b. That the potential for medical assistance fraud or abuse exists if additional providers are certified or additional resources are used by certified providers.
SECTION 1373. 49.45 (2) (b) 7. of the statutes is created to read:
49.45 (2) (b) 7. Require, as a condition of certification under par. (a) 11., all providers of a specific service that is among those enumerated under s. 49.46 (2) (b) or 49.47 (6) (a), as specified in this subdivision, to file with the department a surety bond issued by a surety company licensed to do business in this state. Providers subject to this subdivision provide those services specified under s. 49.46 (2) (b) or 49.47 (6) (a) for which providers have demonstrated significant potential to violate s. 49.489 (2) or (3) or 49.49 (1) (a), (2) (a) or (b), (3), (3m) (a), (3p), (4) (a) or (4m) (a), to require recovery under par. (a) 10. or to need additional sanctions under par. (a) 13. The surety bond shall be payable to the department and in an amount that would reasonably pay the amount of a recovery and the department's costs to pursue recovery under par. (a) 10. or to investigate and pursue allegations of violations of s. 49.489 or 49.49. The department shall promulgate rules under this subdivision that specify all of the following:
a. Services under medical assistance for which providers have demonstrated significant potential to violate s. 49.489 (2) or (3) or 49.49 (1) (a), (2) (a) or (b), (3), (3m) (a), (3p), (4) (a) or (4m) (a), to require recovery under par. (a) 10. or to need additional sanctions under par. (a) 13.
b. The amount or amounts of the surety bonds.
c. Terms of the surety bond, including amounts, if any, without interest to be refunded to the provider upon withdrawal or decertification from the medical assistance program.
SECTION 1374. 49.45 (3) (ag) of the statutes is amended to read:
49.45 (3) (ag) Reimbursement shall be made to each entity contracted with under s. 46.271 (2m) 46.281 (1) (d) for assessments completed functional screens performed under s. 46.271 (2m) (a) 2. 46.281 (1) (d).
SECTION 1375. 49.45 (3) (am) 1. of the statutes is amended to read:
49.45 (3) (am) 1. From the appropriation under s. 20.435 (1) (4) (bm), the department shall make incentive payments to counties to encourage counties to identify medical assistance applicants and recipients who have other health care coverage and the providers of the health care coverage and give that information to the department.
SECTION 1376. 49.45 (3) (f) 3. of the statutes is amended to read:
49.45 (3) (f) 3. Contractors under sub. (2) (b) shall maintain records as required by the department for audit purposes. Contractors Upon request of the department, contractors shall immediately provide the department access to the records upon request of the department, and, which the department may audit the records.
SECTION 1377. 49.45 (3) (g) of the statutes is amended to read:
49.45 (3) (g) The secretary may appoint authorize personnel to audit or investigate and report to the department on any matter involving violations or complaints alleging violations of laws statutes, regulations, or rules applicable to Title XIX of the federal social security act or the medical assistance program and to perform such investigations or audits as are required to verify the actual provision of services or items available under the medical assistance program and the appropriateness and accuracy of claims for reimbursement submitted by providers participating in the program. Department employes appointed authorized by the secretary under this paragraph shall be issued, and shall possess at all times during which while they are performing their investigatory or audit functions under this section, identification, signed by the secretary which, that specifically designates the bearer as possessing the authorization to conduct medical assistance investigations or audits. Pursuant to Under the request of a designated person and upon presentation of that the person's authorization, providers and medical assistance recipients shall immediately accord such the person access to any provider personnel, records, books, recipient medical records, or documents or other information needed. Under the written request of a designated person and upon presentation of the person's authorization, providers and recipients shall immediately accord the person access to any needed patient health care records of a recipient. Authorized employes shall have authority to may hold hearings, administer oaths, take testimony and perform all other duties necessary to bring such the matter before the department for final adjudication and determination.
SECTION 1378. 49.45 (3) (h) 1. of the statutes is repealed.
SECTION 1379. 49.45 (3) (h) 2. of the statutes is repealed.
SECTION 1380. 49.45 (3) (h) 3. of the statutes is renumbered 49.45 (3) (h) and amended to read:
49.45 (3) (h) The failure or refusal of a person to purge himself or herself of contempt found under s. 885.12 and perform the act as required by law shall constitute provider immediately to accord department auditors under par. (f) 3. or investigators under par. (g) access to any provider personnel, records, books, patient health care records of medical assistance recipients or documents or other information requested constitutes grounds for decertification or suspension of that person the provider from participation in the medical assistance program and no payment may be made for services rendered by that person subsequent to the provider following decertification or during the period of suspension.
SECTION 1381. 49.45 (3) (j) of the statutes is amended to read:
49.45 (3) (j) Reimbursement for administrative contract costs under this section is limited to the funds available under s. 20.435 (1) (4) (bm).
SECTION 1382. 49.45 (5m) (a) of the statutes is renumbered 49.45 (5m) (am) and amended to read:
49.45 (5m) (am) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (5) (4) (b) and (o) the department shall distribute not more than $2,256,000 in each fiscal year, to provide supplemental funds to rural hospitals that, as determined by the department, have high utilization of inpatient services by patients whose care is provided from governmental sources, and to provide supplemental funds to critical access hospitals, except that the department may not distribute funds to a rural hospital or to a critical access hospital to the extent that the distribution would exceed any limitation under 42 USC 1396b (i) (3).
****NOTE: This is reconciled s. 49.45 (5m) (am). This paragraph has been affected by drafts with the following LRB numbers: LRB-0028/6 and LRB-0264/2.
SECTION 1383. 49.45 (5m) (ag) of the statutes is created to read:
49.45 (5m) (ag) In this subsection, "critical access hospital" has the meaning given in s. 50.33 (1g).
SECTION 1384. 49.45 (5m) (b) of the statutes is amended to read:
49.45 (5m) (b) The supplemental funding for rural hospitals under par. (a) (am) shall be based on the utilization, by recipients of medical assistance, of the total inpatient days of a rural hospital in relation to that utilization in other rural hospitals.
SECTION 1385. 49.45 (6b) (intro.) of the statutes is renumbered 49.45 (6b) and amended to read:
49.45 (6b) CENTERS FOR THE DEVELOPMENTALLY DISABLED. From the appropriation under s. 20.435 (2) (gk), the department may reimburse the cost of services provided by the centers for the developmentally disabled. Reimbursement to the centers for the developmentally disabled shall be reduced following each placement made under s. 46.275 which that involves a relocation from a center for the developmentally disabled, as follows: by $184 per day, beginning in fiscal year 1999-2000, and by $190 per day, beginning in fiscal year 2000-01.
SECTION 1386. 49.45 (6b) (a) of the statutes is repealed.
SECTION 1387. 49.45 (6b) (b) of the statutes is repealed.
SECTION 1388. 49.45 (6b) (c) of the statutes is repealed.
SECTION 1389. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:
49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this subsection made under s. 20.435 (1) (p) or (5) (b) (4) (b), (pa) or (o) shall, except as provided in pars. (bg), (bm) and (br), be determined according to a prospective payment system updated annually by the department. The payment system shall implement standards that are necessary and proper for providing patient care and that meet quality and safety standards established under subch. II of ch. 50 and ch. 150. The payment system shall reflect all of the following:
****NOTE: This redraft (-0028/5) deletes treatment of s. 49.45 (6m) (ag) 8., which is repealed in LRB-1756. If LRB-1756 is not included in the budget bill, the treatment should be restored.
SECTION 1390. 49.45 (6m) (ag) 3m. of the statutes is repealed.
SECTION 1391. 49.45 (6m) (ag) 8. of the statutes is repealed.
SECTION 1392. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:
49.45 (6m) (ar) 1. a. The department shall establish standards for payment of allowable direct care costs, for facilities that do not primarily serve the developmentally disabled, that are not less than the median for take into account direct care costs for a sample of all of those facilities in this state and separate standards for payment of allowable direct care costs, for facilities that primarily serve the developmentally disabled, that are not less than the median for take into account direct care costs for a sample of all of those facilities in this state. The standards shall be adjusted by the department for regional labor cost variations.
SECTION 1393. 49.45 (6m) (ar) 1. cm. of the statutes is amended to read:
49.45 (6m) (ar) 1. cm. Notwithstanding the limitations under par. (ag) 8., funding Funding distributed to facilities for the provision of active treatment to residents with a diagnosis of developmental disability shall be distributed in accordance with a method developed by the department which is consistent with a prudent buyer approach to payment for services.
SECTION 1394. 49.45 (6m) (ar) 2. a. of the statutes is amended to read:
49.45 (6m) (ar) 2. a. The department shall establish one or more standards for the payment of support service costs that are not less than the median of take into account support service costs for a sample of all facilities within the state.
SECTION 1395. 49.45 (6m) (ar) 3. a. of the statutes is amended to read:
49.45 (6m) (ar) 3. a. The department shall establish standards, adjusted for heating degree day variations in the state, for payment of fuel and utility costs that are not less than the median of take into account heating fuel and utility costs for a sample of all facilities within the state.
SECTION 1396. 49.45 (6m) (ar) 4. of the statutes is amended to read:
49.45 (6m) (ar) 4. For net property taxes or municipal services, payment shall be made for those costs that range from the amount of the previous calendar year's tax or the amount of municipal service costs for a period specified by the department, subject to a maximum limit as determined by the department.
SECTION 1397. 49.45 (6m) (ar) 5. a. of the statutes is amended to read:
49.45 (6m) (ar) 5. a. The department shall establish one or more standards for the payment of administrative and general costs that are not less than the median of take into account administrative and general costs for a sample of all facilities within the state.
SECTION 1398. 49.45 (6m) (ar) 6. of the statutes is amended to read:
49.45 (6m) (ar) 6. Capital payment shall be based on a replacement value for a facility. The replacement value shall be determined by a commercial estimator contracted for by the department and paid for by the facility. The replacement value shall be subject to limitations determined by the department, except that the department may not reduce final capital payment of a facility by more than $3.50 per patient day.
SECTION 1399. 49.45 (6m) (av) 1. of the statutes is amended to read:
49.45 (6m) (av) 1. The department shall calculate a payment rate for a facility by applying the criteria set forth under pars. (ag) 1. to 5., and 7. and 8., (am) 1. to 5. and (ar) 1. to 5. to information from cost reports submitted by the facility.
SECTION 1400. 49.45 (6m) (av) 5m. of the statutes is amended to read:
49.45 (6m) (av) 5m. Notwithstanding the limitations under par. (ag) 8., the The rate under subd. 1., 4. or 5. may be adjusted by the department to reflect payments for the provision of active treatment to facility residents with a diagnosis of developmental disability.
SECTION 1401. 49.45 (6m) (bp) (intro.) of the statutes is amended to read:
49.45 (6m) (bp) (intro.) Notwithstanding pars. (ag) 3m., (am) 6. and (ar) 6., the department may establish payment methods based on actual costs for capital payment for a facility to which, after December 31, 1982, any of the following applies:
SECTION 1402. 49.45 (6m) (br) 1. of the statutes is amended to read:
49.45 (6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435 (5) (4) (bt) or (bu) or (7) (b) or 20.445 (3) (dz), the department shall reduce allocations of funds to counties in the amount of the disallowance from the appropriation account under s. 20.435 (5) (4) (bt) or (bu) or (7) (b), or the department shall direct the department of workforce development to reduce allocations of funds to counties or Wisconsin works agencies in the amount of the disallowance from the appropriation account under s. 20.445 (3) (dz) or direct the department of corrections to reduce allocations of funds to counties in the amount of the disallowance from the appropriation account under s. 20.410 (3) (cd), in accordance with s. 16.544 to the extent applicable.
****NOTE: This provision contains a cross-reference to s. 20.435 (5) (bt), which is renumbered in this bill to s. 20.435 (4) (bt) to conform to the changes in LRB-0028. If LRB-0028 is not included in the budget bill, this renumbering should be deleted.
SECTION 1403. 49.45 (6m) (c) 5. of the statutes is amended to read:
49.45 (6m) (c) 5. Admit only patients assessed or who waive or are exempt from the requirement of assessment under s. 46.27 (6) (a) or, if required under s. 50.035 (4n) or 50.04 (2h), who have been referred to a resource center.
SECTION 1404. 49.45 (6t) (intro.) of the statutes is amended to read:
49.45 (6t) COUNTY DEPARTMENT AND LOCAL HEALTH DEPARTMENT OPERATING DEFICIT REDUCTION. (intro.) From the appropriation under s. 20.435 (5) (4) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a county department under s. 46.215, 46.22, 46.23 or 51.42 or by a local health department, as defined in s. 250.01 (4), for services provided under s. 49.46 (2) (a) 4. d. and (b) 6. f., j., k. and L., 9. and 15., for case management services under s. 49.46 (2) (b) 12. and for mental health day treatment services for minors provided under the authorization under 42 USC 1396d (r) (5), the department shall allocate up to $4,500,000 in each fiscal year to these county departments, or local health departments as determined by the department, and shall perform all of the following:
SECTION 1405. 49.45 (6t) (d) of the statutes is amended to read:
49.45 (6t) (d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (5) (4) (o) that result in a lesser allocation amount than that allocated under this subsection or disallows use of the allocation of federal medicaid funds under par. (c), reduce allocations under this subsection and distribute on a prorated basis, as determined by the department.
SECTION 1406. 49.45 (6u) (intro.) of the statutes is amended to read:
49.45 (6u) SUPPLEMENTAL PAYMENTS TO CERTAIN FACILITIES. (intro.) Notwithstanding sub. (6m), from the appropriation under s. 20.435 (5) (4) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a facility, as defined under sub. (6m) (a) 3., that is established under s. 49.70 (1) or that is owned and operated by a city, village or town, the department may not distribute to these facilities more than $38,600,000 in each fiscal year, as determined by the department, except that the department shall also distribute for this same purpose from the appropriation under s. 20.435 (5) (4) (o) any additional federal medical assistance moneys that were not anticipated before enactment of the biennial budget act or other legislation affecting s. 20.435 (5) (4) (o) and that were not used to fund nursing home rate increases under sub. (6m) (ag) 8. The total amount that a county certifies under this subsection may not exceed 100% of otherwise-unreimbursed care. In distributing funds under this subsection, the department shall perform all of the following:
****NOTE: This is reconciled s. 49.45 (6u) (intro.). This SECTION has been affected by drafts with the following LRB numbers: LRB-0028/6 and LRB-1756/1.
SECTION 1407. 49.45 (6u) (d) of the statutes is amended to read:
49.45 (6u) (d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (5) (4) (o) that result in a lesser allocation amount than that allocated under this subsection, allocate not more than the lesser amount so approved by the federal department of health and human services.
SECTION 1408. 49.45 (6u) (e) of the statutes is amended to read:
49.45 (6u) (e) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (5) (4) (o) that result in a lesser allocation amount than that allocated under this subsection, submit a revision of the method developed under par. (b) for approval by the joint committee on finance in that state fiscal year.
SECTION 1409. 49.45 (6v) (b) of the statutes is amended to read:
49.45 (6v) (b) The department shall, each year, submit to the joint committee on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that provides information on the utilization of beds by recipients of medical assistance in facilities and a discussion and detailed projection of the likely balances, expenditures, encumbrances and carry over of currently appropriated amounts in the appropriation accounts under s. 20.435 (4) (b) and (o).
****NOTE: This is reconciled s. 49.45 (6v) (b). This SECTION has been affected by drafts with the following LRB numbers: LRB-0028/6 and LRB-1060/2.
SECTION 1410. 49.45 (6v) (c) of the statutes is amended to read:
49.45 (6v) (c) If the report specified in par. (b) indicates that utilization of beds by recipients of medical assistance in facilities decreased is less than estimates for that utilization reflected in the intentions of the joint committee on finance, legislature and governor, as expressed by them in the budget determinations, the department shall include a proposal to transfer moneys from the appropriation under s. 20.435 (5) (4) (b) to the appropriation under s. 20.435 (7) (bd) for the purpose of increasing funding for the community options program under s. 46.27. The amount proposed for transfer may not reduce the balance in the appropriation account under s. 20.435 (4) (b) below an amount necessary to ensure that that appropriation account will end the current fiscal year or the current fiscal biennium with a positive balance. The secretary shall transfer the amount identified under the proposal.
****NOTE: This is reconciled s. 49.45 (6v) (c). This SECTION has been affected by drafts with the following LRB numbers: LRB-0028/6 and LRB-1060/2.
SECTION 1411. 49.45 (6w) (intro.) of the statutes is amended to read:
49.45 (6w) HOSPITAL OPERATING DEFICIT REDUCTION. (intro.) From the appropriation under s. 20.435 (5) (4) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a hospital, as defined under s. 50.33 (2) (a) and (b), that is operated by the state, established under s. 49.71 or owned and operated by a city or village, the department shall allocate up to $3,300,000 in each fiscal year to these hospitals, as determined by the department, and shall perform all of the following:
SECTION 1412. 49.45 (6w) (d) of the statutes is amended to read:
49.45 (6w) (d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (5) (4) (o) that result in a lesser allocation amount than that allocated under this subsection or disallows use of the allocation of federal medicaid funds under par. (c), reduce allocations under this subsection and distribute on a prorated basis, as determined by the department.
SECTION 1413. 49.45 (6x) (a) of the statutes is amended to read:
49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (5) (4) (b) and (o) the department shall distribute not more than $4,748,000 in each fiscal year, to provide funds to an essential access city hospital, except that the department may not allocate funds to an essential access city hospital to the extent that the allocation would exceed any limitation under 42 USC 1396b (i) (3).
SECTION 1414. 49.45 (6x) (d) of the statutes is amended to read:
49.45 (6x) (d) If the federal department of health and human services approves for state expenditure in any state fiscal year amounts under s. 20.435 (5) (4) (o) that result in a lesser distribution amount than that distributed under this subsection or disallows use of federal medicaid funds under par. (a), the department of health and family services shall reduce the distributions under this subsection.
SECTION 1415. 49.45 (6y) (a) of the statutes is amended to read:
49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (5) (4) (b) and (o) the department shall distribute funding in each fiscal year to provide supplemental payment to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2).
SECTION 1416. 49.45 (6y) (am) of the statutes is created to read:
49.45 (6y) (am) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b), (h) and (o) the department shall distribute funding in each fiscal year to provide supplemental payments to hospitals that enter into contracts under s. 49.02 (2) with a county having a population of 500,000 or more to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3).
SECTION 1417. 49.45 (6y) (b) of the statutes is amended to read:
49.45 (6y) (b) The department need not promulgate as rules under ch. 227 the procedures, methods of distribution and criteria required for distribution under par. pars. (a) and (am).
SECTION 1418. 49.45 (6z) (a) (intro.) of the statutes is amended to read:
49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (5) (4) (b) and (o) the department shall distribute funding in each fiscal year to supplement payment for services to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant under this chapter, if the department determines that the hospitals serve a disproportionate number of low-income patients with special needs. If no medical relief block grant under this chapter is awarded or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2). The department may not distribute funds under this subsection to the extent that the distribution would do any of the following:
