49.45(6m)(k)
(k) Notwithstanding
pars. (ag) to
(b),
(bp) and
(br), the department may participate in a demonstration project on case mix nursing home reimbursement authorized under
42 USC 1315 (a) and may modify the payment system under this section, on an experimental basis, as necessary for participation in the demonstration project.
49.45(6m)(L)
(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).
49.45(6r)(a)1g.
1g. "Facility" means a nursing home as defined in
s. 50.01 (3) or a community-based residential facility that is licensed under
s. 50.03 and that is certified by the department as a provider of medical assistance.
49.45(6r)(a)1m.
1m. "Provider" means a facility or an ambulatory surgery center, except that "provider" does not include a facility or ambulatory surgery center that is state-owned or state-operated, federally owned or federally operated or located outside the state.
49.45(6r)(a)1r.
1r. "Services" means services or items under this section that the provider directly provides and does not reimburse a 3rd party for providing.
49.45(6r)(a)2.
2. "State share" means that portion of the medical assistance payments made to a provider under this section for the provision of authorized services that is not reimbursed by federal funds, unless no federal financial participation is available for these services. If no federal financial participation is available for a service that is payable under this section, "state share" means that portion of the payments that would be the state share if federal financial participation were available.
49.45(6r)(b)
(b) For the privilege of doing business in this state, there is imposed on a provider an assessment at the rate of 6.98% in fiscal year 1991-92 and 13.10% in fiscal year 1992-93 that shall be deposited in the general fund. The assessment shall be made on the state share of payments made to a provider for services provided beginning on July 1, 1991, except that assessments imposed on ambulatory surgery centers shall be made for services provided beginning on January 1, 1992.
49.45(6r)(c)
(c) The department shall send an invoice to each provider on October 31, 1991, for the amount due for the 3 months preceding that month and shall, thereafter, send an invoice to each provider by the end of every month for the amount due, which shall be based on payments received for services to which the assessment is applicable for the month preceding the month during which the invoice is sent, except that, for an ambulatory surgery center, the department shall first send an invoice by February 29, 1992. Each provider shall pay the amount shown on the invoice on or before the last day of the month after the month in which the invoice is sent. The department may provide to a provider an alternative to payment by invoice under which a provider may elect to have the assessment amounts deducted from net payments made for services.
49.45(6r)(e)
(e) The department shall levy, enforce and collect the assessment under this subsection.
49.45(6r)(f)
(f) Sections 71.74 (1) to
(3),
(6),
(7) and
(9) to
(15),
71.75 (1),
(2),
(4),
(5) and
(6) to
(10),
71.76,
71.77,
71.78 (1) to
(8),
71.80 (1) (a) to
(d),
(3),
(3m),
(6),
(8) to
(12),
(14) and
(18),
71.87,
71.88,
71.89,
71.90,
71.91 and
71.93 as they apply to the taxes under
ch. 71 and to the department of revenue apply to the assessment under this subsection and to the department.
49.45(6r)(g)
(g) This subsection does not apply after September 30, 1992.
49.45(6s)
(6s) Supplemental payments to county homes. Notwithstanding
sub. (6m), the department shall, from the appropriation under
s. 20.435 (1) (o), distribute not more than $20,000,000 in fiscal year 1995-96 and not more than $20,000,000 in fiscal year 1996-97, to provide supplemental payments for care to recipients of medical assistance provided in county homes established under
s. 49.14 (1) [49.70 (1)], except that the department shall also distribute for this same purpose from the appropriation under
s. 20.435 (1) (o) any additional federal medical assistance funds that were not anticipated before enactment of the biennial budget act or other legislation affecting
s. 20.435 (1) (o), were not used to fund nursing home rate increases under
sub. (6m) (ag) 8. and are matched by county funds under
sub. (6u) (b) 2. and certified under
sub. (6u) (b) 2m. The total amount certified under
sub. (6u) (b) 2m. and under this subsection may not exceed 100% of otherwise-unreimbursed care.
49.45 Note
NOTE: The bracketed language indicates the correct cross-reference.
1995 Wis. Act 27 renumbered s. 49.14 (1) to be 49.70 (1). Corrective legislation is pending.
49.45(6t)
(6t) County department and local health 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 or by a local health department, as defined in
s. 250.01 (4), for services provided under
s. 49.46 (2) (a) 4. d. and
(b) 6. f.,
j.,
k. and
L.,
9. and
15., for case management services under
s. 49.46 (2) (b) 12. and for mental health day treatment services for minors provided under the authorization under
42 USC 1396d (r) (5), the department shall allocate up to $4,500,000 in each fiscal year to these county departments, or local health departments as determined by the department, and shall perform all of the following:
49.45(6t)(a)
(a) For the reduction of operating deficits incurred by the county departments or local health departments, estimate the availability of federal medicaid funds that may be matched to county, city, town or village 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.,
j.,
k. and
L.,
9. and
15., for case management services under
s. 49.46 (2) (b) 12. and for mental health day treatment services for minors provided under the authorization under
42 USC 1396d (r) (5).
49.45(6t)(b)
(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 or to local health departments that have incurred operating deficits that shall include all of the following:
49.45(6t)(b)1.
1. Development of criteria for determining operating deficits.
49.45(6t)(b)2.
2. Agreement, by the county in which is located a county department that has an operating deficit, or by the county, city, town or village that has established a local health department that has an operating deficit, to provide funds to match federal medicaid funds.
49.45(6t)(b)3.
3. Consideration of the size of a county department's or local health department's operating deficit.
49.45(6t)(c)
(c) Except as provided in
par. (d), distribute the allocation under the distribution method that is developed.
49.45(6t)(d)
(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.
49.45(6u)
(6u) Facility operating deficit reduction. 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. 49.70 (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:
49.45(6u)(a)
(a) Estimate the availability of federal medical assistance funds that may be matched to county funds or funds of a city, village or town for the reduction of operating deficits incurred by the facility.
49.45(6u)(b)
(b) Based on the amount estimated available under
par. (a), develop a method to distribute this allocation to the individual facilities that have incurred operating deficits that shall include:
49.45(6u)(b)1.
1. Development of criteria for determining operating deficits.
49.45(6u)(b)2.
2. Agreement by the county in which is located the facility established under
s. 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.
49.45(6u)(b)2m.
2m. Identification by the county in which is located the facility established under
s. 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.
49.45(6u)(b)3.
3. Consideration of the size of a facility's operating deficit.
49.45(6u)(c)
(c) Distribute the allocation under the distribution method that is developed, unless a county has failed to comply with
par. (b) 2m.
49.45(6u)(d)
(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, allocate not more than the lesser amount so approved by the federal department of health and human services.
49.45(6u)(e)
(e) 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, submit a revision of the method developed under
par. (b) for approval by the joint committee on finance in that state fiscal year.
49.45(6u)(f)
(f) If the federal department of health and human services disallows use of the allocation of matching federal medical assistance funds distributed under
par. (c), the requirements under
sub. (6m) (br) shall apply.
49.45(6u)(g)
(g) If a facility that is otherwise eligible for an allocation of funds under this section is found by the federal health care financing administration or the department to be an institution for mental diseases, as defined under
42 CFR 435.1009, the department may not allocate to that facility funds under this section after the date on which the finding is made.
49.45(6w)
(6w) Hospital 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 hospital, as defined under
s. 50.33 (2) (a) and
(b), that is operated by the state, established under
s. 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:
49.45(6w)(a)
(a) For the reduction of operating deficits incurred by the hospital, estimate the availability of federal medicaid funds that may be matched to any of the following:
49.45(6w)(a)1.
1. State general purpose revenues, for a hospital operated by the state.
49.45(6w)(a)3.
3. Funds of a city or village, for a hospital owned and operated by a city or village.
49.45(6w)(b)
(b) Based on the amount estimated available under
par. (a), develop a method to distribute this allocation to the individual hospitals that have incurred operating deficits that shall include:
49.45(6w)(b)1.
1. Development of criteria for determining operating deficits.
49.45(6w)(b)2.
2. With respect to funds to match federal medicaid matching funds under this section, any of the following, as applicable:
49.45(6w)(b)2.a.
a. Provision by the state of matching funds from general purpose revenues for a hospital operated by the state.
49.45(6w)(b)2.b.
b. Agreement to provide matching funds by the county in which is located a hospital established under
s. 49.71.
49.45(6w)(b)2.c.
c. Agreement to provide matching funds by the city or village that owns and operates a hospital.
49.45(6w)(b)3.
3. Consideration of the size of a hospital's operating deficit.
49.45(6w)(c)
(c) Except as provided in
par. (d), distribute the allocation under the distribution method that is developed.
49.45(6w)(d)
(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.
49.45(6x)
(6x) Funding for essential access city hospital. 49.45(6x)(a)(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 fiscal 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).
49.45(6x)(b)
(b) The department shall develop procedures for solicitation and review of requests for funds and a method to distribute the funds under
par. (a) to an individual hospital that shall include establishment of criteria for the designation as an essential access city hospital.
49.45(6x)(c)
(c) Except as provided in
par. (d), the department shall distribute the funds under
par. (a) under the distribution method that is developed under
par. (b).
49.45(6x)(d)
(d) If the federal department of health and human services approves for state expenditure in any state fiscal year amounts under
s. 20.435 (1) (o) that result in a lesser distribution amount than that distributed under this subsection or disallows use of federal medicaid funds under
par. (a), the department of health and family services shall reduce the distributions under this subsection.
49.45(6x)(e)
(e) The department need not promulgate as rules under
ch. 227 the procedures, method of distribution and criteria required for distribution under this subsection.
49.45(6y)
(6y) Supplemental funding for certain hospitals. 49.45(6y)(a)(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 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).
49.45(6y)(b)
(b) The department need not promulgate as rules under
ch. 227 the procedures, methods of distribution and criteria required for distribution under
par. (a).
49.45(6z)
(6z) Supplemental funding for certain hospitals serving low-income patients. 49.45(6z)(a)(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 supplement payment for services to 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. 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:
49.45(6z)(b)
(b) The department need not promulgate as rules under
ch. 227 the procedures, methods of distribution and criteria required for distribution under
par. (a).
49.45(7)(a)(a) A recipient who is a patient in a public medical institution or an accommodated person and has a monthly income exceeding the payment rates established under
42 USC 1382 (e) may retain $40 unearned income or the amount of any pension paid under
38 USC 3203 (f), whichever is greater, per month for personal needs. Except as provided in
s. 49.455 (4) (a), the recipient shall apply income in excess of $40 or the amount of any pension paid under
38 USC 3203 (f), whichever is greater, less any amount deducted under rules promulgated by the department, toward the cost of care in the facility.
49.45(7)(b)
(b) Where a facility participating in the medical assistance program has been delegated in writing by a resident within that facility to manage and control the personal funds of the resident including but not limited to those funds identified in
par. (a) the facility shall establish for the resident a personal fund account. All deposits and withdrawals of funds shall be documented by the facility to indicate the amount and date of deposit and amount, date and purpose of withdrawal. Such documentation shall be maintained in the resident's records.
49.45(7)(c)
(c) Upon the removal of a resident from the facility as a result of death or permanent transfer, the facility shall transfer the balance of the resident's trust account to the personal representative of the resident's estate, the legal guardian of the resident or if appropriate to the resident personally. A copy of the trust account records shall be transferred with the funds. No facility or any of its employes or representatives may benefit from the distribution of a deceased resident's personal funds unless they are specifically named in the resident's will or constitute an heir at law.
49.45(7)(d)1.1. The department shall accept from any person a verified complaint concerning any violation of this subsection. The department shall forward to the accused within 10 days a copy of such complaint. The department, upon such investigation as it deems necessary, may dismiss the complaint or may find probable cause to believe that a violation of this subsection has occurred.
49.45(7)(d)2.
2. If the department finds probable cause to believe that a violation of this subsection has occurred, it may assess a forfeiture of not less than $25 nor more than $500 for each occurrence, and in addition may order that any amount illegally charged against a resident's account be restored. The department shall immediately inform the complainant and respondent of any such decision and the amount of forfeiture or repayment, if any. If the department is not notified in writing that a party wishes to contest a decision within 15 working days after the parties are informed of such decision, the department's determination shall be deemed final and may not be appealed to a court.
49.45(7)(d)3.
3. The department shall inform the nursing home administrators examining board of all decisions made under this paragraph.
49.45(7)(d)4.
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 this subchapter.
49.45(7)(e)
(e) Nursing homes shall adopt a uniform accounting system prescribed by the department for purposes of managing residents personal fund accounts.
49.45(8)
(8) Per-visit limits on home health services reimbursement. 49.45(8)(a)4.
4. "Patient care visit" means a personal contact with a patient in a patient's home that is made by a registered nurse, licensed practical nurse, home health aide, physical therapist, occupational therapist or speech-language pathologist who is on the staff of or under contract or arrangement with a home health agency, or by a registered nurse or licensed practical nurse practicing independently, to provide a service that is covered under
s. 49.46 or
49.47. "Patient care visit" does not include time spent by a nurse, therapist or home health aide on case management, care coordination, travel, record keeping or supervision that is related to the patient care visit.
49.45(8)(a)7.
7. "Speech-language pathologist" means an individual engaged in the practice of speech-language pathology, as regulated under
ch. 459.
49.45(8)(b)
(b) Reimbursement under
s. 20.435 (1) (b) and
(o) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under
par. (c).
49.45(8)(c)
(c) The department shall establish a maximum statewide allowable fee per patient care visit, for each type of visit with respect to provider, that may be no greater than the cost per patient care visit, as determined by the department from cost reports of home health agencies, adjusted for costs related to case management, care coordination, travel, record keeping and supervision.
49.45(8e)
(8e) Monthly limits on home health, personal care and private-duty nursing services reimbursement. 49.45(8e)(a)(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 120% of the average monthly cost of nursing home care, as determined by the department.
49.45(8e)(b)
(b) This subsection does not apply to any of the following:
