AB100,827,2322 49.45 (3) (ag) Reimbursement shall be made to each entity contracted with
23under s. 46.271 (2m) for assessments completed under s. 46.271 (2m) (a) 2.
AB100, s. 1911 24Section 1911. 49.45 (5) of the statutes is renumbered 49.45 (5) (a) and
25amended to read:
AB100,828,6
149.45 (5) (a) Any person whose application for medical assistance is denied or
2is not acted upon promptly or who believes that the payments made in the person's
3behalf have not been properly determined or that his or her eligibility has not been
4properly determined
may file an appeal with the department pursuant to s. 49.21 (1)
5par. (b). Review is unavailable if the decision or failure to act arose more than 45 days
6before submission of the petition for a hearing
.
AB100, s. 1912 7Section 1912. 49.45 (5) (b) of the statutes is created to read:
AB100,828,218 49.45 (5) (b) 1. Upon receipt of a timely petition under par. (a) the department
9shall give the applicant or recipient reasonable notice and opportunity for a fair
10hearing. The department may make such additional investigation as it considers
11necessary. Notice of the hearing shall be given to the applicant or recipient and to
12the county clerk or Wisconsin works agency. The county or Wisconsin works agency
13may be represented at such hearing. The department shall render its decision as
14soon as possible after the hearing and shall send a certified copy of its decision to the
15applicant or recipient, the county clerk and to the county officer or Wisconsin works
16agency charged with administration of the medical assistance program. The decision
17of the department shall have the same effect as an order of the county officer or
18Wisconsin works agency charged with the administration of the medical assistance
19program. The decision shall be final, but may be revoked or modified as altered
20conditions may require. The department shall deny a petition for a hearing or shall
21refuse to grant relief if:
AB100,828,2222 a. The petitioner withdraws the petition in writing.
AB100,828,2523 b. The sole issue in the petition concerns an automatic payment adjustment or
24change that affects an entire class of recipients and is the result of a change in state
25or federal law.
AB100,829,3
1c. The petitioner abandons the petition. Abandonment occurs if the petitioner
2fails to appear in person or by representative at a scheduled hearing without good
3cause, as determined by the department.
AB100,829,114 2. If a recipient requests a hearing within the timely notice period specified in
542 CFR 431.231 (c), medical assistance coverage shall not be suspended, reduced or
6discontinued until a decision is rendered after the hearing but medical assistance
7payments made pending the hearing decision may be recovered by the department
8if the contested decision or failure to act is upheld. The department shall promptly
9notify the county department or Wisconsin works agency of the county in which the
10recipient resides that the recipient has requested a hearing. Medical assistance
11coverage shall be suspended, reduced or discontinued if:
AB100,829,1312 a. The recipient is contesting a state or federal law or a change in state or
13federal law and not the determination of the payment made on the recipient's behalf.
AB100,829,1614 b. The recipient is notified of a change in his or her medical assistance coverage
15while the hearing decision is pending but the recipient fails to request a hearing on
16the change.
AB100,829,1817 3. The recipient shall be promptly informed in writing if medical assistance is
18to be suspended, reduced or terminated pending the hearing decision.
AB100, s. 1913 19Section 1913. 49.45 (5m) (a) of the statutes is amended to read:
AB100,830,220 49.45 (5m) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
2120.435 (1) (5) (b) and (o) the department shall distribute not more than $2,256,000
22in each fiscal year, to provide supplemental funds to rural hospitals that, as
23determined by the department, have high utilization of inpatient services by
24patients whose care is provided from governmental sources, except that the

1department may not distribute funds to a rural hospital to the extent that the
2distribution would exceed any limitation under 42 USC 1396b (i) (3).
AB100, s. 1914 3Section 1914. 49.45 (6b) (b) of the statutes is amended to read:
AB100,830,64 49.45 (6b) (b) Beginning in fiscal year 1995-96 1997-98, for relocations from
5the northern Wisconsin center for the developmentally disabled, by $199 $174 per
6day.
AB100, s. 1915 7Section 1915. 49.45 (6b) (c) of the statutes is amended to read:
AB100,830,108 49.45 (6b) (c) Beginning in fiscal year 1995-96 1997-98, for relocations from
9the southern Wisconsin center for the developmentally disabled, by $149 $174 per
10day.
