SB55-ASA1-AA1,436,1310 49.45 (2) (a) 11. Establish criteria for the certification of eligible providers of
11services under Title XIX of the social security act medical assistance and, except as
12provided in par. (b) 6m. and s. 49.48, and subject to par. (b) 7. and 8., certify such
13eligible
providers who meet the criteria.
SB55-ASA1-AA1, s. 1750j 14Section 1750j. 49.45 (2) (a) 12. of the statutes is amended to read:
SB55-ASA1-AA1,437,415 49.45 (2) (a) 12. Decertify or suspend under this subdivision a provider from
16or restrict a provider's participation in the medical assistance program, if after
17giving reasonable notice and opportunity for hearing, the department finds that the
18provider has violated a federal statute or regulation or a state law statute or
19administrative rule and such violations are by law the violation is by statute,
20regulation, or rule grounds for decertification or suspension restriction. The
21department shall suspend the provider pending the hearing under this subdivision
22if the department includes in its decertification notice findings that the provider's
23continued participation in the medical assistance program pending hearing is likely
24to lead to the irretrievable loss of public funds and is unnecessary to provide
25adequate access to services to medical assistance recipients. As soon as practicable

1after the hearing, the department shall issue a written decision
. No payment may
2be made under the medical assistance program with respect to any service or item
3furnished by the provider subsequent to decertification or during the period of
4suspension.
SB55-ASA1-AA1, s. 1750L 5Section 1750L. 49.45 (2) (b) 6m. of the statutes is created to read:
SB55-ASA1-AA1,437,96 49.45 (2) (b) 6m. Limit the number of providers of particular services that may
7be certified under par. (a) 11. or the amount of resources, including employees and
8equipment, that a certified provider may use to provide particular services to medical
9assistance recipients, if the department finds all of the following:
SB55-ASA1-AA1,437,1210 a. That existing certified providers and resources provide services that are
11adequate in quality and amount to meet the need of medical assistance recipients for
12the particular services.
SB55-ASA1-AA1,437,1413 b. That the potential for medical assistance fraud or abuse exists if additional
14providers are certified or additional resources are used by certified providers.
SB55-ASA1-AA1, s. 1750n 15Section 1750n. 49.45 (2) (b) 7. of the statutes is created to read:
SB55-ASA1-AA1,438,216 49.45 (2) (b) 7. Require, as a condition of certification under par. (a) 11., all
17providers of a specific service that is among those enumerated under s. 49.46 (2) or
1849.47 (6) (a), as specified in this subdivision, to file with the department a surety bond
19issued by a surety company licensed to do business in this state. Providers subject
20to this subdivision provide those services specified under s. 49.46 (2) or 49.47 (6) (a)
21for which providers have demonstrated significant potential to violate s. 49.49 (1) (a),
22(2) (a) or (b), (3), (3m) (a), (3p), (4) (a), or (4m) (a), to require recovery under par. (a)
2310., or to need additional sanctions under par. (a) 13. The surety bond shall be
24payable to the department in an amount that the department determines is
25reasonable in view of amounts of former recoveries against providers of the specific

1service and the department's costs to pursue those recoveries. The department shall
2promulgate rules under this subdivision that specify all of the following:
SB55-ASA1-AA1,438,63 a. Services under medical assistance for which providers have demonstrated
4significant potential to violate s. 49.49 (1) (a), (2) (a) or (b), (3), (3m) (a), (3p), (4) (a),
5or (4m) (a), to require recovery under par. (a) 10., or to need additional sanctions
6under par. (a) 13.
SB55-ASA1-AA1,438,77 b. The amount or amounts of the surety bonds.
SB55-ASA1-AA1,438,108 c. Terms of the surety bond, including amounts, if any, without interest to be
9refunded to the provider upon withdrawal or decertification from the medical
10assistance program.
SB55-ASA1-AA1, s. 1750p 11Section 1750p. 49.45 (2) (b) 8. of the statutes is created to read:
SB55-ASA1-AA1,438,1612 49.45 (2) (b) 8. Require a person who takes over the operation, as defined in sub.
13(21) (ag), of a provider, to first obtain certification under par. (a) 11. for the operation
14of the provider, regardless of whether the person is currently certified. The
15department may withhold the certification required under this subdivision until any
16outstanding repayment under sub. (21) is made.
SB55-ASA1-AA1, s. 1750r 17Section 1750r. 49.45 (2) (b) 9. of the statutes is created to read:
SB55-ASA1-AA1,439,1218 49.45 (2) (b) 9. After providing reasonable notice and opportunity for a hearing,
19charge an assessment to a provider that repeatedly has been subject to recoveries
20under par. (a) 10. a. because of the provider's failure to follow identical or similar
21billing procedures or to follow other identical or similar program requirements. The
22assessment shall be used to defray in part the costs of audits and investigations by
23the department under sub. (3) (g) and may not exceed $1,000 or 200% of the amount
24of any such repeated recovery made, whichever is greater. The provider shall pay the
25assessment to the department within 10 days after receipt of notice of the assessment

1or the final decision after administrative hearing, whichever is later. The
2department may recover any part of an assessment not timely paid by offsetting the
3assessment against any medical assistance payment owed to the provider and may
4refer any such unpaid assessments not collected in this manner to the attorney
5general, who may proceed with collection under this subdivision. Failure to timely
6pay in any manner an assessment charged under this subdivision, other than an
7assessment that is offset against any medical assistance payment owed to the
8provider, is grounds for decertification under subd. 12. A provider's payment of an
9assessment does not relieve the provider of any other legal liability incurred in
10connection with the recovery for which the assessment is charged, but is not evidence
11of violation of a statute or rule. The department shall credit all assessments received
12under this subdivision to the appropriation account under s. 20.435 (4) (iL).
SB55-ASA1-AA1, s. 1750t 13Section 1750t. 49.45 (3) (g) of the statutes is amended to read:
SB55-ASA1-AA1,440,1014 49.45 (3) (g) The secretary may appoint authorize personnel to audit or
15investigate and report to the department on any matter involving violations or
16complaints alleging violations of laws statutes, regulations, or rules applicable to
17Title XIX of the federal social security act or the medical assistance program and to
18perform such investigations or audits as are required to verify the actual provision
19of services or items available under the medical assistance program and the
20appropriateness and accuracy of claims for reimbursement submitted by providers
21participating in the program. Department employees appointed authorized by the
22secretary under this paragraph shall be issued, and shall possess at all times during
23which
while they are performing their investigatory or audit functions under this
24section, identification, signed by the secretary which, that specifically designates the
25bearer as possessing the authorization to conduct medical assistance investigations

1or audits. Pursuant to Under the request of a designated person and upon
2presentation of that the person's authorization, providers and medical assistance
3recipients shall accord such the person access to any provider personnel, records,
4books, recipient medical records, or documents or other information needed. Under
5the written request of a designated person and upon presentation of the person's
6authorization, providers and recipients shall accord the person access to any needed
7patient health care records of a recipient.
Authorized employees shall have authority
8to
may hold hearings, administer oaths, take testimony, and perform all other duties
9necessary to bring such the matter before the department for final adjudication and
10determination.
SB55-ASA1-AA1, s. 1750v 11Section 1750v. 49.45 (3) (h) 1. of the statutes is repealed.
SB55-ASA1-AA1, s. 1750x 12Section 1750x. 49.45 (3) (h) 2. of the statutes is repealed.
SB55-ASA1-AA1, s. 1750z 13Section 1750z. 49.45 (3) (h) 3. of the statutes is renumbered 49.45 (3) (h) and
14amended to read:
SB55-ASA1-AA1,440,2415 49.45 (3) (h) The failure or refusal of a person to purge himself or herself of
16contempt found under s. 885.12 and perform the act as required by law shall
17constitute
provider to accord department auditors or investigators access as required
18under par. (g) to any provider personnel, records, books, patient health care records
19of medical assistance recipients, or documents or other information requested
20constitutes
grounds for decertification or suspension of that person the provider from
21participation in the medical assistance program and no. No payment may be made
22for services rendered by that person subsequent to the provider following
23decertification or, during the period of suspension, or during any period of provider
24failure or refusal to accord access as required under par. (g)
.".
SB55-ASA1-AA1,441,1
1815. Page 621, line 12: after that line insert:
SB55-ASA1-AA1,441,2 2" Section 1750w. 49.45 (2) (a) 24. of the statutes is created to read:
SB55-ASA1-AA1,441,123 49.45 (2) (a) 24. Promulgate rules that require that the written plan of care for
4persons receiving personal care services under medical assistance be reviewed by a
5registered nurse at least every 60 days. The rules shall provide that the written plan
6of care shall designate intervals for visits to the recipient's home by a registered
7nurse as part of the review of the plan of care. The designated intervals for visits
8shall be based on the individual recipient's needs, and each recipient shall be visited
9in his or her home by a registered nurse at least once in every 12-month period. The
10rules shall also provide that a visit to the recipient is also required if, in the course
11of the nurse's review of the plan of care, there is evidence that a change in the
12recipient's condition has occurred that may warrant a change in the plan of care.".
SB55-ASA1-AA1,441,13 13816. Page 622, line 8: delete ", or (w)" and substitute ", (w), or (wm)".
SB55-ASA1-AA1,441,14 14817. Page 622, line 14: delete lines 14 to 21.
SB55-ASA1-AA1,441,15 15818. Page 624, line 21: delete "and (w)" and substitute ", (w), and (wm)".
SB55-ASA1-AA1,441,16 16819. Page 628, line 21: after that line insert:
SB55-ASA1-AA1,441,17 17" Section 1783g. 49.45 (18) (d) of the statutes is amended to read:
SB55-ASA1-AA1,441,2318 49.45 (18) (d) A person is liable for a copayment of $1 for each prescription drug
19that bears only a generic name, as defined in s. 450.12 (1) (b), and is liable for a
20copayment of $2 for each prescription drug that does not bear only a generic name.

21No person who designates a pharmacy or pharmacist as his or her sole provider of
22prescription drugs and who so uses that pharmacy or pharmacist is liable under this
23subsection for more than $5 per month for prescription drugs received.".
SB55-ASA1-AA1,441,24 24820. Page 628, line 21: after that line insert:
SB55-ASA1-AA1,442,1
1" Section 1786g. 49.45 (21) (title) of the statutes is amended to read:
SB55-ASA1-AA1,442,32 49.45 (21) (title) Transfer of business, liability for Taking over provider's
3operation;
repayments required.
SB55-ASA1-AA1, s. 1786h 4Section 1786h. 49.45 (21) (a) of the statutes is renumbered 49.45 (21) (ar) and
5amended to read:
SB55-ASA1-AA1,442,146 49.45 (21) (ar) If any provider Before a person may take over the operation of
7a provider that is
liable for repayment of improper or erroneous payments or
8overpayments under ss. 49.43 to 49.497 sells or otherwise transfers ownership of his
9or her business or all or substantially all of the assets of the business, the transferor
10and transferee are each liable for the repayment. Prior to final transfer, the
11transferee is responsible for contacting the department and ascertaining if the
12transferor
, full repayment shall be made. Upon request, the department shall notify
13the provider or the person that intends to take over the operation of the provider as
14to whether the provider
is liable under this paragraph.
SB55-ASA1-AA1, s. 1786i 15Section 1786i. 49.45 (21) (ag) of the statutes is created to read:
SB55-ASA1-AA1,442,1816 49.45 (21) (ag) In this subsection, "take over the operation" means obtain, with
17respect to an aspect of a provider's business for which the provider has filed claims
18for medical assistance reimbursement, any of the following:
SB55-ASA1-AA1,442,2019 1. Ownership of the provider's business or all or substantially all of the assets
20of the business.
SB55-ASA1-AA1,442,2121 2. Majority control over decisions.
SB55-ASA1-AA1,442,2222 3. The right to any profits or income.
SB55-ASA1-AA1,442,2423 4. The right to contact and offer services to patients, clients, or residents served
24by the provider.
SB55-ASA1-AA1,443,3
15. An agreement that the provider will not compete with the person at all or
2with respect to a patient, client, resident, service, geographical area, or other part
3of the provider's business.
SB55-ASA1-AA1,443,54 6. The right to perform services that are substantially similar to services
5performed by the provider at the same location as those performed by the provider.
SB55-ASA1-AA1,443,76 7. The right to use any distinctive name or symbol by which the provider is
7known in connection with services to be provided by the person.
SB55-ASA1-AA1, s. 1786j 8Section 1786j. 49.45 (21) (b) of the statutes is amended to read:
SB55-ASA1-AA1,443,189 49.45 (21) (b) If a transfer occurs If, notwithstanding the prohibition under par.
10(ar), a person takes over the operation of a provider
and the applicable amount under
11par. (a) (ar) has not been repaid, the department may, in addition to withholding
12certification as authorized under sub. (2) (b) 8.,
proceed against either the transferor
13or the transferee
the provider or the person. Within 30 days after receiving the
14certified provider receives
notice from the department, the transferor or the
15transferee shall pay the
amount shall be repaid in full. Upon failure to comply If the
16amount is not repaid in full
, the department may bring an action to compel payment.
17If a transferor fails to pay within 90 days after receiving notice from the department,
18the department
, may proceed under sub. (2) (a) 12. , or may do both.".
SB55-ASA1-AA1,443,19 19821. Page 630, line 20: after that line insert:
SB55-ASA1-AA1,443,20 20" Section 1792g. 49.45 (49) of the statutes is created to read:
SB55-ASA1-AA1,444,221 49.45 (49) Prior authorization for legend drugs. If, after June 30, 2002, and
22before July 1, 2004, a manufacturer has in force a rebate agreement under s. 49.688
23(7), the department may not during that period expand the prior authorization
24requirements for prescription drugs manufactured by the manufacturer for which

1coverage is provided under s. 49.46 (2) (b) 6. h. beyond those prior authorization
2requirements that are in effect on July 1, 2002.".
SB55-ASA1-AA1,444,3 3822. Page 630, line 20: after that line insert:
SB55-ASA1-AA1,444,4 4" Section 1792r. 49.45 (53) of the statutes is created to read:
SB55-ASA1-AA1,444,155 49.45 (53) Refund of medical relief and general relief. (a) If a service
6provider receives reimbursement under this section for a claim submitted by or on
7behalf of the service provider under the circumstance specified under s. 49.45 (2) (a)
82m. b., the service provider shall, as a condition of certification under sub. (2) (a) 11.,
9refund to the county that initially reimbursed the services as general relief or as
10medical relief, any medical relief under a relief block grant or any general relief paid
11to the service provider for the medical assistance-reimbursable services rendered.
12The county shall separately identify this refund and remit to the department for
13deposit in the appropriation account under s. 20.435 (4) (ib) an amount that
14represents the state's contribution toward the original medical relief or general relief
15paid.
SB55-ASA1-AA1,444,2116 (b) If the federal department of health and human services disallows payment
17to the state of federal financial participation for a claim submitted by or on behalf of
18a service provider under the circumstance specified under sub. (2) (a) 2m. b., the
19county shall remit to the department for deposit in the appropriation account under
20s. 20.435 (4) (ib) an amount that is equal to the amount of federal financial
21participation paid by the department to the service provider under par. (a).
SB55-ASA1-AA1,444,2222 (c) This subsection does not apply after June 30, 2005.".
SB55-ASA1-AA1,444,23 23823. Page 631, line 5: delete lines 5 to 17.
SB55-ASA1-AA1,445,2
1824. Page 631, line 23: delete the material beginning with that line and
2ending with page 632, line 4.
SB55-ASA1-AA1,445,3 3825. Page 632, line 10: delete lines 10 to 16.
SB55-ASA1-AA1,445,4 4826. Page 633, line 13: delete lines 13 to 24.
SB55-ASA1-AA1,445,5 5827. Page 634, line 8: delete lines 8 to 15.
SB55-ASA1-AA1,445,6 6828. Page 637, line 6: after that line insert:
SB55-ASA1-AA1,445,7 7" Section 1814L. 49.47 (4) (aq) of the statutes is created to read:
SB55-ASA1-AA1,445,128 49.47 (4) (aq) 1. Subject to subd. 2., an individual who does not meet the
9limitation on income under par. (c) is eligible for medical assistance if the individual's
10income does not exceed 100% of the federal poverty level, and the individual is 65
11years of age or older or is blind or totally and permanently disabled, as defined under
12federal Title XVI.
SB55-ASA1-AA1,445,1613 2. If a federal waiver is necessary to provide medical assistance to individuals
14specified in subd. 1., the department shall request a waiver from the secretary of the
15federal department of health and human services before providing medical
16assistance under this paragraph.".
SB55-ASA1-AA1,445,17 17829. Page 637, line 13: after that line insert:
SB55-ASA1-AA1,445,18 18" Section 1815cb. 49.47 (4) (b) 2m. b. of the statutes is amended to read:
SB55-ASA1-AA1,445,2119 49.47 (4) (b) 2m. b. For persons who are eligible under par. (a) 3. or 4. or (aq),
20motor vehicles are exempt from consideration as an asset to the same extent as
21provided under 42 USC 1381 to 1385.
SB55-ASA1-AA1, s. 1815cc 22Section 1815cc. 49.47 (4) (b) 2r. of the statutes is amended to read:
SB55-ASA1-AA1,446,223 49.47 (4) (b) 2r. For a person who is eligible under par. (a) 3. or 4. or (aq), the
24value of any burial space or agreement representing the purchase of a burial space

1held for the purpose of providing a place for the burial of the person or any member
2of his or her immediate family.
SB55-ASA1-AA1, s. 1815cd 3Section 1815cd. 49.47 (4) (b) 2w. of the statutes is amended to read:
SB55-ASA1-AA1,446,64 49.47 (4) (b) 2w. For a person who is eligible under par. (a) 3. or 4. or (aq), life
5insurance with cash surrender values if the total face value of all life insurance
6policies is not more than $1,500.
SB55-ASA1-AA1, s. 1815ce 7Section 1815ce. 49.47 (4) (b) 3. of the statutes is amended to read:
SB55-ASA1-AA1,446,128 49.47 (4) (b) 3. For a person who is eligible under par. (a) 3. or 4. or (aq), funds
9set aside to meet the burial and related expenses of the person and his or her spouse
10in an amount not to exceed $1,500 each, minus the sum of the cash value of any life
11insurance excluded under subd. 2w. and the amount in any irrevocable burial trust
12under s. 445.125 (1) (a).
SB55-ASA1-AA1, s. 1815cf 13Section 1815cf. 49.47 (4) (c) 1. of the statutes is amended to read:
SB55-ASA1-AA1,446,2514 49.47 (4) (c) 1. Except as provided in par. pars. (am) and (aq) and as limited by
15subd. 3., eligibility exists if income does not exceed 133 1/3% 133.33% of the
16maximum aid to families with dependent children payment under s. 49.19 (11) for
17the applicant's family size or the combined benefit amount available under
18supplemental security income under 42 USC 1381 to 1383c and state supplemental
19aid under s. 49.77 whichever is higher. In this subdivision "income" includes earned
20or unearned income that would be included in determining eligibility for the
21individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled under
2242 USC 1381 to 1385. "Income" does not include earned or unearned income which
23would be excluded in determining eligibility for the individual or family under s.
2449.19 or 49.77, or for the aged, blind or disabled individual under 42 USC 1381 to
251385.".
SB55-ASA1-AA1,447,2
1830. Page 637, line 14: delete the material beginning with that line and
2ending with page 638, line 16.
SB55-ASA1-AA1,447,3 3831. Page 638, line 16: after that line insert:
SB55-ASA1-AA1,447,4 4" Section 1815L. 49.47 (4) (c) 3. of the statutes is amended to read:
SB55-ASA1-AA1,447,85 49.47 (4) (c) 3. Except as provided in par. pars. (am) and (aq), no person is
6eligible for medical assistance under this section if the person's income exceeds the
7maximum income levels that the U.S. department of health and human services sets
8for federal financial participation under 42 USC 1396b (f).
SB55-ASA1-AA1, s. 1815p 9Section 1815p. 49.47 (4) (i) 2. (intro.) of the statutes is amended to read:
SB55-ASA1-AA1,447,1210 49.47 (4) (i) 2. (intro.) Notwithstanding par. (b) 2r. and 3., a person who is
11described in par. (a) 3. or 4. or (aq) is not eligible for benefits under this section if any
12of the following criteria is met:".
SB55-ASA1-AA1,447,13 13832. Page 642, line 20: after that line insert:
SB55-ASA1-AA1,447,14 14" Section 1823r. 49.4981 of the statutes is created to read:
SB55-ASA1-AA1,447,20 1549.4981 Comprehensive quality assessment pilot project. (1) If the
16department receives a waiver of federal medical assistance laws, as requested under
172001 Wisconsin Act .... (this act), section 9123 (19g), the department shall conduct
18a pilot project in the counties of Brown, Grant, Polk, and Waukesha under which
19nursing facilities shall apply to the department, under requirements specified by the
20department, to participate in the pilot project.
SB55-ASA1-AA1,448,10 21(2) If participation for a nursing facility is approved by the department under
22subsection (1), and if the nursing facility contracts to receive a comprehensive quality
23assessment, under standards and principles of comprehensive assessments of the
24quality of care provided to residents of nursing facilities, the nursing facility shall

1provide to the department a copy of a report by the assessment provider of each such
2assessment that is conducted. Each report shall include any findings of violations
3of state statutes or rules by the nursing facility that are discovered in the course of
4performance of the assessment. The nursing facility shall provide information that
5the department requests concerning any violations noted. The department may use
6the assessment report and information provided by the nursing facility as evidence
7to which s. 50.04 (4) applies or upon which an applicable forfeiture under s. 49.498
8(16) or 50.04 (5) may be assessed. Upon receipt of the assessment report, the
9department may, but is not required to, waive the requirement under s. 49.498 (13)
10for an annual survey of the nursing facility.".
SB55-ASA1-AA1,448,11 11833. Page 642, line 20: after that line insert:
SB55-ASA1-AA1,448,12 12" Section 1835h. 49.496 (3) (f) of the statutes is amended to read:
SB55-ASA1-AA1,448,1513 49.496 (3) (f) The department may contract with or employ an attorney to
14probate estates to recover under this subsection the costs of care. Any such contract
15is subject to the requirements of s. 20.930 (2) to (5).
".
SB55-ASA1-AA1,448,16 16834. Page 644, line 14: after that line insert:
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