SB45, s. 1369
1Section
1369. 49.45 (2) (a) 13. of the statutes is amended to read:
SB45,719,52
49.45
(2) (a) 13. Impose additional sanctions for noncompliance with the
3conditions of participation and terms of
provider agreements reimbursement under
4subd. 9. or certification criteria established under subd. 11.
and, if prescribed by the
5department, under par. (b) 6. or 7.
SB45, s. 1370
6Section
1370. 49.45 (2) (a) 14. of the statutes is repealed.
SB45, s. 1371
7Section
1371. 49.45 (2) (a) 17. of the statutes is amended to read:
SB45,719,118
49.45
(2) (a) 17. Notify the governor, the joint committee on legislative
9organization, the joint committee on finance and appropriate standing committees,
10as determined by the presiding officer of each house, if the appropriation under s.
1120.435
(5) (4) (b) is insufficient to provide the state share of medical assistance.
SB45, s. 1372
12Section
1372. 49.45 (2) (b) 6. of the statutes is created to read:
SB45,719,1713
49.45
(2) (b) 6. Prescribe criteria for certification of providers of medical
14assistance that limit the number of providers of particular services or that limit the
15amount of resources, including employes and equipment, that a certified provider
16may use to provide particular services to medical assistance recipients, if the
17department finds all of the following:
SB45,719,2018
a. That existing certified providers and resources provide services that are
19adequate in quality and amount to meet the need of medical assistance recipients for
20the particular services.
SB45,719,2221
b. That the potential for medical assistance fraud or abuse exists if additional
22providers are certified or additional resources are used by certified providers.
SB45, s. 1373
23Section
1373. 49.45 (2) (b) 7. of the statutes is created to read:
SB45,720,1124
49.45
(2) (b) 7. Require, as a condition of certification under par. (a) 11., all
25providers of a specific service that is among those enumerated under s. 49.46 (2) (b)
1or 49.47 (6) (a), as specified in this subdivision, to file with the department a surety
2bond issued by a surety company licensed to do business in this state. Providers
3subject to this subdivision provide those services specified under s. 49.46 (2) (b) or
449.47 (6) (a) for which providers have demonstrated significant potential to violate
5s. 49.489 (2) or (3) or 49.49 (1) (a), (2) (a) or (b), (3), (3m) (a), (3p), (4) (a) or (4m) (a),
6to require recovery under par. (a) 10. or to need additional sanctions under par. (a)
713. The surety bond shall be payable to the department and in an amount that would
8reasonably pay the amount of a recovery and the department's costs to pursue
9recovery under par. (a) 10. or to investigate and pursue allegations of violations of
10s. 49.489 or 49.49. The department shall promulgate rules under this subdivision
11that specify all of the following:
SB45,720,1512
a. Services under medical assistance for which providers have demonstrated
13significant potential to violate s. 49.489 (2) or (3) or 49.49 (1) (a), (2) (a) or (b), (3), (3m)
14(a), (3p), (4) (a) or (4m) (a), to require recovery under par. (a) 10. or to need additional
15sanctions under par. (a) 13.
SB45,720,1616
b. The amount or amounts of the surety bonds.
SB45,720,1917
c. Terms of the surety bond, including amounts, if any, without interest to be
18refunded to the provider upon withdrawal or decertification from the medical
19assistance program.
SB45, s. 1374
20Section
1374. 49.45 (3) (ag) of the statutes is amended to read:
SB45,720,2321
49.45
(3) (ag) Reimbursement shall be made to each entity contracted with
22under s.
46.271 (2m) 46.281 (1) (d) for
assessments completed functional screens
23performed under s.
46.271 (2m) (a) 2. 46.281 (1) (d).
SB45, s. 1375
24Section
1375. 49.45 (3) (am) 1. of the statutes is amended to read:
SB45,721,5
149.45
(3) (am) 1. From the appropriation under s. 20.435
(1) (4) (bm), the
2department shall make incentive payments to counties to encourage counties to
3identify medical assistance applicants and recipients who have other health care
4coverage and the providers of the health care coverage and give that information to
5the department.
SB45, s. 1376
6Section
1376. 49.45 (3) (f) 3. of the statutes is amended to read:
SB45,721,107
49.45
(3) (f) 3. Contractors under sub. (2) (b) shall maintain records as required
8by the department for audit purposes.
Contractors
Upon request of the department,
9contractors shall
immediately provide the department access to the records
upon
10request of the department, and, which the department may audit
the records.
