AB100-engrossed, s. 1905 10Section 1905. 49.45 (2) (a) 3. of the statutes is amended to read:
AB100-engrossed,905,1611 49.45 (2) (a) 3. Determine the eligibility of persons for medical assistance,
12rehabilitative and social services under ss. 49.46, 49.468 and 49.47 and rules and
13policies adopted by the department and may designate this function to the county
14department under s. 46.215 or, 46.22 or 46.23 or , to the extent permitted by federal
15law or a waiver from federal secretary of health and human services, to a Wisconsin
16works agency
.
AB100-engrossed, s. 1906 17Section 1906. 49.45 (2) (a) 5. of the statutes is amended to read:
AB100-engrossed,905,2018 49.45 (2) (a) 5. Cooperate with the division for learning support, equity and
19advocacy in the department of education public instruction to carry out the
20provisions of Title XIX.
AB100-engrossed, s. 1909 21Section 1909. 49.45 (2) (a) 17. of the statutes is amended to read:
AB100-engrossed,905,2522 49.45 (2) (a) 17. Notify the governor, the joint committee on legislative
23organization, the joint committee on finance and appropriate standing committees,
24as determined by the presiding officer of each house, if the appropriation under s.
2520.435 (1) (5) (b) is insufficient to provide the state share of medical assistance.
AB100-engrossed, s. 1910
1Section 1910. 49.45 (3) (ag) of the statutes is created to read:
AB100-engrossed,906,32 49.45 (3) (ag) Reimbursement shall be made to each entity contracted with
3under s. 46.271 (2m) for assessments completed under s. 46.271 (2m) (a) 2.
AB100-engrossed, s. 1911 4Section 1911. 49.45 (5) of the statutes is renumbered 49.45 (5) (a) and
5amended to read:
AB100-engrossed,906,116 49.45 (5) (a) Any person whose application for medical assistance is denied or
7is not acted upon promptly or who believes that the payments made in the person's
8behalf have not been properly determined or that his or her eligibility has not been
9properly determined
may file an appeal with the department pursuant to s. 49.21 (1)
10par. (b). Review is unavailable if the decision or failure to act arose more than 45 days
11before submission of the petition for a hearing
.
AB100-engrossed, s. 1912 12Section 1912. 49.45 (5) (b) of the statutes is created to read:
AB100-engrossed,907,213 49.45 (5) (b) 1. Upon receipt of a timely petition under par. (a) the department
14shall give the applicant or recipient reasonable notice and opportunity for a fair
15hearing. The department may make such additional investigation as it considers
16necessary. Notice of the hearing shall be given to the applicant or recipient and to
17the county clerk or, if a Wisconsin works agency is responsible for making the medical
18assistance determination, the Wisconsin works agency. The county or the Wisconsin
19works agency may be represented at such hearing. The department shall render its
20decision as soon as possible after the hearing and shall send a certified copy of its
21decision to the applicant or recipient, the county clerk and to the county officer or the
22Wisconsin works agency charged with administration of the medical assistance
23program. The decision of the department shall have the same effect as an order of
24the county officer or the Wisconsin works agency charged with the administration
25of the medical assistance program. The decision shall be final, but may be revoked

1or modified as altered conditions may require. The department shall deny a petition
2for a hearing or shall refuse to grant relief if:
AB100-engrossed,907,33 a. The petitioner withdraws the petition in writing.
AB100-engrossed,907,64 b. The sole issue in the petition concerns an automatic payment adjustment or
5change that affects an entire class of recipients and is the result of a change in state
6or federal law.
AB100-engrossed,907,97 c. The petitioner abandons the petition. Abandonment occurs if the petitioner
8fails to appear in person or by representative at a scheduled hearing without good
9cause, as determined by the department.
AB100-engrossed,907,1810 2. If a recipient requests a hearing within the timely notice period specified in
1142 CFR 431.231 (c), medical assistance coverage shall not be suspended, reduced or
12discontinued until a decision is rendered after the hearing but medical assistance
13payments made pending the hearing decision may be recovered by the department
14if the contested decision or failure to act is upheld. The department shall promptly
15notify the county department or, if a Wisconsin works agency is responsible for
16making the medical assistance determination, the Wisconsin works agency of the
17county in which the recipient resides that the recipient has requested a hearing.
18Medical assistance coverage shall be suspended, reduced or discontinued if:
AB100-engrossed,907,2019 a. The recipient is contesting a state or federal law or a change in state or
20federal law and not the determination of the payment made on the recipient's behalf.
AB100-engrossed,907,2321 b. The recipient is notified of a change in his or her medical assistance coverage
22while the hearing decision is pending but the recipient fails to request a hearing on
23the change.
AB100-engrossed,907,2524 3. The recipient shall be promptly informed in writing if medical assistance is
25to be suspended, reduced or terminated pending the hearing decision.
AB100-engrossed, s. 1913
1Section 1913. 49.45 (5m) (a) of the statutes is amended to read:
AB100-engrossed,908,82 49.45 (5m) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
320.435 (1) (5) (b) and (o) the department shall distribute not more than $2,256,000
4in each fiscal year, to provide supplemental funds to rural hospitals that, as
5determined by the department, have high utilization of inpatient services by
6patients whose care is provided from governmental sources, except that the
7department may not distribute funds to a rural hospital to the extent that the
8distribution would exceed any limitation under 42 USC 1396b (i) (3).
AB100-engrossed, s. 1913m 9Section 1913m. 49.45 (6b) (intro.) of the statutes is amended to read:
AB100-engrossed,908,1510 49.45 (6b) (title) Centers Center for the developmentally disabled. (intro.)
11From the appropriation under s. 20.435 (2) (gk), the department may reimburse the
12cost of services provided by the centers a center for the developmentally disabled.
13Reimbursement to the centers a center for the developmentally disabled shall be
14reduced following each placement made under s. 46.275 which involves a relocation
15from a center for the developmentally disabled, as follows:
AB100-engrossed, s. 1913r 16Section 1913r. 49.45 (6b) (a) of the statutes is amended to read:
AB100-engrossed,908,1917 49.45 (6b) (a) Beginning in fiscal year 1995-96 1997-98, for relocations from
18the central Wisconsin a center for the developmentally disabled, by $205 per day, if
19that center is located in Dane County
.
AB100-engrossed, s. 1914m 20Section 1914m. 49.45 (6b) (b) of the statutes is amended to read:
AB100-engrossed,908,2321 49.45 (6b) (b) Beginning in fiscal year 1995-96 1997-98, for relocations from
22the northern Wisconsin a center for the developmentally disabled, by $199 $174 per
23day, if that center is located in Chippewa County.
AB100-engrossed, s. 1915m 24Section 1915m. 49.45 (6b) (c) of the statutes is amended to read:
AB100-engrossed,909,3
149.45 (6b) (c) Beginning in fiscal year 1995-96 1997-98, for relocations from
2the southern Wisconsin a center for the developmentally disabled, by $149 $174 per
3day, if that center is located in Racine County.
AB100-engrossed, s. 1916 4Section 1916. 49.45 (6c) (c) (intro.) of the statutes is amended to read:
AB100-engrossed,909,105 49.45 (6c) (c) Resident review. (intro.) Except as provided in par. (e), by April
61, 1990, and at least annually thereafter,
the department or an entity to which the
7department has delegated authority shall review every resident of a facility or
8institution for mental diseases who has a developmental disability or mental illness
9and who has experienced a significant change in his or her physical or mental
10condition
to determine if any of the following applies:
AB100-engrossed, s. 1917 11Section 1917. 49.45 (6m) (a) 3. of the statutes is amended to read:
AB100-engrossed,909,1412 49.45 (6m) (a) 3. "Facility" means a nursing home as defined under s. 50.01 (3)
13or a community-based residential facility that is licensed under s. 50.03 and that is
14certified by the department as a provider of medical assistance.
AB100-engrossed, s. 1918 15Section 1918. 49.45 (6m) (a) 5. of the statutes is created to read:
AB100-engrossed,909,1616 49.45 (6m) (a) 5. "Nursing home" has the meaning given under s. 50.01 (3).
AB100-engrossed, s. 1919 17Section 1919. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:
AB100-engrossed,910,518 49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this
19subsection made under s. 20.435 (1) (b), (o) or (p) or (5) (b) or (o) shall, except as
20provided in pars. (bg), (bm) and (br), be determined according to a prospective
21payment system updated annually by the department. The payment system shall
22implement standards which are reasonable and adequate to meet the costs which
23must be incurred by efficiently and economically operated facilities in order to
24provide care in conformity with this section, with federal regulations authorized
25under 42 USC 1396a (a) (13) (A), 1396a (a) (30), 1396b (i) (3), 1396L and 1396r (e)

1and with quality and safety standards established under subch. II of ch. 50 and ch.
2150. In administering this payment system, the department shall allow costs it
3determines
that are necessary and proper for providing patient care and that meet
4quality and safety standards established under subch. II of ch. 50 and ch. 150
. The
5payment system shall reflect all of the following:
AB100-engrossed, s. 1919g 6Section 1919g. 49.45 (6m) (ag) 2. of the statutes is amended to read:
AB100-engrossed,910,107 49.45 (6m) (ag) 2. Standards established by the department for costs of
8economically and efficiently operated facilities
that shall be based upon allowable
9costs incurred by facilities in the state as available from information submitted
10under par. (c) 3. and compiled by the department.
AB100-engrossed, s. 1920 11Section 1920. 49.45 (6m) (ag) 3m. of the statutes is amended to read:
AB100-engrossed,910,1612 49.45 (6m) (ag) 3m. For state fiscal year 1995-96 1997-98, rates that shall be
13set by the department based on information from cost reports for the 1994 1996 fiscal
14year of the facility and for state fiscal year 1996-97 1998-99, rates that shall be set
15by the department based on information from cost reports for the 1995 1997 fiscal
16year of the facility.
AB100-engrossed, s. 1921 17Section 1921. 49.45 (6m) (ag) 8. of the statutes is amended to read:
AB100-engrossed,911,1018 49.45 (6m) (ag) 8. Calculation of total payments and supplementary payments
19to facilities that permits an aggregate increase in funds allocated under s. 20.435 (1)
20(5) (b) and (o) for nursing home care provided medical assistance recipients,
21including an increase resulting in adjustment of facility base rates and percentage
22increases over facility base rates,
over that paid for services provided in state fiscal
23year 1994-95 1996-97 of no more than 4.25% 5.4% or $45,908,500, whichever is less,
24during state fiscal year 1995-96 and 1997-98; and calculation of total payments and
25supplementary payments to facilities that permits an aggregate increase in funds

1allocated under s. 20.435 (5) (b) and (o) for nursing home care provided medical
2assistance recipients, including a percentage increase over facility base rates,
over
3that paid for services provided in state fiscal year 1995-96 1997-98 of no more than
43.5% or $30,145,200, whichever is less, during state fiscal year 1996-97, excluding
51998-99. Calculation of total payments and supplementary payments under this
6subdivision excludes
increases in total payments attributable to increases in
7recipient utilization of facility care, payments for the provision of active treatment
8to facility residents with developmental disability or chronic mental illness and
9payments for preadmission screening of facility applicants and annual reviews of
10facility residents required under 42 USC 1396r (e).
AB100-engrossed, s. 1922 11Section 1922. 49.45 (6m) (ap) of the statutes is created to read:
AB100-engrossed,911,1612 49.45 (6m) (ap) If the bed occupancy of a nursing home is below the minimum
13patient day occupancy standards that are established by the department under par.
14(ar) (intro.), the department may approve a request by the nursing home to delicense
15any of the nursing home's licensed beds. If the department approves the nursing
16home's request, all of the following apply:
AB100-engrossed,911,1817 1. The department shall delicense the number of beds in accordance with the
18nursing home's request.
AB100-engrossed,911,2119 2. The department may not include the number of beds of the nursing home
20that the department delicenses under this paragraph in determining the costs per
21patient day under the minimum patient day occupancy standards under par. (ar).
AB100-engrossed,911,2322 3. The nursing home may not use or sell a bed that is delicensed under this
23paragraph.
AB100-engrossed,912,624 4. a. Every 12 months following the delicensure of a bed under this paragraph,
25for which a nursing home has not resumed licensure under subd. 5., the department

1shall reduce the licensed bed capacity of the nursing home by 10% of all of the nursing
2home's beds that remain delicensed under this paragraph or by 25% of one bed,
3whichever is greater. The department shall reduce the statewide maximum number
4of licensed nursing home beds under s. 150.31 (1) (intro.) by the number or portion
5of a number of beds by which the nursing home's licensed bed capacity is reduced
6under this subdivision.
AB100-engrossed,912,107 b. Subdivision 4. a. does not apply with respect to the delicensure of beds
8between July 1, 1997, and October 1, 1997, during the period of any contract entered
9into by a nursing home prior to January 1, 1997, if the contract requires the nursing
10home to maintain its current licensed bed capacity.
AB100-engrossed,912,1811 5. A nursing home retains the right to resume licensure of a bed of the nursing
12home that was delicensed under this paragraph unless the licensed bed capacity of
13the nursing home has been reduced by that bed under subd. 4. The nursing home
14may not resume licensure of a fraction of a bed. The nursing home may resume
15licensure 18 months after the nursing home notifies the department in writing that
16the nursing home intends to resume the licensure. If a nursing home resumes
17licensure of a bed under this subdivision, subd. 2. does not apply with respect to that
18bed.
AB100-engrossed,912,2419 6. If subd. 4. b. applies and the nursing home later resumes licensure of a bed
20that was delicensed between the effective date of this subdivision .... [revisor inserts
21date], and the date that is 60 days after the effective date of this subdivision ....
22[revisor inserts date], the department shall calculate the costs per patient day using
23the methodology specified in the state plan that is in place at the time that the
24delicensed beds are resumed.
AB100-engrossed, s. 1923 25Section 1923. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:
AB100-engrossed,913,12
149.45 (6m) (ar) 1. a. The department shall establish standards for payment of
2allowable direct care costs, for facilities that do not primarily serve the
3developmentally disabled,
that are at least 110% of not less than the median for
4direct care costs for a sample of all of those facilities that do not primarily serve the
5developmentally disabled
in this state and separate standards for payment of
6allowable direct care costs, for facilities that primarily serve the developmentally
7disabled,
that are at least 110% of not less than the median for direct care costs for
8a sample of all of those facilities primarily serving the developmentally disabled in
9this state
. The standards shall be adjusted by the department for regional labor cost
10variations. The department may decrease the percentage established for the
11standards only if amounts available under par. (ag) (intro.) are insufficient to provide
12total payment under par. (am), less capital costs under subd. 6.
AB100-engrossed, s. 1924 13Section 1924. 49.45 (6m) (br) 1. of the statutes, as affected by 1997 Wisconsin
14Act 3
, is amended to read:
AB100-engrossed,913,2415 49.45 (6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435 (1) (5) (bt) or (bu)
16or (7) (b) or 20.445 (3) (de) (dz), the department shall reduce allocations of funds to
17counties in the amount of the disallowance from the appropriations appropriation
18account
under s. 20.410 (3) (cd) or 20.435 (1) (5) (bt) or (bu) or (7) (b), or the
19department shall direct the department of workforce development to reduce
20allocations of funds to counties or Wisconsin works agencies in the amount of the
21disallowance from the appropriation account under s. 20.445 (3) (de) or (dz) or direct
22the department of corrections to reduce allocations of funds to counties in the amount
23of the disallowance from the appropriation account under s. 20.410 (3) (cd)
, in
24accordance with s. 16.544 to the extent applicable.
AB100-engrossed, s. 1925 25Section 1925. 49.45 (6s) of the statutes is repealed.
AB100-engrossed, s. 1926
1Section 1926. 49.45 (6t) (intro.) of the statutes is amended to read:
AB100-engrossed,914,122 49.45 (6t) County department and local health department operating
3deficit reduction.
(intro.) From the appropriation under s. 20.435 (1) (5) (o), for
4reduction of operating deficits, as defined under criteria developed by the
5department, incurred by a county department under s. 46.215, 46.22, 46.23 or 51.42
6or by a local health department, as defined in s. 250.01 (4), for services provided
7under s. 49.46 (2) (a) 4. d. and (b) 6. f., j., k. and L., 9. and 15., for case management
8services under s. 49.46 (2) (b) 12. and for mental health day treatment services for
9minors provided under the authorization under 42 USC 1396d (r) (5), the department
10shall allocate up to $4,500,000 in each fiscal year to these county departments, or
11local health departments as determined by the department, and shall perform all of
12the following:
AB100-engrossed, s. 1927 13Section 1927. 49.45 (6t) (d) of the statutes is amended to read:
AB100-engrossed,914,1814 49.45 (6t) (d) If the federal department of health and human services approves
15for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (o) that result
16in a lesser allocation amount than that allocated under this subsection or disallows
17use of the allocation of federal medicaid funds under par. (c), reduce allocations under
18this subsection and distribute on a prorated basis, as determined by the department.
AB100-engrossed, s. 1928 19Section 1928. 49.45 (6u) (intro.) of the statutes is amended to read:
AB100-engrossed,915,920 49.45 (6u) (title) Facility operating deficit reduction Supplemental
21payments to certain facilities
. (intro.) Except as provided in par. (g)
22Notwithstanding sub. (6m), from the appropriation under s. 20.435 (1) (5) (o), for
23reduction of operating deficits, as defined under criteria developed by the
24department, incurred by a facility, as defined under sub. (6m) (a) 2. 3., that is
25established under s. 49.70 (1) or that is owned and operated by a city, village or town,

1the department shall may not distribute to these facilities not more than $18,600,000
2$38,600,000 in each fiscal year, as determined by the department, and except that
3the department shall also distribute for this same purpose from the appropriation
4under s. 20.435 (5) (o) any additional federal medical assistance moneys that were
5not anticipated before enactment of the biennial budget act or other legislation
6affecting s. 20.435 (5) (o) and that were not used to fund nursing home rate increases
7under sub. (6m) (ag) 8. The total amount that a county certifies under this subsection
8may not exceed 100% of otherwise-unreimbursed care. In distributing funds under
9this subsection, the department
shall perform all of the following:
AB100-engrossed, s. 1929 10Section 1929. 49.45 (6u) (d) of the statutes is amended to read:
AB100-engrossed,915,1511 49.45 (6u) (d) If the federal department of health and human services approves
12for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (o) that result
13in a lesser allocation amount than that allocated under this subsection, allocate not
14more than the lesser amount so approved by the federal department of health and
15human services.
AB100-engrossed, s. 1930 16Section 1930. 49.45 (6u) (e) of the statutes is amended to read:
AB100-engrossed,915,2117 49.45 (6u) (e) If the federal department of health and human services approves
18for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (o) that result
19in a lesser allocation amount than that allocated under this subsection, submit a
20revision of the method developed under par. (b) for approval by the joint committee
21on finance in that state fiscal year.
AB100-engrossed, s. 1931 22Section 1931. 49.45 (6u) (f) of the statutes is amended to read:
AB100-engrossed,915,2523 49.45 (6u) (f) If the federal department of health and human services disallows
24use of the allocation of matching federal medical assistance funds distributed under
25par. (c), apply the requirements under sub. (6m) (br) shall apply.
AB100-engrossed, s. 1932
1Section 1932. 49.45 (6u) (g) of the statutes is amended to read:
AB100-engrossed,916,62 49.45 (6u) (g) If a facility that is otherwise eligible for an allocation of funds
3under this section is found by the federal health care financing administration or the
4department to be an institution for mental diseases, as defined under 42 CFR
5435.1009
, the department may not allocate cease distributing to that facility funds
6under this section after the date on which the finding is made.
AB100-engrossed, s. 1932m 7Section 1932m. 49.45 (6v) of the statutes is created to read:
AB100-engrossed,916,98 49.45 (6v) (a) In this subsection, "facility" has the meaning given in sub. (6m)
9(a) 3.
AB100-engrossed,916,1310 (b) The department shall, by December 1 of each year, submit to the joint
11committee on finance a report that provides information on the utilization of beds by
12recipients of medical assistance in facilities for the immediate prior 2 consecutive
13fiscal years.
AB100-engrossed,916,1814 (c) If the report specified in par. (b) indicates that utilization of beds by
15recipients of medical assistance in facilities decreased during the most recently
16completed fiscal year from the utilization of beds by recipients of medical assistance
17in facilities in the next most recently completed fiscal year, the department shall do
18all of the following:
AB100-engrossed,916,2319 1. Multiply the difference between the number of days of care provided in the
20facilities in each of the immediate prior 2 consecutive fiscal years by the average
21daily costs of care in such facilities. The average daily costs of care shall be calculated
22by dividing the total medical assistance expenditures for care in facilities by the total
23number of days of care provided in facilities in that fiscal year.
AB100-engrossed,917,3
12. For new placements under ss. 46.275, 46.277 and 46.278 in the most recently
2completed fiscal year, multiply the number of days of service under ss. 46.275, 46.277
3and 46.278 by the rate paid by the department for those placements.
AB100-engrossed,917,54 3. Subtract the product calculated under subd. 2. from the product calculated
5under subd. 1.
AB100-engrossed,917,76 4. Multiply the difference in subd. 3. by the amount paid by the department for
7the state's share of the costs of care.
AB100-engrossed,917,148 (d) If par. (c) applies, the department's report under par. (b) shall include a
9proposal to transfer the amount calculated under par. (c) 4. from the appropriation
10under s. 20.435 (5) (b) to the appropriation under s. 20.435 (7) (bd) for the purpose
11of increasing funding for the community options program under s. 46.27. The
12secretary shall transfer the amount identified under the proposal if within 14
13working days after the submission of the proposal the joint committee on finance
14does not schedule a meeting for the purpose of reviewing the proposed action.
AB100-engrossed,917,1615 (e) The joint committee on finance may approve or modify any proposal
16submitted by the department under this subsection.
AB100-engrossed, s. 1933 17Section 1933. 49.45 (6w) (intro.) of the statutes is amended to read:
AB100-engrossed,917,2418 49.45 (6w) Hospital operating deficit reduction. (intro.) From the
19appropriation under s. 20.435 (1) (5) (o), for reduction of operating deficits, as defined
20under criteria developed by the department, incurred by a hospital, as defined under
21s. 50.33 (2) (a) and (b), that is operated by the state, established under s. 49.71 or
22owned and operated by a city or village, the department shall allocate up to
23$3,300,000 in each fiscal year to these hospitals, as determined by the department,
24and shall perform all of the following:
AB100-engrossed, s. 1934 25Section 1934. 49.45 (6w) (d) of the statutes is amended to read:
AB100-engrossed,918,5
149.45 (6w) (d) If the federal department of health and human services approves
2for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (o) that result
3in a lesser allocation amount than that allocated under this subsection or disallows
4use of the allocation of federal medicaid funds under par. (c), reduce allocations under
5this subsection and distribute on a prorated basis, as determined by the department.
AB100-engrossed, s. 1935 6Section 1935. 49.45 (6x) (a) of the statutes is amended to read:
AB100-engrossed,918,117 49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
820.435 (1) (5) (b) and (o) the department shall distribute not more than $4,748,000
9in each fiscal year, to provide funds to an essential access city hospital, except that
10the department may not allocate funds to an essential access city hospital to the
11extent that the allocation would exceed any limitation under 42 USC 1396b (i) (3).
AB100-engrossed, s. 1936 12Section 1936. 49.45 (6x) (d) of the statutes is amended to read:
AB100-engrossed,918,1713 49.45 (6x) (d) If the federal department of health and human services approves
14for state expenditure in any state fiscal year amounts under s. 20.435 (1) (5) (o) that
15result in a lesser distribution amount than that distributed under this subsection or
16disallows use of federal medicaid funds under par. (a), the department of health and
17family services shall reduce the distributions under this subsection.
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