SB406, s. 2 3Section 2. 49.45 (2) (a) 9. of the statutes is amended to read:
SB406,4,74 49.45 (2) (a) 9. Periodically set forth conditions of participation and
5reimbursement in a contract with provider for contracts with providers of service
6under this section. The department shall promulgate rules that specify criteria for
7and required procedures for submittal of appropriate claims for reimbursement.
SB406, s. 3 8Section 3. 49.45 (2) (a) 10. a. of the statutes, as affected by 2001 Wisconsin Act
916
, is renumbered 49.45 (2) (a) 10. and amended to read:
SB406,4,1610 49.45 (2) (a) 10. After reasonable notice and opportunity for a hearing
11conducted as a class 2 proceeding under ch. 227, recover money improperly or
12erroneously paid or overpayments to a provider by offsetting or adjusting amounts
13owed the provider under the program, crediting against a provider's future claims
14for reimbursement for other services or items furnished by the provider under the
15program, or requiring the provider to make direct payment to the department or its
16fiscal intermediary.
SB406, s. 4 17Section 4. 49.45 (2) (a) 10. b. of the statutes, as created by 2001 Wisconsin Act
1816
, is repealed.
SB406, s. 5 19Section 5. 49.45 (2) (a) 10. c. of the statutes, as created by 2001 Wisconsin Act
2016
, is repealed.
SB406, s. 6
1Section 6. 49.45 (2) (a) 11. a. of the statutes, as affected by 2001 Wisconsin Act
216
, is renumbered 49.45 (2) (a) 11. and amended to read:
SB406,5,53 49.45 (2) (a) 11. Establish criteria for the certification of eligible providers of
4medical assistance and, except as provided in par. (b) 6m. and s. 49.48, and subject
5to par. (b) 7. and 8.
, certify providers who meet the criteria.
SB406, s. 7 6Section 7. 49.45 (2) (a) 11. b. of the statutes, as created by 2001 Wisconsin Act
716
, is repealed.
SB406, s. 8 8Section 8. 49.45 (2) (a) 12. a. of the statutes, as affected by 2001 Wisconsin Act
916
, is renumbered 49.45 (2) (a) 12. and amended to read:
SB406,5,2310 49.45 (2) (a) 12. Decertify or suspend under this subdivision a provider from
11or restrict a provider's participation in the medical assistance program, if after
12giving reasonable notice and opportunity for hearing the department finds that the
13provider has violated a federal statute or regulation or a state statute or
14administrative rule and the violation is by statute, regulation, or rule grounds for
15decertification or restriction. The department shall suspend the provider pending
16the hearing under this subdivision if the department includes in its decertification
17notice findings that the provider's continued participation in the medical assistance
18program pending hearing is likely to lead to the irretrievable loss of public funds and
19is unnecessary to provide adequate access to services to medical assistance
20recipients. As soon as practicable after the hearing, the department shall issue a
21written decision
suspension. No payment may be made under the medical assistance
22program with respect to any service or item furnished by the provider subsequent to
23decertification or during the period of suspension.
SB406, s. 9 24Section 9. 49.45 (2) (a) 12. b. of the statutes, as created by 2001 Wisconsin Act
2516
, is repealed.
SB406, s. 10
1Section 10. 49.45 (2) (a) 14. of the statutes is amended to read:
SB406,6,42 49.45 (2) (a) 14. Assure due process in implementing subds. 12. and 13. by
3providing written notice, a fair hearing and a written decision and a hearing
4conducted as a class 2 proceeding under ch. 227
.
SB406, s. 11 5Section 11. 49.45 (2) (b) 6m. of the statutes, as created by 2001 Wisconsin Act
616
, is repealed.
SB406, s. 12 7Section 12. 49.45 (2) (b) 7. of the statutes, as created by 2001 Wisconsin Act
816
, is repealed.
SB406, s. 13 9Section 13. 49.45 (2) (b) 8. of the statutes, as created by 2001 Wisconsin Act
1016
, is repealed.