SB45, s. 1377
11Section
1377. 49.45 (3) (g) of the statutes is amended to read:
SB45,722,812
49.45
(3) (g) The secretary may
appoint authorize personnel to audit or
13investigate and report to the department on any matter involving violations or
14complaints alleging violations of
laws statutes, regulations, or rules applicable to
15Title XIX of the federal social security act or the medical assistance program and to
16perform such investigations or audits as are required to verify the actual provision
17of services or items available under the medical assistance program and the
18appropriateness and accuracy of claims for reimbursement submitted by providers
19participating in the program. Department employes
appointed authorized by the
20secretary under this paragraph shall be issued
, and shall possess at all times
during
21which while they are performing their investigatory or audit functions under this
22section
, identification
, signed by the secretary
which, that specifically designates the
23bearer as possessing the authorization to conduct medical assistance investigations
24or audits.
Pursuant to Under the request of a designated person and upon
25presentation of
that the person's authorization, providers and
medical assistance
1recipients shall
immediately accord
such the person access to any
provider
2personnel, records, books
, recipient medical records, or documents or other
3information needed.
Under the written request of a designated person and upon
4presentation of the person's authorization, providers and recipients shall
5immediately accord the person access to any needed patient health care records of
6a recipient. Authorized employes
shall have authority to may hold hearings,
7administer oaths, take testimony and perform all other duties necessary to bring
8such the matter before the department for final adjudication and determination.
SB45, s. 1378
9Section
1378. 49.45 (3) (h) 1. of the statutes is repealed.
SB45, s. 1379
10Section
1379. 49.45 (3) (h) 2. of the statutes is repealed.
SB45, s. 1380
11Section
1380. 49.45 (3) (h) 3. of the statutes is renumbered 49.45 (3) (h) and
12amended to read:
SB45,722,2113
49.45
(3) (h) The failure or refusal of a
person to purge himself or herself of
14contempt found under s. 885.12 and perform the act as required by law shall
15constitute provider immediately to accord department auditors under par. (f) 3. or
16investigators under par. (g) access to any provider personnel, records, books, patient
17health care records of medical assistance recipients or documents or other
18information requested constitutes grounds for decertification or suspension of
that
19person the provider from participation in the medical assistance program and no
20payment may be made for services rendered by
that person subsequent to the
21provider following decertification or during the period of suspension.
SB45, s. 1381
22Section
1381. 49.45 (3) (j) of the statutes is amended to read:
SB45,722,2423
49.45
(3) (j) Reimbursement for administrative contract costs under this
24section is limited to the funds available under s. 20.435
(1) (4) (bm).
SB45, s. 1382
1Section
1382. 49.45 (5m) (a) of the statutes is renumbered 49.45 (5m) (am) and
2amended to read:
SB45,723,103
49.45
(5m) (am) Notwithstanding sub. (3) (e), from the appropriations under
4s. 20.435
(5) (4) (b) and (o) the department shall distribute not more than $2,256,000
5in each fiscal year, to provide supplemental funds to rural hospitals that, as
6determined by the department, have high utilization of inpatient services by
7patients whose care is provided from governmental sources,
and to provide
8supplemental funds to critical access hospitals, except that the department may not
9distribute funds to a rural hospital
or to a critical access hospital to the extent that
10the distribution would exceed any limitation under
42 USC 1396b (i) (3).
SB45, s. 1383
11Section
1383. 49.45 (5m) (ag) of the statutes is created to read:
SB45,723,1312
49.45
(5m) (ag) In this subsection, "critical access hospital" has the meaning
13given in s. 50.33 (1g).
SB45, s. 1384
14Section
1384. 49.45 (5m) (b) of the statutes is amended to read:
SB45,723,1815
49.45
(5m) (b) The supplemental funding
for rural hospitals under par.
(a) (am) 16shall be based on the utilization, by recipients of medical assistance, of the total
17inpatient days of a rural hospital in relation to that utilization in other rural
18hospitals.
SB45, s. 1385
19Section
1385. 49.45 (6b) (intro.) of the statutes is renumbered 49.45 (6b) and
20amended to read:
SB45,724,221
49.45
(6b) Centers for the developmentally disabled. From the
22appropriation under s. 20.435 (2) (gk), the department may reimburse the cost of
23services provided by the centers for the developmentally disabled. Reimbursement
24to the centers for the developmentally disabled shall be reduced following each
25placement made under s. 46.275
which that involves a relocation from a center for
1the developmentally disabled,
as follows:
by $184 per day, beginning in fiscal year
21999-2000, and by $190 per day, beginning in fiscal year 2000-01.
SB45, s. 1386
3Section
1386. 49.45 (6b) (a) of the statutes is repealed.
SB45, s. 1387
4Section
1387. 49.45 (6b) (b) of the statutes is repealed.
SB45, s. 1388
5Section
1388. 49.45 (6b) (c) of the statutes is repealed.
SB45, s. 1389
6Section
1389. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:
SB45,724,137
49.45
(6m) (ag) (intro.) Payment for care provided in a facility under this
8subsection made under s. 20.435
(1) (p) or (5) (b)
(4) (b), (pa) or (o) shall, except as
9provided in pars. (bg), (bm) and (br), be determined according to a prospective
10payment system updated annually by the department. The payment system shall
11implement standards that are necessary and proper for providing patient care and
12that meet quality and safety standards established under subch. II of ch. 50 and ch.
13150. The payment system shall reflect all of the following:
SB45, s. 1390
14Section
1390. 49.45 (6m) (ag) 3m. of the statutes is repealed.
SB45, s. 1391
15Section
1391. 49.45 (6m) (ag) 8. of the statutes is repealed.
SB45, s. 1392
16Section
1392. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:
SB45,724,2417
49.45
(6m) (ar) 1. a. The department shall establish standards for payment of
18allowable direct care costs, for facilities that do not primarily serve the
19developmentally disabled, that
are not less than the median for take into account 20direct care costs for a sample of all of those facilities in this state and separate
21standards for payment of allowable direct care costs, for facilities that primarily
22serve the developmentally disabled, that
are not less than the median for take into
23account direct care costs for a sample of all of those facilities in this state. The
24standards shall be adjusted by the department for regional labor cost variations.
SB45, s. 1393
25Section
1393. 49.45 (6m) (ar) 1. cm. of the statutes is amended to read:
SB45,725,5
149.45
(6m) (ar) 1. cm.
Notwithstanding the limitations under par. (ag) 8.,
2funding Funding distributed to facilities for the provision of active treatment to
3residents with a diagnosis of developmental disability shall be distributed in
4accordance with a method developed by the department which is consistent with a
5prudent buyer approach to payment for services.
SB45, s. 1394
6Section
1394. 49.45 (6m) (ar) 2. a. of the statutes is amended to read:
SB45,725,97
49.45
(6m) (ar) 2. a. The department shall establish one or more standards for
8the payment of support service costs that
are not less than the median of take into
9account support service costs for a sample of all facilities within the state.
SB45, s. 1395
10Section
1395. 49.45 (6m) (ar) 3. a. of the statutes is amended to read:
SB45,725,1411
49.45
(6m) (ar) 3. a. The department shall establish standards, adjusted for
12heating degree day variations in the state, for payment of fuel and utility costs that
13are not less than the median of take into account heating fuel and utility costs for a
14sample of all facilities within the state.
SB45, s. 1396
15Section
1396. 49.45 (6m) (ar) 4. of the statutes is amended to read:
SB45,725,1916
49.45
(6m) (ar) 4. For net property taxes or municipal services, payment shall
17be made for
those costs that range from the amount of the previous calendar year's
18tax or the amount of municipal service costs for a period specified by the department
,
19subject to a maximum limit as determined by the department.
SB45, s. 1397
20Section
1397. 49.45 (6m) (ar) 5. a. of the statutes is amended to read:
SB45,725,2421
49.45
(6m) (ar) 5. a. The department shall establish one or more standards for
22the payment of administrative and general costs that
are not less than the median
23of take into account administrative and general costs for a sample of all facilities
24within the state.
SB45, s. 1398
25Section
1398. 49.45 (6m) (ar) 6. of the statutes is amended to read:
SB45,726,6
149.45
(6m) (ar) 6. Capital payment shall be based on a replacement value for
2a facility. The replacement value shall be determined by a commercial estimator
3contracted for by the department and paid for by the facility. The replacement value
4shall be subject to limitations determined by the department
, except that the
5department may not reduce final capital payment of a facility by more than $3.50 per
6patient day.
SB45, s. 1399
7Section
1399. 49.45 (6m) (av) 1. of the statutes is amended to read:
SB45,726,108
49.45
(6m) (av) 1. The department shall calculate a payment rate for a facility
9by applying the criteria set forth under pars. (ag) 1. to 5.
, and 7.
and 8., (am) 1. to 5.
10and (ar) 1. to 5. to information from cost reports submitted by the facility.
SB45, s. 1400
11Section
1400. 49.45 (6m) (av) 5m. of the statutes is amended to read:
SB45,726,1512
49.45
(6m) (av) 5m.
Notwithstanding the limitations under par. (ag) 8., the The 13rate under subd. 1., 4. or 5. may be adjusted by the department to reflect payments
14for the provision of active treatment to facility residents with a diagnosis of
15developmental disability.
SB45, s. 1401
16Section
1401. 49.45 (6m) (bp) (intro.) of the statutes is amended to read:
SB45,726,1917
49.45
(6m) (bp) (intro.) Notwithstanding pars.
(ag) 3m., (am) 6. and (ar) 6., the
18department may establish payment methods based on actual costs for capital
19payment for a facility to which, after December 31, 1982, any of the following applies:
SB45, s. 1402
20Section
1402. 49.45 (6m) (br) 1. of the statutes is amended to read:
SB45,727,421
49.45
(6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435
(5) (4) (bt)
or (bu) 22or (7) (b) or 20.445 (3) (dz), the department shall reduce allocations of funds to
23counties in the amount of the disallowance from the appropriation account under s.
2420.435
(5) (4) (bt)
or (bu) or (7) (b), or the department shall direct the department of
25workforce development to reduce allocations of funds to counties or Wisconsin works
1agencies in the amount of the disallowance from the appropriation account under s.
220.445 (3) (dz) or direct the department of corrections to reduce allocations of funds
3to counties in the amount of the disallowance from the appropriation account under
4s. 20.410 (3) (cd), in accordance with s. 16.544 to the extent applicable.
SB45, s. 1403
5Section
1403. 49.45 (6m) (c) 5. of the statutes is amended to read:
SB45,727,86
49.45
(6m) (c) 5. Admit only patients assessed or who waive or are exempt from
7the requirement of assessment under s. 46.27 (6) (a)
or, if required under s. 50.035
8(4n) or 50.04 (2h), who have been referred to a resource center.
SB45, s. 1404
9Section
1404. 49.45 (6t) (intro.) of the statutes is amended to read:
SB45,727,2010
49.45
(6t) County department and local health department operating
11deficit reduction. (intro.) From the appropriation under s. 20.435
(5) (4) (o), for
12reduction of operating deficits, as defined under criteria developed by the
13department, incurred by a county department under s. 46.215, 46.22, 46.23 or 51.42
14or by a local health department, as defined in s. 250.01 (4), for services provided
15under s. 49.46 (2) (a) 4. d. and (b) 6. f., j., k. and L., 9. and 15., for case management
16services under s. 49.46 (2) (b) 12. and for mental health day treatment services for
17minors provided under the authorization under
42 USC 1396d (r) (5), the department
18shall allocate up to $4,500,000 in each fiscal year to these county departments, or
19local health departments as determined by the department, and shall perform all of
20the following:
SB45, s. 1405
21Section
1405. 49.45 (6t) (d) of the statutes is amended to read:
SB45,728,222
49.45
(6t) (d) If the federal department of health and human services approves
23for state expenditure in a fiscal year amounts under s. 20.435
(5) (4) (o) that result
24in a lesser allocation amount than that allocated under this subsection or disallows
1use of the allocation of federal medicaid funds under par. (c), reduce allocations under
2this subsection and distribute on a prorated basis, as determined by the department.
SB45, s. 1406
3Section
1406. 49.45 (6u) (intro.) of the statutes is amended to read:
SB45,728,174
49.45
(6u) Supplemental payments to certain facilities. (intro.)
5Notwithstanding sub. (6m), from the appropriation under s. 20.435
(5) (4) (o), for
6reduction of operating deficits, as defined under criteria developed by the
7department, incurred by a facility, as defined under sub. (6m) (a) 3., that is
8established under s. 49.70 (1) or that is owned and operated by a city, village or town,
9the department may not distribute to these facilities more than $38,600,000 in each
10fiscal year, as determined by the department, except that the department shall also
11distribute for this same purpose from the appropriation under s. 20.435
(5) (4) (o) any
12additional federal medical assistance moneys that were not anticipated before
13enactment of the biennial budget act or other legislation affecting s. 20.435
(5) (4) (o)
14and that were not used to fund nursing home rate increases under sub. (6m) (ag) 8.
15The total amount that a county certifies under this subsection may not exceed 100%
16of otherwise-unreimbursed care. In distributing funds under this subsection, the
17department shall perform all of the following:
SB45, s. 1407
18Section
1407. 49.45 (6u) (d) of the statutes is amended to read:
SB45,728,2319
49.45
(6u) (d) If the federal department of health and human services approves
20for state expenditure in a fiscal year amounts under s. 20.435
(5) (4) (o) that result
21in a lesser allocation amount than that allocated under this subsection, allocate not
22more than the lesser amount so approved by the federal department of health and
23human services.
SB45, s. 1408
24Section
1408. 49.45 (6u) (e) of the statutes is amended to read:
SB45,729,5
149.45
(6u) (e) If the federal department of health and human services approves
2for state expenditure in a fiscal year amounts under s. 20.435
(5) (4) (o) that result
3in a lesser allocation amount than that allocated under this subsection, submit a
4revision of the method developed under par. (b) for approval by the joint committee
5on finance in that state fiscal year.
SB45, s. 1409
6Section
1409. 49.45 (6v) (b) of the statutes is amended to read:
SB45,729,127
49.45
(6v) (b) The department shall, each year, submit to the joint committee
8on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that
9provides information on the utilization of beds by recipients of medical assistance in
10facilities
and a discussion and detailed projection of the likely balances,
11expenditures, encumbrances and carry over of currently appropriated amounts in
12the appropriation accounts under s. 20.435 (4) (b) and (o).
SB45, s. 1410
13Section
1410. 49.45 (6v) (c) of the statutes is amended to read:
SB45,729,2514
49.45
(6v) (c) If the report specified in par. (b) indicates that utilization of beds
15by recipients of medical assistance in facilities
decreased is less than estimates for
16that utilization reflected in the intentions of the joint committee on finance,
17legislature and governor, as expressed by them in the budget determinations, the
18department shall include a proposal to transfer
moneys from the appropriation
19under s. 20.435
(5) (4) (b) to the appropriation under s. 20.435 (7) (bd) for the purpose
20of increasing funding for the community options program under s. 46.27.
The
21amount proposed for transfer may not reduce the balance in the appropriation
22account under s. 20.435 (4) (b) below an amount necessary to ensure that that
23appropriation account will end the current fiscal year or the current fiscal biennium
24with a positive balance. The secretary shall transfer the amount identified under the
25proposal.
SB45, s. 1411
1Section
1411. 49.45 (6w) (intro.) of the statutes is amended to read:
SB45,730,82
49.45
(6w) Hospital operating deficit reduction. (intro.) From the
3appropriation under s. 20.435
(5) (4) (o), for reduction of operating deficits, as defined
4under criteria developed by the department, incurred by a hospital, as defined under
5s. 50.33 (2) (a) and (b), that is operated by the state, established under s. 49.71 or
6owned and operated by a city or village, the department shall allocate up to
7$3,300,000 in each fiscal year to these hospitals, as determined by the department,
8and shall perform all of the following:
SB45, s. 1412
9Section
1412. 49.45 (6w) (d) of the statutes is amended to read:
SB45,730,1410
49.45
(6w) (d) If the federal department of health and human services approves
11for state expenditure in a fiscal year amounts under s. 20.435
(5) (4) (o) that result
12in a lesser allocation amount than that allocated under this subsection or disallows
13use of the allocation of federal medicaid funds under par. (c), reduce allocations under
14this subsection and distribute on a prorated basis, as determined by the department.
SB45, s. 1413
15Section
1413. 49.45 (6x) (a) of the statutes is amended to read:
SB45,730,2016
49.45
(6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
1720.435
(5) (4) (b) and (o) the department shall distribute not more than $4,748,000
18in each fiscal year, to provide funds to an essential access city hospital, except that
19the department may not allocate funds to an essential access city hospital to the
20extent that the allocation would exceed any limitation under
42 USC 1396b (i) (3).
SB45, s. 1414
21Section
1414. 49.45 (6x) (d) of the statutes is amended to read:
SB45,731,222
49.45
(6x) (d) If the federal department of health and human services approves
23for state expenditure in any state fiscal year amounts under s. 20.435
(5) (4) (o) that
24result in a lesser distribution amount than that distributed under this subsection or
1disallows use of federal medicaid funds under par. (a), the department of health and
2family services shall reduce the distributions under this subsection.