AB100, s. 1916 11Section 1916. 49.45 (6c) (c) (intro.) of the statutes is amended to read:
AB100,830,1712 49.45 (6c) (c) Resident review. (intro.) Except as provided in par. (e), by April
131, 1990, and at least annually thereafter,
the department or an entity to which the
14department has delegated authority shall review every resident of a facility or
15institution for mental diseases who has a developmental disability or mental illness
16and who has experienced a significant change in his or her physical or mental
17condition
to determine if any of the following applies:
AB100, s. 1917 18Section 1917. 49.45 (6m) (a) 3. of the statutes is amended to read:
AB100,830,2119 49.45 (6m) (a) 3. "Facility" means a nursing home as defined under s. 50.01 (3)
20or a community-based residential facility that is licensed under s. 50.03 and that is
21certified by the department as a provider of medical assistance.
AB100, s. 1918 22Section 1918. 49.45 (6m) (a) 5. of the statutes is created to read:
AB100,830,2323 49.45 (6m) (a) 5. "Nursing home" has the meaning given under s. 50.01 (3).
AB100, s. 1919 24Section 1919. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:
AB100,831,12
149.45 (6m) (ag) (intro.) Payment for care provided in a facility under this
2subsection made under s. 20.435 (1) (b), (o) or (p) or (5) (b) or (o) shall, except as
3provided in pars. (bg), (bm) and (br), be determined according to a prospective
4payment system updated annually by the department. The payment system shall
5implement standards which are reasonable and adequate to meet the costs which
6must be incurred by efficiently and economically operated facilities in order to
7provide care in conformity with this section, with federal regulations authorized
8under 42 USC 1396a (a) (13) (A), 1396a (a) (30), 1396b (i) (3), 1396L and 1396r (e)
9and with quality and safety standards established under subch. II of ch. 50 and ch.
10150. In administering this payment system, the department shall allow costs it
11determines are necessary and proper for providing patient care. The payment
12system shall reflect all of the following:
AB100, s. 1920 13Section 1920. 49.45 (6m) (ag) 3m. of the statutes is amended to read:
AB100,831,1814 49.45 (6m) (ag) 3m. For state fiscal year 1995-96 1997-98, rates that shall be
15set by the department based on information from cost reports for the 1994 1996 fiscal
16year of the facility and for state fiscal year 1996-97 1998-99, rates that shall be set
17by the department based on information from cost reports for the 1995 1997 fiscal
18year of the facility.
AB100, s. 1921 19Section 1921. 49.45 (6m) (ag) 8. of the statutes is amended to read:
AB100,832,1220 49.45 (6m) (ag) 8. Calculation of total payments and supplementary payments
21to facilities that permits an aggregate increase in funds allocated under s. 20.435 (1)
22(5) (b) and (o) for nursing home care provided medical assistance recipients,
23including an increase resulting in adjustment of facility base rates and percentage
24increases over facility base rates,
over that paid for services provided in state fiscal
25year 1994-95 1996-97 of no more than 4.25% 6.1% or $50,975,000, whichever is less,

1during state fiscal year 1995-96 and 1997-98; and calculation of total payments and
2supplementary payments to facilities that permits an aggregate increase in funds
3allocated under s. 20.435 (5) (b) and (o) for nursing home care provided medical
4assistance recipients, including a percentage increase over facility base rates,
over
5that paid for services provided in state fiscal year 1995-96 1997-98 of no more than
63.5% or $30,322,500, whichever is less, during state fiscal year 1996-97, excluding
71998-99. Calculation of total payments and supplementary payments under this
8subdivision excludes
increases in total payments attributable to increases in
9recipient utilization of facility care, payments for the provision of active treatment
10to facility residents with developmental disability or chronic mental illness and
11payments for preadmission screening of facility applicants and annual reviews of
12facility residents required under 42 USC 1396r (e).
AB100, s. 1922 13Section 1922. 49.45 (6m) (ap) of the statutes is created to read:
AB100,832,1814 49.45 (6m) (ap) If the bed occupancy of a nursing home is below the minimum
15patient day occupancy standards that are established by the department under par.
16(ar) (intro.), the department may approve a request by the nursing home to delicense
17any of the nursing home's licensed beds. If the department approves the nursing
18home's request, all of the following apply:
AB100,832,2019 1. The department shall delicense the number of beds in accordance with the
20nursing home's request.
AB100,832,2321 2. The department may not include the number of beds of the nursing home
22that the department delicenses under this paragraph in determining the costs per
23patient day under the minimum patient day occupancy standards under par. (ar).
