1997 Wisconsin Act 27

27,1909 Section 1909 . 49.45 (2) (a) 17. of the statutes is amended to read:

49.45 (2) (a) 17. Notify the governor, the joint committee on legislative organization, the joint committee on finance and appropriate standing committees, as determined by the presiding officer of each house, if the appropriation under s. 20.435 (1) (5) (b) is insufficient to provide the state share of medical assistance.

27,1910 Section 1910 . 49.45 (3) (ag) of the statutes is created to read:

49.45 (3) (ag) Reimbursement shall be made to each entity contracted with under s. 46.271 (2m) for assessments completed under s. 46.271 (2m) (a) 2.

27,1911 Section 1911 . 49.45 (5) of the statutes is renumbered 49.45 (5) (a) and amended to read:

49.45 (5) (a) Any person whose application for medical assistance is denied or is not acted upon promptly or who believes that the payments made in the person's behalf have not been properly determined or that his or her eligibility has not been properly determined may file an appeal with the department pursuant to s. 49.21 (1) par. (b). Review is unavailable if the decision or failure to act arose more than 45 days before submission of the petition for a hearing.

27,1912 Section 1912 . 49.45 (5) (b) of the statutes is created to read:

49.45 (5) (b) 1. Upon receipt of a timely petition under par. (a) the department shall give the applicant or recipient reasonable notice and opportunity for a fair hearing. The department may make such additional investigation as it considers necessary. Notice of the hearing shall be given to the applicant or recipient and to the county clerk or, if a Wisconsin works agency is responsible for making the medical assistance determination, the Wisconsin works agency. The county or the Wisconsin works agency may be represented at such hearing. The department shall render its decision as soon as possible after the hearing and shall send a certified copy of its decision to the applicant or recipient, the county clerk and to the county officer or the Wisconsin works agency charged with administration of the medical assistance program. The decision of the department shall have the same effect as an order of the county officer or the Wisconsin works agency charged with the administration of the medical assistance program. The decision shall be final, but may be revoked or modified as altered conditions may require. The department shall deny a petition for a hearing or shall refuse to grant relief if:

a. The petitioner withdraws the petition in writing.

b. The sole issue in the petition concerns an automatic payment adjustment or change that affects an entire class of recipients and is the result of a change in state or federal law.

c. The petitioner abandons the petition. Abandonment occurs if the petitioner fails to appear in person or by representative at a scheduled hearing without good cause, as determined by the department.

2. If a recipient requests a hearing within the timely notice period specified in 42 CFR 431.231 (c), medical assistance coverage shall not be suspended, reduced or discontinued until a decision is rendered after the hearing but medical assistance payments made pending the hearing decision may be recovered by the department if the contested decision or failure to act is upheld. The department shall promptly notify the county department or, if a Wisconsin works agency is responsible for making the medical assistance determination, the Wisconsin works agency of the county in which the recipient resides that the recipient has requested a hearing. Medical assistance coverage shall be suspended, reduced or discontinued if:

a. The recipient is contesting a state or federal law or a change in state or federal law and not the determination of the payment made on the recipient's behalf.

b. The recipient is notified of a change in his or her medical assistance coverage while the hearing decision is pending but the recipient fails to request a hearing on the change.

3. The recipient shall be promptly informed in writing if medical assistance is to be suspended, reduced or terminated pending the hearing decision.

27,1913 Section 1913 . 49.45 (5m) (a) of the statutes is amended to read:

49.45 (5m) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (5) (b) and (o) the department shall distribute not more than $2,256,000 in each fiscal year, to provide supplemental funds to rural hospitals that, as determined by the department, have high utilization of inpatient services by patients whose care is provided from governmental sources, except that the department may not distribute funds to a rural hospital to the extent that the distribution would exceed any limitation under 42 USC 1396b (i) (3).

27,1914m Section 1914m. 49.45 (6b) (b) of the statutes is amended to read:

49.45 (6b) (b) Beginning in fiscal year 1995-96 1997-98, for relocations from the northern Wisconsin center for the developmentally disabled, by $199 $174 per day.

27,1915m Section 1915m. 49.45 (6b) (c) of the statutes is amended to read:

49.45 (6b) (c) Beginning in fiscal year 1995-96 1997-98, for relocations from the southern Wisconsin center for the developmentally disabled, by $149 $174 per day.

27,1916 Section 1916 . 49.45 (6c) (c) (intro.) of the statutes is amended to read:

49.45 (6c) (c) Resident review. (intro.) Except as provided in par. (e), by April 1, 1990, and at least annually thereafter, the department or an entity to which the department has delegated authority shall review every resident of a facility or institution for mental diseases who has a developmental disability or mental illness and who has experienced a significant change in his or her physical or mental condition to determine if any of the following applies:

27,1917 Section 1917 . 49.45 (6m) (a) 3. of the statutes is amended to read:

49.45 (6m) (a) 3. “Facility" means a nursing home as defined under 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.

27,1918 Section 1918 . 49.45 (6m) (a) 5. of the statutes is created to read:

49.45 (6m) (a) 5. “Nursing home" has the meaning given under s. 50.01 (3).

27,1919 Section 1919 . 49.45 (6m) (ag) (intro.) of the statutes is amended to read:

49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this subsection made under s. 20.435 (1) (b), (o) or (p) or (5) (b) or (o) shall, except as provided in pars. (bg), (bm) and (br), be determined according to a prospective payment system updated annually by the department. The payment system shall implement standards which are reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities in order to provide care in conformity with this section, with federal regulations authorized under 42 USC 1396a (a) (13) (A), 1396a (a) (30), 1396b (i) (3), 1396L and 1396r (e) and with quality and safety standards established under subch. II of ch. 50 and ch. 150. In administering this payment system, the department shall allow costs it determines that are necessary and proper for providing patient care and that meet quality and safety standards established under subch. II of ch. 50 and ch. 150. The payment system shall reflect all of the following:

27,1919g Section 1919g. 49.45 (6m) (ag) 2. of the statutes is amended to read:

49.45 (6m) (ag) 2. Standards established by the department for costs of economically and efficiently operated facilities that shall be based upon allowable costs incurred by facilities in the state as available from information submitted under par. (c) 3. and compiled by the department.

27,1920 Section 1920 . 49.45 (6m) (ag) 3m. of the statutes is amended to read:

49.45 (6m) (ag) 3m. For state fiscal year 1995-96 1997-98, rates that shall be set by the department based on information from cost reports for the 1994 1996 fiscal year of the facility and for state fiscal year 1996-97 1998-99, rates that shall be set by the department based on information from cost reports for the 1995 1997 fiscal year of the facility.

27,1921 Section 1921 . 49.45 (6m) (ag) 8. of the statutes is amended to read:

49.45 (6m) (ag) 8. Calculation of total payments and supplementary payments to facilities that permits an aggregate increase in funds allocated under s. 20.435 (1) (5) (b) and (o) for nursing home care provided medical assistance recipients, including an increase resulting in adjustment of facility base rates and percentage increases over facility base rates, over that paid for services provided in state fiscal year 1994-95 1996‐97 of no more than 4.25% 5 .4% or $45,908,500, whichever is less, during state fiscal year 1995-96 and 1997‐98; and calculation of total payments and supplementary payments to facilities that permits an aggregate increase in funds allocated under s. 20.435 (5) (b) and (o) for nursing home care provided medical assistance recipients, including a percentage increase over facility base rates, over that paid for services provided in state fiscal year 1995-96 1997‐ 98 of no more than 3.5% or $30,145,200, whichever is less, during state fiscal year 1996-97, excluding 1998‐99. Calculation of total payments and supplementary payments under this subdivision excludes increases in total payments attributable to increases in recipient utilization of facility care, payments for the provision of active treatment to facility residents with developmental disability or chronic mental illness and payments for preadmission screening of facility applicants and annual reviews of facility residents required under 42 USC 1396r (e).

27,1922 Section 1922 . 49.45 (6m) (ap) of the statutes is created to read:

49.45 (6m) (ap) If the bed occupancy of a nursing home is below the minimum patient day occupancy standards that are established by the department under par. (ar) (intro.), the department may approve a request by the nursing home to delicense any of the nursing home's licensed beds. If the department approves the nursing home's request, all of the following apply:

1. The department shall delicense the number of beds in accordance with the nursing home's request.

2. The department may not include the number of beds of the nursing home that the department delicenses under this paragraph in determining the costs per patient day under the minimum patient day occupancy standards under par. (ar).

3. The nursing home may not use or sell a bed that is delicensed under this paragraph.

4. a. Every 12 months following the delicensure of a bed under this paragraph, for which a nursing home has not resumed licensure under subd. 5., the department shall reduce the licensed bed capacity of the nursing home by 10% of all of the nursing home's beds that remain delicensed under this paragraph or by 25% of one bed, whichever is greater. The department shall reduce the statewide maximum number of licensed nursing home beds under s. 150.31 (1) (intro.) by the number or portion of a number of beds by which the nursing home's licensed bed capacity is reduced under this subdivision.

b. Subdivision 4. a. does not apply with respect to the delicensure of beds between the effective date of this subd. 4. b. .... [revisor inserts date], and the date that is 60 days after the effective date of this subd. 4. b. .... [revisor inserts date], during the period of any contract entered into by a nursing home prior to January 1, 1997, if the contract requires the nursing home to maintain its current licensed bed capacity.

5. A nursing home retains the right to resume licensure of a bed of the nursing home that was delicensed under this paragraph unless the licensed bed capacity of the nursing home has been reduced by that bed under subd. 4. The nursing home may not resume licensure of a fraction of a bed. The nursing home may resume licensure 18 months after the nursing home notifies the department in writing that the nursing home intends to resume the licensure. If a nursing home resumes licensure of a bed under this subdivision, subd. 2. does not apply with respect to that bed.

6. If subd. 4. b. applies and the nursing home later resumes licensure of a bed that was delicensed between the effective date of this subdivision .... [revisor inserts date], and the date that is 60 days after the effective date of this subdivision .... [revisor inserts date], the department shall calculate the costs per patient day using the methodology specified in the state plan that is in place at the time that the delicensed beds are resumed.

27,1923 Section 1923 . 49.45 (6m) (ar) 1. a. of the statutes is amended to read:

49.45 (6m) (ar) 1. a. The department shall establish standards for payment of allowable direct care costs, for facilities that do not primarily serve the developmentally disabled, that are at least 110% of not less than the median for direct care costs for a sample of all of those facilities that do not primarily serve the developmentally disabled in this state and separate standards for payment of allowable direct care costs, for facilities that primarily serve the developmentally disabled, that are at least 110% of not less than the median for direct care costs for a sample of all of those facilities primarily serving the developmentally disabled in this state. The standards shall be adjusted by the department for regional labor cost variations. The department may decrease the percentage established for the standards only if amounts available under par. (ag) (intro.) are insufficient to provide total payment under par. (am), less capital costs under subd. 6.

27,1924 Section 1924 . 49.45 (6m) (br) 1. of the statutes, as affected by 1997 Wisconsin Act 3, is amended to read:

49.45 (6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435 (1) (5) (bt) or (bu) or (7) (b) or 20.445 (3) (de) (dz), the department shall reduce allocations of funds to counties in the amount of the disallowance from the appropriations appropriation account under s. 20.410 (3) (cd) or 20.435 (1) (5) (bt) or (bu) or (7) (b), or the department shall direct the department of workforce development to reduce allocations of funds to counties or Wisconsin works agencies in the amount of the disallowance from the appropriation account under s. 20.445 (3) (de) or (dz) or direct the department of corrections to reduce allocations of funds to counties in the amount of the disallowance from the appropriation account under s. 20.410 (3) (cd), in accordance with s. 16.544 to the extent applicable.

27,1925 Section 1925 . 49.45 (6s) of the statutes is repealed.

27,1926 Section 1926 . 49.45 (6t) (intro.) of the statutes is amended to read:

49.45 (6t) County department and local health department operating deficit reduction. (intro.) From the appropriation under s. 20.435 (1) (5) (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:

27,1927 Section 1927 . 49.45 (6t) (d) of the statutes is amended to read:

49.45 (6t) (d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (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.

27,1928 Section 1928 . 49.45 (6u) (intro.) of the statutes is amended to read:

49.45 (6u) (title) Facility operating deficit reduction Supplemental payments to certain facilities. (intro.) Except as provided in par. (g) Notwithstanding sub. (6m), from the appropriation under s. 20.435 (1) (5) (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. 3., that is established under s. 49.70 (1) or that is owned and operated by a city, village or town, the department shall may not distribute to these facilities not more than $18,600,000 $38,600,000 in each fiscal year, as determined by the department, and except that the department shall also distribute for this same purpose from the appropriation under s. 20.435 (5) (o) any additional federal medical assistance moneys that were not anticipated before enactment of the biennial budget act or other legislation affecting s. 20.435 (5) (o) and that were not used to fund nursing home rate increases under sub. (6m) (ag) 8. The total amount that a county certifies under this subsection may not exceed 100% of otherwise-unreimbursed care. In distributing funds under this subsection, the department shall perform all of the following:

27,1929 Section 1929 . 49.45 (6u) (d) of the statutes is amended to read:

49.45 (6u) (d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (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.

27,1930 Section 1930 . 49.45 (6u) (e) of the statutes is amended to read:

49.45 (6u) (e) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (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.

27,1931 Section 1931 . 49.45 (6u) (f) of the statutes is amended to read:

49.45 (6u) (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), apply the requirements under sub. (6m) (br) shall apply.

27,1932 Section 1932. 49.45 (6u) (g) of the statutes is amended to read:

49.45 (6u) (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 cease distributing to that facility funds under this section after the date on which the finding is made.

27,1932m Section 1932m. 49.45 (6v) of the statutes is created to read:

49.45 (6v) (a) In this subsection, “facility" has the meaning given in sub. (6m) (a) 3.

(b) The department shall, by December 1 of each year, submit to the joint committee on finance a report that provides information on the utilization of beds by recipients of medical assistance in facilities for the immediate prior 2 consecutive fiscal years.

(c) If the report specified in par. (b) indicates that utilization of beds by recipients of medical assistance in facilities decreased during the most recently completed fiscal year from the utilization of beds by recipients of medical assistance in facilities in the next most recently completed fiscal year, the department shall do all of the following:

1. Multiply the difference between the number of days of care provided in the facilities in each of the immediate prior 2 consecutive fiscal years by the average daily costs of care in such facilities. The average daily costs of care shall be calculated by dividing the total medical assistance expenditures for care in facilities by the total number of days of care provided in facilities in that fiscal year.

2. For new placements under ss. 46.275, 46.277 and 46.278 in the most recently completed fiscal year, multiply the number of days of service under ss. 46.275, 46.277 and 46.278 by the rate paid by the department for those placements.

3. Subtract the product calculated under subd. 2. from the product calculated under subd. 1.

4. Multiply the difference in subd. 3. by the amount paid by the department for the state's share of the costs of care.

(d) If par. (c) applies, the department's report under par. (b) shall include a proposal to transfer the amount calculated under par. (c) 4. from the appropriation under s. 20.435 (5) (b) to the appropriation under s. 20.435 (7) (bd) for the purpose of increasing funding for the community options program under s. 46.27. The secretary shall transfer the amount identified under the proposal if within 14 working days after the submission of the proposal the joint committee on finance does not schedule a meeting for the purpose of reviewing the proposed action.

(e) The joint committee on finance may approve or modify any proposal submitted by the department under this subsection.

27,1933 Section 1933 . 49.45 (6w) (intro.) of the statutes is amended to read:

49.45 (6w) Hospital operating deficit reduction. (intro.) From the appropriation under s. 20.435 (1) (5) (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:

27,1934 Section 1934 . 49.45 (6w) (d) of the statutes is amended to read:

49.45 (6w) (d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (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.

27,1935 Section 1935 . 49.45 (6x) (a) of the statutes is amended to read:

49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (5) (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).

27,1936 Section 1936 . 49.45 (6x) (d) of the statutes is amended to read:

49.45 (6x) (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) (5) (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.

27,1937 Section 1937 . 49.45 (6y) (a) of the statutes is amended to read:

49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (5) (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).

27,1938 Section 1938 . 49.45 (6z) (a) (intro.) of the statutes is amended to read:

49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (5) (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:

27,1939 Section 1939 . 49.45 (8) (b) of the statutes is amended to read:

49.45 (8) (b) Reimbursement under s. 20.435 (1) (5) (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).

27,1940 Section 1940 . 49.45 (8e) of the statutes is repealed.

27,1941 Section 1941 . 49.45 (8m) (intro.) of the statutes is amended to read: