AB100-ASA1,492,18
149.197 (1m) Fraud investigation. From the appropriations under s. 20.445 (3)
2(dz), (kx), (L), (md), (n), and (nL), the department shall establish a program to
3investigate suspected fraudulent activity on the part of recipients of aid to families
4with dependent children under s. 49.19, on the part of participants in the Wisconsin
5works Works program under ss. 49.141 to 49.161, and, if the department of health
6and family services contracts with the department under sub. (5), on the part of
7recipients of medical assistance under subch. IV and, food stamp benefits under the
8food stamp program under 7 USC 2011 to 2036, supplemental security income
9payments under s. 49.77, payments for the support of children of supplemental
10security income recipients under s. 49.775, and health care benefits under the
11Badger Care health care program under s. 49.665
. The department's activities under
12this subsection may include, but are not limited to, comparisons of information
13provided to the department by an applicant and information provided by the
14applicant to other federal, state, and local agencies, development of an advisory
15welfare investigation prosecution standard, and provision of funds to county
16departments under ss. 46.215, 46.22, and 46.23 and to Wisconsin works Works
17agencies to encourage activities to detect fraud. The department shall cooperate
18with district attorneys regarding fraud prosecutions.
AB100-ASA1, s. 1115 19Section 1115. 49.197 (3) of the statutes is amended to read:
AB100-ASA1,493,220 49.197 (3) State error reduction activities. The department shall conduct
21activities to reduce payment errors in Wisconsin works Works under ss. 49.141 to
2249.161 and, if the department of health and family services contracts with the
23department under sub. (5), the medical assistance Medical Assistance program
24under subch. IV and, the food stamp program under 7 USC 2011 to 2036, the
25supplemental security income payments program under s. 49.77, the program

1providing payments for the support of children of supplemental security income
2recipients under s. 49.775, and the Badger Care health care program under s. 49.665
.
AB100-ASA1, s. 1116 3Section 1116. 49.197 (4) of the statutes is amended to read:
AB100-ASA1,493,134 49.197 (4) County and tribal error reduction. If the department of health and
5family services contracts with the department under sub. (5), the department shall
6provide funds from the appropriation under s. 20.445 (3) (kx) to counties and
7governing bodies of federally recognized American Indian tribes administering
8medical assistance Medical Assistance under subch. IV or, the food stamp program
9under 7 USC 2011 to 2036, the supplemental security income payments program
10under s. 49.77, the program providing payments for the support of children of
11supplemental security income recipients under s. 49.775, and the Badger Care
12health care program under s. 49.665
to offset administrative costs of reducing
13payment errors in those programs.
AB100-ASA1, s. 1117 14Section 1117. 49.197 (5) of the statutes is amended to read:
AB100-ASA1,494,315 49.197 (5) Contracts for medical assistance and, food stamps, supplemental
16security income, and caretaker supplement
. The Notwithstanding s. 49.845 (1) and
17(2), the
department of health and family services may contract with the department
18to investigate suspected fraudulent activity on the part of recipients of medical
19assistance under subch. IV or recipients of, food stamp benefits under the food stamp
20program under 7 USC 2011 to 2036, supplemental security income payments under
21s. 49.77, payments for the support of children of supplemental security income
22recipients under s. 49.775, and health care benefits under the Badger Care health
23care program under s. 49.665 and to conduct activities to reduce payment errors in
24the Medical Assistance program under subch. IV, the food stamp program under 7
25USC 2011
to 2036, the supplemental security income payments program under s.

149.77, the program providing payments for the support of children of supplemental
2security income recipients under s. 49.775, and the Badger Care health care program
3under s. 49.665,
as provided in this section.
AB100-ASA1, s. 1118 4Section 1118. 49.22 (1) of the statutes is amended to read:
AB100-ASA1,494,195 49.22 (1) There is created a child and spousal support and establishment of
6paternity and medical liability support liability program in the department. The
7purpose of this program is to establish paternity when possible, to establish or modify
8support obligations, to enforce support obligations owed by parents to their children
9and maintenance obligations owed to spouses or former spouses with whom the
10children reside in this state or owed in other states if the support order was issued
11in this state or owed in other states if the parent, spouse, or former spouse resides
12in this state, to locate persons who are alleged to have taken their child in violation
13of s. 948.31 or of similar laws in other states, and to locate and value property of any
14person having a support duty. To accomplish the objectives of this program and of
15other assistance programs under this chapter, county and state agencies will
16cooperate with one another to implement a child and spousal support and paternity
17establishment and medical support liability program in accordance with state and
18federal laws, regulations, and rules and to assure proper distribution of benefits of
19all assistance programs authorized under this chapter.
AB100-ASA1, s. 1119 20Section 1119. 49.36 (2) of the statutes is amended to read:
AB100-ASA1,495,421 49.36 (2) The department may contract with any county, tribal governing body,
22or Wisconsin works Works agency to administer a work experience and job training
23program for parents who are not custodial parents and who fail to pay child support
24or to meet their children's needs for support as a result of unemployment or
25underemployment. The program may provide the kinds of work experience and job

1training services available from the program under s. 49.193, 1997 stats., or s. 49.147
2(3) or (4). The program may also include job search and job orientation activities.
3The department shall fund the program from the appropriation appropriations
4under s. 20.445 (3) (dz) and (k).
AB100-ASA1, s. 1120 5Section 1120. 49.45 (2) (a) 3m. of the statutes is repealed.
AB100-ASA1, s. 1124 6Section 1124. 49.45 (3) (i) of the statutes is repealed.
AB100-ASA1, s. 1124g 7Section 1124g. 49.45 (3) (m) of the statutes is created to read:
AB100-ASA1,495,118 49.45 (3) (m) Reimbursement for services provided by a health maintenance
9organization, as defined in s. 609.01 (2), with a contract under sub. (2) (b) 2. to provide
10health care to recipients of Medical Assistance or Badger Care, shall be made under
11capitation rates that are actuarially sound.
AB100-ASA1, s. 1125s 12Section 1125s. 49.45 (6m) (a) 6. of the statutes is created to read:
AB100-ASA1,495,1613 49.45 (6m) (a) 6. "Resource Utilization Groupings III" means a comparative
14resource utilization grouping that classifies each facility resident based on
15information obtained from performing, for the resident, a minimum data set
16assessment developed by the federal Centers for Medicare and Medicaid Services.
AB100-ASA1, s. 1128m 17Section 1128m. 49.45 (6m) (ag) 3p. of the statutes is created to read:
AB100-ASA1,495,1918 49.45 (6m) (ag) 3p. For all costs specified under par. (am) 1. bm., an
19acuity-based payment rate system to which all of the following applies:
AB100-ASA1,495,2220 a. The system shall incorporate acuity measurements under the most recent
21Resource Utilization Groupings III methodology to determine factors for case-mix
22adjustment.
AB100-ASA1,496,223 b. Four times annually, for each facility resident who is a Medical Assistance
24recipient on March 31, June 30, September 30, or December 31, as applicable, the

