State Codes and Statutes

Statutes > Wisconsin > 16 > 16.009

16.009

16.009 Board on aging and long-term care.

16.009(1)

(1) In this section:

16.009(1)(a)

(a) "Beneficiary" means an individual who is eligible for coverage.

16.009(1)(ag)

(ag) "Board" means the board on aging and long-term care.

16.009(1)(ar)

(ar) "Client" means an individual who requests services of the office, or a resident on whose behalf a request is made.

16.009(1)(b)

(b) "Homestead credit program" means the program under ss. 71.51 to 71.55.

16.009(1)(c)

(c) "Household" has the meaning given in s. 71.52 (4).

16.009(1)(d)

(d) "Household income" has the meaning given in s. 71.52 (5).

16.009(1)(e)

(e) "Income" has the meaning given in s. 71.52 (6).

16.009(1)(em)

(em) "Long-term care facility" includes any of the following:

16.009(1)(em)1.

1. A nursing home, as defined in s. 50.01 (3).

16.009(1)(em)2.

2. A community-based residential facility, as defined in s. 50.01 (1g).

16.009(1)(em)3.

3. A facility, as defined in s. 647.01 (4).

16.009(1)(em)4.

4. A swing bed in an acute care facility or extended care facility, as specified under 42 USC 1395tt.

16.009(1)(em)5.

5. A hospice, as defined in s. 50.90 (1) (c).

16.009(1)(em)6.

6. An adult family home, as defined in s. 50.01 (1) (a) or (b).

16.009(1)(em)7.

7. A residential care apartment complex, as defined in s. 50.01 (1d).

16.009(1)(f)

(f) "Long-term care insurance" means insurance that provides coverage both for an extended stay in a nursing home and home health services for a person with a chronic condition. The insurance may also provide coverage for other services that assist the insured person in living outside a nursing home, including but not limited to adult day care and continuing care retirement communities.

16.009(1)(gm)

(gm) "Office" means the office of the long-term care ombudsman.

16.009(1)(gr)

(gr) "Ombudsman" means the long-term care ombudsman, as specified in sub. (4) (a).

16.009(1)(h)

(h) "Physician" has the meaning given in s. 448.01 (5).

16.009(1)(i)

(i) "Program" means the long-term care ombudsman program.

16.009(1)(j)

(j) "Resident" means a person cared for or treated in a long-term care facility.

16.009(2)

(2) The board shall:

16.009(2)(a)

(a) Appoint an executive director within the classified service who shall employ staff within the classified service.

16.009(2)(b)

(b) Implement a long-term care ombudsman program, to do all of the following:

16.009(2)(b)1.

1. Investigate complaints from any person concerning improper conditions or treatment of aged or disabled persons who receive long-term care or concerning noncompliance with or improper administration of federal statutes or regulations or state statutes or rules related to long-term care for the aged or disabled.

16.009(2)(b)2.

2. Serve as mediator or advocate to resolve any problem or dispute relating to long-term care for the aged or disabled.

16.009(2)(d)

(d) Promote public education, planning and voluntary acts to resolve problems and improve conditions involving long-term care for the aged or disabled.

16.009(2)(e)

(e) Monitor the development and implementation of federal, state and local laws, regulations, rules, ordinances and policies that relate to long-term care facilities for the aged or disabled.

16.009(2)(em)

(em) Monitor, evaluate and make recommendations concerning long-term community support services received by clients of the long-term support community options program under s. 46.27.

16.009(2)(f)

(f) As a result of information received while investigating complaints and resolving problems or disputes, publish material that assesses existing inadequacies in federal and state laws, regulations and rules concerning long-term care for the aged or disabled. The board shall initiate legislation as a means of correcting these inadequacies.

16.009(2)(g)

(g) Stimulate resident, client and provider participation in the development of programs and procedures involving resident rights and facility responsibilities, by establishing resident councils and by other means.

16.009(2)(h)

(h) Conduct statewide hearings on issues of concern to aged or disabled persons who are receiving or who may receive long-term care.

16.009(2)(i)

(i) Report annually to the governor and the chief clerk of each house of the legislature for distribution to the appropriate standing committees under s. 13.172 (3). The report shall set forth the scope of the programs for providing long-term care for the aged or disabled developed in the state, findings regarding the state's activities in the field of long-term care for the aged and disabled, recommendations for a more effective and efficient total program and the actions taken by the agencies of the state to carry out the board's recommendations.

16.009(2)(j)

(j) Provide information and counseling to consumers regarding insurance policies available to supplement federal medicare insurance coverage, including long-term care insurance, and the eligibility requirements for medical assistance under s. 49.46 (1), 49.468 or 49.47 (4). To implement this responsibility, the board shall provide training, educational materials and technical assistance to volunteer organizations and private businesses willing and able to provide insurance and medical assistance eligibility information and counseling, in order that these organizations and businesses may provide the information and counseling to consumers.

16.009(2)(p)

(p) Employ staff within the classified service or contract with one or more organizations to provide advocacy services to potential or actual recipients of the family care benefit, as defined in s. 46.2805 (4), or their families or guardians. The board and contract organizations under this paragraph shall assist these persons in protecting their rights under all applicable federal statutes and regulations and state statutes and rules. An organization with which the board contracts for these services may not be a provider, nor an affiliate of a provider, of long-term care services, a resource center under s. 46.283 or a care management organization under s. 46.284. For potential or actual recipients of the family care benefit, advocacy services required under this paragraph shall include all of the following:

16.009(2)(p)1.

1. Providing information, technical assistance and training about how to obtain needed services or support items.

16.009(2)(p)2.

2. Providing advice and assistance in preparing and filing complaints, grievances and appeals of complaints or grievances.

16.009(2)(p)3.

3. Providing negotiation and mediation.

16.009(2)(p)4.

4. Providing individual case advocacy assistance regarding the appropriate interpretation of statutes, rules or regulations.

16.009(2)(p)5.

5. Providing individual case advocacy services in administrative hearings and legal representation for judicial proceedings regarding family care services or benefits.

16.009(3)

(3) The board may:

16.009(3)(a)

(a) Contract with any state agency to carry out the board's activities.

16.009(3)(bm)

(bm) Employ an attorney for provision of legal services in accordance with requirements of the long-term care ombudsman program under 42 USC 3027 (a) (12) and 42 USC 3058g (g).

16.009(4)

(4)

16.009(4)(a)

(a) The board shall operate the office in order to carry out the requirements of the long-term care ombudsman program under 42 USC 3027 (a) (12) (A) and 42 USC 3058f to 3058h. The executive director of the board shall serve as ombudsman under the office. The executive director of the board may delegate operation of the office to the staff employed under sub. (2) (a), as designated representatives of the ombudsman.

16.009(4)(b)

(b) The ombudsman or his or her designated representative may have the following access to clients, residents and long-term care facilities:

16.009(4)(b)1.

1. The ombudsman or designated representative may:

16.009(4)(b)1.a.

a. At any time without notice, enter, and have immediate access to a client or resident in, a long-term care facility.

16.009(4)(b)1.b.

b. Communicate in private, without restriction, with a client or resident.

16.009(4)(b)1.c.

c. Except as provided in subd. 1. d., have access to and review records that pertain to the care of the resident if the resident or his or her guardian has consented or if the resident has no guardian and is unable to consent.

16.009(4)(b)1.d.

d. With the consent of a resident or his or her legal counsel, have access to and review records that pertain to the care of the resident, as specified in s. 49.498 (5) (e).

16.009(4)(b)1.e.

e. Have access to and review records of a long-term care facility as necessary to investigate a complaint if the resident's guardian refuses to consent; if the ombudsman or designated representative has reason to believe that the guardian is not acting in the best interests of the resident; and, for investigation only by a designated representative, if the designated representative obtains the approval of the ombudsman.

16.009(4)(b)1.f.

f. Have access to those administrative records, policies and documents of a long-term care facility to which the resident or public has access.

16.009(4)(b)1.g.

g. Have access to and, on request, be furnished copies of all licensing or certification records maintained by the department of health services with respect to regulation of a long-term care facility.

16.009(4)(b)2.

2. The ombudsman shall receive, upon request to a long-term care facility, the name, address and telephone number of the guardian, legal counsel or immediate family member of any resident.

16.009(4)(d)

(d) A long-term care facility or personnel of a long-term care facility that disclose information as authorized under this subsection are not liable for that disclosure.

16.009(4)(e)

(e) Information of the office relating to a client, complaints or investigations under the program may be disclosed only at the discretion of the ombudsman or his or her designated representative. The identity of a client or named witness or of a resident who is not a client may be revealed under this paragraph only if one of the following conditions is met:

16.009(4)(e)1.

1. Under written authorization by the client, witness or resident or his or her guardian, if any.

16.009(4)(e)2.

2. Under the lawful order of a court of competent jurisdiction.

16.009(5)

(5)

16.009(5)(a)

(a) No person may do any of the following:

16.009(5)(a)1.

1. Discharge or otherwise retaliate or discriminate against any person for contacting, providing information to or otherwise cooperating with any representative of the board.

16.009(5)(a)2.

2. Discharge or otherwise retaliate or discriminate against any person on whose behalf another person has contacted, provided information to or otherwise cooperated with any representative of the board.

16.009(5)(b)

(b) Any person who violates par. (a) may be fined not more than $1,000 or imprisoned for not more than 6 months or both.

16.009(5)(d)

(d) Any employee who is discharged or otherwise retaliated or discriminated against in violation of par. (a) may file a complaint with the department of workforce development under s. 106.54 (5).

16.009(5)(e)

(e) Any person not described in par. (d) who is retaliated or discriminated against in violation of par. (a) may commence an action in circuit court for damages incurred as a result of the violation.

16.009 - ANNOT.

History: 1981 c. 20; 1983 a. 524; 1985 a. 29; 1987 a. 27; 1989 a. 31, 294; 1991 a. 39, 232; 1993 a. 16, 205; 1995 a. 27 s. 9126 (19); 1997 a. 131; 1999 a. 9, 82, 86, 186; 2003 a. 33; 2007 a. 20 ss. 74, 9121 (6) (a); 2009 a. 28.