The bill allows a patient’s representative to consent to an admission of an incapacitated individual from a hospital to a nursing home or community-based residential facility without a petition for guardianship or protective placement and allows a patient’s representative to make health care decisions and authorize expenditures related to health care on behalf of an incapacitated individual without certain time limitations that are imposed under current law if certain conditions are met. Under current law, an individual who is either related to an incapacitated individual as provided under current law or is an adult close friend of an incapacitated individual may consent to admission, directly from a hospital to a nursing home or community-based residential facility, of the incapacitated individual who does not have a valid power of attorney for health care and who has not been adjudicated incompetent in this state if certain conditions apply, including that the individual for whom admission is sought is not diagnosed as developmentally disabled or as having a mental illness at the time of the proposed admission, that the incapacitated individual does not verbally object to or otherwise actively protest the admission, and that petitions for guardianship for the individual and for protective placement of the individual are filed prior to the proposed admission. An individual who consents to admission of an incapacitated individual may make health care decisions to the same extent as a guardian of the person and authorize expenditures related to health care to the same extent as a guardian of the estate until 60 days after the admission to the facility, discharge of the incapacitated individual from the facility, or appointment of a guardian for the incapacitated individual, whichever occurs first. The bill allows a patient’s representative to consent to an admission of an incapacitated individual from a hospital to a nursing home or community-based residential facility as provided under current law without petitions for guardianship or protective placement of the incapacitated individual being filed if certain conditions apply, including that the patient’s representative promptly notifies all of the incapacitated individual’s family members that can be readily contacted that the patient’s representative may make decisions or authorize expenditures on the incapacitated individual’s behalf, that the patient’s representative provides a written statement to the discharging hospital that contains certain information, and that the facility to which the incapacitated individual is admitted notifies a representative of the Board on Aging and Long Term Care of the admission. Further, the bill allows a patient’s representative to make health care decisions and authorize expenditures related to health care without the time limitations that apply to other direct admissions under current law if the patient’s representative satisfies the conditions for admission provided under the bill. The authority of a patient’s representative to make health care decisions and authorize expenditures related to health care under the bill ends if a court appoints a guardian to make such decisions.

The bill allocates 250 nursing home beds to be awarded to applicants who agree to prioritize admissions of patients with complex needs and to prioritize admissions of patients who have been unable to find appropriate placement at another facility. Under current law, the maximum number of licensed nursing home beds that are available in the state is limited in order to enable the state to budget accurately and to allocate fiscal resources appropriately. At least once each year, the Department of Health Services is required to publish a notice concerning the number of nursing home beds that are available in each of its health planning areas. DHS is required to accept applications for available nursing home beds and review the applications based on criteria provided under current law, including cost containment, a need for additional beds in the health planning area where the beds are requested, and whether health care personnel, capital, and operating funds and other resources needed to provide proposed services are available. This bill directs DHS to allocate 250 nursing home beds to be awarded to applicants as provided in the bill. An applicant for nursing home beds allocated under the bill must apply to DHS on a form provided DHS and include a plan for the applicant to become licensed for the nursing home beds that the applicant requested, to become certified as a provider under the Medical Assistance program, and to hire sufficient health care personnel and expend sufficient resources to provide 24-hour nursing services within 18 months of DHS approval. The bill requires that within 30 days of receipt of an application, DHS must review applications received and approve applications that contain reasonable plans to satisfy the above criteria within 18 months. The bill requires DHS to make determinations on applications in the order that they are received. If DHS approves an application, the bill requires DHS to award the beds requested in the application. If not enough beds remain under the program to award all of the beds requested in an application, DHS must contact the applicant and determine whether the applicant will accept some or all of the remaining beds instead of the beds requested in the application. If the applicant is willing to accept some or all of the remaining beds, DHS must award those beds. DHS must continue to request and approve applications until DHS awards all 250 nursing home beds allocated under the bill.

The bill requires DHS to select, using a competitive grant selection process, partnership groups to be designated as participating sites for a complex patient pilot program and then award grants to the partnership groups selected. The bill provides that a partnership group is one or more hospitals in partnership with one or more post-acute facilities. The bill provides that DHS must solicit feedback regarding the pilot program from representatives of healthcare system organizations, long-term care provider organizations, long-term care operator organizations, patient advocate groups, insurers, and any other organization determined to be relevant by the secretary of health services. Under the bill, DHS must require each partnership group that applies to be designated as a site for the pilot program to address certain issues in its application, including: 1) the number of complex patient care beds that will be set aside in a post-acute facility or through implementation of another innovative model of patient care in a post-acute facility to which participating hospitals agree; 2) defined goals and measurable outcomes of the partnership both during and after the pilot program; 3) the types of complex patients for whom care will be provided; 4) an operating budget for the proposed site; and 5) the participant group’s expertise to successfully implement the proposal.

The bill requires DHS to reserve 10 percent of the pilot program funding for reconciliation to help address unanticipated costs. Under the bill, DHS must also develop a methodology to evaluate the pilot program and contract with an independent organization to complete the evaluation. Under the bill, DHS may pay the organization’s fee from the funding appropriated for the pilot program. Under the bill, DHS must give additional weight to partnership groups that would ensure geographic diversity.

AB1088,,171750.06 (5) (am) Except as otherwise provided in par. (b), a patient’s representative may, for the incapacitated individual, make health care decisions to the same extent as a guardian of the person may and authorize expenditures related to health care to the same extent as a guardian of the estate may if the patient’s representative consents to admission for the incapacitated individual in the manner provided in sub. (8). The authority of a patient’s representative to make health care decisions or authorize expenditures under this paragraph ends if a court appoints a guardian to make such decisions for the incapacitated individual.