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,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,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,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,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,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,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,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,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,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,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,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,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,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,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.
AB100-engrossed,919,319
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
2020.435
(1) (5) (b) and (o) the department shall distribute funding in each fiscal year
21to provide supplemental payment to hospitals that enter into a contract under s.
2249.02 (2) to provide health care services funded by a relief block grant, as determined
23by the department, for hospital services that are not in excess of the hospitals'
24customary charges for the services, as limited under
42 USC 1396b (i) (3). If no relief
25block grant is awarded under this chapter or if the allocation of funds to such
1hospitals would exceed any limitation under
42 USC 1396b (i) (3), the department
2may distribute funds to hospitals that have not entered into a contract under s. 49.02
3(2).
AB100-engrossed,919,155
49.45
(6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations
6under s. 20.435
(1) (5) (b) and (o) the department shall distribute funding in each
7fiscal year to supplement payment for services to hospitals that enter into a contract
8under s. 49.02 (2) to provide health care services funded by a relief block grant under
9this chapter, if the department determines that the hospitals serve a
10disproportionate number of low-income patients with special needs. If no medical
11relief block grant under this chapter is awarded or if the allocation of funds to such
12hospitals would exceed any limitation under
42 USC 1396b (i) (3), the department
13may distribute funds to hospitals that have not entered into a contract under s. 49.02
14(2). The department may not distribute funds under this subsection to the extent
15that the distribution would do any of the following:
AB100-engrossed,919,2117
49.45
(8) (b) Reimbursement under s. 20.435
(1) (5) (b) and (o) for home health
18services provided by a certified home health agency or independent nurse shall be
19made at the home health agency's or nurse's usual and customary fee per patient care
20visit, subject to a maximum allowable fee per patient care visit that is established
21under par. (c).
AB100-engrossed,920,324
49.45
(8m) Rates for respiratory care services. (intro.) Notwithstanding the
25limits under subs. (8) and (8e) limit under sub. (8), the rates under sub. (8) and rates
1charged by providers under s. 49.46 (2) (a) 4. d. that are not home health agencies,
2for reimbursement for respiratory care services for ventilator-dependent
3individuals under ss. 49.46 (2) (b) 6. m. and 49.47 (6) (a) 1., shall be as follows:
AB100-engrossed,920,65
49.45
(8m) (a) For visits subsequent to an initial visit and for extended visits
6by a licensed registered nurse,
$30 $30.60 per hour.
AB100-engrossed, s. 1941c
7Section 1941c. 49.45 (8m) (a) of the statutes, as affected by 1997 Wisconsin
8Act .... (this act), is amended to read:
AB100-engrossed,920,109
49.45
(8m) (a) For visits subsequent to an initial visit and for extended visits
10by a licensed registered nurse,
$30.60 $31.21 per hour.
AB100-engrossed,920,1312
49.45
(8m) (b) For visits subsequent to an initial visit and for extended visits
13by a licensed practical nurse,
$20 $20.40 per hour.
AB100-engrossed, s. 1941e
14Section 1941e. 49.45 (8m) (b) of the statutes, as affected by 1997 Wisconsin
15Act .... (this act), is amended to read:
AB100-engrossed,920,1716
49.45
(8m) (b) For visits subsequent to an initial visit and for extended visits
17by a licensed practical nurse,
$20.40 $20.81 per hour.
AB100-engrossed,921,219
49.45
(8r) Payment for certain obstetric and gynecological care. The rate
20of payment for obstetric and gynecological care provided in primary care
health
21professional shortage areas, as defined in s.
560.184 (1) (c) 560.183 (1) (cm), or
22provided to recipients of medical assistance who reside in primary care
health
23professional shortage areas, that is equal to 125% of the rates paid under this section
24to primary care physicians in primary care
health professional shortage areas, shall
1be paid to all certified primary care providers who provide obstetric or gynecological
2care to those recipients.
AB100-engrossed,921,44
49.45
(18) (b) 5. Family planning services
, as defined in s. 253.07 (1) (b).
AB100-engrossed,921,186
49.45
(24g) Managed care for dental services pilot. (a) The department
7shall, in consultation with the Wisconsin Dental Association, develop a pilot project
8for the provision of dental services under a managed care system. The department
9shall request a waiver from the secretary of the federal department of health and
10human services to permit the department to implement the pilot project developed
11under this subsection. If the waiver is granted and in effect, and if the department
12of health and family services determines that the costs of providing dental services
13under s. 49.46 (2) (b) 1. under the pilot project will not exceed the costs of providing
14those dental services in the absence of the pilot project, the department shall
15implement the pilot project in Ashland, Douglas, Bayfield and Iron counties for the
16period beginning no later than January 1, 1998, and ending on June 30, 1999. Only
17those dental services covered under s. 49.46 (2) (b) 1. may be covered under the pilot
18project.
