AB150-engrossed,985,95
49.45
(6m) (ag) 3m. For state fiscal year
1993-94 1995-96, rates that shall be
6set by the department based on information from cost reports for the
1992 1994 fiscal
7year of the facility and for state fiscal year
1994-95
1996-97, rates that shall be set
8by the department based on information from cost reports for the
1993 1995 fiscal
9year of the facility.
AB150-engrossed,985,2111
49.45
(6m) (ag) 8. Calculation of total payments and supplementary payments
12to facilities that permits an increase in funds allocated under s. 20.435 (1) (b) and (o)
13for nursing home care provided medical assistance recipients over that paid for
14services provided in state fiscal year
1992-93 1994-95 of no more than
3.58% 4.25% 15during state fiscal year
1993-94 1995-96 and over that paid for services provided in
16state fiscal year
1993-94 1995-96 of no more than
3.57% 3.5% during state fiscal
17year
1994-95 1996-97, excluding increases in total payments attributable to
18increases in recipient utilization of facility care, payments for the provision of active
19treatment to facility residents with developmental disability or chronic mental
20illness and payments for preadmission screening of facility applicants and annual
21reviews of facility residents required under
42 USC 1396r (e).
AB150-engrossed,986,223
49.45
(6m) (am) 5. Allowable administrative and general costs, including costs
24related to the facility's overall management and administration and allowable
1expenses that are not recognized or reimbursed in other cost centers
and including
2the costs of commercial estimators approved by the department under par. (ar) 6.
AB150-engrossed,986,64
49.45
(6m) (am) 5m. Allowable interest expense of the facility, less interest
5income of the facility and less interest income of affiliated entities, to the extent
6required under the approved state plan for services under
42 USC 1396.
AB150-engrossed,986,138
49.45
(6m) (ar) 1. c. If a facility has an approved program for provision of
9service to
emotionally disturbed or mentally retarded residents, residents dependent
10upon ventilators, or residents requiring supplemental skilled care due to complex
11medical conditions, a supplement to the direct care component of the facility rate
12under subd. 1. b. may be made to that facility according to a method developed by the
13department.
AB150-engrossed,986,2015
49.45
(6m) (ar) 6. Capital payment shall be based on a replacement value for
16a facility
, as. The replacement value shall be determined by a commercial estimator
17with which contracted for by the department
has contracted for service, and
paid for
18by the facility. The replacement value shall be subject to limitations determined by
19the department, except that the department may not reduce final capital payment
20of a facility by more than $3.50 per patient day.
AB150-engrossed,987,222
49.45
(6m) (av) 2. The department shall compile an average payment rate for
23each facility based on that facility's rates for cost centers described under par. (am)
241. to 5. that were in effect on June 30
of the previous year, 1994. The department may
1develop a method for adjusting the facility's rate for the cost center under par. (am)
21. in compiling the average payment rate under this subdivision.
AB150-engrossed,987,84
49.45
(6m) (av) 4. If the facility's payment rate under subd. 1. is a decrease from
5its average payment rate
from the previous year under subd. 2., and if the figure
6calculated under subd. 3. exceeds the payment rate for the facility under subd. 1., the
7facility's average payment rate shall be the greater of its average payment rate under
8subd. 2. or its rate under subd. 1.
AB150-engrossed,987,1811
49.45
(6m) (br) 1. Notwithstanding s.
20.410 (3) (cd), 20.435
(3) (cd), (4) (de) or
12(eb) (1) (bt) or (bu) or (7) (b)
or 20.445 (3) (de), the department shall reduce allocations
13of funds to counties in the amount of the disallowance from the appropriations under
14s.
20.410 (3) (cd) or 20.435
(3) (cd), (4) (de) or (eb) (1) (bt) or (bu) or (7) (b)
, or the
15department shall direct the department of industry, labor and human relations to
16reduce allocations of funds to counties in the amount of the disallowance from the
17appropriation under s. 20.445 (3) (de), in accordance with s. 16.544 to the extent
18applicable.
AB150-engrossed,987,2120
49.45
(6m) (c) 6. Provide, upon request, such information as the department
21considers necessary to determine allowable interest expenses under par. (am) 5m.
AB150-engrossed,988,323
49.45
(6m) (h) The department may require by rule that all claims for payment
24of services provided facility residents under this
chapter subchapter be submitted or
25countersigned by the respective facility administrator. The department may specify
1those categories of services for which payment will be made only if the services are
2rendered or authorized in writing by a primary health care provider designated by
3the recipient for the particular category of services.
AB150-engrossed,988,105
49.45
(6m) (L) For purposes of ss. 46.27 (11) (c) 7. and 46.277 (5) (e), the
6department shall, by July 1 annually, determine the statewide medical assistance
7daily cost of nursing home care and submit the determination to the department of
8administration for review. The department of administration shall approve the
9determination before payment may be made under s. 46.27 (11) (c) 7. or 46.277 (5)
10(e).
AB150-engrossed,988,1812
49.45
(6t) County department operating deficit reduction. From the
13appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined
14under criteria developed by the department, incurred by a county department under
15s. 46.215, 46.22, 46.23 or 51.42 for services provided under s. 49.46 (2) (a) 4. d. and
16(b) 6. f., the department shall allocate up to $4,500,000 in each fiscal year to these
17county departments, as determined by the department, and shall perform all of the
18following:
AB150-engrossed,988,2219
(a) For the reduction of operating deficits incurred by the county departments,
20estimate the availability of federal medicaid funds that may be matched to county
21funds that are expended for costs in excess of reimbursement for services provided
22under s. 49.46 (2) (a) 4. d. and (b) 6. f.
AB150-engrossed,989,223
(b) Based on the amount estimated to be available under par. (a), develop a
24method, which need not be promulgated as rules under ch. 227, to distribute this
1allocation to the individual county departments under s. 46.215, 46.22, 46.23 or
251.42 that have incurred operating deficits that shall include all of the following:
AB150-engrossed,989,33
1. Development of criteria for determining operating deficits.
AB150-engrossed,989,54
2. Agreement, by the county in which is located a county department that has
5an operating deficit, to provide funds to match federal medicaid funds.
AB150-engrossed,989,66
3. Consideration of the size of a county department's operating deficit.
AB150-engrossed,989,87
(c) Except as provided in par. (d), distribute the allocation under the
8distribution method that is developed.
AB150-engrossed,989,139
(d) If the federal department of health and human services approves for state
10expenditure in a fiscal year amounts under s. 20.435 (1) (o) that result in a lesser
11allocation amount than that allocated under this subsection or disallows use of the
12allocation of federal medicaid funds under par. (c), reduce allocations under this
13subsection and distribute on a prorated basis, as determined by the department.
AB150-engrossed,989,2115
49.45
(6u) Facility operating deficit reduction. (intro.) Except as provided
16in par. (g), from the appropriation under s. 20.435 (1) (o), for reduction of operating
17deficits, as defined under criteria developed by the department, incurred by a facility,
18as defined under sub. (6m) (a) 2., that is established under s.
49.14 (1) 49.70 (1) or
19that is owned and operated by a city, village or town, the department shall distribute
20to these facilities not more than $18,600,000 in each fiscal year, as determined by the
21department, and shall perform all of the following:
AB150-engrossed,990,223
49.45
(6u) (b) 2. Agreement by the county in which is located the facility
24established under s.
49.14 (1) 49.70 (1) and agreement by the city, village or town that
25owns and operates the facility that the applicable county, city, village or town shall
1provide funds to match federal medical assistance matching funds under this
2subsection.
AB150-engrossed,990,74
49.45
(6u) (b) 2m. Identification by the county in which is located the facility
5established under s.
49.14 (1) 49.70 (1) of all county funds expended in each calendar
6year to operate the facility, and certification by the county to the department of this
7amount.
AB150-engrossed,990,1610
49.45
(6w) Hospital operating deficit reduction. (intro.) From the
11appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined
12under criteria developed by the department, incurred by a hospital, as defined under
13s. 50.33 (2) (a) and (b), that is operated by the state, established under s.
49.16 49.71 14or owned and operated by a city or village, the department shall allocate up to
15$3,300,000 in each fiscal year to these hospitals, as determined by the department,
16and shall perform all of the following:
AB150-engrossed,990,1818
49.45
(6w) (a) 2. County funds, for a hospital established under s.
49.16 49.71.
AB150-engrossed,990,2120
49.45
(6w) (b) 2. b. Agreement to provide matching funds by the county in
21which is located a hospital established under s.
49.16
49.71.
AB150-engrossed,991,323
49.45
(6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
2420.435 (1) (b) and (o) the department shall distribute not more than $4,748,000 in
25each
of fiscal
years 1993-94 and 1994-95 year, to provide funds to an essential access
1city hospital, except that the department may not allocate funds to an essential
2access city hospital to the extent that the allocation would exceed any limitation
3under
42 USC 1396b (i) (3).
AB150-engrossed,991,55
49.45
(6y) (title)
Supplemental funding for county certain hospitals.
AB150-engrossed,991,127
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
820.435 (1) (b) and (o) the department shall distribute funding in each fiscal year to
9provide supplemental payment to county hospitals and to county mental health
10complexes, as determined by the department, for
inpatient hospital services that are
11not in excess of the hospitals' customary charges for the services, as limited under
1242 USC 1396b (i) (3).
AB150-engrossed, s. 2985e
13Section 2985e. 49.45 (6y) (a) of the statutes, as affected by 1995 Wisconsin Act
14.... (this act), is amended to read:
AB150-engrossed,991,2415
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
1620.435 (1) (b) and (o) the department shall distribute funding in each fiscal year to
17provide supplemental payment to
county hospitals and to county mental health
18complexes hospitals that enter into a contract under s. 49.02 (2) to provide health
19care services funded by a relief block grant, as determined by the department, for
20hospital services that are not in excess of the hospitals' customary charges for the
21services, as limited under
42 USC 1396b (i) (3).
If no relief block grant is awarded
22under this chapter or if the allocation of funds to such hospitals would exceed any
23limitation under 42 USC 1396b (i) (3), the department may distribute funds to
24hospitals that have not entered into a contract under s. 49.02 (2).
AB150-engrossed,992,2
149.45
(6z) (title)
Supplemental funding for certain hospitals serving
2low-income patients.
AB150-engrossed,992,154
49.45
(6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations
5under s. 20.435 (1) (b) and (o) the department shall distribute funding in each fiscal
6year to supplement payment for
inpatient services to
county hospitals and county
7mental health complexes that, as determined by the department,
hospitals that
8enter into a contract under s. 49.02 (2) to provide health care services funded by a
9relief block grant under this chapter, if the department determines that the hospitals 10serve a disproportionate number of low-income patients with special needs
, except
11that the. If no medical relief block grant under this chapter is awarded or if the
12allocation of funds to such hospitals would exceed any limitation under 42 USC
131396b (i) (3), the department may distribute funds to hospitals that have not entered
14into a contract under s. 49.02 (2). The department may not distribute funds under
15this subsection to the extent that the distribution would do any of the following:
AB150-engrossed,992,2017
49.45
(7) (d) 4. The department's determination of serious misconduct under
18this subsection shall be cause for terminating the facility's participation in the
19state-funded portion of the medical assistance program under
ss. 49.45 to 49.47 this
20subchapter.
AB150-engrossed,992,2322
49.45
(8) (title)
Home
Per-visit limits on home health services
23reimbursement.
AB150-engrossed,993,6
149.45
(8e) Monthly limits on home health, personal care and private-duty
2nursing services reimbursement. (a) Except as provided in par. (b), reimbursement
3under s. 20.435 (1) (b) and (o) for home health, personal care and private-duty
4nursing services provided to a medical assistance recipient in a month may not
5exceed the average monthly cost of nursing home care, as determined by the
6department.
AB150-engrossed,993,77
(b) This subsection does not apply to any of the following:
AB150-engrossed,993,88
1. A medical assistance recipient under the age of 22.
AB150-engrossed,993,109
2. A ventilator-dependent individual under s. 49.46 (2) (b) 6. m. or 49.47 (6) (a)
101.
AB150-engrossed,993,1311
3. Any individual, if the department determines that the cost of providing the
12individual with nursing home care would exceed the cost of providing the individual
13with home health, personal care and private-duty nursing services.
AB150-engrossed,993,1514
4. Any individual, if the department determines that nursing home care is not
15available for that individual.
AB150-engrossed,993,2117
49.45
(8f) Limits on reimbursement of providers of home health services. (a)
18For any home health, personal care or private-duty nursing service provided to a
19medical assistance recipient in a month, the department may require, as a condition
20of reimbursement, that the provider charge the department the lesser of the
21following for the service:
AB150-engrossed,993,2422
1. The amount that the federal medicare program reimburses for a service,
23separately identified under
42 CFR Part 413, including skilled nursing service, home
24health aid service and physical therapy service.
AB150-engrossed,993,2525
2. The provider's usual and customary charge for providing the service.
AB150-engrossed,994,2
13. A maximum reimbursement rate, determined by the department, for the
2service.
AB150-engrossed,994,43
(b) When a provider is required to charge the department a price under par. (a),
4the department may not reimburse the provider for more than that amount.
AB150-engrossed,994,116
49.45
(8m) Rates for respiratory care services. (intro.) Notwithstanding
a
7determination by the department of a maximum rate the limits under
sub. subs. (8)
,
8(8e) and (8f), the rates under sub. (8) and rates charged by providers under s. 49.46
9(2) (a) 4. d. that are not home health agencies, for reimbursement for respiratory care
10services for ventilator-dependent individuals under ss. 49.46 (2) (b) 6. m. and 49.47
11(6) (a) 1., shall be as follows:
AB150-engrossed,994,2213
49.45
(8v) Incentive-based pharmacy payment system. By January 1, 1996, the
14department shall establish a system of payment to pharmacies for legend and
15over-the-counter drugs provided to recipients of medical assistance that has
16financial incentives for pharmacists who perform services that result in savings to
17the medical assistance program. Under this system, the department shall establish
18a schedule of fees that is designed to ensure that any incentive payments made are
19equal to or less than the documented savings. The department may discontinue the
20system established under this subsection if the department determines, after
21performance of a study, that payments to pharmacists under the system exceed the
22documented savings under the system.
AB150-engrossed,995,3
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-engrossed,995,115
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-engrossed, s. 2993
12Section
2993. 49.45 (25) (am) of the statutes is renumbered 49.45 (25) (am)
13(intro.) and amended to read:
AB150-engrossed,995,1914
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-engrossed,995,20
201. Has a developmental disability, as defined under s. 51.01 (5) (a)
,.
AB150-engrossed,995,21
212. Has a chronic mental illness, as defined under s. 51.01 (3g)
, or.
AB150-engrossed,995,22
223. Has Alzheimer's disease, as defined under s. 46.87 (1) (a)
, is.