46.2804 HistoryHistory: 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 Family Care Partnership program under a federal waiver authorized under 42 USC 1396n. 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. 46.28146.281 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 and the self-directed services option 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(1k)(1k) Worker’s compensation coverage. An individual who is performing services for a person receiving the Family Care benefit, or benefits under Family Care Partnership, on a self-directed basis and who does not otherwise have worker’s compensation coverage for those services is considered, for purposes of worker’s compensation coverage, to be an employee of the entity that is providing financial management services for that person. 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)(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(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 (4) (h). 46.28346.283 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. 46.283(3)(f)(f) Assistance to a person with respect to the person’s choice of whether or not to enroll in the self-directed services option, as defined in s. 46.2899 (1), a care management organization for the family care benefit or the Family Care Partnership program, or the program of all-inclusive care for the elderly and, if so, which available long-term care program or 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)(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)(f)(f) Perform a functional screening and a financial and cost-sharing screening for any resident who requests a screening and assist any resident who is eligible and chooses to enroll in a care management organization or the self-directed services option to do so. 46.283(4)(g)(g) Perform a functional screening and a financial and cost-sharing screening for 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 and cost-sharing screening for a person seeking admission or about to be admitted on a private pay basis who waives the requirement for a financial and cost-sharing screening under this paragraph, unless the person is expected to become eligible for medical assistance within 6 months. A resource center need not perform a functional screening for a person seeking admission or about to be admitted for whom a functional screening was performed 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 elder-adult-at-risk agency or the adult-at-risk agency that provides 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(4)(j)(j) Target any outreach, education, and prevention services it provides and any service development efforts it conducts on the basis of findings made by the governing board of the resource center under sub. (6) (b) 2. and 3. 46.283(5)(5) Funding. From the appropriation accounts under s. 20.435 (1) (n), (4) (b), (bd), (bm), (gm), (pa), and (w), and (7) (b) 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)(a)1.1. A resource center shall have a governing board that reflects the ethnic and economic diversity of the geographic area served by the resource center. 46.283(6)(a)2.2. At least one-fourth of the members of the governing board shall be individuals who belong to a client group served by the resource center or their family members, guardians, or other advocates. The proportion of these board members who belong to each client group, or their family members, guardians, or advocates, shall be the same, respectively, as the proportion of individuals in this state who receive services under s. 46.2805 to 46.2895 and belong to each client group. 46.283(6)(a)3.3. An individual who has a financial interest in, or serves on the governing board of, a care management organization or an organization that administers a program described under s. 46.2805 (1) (a) or (b) or a managed care program under s. 49.45 for individuals who are eligible to receive supplemental security income under 42 USC 1381 to 1383c, which serves any geographic area also served by a resource center, and the individual’s family members, may not serve as members of the governing board of the resource center. 46.283(6)(b)(b) The governing board of a resource center shall do all of the following: 46.283(6)(b)1.1. Determine the structure, policies, and procedures of, and oversee the operations of, the resource center. The operations of a resource center that is operated by a county are subject to the county’s ordinances and budget. 46.283(6)(b)2.2. Annually gather information from consumers and providers of long-term care services and other interested persons concerning the adequacy of long-term care services offered in the area served by the resource center. The board shall provide well-advertised opportunities for persons to participate in the board’s information gathering activities conducted under this subdivision.
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