AB100-engrossed,921,2319
(b) In developing the pilot project under this subsection, the department shall
20provide that recipients who are subject to the pilot project are required to select a
21dental provider from among those dentists participating in the pilot project. The
22department shall also provide that, if a recipient does not make a selection, a dental
23provider will be assigned to the recipient.
AB100-engrossed,921,2524
(c) If the department is able to implement the pilot project under this
25subsection, the department shall contract with a person to do all of the following:
AB100-engrossed,922,2
11. Accept a capitation payment from the department for each recipient who is
2subject to the pilot project.
AB100-engrossed,922,33
2. Enroll dentists to be participating providers under the pilot project.
AB100-engrossed,922,54
3. Coordinate with county departments to provide outreach and education to
5recipients and persons who are eligible to be recipients.
AB100-engrossed,922,86
4. Pay all allowable charges on a fee-for-service basis to participating dentists
7on behalf of recipients in the pilot counties for dental services received by those
8recipients.
AB100-engrossed,922,1410
49.45
(24m) Home health care and personal care pilot program. (intro.)
11From the appropriations under s. 20.435
(1) (5) (b) and (o), in order to test the
12feasibility of instituting a system of reimbursement for providers of home health care
13and personal care services for medical assistance recipients that is based on
14competitive bidding, the department shall:
AB100-engrossed,922,2516
49.45
(24r) Family planning demonstration project. No later than January
171, 1998, the department shall request a waiver from the secretary of the federal
18department of health and human services to permit the department to conduct a
19demonstration project to provide family planning services, as defined in s. 253.07 (1)
20(b), under medical assistance to any woman between the ages of 15 and 44 whose
21family income does not exceed 185% of the poverty line for a family the size of the
22woman's family. If the waiver is granted, the department shall submit to the chief
23clerk of each house of the legislature, for distribution to the appropriate standing
24committees under s. 13.172 (3), proposed legislation to enable the department to
25implement the demonstration project.
AB100-engrossed,923,42
49.45
(25) (am) 14. Is a woman who is aged 45 to 64 and who is not a resident
3of a nursing home or otherwise receiving case management services under this
4paragraph.
AB100-engrossed,923,146
49.45
(25) (b) A county, city, village
or
, town
or, in a county having a population
7of 500,000 or more, the department may elect to make case management services
8under this subsection available in the county, city, village or town to one or more of
9the categories of beneficiaries under par. (am) through the medical assistance
10program. A county, city, village
or, town
or, in a county having a population of 500,000
11or more, the department that elects to make the services available shall reimburse
12a case management provider for the amount of the allowable charges for those
13services under the medical assistance program that is not provided by the federal
14government.
AB100-engrossed,923,2116
49.45
(25) (be) A private nonprofit agency that is a certified case management
17provider may elect to provide case management services to medical assistance
18beneficiaries who have HIV infection, as defined in s. 252.01 (2). The amount of the
19allowable charges for those services under the medical assistance program that is not
20provided by the federal government shall be paid from the appropriation under s.
2120.435
(1) (5) (am).
AB100-engrossed,924,223
49.45
(30e) Community-based psychosocial service programs. (a)
When
24services are reimbursable. Services under s. 49.46 (2) (b) 6. Lm. provided to an
1individual are reimbursable under the medical assistance program only if all of the
2following conditions are met:
AB100-engrossed,924,53
1. Reimbursement for the services under s. 49.46 (2) (b) 6. Lm. in the manner
4provided under this subsection is permitted pursuant to federal law or pursuant to
5a waiver from the secretary of the federal department of health and human services.
AB100-engrossed,924,86
2. The county in which the individual resides elects to make the services under
7s. 49.46 (2) (b) 6. Lm. available in the county through the medical assistance
8program.
AB100-engrossed,924,119
3. The individual's psychosocial health needs require more than outpatient
10counseling, but less than the services provided by a community support program
11under s. 51.421.
AB100-engrossed,924,1412
4. The psychosocial services are provided by a community-based psychosocial
13service program certified under rules promulgated by the department under par. (b)
143.
AB100-engrossed,924,1615
(b)
Rules. The department shall promulgate rules regarding all of the
16following:
AB100-engrossed,924,1817
1. Standards for determining whether an individual is eligible under par. (a)
183.
AB100-engrossed,924,2019
2. The scope of psychosocial services that may be provided under s. 49.46 (2)
20(b) 6. Lm.
AB100-engrossed,924,2221
3. Requirements for certification of community-based psychosocial service
22programs.
AB100-engrossed,925,423
(c)
Provider reimbursement. A county that elects to make the services under
24s. 49.46 (2) (b) 6. Lm. available shall reimburse a provider of the services for the
25amount of the allowable charges for those services under the medical assistance
1program that is not provided by the federal government. The department shall
2reimburse the provider only for the amount of the allowable charges for those
3services under the medical assistance program that is provided by the federal
4government.