This bill permits school districts to receive federal medical assistance funds for certain health care services provided in schools to children who are eligible for medical assistance. The bill covers those health care services that are appropriate to a school setting under rules promulgated by DHSS. The bill covers all public schools, including charter schools, and includes early childhood programs for developmentally delayed and disabled 4-year-old and 5-year-old children. If a school district elects to provide school medical services and meets all certification and reporting requirements established by DHSS, DHSS must reimburse a school district for the federal share of allowable charges for the school medical services that the school district provides and for allowable administrative costs. The bill requires DHSS to promulgate rules establishing a methodology for making these reimbursements. All other expenses for school medical services must be paid for by the school district with public funds received from state or local taxes. The bill also requires the school district to comply with all requirements of the federal department of health and human services for receiving federal financial participation.
*** Analysis from -2411/1 ***
Under current law, mental health crisis intervention services are not a covered benefit under the medical assistance program. This bill allows a county, city, village or town to elect to provide mental health crisis intervention services to medical assistance recipients as a medical assistance benefit. If a county, city, village or town elects to provide these services as a medical assistance benefit, the county, city, village or town is required to reimburse the provider of the mental health crisis intervention services for the amount of the allowable charges for those services under the medical assistance program that is not provided by the federal government. DHSS is required to reimburse the provider for the amount that is provided by the federal government.
*** Analysis from -0719/1 ***
Under current law, medical assistance covers nurse-midwifery services only if prescribed by a physician. This bill changes this provision to cover all nurse-midwifery services regardless of whether they are prescribed by a physician.
*** Analysis from -0734/3 ***
Under current law, medical assistance provides reimbursement only for certain case management services. Generally, in order for medical assistance to provide reimbursement, the services must be provided by or through a certified case management provider in a county, city, village or town that elects to reimburse the case management provider for the portion of the costs that are not reimbursed by the federal government. In addition, the case management services must be provided to recipients with certain specified diseases or disabilities. Under current law, case management services reimbursement may generally be provided for severely emotionally disturbed children and for persons with a developmental disability, a chronic mental illness, Alzheimer's disease, alcoholism or drug dependency, a physical disability or HIV infection. This bill also permits reimbursement of case management services for a family who has a child at risk of physical, mental or emotional dysfunction, as defined by DHSS.
*** Analysis from -0452/2 ***
Currently, counties provide early intervention services, funded by state and federal moneys, to certain very young children with certain documented physical or mental conditions and their families under what is known as the "birth to 3" program. This bill expands eligibility for case management services to include children who are otherwise eligible for medical assistance who receive early intervention services under the "birth to 3" program.
*** Analysis from -0736/1 ***
Under current law, the medical assistance program covers alcohol and other drug abuse day treatment services. This benefit expires on June 30, 1995, or on the day after publication of the 1995-97 biennial budget act, whichever is later. This bill removes this expiration date.
*** Analysis from -0721/3 ***
Medical assistance provider reimbursement and funding
Under current law, there are a number of provisions that govern the amount that a nursing home is reimbursed for providing care to medical assistance recipients. This bill makes the following changes to the nursing home reimbursement provisions:
1. Under current law, a nursing home's reimbursement rate may not fall below the rate that was in effect for the nursing home during the previous fiscal year. This bill provides that the nursing home's reimbursement rate may not fall below the rate that was in effect for the nursing home on June 30, 1994.
2. Under current law, DHSS is permitted to distribute supplemental payments to nursing homes to cover the costs of caring for emotionally disturbed residents. This bill eliminates supplemental payments for emotionally disturbed residents effective July 1, 1997.
3. This bill requires DHSS to use interest and investment income of a nursing home and affiliated entities, to the extent required under the state's approved medical assistance plan, to offset allowable interest expenses in determining the nursing home's reimbursement rate. It also requires, as a condition of receiving reimbursement under the medical assistance program, that nursing homes provide information to DHSS, upon request, that DHSS considers necessary to determine allowable interest expenses of the nursing home and of affiliated entities.
4. Under current law, the "capital" component of a nursing home's reimbursement rate is based on the replacement value of a nursing home facility, as determined by a commercial estimator who is paid and contracted for by DHSS. This provision is changed to require the nursing home to pay for a commercial estimator contracted for by DHSS.
5. This bill permits an increase in total payments to nursing home facilities for state fiscal year 1995-96 of no more than 4.25% over that paid for services in state fiscal year 1994-95 and for state fiscal year 1996-97 of no more than 5% over that paid for services in state fiscal year 1995-96.
*** Analysis from -0742/2 ***
Under current law, DHSS may reimburse the 3 state centers for the developmentally disabled for the cost of services provided by the centers. This reimbursement is made from state revenues under the medical assistance program and from federal matching funds. The reimbursement is reduced by a specified amount following each placement made under the community reintegration program that involves a relocation from one of the state centers. Under current law, the specified reduction amount for the central Wisconsin center for the developmentally disabled is $55.77 per day; the amount for the northern Wisconsin center for the developmentally disabled is $49.06 per day; and the amount from the southern Wisconsin center for the developmentally disabled is $48.37 per day. This bill changes these amounts, beginning in fiscal year 1995-96, to $232, $225 and $173, respectively.
*** Analysis from -2510/3 ***
This bill permits DHSS to impose certain requirements on certain providers of medical assistance services relating to the amount that the provider may claim from DHSS as reimbursement for medical assistance services. DHSS may impose these requirements with respect to all medical assistance services except certain hospital services, skilled nursing facility and intermediate care facility services, and home and community-based services. The bill allows DHSS to require that the providers of these services charge DHSS the lesser of the provider's "best price" for the service or the provider's actual cost for the service, unless a different price is determined by a contract. The bill defines "best price" for a service to mean the lowest price that a provider has accepted or agreed to accept as payment, from any 3rd-party payer, including self-insured plans, the medicare program and insurers, for a like service provided to a customer during the same month that the service is provided. If DHSS requires that a provider charge a particular price for a service, DHSS may not reimburse the provider for more than that amount.
*** Analysis from -1137/3 ***
This bill provides that medical assistance reimbursement for home health 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 DHSS. The monthly limit does not apply to a medical assistance recipient under the age of 22, to a ventilator-dependent individual or to any other individual if DHSS determines that the cost of providing that individual with nursing home care would exceed the cost of providing the individual with the home health and private-duty nursing services.
*** Analysis from -2410/2 ***
This bill provides up to $4,500,000 in federal medical assistance moneys in each fiscal year as a match to costs of a county department of social services or human services that exceed medical assistance reimbursement for home health services, medical day treatment services, mental health services and alcohol and other drug abuse services. Under the bill, county departments that have operating deficits resulting from these costs may apply to DHSS for federal matching funds. DHSS must develop a method, using criteria specified in the bill, to distribute the federal moneys to individual county departments of social services or human services.
*** Analysis from -2409/2 ***
Under current law, DHSS must annually submit to the joint committee on finance (JCF) a report on nursing home bed use by medical assistance recipients for the immediate prior 2 fiscal years. If the report indicates a decrease in the number of beds used in the most recent fiscal year from the previous fiscal year, DHSS must calculate the difference in costs between the 2 fiscal years for the provision of the care. The DHSS report to JCF must include a proposal to transfer an amount equal to the difference from the appropriation for medical assistance to the appropriation for the community options program. If within 14 working days after submission of the report JFC does not schedule a meeting to review the action, the secretary of health and social services must transfer the funds.
This bill eliminates the requirements that DHSS annually submit a report to JCF concerning medical assistance-funded bed utilization in nursing homes; that, if the bed utilization has decreased, DHSS calculate a figure that is the difference in costs for the provision of this care; and that, if JCF fails to schedule a meeting to review the issue, funds be transferred from the medical assistance program to the community options program.
*** Analysis from -2407/1 ***
This bill requires DHSS to conduct a study of the feasibility of contracting out the operation of the medical assistance program. DHSS is required to report its findings to the governor and to the appropriate standing committees of the legislature before July 1, 1996.
*** Analysis from -0714/1 ***
Under current law, DHSS distributes certain supplemental funding under the medical assistance program to county hospitals and county mental health complexes, as determined by DHSS, for inpatient hospital services that are not in excess of the hospitals' customary charges for the services, subject to certain limitations under federal law. This bill allows DHSS to distribute this supplemental funding to county hospitals and county mental health complexes for all hospital services, not just inpatient services.
*** Analysis from -2301/2 ***
Other public assistance
Under current law, the state makes payments to certain individuals who meet the resource limitations and the nonfinancial eligibility requirements of the federal SSI program, including needy persons or couples residing in this state who receive benefits under the federal SSI program or whose income, after deducting income excludable under the federal SSI program, is less than the combined benefit level available under the federal SSI program and the state supplement. This bill changes these eligibility criteria. First, the bill eliminates eligibility for the state supplement for those needy persons and couples whose income, after deducting income excludable under the federal SSI program, is less than the combined benefit level available under the federal SSI program and the state supplement. Second, the bill allows DHSS to make certain needy persons or couples residing in this state who receive benefits under the federal SSI program ineligible for the state supplement if DHSS and the secretary of administration approve the change in eligibility and the change is not disapproved by the JCF or the governor. This procedure for changing eligibility criteria is virtually identical to the procedure under current law that allows DHSS to adjust state supplement benefit levels.
Current law allows DHSS the option of administering the state supplement directly or under a contract with the federal government. However, the appropriation from which state supplement administrative expenses are paid authorizes expenditures only for the payment of fees charged by the federal government for administration of the state supplement. This bill allows moneys to be expended from the appropriation to administer the state supplement, either directly or under a contract with the federal government.
*** Analysis from -2293/2 ***
Under current law, DHSS supplements the provision of supplemental foods, nutrition education and other services to individuals who meet the eligibility criteria under the federal special supplemental food program for women, infants and children (WIC). This bill eliminates the state supplement to the WIC program.
*** Analysis from -1603/2 ***
Under current law, DHSS may distribute funds to nonprofit organizations for certain food stamp outreach projects. The projects must inform individuals with low incomes about the availability, eligibility requirements, application procedures and benefits of the food stamp program and must meet federal requirements to allow federal reimbursement of 50% of the project costs. This bill repeals the provisions that allow DHSS to distribute funds for these outreach projects.
*** Analysis from -1700/4 ***
Under current law, if a recipient of certain types of public assistance dies and the recipient's estate is insufficient to pay the cemetery, funeral and burial expenses, the county or the applicable tribal governing body, or other organization responsible for the burial of the recipient, is required to pay certain cemetery, funeral and burial expenses. In particular, the county or tribal governing body or organization is required to pay all of the deceased recipient's cemetery expenses and the lesser of $1,000 or the amount of funeral and burial expenses that are not paid by the deceased recipient's estate or by other persons. Current law also requires DHSS to reimburse the county or tribal governing body or organization for all cemetery expenses that it pays and for those funeral and burial expenses that it is required to pay under the provision. If DHSS approves the reimbursement due to unusual circumstances, DHSS may reimburse a county or applicable tribal governing body or organization for funeral and burial expenses that it pays for the deceased, even if these expenses exceed the amount that the county or tribal governing body or organization is required to pay under the provision.
Under this bill, the county or tribal governing body or organization is required to pay the lesser of $1,000 or the amount of cemetery expenses that are not paid by the estate of the deceased and other persons. For funeral and burial expenses, the county or tribal governing body or organization is required to pay the lesser of the amount of funeral and burial expenses that are not paid by the deceased recipient's estate and other persons or the following: 1) if the total funeral and burial expenses are $1,000 or less, the amount of these expenses; 2) if the total funeral and burial expenses are more than $1,000 but not more than $2,000, 50% of the total funeral and burial expenses; and 3) if the total funeral and burial expenses are more than $2,000, $0. DHSS is required to reimburse a county or applicable tribal governing body for any cemetery, funeral or burial expenses that it is required to pay under these provisions and, if DHSS approves the reimbursement due to unusual circumstances, for any additional expenses.
*** Analysis from -0727/4 ***
Under current law, counties and tribal governing bodies are authorized to recover overpayments under the food stamp, AFDC and medical assistance programs; they are also authorized to retain a percentage of the amount recovered. Current law also authorizes DHSS to certify certain overpayments under these programs to the department of revenue (DOR) for offset against any tax refunds due the recipient of the overpayment. This bill allows DHSS to charge counties and tribal governing bodies for the administrative costs that are incurred by DOR and that are related to certification of these amounts. Recovered administrative costs may be used by DHSS for reducing error and fraud in the food stamp, AFDC and medical assistance programs.
Under current law, overpayments under the food stamp, AFDC and medical assistance programs are often recovered under a recovery plan. This bill authorizes a county or tribal governing body to assess persons who fail to comply with the terms of a recovery plan a fee in an amount not to exceed 10% of the amount remaining to be recovered at the time of the noncompliance. The fee may not be assessed more than once with respect to the same overpayment and may be assessed only if a person is no longer eligible for the type of benefits, such as food stamps, AFDC or medical assistance, that were overpaid. The fee may be retained by the county or the tribal governing body.
*** Analysis from -0751/3 ***
Under current law, DHSS may contract with a county to administer a work experience and job training program for noncustodial parents who fail to pay child support or to meet their children's needs for support as a result of unemployment or underemployment. This program is commonly referred to as the "children-first program". A judge may order, in certain child support actions, a noncustodial parent to participate in the children-first program if the noncustodial parent lives in the county in which the court action occurs and that county has a children-first program. This bill permits a judge to order a noncustodial parent to participate in a children-first program regardless of whether the noncustodial parent resides in the county in which the court action occurs. However, if the parent resides in a county other than the county in which the court action occurs, the judge may order the parent to participate in a children-first program only if the parent's county of residence has a children-first program and that county agrees to enroll the parent in that program.
*** Analysis from -0725/2 ***
Under current law, DHSS, a county or an elected tribal governing body that provides certain types of public assistance as the result of an injury, sickness or death that results in a possible recovery of an indemnity from a 3rd party, including an insurer, may require an assignment of the right to the indemnity from the public assistance recipient. Under this bill, this assignment is automatic upon the application for public assistance.
Current law provides for subrogation of certain claims against a 3rd party by a public assistance recipient, if the public assistance is provided as a result of the occurrence of an injury, sickness or death that creates a claim or cause of action against the 3rd party. This bill establishes certain notice requirements for claims assigned or subrogated under these provisions. The notice requirements generally apply to the attorney retained to represent the public assistance recipient, or his or her estate, in asserting the claim. If no attorney is retained, the notice requirements apply to the public assistance recipient or his or her guardian or, if the recipient is deceased, to the personal representative of the recipient's estate. A person who is subject to the notice requirements is required to provide notice by certified mail to DHSS as soon as practicable after the filing of the action asserting the claim; the intervention in, or consolidation of, the action; or the settlement of all or part of the claim.
*** Analysis from -0741/2 ***
Current law provides that the provision of medical benefits under the general relief program or the RNIP program or under medical assistance constitutes an assignment to DHSS, or to a county providing medical assistance or benefits, to the extent of the medical benefits or assistance provided and for benefits to which the recipient would be entitled under any policy of health and disability insurance. A similar provision assigns rights under uninsured health plans, for example, self-insured employer health plans, although this provision covers only medical assistance. Separate provisions also prohibit the imposition of requirements on DHSS, as an assignee, that are different from those imposed on any other agent or assignee of a person covered under the health and disability insurance policy or under the uninsured health plan.
This bill makes several changes to these provisions. The bill amends the provision covering assignments by uninsured health plans to cover medical benefits under the general relief and RNIP programs, or, after January 1, 1996, the emergency medical relief program, as well as medical assistance. Under current law, only the provision regarding assignment of rights under health and disability policies applies to counties providing medical assistance or benefits, as well as to DHSS. Under this bill, all of the provisions require assignment not only to DHSS, but also to counties providing medical assistance or benefits and to health maintenance organizations with which DHSS has contracted to provide medical assistance or benefits.
*** Analysis from -0773/2 ***
This bill requires DHSS to seek a waiver from the secretary of the federal department of agriculture to apply certain special eligibility criteria to migrant workers and their dependents in determining eligibility for benefits under the food stamp program. The bill uses the definition of migrant worker that is used for the waiver that the bill requires DHSS to request for migrant workers under the medical assistance program. If the waiver is granted and in effect, DHSS must determine food stamp eligibility for a migrant worker and his or her dependents using an income-averaging method, if the migrant worker and his or her dependents are not eligible for food stamps using prospective budgeting.
*** Analysis from -0754/4 ***
Under current law, DHSS has an appropriation for employment and training programs, which include the JOBS program and the food stamp employment and training project. Under this appropriation, funds that are not encumbered by December 31 of each year lapse to the general fund on the next January 1 unless transferred to the next calendar year by JCF.
This bill allows DHSS to carry forward for a county funds that are committed to the county under a performance-based contract for a specific calendar year and that are earned by the county in that year to the following calendar year, if the carry-forward is approved by the secretary of administration, without approval of JCF. The funds carried forward do not affect a county's base allocation.
*** Analysis from -0774/2 ***
The low-income energy assistance program (LIEAP) is a federal block grant program designed to support energy costs incurred by low-income households. Current law requires that $2,400,000 of LIEAP block grant funds be allocated to the payment of crisis assistance benefits to meet weather-related or fuel supply shortage emergencies. This bill eliminates this requirement and allows DHSS or, after July 1, 1996, DOA to determine the amount of the allocation.
*** Analysis from -1338/3 ***
Health
Under current law, with certain exceptions, the 3-member cost containment commission is responsible for reviewing and approving the following proposed projects:
A capital expenditure in excess of $1,000,000 made by or on behalf of a hospital.
The implementation of new services to a hospital that exceed $500,000 in a 12-month period.
An expenditure in excess of $500,000 made by or on behalf of a hospital, independent practitioner, limited liability company, partnership, unincorporated medical group or service corporation for clinical medical equipment.