1system shall determine the average case-mix index by use of the factors specified
2under subd. 3p. a.
AB100-ASA1,496,43 c. The system shall incorporate payment adjustments for dementia, behavioral
4needs, or other complex medical conditions.
AB100-ASA1,496,55 d. The system may include incentives for providing high quality of care.
AB100-ASA1,496,86 e. The system shall identify the extent to which payment is made to facilities,
7under the system, for facilities' direct care nursing costs allowable under Medical
8Assistance.
AB100-ASA1, s. 1132f 9Section 1132f. 49.45 (6m) (m) of the statutes is created to read:
AB100-ASA1,496,1210 49.45 (6m) (m) The department may not use the criteria for functional
11eligibility specified in s. 46.286 (1) (a) to determine rates of payment to facilities
12under this subsection.
AB100-ASA1, s. 1133 13Section 1133. 49.45 (6t) of the statutes, as affected by 2003 Wisconsin Act 318,
14is repealed.
AB100-ASA1, s. 1135c 15Section 1135c. 49.45 (6x) (title) of the statutes is amended to read:
AB100-ASA1,496,1616 49.45 (6x) (title) Funding for essential access city hospital hospitals.
AB100-ASA1, s. 1135d 17Section 1135d. 49.45 (6x) (a) of the statutes is amended to read:
AB100-ASA1,496,2318 49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriation accounts
19under s. 20.435 (4) (b), (gp), (o), and (w), the department shall distribute not more
20than $4,748,000 in each fiscal year, to provide funds to an essential access city
21hospital hospitals, except that the department may not allocate funds to an essential
22access city hospital to the extent that the allocation would exceed any limitation
23under 42 USC 1396b (i) (3).
AB100-ASA1, s. 1135e 24Section 1135e. 49.45 (6x) (b) of the statutes is amended to read:
AB100-ASA1,497,9
149.45 (6x) (b) The department shall develop procedures for solicitation and
2review of requests for funds and a method to distribute the funds under par. (a) to
3an individual hospital hospitals that shall include establishment of criteria for the
4designation as an essential access city hospital. Beginning on July 1, 2007, the
5criteria established by the department may not include reference to criteria that
6were required to have been met during July 1, 1995, to June 30, 1996, but shall
7include the requirement that more than 30 percent of a hospital's total inpatient days
8are reimbursable under Medical Assistance. No hospital that qualifies for a Medical
9Assistance pediatric inpatient supplement is eligible for funds under this subsection.
AB100-ASA1, s. 1144p 10Section 1144p. 49.45 (18) (ag) 1. of the statutes is amended to read:
AB100-ASA1,497,1211 49.45 (18) (ag) 1. A copayment of $1 $3 for each prescription of a drug that bears
12only a generic name, as defined in s. 450.12 (1) (b).
AB100-ASA1, s. 1146j 13Section 1146j. 49.45 (27) of the statutes is amended to read:
AB100-ASA1,497,1714 49.45 (27) Eligibility of aliens. A person who is not a U.S. citizen or an alien
15lawfully admitted for permanent residence or otherwise permanently residing in the
16United States under color of law may not receive medical assistance benefits except
17as provided under 8 USC 1255a (h) (3) or 42 USC 1396b (v), subject to s. 49.46 (2) (f).
AB100-ASA1, s. 1147 18Section 1147. 49.45 (39) (b) 1. of the statutes is amended to read:
AB100-ASA1,499,219 49.45 (39) (b) 1. `Payment for school medical services.' If a school district or a
20cooperative educational service agency elects to provide school medical services and
21meets all requirements under par. (c), the department shall reimburse the school
22district or the cooperative educational service agency for 60% of the federal share of
23allowable charges for the school medical services that it provides and, as specified
24in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind
25and Visually Impaired or the Wisconsin Educational Services Program for the Deaf

1and Hard of Hearing elects to provide school medical services and meets all
2requirements under par. (c), the department shall reimburse the department of
3public instruction for 60% of the federal share of allowable charges for the school
4medical services that the Wisconsin Center for the Blind and Visually Impaired or
5the Wisconsin Educational Services Program for the Deaf and Hard of Hearing
6provides and, as specified in subd. 2., for allowable administrative costs. A school
7district, cooperative educational service agency, the Wisconsin Center for the Blind
8and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
9and Hard of Hearing may submit, and the department shall allow, claims for common
10carrier transportation costs as a school medical service unless the department
11receives notice from the federal health care financing administration that, under a
12change in federal policy, the claims are not allowed. If the department receives the
13notice, a school district, cooperative educational service agency, the Wisconsin
14Center for the Blind and Visually Impaired, or the Wisconsin Educational Services
15Program for the Deaf and Hard of Hearing may submit, and the department shall
16allow, unreimbursed claims for common carrier transportation costs incurred before
17the date of the change in federal policy. The department shall promulgate rules
18establishing a methodology for making reimbursements under this paragraph.
19Except as provided in subd. 1m., all All other expenses for the school medical services
20provided by a school district or a cooperative educational service agency shall be paid
21for by the school district or the cooperative educational service agency with funds
22received from state or local taxes. The school district, the Wisconsin Center for the
23Blind and Visually Impaired, the Wisconsin Educational Services Program for the
24Deaf and Hard of Hearing, or the cooperative educational service agency shall

1comply with all requirements of the federal department of health and human
2services for receiving federal financial participation.
AB100-ASA1, s. 1148 3Section 1148. 49.45 (39) (b) 1m. of the statutes is repealed.
AB100-ASA1, s. 1149 4Section 1149. 49.45 (39) (b) 2. of the statutes is amended to read:
AB100-ASA1,499,145 49.45 (39) (b) 2. `Payment for school medical services administrative costs.' The
6department shall reimburse a school district or a cooperative educational service
7agency specified under subds. subd. 1. and 1m. and shall reimburse the department
8of public instruction on behalf of the Wisconsin Center for the Blind and Visually
9Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of
10Hearing for 90% of the federal share of allowable administrative costs, using time
11studies, beginning in fiscal year 1999-2000. A school district or a cooperative
12educational service agency may submit, and the department of health and family
13services shall allow, claims for administrative costs incurred during the period that
14is up to 24 months before the date of the claim, if allowable under federal law.
AB100-ASA1, s. 1149f 15Section 1149f. 49.45 (42m) of the statutes is created to read:
AB100-ASA1,499,2216 49.45 (42m) Physical and occupational therapy. (a) If, in authorizing the
17provision of physical or occupational therapy services under s. 49.46 (2) (b) 6. b., the
18department authorizes a reduced duration of services from the duration that the
19provider specifies in the authorization request, the department shall substantiate
20the reduction that the department made in the duration of the services if the provider
21of the services requests any additional authorizations for the provision of physical
22or occupational therapy services to the same individual.
AB100-ASA1,500,223 (b) The division of the department that is responsible for health care financing
24shall monitor compliance with the requirement under par. (a) in concert with

1representatives of the Wisconsin Physical Therapy Association and the Wisconsin
2Occupational Therapy Association.
AB100-ASA1, s. 1150 3Section 1150. 49.46 (1) (a) 5. of the statutes is amended to read:
AB100-ASA1,500,64 49.46 (1) (a) 5. Any child in an adoption assistance, foster care, kinship care,
5long-term kinship care or, treatment foster care, or subsidized guardianship
6placement under ch. 48 or 938, as determined by the department.
AB100-ASA1, s. 1153 7Section 1153. 49.46 (1) (a) 14. of the statutes is amended to read:
AB100-ASA1,500,138 49.46 (1) (a) 14. Any person who would meet the financial and other eligibility
9requirements for home or community-based services under s. 46.27 (11) or, 46.277,
10or 46.2785
but for the fact that the person engages in substantial gainful activity
11under 42 USC 1382c (a) (3), if a waiver under s. 49.45 (38) is in effect or federal law
12permits federal financial participation for medical assistance coverage of the person
13and if funding is available for the person under s. 46.27 (11) or, 46.277, or 46.2785.
AB100-ASA1, s. 1154 14Section 1154. 49.46 (1) (a) 15. of the statutes is amended to read:
AB100-ASA1,500,1715 49.46 (1) (a) 15. Any individual who is infected with tuberculosis and meets the
16income and resource eligibility requirements for the federal supplemental security
17Supplemental Security Income program under 42 USC 1381 to 1383d.
AB100-ASA1, s. 1157 18Section 1157. 49.46 (2) (b) 8. of the statutes is amended to read:
AB100-ASA1,500,2219 49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27
20(11), 46.275, 46.277 or, 46.278, or 46.2785, under the family care benefit if a waiver
21is in effect under s. 46.281 (1) (c), or under a waiver requested under 2001 Wisconsin
22Act 16
, section 9123 (16rs), or 2003 Wisconsin Act 33, section 9124 (8c).
AB100-ASA1, s. 1157j 23Section 1157j. 49.46 (2) (f) of the statutes is amended to read:
AB100-ASA1,501,324 49.46 (2) (f) Benefits under this subsection or s. 49.45 (27) may not include
25payment for gastric bypass surgery or gastric stapling surgery unless it is performed

1because of a medical emergency
the procedure is required to be covered under federal
2medicaid law, as interpreted by the federal centers for medicare and medicaid
3services
.
AB100-ASA1, s. 1158 4Section 1158. 49.47 (4) (as) 1. of the statutes is amended to read:
AB100-ASA1,501,95 49.47 (4) (as) 1. The person would meet the financial and other eligibility
6requirements for home or community-based services under s. 46.27 (11) or, 46.277,
7or 46.2785
or under the family care benefit if a waiver is in effect under s. 46.281 (1)
8(c) but for the fact that the person engages in substantial gainful activity under 42
9USC 1382c
(a) (3).
AB100-ASA1, s. 1159 10Section 1159. 49.47 (4) (as) 3. of the statutes is amended to read:
AB100-ASA1,501,1311 49.47 (4) (as) 3. Funding is available for the person under s. 46.27 (11) or,
1246.277, or 46.2785 or under the family care benefit if a waiver is in effect under s.
1346.281 (1) (c).
AB100-ASA1, s. 1167 14Section 1167. 49.497 (title) of the statutes is amended to read:
AB100-ASA1,501,16 1549.497 (title) Recovery of incorrect medical assistance Medical
16Assistance or Badger Care
payments.
AB100-ASA1, s. 1168 17Section 1168. 49.497 (1) of the statutes is renumbered 49.497 (1) (a) (intro.)
18and amended to read:
AB100-ASA1,501,2119 49.497 (1) (a) (intro.) The department may recover any payment made
20incorrectly for benefits specified under s. 49.46, 49.468 or 49.47 provided under this
21subchapter or s. 49.665
if the incorrect payment results from any of the following:
AB100-ASA1,501,23 221. A misstatement or omission of fact by a person supplying information in an
23application for benefits under s. 49.46, 49.468 or 49.47 this subchapter or s. 49.665.
AB100-ASA1,502,2 242. The department may also recover if a medical assistance failure of a Medical
25Assistance or Badger Care
recipient or any other person responsible for giving

1information on the recipient's behalf fails to report the receipt of income or assets in
2an amount that would have affected the recipient's eligibility for benefits.
AB100-ASA1,502,9 3(b) The department's right of recovery is against any medical assistance
4Medical Assistance or Badger Care recipient to whom or on whose behalf the
5incorrect payment was made. The extent of recovery is limited to the amount of the
6benefits incorrectly granted. The county department under s. 46.215 or 46.22 or the
7governing body of a federally recognized American Indian tribe administering
8medical assistance Medical Assistance or Badger Care shall begin recovery actions
9on behalf of the department according to rules promulgated by the department.
AB100-ASA1, s. 1169 10Section 1169. 49.497 (1) (a) 3. of the statutes is created to read:
AB100-ASA1,502,1511 49.497 (1) (a) 3. The failure of a Medical Assistance or Badger Care recipient
12or any other person responsible for giving information on the recipient's behalf to
13report any change in the recipient's financial or nonfinancial situation or eligibility
14characteristics that would have affected the recipient's eligibility for benefits or the
15recipient's cost-sharing requirements.
AB100-ASA1, s. 1170 16Section 1170. 49.497 (1m) of the statutes is created to read:
AB100-ASA1,503,217 49.497 (1m) (a) If, after notice that an incorrect payment was made, a recipient,
18or parent of a minor recipient, who is liable for repayment of an incorrect payment
19fails to repay the incorrect payment or enter into, or comply with, an agreement for
20repayment, the department may bring an action to enforce the liability or may issue
21an order to compel payment of the liability. Any person aggrieved by an order issued
22by the department under this paragraph may appeal the order as a contested case
23under ch. 227 by filing with the department a request for a hearing within 30 days
24after the date of the order. The only issue at hearing shall be the determination by

