AB150-ASA,974,94
49.45
(6m) (ar) 6. Capital payment shall be based on a replacement value for
5a facility
, as. The replacement value shall be determined by a commercial estimator
6with which contracted for by the department
has contracted for service, and
paid for
7by the facility. The replacement value shall be subject to limitations determined by
8the department, except that the department may not reduce final capital payment
9of a facility by more than $3.50 per patient day.
AB150-ASA,974,1511
49.45
(6m) (av) 2. The department shall compile an average payment rate for
12each facility based on that facility's rates for cost centers described under par. (am)
131. to 5. that were in effect on June 30
of the previous year, 1994. The department may
14develop a method for adjusting the facility's rate for the cost center under par. (am)
151. in compiling the average payment rate under this subdivision.
AB150-ASA,974,2117
49.45
(6m) (av) 4. If the facility's payment rate under subd. 1. is a decrease from
18its average payment rate
from the previous year under subd. 2., and if the figure
19calculated under subd. 3. exceeds the payment rate for the facility under subd. 1., the
20facility's average payment rate shall be the greater of its average payment rate under
21subd. 2. or its rate under subd. 1.
AB150-ASA,975,624
49.45
(6m) (br) 1. Notwithstanding s.
20.410 (3) (cd), 20.435
(3) (cd), (4) (de) or
25(eb) (1) (bt) or (bu) or (7) (b)
or 20.445 (3) (de), the department shall reduce allocations
1of funds to counties in the amount of the disallowance from the appropriations under
2s.
20.410 (3) (cd) or 20.435
(3) (cd), (4) (de) or (eb) (1) (bt) or (bu) or (7) (b)
, or the
3department shall direct the department of industry, labor and human relations to
4reduce allocations of funds to counties in the amount of the disallowance from the
5appropriation under s. 20.445 (3) (de), in accordance with s. 16.544 to the extent
6applicable.
AB150-ASA,975,98
49.45
(6m) (c) 6. Provide, upon request, such information as the department
9considers necessary to determine allowable interest expenses under par. (am) 5m.
AB150-ASA,975,1611
49.45
(6m) (h) The department may require by rule that all claims for payment
12of services provided facility residents under this
chapter subchapter be submitted or
13countersigned by the respective facility administrator. The department may specify
14those categories of services for which payment will be made only if the services are
15rendered or authorized in writing by a primary health care provider designated by
16the recipient for the particular category of services.
AB150-ASA,975,2318
49.45
(6m) (L) For purposes of ss. 46.27 (11) (c) 7. and 46.277 (5) (e), the
19department shall, by July 1 annually, determine the statewide medical assistance
20daily cost of nursing home care and submit the determination to the department of
21administration for review. The department of administration shall approve the
22determination before payment may be made under s. 46.27 (11) (c) 7. or 46.277 (5)
23(e).
AB150-ASA,976,7
149.45
(6t) County department operating deficit reduction. From the
2appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined
3under criteria developed by the department, incurred by a county department under
4s. 46.215, 46.22, 46.23 or 51.42 for services provided under s. 49.46 (2) (a) 4. d. and
5(b) 6. f., the department shall allocate up to $4,500,000 in each fiscal year to these
6county departments, as determined by the department, and shall perform all of the
7following:
AB150-ASA,976,118
(a) For the reduction of operating deficits incurred by the county departments,
9estimate the availability of federal medicaid funds that may be matched to county
10funds that are expended for costs in excess of reimbursement for services provided
11under s. 49.46 (2) (a) 4. d. and (b) 6. f.
AB150-ASA,976,1512
(b) Based on the amount estimated to be available under par. (a), develop a
13method, which need not be promulgated as rules under ch. 227, to distribute this
14allocation to the individual county departments under s. 46.215, 46.22, 46.23 or
1551.42 that have incurred operating deficits that shall include all of the following:
AB150-ASA,976,1616
1. Development of criteria for determining operating deficits.
AB150-ASA,976,1817
2. Agreement, by the county in which is located a county department that has
18an operating deficit, to provide funds to match federal medicaid funds.
AB150-ASA,976,1919
3. Consideration of the size of a county department's operating deficit.
AB150-ASA,976,2120
(c) Except as provided in par. (d), distribute the allocation under the
21distribution method that is developed.
AB150-ASA,977,222
(d) If the federal department of health and human services approves for state
23expenditure in a fiscal year amounts under s. 20.435 (1) (o) that result in a lesser
24allocation amount than that allocated under this subsection or disallows use of the
1allocation of federal medicaid funds under par. (c), reduce allocations under this
2subsection and distribute on a prorated basis, as determined by the department.
AB150-ASA,977,104
49.45
(6u) Facility operating deficit reduction. (intro.) Except as provided
5in par. (g), from the appropriation under s. 20.435 (1) (o), for reduction of operating
6deficits, as defined under criteria developed by the department, incurred by a facility,
7as defined under sub. (6m) (a) 2., that is established under s.
49.14 (1) 49.70 (1) or
8that is owned and operated by a city, village or town, the department shall distribute
9to these facilities not more than $18,600,000 in each fiscal year, as determined by the
10department, and shall perform all of the following:
AB150-ASA,977,1612
49.45
(6u) (b) 2. Agreement by the county in which is located the facility
13established under s.
49.14 (1) 49.70 (1) and agreement by the city, village or town that
14owns and operates the facility that the applicable county, city, village or town shall
15provide funds to match federal medical assistance matching funds under this
16subsection.
AB150-ASA,977,2118
49.45
(6u) (b) 2m. Identification by the county in which is located the facility
19established under s.
49.14 (1) 49.70 (1) of all county funds expended in each calendar
20year to operate the facility, and certification by the county to the department of this
21amount.
AB150-ASA,978,524
49.45
(6w) Hospital operating deficit reduction. (intro.) From the
25appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined
1under criteria developed by the department, incurred by a hospital, as defined under
2s. 50.33 (2) (a) and (b), that is operated by the state, established under s.
49.16 49.71 3or owned and operated by a city or village, the department shall allocate up to
4$3,300,000 in each fiscal year to these hospitals, as determined by the department,
5and shall perform all of the following:
AB150-ASA,978,77
49.45
(6w) (a) 2. County funds, for a hospital established under s.
49.16 49.71.
AB150-ASA, s. 2983
8Section
2983. 49.45 (6w) (b) 2. b. of the statutes is amended to read:
AB150-ASA,978,109
49.45
(6w) (b) 2. b. Agreement to provide matching funds by the county in
10which is located a hospital established under s.
49.16
49.71.
AB150-ASA,978,1712
49.45
(6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
1320.435 (1) (b) and (o) the department shall distribute not more than $4,748,000 in
14each
of fiscal
years 1993-94 and 1994-95 year, to provide funds to an essential access
15city hospital, except that the department may not allocate funds to an essential
16access city hospital to the extent that the allocation would exceed any limitation
17under
42 USC 1396b (i) (3).
AB150-ASA,978,1919
49.45
(6y) (title)
Supplemental funding for county certain hospitals.
AB150-ASA,979,221
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
2220.435 (1) (b) and (o) the department shall distribute funding in each fiscal year to
23provide supplemental payment to county hospitals and to county mental health
24complexes, as determined by the department, for
inpatient hospital services that are
1not in excess of the hospitals' customary charges for the services, as limited under
242 USC 1396b (i) (3).
AB150-ASA, s. 2985e
3Section 2985e. 49.45 (6y) (a) of the statutes, as affected by 1995 Wisconsin Act
4.... (this act), is amended to read:
AB150-ASA,979,145
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
620.435 (1) (b) and (o) the department shall distribute funding in each fiscal year to
7provide supplemental payment to
county hospitals and to county mental health
8complexes hospitals that enter into a contract under s. 49.02 (2) to provide health
9care services funded by a relief block grant, as determined by the department, for
10hospital services that are not in excess of the hospitals' customary charges for the
11services, as limited under
42 USC 1396b (i) (3).
If no relief block grant is awarded
12under this chapter or if the allocation of funds to such hospitals would exceed any
13limitation under 42 USC 1396b (i) (3), the department may distribute funds to
14hospitals that have not entered into a contract under s. 49.02 (2).
AB150-ASA,979,1716
49.45
(6z) (title)
Supplemental funding for certain hospitals serving
17low-income patients.
AB150-ASA, s. 2985s
18Section 2985s. 49.45 (6z) (a) (intro.) of the statutes is amended to read:
AB150-ASA,980,519
49.45
(6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations
20under s. 20.435 (1) (b) and (o) the department shall distribute funding in each fiscal
21year to supplement payment for
inpatient services to
county hospitals and county
22mental health complexes that, as determined by the department,
hospitals that
23enter into a contract under s. 49.02 (2) to provide health care services funded by a
24relief block grant under this chapter, if the department determines that the hospitals 25serve a disproportionate number of low-income patients with special needs
, except
1that the. If no medical relief block grant under this chapter is awarded or if the
2allocation of funds to such hospitals would exceed any limitation under 42 USC
31396b (i) (3), the department may distribute funds to hospitals that have not entered
4into a contract under s. 49.02 (2). The department may not distribute funds under
5this subsection to the extent that the distribution would do any of the following:
AB150-ASA,980,107
49.45
(7) (d) 4. The department's determination of serious misconduct under
8this subsection shall be cause for terminating the facility's participation in the
9state-funded portion of the medical assistance program under
ss. 49.45 to 49.47 this
10subchapter.
AB150-ASA,980,1312
49.45
(8) (title)
Home
Per-visit limits on home health services
13reimbursement.
AB150-ASA,980,2015
49.45
(8e) Monthly limits on home health, personal care and private-duty
16nursing services reimbursement. (a) Except as provided in par. (b), reimbursement
17under s. 20.435 (1) (b) and (o) for home health, personal care and private-duty
18nursing services provided to a medical assistance recipient in a month may not
19exceed the average monthly cost of nursing home care, as determined by the
20department.
AB150-ASA,980,2121
(b) This subsection does not apply to any of the following:
AB150-ASA,980,2222
1. A medical assistance recipient under the age of 22.
AB150-ASA,980,2423
2. A ventilator-dependent individual under s. 49.46 (2) (b) 6. m. or 49.47 (6) (a)
241.
AB150-ASA,981,3
13. Any individual, if the department determines that the cost of providing the
2individual with nursing home care would exceed the cost of providing the individual
3with home health, personal care and private-duty nursing services.
AB150-ASA,981,54
4. Any individual, if the department determines that nursing home care is not
5available for that individual.
AB150-ASA,981,127
49.45
(8m) Rates for respiratory care services. (intro.) Notwithstanding
a
8determination by the department of a maximum rate the limits under
sub. subs. (8)
9and (8e), the rates under sub. (8) and rates charged by providers under s. 49.46 (2)
10(a) 4. d. that are not home health agencies, for reimbursement for respiratory care
11services for ventilator-dependent individuals under ss. 49.46 (2) (b) 6. m. and 49.47
12(6) (a) 1., shall be as follows:
AB150-ASA,981,2314
49.45
(8v) Incentive-based pharmacy payment system. By January 1, 1996, the
15department shall establish a system of payment to pharmacies for legend and
16over-the-counter drugs provided to recipients of medical assistance that has
17financial incentives for pharmacists who perform services that result in savings to
18the medical assistance program. Under this system, the department shall establish
19a schedule of fees that is designed to ensure that any incentive payments made are
20equal to or less than the documented savings. The department may discontinue the
21system established under this subsection if the department determines, after
22performance of a study, that payments to pharmacists under the system exceed the
23documented savings under the system.
AB150-ASA,982,3
149.45
(11) Penalty. Any person who receives or assists another in receiving
2assistance under this section, to which the recipient is not entitled, shall be subject
3to the penalties under s.
49.12 49.95.
AB150-ASA,982,115
49.45
(12) (c) The department shall request proposals for a system of
6machine-readable identification cards for medical assistance recipients and a
7computerized support system for the cards that will accept and respond to
8electronically conveyed requests from health care providers for information related
9to medical assistance recipients, such as eligibility, coverages and authorizations.
10The request for proposals shall specify that the systems are to be operating by
11January 1,
1996 1997.
AB150-ASA, s. 2993
12Section
2993. 49.45 (25) (am) of the statutes is renumbered 49.45 (25) (am)
13(intro.) and amended to read:
AB150-ASA,982,1914
49.45
(25) (am) (intro.) Except as provided under pars. (be) and (bg) and sub.
15(24), case management services under s. 49.46 (2) (b) 9.
and (bm) are reimbursable
16under medical assistance only if provided to a medical assistance beneficiary who
17receives case management services from or through a certified case management
18provider in a county, city, village or town that elects, under par. (b), to make the
19services available and who
has meets at least one of the following conditions:
AB150-ASA,982,20
201. Has a developmental disability, as defined under s. 51.01 (5) (a)
,.
AB150-ASA,982,21
212. Has a chronic mental illness, as defined under s. 51.01 (3g)
, or.
AB150-ASA,982,22
223. Has Alzheimer's disease, as defined under s. 46.87 (1) (a)
, is.
AB150-ASA,982,23
234. Is an alcoholic, as defined under s. 51.01 (1)
, or.
AB150-ASA,982,24
245. Is drug dependent, as defined under s. 51.01 (8)
, is.
AB150-ASA,982,25
256. Is physically disabled, as defined by the department
, is.
AB150-ASA,983,1
17. Is a severely emotionally disturbed child
, is.
AB150-ASA,983,2
28. Is age 65 or over
or, after December 31, 1991, has.
AB150-ASA,983,3
310. Has HIV infection, as defined in s. 252.01 (2).
AB150-ASA,983,65
49.45
(25) (am) 9. Is a member of a family that has a child who is at risk of
6serious physical, mental or emotional dysfunction, as defined by the department.
AB150-ASA,983,98
49.45
(25) (am) 11. Is a child who is eligible for early intervention services
9under s. 51.44.
AB150-ASA, s. 2996
10Section
2996. 49.45 (25) (am) 12. of the statutes is created to read:
AB150-ASA,983,1111
49.45
(25) (am) 12. Is infected with tuberculosis.