The purchase or acquisition of a hospital.
The construction or operation of an ambulatory surgery center or a home health agency.
Current law sets forth criteria that the commission must use in its review of an application for project approval. These criteria focus on the economic efficiency of and need for the proposed projects. The first priority of the commission in applying the criteria must be cost containment.
The cost containment council represents economic, provider, scientific and consumer viewpoints. It advises the commission, reviews proposed commission rules and periodically reports on the performance of the commission and its operations.
This bill eliminates the cost containment commission, the cost containment council and the capital expenditure review program.
*** Analysis from -0415/3 ***
Under current law, DHSS must investigate the concept of regulating a new category of health care providers known as rural medical centers.
This bill eliminates that requirement and establishes rural medical centers as a category of health care providers that, beginning on January 1, 1997, must be licensed, inspected and otherwise regulated by DHSS. Under the bill, a facility may be regulated as a rural medical center if it is located in a county, city, town or village that has a population of less than 15,000 and in an area that the federal bureau of the census has not defined as an urbanized area, and if it provides 2 or more health care services. "Health care services" means those provided by a hospital, nursing home, hospice, rural health clinic or ambulatory surgery center; or home health services, outpatient physical therapy services, end-stage renal disease services or other services that are specified by DHSS by rule.
The bill establishes licensing procedures and requires that DHSS promulgate rules that establish standards for operation of rural medical centers, minimum requirements for license issuance, licensure fee amounts, and procedures and criteria for waiver of or variance from standards and requirements. The bill authorizes DHSS to conduct unannounced inspections of rural medical centers and requires a rural medical center to provide access to any patient health care records necessary to fulfill the purpose of any DHSS inspections or investigations. The bill prohibits an unlicensed entity from using the phrase "rural medical center" to describe itself, prohibits intentional interference with any investigation by DHSS of alleged violations, prohibits certain intentional retaliation or discrimination against employes or patients and prohibits intentional destruction or modification of original inspection reports.
*** Analysis from -2300/1 ***
Under current law, DHSS allocates $50,000 in each fiscal year as a grant for the provision of direct health care services to migrant workers and their families. A migrant worker is any person who temporarily leaves a principal place of residence outside of this state and comes to this state for not more than 10 months in a year to accept seasonal employment related to unmanufactured agricultural or horticultural commodities. This bill eliminates the migrant health care program.
*** Analysis from -0416/5 ***
Under current law, DHSS is authorized to conduct plan reviews of all capital construction and remodeling for nursing homes and hospitals, to ensure compliance with certain federal life safety code requirements for nursing homes and with certain physical plant requirements. At the same time, DILHR must examine plans of public buildings (which include hospitals and nursing homes) for compliance with building code requirements. Both DHSS and DILHR charge fees for these plan reviews.
Beginning on October 1, 1995, this bill exempts hospitals and nursing homes from DILHR's review for compliance with building code requirements. Instead, the bill requires DHSS to conduct plan reviews of hospitals and nursing homes for compliance with both the building code requirements and with the physical plant and life safety code requirements. The bill requires DHSS to promulgate rules that establish fees for the reviews that are less than the sum of the amounts collected by both DHSS and DILHR. However, until DHSS promulgates these rules or until June 30, 1996, whichever is earlier, the bill permits DHSS to collect fees that are equal to the amounts collected by both DHSS and DILHR.
*** Analysis from -2487/2 ***
Under current law, a community-based residential facility (C-BRF) is annually licensed by DHSS and annually pays a fee, plus a per resident fee, based on the C-BRF's licensed capacity. Certain adult family homes are annually licensed by county departments of social services, human services, community programs or developmental disabilities services or by DHSS.
Beginning on January 1, 1996, this bill changes the licensure period for a C-BRF and for a licensed adult family home to 2 years, increases biennial license fees for C-BRFs and establishes license fees for licensed adult family homes.
Under current law, DHSS may order certain sanctions against a C-BRF that violates specific statutes or rules and, if the C-BRF fails to comply with such an order, may directly assess forfeitures (civil monetary penalties). Under this bill, if DHSS provides notice and explanations of sanctions or penalties, DHSS may, without issuing an order, assess forfeitures against a C-BRF that violates statutes or rules.
*** Analysis from -2290/1 ***
Under current law, DHSS must award grants to local health departments to fund specified activities related to lead poisoning or lead exposure, including educational programs, screening, care coordination and follow-up services such as lead inspection. Certain grants are awarded under criteria that ensure that funding is provided for areas, including Milwaukee, with significant incidence of lead poisoning or lead exposure. This bill eliminates these grants under the program.
