LRB-4960/1
DAK:kmg:rs
2001 - 2002 LEGISLATURE
February 28, 2002 - Introduced by Senator M. Meyer, cosponsored by
Representative Johnsrud. Referred to Committee on Health, Utilities,
Veterans and Military Affairs.
SB479,1,5
1An Act to renumber and amend 49.45 (6u) (ag);
to amend 49.45 (6u) (title) and
249.45 (6u) (bm); and
to create 49.45 (6u) (ag) 1. of the statutes;
relating to:
3payment of a medical assistance supplement to care management
4organizations that contract with municipal nursing homes for the provision of
5services to family care recipients.
Analysis by the Legislative Reference Bureau
Under current state law, county, city, village, or town (municipal) nursing
homes receive, for care provided to medical assistance (MA) recipients, supplemental
payments that are in addition to payments made under the MA nursing home
reimbursement formula. These supplemental payments are made from federal
medicaid moneys, with a matching requirement for the municipal nursing homes, or
from a combination of federal medicaid moneys and MA trust fund moneys (which
are derived from intergovernmental transfers), with no matching requirement.
Also under current state law, care management organizations, acting as
prepaid health plans, purchase, on a capitated basis, nursing home services for
family care recipients, who are eligible for MA.
Under a current federal regulation, a nursing home that provides MA services
that are purchased by a health maintenance organization or a prepaid health plan
may not be paid a MA supplement from another source.
This bill authorizes the department of health and family services (DHFS) to
make supplemental MA payments of federal medicaid and MA trust fund moneys to
care management organizations that contract with municipal nursing homes for the
provision of services to family care recipients. The methodology used by DHFS for
payment to the care management organizations must be specified in the state plan
for MA services.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB479, s. 1
1Section
1. 49.45 (6u) (title) of the statutes is amended to read:
SB479,2,32
49.45
(6u) (title)
Supplemental payments to certain facilities and care
3management organizations.
SB479,2,66
49.45
(6u) (ag) (intro.) In this subsection
, "facility":
SB479,2,7
72. "Facility" has the meaning given in sub. (6m) (a) 3.
SB479, s. 3
8Section
3. 49.45 (6u) (ag) 1. of the statutes is created to read:
SB479,2,129
49.45
(6u) (ag) 1. "Care management organization" means a care management
10organization, as defined in s. 46.2805 (1), that contracts under s. 46.284 (4) (d) for
11provision of services with a facility that is established under s. 49.70 (2) or that is
12owned and operated by a city, village, or town.
SB479,3,415
49.45
(6u) (bm) In state fiscal years in which $1 or more in federal financial
16participation relating to facilities is received under
42 CFR 433.51, from the
17appropriations under s. 20.435 (4) (o) and (w), for reduction of operating deficits, as
18defined under criteria developed by the department, incurred by a facility that is
19established under s. 49.70 (1) or that is owned and operated by a city, village, or town,
1the department may not distribute to these facilities
and to care management
2organizations more than $77,100,000 in each fiscal year, as determined by the
3department under a methodology as specified in the state plan for services under
42
4USC 1396.
SB479,3,66
(1)
This act takes effect on July 1, 2002.
