44] of the 8
statutes is amended to read:
JURISDICTION OVER PERSON 17
OR OLDER adults
48.44 of the statutes is amended to read:
1448.44 Jurisdiction over persons 17 or older adults.
The court has 15
jurisdiction over persons 17 years of age or older
as provided under ss. 48.133, 16
48.355 (4), 48.357 (6), 48.365 (5), and 48.45 and as otherwise specifically provided in 17
48.45 (1) (a) of the statutes is amended to read:
(a) If in the hearing of a case of a child alleged to be in a condition 20
described in s. 48.13 it appears that any person 17 years of age or older adult
has been 21
guilty of contributing to, encouraging, or tending to cause by any act or omission,
condition of the child, the judge may make orders with respect to the 23
conduct of such that
person in his or her relationship to the child, including orders 24
determining the ability of the person to provide for the maintenance or care of the
child and directing when, how,
where funds for the maintenance or care 2
shall be paid.
48.45 (1) (am) of the statutes is amended to read:
(am) If in the hearing of a case of an unborn child and the unborn 5
child's expectant mother alleged to be in a condition described in s. 48.133 it appears 6
that any person 17 years of age or over adult
has been guilty of contributing to, 7
encouraging, or tending to cause by any act or omission, such that
condition of the 8
unborn child and expectant mother, the judge may make orders with respect to the 9
conduct of such that
person in his or her relationship to the unborn child and 10
48.45 (3) of the statutes is amended to read:
If it appears at a court hearing that any person 17 years of age or older 13adult
has violated s. 948.40, the judge shall refer the record to the district attorney 14
for criminal proceedings as may be warranted in the district attorney's judgment. 15
This subsection does not prevent prosecution of violations of s. 948.40 without the 16
prior reference by the judge to the district attorney, as in other criminal cases.
48.48 (17) (a) 3. of the statutes is amended to read:
(a) 3. Provide appropriate protection and services for children and 19
the expectant mothers of unborn children in its care, including providing services for 20
those children and their families and for those expectant mothers in their own 21
homes, placing the those
children in licensed foster homes or group homes in this 22
state or a similar facility regulated in
another state within a reasonable proximity 23
to the agency with legal custody, placing the
children in the homes of guardians 24
under s. 48.977 (2), placing those children in a qualifying residential family-based
25treatment facility with a parent or in a similar facility regulated in another state,
contracting for services for those children by licensed child welfare agencies in this
2state or a similar child welfare agency regulated in another state
, except that the 3
department may not purchase the educational component of private day treatment 4
programs unless the department, the school board, as defined in s. 115.001 (7), and 5
the state superintendent of public instruction all determine that an appropriate 6
public education program is not available. Disputes between the department and the 7
school district shall be resolved by the state superintendent of public instruction.
48.48 (17) (c) 4. of the statutes is amended to read:
(c) 4. Is living in a foster home, group home, or
residential care center 10
for children and youth, qualifying residential family-based treatment facility, or a
11similar facility regulated in another state
or in a supervised independent living 12
48.481 (3) of the statutes is repealed.
48.481 (4) of the statutes is created to read:
48.481 (4) Driver education program.
The department shall establish or 16
contract for a driver education program for individuals who are 15 years of age or 17
older and in out-of-home care. The program shall provide assistance with 18
identifying and enrolling in an appropriate driver education course, obtaining an 19
operator's license, and obtaining motor vehicle liability insurance. From the 20
appropriation under s. 20.437 (1) (a), the department may pay all of the following 21
expenses that apply to an individual in the program:
(a) Fees required to enroll in a driver education course.