Section 10.23. Standards for performance by resource centers.

 

(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.

(2)   Services. A resource center shall ensure that the following services, meeting the standards specified, are available to its target population:

(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:

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.

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:

a. Professional advice and counseling to assist consumers in identifying needs, capacities and personal preferences.

b. Educating consumers regarding available service options and resources.

c. Identifying service providers capable of meeting the person's needs.

d. Actively assisting the consumer in accessing services when necessary.

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.

(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.

(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:

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.

2. Sources and methods of both public and private payment for long-term care services, including family care and the fee-for-service system.

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.

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.

5. Opportunities and methods for maximizing independence and self-reliance, including the utilization of supports from family, friends and community.

(d) Benefits counseling .

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.

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.

3. When a benefit specialist represents a client in a matter in which a decision or action of the resource center is at issue, the resource center may not attempt to influence the benefit specialist's representation of the client.

(e) Transitional services. A resource center that serves young adults shall coordinate with school districts, boards appointed under s. 51.437 , Stats., county human services departments or departments of community programs to assist young adults with physical or developmental disabilities in making the transition from children's services to the adult long-term care system.

(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:

1. Educate communities in its area on prevention of disabling conditions.

2. Provide specific prevention advice and education to individuals in its target group, regardless of whether they are eligible for the family care benefit.

(g) Emergency response . The resource center shall assure that emergency calls to the resource center are received 24 hours a day, seven days a week, responded to promptly and that people are connected promptly with the appropriate providers of emergency services.

(h) Choice counseling. The resource center shall provide information and counseling to assist persons who are eligible for the family care benefit and their families or other representatives with respect to the person's choice of whether or not to enroll in a care management organization and, if so, which available care management organization would best meet his or her needs. Information provided under this paragraph shall include information about all of the following:

1. The availability of mechanisms for self-management of service funding under s. DHS 10.44 (2) (d) and (6) , through which an enrollee may manage the funding for some or all of his or her own services under the family care benefit.

2. How to find additional assistance within or outside the resource center, a care management organization and the family care benefit.

3. Opportunities for enrollees in a CMO to do as much for themselves as possible and desired and for full participation in service planning and delivery.

(i) Enrollment assistance. The resource center shall assist a person found eligible for the family care benefit and wishing to enroll in a care management organization to enroll in the care management organization of the person's choice.

(j) Disenrollment counseling. The resource center shall provide information and counseling to assist persons in the process of voluntarily or involuntarily disenrolling from a care management organization, including all of the following:

1. Information about clients' rights and grievance procedures.

2. Advocacy resources available to assist the person in resolving complaints and grievances.

3. Service and program options available to the person if the disenrollment occurs.

4. Information about the availability of assistance with re-enrollment.

(k) Waiting list management . The resource center shall manage, as directed by the department, any waiting lists that become necessary under s. DHS 10.36 (2) or (3) .

(3)   Access to family care and other benefits. If it is a county agency, the resource center shall provide to members of its target population access to the benefits under pars. (a) and (b) directly or through subcontract or other arrangement with the appropriate county agency. If it is not a county agency, the resource center shall have a departmentally approved memorandum of understanding with a county agency to which it will make referrals for access to these benefits. The memorandum of understanding shall clearly define the respective responsibilities of the two organizations, and how eligibility determination for the benefits under pars. (a) and (b) will be coordinated with other resource center functions for the convenience of members of the resource center's target population. Benefits to which the resource center shall provide access are all the following:

(a) Family care .

1. The requirements specified in s. DHS 10.31 shall govern application and determination of eligibility for the family care benefit.

2. A resource center shall offer a functional screening and a financial eligibility and cost-sharing screening to any individual over the age of 17 years and 9 months who appears to have a disability or condition requiring long-term care and who meets any of the following conditions:

a. The person requests or is referred for the screens.

b. The person is seeking access to the family care benefit.

c. The person is seeking admission to a nursing home, community-based residential facility, adult family home, or residential care apartment complex, subject to the exceptions under ss. DHS 10.72 (4) and 10.73 (4) (a) .

3. If a person accepts the offer, the resource center or the county agency shall provide the screens.

(b) Medical assistance, SSI, state supplemental payments and food stamps . The resource center shall provide, directly or through referral, access to all of the following:

1. Medical assistance under s. 49.46 , 49.468 or 49.47 , Stats.

2. State supplemental payments under s. 49.77 , Stats., to the federal supplemental security income (SSI) program under USC 1381 to 1383d, including the increased or "exceptional" payments (SSI-E) under s. 49.77 (3s) , Stats.

