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:
49.45 (8m) Rates for respiratory care services. (intro.) Notwithstanding the limits under subs. (8) and (8e) limit under sub. (8), the rates under sub. (8) and rates charged by providers under s. 49.46 (2) (a) 4. d. that are not home health agencies, for reimbursement for respiratory care services for ventilator-dependent individuals under ss. 49.46 (2) (b) 6. m. and 49.47 (6) (a) 1., shall be as follows:
27,1941b
Section 1941b. 49.45 (8m) (a) of the statutes is amended to read:
49.45 (8m) (a) For visits subsequent to an initial visit and for extended visits by a licensed registered nurse, $30 $30.60 per hour.
27,1941c
Section 1941c. 49.45 (8m) (a) of the statutes, as affected by 1997 Wisconsin Act .... (this act), is amended to read:
49.45 (8m) (a) For visits subsequent to an initial visit and for extended visits by a licensed registered nurse, $30.60 $31.21 per hour.
27,1941d
Section 1941d. 49.45 (8m) (b) of the statutes is amended to read:
49.45 (8m) (b) For visits subsequent to an initial visit and for extended visits by a licensed practical nurse, $20 $20.40 per hour.
27,1941e
Section 1941e. 49.45 (8m) (b) of the statutes, as affected by 1997 Wisconsin Act .... (this act), is amended to read:
49.45 (8m) (b) For visits subsequent to an initial visit and for extended visits by a licensed practical nurse, $20.40 $20.81 per hour.
27,1942
Section 1942
. 49.45 (8r) of the statutes is amended to read:
49.45 (8r) Payment for certain obstetric and gynecological care. The rate of payment for obstetric and gynecological care provided in primary care health professional shortage areas, as defined in s. 560.184 (1) (c) 560.183 (1) (cm), or provided to recipients of medical assistance who reside in primary care health professional shortage areas, that is equal to 125% of the rates paid under this section to primary care physicians in primary care health professional shortage areas, shall be paid to all certified primary care providers who provide obstetric or gynecological care to those recipients.
27,1942e
Section 1942e. 49.45 (18) (b) 5. of the statutes is amended to read:
49.45 (18) (b) 5. Family planning services, as defined in s. 253.07 (1) (b).
27,1942m
Section 1942m. 49.45 (24g) of the statutes is created to read:
49.45 (24g) Managed care for dental services pilot. (a) The department shall, in consultation with the Wisconsin Dental Association, develop a pilot project for the provision of dental services under a managed care system. The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to implement the pilot project developed under this subsection. If the waiver is granted and in effect, and if the department of health and family services determines that the costs of providing dental services under s. 49.46 (2) (b) 1. under the pilot project will not exceed the costs of providing those dental services in the absence of the pilot project, the department shall implement the pilot project in Ashland, Douglas, Bayfield and Iron counties
for the period beginning no later than January 1, 1998, and ending on June 30, 1999. Only those dental services covered under s. 49.46 (2) (b) 1. may be covered under the pilot project.
(b) In developing the pilot project under this subsection, the department shall provide that recipients who are subject to the pilot project are required to select a dental provider from among those dentists participating in the pilot project. The department shall also provide that, if a recipient does not make a selection, a dental provider will be assigned to the recipient.
(c) If the department is able to implement the pilot project under this subsection, the department shall contract with a person to do all of the following:
1. Accept a capitation payment from the department for each recipient who is subject to the pilot project.
2. Enroll dentists to be participating providers under the pilot project.
3. Coordinate with county departments to provide outreach and education to recipients and persons who are eligible to be recipients.
4. Pay all allowable charges on a fee-for-service basis to participating dentists on behalf of recipients in the pilot counties for dental services received by those recipients.
27,1943
Section 1943
. 49.45 (24m) (intro.) of the statutes is amended to read:
49.45 (24m) Home health care and personal care pilot program. (intro.) From the appropriations under s. 20.435 (1) (5) (b) and (o), in order to test the feasibility of instituting a system of reimbursement for providers of home health care and personal care services for medical assistance recipients that is based on competitive bidding, the department shall:
27,1943c
Section 1943c. 49.45 (24r) of the statutes is created to read:
49.45 (24r) Family planning demonstration project. The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to conduct a demonstration project to provide family planning services, as defined in s. 253.07 (1) (b), under medical assistance to any woman between the ages of 15 and 44 whose family income does not exceed 185% of the poverty line for a family the size of the woman's family. If the waiver is granted and in effect, the department shall implement the waiver no later than July 1, 1998, or on the effective date of the waiver, whichever is later.
27,1944
Section 1944
. 49.45 (25) (am) 14. of the statutes is created to read:
49.45 (25) (am) 14. Is a woman who is aged 45 to 64 and who is not a resident of a nursing home or otherwise receiving case management services under this paragraph.
27,1945
Section 1945
. 49.45 (25) (b) of the statutes is amended to read:
49.45 (25) (b) A county, city, village or, town or, in a county having a population of 500,000 or more, the department may elect to make case management services under this subsection available in the county, city, village or town to one or more of the categories of beneficiaries under par. (am) through the medical assistance program. A county, city, village or, town
or, in a county having a population of 500,000 or more, the department that elects to make the services available shall reimburse a case management provider for the amount of the allowable charges for those services under the medical assistance program that is not provided by the federal government.
27,1946
Section 1946
. 49.45 (25) (be) of the statutes is amended to read:
49.45 (25) (be) A private nonprofit agency that is a certified case management provider may elect to provide case management services to medical assistance beneficiaries who have HIV infection, as defined in s. 252.01 (2). The amount of the allowable charges for those services under the medical assistance program that is not provided by the federal government shall be paid from the appropriation under s. 20.435 (1) (5) (am).
27,1946m
Section 1946m. 49.45 (30e) of the statutes is created to read:
49.45 (30e) Community-based psychosocial service programs. (a) When services are reimbursable. Services under s. 49.46 (2) (b) 6. Lm. provided to an individual are reimbursable under the medical assistance program only if all of the following conditions are met:
1. Reimbursement for the services under s. 49.46 (2) (b) 6. Lm. in the manner provided under this subsection is permitted pursuant to federal law or pursuant to a waiver from the secretary of the federal department of health and human services.
2. The county in which the individual resides elects to make the services under s. 49.46 (2) (b) 6. Lm. available in the county through the medical assistance program.
3. The individual's psychosocial health needs require more than outpatient counseling, but less than the services provided by a community support program under s. 51.421.
4. The psychosocial services are provided by a community-based psychosocial service program certified under rules promulgated by the department under par. (b) 3.
(b) Rules. The department shall promulgate rules regarding all of the following:
1. Standards for determining whether an individual is eligible under par. (a) 3.
2. The scope of psychosocial services that may be provided under s. 49.46 (2) (b) 6. Lm.
3. Requirements for certification of community-based psychosocial service programs.
(c) Provider reimbursement. A county that elects to make the services under s. 49.46 (2) (b) 6. Lm. available shall reimburse a provider of the services for the amount of the allowable charges for those services under the medical assistance program that is not provided by the federal government. The department shall reimburse the provider only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.
27,1948m
Section 1948m. 49.45 (45) of the statutes is created to read:
49.45 (45) In-home and community mental health and alcohol and other drug abuse services. (a) Services under s. 49.46 (2) (b) 6. fm. provided to an individual are reimbursable under the medical assistance program only if all of the following conditions are met:
1. Reimbursement for the services under s. 49.46 (2) (b) 6. fm. in the manner provided under this subsection is permitted pursuant to federal law or pursuant to a waiver from the secretary of the federal department of health and human services.
2. The county, city, town or village in which the individual resides elects to make the services under s. 49.46 (2) (b) 6. fm. available in the county, city, town or village through the medical assistance program.
(b) A county, city, town or village that elects to make the services under s. 49.46 (2) (b) 6. fm. available shall reimburse a provider of the services for the amount of the allowable charges for those services under the medical assistance program that is not provided by the federal government. The department shall reimburse the provider only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.
27,1949
Section 1949
. 49.46 (1) (a) 1. of the statutes is amended to read:
49.46 (1) (a) 1. Any person included in the grant of aid to families with dependent children and any person who does not receive such aid solely because of the application of s. 49.19 (11) (a) 7. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1950b
Section 1950b. 49.46 (1) (a) 1m. of the statutes is amended to read:
49.46 (1) (a) 1m. Any pregnant woman who meets the resource and income limits under s. 49.19 (4) (bm) and (es) and whose pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th day after the last day of the pregnancy falls. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1951
Section 1951
. 49.46 (1) (a) 4m. of the statutes is created to read:
49.46 (1) (a) 4m. Any child for whom a payment is made under s. 49.775.
27,1952
Section 1952
. 49.46 (1) (a) 6. of the statutes is amended to read:
49.46 (1) (a) 6. Any person not described in pars. (c) to (e) who is considered, under federal law, to be receiving aid to families with dependent children for the purpose of determining eligibility for medical assistance. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1953b
Section 1953b. 49.46 (1) (a) 9. of the statutes is amended to read:
49.46 (1) (a) 9. Any pregnant woman not described under subd. 1. or 1m. whose family income does not exceed 133% of the poverty line for a family the size of the woman's family. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1954d
Section 1954d. 49.46 (1) (a) 10. of the statutes is amended to read:
49.46 (1) (a) 10. Any child not described under subd. 1. who is under 6 years of age and whose family income does not exceed 133% of the poverty line for a family the size of the child's family. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
27,1955d
Section 1955d. 49.46 (1) (a) 11. of the statutes is amended to read:
49.46 (1) (a) 11. Any If a waiver under s. 49.665 is granted and in effect, any child not described under subd. 1. who was born after September 30, 1983, who has attained the age of 6 but has not attained the age of 19 and whose family income does not exceed 100% of the poverty line for a family the size of the child's family. This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d) If a waiver under s. 49.665 is not granted or in effect, any child not described in subd. 1. who was born after September 30,1983, who has attained the age of 6 but has not attained the age of 19 and whose family income does not exceed 100% of the poverty line for a family the size of the child's family.
27,1956b
Section 1956b. 49.46 (1) (a) 12. of the statutes is amended to read:
49.46 (1) (a) 12. Any child not described under subd. 1. who is under 19 years of age and who meets the resource and income limits under s. 49.19 (4). This subdivision does not apply beginning on the first day of the 6th month beginning after the date stated in the notice under s. 49.141 (2) (d).