1the department that the person has not repaid the incorrect payment or entered into,
2or complied with, an agreement for repayment.
AB100-ASA1,503,123 (b) If any recipient, or parent of a minor recipient, named in an order to compel
4payment issued under par. (a) fails to pay the department any amount due under the
5terms of the order and no contested case to review the order is pending and the time
6for filing for a contested case review has expired, the department may present a
7certified copy of the order to the circuit court for any county. The sworn statement
8of the secretary shall be evidence of the incorrect payment. The circuit court shall,
9without notice, render judgment in accordance with the order. A judgment rendered
10under this paragraph shall have the same effect and shall be entered in the judgment
11and lien docket and may be enforced in the same manner as if the judgment had been
12rendered in an action tried and determined by the circuit court.
AB100-ASA1,503,1413 (c) The recovery procedure under this subsection is in addition to any other
14recovery procedure authorized by law.
AB100-ASA1, s. 1171 15Section 1171. 49.497 (2) of the statutes is amended to read:
AB100-ASA1,503,1916 49.497 (2) A county or governing body of a federally recognized American
17Indian tribe may retain 15% of benefits distributed under s. 49.46, 49.468 or 49.47
18provided under this subchapter or s. 49.665 that are recovered under sub. (1) this
19section
due to the efforts of an employee or officer of the county or tribe.
AB100-ASA1, s. 1172 20Section 1172. 49.497 (4) of the statutes is created to read:
AB100-ASA1,503,2421 49.497 (4) The department may appear for the state in any and all collection
22matters under this section, and may commence suit in the name of the department
23to recover an incorrect payment from the recipient to whom or on whose behalf it was
24made.
AB100-ASA1, s. 1173 25Section 1173. 49.497 (5) of the statutes is created to read:
AB100-ASA1,504,3
149.497 (5) The department may make an agreement with a recipient, or parent
2of a minor recipient, who is liable under sub. (1), providing for repayment of an
3incorrect payment at a specified rate or amount.
AB100-ASA1, s. 1174 4Section 1174. 49.665 (1) (b) of the statutes is amended to read:
AB100-ASA1,504,65 49.665 (1) (b) "Child" means a person who is born and who is under the age of
619.
AB100-ASA1, s. 1175 7Section 1175. 49.665 (1) (g) of the statutes is created to read:
AB100-ASA1,504,98 49.665 (1) (g) "Unborn child" means a person from the time of conception until
9it is born alive.
AB100-ASA1, s. 1176 10Section 1176. 49.665 (2) (a) of the statutes is renumbered 49.665 (2) (a) 1. and
11amended to read:
AB100-ASA1,504,2212 49.665 (2) (a) 1. The department of health and family services shall request a
13waiver from the secretary of the federal department of health and human services
14to permit the department of health and family services to implement, beginning not
15later than July 1, 1998, or the effective date of the waiver, whichever is later, a health
16care program under this section. If a waiver that is consistent with all of the
17provisions of this section, excluding sub. (4) (a) 3m. and (ap) and provisions related
18to sub. (4) (ap)
, is granted and in effect, the department of health and family services
19shall implement the program under this section, subject to subd. 2. The department
20of health and family services may not implement the program under this section
21unless a waiver that is consistent with all of the provisions of this section, excluding
22sub. (4) (a) 3m. and (ap) and provisions related to sub. (4) (ap), is granted and in effect.
AB100-ASA1, s. 1177 23Section 1177. 49.665 (2) (a) 2. of the statutes is created to read:
AB100-ASA1,505,224 49.665 (2) (a) 2. The department may not implement sub. (4) (ap) or provisions
25related to the coverage under sub. (4) (ap) unless a state plan amendment

1authorizing the coverage under sub. (4) (ap) is approved by the federal department
2of health and human services.
AB100-ASA1, s. 1178 3Section 1178. 49.665 (3) of the statutes is amended to read:
AB100-ASA1,505,164 49.665 (3) Administration. The Subject to sub. (2) (a) 2., the department shall
5administer a program to provide the health services and benefits described in s. 49.46
6(2) to persons that meet the eligibility requirements specified in sub. (4). The
7department shall promulgate rules setting forth the application procedures and
8appeal and grievance procedures. The department may promulgate rules limiting
9access to the program under this section to defined enrollment periods. The
10department may also promulgate rules establishing a method by which the
11department may purchase family coverage offered by the employer of a member of
12an eligible family or by of a member of a an eligible child's household , or family or
13individual coverage offered by the employer of an eligible unborn child's mother or
14her spouse,
under circumstances in which the department determines that
15purchasing that coverage would not be more costly than providing the coverage
16under this section.
AB100-ASA1, s. 1179 17Section 1179. 49.665 (4) (ap) of the statutes is created to read:
Loading...
Loading...