AB100,832,2524 3. The nursing home may not use or sell a bed that is delicensed under this
25paragraph.
AB100,833,8
14. Every 12 months following the delicensure of a bed under this paragraph,
2for which a nursing home has not resumed licensure under subd. 5., the department
3shall reduce the licensed bed capacity of the nursing home by 10% of all of the nursing
4home's beds that remain delicensed under this paragraph or by 25% of one bed,
5whichever is greater. The department shall reduce the statewide maximum number
6of licensed nursing home beds under s. 150.31 (1) (intro.) by the number or portion
7of a number of beds by which the nursing home's licensed bed capacity is reduced
8under this subdivision.
AB100,833,169 5. A nursing home retains the right to resume licensure of a bed of the nursing
10home that was delicensed under this paragraph unless the licensed bed capacity of
11the nursing home has been reduced by that bed under subd. 4. The nursing home
12may not resume licensure of a fraction of a bed. The nursing home may resume
13licensure 18 months after the nursing home notifies the department in writing that
14the nursing home intends to resume the licensure. If a nursing home resumes
15licensure of a bed under this subdivision, subd. 2 does not apply with respect to that
16bed.
AB100, s. 1923 17Section 1923. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:
AB100,834,418 49.45 (6m) (ar) 1. a. The department shall establish standards for payment of
19allowable direct care costs, for facilities that do not primarily serve the
20developmentally disabled,
that are at least 110% of not less than the median for
21direct care costs for a sample of all of those facilities that do not primarily serve the
22developmentally disabled
in this state and separate standards for payment of
23allowable direct care costs, for facilities that primarily serve the developmentally
24disabled,
that are at least 110% of not less than the median for direct care costs for
25a sample of all of those facilities primarily serving the developmentally disabled in

1this state
. The standards shall be adjusted by the department for regional labor cost
2variations. The department may decrease the percentage established for the
3standards only if amounts available under par. (ag) (intro.) are insufficient to provide
4total payment under par. (am), less capital costs under subd. 6.
AB100, s. 1924 5Section 1924. 49.45 (6m) (br) 1. of the statutes is amended to read:
AB100,834,156 49.45 (6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435 (1) (5) (bt) or (bu)
7or (7) (b) or 20.445 (3) (de) (dz), the department shall reduce allocations of funds to
8counties in the amount of the disallowance from the appropriations appropriation
9account
under s. 20.410 (3) (cd) or 20.435 (1) (5) (bt) or (bu) or (7) (b), or the
10department shall direct the department of industry, labor and job development to
11reduce allocations of funds to counties or Wisconsin works agencies in the amount
12of the disallowance from the appropriation account under s. 20.445 (3) (de) or (dz) or
13direct the department of corrections to reduce allocations of funds to counties in the
14amount of the disallowance from the appropriation account under s. 20.410 (3) (cd)
,
15in accordance with s. 16.544 to the extent applicable.
AB100, s. 1925 16Section 1925. 49.45 (6s) of the statutes is repealed.
AB100, s. 1926 17Section 1926. 49.45 (6t) (intro.) of the statutes is amended to read:
AB100,835,318 49.45 (6t) County department and local health department operating
19deficit reduction.
(intro.) From the appropriation under s. 20.435 (1) (5) (o), for
20reduction of operating deficits, as defined under criteria developed by the
21department, incurred by a county department under s. 46.215, 46.22, 46.23 or 51.42
22or by a local health department, as defined in s. 250.01 (4), for services provided
23under s. 49.46 (2) (a) 4. d. and (b) 6. f., j., k. and L., 9. and 15., for case management
24services under s. 49.46 (2) (b) 12. and for mental health day treatment services for
25minors provided under the authorization under 42 USC 1396d (r) (5), the department

1shall allocate up to $4,500,000 in each fiscal year to these county departments, or
2local health departments as determined by the department, and shall perform all of
3the following:
AB100, s. 1927 4Section 1927. 49.45 (6t) (d) of the statutes is amended to read:
AB100,835,95 49.45 (6t) (d) If the federal department of health and human services approves
6for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (o) that result
7in a lesser allocation amount than that allocated under this subsection or disallows
8use of the allocation of federal medicaid funds under par. (c), reduce allocations under
9this subsection and distribute on a prorated basis, as determined by the department.
