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****NOTE: This redraft (-0028/5) deletes treatment of s. 49.45 (6m) (ag) 8., which is repealed in LRB-1756.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 of the statutes is repealed.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 of the statutes is repealed.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:
SECTION 1419. 49.45 (8) (b) of the statutes is amended to read:
49.45 (8) (b) Reimbursement under s. 20.435 (5) (4) (b) and (o) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under par. (c).
SECTION 1420. 49.45 (13) (a) of the statutes is amended to read:
49.45 (13) (a) The department may require service providers to prepare and submit cost reports or financial reports for purposes of rate certification under Title XIX of the federal Social Security Act, cost verification, fee schedule determination or research and study purposes. These financial reports may include independently audited financial statements which shall include, including balance sheets and statements of revenues and expenses. The department may withhold reimbursement or may decrease or not increase reimbursement rates if a provider does not submit the reports required under this paragraph within the period specified by the department or if the costs on which the reimbursement rates are based cannot be verified from the provider's cost or financial reports or records from which the reports are derived.
SECTION 1421. 49.45 (13) (b) of the statutes is amended to read:
49.45 (13) (b) The In addition to the remedies specified under par. (a), the department may require any provider who fails to submit a cost report or financial report under par. (a) within the period specified by the department to forfeit not less than $10 nor more than $100 for each day the provider fails to submit the report. A provider may contest the imposition of a forfeiture under this paragraph by submitting a written request for a hearing under s. 227.44 to the department within 10 days following the date on which the provider received notice of the forfeiture.
SECTION 1422. 49.45 (21) (a) of the statutes is renumbered 49.45 (21) (a) (intro.) and amended to read:
49.45 (21) (a) (intro.) If any Before a provider liable for repayment of improper or erroneous payments or overpayments under ss. 49.43 to 49.497 sells or otherwise transfers ownership of his or her business or all or substantially all of the assets of the business, the transferor and transferee are each liable for the repayment. Prior to final transfer, the transferee is responsible for contacting the department and ascertaining if the transferor is liable under this paragraph. all of the following shall take place:
SECTION 1423. 49.45 (21) (a) 1. to 6. of the statutes are created to read:
49.45 (21) (a) 1. The provider shall notify the department of the proposed sale or other transfer.
2. Upon notification under subd. 1., the department shall inform the provider of the extent of the provider's liability, if any, for repayment of improper or erroneous payments or overpayments under ss. 49.43 to 49.497.
3. If the department informs the provider under subd. 2. that the provider has liability, the provider shall so inform the prospective buyer or other transferee.
4. If the provider informs the prospective buyer or other transferee under subd. 3., joint and several liability for the repayment attaches to the provider and to the prospective buyer or other transferee and the sale or other transfer is conditioned upon repayment.
5. If the provider fails to notify the prospective buyer or other transferee under subd. 3., no liability for the repayment attaches to the prospective buyer or other transferee.
6. The provider and, if subd. 4. applies, the prospective buyer or other transferee shall repay the amount of improper or erroneous payments or overpayments under ss. 49.43 to 49.497 for which the provider and, if subd. 4. applies, the prospective buyer or other transferee have liability.
SECTION 1424. 49.45 (21) (b) of the statutes is amended to read:
49.45 (21) (b) If a sale or other transfer specified in par. (a) occurs and the applicable amount under par. (a) has not been repaid, the department may proceed against either the transferor or the transferee. Within 30 days after receiving notice from the department, the transferor or the transferee shall pay the amount in full. Upon failure to comply, the sale or other transfer is void. The department may bring an action to compel payment. If a transferor fails to pay within 90 days after receiving notice from the department, the department or may proceed under sub. (2) (a) 12., or both.
SECTION 1425. 49.45 (24h) of the statutes is created to read:
49.45 (24h) PAYMENT RATES FOR DENTAL SERVICES. (a) From the appropriation under s. 20.435 (4) (b), the department shall provide an increase in the rate of payment to providers of dental services specified under ss. 49.46 (2) (b) 1. and 49.47 (6) (a) 1. who provide the services on a fee-for-service basis. For state fiscal year 1999-2000, the total increase is an amount equal to the lesser of 10% over that paid from this appropriation for the dental services in state fiscal year 1998-99 or $1,225,300. For state fiscal year 2000-01, the total increase is an amount equal to the least of all of the following:
1. Ten percent over the amount paid for the dental services from the appropriation in state fiscal year 2000-01.
2. An amount equal to $1,504,200.
3. Whatever percentage over the amount paid for the dental services from the appropriation in state fiscal year 2000-01 equals the percentage of increase in the number of medical assistance recipients receiving dental services on a fee-for-service basis in state fiscal year 2000-01 over the number receiving dental services on a fee-for-service basis in state fiscal year 1999-2000. By September 1, 2000, the department shall determine the percentage figure under this subdivision.
(b) Calculation of the payments under this subsection excludes estimated changes in total payments reflected in the intentions of the joint committee on finance, legislature and governor as expressed by them in the budget determinations attributable to changes in recipient utilization of dental services provided on a fee-for-service basis.
SECTION 1426. 49.45 (24m) (intro.) of the statutes is amended to read:
49.45 (24m) HOME HEALTH CARE AND PERSONAL CARE PILOT PROGRAM. (intro.) From the appropriations under s. 20.435 (5) (4) (b) and (o), in order to test the feasibility of instituting a system of reimbursement for providers of home health care and personal care services for medical assistance recipients that is based on competitive bidding, the department shall:
SECTION 1427. 49.45 (25m) of the statutes is created to read:
49.45 (25m) MANAGED CARE FOR CHILDREN IN FOSTER CARE. The department may request a waiver from the secretary of the federal department of health and human services to allow the department to require a child who is in foster care to enroll in a managed care plan as a condition of receiving medical assistance. If the waiver is granted and in effect, the department may require a child who is in foster care to enroll in a managed care plan as a condition of receiving medical assistance.
SECTION 1428. 49.45 (46) of the statutes is created to read:
49.45 (46) ALCOHOL AND OTHER DRUG ABUSE RESIDENTIAL TREATMENT SERVICES. (a) If a county, city, town or village elects to become certified as a provider of alcohol and other drug abuse residential treatment services or to contract with a certified provider to provide the services, the county, city, town or village may provide directly or under contract alcohol and other drug abuse residential treatment services in facilities with fewer than 16 beds under this subsection in the county, city, town or village to medical assistance recipients through the medical assistance program. A county, city, town or village that elects to provide or to contract for the services shall pay the amount of the allowable charges for the services under the medical assistance program that is not provided by the federal government. The department shall reimburse the county, city, town or village under this subsection only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.
(b) This subsection does not apply after July 1, 2003.
SECTION 1429. 49.45 (47) of the statutes is created to read:
