1995 - 1996 LEGISLATURE
January 4, 1996 - Introduced by Representatives Baldwin, Meyer, Notestein, La
Fave, Carpenter, R. Potter, Bock, Plache, Robson, Hanson, Murat, Turner,
Ryba, Baldus, Dueholm, Wilder, Travis, Reynolds, Wirch, R. Young,
Plombon, Black, Krusick, Coggs, Wasserman, Krug, Kreuser, Riley, Huber,
Springer, Cullen, L. Young, Kunicki, Vander Loop, Gronemus, Linton, Boyle,
Morris-Tatum and
Bell, cosponsored by Senators Moen, Jauch, Decker,
Burke, Andrea, Wineke, Breske, C. Potter, Risser, Clausing, George,
Shibilski, Chvala, Moore, Adelman and Grobschmidt. Referred to Joint
committee on Finance.
AB772,1,7
1An Act to repeal 46.27 (7) (b) 1r., 46.27 (11) (c) 3m., 49.45 (8e), 49.45 (8f) and
249.45 (4z); and
to amend 49.45 (8m) (intro.), 49.46 (2) (a) 4. d. and 49.46 (2) (b)
36. j. of the statutes;
relating to: eliminating certain limitations on medical
4assistance reimbursement for home health services, personal care and
5private-duty nursing services and eliminating certain limitations on
6reimbursement for long-term community support services provided under the
7long-term support community options program.
Analysis by the Legislative Reference Bureau
Under current law, the medical assistance program pays certified providers for
a range of benefits provided on behalf of medical assistance recipients. These
benefits include certain home health, personal care and private-duty nursing
services. Prior to enactment of
1995 Wisconsin Act 27 (the budget act), a
per-patient-visit limit existed for reimbursement for certain home health services
provided under the medical assistance program. Under the budget act, an additional
limitation on medical assistance reimbursement for personal care and private-duty
nursing services, as well as home health services, was added, under which
reimbursement for these services that are 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 of health and social services (DHSS). This monthly
limit does not apply to a medical assistance recipient under the age of 22; to a
ventilator-dependent individual; if DHSS determines that the cost of providing an
individual with nursing home care would exceed the cost of providing the individual
with the home health, personal care and private-duty nursing services; or if DHSS
determines that nursing home care is not available for the individual. In addition,
DHSS may require, as a condition of reimbursement, that the provider charge the
lesser of the amount that the federal medicare program reimburses for a service, the
provider's usual and customary charge or a maximum reimbursement rate that is
determined by DHSS. These limitations do not apply, however, to rates for
reimbursement for respiratory care services for ventilator-dependent individuals.
Also under the budget act, additional limitations were placed on the provision of
personal care services that require that the provider of the personal care services
receive prior authorization from DHSS for all personal care services that exceed 50
hours in a calendar year that are provided to an individual and that the individual
be ineligible to receive home health aide services under the medicare program.
Under current law, the long-term support community options program
provides long-term community support services that serve as alternatives to
institutional care for individuals in nursing homes. The part of the program that is
funded under state general purpose revenue is frequently termed "regular COP";
and the part of the program that, for medical assistance recipients, is funded under
state general purpose revenue and federal funds as a waiver to federal medicaid laws
is frequently termed "COP waiver". Under current law as affected by the budget act,
reimbursement for long-term community support services provided to an individual
under both the regular COP and COP waiver parts of the long-term support
community options program is limited to the average monthly cost of nursing home
care, as determined by DHSS. This limitation does not apply to individuals under
the age of 22; ventilator-dependent individuals; individuals for whom DHSS
determines that the cost of providing nursing home care would exceed the cost of
providing the individual with care in the community; individuals for whom nursing
home care is not available; and individuals for whom public funding is not available
for their institutional care.
This bill eliminates the limitations on provision of, and reimbursement for,
home health services, personal care and private-duty nursing services that were
enacted under the budget act. Further, the bill eliminates the limitations on
reimbursement for long-term community support services provided to individuals
under the long-term support community options program that were enacted under
the budget act.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB772,3,149
49.45
(8m) Rates for respiratory care services. (intro.) Notwithstanding
the
10limits a determination by the department of a maximum rate under
subs. sub. (8)
,
11(8e) and (8f), the rates under sub. (8) and rates charged by providers under s. 49.46
12(2) (a) 4. d. that are not home health agencies, for reimbursement for respiratory care
13services for ventilator-dependent individuals under ss. 49.46 (2) (b) 6. m. and 49.47
14(6) (a) 1., shall be as follows:
AB772,3,2119
49.46
(2) (a) 4. d. Home health services, subject to the limitations under s. 49.45
20(8)
, (8e) and (8f), or, if a home health agency is unavailable, nursing services
, subject
21to the limitations under s. 49.45 (8e) and (8f).
AB772,4,2
149.46
(2) (b) 6. j. Personal care services
, subject to the limitations under s. 49.45
2(8e), (8f) and (42).
