1995 Wisconsin Act 27

49.45 (3) (a) Reimbursement shall be made to each county department under ss. 46.215, 46.22 and 46.23 for the administrative services performed in the medical assistance program on the basis of s. 49.52 49.33 (8). For purposes of reimbursement under this paragraph, assessments completed under s. 46.27 (6) (a) are administrative services performed in the medical assistance program.

27,2952g Section 2952g. 49.45 (3) (e) 7m. of the statutes is created to read:

49.45 (3) (e) 7m. Notwithstanding subd. 7., the daily reimbursement or payment rate for services at a hospital established under s. 45.375 (1) provided to medical assistance recipients whose continued hospitalization is no longer medically necessary or appropriate during a period where the recipient awaits placement in an alternate custodial living arrangement shall be the skilled nursing facility rate paid to the facility created under s. 45.365 (1).

27,2953 Section 2953 . 49.45 (5) of the statutes is amended to read:

49.45 (5) Appeal. Any person whose application for medical assistance is denied or is not acted upon promptly or who believes that the payments made in the person's behalf have not been properly determined may file an appeal with the department pursuant to s. 49.50 (8) 49.21 (1).

27,2954 Section 2954 . 49.45 (5m) (a) of the statutes is amended to read:

49.45 (5m) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (b) and (o) the department shall distribute not more than $2,256,000 in each of fiscal years 1993-94 and 1994-95 year, to provide supplemental funds to rural hospitals that, as determined by the department, have high utilization of inpatient services by patients whose care is provided from governmental sources, except that the department may not distribute funds to a rural hospital to the extent that the distribution would exceed any limitation under 42 USC 1396b (i) (3).

27,2955 Section 2955 . 49.45 (6b) (a) of the statutes is amended to read:

49.45 (6b) (a) Beginning in fiscal year 1994-95 1995-96, for relocations from the central Wisconsin center for the developmentally disabled, by $55.77 $205 per day.

27,2956 Section 2956 . 49.45 (6b) (b) of the statutes is amended to read:

49.45 (6b) (b) Beginning in fiscal year 1994-95 1995-96, for relocations from the northern Wisconsin center for the developmentally disabled, by $49.06 $199 per day.

27,2957 Section 2957 . 49.45 (6b) (c) of the statutes is amended to read:

49.45 (6b) (c) Beginning in fiscal year 1994-95 1995-96, for relocations from the southern Wisconsin center for the developmentally disabled, by $48.37 $149 per day.

27,2960 Section 2960 . 49.45 (6m) (ag) 3m. of the statutes is amended to read:

49.45 (6m) (ag) 3m. For state fiscal year 1993-94 1995-96, rates that shall be set by the department based on information from cost reports for the 1992 1994 fiscal year of the facility and for state fiscal year 1994-95 1996-97, rates that shall be set by the department based on information from cost reports for the 1993 1995 fiscal year of the facility.

27,2961 Section 2961 . 49.45 (6m) (ag) 8. of the statutes is amended to read:

49.45 (6m) (ag) 8. Calculation of total payments and supplementary payments to facilities that permits an increase in funds allocated under s. 20.435 (1) (b) and (o) for nursing home care provided medical assistance recipients over that paid for services provided in state fiscal year 1992-93 1994-95 of no more than 3.58% 4.25% during state fiscal year 1993-94 1995-96 and over that paid for services provided in state fiscal year 1993-94 1995-96 of no more than 3.57% 3.5% during state fiscal year 1994-95 1996-97, excluding increases in total payments attributable to increases in recipient utilization of facility care, payments for the provision of active treatment to facility residents with developmental disability or chronic mental illness and payments for preadmission screening of facility applicants and annual reviews of facility residents required under 42 USC 1396r (e).

27,2962 Section 2962 . 49.45 (6m) (am) 5. of the statutes is amended to read:

49.45 (6m) (am) 5. Allowable administrative and general costs, including costs related to the facility's overall management and administration and allowable expenses that are not recognized or reimbursed in other cost centers and including the costs of commercial estimators approved by the department under par. (ar) 6.

27,2963 Section 2963 . 49.45 (6m) (am) 5m. of the statutes is created to read:

49.45 (6m) (am) 5m. Allowable interest expense of the facility, less interest income of the facility and less interest income of affiliated entities, to the extent required under the approved state plan for services under 42 USC 1396.

27,2964 Section 2964 . 49.45 (6m) (ar) 1. c. of the statutes is amended to read:

49.45 (6m) (ar) 1. c. If a facility has an approved program for provision of service to emotionally disturbed or mentally retarded residents, residents dependent upon ventilators, or residents requiring supplemental skilled care due to complex medical conditions, a supplement to the direct care component of the facility rate under subd. 1. b. may be made to that facility according to a method developed by the department.

27,2965 Section 2965 . 49.45 (6m) (ar) 6. of the statutes is amended to read:

49.45 (6m) (ar) 6. Capital payment shall be based on a replacement value for a facility, as. The replacement value shall be determined by a commercial estimator with which contracted for by the department has contracted for service, and paid for by the facility. The replacement value shall be subject to limitations determined by the department, except that the department may not reduce final capital payment of a facility by more than $3.50 per patient day.

27,2966 Section 2966 . 49.45 (6m) (av) 2. of the statutes is amended to read:

49.45 (6m) (av) 2. The department shall compile an average payment rate for each facility based on that facility's rates for cost centers described under par. (am) 1. to 5. that were in effect on June 30 of the previous year , 1994. The department may develop a method for adjusting the facility's rate for the cost center under par. (am) 1. in compiling the average payment rate under this subdivision.

27,2967 Section 2967 . 49.45 (6m) (av) 4. of the statutes is amended to read:

49.45 (6m) (av) 4. If the facility's payment rate under subd. 1. is a decrease from its average payment rate from the previous year under subd. 2., and if the figure calculated under subd. 3. exceeds the payment rate for the facility under subd. 1., the facility's average payment rate shall be the greater of its average payment rate under subd. 2. or its rate under subd. 1.

27,2968 Section 2968 . 49.45 (6m) (bm) 4. of the statutes is repealed.

27,2969 Section 2969 . 49.45 (6m) (br) 1. of the statutes is amended to read:

49.45 (6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435 (3) (cd), (4) (de) or (eb) (1) (bt) or (bu) or (7) (b) or 20.445 (3) (de), the department shall reduce allocations of funds to counties in the amount of the disallowance from the appropriations under s. 20.410 (3) (cd) or 20.435 (3) (cd), (4) (de) or (eb) (1) (bt) or (bu) or (7) (b), or the department shall direct the department of industry, labor and human relations to reduce allocations of funds to counties in the amount of the disallowance from the appropriation under s. 20.445 (3) (de), in accordance with s. 16.544 to the extent applicable.

27,2970 Section 2970 . 49.45 (6m) (c) 6. of the statutes is created to read:

49.45 (6m) (c) 6. Provide, upon request, such information as the department considers necessary to determine allowable interest expenses under par. (am) 5m.

27,2971 Section 2971 . 49.45 (6m) (h) of the statutes is amended to read:

49.45 (6m) (h) The department may require by rule that all claims for payment of services provided facility residents under this chapter subchapter be submitted or countersigned by the respective facility administrator. The department may specify those categories of services for which payment will be made only if the services are rendered or authorized in writing by a primary health care provider designated by the recipient for the particular category of services.

27,2974b Section 2974b. 49.45 (6m) (L) of the statutes is created to read:

49.45 (6m) (L) For purposes of ss. 46.27 (11) (c) 7. and 46.277 (5) (e), the department shall, by July 1 annually, determine the statewide medical assistance daily cost of nursing home care and submit the determination to the department of administration for review. The department of administration shall approve the determination before payment may be made under s. 46.27 (11) (c) 7. or 46.277 (5) (e).

27,2975 Section 2975 . 49.45 (6t) of the statutes is created to read:

49.45 (6t) County department operating deficit reduction. From the appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a county department under s. 46.215, 46.22, 46.23 or 51.42 for services provided under s. 49.46 (2) (a) 4. d. and (b) 6. f., the department shall allocate up to $4,500,000 in each fiscal year to these county departments, as determined by the department, and shall perform all of the following:

(a) For the reduction of operating deficits incurred by the county departments, estimate the availability of federal medicaid funds that may be matched to county funds that are expended for costs in excess of reimbursement for services provided under s. 49.46 (2) (a) 4. d. and (b) 6. f.

(b) Based on the amount estimated to be available under par. (a), develop a method, which need not be promulgated as rules under ch. 227, to distribute this allocation to the individual county departments under s. 46.215, 46.22, 46.23 or 51.42 that have incurred operating deficits that shall include all of the following:

1. Development of criteria for determining operating deficits.

2. Agreement, by the county in which is located a county department that has an operating deficit, to provide funds to match federal medicaid funds.

3. Consideration of the size of a county department's operating deficit.

(c) Except as provided in par. (d), distribute the allocation under the distribution method that is developed.

(d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (1) (o) that result in a lesser allocation amount than that allocated under this subsection or disallows use of the allocation of federal medicaid funds under par. (c), reduce allocations under this subsection and distribute on a prorated basis, as determined by the department.

27,2976 Section 2976 . 49.45 (6u) (intro.) of the statutes is amended to read:

49.45 (6u) Facility operating deficit reduction. (intro.) Except as provided in par. (g), from the appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a facility, as defined under sub. (6m) (a) 2., that is established under s. 49.14 (1) 49.70 (1) or that is owned and operated by a city, village or town, the department shall distribute to these facilities not more than $18,600,000 in each fiscal year, as determined by the department, and shall perform all of the following:

27,2977 Section 2977 . 49.45 (6u) (b) 2. of the statutes is amended to read:

49.45 (6u) (b) 2. Agreement by the county in which is located the facility established under s. 49.14 (1) 49.70 (1) and agreement by the city, village or town that owns and operates the facility that the applicable county, city, village or town shall provide funds to match federal medical assistance matching funds under this subsection.

27,2978 Section 2978 . 49.45 (6u) (b) 2m. of the statutes is amended to read:

49.45 (6u) (b) 2m. Identification by the county in which is located the facility established under s. 49.14 (1) 49.70 (1) of all county funds expended in each calendar year to operate the facility, and certification by the county to the department of this amount.

27,2979 Section 2979 . 49.45 (6v) of the statutes is repealed.

27,2981b Section 2981b. 49.45 (6w) (intro.) of the statutes is amended to read:

49.45 (6w) Hospital operating deficit reduction. (intro.) From the appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a hospital, as defined under s. 50.33 (2) (a) and (b), that is operated by the state, established under s. 49.16 49.71 or owned and operated by a city or village, the department shall allocate up to $3,300,000 in each fiscal year to these hospitals, as determined by the department, and shall perform all of the following:

27,2982 Section 2982 . 49.45 (6w) (a) 2. of the statutes is amended to read:

49.45 (6w) (a) 2. County funds, for a hospital established under s. 49.16 49.71.

27,2983 Section 2983 . 49.45 (6w) (b) 2. b. of the statutes is amended to read:

49.45 (6w) (b) 2. b. Agreement to provide matching funds by the county in which is located a hospital established under s. 49.16 49.71.

27,2984 Section 2984 . 49.45 (6x) (a) of the statutes is amended to read:

49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (b) and (o) the department shall distribute not more than $4,748,000 in each of fiscal years 1993-94 and 1994-95 year, to provide funds to an essential access city hospital, except that the department may not allocate funds to an essential access city hospital to the extent that the allocation would exceed any limitation under 42 USC 1396b (i) (3).

27,2984r Section 2984r. 49.45 (6y) (title) of the statutes is amended to read:

49.45 (6y) (title) Supplemental funding for county certain hospitals.

27,2985 Section 2985 . 49.45 (6y) (a) of the statutes is amended to read:

49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (b) and (o) the department shall distribute funding in each fiscal year to provide supplemental payment to county hospitals and to county mental health complexes, as determined by the department, for inpatient hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3).

27,2985e Section 2985e. 49.45 (6y) (a) of the statutes, as affected by 1995 Wisconsin Act .... (this act), is amended to read:

49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (b) and (o) the department shall distribute funding in each fiscal year to provide supplemental payment to county hospitals and to county mental health complexes hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2).

27,2985m Section 2985m. 49.45 (6z) (title) of the statutes is amended to read:

49.45 (6z) (title) Supplemental funding for certain hospitals serving low-income patients.

27,2985s Section 2985s. 49.45 (6z) (a) (intro.) of the statutes is amended to read:

49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (b) and (o) the department shall distribute funding in each fiscal year to supplement payment for inpatient services to county hospitals and county mental health complexes that, as determined by the department, hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant under this chapter, if the department determines that the hospitals serve a disproportionate number of low-income patients with special needs, except that the. If no medical relief block grant under this chapter is awarded or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2). The department may not distribute funds under this subsection to the extent that the distribution would do any of the following:

27,2986 Section 2986 . 49.45 (7) (d) 4. of the statutes is amended to read:

49.45 (7) (d) 4. The department's determination of serious misconduct under this subsection shall be cause for terminating the facility's participation in the state-funded portion of the medical assistance program under ss. 49.45 to 49.47 this subchapter.

27,2987 Section 2987 . 49.45 (8) (title) of the statutes is amended to read:

49.45 (8) (title) Home Per-visit limits on home health services reimbursement.

27,2988 Section 2988 . 49.45 (8e) of the statutes is created to read:

49.45 (8e) Monthly limits on home health, personal care and private-duty nursing services reimbursement. (a) Except as provided in par. (b), reimbursement under s. 20.435 (1) (b) and (o) for home health, personal care and private-duty nursing services provided to a medical assistance recipient in a month may not exceed the average monthly cost of nursing home care, as determined by the department.

(b) This subsection does not apply to any of the following:

1. A medical assistance recipient under the age of 22.

2. A ventilator-dependent individual under s. 49.46 (2) (b) 6. m. or 49.47 (6) (a) 1.

3. Any individual, if the department determines that the cost of providing the individual with nursing home care would exceed the cost of providing the individual with home health, personal care and private-duty nursing services.

4. Any individual, if the department determines that nursing home care is not available for that individual.

27,2988b Section 2988b. 49.45 (8f) of the statutes is created to read:

49.45 (8f) Limits on reimbursement of providers of home health services. (a) For any home health, personal care or private-duty nursing service provided to a medical assistance recipient in a month, the department may require, as a condition of reimbursement, that the provider charge the department the lesser of the following for the service:

1. The amount that the federal medicare program reimburses for a service, separately identified under 42 CFR Part 413, including skilled nursing service, home health aid service and physical therapy service.

2. The provider's usual and customary charge for providing the service.

3. A maximum reimbursement rate, determined by the department, for the service.

(b) When a provider is required to charge the department a price under par. (a), the department may not reimburse the provider for more than that amount.