SB406, s. 14 11Section 14. 49.45 (2) (b) 9. of the statutes, as created by 2001 Wisconsin Act
1216
, is repealed.
SB406, s. 15 13Section 15. 49.45 (3) (g) 1. of the statutes, as affected by 2001 Wisconsin Act
1416
, is renumbered 49.45 (3) (g) and amended to read:
SB406,7,915 49.45 (3) (g) The secretary may authorize personnel to audit or investigate and
16report to the department on any matter involving violations or complaints alleging
17violations of statutes, regulations, or rules applicable to the medical assistance
18program and to perform such investigations or audits as are required to verify the
19actual provision of services or items available under the medical assistance program
20and the appropriateness and accuracy of claims for reimbursement submitted by
21providers participating in the program. Department employees authorized by the
22secretary under this paragraph shall be issued, and shall possess at all times while
23they are performing their investigatory or audit functions under this section,
24identification, signed by the secretary, that specifically designates the bearer as
25possessing the authorization to conduct medical assistance investigations or audits.

1Under the request of a designated person and upon presentation of the person's
2authorization, providers and medical assistance recipients shall accord the person
3access to any provider personnel, records, books, or documents or other information
4needed. Under the written request of a designated person and upon presentation of
5the person's authorization, providers and recipients shall accord the person access
6to any needed patient health care records of a recipient. Authorized employees may
7hold hearings, administer oaths, take testimony, and perform all other duties
8necessary to bring the matter before the department for final adjudication and
9determination.
SB406, s. 16 10Section 16. 49.45 (3) (g) 2. of the statutes, as created by 2001 Wisconsin Act
1116
, is repealed.
SB406, s. 17 12Section 17. 49.45 (3) (h) 1. of the statutes is created to read:
SB406,7,2313 49.45 (3) (h) 1. For purposes of any audit, investigation, examination, analysis,
14review, or other function authorized by law with respect to the medical assistance
15program, the secretary shall have the power to sign and issue subpoenas to any
16person requiring the production of any pertinent books, records, patient health care
17records, or other information. Subpoenas so issued shall be served by anyone
18authorized by the secretary by delivering a copy to the person named in the
19subpoena, or by registered mail or certified mail addressed to the person at his or her
20last-known residence or principal place of business. A verified return by the person
21serving the subpoena setting forth the manner of service, or, in the event service is
22by registered or certified mail, the return post-office receipt signed by the person
23served constitutes proof of service.
SB406, s. 18 24Section 18. 49.45 (3) (h) 1m. of the statutes, as affected by 2001 Wisconsin Act
2516
, is renumbered 49.45 (3) (h) 3. and amended to read:
SB406,8,10
149.45 (3) (h) 3. The failure or refusal of a provider to accord department
2auditors or investigators access as required under par. (g) to any provider personnel,
3records, books, patient health care records of medical assistance recipients, or
4documents or other information requested constitutes
person to purge himself or
5herself of contempt found under s. 885.12 and perform the act as required by law
6shall constitute
grounds for decertification or suspension of the provider that person
7from participation in the medical assistance program. No payment may be made for
8services rendered by the provider that person following decertification, or during the
9period of suspension, or during any period of provider failure or refusal to accord
10access as required under par. (g)
.
SB406, s. 19 11Section 19. 49.45 (3) (h) 1n. of the statutes, as created by 2001 Wisconsin Act
1216
, is repealed.
SB406, s. 20 13Section 20. 49.45 (3) (h) 2. of the statutes is created to read:
SB406,8,1714 49.45 (3) (h) 2. In the event of contumacy or refusal to obey a subpoena issued
15under this paragraph and duly served upon any person, any judge in a court of record
16in the county in which the person was served may enforce the subpoena in accordance
17with s. 885.12.
SB406, s. 21 18Section 21. 49.45 (21) (title) of the statutes, as affected by 2001 Wisconsin Act
1916
, is amended to read:
SB406,8,2120 49.45 (21) (title) Taking over provider's operation Transfer of business,
21liability for
; repayments required.
SB406, s. 22 22Section 22. 49.45 (21) (ag) of the statutes, as created by 2001 Wisconsin Act
2316
, is repealed.
SB406, s. 23 24Section 23. 49.45 (21) (ar) of the statutes, as affected by 2001 Wisconsin Act
2516
, is renumbered 49.45 (21) (a) and amended to read:
SB406,9,9
149.45 (21) (a) Before a person may take over the operation of a provider that
2is
If any provider liable for repayment of improper or erroneous payments or
3overpayments under ss. 49.43 to 49.497, full repayment shall be made. Upon
4request, the department shall notify the provider or the person that intends to take
5over the operation of the provider as to whether the provider
sells or otherwise
6transfers ownership of his or her business or all or substantially all of the assets of
7the business, the transferor and transferee are each liable for the repayment. Prior
8to final transfer, the transferee is responsible for contacting the department and
9ascertaining if the transferor
is liable under this paragraph.
SB406, s. 24 10Section 24. 49.45 (21) (b) of the statutes, as affected by 2001 Wisconsin Act 16,
11is amended to read:
SB406,9,2112 49.45 (21) (b) If, notwithstanding the prohibition under par. (ar), a person takes
13over the operation of a provider
If a transfer occurs and the applicable amount under
14par. (ar) (a) has not been repaid, the department may, in addition to withholding
15certification as authorized under sub. (2) (b) 8.,
proceed against the provider or the
16person
either the transferor or the transferee. Within 30 days after the certified
17provider receives
receiving notice from the department, the transferor or the
18transferee shall pay the
amount shall be repaid in full. If the amount is not repaid
19in full
Upon failure to comply, the department may bring an action to compel
20payment,. If a transferor fails to pay within 90 days after receiving notice from the
21department, the department
may proceed under sub. (2) (a) 12., or may do both.
SB406, s. 25 22Section 25. 49.45 (21) (e) of the statutes, as created by 2001 Wisconsin Act 16,
23is repealed.
SB406, s. 26 24Section 26. 49.85 (2) (a) of the statutes, as affected by 2001 Wisconsin Act 16,
25is amended to read:
SB406,10,8
149.85 (2) (a) At least annually, the department of health and family services
2shall certify to the department of revenue the amounts that, based on the
3notifications received under sub. (1) and on other information received by the
4department of health and family services, the department of health and family
5services has determined that it may recover under s. 49.45 (2) (a) 10. or 49.497, except
6that the department of health and family services may not certify an amount under
7this subsection unless it has met the notice requirements under sub. (3) and unless
8its determination has either not been appealed or is no longer under appeal.
SB406, s. 27 9Section 27. 49.85 (3) (a) 1. of the statutes, as affected by 2001 Wisconsin Act
1016
, is amended to read:
SB406,10,1411 49.85 (3) (a) 1. Inform the person that the department of health and family
12services intends to certify to the department of revenue an amount that the
13department of health and family services has determined to be due under s. 49.45
14(2) (a) 10. or
49.497, for setoff from any state tax refund that may be due the person.
SB406, s. 28 15Section 28. 71.93 (1) (a) 3. of the statutes, as affected by 2001 Wisconsin Act
1616
, is amended to read:
SB406,10,1917 71.93 (1) (a) 3. An amount that the department of health and family services
18may recover under s. 49.45 (2) (a) 10. or 49.497, if the department of health and
19family services has certified the amount under s. 49.85.
SB406, s. 29 20Section 29. 227.43 (1) (bg) of the statutes is amended to read:
SB406,11,221 227.43 (1) (bg) Assign a hearing examiner to preside over any hearing or review
22under ss. 49.45 (2) (a) 10. and 14., 84.30 (18), 84.31 (6) (a), 85.013 (1), 86.073 (3), 86.16
23(5), 86.195 (9) (b), 86.32 (1), 101.935 (2) (b), 101.951 (7) (a) and (b), 114.134 (4) (b),
24114.135 (9), 114.20 (19), 175.05 (4) (b), 194.145 (1), 194.46, 218.0114 (7) (d) and (12)
25(b), 218.0116 (2), (4), (7) (a), (8) (a), and (10), 218.0131 (3), 218.11 (7) (a) and (b), 218.22

1(4) (a) and (b), 218.32 (4) (a) and (b), 218.41 (4), 218.51 (5) (a) and (b), 341.09 (2m) (d),
2342.26, 343.69, and 348.25 (9).
SB406, s. 30 3Section 30. 2001 Wisconsin Act 16, section 9323 (18k), (18m), (18n), (18pk),
4(18pm) and (18pn) are repealed.
SB406, s. 31 5Section 31. 2001 Wisconsin Act 16, section 9423 (18k) is repealed.
SB406, s. 32 6Section 32 . Nonstatutory provisions.
SB406,11,11 7(1 ) Medical assistance provider fraud and abuse; rules. The department of
8health and family services shall submit in proposed form the rules required under
9section 49.45 (2) (a) 9. of the statutes, as affected by this act, to the legislative council
10staff under section 227.15 (1) of the statutes no later than the first day of the 7th
11month beginning after the effective date of this subsection.
SB406, s. 33 12Section 33. Appropriation changes.
SB406,11,1713 (1) Medical assistance audits and investigations; lapse. Notwithstanding
14section 20.001 (3) (c) of the statutes, on January 1, 2003, there is lapsed to the general
15fund the unencumbered balance in the appropriation under section 20.435 (4) (iL)
16of the statutes immediately before the effective date of the repeal of section 20.435
17(4) (iL) of the statutes.
SB406, s. 34 18Section 34. Initial applicability.
SB406,11,2119 (1) Liability for transfer of business. The treatment of section 49.45 (2) (b)
208. and (21) (title), (ag), (ar), (b), and (e) of the statutes first applies to sales or other
21transfers completed on the effective date of this subsection.
SB406,11,2522 (2) Assessment for repeated recoveries against providers of medical
23assistance.
The treatment of section 49.45 (2) (b) 9. of the statutes first applies to
24repeated recoveries from the identical provider that are made on the effective date
25of this subsection.
SB406,12,4
1(3) Decertification or suspension of providers of medical assistance. The
2treatment of section 49.45 (2) (a) 12. a. and b. and 14. of the statutes first applies to
3violations of federal statutes or regulations or state statutes or rules committed on
4the effective date of this subsection.
SB406,12,7 5(4) Certification of providers of medical assistance. The treatment of section
649.45 (2) (a) 11. a. and b. and (b) 7. of the statutes first applies to applications for
7certification received on the effective date of this subsection.
SB406,12,11 8(5) Recoveries against providers of medical assistance. The treatment of
9sections 49.45 (2) (a) 9. and 10. a., b., and c., 49.85 (2) (a) and (3) (a) 1., and 71.93 (1)
10(a) 3. of the statutes first applies to recoveries imposed on the effective date of this
11subsection.
SB406,12,15 12(6) Audits and access to records of providers of medical assistance. The
13treatment of section 49.45 (3) (g) 1. and 2. and (h) 1., 1m., 1n., and 2. of the statutes
14first applies to audits or investigations performed on or access requested on the
15effective date of this subsection.
SB406,12,18 16(7) Limit on number of certified medical assistance providers. The treatment
17of section 49.45 (2) (b) 6m. of the statutes first applies to certifications made on the
18effective date of this subsection.
SB406, s. 35 19Section 35. Effective dates. This act takes effect on January 1, 2003, except
20as follows:
SB406,12,2121 (1) Section 32 (1) of this act takes effect on the day after publication.
SB406,12,2222 (End)
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