3. The federal food stamp program under 7 USC 2011 to 2029 .

(4)   Elder abuse and adult protective services .

(a) The resource center shall identify persons who may need elder abuse or adult protective services and shall provide or facilitate access to services for eligible individuals under s. 46.90 and chs. 51 and 55 , Stats.

(b) The resource center may provide elder abuse and adult protective services directly, if a county agency, or through cooperation with the local public agency or agencies that provide the services. If the resource center is not the county agency designated under s. 46.90 or ch. 55 , Stats., it shall have a memorandum of understanding with the designated agency or agencies regarding how these services are to be coordinated. The memorandum shall specify staff contacts, hours of operation and referral processes and procedures.

(5)   Staff qualifications. Persons providing resource center services, whether directly employed by the resource center or indirectly under subcontract or memorandum of understanding with another organization, shall have the following qualifications:

(a) Persons answering the information and assistance telephone line shall be trained and knowledgeable about all of the following:

1. The mission, operations and referral policies of the resource center.

2. The target populations served and their needs.

3. Telephone etiquette and communication skills, including how to recognize and respond to special hearing or language needs.

4. How to recognize and handle emergencies.

(b) Persons providing information and assistance services, long-term care options counseling, benefits counseling, the functional screen and financial eligibility and cost-sharing screen and choice counseling shall:

1. Be competent to provide these services to the resource center's target population.

2. Meet at least one of the following requirements for education and experience:

a. Bachelor of arts or science degree, preferably in a health or human services related field, and at least one year of experience working with at least one of the resource center's target populations.

b. Four years of post-secondary education and experience working with at least one of the target populations or an equivalent combination of education and experience, either in long-term support or a related human services field.

c. Other experience, training or both, as approved by the department based on a plan for providing formal and on-the-job training to develop the required expertise.

3. Be knowledgeable about the range, quality and availability of long-term care services offered within the resource center's service area.

(6)   Operational requirements. A resource center shall do all of the following:

(a) Outreach and public education .

1. Develop and implement an ongoing program of marketing and outreach to inform members of its target population and their families, community agencies, health professionals and service providers of the availability of resource center services.

2. Within 6 months after the family care benefit is available to all eligible persons in its service area, provide information about family care to persons who are members of a target population served by a CMO that operates in the county and who are residents of nursing homes, community-based residential facilities, adult family homes and residential care apartment complexes in the geographic area of the resource center. The information provided shall cover all of the following:

a. The family care benefit, and the opportunities for enrollee choice within the benefit, including the opportunity for self-management of service funding under s. DHS 10.44 (2) (d) and (6) .

b. The services of the resource center, including information and assistance, benefits counseling, long-term care options counseling, advocacy assistance, the functional screen and financial eligibility and cost-sharing screen, and eligibility determination and enrollment in family care.

c. The services of any available care management organization, including the comprehensive assessment and care plan.

d. How to contact the resource center for assistance.

e. The services of available advocacy services external to the resource center, including services under s. 16.009 (2) (p) , Stats., and how to access these services.

(b) Community needs identification . Implement a process for identifying unmet needs of its target population in the geographic area it serves. The process shall include input from the regional long-term care advisory committee, members of the target populations and their representatives, and local government and service agencies including the care management organization, if any. The process shall include a systematic review of the needs of populations residing in public and private long-term care facilities, members of minority groups and people in rural areas. A resource center shall target its outreach, education, prevention and service development efforts based on the results of the needs identification process.

(c) Grievance and appeal processes. Implement a process for reviewing client complaints and resolving client grievances as required under s. DHS 10.53 (1) .

(d) Reporting and records.

1. Except as provided in this par. and sub. (7) , collect data about its operations as required by the department by contract. No data collection effort shall interfere with a person's right to receive information anonymously or require personally identifiable information unless the person has authorized the resource center to have or share that information.

2. Report information as the department determines necessary, including information needed for doing all of the following:

a. Determining whether the resource center is meeting minimum quality standards and other requirements of its contract with the department.

b. Determining the extent to which the resource center is improving its performance on measurable indicators identified by the resource center in its current quality improvement plan.

c. Evaluating the effects of providing long-term care options counseling and choice counseling under this section.

d. Evaluating the effects for enrollees and cost-effectiveness of providing the family care benefit.

3. Submit to the department all reports and data required or requested by the department, in the format and timeframe specified by the department.

(e) Internal quality assurance and quality improvement . Implement an internal quality assurance and quality improvement program that meets the requirements of its contract with the department. As part of the program, the resource center shall do all of the following:

1. Develop and implement a written quality assurance and quality improvement plan designed to ensure and improve outcomes for its target population. The plan shall be approved by the department and shall include at least all of the following components:

a. Identification of performance goals, specific to the needs of the resource center's customers, including any goals specified by the department.

b. Identification of objective and measurable indicators of whether the identified goals are being achieved, including any indicators specified by the department.

c. Identification of timelines within which goals will be achieved.

d. Description of the process that the resource center will use to gather feedback from the resource center's customers and staff and other sources on the quality and effectiveness of the resource center's performance.

e. Description of the process the resource center will use to monitor and act on the results and feedback received.

f. A process for regularly updating the plan, including a description of the process the resource center will use for annually assessing the effectiveness of the quality assurance and quality improvement plan and the impact of its implementation on outcomes.

2. Measure resource center performance, using standard measures as required by its contract with the department, and report its findings on these measurements to the department.

3. Achieve minimum performance levels and performance improvement levels, as demonstrated by standardized measures agreed to in its contract with the department.

4. Initiate performance improvement projects that examine aspects of services related to improving resource center quality. These projects shall include all of the following:

a. Measuring performance.

b. Implementing system interventions.

c. Evaluating the effectiveness of the interventions.

d. Planning for sustained or increased improvement in performance based on the findings of the evaluation.

5. Comply with quality standards for services included in the resource center's contract with the department in all of the following areas:

a. Timeliness and accuracy of the functional screen and financial eligibility and cost-sharing screen.

b. Timely and accurate eligibility determination and enrollment procedures.

c. Information and assistance services and long-term care options counseling.

d. Protection of applicant rights.

e. Effective processes for considering and acting on complaints and resolving grievances of applicants and other persons who use resource center services.

f. Services to minority, rural and institutionalized populations.

6. Report all data required by the department related to standardized measures of performance, in the timeframes and format specified by the department.

7. Cooperate with the department in evaluating outcomes and in developing and implementing plans to sustain and improve performance.

(f) Cooperation with external reviews . Cooperate with any review of resource center activities by the department, another state agency or the federal government.

(7)   Confidentiality and exchange of information. No record, as defined in s. 19.32 (2) , Stats., of a resource center that contains personally identifiable information, as defined in s. 19.62 (5) , Stats., concerning an individual who receives services from the resource center may be disclosed by the resource center without the individual's informed consent, except as follows:

(a) A resource center shall provide information as required to comply with s. 16.009 (2) (p) or 49.45 (4) , Stats., or as necessary for the department to administer the family care program under ss. 46.2805 to 46.2895 , Stats.

(b) Notwithstanding ss. 48.78 (2) (a) , 49.45 (4) , 49.83 , 51.30 , 51.45 (14) (a) , 55.22 , 146.82 , 252.11 (7) , 253.07 (3) (c) and 938.78 (2) (a) , Stats., and except as provided in sub. (2) (d) 2. , a resource center may exchange confidential information about a client without the informed consent of the client, in the county of the resource center, if the exchange of information is necessary to enable the resource center to perform its duties or to coordinate the delivery of services to the client, as authorized under s. 46.21 (2m) (c) , 46.215 (1m) , 46.22 (1) (dm) , 46.23 (3) (e) , 46.284 (7) , 46.2895 (10) , 51.42 (3) (e) or 51.437 (4r) (b) , Stats.

History: Cr. Register, October, 2000, No. 538 , eff. 11-1-00; CR 04-040 : am. (2) (d) 1., (3) (a) 2. (intro.) Register November 2004 No. 587 , eff. 12-1-04; correction in (7) (b) made under s. 13.92 (4) (b) 7. , Stats., Register November 2008 No. 635 ; EmR0834 : emerg. am. (2) (d) 2., eff. 11-3-08; CR 08-109 : am. (2) (d) 2. Register June 2009 No. 642 , eff. 7-1-09; correction in (6) (b) made under s. 13.92 (4) (b) 6. , Stats., Register November 2009 No. 647 .