49.37(1)(1) From the appropriation under
s. 20.445 (3) (dk), the department shall allocate funds to new hope project, inc., for a demonstration project that will be conducted in 2 areas in the city of Milwaukee, if all of the following conditions are satisfied:
49.37(1)(a)
(a) A person who lives in either of the 2 areas is eligible to enter the project if he or she is at least 18 years of age and has a family income below 200% of the poverty line, as defined in
s. 49.01 (6m) [49.001 (5)], for a family the size of the person's family.
49.37 Note
NOTE: The bracketed language indicates the correct cross-reference.
1995 Wis. Act 27 renumbered s. 49.01 (6m) to be 49.001 (5). Corrective legislation is pending.
49.37(1)(b)
(b) The project assists a participant who is not employed to obtain a job other than a community service job under
par. (c).
49.37(1)(c)
(c) The project assists a participant who is not employed before entering the project and who does not obtain a job under
par. (b) within a reasonable time, as determined by new hope project, inc., to obtain a community service job and funds the wages paid for that community service job.
49.37(1)(d)
(d) If a participant is employed before starting the project or becomes employed under
par. (b) but his or her wages are lower than wage levels established by new hope project, inc., the project assists the participant in obtaining state and federal earned income tax credits and, if the wages plus the earned income tax credits are lower than the established wage levels, provides the participant with wage supplements.
49.37(1)(e)
(e) If a participant is employed, the project assists the participant to obtain and, if necessary, funds any of the following services needed by a participant and his or her family:
49.37(1)(e)3.
3. Counseling and training for job retention or advancement.
49.37(1)(g)
(g) New hope project, inc., contracts for an evaluation of the project of a quality sufficient to show whether and to what extent the project has succeeded in reducing welfare dependency, unemployment and poverty.
49.37(1)(h)
(h) New hope project, inc., demonstrates that it has obtained funds for the project from other public or private sources in an amount that is at least equal to the amount of state funds appropriated for the program.
49.37(2)
(2) New hope project, inc., may require a participant to pay a portion of the cost of health care and child care funded by the project.
49.37(3)
(3) The contract under
sub. (1) (g) shall require an interim evaluation to be submitted to the department no later than January 1, 1993. New hope project, inc., may not use funds appropriated under
s. 20.445 (3) (dk) to fund the evaluation under
sub. (1) (g).
49.37(4)
(4) This section does not apply after June 30, 1997.
49.38
49.38
Menominee Enterprises, Inc., bonds, acquisition. 49.38(1)(1) The department is authorized to exercise options to purchase securities assigned to the state of Wisconsin under s.
710.05, 1973 stats., at par value, or to accept an assignment of such securities, for the purpose of providing relief, public assistance or welfare aid under this section.
49.38(2)
(2) The department shall exercise the options to purchase such securities or accept an assignment of such securities when it finds that the owner of the securities is a resident of this state and is in need of public assistance, or who but for the ownership of such securities would qualify for public assistance. If the department exercises an option to purchase such security, the purchase price shall be paid out, at par value, as a relief payment. Where the department accepts an assignment of such security as provided in this section it shall pay out as relief an amount equal to the par value of the security assigned. The relief furnished, whether by money or otherwise, shall be at such times and in such amounts as will in the discretion of the department meet the needs of the recipient and protect the public. The department is authorized to exercise the options to purchase assigned to it in whole or in part, or to accept an assignment of such securities in whole or in part. The department is granted such authority as may be necessary and convenient to enable it to exercise the functions and perform the duties required of it by this section, including without limitation because of enumeration the authority to promulgate rules governing eligibility and the furnishing and paying of relief under this section, the authority to enter into suitable agreements with the owner of the security or other appropriate persons for the purpose of carrying out this section, and the authority to sell or transfer the securities or defend and prosecute all actions concerning it and pay all just claims against it and do all other things necessary for the protection, preservation and management of the securities.
49.38(3)
(3) If the relief, public assistance, or other welfare aid provided pursuant to this section is discontinued during the life of the person receiving such aid and the value of the securities transferred to the department exceed the total amount of assistance paid under this section, the excess of such property shall be returned to such person; and in the event of the person's death the excess shall be considered the property of such person for administration proceedings.
49.38(4)
(4) The department may make loans to the owner of such securities for relief and welfare purposes which loans shall be secured by pledges of the securities to the state. The department may by rule establish the purposes for which loans may be made, permissible interest rates and fees, time and manner in which the loan is paid out, time and manner of repayment, general procedures to be followed in making loans, the action which shall be taken if a borrower defaults on a loan, maximum amount which may be loaned to any one borrower, and any other rules necessary to carry out the purposes of this section.
49.38(5)
(5) Nothing in this section as created by
chapter 2, laws of Special Session of 1963, is in derogation of other rights and remedies provided by law.
49.38(6)
(6) On and after May 20, 1972, where the owner of such security is otherwise eligible for welfare assistance, such security shall be an exempt asset under the welfare law and shall not disqualify such person from receiving welfare assistance.
49.38 Note
NOTE: Ch. 303, 1971 laws, provided for returning to its original owners Menominee Enterprises, Inc. bonds assigned to the state as a condition for receiving public assistance.
49.385
49.385
No action against members of the Menominee Indian tribe in certain cases. No action shall be commenced under
s. 46.10 or
49.08 or any other provision of law for the recovery from assets distributed to members of the Menominee Indian tribe and others by the United States pursuant to
P.L. 83-399, as amended, for the value of relief or old-age assistance under s.
49.20, 1971 stats., as affected by
chapter 90, laws of 1973, and the value of maintenance in state institutions under
ch. 46, furnished prior to termination date as defined in s.
70.057 (1), 1967 stats., to any legally enrolled member of the Menominee Indian tribe, his or her dependents, or lawful distributees of such member under section 3, said
P.L. 83-399, as amended. For purposes of this section, "legally enrolled members of the Menominee Indian tribe" shall include only those persons whose names appear on "Final Roll-Menominee Indian Tribe of Wisconsin" as proclaimed by the secretary of the interior November 26, 1957, and published at pages 9951 et seq. of the federal register, Thursday, December 12, 1957.
49.385 History
History: 1973 c. 147,
243;
1983 a. 192;
1995 a. 27 s.
2768m; Stats. 1995 s. 49.385.
MEDICAL ASSISTANCE
49.43
49.43
Definitions. As used in
ss. 49.43 to
49.497 unless the context indicates otherwise:
49.43(1e)
(1e) "Accommodated person" means any person in a hospital or in a skilled nursing facility or intermediate care facility, as defined in Title XIX of the social security act, who would have been eligible for benefits under
s. 49.19 or
49.77 or federal Title XVI if the person were not in such a hospital or facility, and any person in such an institution who can be found eligible for Title XIX under the social security act.
49.43(1m)
(1m) "Charge" means the customary, usual and reasonable demand for payment as established prospectively, concurrently or retrospectively by the department for services, care or commodities which does not exceed the general level of charges by others who render such service or care, or provide such commodities, under similar or comparable circumstances within the community in which the charge is incurred.
49.43(2)
(2) "Cost" means the reasonable cost of services, care or commodities as determined by the principles of reimbursement used under
42 USC 1395 to
1395rr, in effect on April 30, 1980.
49.43(2m)
(2m) "Cost-effective" has the meaning given in
P.L. 101-508, section 4402 (a) (2).
49.43(3)
(3) "Dentist" means a person licensed to practice dentistry.
49.43(3e)
(3e) "Department" means the department of health and family services.
49.43(3r)
(3r) "Group health plan" has the meaning given in
P.L. 101-508, section 4402 (a) (2).
49.43(5)
(5) "Hospital" means an institution, approved by the appropriate state agency, providing 24-hour continuous nursing service to patients confined therein; which provides standard dietary, nursing, diagnostic and therapeutic facilities; and whose professional staff is composed only of physicians and surgeons, or of physicians and surgeons and doctors of dental surgery.
49.43(6)
(6) "Inpatient psychiatric hospital services for individuals 21 years of age or for individuals under 22 years of age who are receiving such service immediately prior to reaching age 21" has the same meaning as provided in section 1905 (h) of the federal social security act.
49.43(7)
(7) "Intermediate care facility" means either of the following:
49.43(7)(a)
(a) An institution or distinct part thereof, which is:
49.43(7)(a)1.
1. Licensed or approved under state law to provide, on a regular basis, health related care and services to individuals who do not require the degree of care and treatment which a hospital or skilled nursing home is designated to provide but who because of their mental or physical condition require care and services above the level of room and board, which can be made available to them only through institutional facilities; and
49.43(7)(a)2.
2. Qualifies as an "intermediate care facility" within the meaning of Title XIX of the social security act.
49.43(7)(b)
(b) A public institution, or distinct part thereof, which is:
49.43(7)(b)1.
1. Licensed or approved under state law for the mentally retarded or persons with related conditions, the primary purpose of which is to provide health or rehabilitative services for mentally retarded individuals according to rules promulgated by the department; and
49.43(7)(b)2.
2. Qualifies as an "intermediate care facility" within the meaning of Title XIX of the social security act.
49.43(8)
(8) "Medical assistance" means any services or items under
ss. 49.45 to
49.47 and
49.49 to
49.497, or any payment or reimbursement made for such services or items.
49.43(9)
(9) "Physician" means a person licensed to practice medicine and surgery, and includes graduates of osteopathic colleges holding an unlimited license to practice medicine and surgery.
49.43(10)
(10) "Provider" means a person, corporation, limited liability company, partnership, unincorporated business or professional association and any agent or employe thereof who provides medical assistance.
49.43(10m)
(10m) "Public medical institution" has the meaning designated in Title XIX of the federal social security act.
49.43(10s)
(10s) "Secretary" means the secretary of health and family services.
49.43(11)
(11) "Skilled nursing home" means a facility or distinct part thereof, which:
49.43(11)(a)
(a) Is licensed or approved under state law for the accommodation of convalescents or other persons who are not acutely ill and not in need of hospital care;
49.43(11)(b)
(b) Employs sufficient registered nursing practitioners for supervision of those giving nursing care to patients; and
49.43(11)(c)
(c) Qualifies as a "skilled nursing facility" within the meaning of Title XIX of the social security act.
49.43(12)
(12) "Spouse" means the legal husband or wife of the beneficiary, whether or not eligible for medical assistance.
49.45
49.45
Medical assistance; administration. 49.45(1)
(1)
Purpose. To provide appropriate health care for eligible persons and obtain the most benefits available under Title XIX of the federal social security act, the department shall administer medical assistance, rehabilitative and other services to help eligible individuals and families attain or retain capability for independence or self-care as hereinafter provided.
49.45(2)(a)1.
1. Exercise responsibility relating to fiscal matters, the eligibility for benefits under standards set forth in
ss. 49.46 to
49.47 and general supervision of the medical assistance program.
49.45(2)(a)2.
2. Employ necessary personnel under the classified service for the efficient and economical performance of the program and shall supply residents of this state with information concerning the program and procedures.
49.45(2)(a)3.
3. Determine the eligibility of persons for medical assistance, rehabilitative and social services under
ss. 49.46,
49.468 and
49.47 and rules and policies adopted by the department and may designate this function to the county department under
s. 46.215 or
46.22.
49.45(2)(a)4.
4. To the extent funds are available under
s. 20.435 (1) (bm), certify all proper charges and claims for administrative services to the department of administration for payment and the department of administration shall draw its warrant forthwith.
49.45(2)(a)5.
5. Cooperate with the division for learning support, equity and advocacy in the department of education to carry out the provisions of Title XIX.
49.45 Note
NOTE: Subd. 5. is shown as amended by
1995 Wis. Acts 27 and
417. The treatment by Act 27 s. 9145 (1) was held unconstitutional and declared void by the Supreme Court in Thompson v. Craney, case no.
95-2168-OA. Subd. 5. as not affected by Act 27 s. 9145 (1) reads as follows:
Effective date text
5. Cooperate with the division for learning support, equity and advocacy in the department of public instruction to carry out the provisions of Title XIX.
49.45(2)(a)6.
6. Appoint such advisory committees as are necessary and proper.
49.45(2)(a)7.
7. Cooperate with the federal authorities for the purpose of providing the assistance and services available under Title XIX to obtain the best financial reimbursement available to the state from federal funds.
49.45(2)(a)8.
8. Periodically report to the joint committee on finance concerning projected expenditures and alternative reimbursement and cost control policies in the medical assistance program.
49.45(2)(a)9.
9. Periodically set forth conditions of participation and reimbursement in a contract with provider of service under this section.
49.45(2)(a)10.
10. After reasonable notice and opportunity for hearing, recover money improperly or erroneously paid, or overpayments to a provider either by offsetting or adjusting amounts owed the provider under the program, crediting against a provider's future claims for reimbursement for other services or items furnished by the provider under the program, or by requiring the provider to make direct payment to the department or its fiscal intermediary.
49.45(2)(a)11.
11. Establish criteria for the certification of eligible providers of services under Title XIX of the social security act and certify such eligible providers.
49.45(2)(a)12.
12. Decertify or suspend a provider from the medical assistance program, if after giving reasonable notice and opportunity for hearing, the department finds that the provider has violated federal or state law or administrative rule and such violations are by law, regulation or rule grounds for decertification or suspension. No payment may be made under the medical assistance program with respect to any service or item furnished by the provider subsequent to decertification or during the period of suspension.
49.45(2)(a)12r.
12r. Notify the medical examining board, or any affiliated credentialing board attached to the medical examining board, of any decertification or suspension of a person holding a license granted by the board or the affiliated credentialing board if the grounds for the decertification or suspension include fraud or a quality of care issue.
49.45(2)(a)13.
13. Impose additional sanctions for noncompliance with the terms of provider agreements under
subd. 9. or certification criteria established under
subd. 11.
49.45(2)(a)14.
14. Assure due process in implementing
subds. 12. and
13. by providing written notice, a fair hearing and a written decision.
49.45(2)(a)15.
15. Routinely provide notification to persons eligible for medical assistance, or such persons' guardians, of the department's access to provider records.
49.45(2)(a)16.
16. Notify the joint committee on finance and appropriate standing committees in each house of the legislature prior to renewing, extending or amending the claims processing contract under the medical assistance program.
49.45(2)(a)17.
17. Notify the governor, the joint committee on legislative organization, the joint committee on finance and appropriate standing committees, as determined by the presiding officer of each house, if the appropriation under
s. 20.435 (1) (b) is insufficient to provide the state share of medical assistance.
49.45(2)(a)18.
18. Conduct outreach for the early and periodic screening, diagnosis and treatment program as required under
42 CFR 441. This activity is limited to persons under 21 years of age who have been determined to be eligible for medical assistance.
49.45(2)(a)20.
20. Submit a report, by May 1, 1991, and annually thereafter, to the joint committee on finance on the participation rates of children in the early and periodic screening and diagnosis program.
49.45(2)(a)21.
21. Submit a report, by October 1, 1990, and annually thereafter, on access to obstetric and pediatric services under the medical assistance program, including the effect of medical assistance reimbursement rates.
49.45(2)(a)22.
22. After consulting with counties, independent living centers, consumer organizations and home health agencies, periodically identify those barriers to the provision of personal care services under
s. 49.46 (2) (b) 6. j. which lead to a failure to respond to the needs and preferences of individuals who are eligible for these services and act to remove the barriers to the extent possible.
