AB56,474,1611 46.287 (2) (a) 1. (intro.) Except as provided in subd. 2., a client may contest any
12of the following applicable matters by filing, within 45 days of the failure of a resource
13center or care management organization county to act on the contested matter
14within the time frames specified by rule by the department or within 45 days after
15receipt of notice of a decision in a contested matter, a written request for a hearing
16under s. 227.44 to the division of hearings and appeals created under s. 15.103 (1):

AB56,475,322 46.287 (2) (a) 1m. Except as provided in subd. 2., a client may contest any of
23the following adverse benefit determinations by filing, within 90 days of the failure
24of a care management organization to act on a contested adverse benefit
25determination within the time frames specified by rule by the department or within

190 days after receipt of notice of a decision upholding the adverse benefit
2determination, a written request for a hearing under s. 227.44 to the division of
3hearings and appeals created under s. 15.103 (1):

AB56,475,74 a. Denial of functional eligibility under s. 46.286 (1) as a result of the care
5management organization's administration of the long-term care functional screen,
6including a change from a nursing home level of care to a non-nursing home level
7of care.

AB56,475,108 c. Denial or limited authorization of a requested service, including
9determinations based on type or level of service, requirements or medical necessity,
10appropriateness, setting, or effectiveness of a covered benefit.

AB56,475,1311 d. Reduction, suspension, or termination of a previously authorized service,
12unless the service was only authorized for a limited amount or duration and that
13amount or duration has been completed.

AB56,475,1414 e. Denial, in whole or in part, of payment for a service.

AB56,475,1715 f. The failure of a care management organization to act within the time frames
16provided in 42 CFR 438.408 (b) (1) and (2) regarding the standard resolution of
17grievances and appeals.

AB56,475,2018 g. Denial of an enrollee's request to dispute financial liability, including
19copayments, premiums, deductibles, coinsurance, other cost sharing, and other
20member financial liabilities.

AB56,475,2321 h. Denial of an enrollee, who is a resident of a rural area with only one care
22management organization, to obtain services outside the care management
23organization's network of contracted providers.

AB56,476,424 i. Development of a plan of care that is unacceptable to the enrollee because the
25plan of care requires the enrollee to live in a place that is unacceptable to the enrollee;

1the plan of care does not provide sufficient care, treatment, or support to meet the
2enrollee's needs and support the enrollee's identified outcomes; or the plan of care
3requires the enrollee to accept care, treatment, or support that is unnecessarily
4restrictive or unwanted by the enrollee.

AB56,476,55 j. Involuntary disenrollment from the care management organization.

AB56,476,157 46.287 (2) (b) An enrollee may contest a decision, omission or action of a care
8management 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.

AB56,476,2318 46.288 (2) Criteria and procedures for determining functional eligibility under
19s. 46.286 (1) (a), financial eligibility under s. 46.286 (1) (b), and cost sharing under
20s. 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:

AB56,477,4

146.2896 (1) (a) “Long-term care program" means the long-term care program
2under s. 46.27, 46.275, 46.277, 46.278, or 46.2785; the family care program providing
3the benefit under s. 46.286; the Family Care Partnership program; or the long-term
4care program defined in s. 46.2899 (1).

AB56,477,13 646.536 Mobile crisis team Crisis program enhancement grants. From
7the appropriation under s. 20.435 (5) (cf), the department shall award grants in the
8total amount of $250,000 in each fiscal biennium to counties or regions comprised of
9multiple counties to establish certified or enhance crisis programs that create mental
10health mobile crisis teams to serve individuals having mental health crises in rural
11areas. The department shall award a grant under this section in an amount equal
12to one-half the amount of money the county or region provides to establish certified
13or enhance crisis programs that create mobile crisis teams.

AB56,477,18 1646.854 Healthy aging grant program. From the appropriation under s.
1720.435 (1) (bk), the department shall award in each fiscal year a grant of $250,000
18to an entity that conducts programs in healthy aging.