DHS 10.13(18)(18) “Enrollee” means a person who is enrolled in a care management organization to receive the family care benefit. DHS 10.13(19)(19) “Exceptional payments” means the state supplement to federal supplemental security income authorized under s. 49.77 (3s), Stats. DHS 10.13(20)(20) “Fair hearing” means a de novo proceeding under ch. HA 3 before an impartial administrative law judge in which the petitioner or the petitioner’s representative presents the reasons why an administrative action under s. HA 3.03 or inaction by the department, a county agency, a resource center or a CMO in the petitioner’s case should be corrected. DHS 10.13(21)(21) “Family care benefit” has the meaning given in s. 46.2805 (4), Stats., namely, financial assistance for long-term care and support items for an enrollee. DHS 10.13(23)(23) “Family care spouse” means an individual who is a family care applicant or enrollee and is legally married as recognized under state law to an individual who does not reside in a medical institution or a nursing facility. DHS 10.13(24)(24) “Financial eligibility and cost-sharing screening” means a uniform screening tool prescribed by the department that is used to determine financial eligibility and cost-sharing under s. 46.286 (1) (b) and (2), Stats., and ss. DHS 10.32 and 10.34. DHS 10.13(25m)(25m) “Frail elder” means an individual aged 65 or older who has a physical disability, or an irreversible dementia, that restricts the individual’s ability to perform normal daily tasks or that threatens the capacity of the individual to live independently. DHS 10.13(26)(26) “Functional capacity” means the skill to perform activities in an acceptable manner. DHS 10.13(27)(27) “Functional screening” means a uniform screening tool prescribed by the department that is used to determine functional eligibility under s. 46.286 (1) (a), Stats., and ss. DHS 10.32 and 10.33. DHS 10.13(28)(28) “Grievance” means an expression of dissatisfaction about any matter that is not an adverse benefit determination. DHS 10.13(29)(29) “Home” means a place of abode and lands used or operated in connection with the place of abode. DHS 10.13 NoteNote: Note: In urban situations the home usually consists of a house and lot. There will be situations where the home will consist of a house and more than one lot. As long as the lots adjoin one another, they are considered part of the home. In farm situations, the home consists of the house and building together with the total acreage property upon which they are located and which is considered a part of the farm. There will be farms where the land is on both sides of a road, in which case the land on both sides is considered part of the homestead.
DHS 10.13(32)(32) “Instrumental activities of daily living” or “IADLs” means management of medications and treatments, meal preparation and nutrition, money management, using the telephone, arranging and using transportation and the ability to function at a job site. DHS 10.13(34)(34) “Long-term care facility” means a nursing home, adult family home, community-based residential facility or residential care apartment complex. DHS 10.13(36)(36) “Medical institution” means a facility that meets all of the following conditions: DHS 10.13(36)(a)(a) Is organized to provide medical care, including nursing and convalescent care. DHS 10.13(36)(b)(b) Has the necessary professional personnel, equipment and facilities to manage the medical, nursing and other health care needs of patients on a continuing basis in accordance with accepted professional standards. DHS 10.13(36)(d)(d) Is staffed by professional personnel who are responsible for professional medical and nursing services. The professional medical and nursing services include adequate and continual medical care and supervision by a physician, registered nurse or licensed practical nurse supervision and services and nurses’ aide services sufficient to meet nursing care needs and a physician’s guidance on the professional aspects of operating the institution. DHS 10.13(38)(38) “Older person” means a person who is at least 65 years of age. DHS 10.13(40)(40) “Physical disability” means a physical condition, including an anatomical loss or musculoskeletal, neurological, respiratory or cardiovascular impairment, that results from injury, disease or congenital disorder and that significantly interferes with or significantly limits at least one major life activity of a person. In the context of physical disability, “major life activity” means self-care, performance of manual tasks unrelated to gainful employment, walking, receptive and expressive language, breathing, working, participating in educational programs, mobility other than walking and capacity for independent living. DHS 10.13(41)(41) “Residential care apartment complex” or “RCAC” has the meaning specified in s. 50.01 (6d), Stats. DHS 10.13(42)(42) “Resource center” or “aging and disability resource center” means an entity that meets the standards for operation and is under contract with the department to provide services under s. 46.283 (3), Stats., and this chapter or, if under contract to provide a portion of the services specified under s. 46.283 (3), Stats., meets the standards for operation with respect to those services. DHS 10.13(43)(43) “Respite care” means temporary placement in a long-term care facility for maintenance of care, treatment or services, as established by the person’s primary care provider, in addition to room and board, for no more than 28 consecutive days at a time. DHS 10.13(44)(44) “Secretary” means the secretary of the department. DHS 10.13(45)(45) “Supplemental security income” means the supplemental security income program authorized under 42 USC 1381. DHS 10.13(46)(46) “Target population” means any of the following groups that a resource center or a care management organization has contracted with the department to serve: DHS 10.13(47)(47) “Wisconsin partnership program” means a demonstration program known by this name under contract with the department to provide health and long-term care services under a federal waiver authorized under 42 USC 1315. DHS 10.13 HistoryHistory: Cr. Register, October, 2000, No. 538, eff. 11-1-00; CR 04-040: renum. (1) to be (1m), cr. (1), (3m), and (25m), am. (24) and (27), r. and recr. (28), r. (31) Register November 2004 No. 587, eff. 12-1-04; correction in (17) made under s. 13.93 (2m) (b) 7., Stats., Register November 2004 No. 587; corrections in (15) and (35) made under s. 13.92 (4) (b) 6. and 7., Stats., Register November 2008 No. 635; CR 08-109: cr. (16m) Register June 2009 No. 642, eff. 7-1-09; corrections and renum. of (33) to be (40m) made under s. 13.92 (4) (b) 1., 6. and 7., Stats., Register November 2009 No. 647; correction in (41) made under s. 13.92 (4) (b) 7., Stats., Register December 2013 No. 696; 2019 Wis. Act 1: am. (3), (16) Register May 2019 No. 761, eff. 6-1-19; CR 22-026: am. (1) (intro.), (b) 1., 2., r. (1) (b) 4., 5., am. (1) (b) 7., cr. (1) (b) 8. to 10., (c), am. (3m), cr. (8m), r. (12), am. (14), cr. (14m), am. (16), (20), (28), cr. (36m), r. (40m), am. (46) Register May 2023 No. 809, eff. 6-1-23; correction in (1) (c) 2., (20) made under s. 35.17, Stats., Register May 2023 No. 809; EmR2306: emerg. cr. (16g), (16r), eff. 5-1-23; CR 23-045: cr. (16g), (16r) Register January 2024 No. 817, eff. 2-1-24; renum. (16g) to (16p) under s. 13.92 (4) (b) 1., Stats., Register January 2024 No. 817; CR 23-046: am. (3), cr. (14s), am. (16) Register April 2024 No. 820, eff. 5-1-24. DHS 10.21(1)(1) The department may contract for resource center operation only with entities that do all of the following: DHS 10.21(2)(2) The department’s contracts with organizations operating resource centers shall specify sanctions that may be taken if certain contract requirements are not met, including the withholding or deduction of funds. DHS 10.21(3)(3) The department shall use standard contract provisions for contracting with resource centers, except as provided in this subsection. The provisions of the standard contract shall comply with all applicable state and federal laws and may be modified only in accordance with those laws and after consideration of the advice of the secretary’s council on long-term care. DHS 10.21(4)(4) The department shall annually provide to the members of the council on long-term care copies of the standard resource center contract the department proposes to use in the next contract period and seek the advice of the council regarding the contract’s provisions. DHS 10.21(6)(6) Prior to receiving funds to operate a resource center, an organization shall agree to the terms of the standard contract. DHS 10.21 HistoryHistory: Cr. Register, October, 2000, No. 538, eff. 11-1-00; CR 04-040: am. (3) (a) Register November 2004 No. 587, eff. 12-1-04; corrections in (3) (b) and (5) made under s. 13.92 (4) (b) 6. and 7., Stats., Register November 2009 No. 647; CR 22-026: cons. (3) (intro.) and (a) and renum. to (3) and am., r. (3) (b), am. (4), r. (5) Register May 2023 No. 809, eff. 6-1-23; CR 23-046: am. (1) (a) Register April 2024 No. 820, eff. 5-1-24. DHS 10.22(1)(1) Target population. Each contract for operation of a resource center shall specify the target population that the resource center will serve. The target population to be served by the resource center includes all members of the specified group who reside in the geographic area served by the resource center regardless of whether they need or are seeking family care or other long-term care services or programs. DHS 10.22(2)(a)(a) A resource center shall have a name that is appropriate to its target population and includes any of the following phrases: DHS 10.22(2)(b)(b) The resource center’s name may be the primary name of the resource center or a subtitle to another name but shall be included in all advertising and materials, including any telephone book listings. DHS 10.22(3)(3) Governing board. A resource center shall have a governing board that reflects the ethnic and economic diversity of the geographic area served by the resource center. At least one-fourth of the members of the governing board shall be older persons or persons with physical or developmental disabilities or their family members, guardians or other advocates, reflective of the resource center’s target population. No member of the governing board may have any direct financial interest in a care management organization. DHS 10.22(4)(4) Independence from care management organization. To assure that persons receive long-term care counseling and eligibility determination services in an environment that is free from conflict of interest, a resource center shall meet state and federal requirements for organizational independence from any care management organization. DHS 10.22 NoteNote: Before July 1, 2001, the Wisconsin legislature has authorized the department to contract only with a county, a family care district, the governing body of a tribe or band or the Great Lakes Inter-tribal Council, Inc., or with 2 or more of these entities under a joint application, to operate a Resource Center. After June 30, 2001, the department is authorized to contract with these same entities, 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: (1) A county board of supervisors declines in writing to apply for a contract to operate a Resource Center; or (2) A county agency or a family care district applies for a contract but fails to meet the standards for performance for Resource Centers specified in s. DHS 10.23. Certain functions of the Resource Center, such as eligibility determination, must be performed by public employees. Section 46.285, Stats., further requires that no entity may directly operate both a Resource Center and a CMO, except that a pilot Resource Center is required to be structurally separate from the provision of CMO services by January 1, 2001. DHS 10.22 HistoryHistory: Cr. Register, October, 2000, No. 538, eff. 11-1-00; CR 22-026: am. (3), (4) Register May 2023 No. 809, eff. 6-1-23. DHS 10.23DHS 10.23 Standards for performance by resource centers. DHS 10.23(1)(1) Compliance. An aging and disability resource center shall comply with all applicable statutes, all of the standards in this section and all requirements of its contract with the department. DHS 10.23(2)(2) Services. A resource center shall ensure that the following services, meeting the standards specified, are available to its target population: DHS 10.23(2)(a)(a) Information and referral services and other assistance. A resource center shall provide information, referral and assistance at hours that are convenient to the public and consistent with requirements of this chapter and its contract with the department, using a telephone number that is toll-free to all callers in its service area. The resource center shall be physically accessible and be able to provide information and assistance services in a private and confidential manner. The resource center shall be able to provide information and assistance services in a language that a person contacting the resource center can understand. Information and referral services include all of the following: DHS 10.23(2)(a)1.1. Current information on a wide variety of topics related to aging, physical and developmental disabilities, chronic illness and long-term care, as specified by the department and appropriate to the resource center’s target population. DHS 10.23(2)(a)2.2. Referrals to and assistance in accessing an array of voluntary, purchased and public resources to help older people and people with disabilities secure needed services or benefits, live with dignity and security, and achieve maximum independence and quality of life. Referral and assistance includes all the following: DHS 10.23(2)(a)2.a.a. Professional advice and counseling to assist consumers in identifying needs, capacities and personal preferences. DHS 10.23(2)(a)3.3. Continued contact with people, as needed, to determine the outcomes of previous contacts and to offer additional assistance in locating or using services as necessary. DHS 10.23(2)(b)(b) Advocacy. Advocacy on behalf of individuals and groups when needed services are not being adequately provided by an organization within the service delivery system. DHS 10.23(2)(c)(c) Long-term care options counseling. The resource center shall provide members of its target population and their families or other representatives with professional counseling about options available to meet long-term care needs and about factors to consider in making long-term care decisions. The resource center shall offer this counseling to any person in its target population who is seeking or who the resource center determines appears to need long-term care services, and to his or her family members or other representatives if applicable. In making the offer, the resource center shall inform the person that participation in counseling is voluntary on the part of any individual. Information provided shall be timely, factual, thorough, accurate, unbiased and appropriate to the individual’s needs and situation. The resource center shall conduct long-term care options counseling at a location preferred by and at a time convenient to the individual consumer. Long-term care options counseling shall inform and advise the person concerning all of the following: DHS 10.23(2)(c)1.1. The availability of any long-term care options open to the individual, including home care, community services, case management services, residential care and nursing home options. DHS 10.23(2)(c)2.2. Sources and methods of both public and private payment for long-term care services, including family care and the fee-for-service system. DHS 10.23(2)(c)3.3. Factors to consider when choosing among the available programs, services and benefits, including cost, quality, outcomes, estate recovery and compatibility with the person’s preferred lifestyle and residential setting. DHS 10.23(2)(c)4.4. Advantages and disadvantages of the various options in light of the individual’s situation, values, capacities, knowledge and resources and the urgency of the individual’s situation. DHS 10.23(2)(c)5.5. Opportunities and methods for maximizing independence and self-reliance, including the utilization of supports from family, friends and community. DHS 10.23(2)(d)1.1. The resource center shall ensure that people from its target populations have access to the services of a benefit specialist, including information about and assistance in applying for public and private benefits for which they may be eligible, assistance in preparing and filing grievances, appeals, requests for department review or fair hearing, and representation in grievance resolution and fair hearings. DHS 10.23(2)(d)2.2. Notwithstanding sub. (7) (b), a disability benefit specialist may not disclose information about a client without the informed consent of the client, unless required by law. A disability benefit specialist may also disclose information about a client without the informed consent of the client as permitted under s. 55.043 (1m) (br), Stats., if there is reasonable cause to believe that the adult at risk is at imminent risk of serious bodily harm, death, sexual assault, or significant property loss and is unable to make an informed judgment about whether to report the risk or if an adult at risk other than the subject of the report is at risk of serious bodily harm, death, sexual assault, or significant property loss inflicted by a suspected perpetrator. DHS 10.23(2)(d)3.3. When a benefit specialist represents a client in a matter in which a decision or administrative action under s. HA 3.03 of the resource center is at issue, the resource center may not attempt to influence the benefit specialist’s representation of the client. DHS 10.23(2)(e)(e) Transitional services. A resource center that serves young adults age 17 years and 6 months or older with physical or developmental disabilities shall coordinate with school districts, boards appointed under s. 51.437, Stats., county human services departments or departments of community programs to assist in making the transition from children’s services to the adult long-term care system. DHS 10.23(2)(f)(f) Prevention and early intervention. The resource center shall develop a prevention and early intervention plan based on department priorities established through contract and provide prevention and intervention services consistent with the plan and within the limits of available funding. The plan shall include how the resource center will do both of the following: DHS 10.23(2)(f)1.1. Educate communities in its area on prevention of disabling conditions.
/exec_review/admin_code/dhs/001/10
true
administrativecode
/exec_review/admin_code/dhs/001/10/i/13/40
Department of Health Services (DHS)
Chs. DHS 1-19; Management and Technology and Strategic Finance
administrativecode/DHS 10.13(40)
administrativecode/DHS 10.13(40)
section
true