AB100, s. 1928 10Section 1928. 49.45 (6u) (intro.) of the statutes is amended to read:
AB100,835,2511 49.45 (6u) (title) Facility operating deficit reduction Supplemental
12payments to county homes
. (intro.) Except as provided in par. (g) Notwithstanding
13sub. (6m)
, from the appropriation under s. 20.435 (1) (5) (o), for reduction of operating
14deficits, as defined under criteria developed by the department, incurred by a facility,
15as defined under sub. (6m) (a) 2. 3., that is established under s. 49.70 (1) or that is
16owned and operated by a city, village or town
, the department shall may not
17distribute to these facilities not more than $18,600,000 $38,600,000 in each fiscal
18year, as determined by the department, and except that the department shall also
19distribute for this same purpose from the appropriation under s. 20.435 (5) (o) any
20additional federal medical assistance moneys that were not anticipated before
21enactment of the biennial budget act or other legislation affecting s. 20.435 (5) (o) and
22that were not used to fund nursing home rate increases under sub. (6m) (ag) 8. The
23total amount that a county certifies under this subsection may not exceed 100% of
24otherwise-unreimbursed care. In distributing funds under this subsection, the
25department
shall perform all of the following:
AB100, s. 1929
1Section 1929. 49.45 (6u) (d) of the statutes is amended to read:
AB100,836,62 49.45 (6u) (d) If the federal department of health and human services approves
3for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (o) that result
4in a lesser allocation amount than that allocated under this subsection, allocate not
5more than the lesser amount so approved by the federal department of health and
6human services.
AB100, s. 1930 7Section 1930. 49.45 (6u) (e) of the statutes is amended to read:
AB100,836,128 49.45 (6u) (e) If the federal department of health and human services approves
9for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (o) that result
10in a lesser allocation amount than that allocated under this subsection, submit a
11revision of the method developed under par. (b) for approval by the joint committee
12on finance in that state fiscal year.
AB100, s. 1931 13Section 1931. 49.45 (6u) (f) of the statutes is amended to read:
AB100,836,1614 49.45 (6u) (f) If the federal department of health and human services disallows
15use of the allocation of matching federal medical assistance funds distributed under
16par. (c), apply the requirements under sub. (6m) (br) shall apply.
AB100, s. 1932 17Section 1932. 49.45 (6u) (g) of the statutes is amended to read:
AB100,836,2218 49.45 (6u) (g) If a facility that is otherwise eligible for an allocation of funds
19under this section is found by the federal health care financing administration or the
20department to be an institution for mental diseases, as defined under 42 CFR
21435.1009
, the department may not allocate cease distributing to that facility funds
22under this section after the date on which the finding is made.
AB100, s. 1933 23Section 1933. 49.45 (6w) (intro.) of the statutes is amended to read:
AB100,837,524 49.45 (6w) Hospital operating deficit reduction. (intro.) From the
25appropriation under s. 20.435 (1) (5) (o), for reduction of operating deficits, as defined

1under criteria developed by the department, incurred by a hospital, as defined under
2s. 50.33 (2) (a) and (b), that is operated by the state, established under s. 49.71 or
3owned and operated by a city or village, the department shall allocate up to
4$3,300,000 in each fiscal year to these hospitals, as determined by the department,
5and shall perform all of the following:
AB100, s. 1934 6Section 1934. 49.45 (6w) (d) of the statutes is amended to read:
AB100,837,117 49.45 (6w) (d) If the federal department of health and human services approves
8for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (o) that result
9in a lesser allocation amount than that allocated under this subsection or disallows
10use of the allocation of federal medicaid funds under par. (c), reduce allocations under
11this subsection and distribute on a prorated basis, as determined by the department.
AB100, s. 1935 12Section 1935. 49.45 (6x) (a) of the statutes is amended to read:
AB100,837,1713 49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
1420.435 (1) (5) (b) and (o) the department shall distribute not more than $4,748,000
15in each fiscal year, to provide funds to an essential access city hospital, except that
16the department may not allocate funds to an essential access city hospital to the
17extent that the allocation would exceed any limitation under 42 USC 1396b (i) (3).
AB100, s. 1936 18Section 1936. 49.45 (6x) (d) of the statutes is amended to read:
AB100,837,2319 49.45 (6x) (d) If the federal department of health and human services approves
20for state expenditure in any state fiscal year amounts under s. 20.435 (1) (5) (o) that
21result in a lesser distribution amount than that distributed under this subsection or
22disallows use of federal medicaid funds under par. (a), the department of health and
23family services shall reduce the distributions under this subsection.
AB100, s. 1937 24Section 1937. 49.45 (6y) (a) of the statutes is amended to read:
AB100,838,10
149.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
220.435 (1) (5) (b) and (o) the department shall distribute funding in each fiscal year
3to provide supplemental payment to hospitals that enter into a contract under s.
449.02 (2) to provide health care services funded by a relief block grant, as determined
5by the department, for hospital services that are not in excess of the hospitals'
6customary charges for the services, as limited under 42 USC 1396b (i) (3). If no relief
7block grant is awarded under this chapter or if the allocation of funds to such
8hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department
9may distribute funds to hospitals that have not entered into a contract under s. 49.02
10(2).
AB100, s. 1938 11Section 1938. 49.45 (6z) (a) (intro.) of the statutes is amended to read:
AB100,838,2212 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations
13under s. 20.435 (1) (5) (b) and (o) the department shall distribute funding in each
14fiscal year to supplement payment for services to hospitals that enter into a contract
15under s. 49.02 (2) to provide health care services funded by a relief block grant under
16this chapter, if the department determines that the hospitals serve a
17disproportionate number of low-income patients with special needs. If no medical
18relief block grant under this chapter is awarded or if the allocation of funds to such
19hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department
20may distribute funds to hospitals that have not entered into a contract under s. 49.02
21(2). The department may not distribute funds under this subsection to the extent
22that the distribution would do any of the following:
AB100, s. 1939 23Section 1939. 49.45 (8) (b) of the statutes is amended to read:
AB100,839,324 49.45 (8) (b) Reimbursement under s. 20.435 (1) (5) (b) and (o) for home health
25services provided by a certified home health agency or independent nurse shall be

1made at the home health agency's or nurse's usual and customary fee per patient care
2visit, subject to a maximum allowable fee per patient care visit that is established
3under par. (c).
AB100, s. 1940 4Section 1940. 49.45 (8e) of the statutes is repealed.
AB100, s. 1941 5Section 1941. 49.45 (8m) (intro.) of the statutes is amended to read:
AB100,839,106 49.45 (8m) Rates for respiratory care services. (intro.) Notwithstanding the
7limits under subs. (8) and (8e) limit under sub. (8), the rates under sub. (8) and rates
8charged by providers under s. 49.46 (2) (a) 4. d. that are not home health agencies,
9for reimbursement for respiratory care services for ventilator-dependent
10individuals under ss. 49.46 (2) (b) 6. m. and 49.47 (6) (a) 1., shall be as follows:
AB100, s. 1942 11Section 1942. 49.45 (8r) of the statutes is amended to read:
AB100,839,1912 49.45 (8r) Payment for certain obstetric and gynecological care. The rate
13of payment for obstetric and gynecological care provided in primary care health
14professional
shortage areas, as defined in s. 560.184 (1) (c) 560.183 (1) (cm), or
15provided to recipients of medical assistance who reside in primary care health
16professional
shortage areas, that is equal to 125% of the rates paid under this section
17to primary care physicians in primary care health professional shortage areas, shall
18be paid to all certified primary care providers who provide obstetric or gynecological
19care to those recipients.
AB100, s. 1943 20Section 1943. 49.45 (24m) (intro.) of the statutes is amended to read:
AB100,839,2521 49.45 (24m) Home health care and personal care pilot program. (intro.)
22From the appropriations under s. 20.435 (1) (5) (b) and (o), in order to test the
23feasibility of instituting a system of reimbursement for providers of home health care
24and personal care services for medical assistance recipients that is based on
25competitive bidding, the department shall:
AB100, s. 1944
1Section 1944. 49.45 (25) (am) 14. of the statutes is created to read:
AB100,840,42 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, s. 1945 5Section 1945. 49.45 (25) (b) of the statutes is amended to read:
AB100,840,146 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, s. 1946 15Section 1946. 49.45 (25) (be) of the statutes is amended to read:
AB100,840,2116 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, s. 1947 22Section 1947. 49.45 (41) (a) 1. of the statutes is amended to read:
AB100,841,223 49.45 (41) (a) 1. "Mental health crisis intervention services" means services
24that are provided by a mental health crisis intervention program operated by, or
25under contract with, a county or, municipality or, in a county having a population of

1500,000 or more, the department
, if the county or, municipality or department is
2certified as a medical assistance provider.
AB100, s. 1948 3Section 1948. 49.45 (41) (b) of the statutes is amended to read:
Loading...
Loading...