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. 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:
AB100,841,174
49.45
(41) (b) If a county
or, municipality
or, in a county having a population
5of 500,000 or more, the department elects to become certified as a provider of mental
6health crisis intervention services, the county
or, municipality
or department may
7provide mental health crisis intervention services under this subsection in the
8county or municipality to medical assistance recipients through the medical
9assistance program. A county
or, municipality
or, in a county having a population
10of 500,000 or more, the department that elects to provide the services shall pay the
11amount of the allowable charges for the services under the medical assistance
12program that is not provided by the federal government. The
subunit of the 13department
administering the medical assistance program shall reimburse the
14county
or, municipality
or subunit of the department administering child welfare
15services in a county having a population of 500,000 or more under this subsection
16only for the amount of the allowable charges for those services under the medical
17assistance program that is provided by the federal government.
AB100, s. 1949
18Section
1949. 49.46 (1) (a) 1. of the statutes is amended to read:
AB100,841,2419
49.46
(1) (a) 1. Any person included in the grant of aid to families with
20dependent children and any person who does not receive such aid solely because of
21the application of s. 49.19 (11) (a) 7.
This If a waiver under s. 49.153 (1m) (a) is
22granted and in effect or federal legislation that permits the application of s. 49.153
23is enacted, this subdivision does not apply beginning on the first day of the 6th month
24beginning after the date stated in the notice under s.
49.141 (2) (d) 49.153 (1m) (a).
AB100, s. 1950
25Section
1950. 49.46 (1) (a) 1m. of the statutes is amended to read:
AB100,842,7
149.46
(1) (a) 1m. Any pregnant woman who meets the resource and income
2limits under s. 49.19 (4) (bm) and (es) and whose pregnancy is medically verified.
3Eligibility continues to the last day of the month in which the 60th day after the last
4day of the pregnancy falls.
This If a waiver under s. 49.153 (1m) (a) is granted and
5in effect or federal legislation that permits the application of s. 49.153 is enacted, this 6subdivision does not apply beginning on the first day of the 6th month beginning
7after the date stated in the notice under s.
49.141 (2) (d) 49.153 (1m) (a).
AB100, s. 1951
8Section
1951. 49.46 (1) (a) 4m. of the statutes is created to read:
AB100,842,99
49.46
(1) (a) 4m. Any child for whom a payment is made under s. 49.775.
AB100, s. 1952
10Section
1952. 49.46 (1) (a) 6. of the statutes is amended to read:
AB100,842,1711
49.46
(1) (a) 6. Any person not described in pars. (c) to (e) who is considered,
12under federal law, to be receiving aid to families with dependent children for the
13purpose of determining eligibility for medical assistance.
This If a waiver under s.
1449.153 (1m) (a) is granted and in effect or federal legislation that permits the
15application of s. 49.153 is enacted, this subdivision does not apply beginning on the
16first day of the 6th month beginning after the date stated in the notice under s.
49.141
17(2) (d) 49.153 (1m) (a).
AB100, s. 1953
18Section
1953. 49.46 (1) (a) 9. of the statutes is amended to read:
AB100,842,2419
49.46
(1) (a) 9. Any pregnant woman not described under subd. 1. or 1m. whose
20family income does not exceed 133% of the poverty line for a family the size of the
21woman's family.
This If a waiver under s. 49.153 (1m) (a) is granted and in effect or
22federal legislation that permits the application of s. 49.153 is enacted, this 23subdivision does not apply beginning on the first day of the 6th month beginning
24after the date stated in the notice under s.
49.141 (2) (d) 49.153 (1m) (a).
AB100, s. 1954
25Section
1954. 49.46 (1) (a) 10. of the statutes is amended to read:
AB100,843,6
149.46
(1) (a) 10. Any child not described under subd. 1. who is under 6 years
2of age and whose family income does not exceed 133% of the poverty line for a family
3the size of the child's family.
This If a waiver under s. 49.153 (1m) (a) is granted and
4in effect or federal legislation that permits the application of s. 49.153 is enacted, this 5subdivision does not apply beginning on the first day of the 6th month beginning
6after the date stated in the notice under s.
49.141 (2) (d) 49.153 (1m) (a).
AB100, s. 1955
7Section
1955. 49.46 (1) (a) 11. of the statutes is amended to read:
AB100,843,148
49.46
(1) (a) 11. Any child not described under subd. 1. who was born after
9September 30, 1983, who has attained the age of 6 but has not attained the age of 19
10and whose family income does not exceed 100% of the poverty line for a family the
11size of the child's family.
This If a waiver under s. 49.153 (1m) (a) is granted and in
12effect or federal legislation that permits the application of s. 49.153 is enacted, this 13subdivision does not apply beginning on the first day of the 6th month beginning
14after the date stated in the notice under s.
49.141 (2) (d) 49.153 (1m) (a).
AB100, s. 1956
15Section
1956. 49.46 (1) (a) 12. of the statutes is amended to read:
AB100,843,2116
49.46
(1) (a) 12. Any child not described under subd. 1. who is under 19 years
17of age and who meets the resource and income limits under s. 49.19 (4).
This If a
18waiver under s. 49.153 (1m) (a) is granted and in effect or federal legislation that
19permits the application of s. 49.153 is enacted, this subdivision does not apply
20beginning on the first day of the 6th month beginning after the date stated in the
21notice under s.
49.141 (2) (d) 49.153 (1m) (a).
AB100, s. 1957
22Section
1957. 49.46 (1) (a) 13. of the statutes is amended to read:
AB100,844,323
49.46
(1) (a) 13. Any child who is under one year of age, whose mother was
24determined to be eligible under subd. 9. and who lives with his or her mother.
This 25If a waiver under s. 49.153 (1m) (a) is granted and in effect or federal legislation that
1permits the application of s. 49.153 is enacted, this subdivision does not apply
2beginning on the first day of the 6th month beginning after the date stated in the
3notice under s.
49.141 (2) (d) 49.153 (1m) (a).
AB100, s. 1958
4Section
1958. 49.46 (1) (am) 3. of the statutes is amended to read:
AB100,844,75
49.46
(1) (am) 3.
This If a waiver under s. 49.153 (1m) (a) is granted and in
6effect, this paragraph does not apply beginning on the first day of the 6th month
7beginning after the date stated in the notice under s.
49.141 (2) (d) 49.153 (1m) (a).
AB100, s. 1959
8Section
1959. 49.46 (1) (c) (intro.) of the statutes is amended to read:
AB100,844,139
49.46
(1) (c) (intro.) Except as provided under
pars. par. (co)
and (cs), a family
10that becomes ineligible for aid to families with dependent children under s. 49.19
11because of increased income from employment or increased hours of employment or
12because of the expiration of the time during which the disregards under s. 49.19 (5)
13(a) 4. or 4m. or (am) apply shall receive medical assistance for: