SB45,744,2017
49.475
(6) Sharing information. The department may provide to the
18department of workforce development any information that the department receives
19under this section. The 2 departments shall agree on procedures and methods to
20adequately safeguard the confidentiality of the information provided.
SB45, s. 1443
21Section
1443. 49.489 of the statutes is created to read:
SB45,744,22
2249.489 False claims or statements prohibited. (1) In this section:
SB45,744,2423
(a) "Claim" means a request submitted by a provider for payment for services
24or items furnished by the provider under the medical assistance program.
SB45,745,3
1(b) "Statement" means a representation, certification, affirmation, document,
2record or accounting or bookkeeping entry made with respect to a claim or to obtain
3approval or payment of a claim.
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4(2) No provider may submit a claim or cause a claim to be submitted if the
5provider knows or should know any of the following:
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(a) That the claim is false.
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(b) That the claim includes or is supported by a written statement that asserts
8a material fact that is false.
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(c) That the claim includes or is supported by a written statement that omits
10a material fact that the provider has a duty to include and, by reason of the omission,
11is false.
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12(3) No provider may make or cause to be made a written statement that
13contains or is accompanied by an express certification or affirmation of the
14truthfulness and accuracy of the statement if the provider knows or should know any
15of the following:
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(a) That the statement asserts a material fact that is false.
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(b) That the statement omits a material fact that the provider has a duty to
18include and, by reason of the omission, is false.
SB45,745,19
19(4) For purposes of subs. (2) and (3), all of the following apply:
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(a) Each claim form constitutes a separate claim.
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(b) Each representation, certification, affirmation, document, record or
22accounting or bookkeeping entry constitutes a separate statement.
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(c) A claim is subject to this section regardless of whether the claim is actually
24paid.
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(d) A claim is considered to be made when it is received by the fiscal agent.
SB45,746,2
1(e) Except as provided in par. (f), a statement is considered to be made when
2it is received by the fiscal agent.
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(f) A statement that is not submitted to a fiscal agent but is retained by the
4provider to support a claim is considered to be made when it is entered in the
5provider's books, files or other records.
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6(5) Any person who violates sub. (2) or (3) may be required to forfeit not more
7than $5,000 for each offense.
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8(6) If the department assesses a forfeiture under sub. (5) for a violation of sub.
9(2), the department may impose on the violator, in addition to the forfeiture, a false
10claim surcharge in an amount that is not more than 200% of the amount of the claim
11in regard to which sub. (2) was found to have been violated.
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12(7) The department may directly assess a forfeiture provided for in sub. (5).
13If the department determines that a forfeiture should be assessed for a particular
14violation, the department shall send a notice of assessment to the alleged violator.
15The notice shall specify the amount of the forfeiture assessed, the violation and the
16statute alleged to have been violated and shall inform the alleged violator of the right
17to a hearing under sub. (8).
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18(8) An alleged violator may contest an assessment of a forfeiture by sending,
19within 30 days after receipt of the notice under sub. (7), a written request for hearing
20under s. 227.44 to the division of hearings and appeals created under s. 15.103 (1).
21The administrator of the division may designate a hearing examiner to preside over
22the case and recommend a decision to the administrator under s. 227.46. The
23decision of the administrator of the division shall be the final administrative
24decision. The division shall commence the hearing within 30 days after receipt of the
25request for hearing and shall issue a final decision within 15 days after the close of
1the hearing. Proceedings before the division are governed by ch. 227. In any petition
2for judicial review of a decision by the division, the party, other than the petitioner,
3who was in the proceeding before the division shall be the named respondent.
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4(9) All forfeitures and false claim surcharges, if any, shall be paid to the
5department within 10 days after receipt of notice of assessment or, if the forfeiture
6is contested under sub. (8), within 10 days after receipt of the final decision after
7exhaustion of administrative review, unless the final decision is appealed. The
8department shall remit all forfeitures paid to the state treasurer for deposit in the
9school fund. The department shall credit all false claims surcharges to the
10appropriation account under s. 20.435 (1) (kx).
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11(10) The attorney general may bring an action in the name of the state to collect
12any forfeiture or false claim surcharge imposed under this section if the forfeiture or
13false claim surcharge has not been paid following the exhaustion of all
14administrative and judicial reviews. The only issue to be contested in any such action
15is whether the forfeiture or false claim surcharge has been paid.
SB45, s. 1444
16Section
1444. 49.496 (2) (title) of the statutes is amended to read:
SB45,747,1817
49.496
(2) (title)
Liens on the homes of nursing home residents and inpatients
18at hospitals.
SB45, s. 1445
19Section
1445. 49.496 (2) (a) of the statutes is amended to read:
SB45,748,220
49.496
(2) (a) Except as provided in par. (b), the department may obtain a lien
21on a recipient's home if the recipient resides in a nursing home
, or if the recipient
22resides in a hospital and is required to contribute to the cost of care, and
the recipient 23cannot reasonably be expected to be discharged from the nursing home
or hospital 24and return home. The lien is for the amount of medical assistance paid on behalf of
1the recipient
while the recipient resides in a nursing home that is recoverable under
2sub. (3) (a).
SB45, s. 1446
3Section
1446. 49.496 (2) (b) 3. of the statutes is amended to read:
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49.496
(2) (b) 3. The recipient's sibling who has an ownership interest in the
5home and who has lived in the home continuously beginning at least 12 months
6before the recipient was admitted to the nursing home
or hospital.
SB45, s. 1447
7Section
1447. 49.496 (2) (c) 1. of the statutes is amended to read:
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49.496
(2) (c) 1. Notify the recipient in writing of its determination that the
9recipient cannot reasonably be expected to be discharged from the nursing home
or
10hospital, its intent to impose a lien on the recipient's home and the recipient's right
11to a hearing on whether the requirements for the imposition of a lien are satisfied.
SB45, s. 1448
12Section
1448. 49.496 (2) (f) 3. of the statutes is amended to read:
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49.496
(2) (f) 3. A child of any age who resides in the home, if that child resided
14in the home for at least 24 months before the recipient was admitted to the nursing
15home
or hospital and provided care to the recipient that delayed the recipient's
16admission to the nursing home
or hospital.
SB45, s. 1449
17Section
1449. 49.496 (2) (f) 4. of the statutes is amended to read:
SB45,748,2018
49.496
(2) (f) 4. A sibling who resides in the home, if the sibling resided in the
19home for at least 12 months before the recipient was admitted to the nursing home
20or hospital.
SB45, s. 1450
21Section
1450. 49.496 (2) (h) of the statutes is amended to read:
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49.496
(2) (h) The department shall file a release of a lien imposed under this
23subsection if the recipient is discharged from the nursing home
or hospital and
24returns to live in the home.
SB45, s. 1451
25Section
1451. 49.496 (3) (a) (intro.) of the statutes is amended to read:
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149.496
(3) (a) (intro.) Except as provided in par. (b), the department shall file
2a claim against the estate of a recipient
or against the estate of the surviving spouse
3of a recipient for all of the following unless already recovered by the department
4under this section:
SB45, s. 1452
5Section
1452. 49.496 (3) (a) 1. of the statutes is amended to read:
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49.496
(3) (a) 1. The amount of medical assistance paid on behalf of the
7recipient while the recipient resided in a nursing home or while the recipient was an
8inpatient in a
medical institution hospital and was required to contribute to the cost
9of care.
SB45, s. 1453
10Section
1453. 49.496 (3) (a) 2. a. of the statutes is amended to read:
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49.496
(3) (a) 2. a. Home-based or community-based services under
42 USC
121396d (a) (7) and (8) and under any waiver granted under
42 USC 1396n (c) (4) (B)
13or
42 USC 1396u.
SB45, s. 1454
14Section
1454. 49.496 (3) (a) 2. d. of the statutes is created to read:
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49.496
(3) (a) 2. d. Personal care services under s. 49.46 (2) (b) 6. j.
SB45, s. 1455
16Section
1455. 49.496 (3) (am) (intro.) of the statutes is amended to read:
SB45,749,2017
49.496
(3) (am) (intro.) The court shall reduce the amount of a claim under par.
18(a) by up to
$3,000 the amount specified in s. 861.33 (2) if necessary to allow the
19recipient's heirs or the beneficiaries of the recipient's will to retain the following
20personal property:
SB45, s. 1456
21Section
1456. 49.496 (3) (am) 3. of the statutes is amended to read:
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49.496
(3) (am) 3. Other tangible personal property not used in trade,
23agriculture or other business, not to exceed
$1,000 in value
the amount specified in
24s. 861.33 (1) (a) 4.
SB45, s. 1457
25Section
1457. 49.496 (3) (b) of the statutes is amended to read:
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149.496
(3) (b) A claim under par. (a) is not allowable
if while the decedent has
2a surviving child who is under age 21 or disabled or a surviving spouse.
SB45, s. 1458
3Section
1458. 49.496 (3) (c) of the statutes is renumbered 49.496 (3) (c) 1. and
4amended to read:
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49.496
(3) (c) 1. If the department's claim is not allowable because of par. (b)
6and the estate includes an interest in a home, the court exercising probate
7jurisdiction shall, in the final judgment
or summary findings and order, assign the
8interest in the home subject to a lien in favor of the department for the amount
9described in par. (a). The personal representative
or petitioner for summary
10settlement or summary assignment of the estate shall record the final judgment as
11provided in s. 863.29
, 867.01 (3) (h) or 867.02 (2) (h).
SB45, s. 1459
12Section
1459. 49.496 (3) (c) 2. of the statutes is created to read:
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49.496
(3) (c) 2. If the department's claim is not allowable because of par. (b),
14the estate includes an interest in a home and the personal representative closes the
15estate by sworn statement under s. 865.16, the personal representative shall
16stipulate in the statement that the home is assigned subject to a lien in favor of the
17department for the amount described in par. (a). The personal representative shall
18record the statement in the same manner as described in s. 863.29, as if the
19statement were a final judgment.
SB45, s. 1460
20Section
1460. 49.496 (3) (f) of the statutes is created to read:
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49.496
(3) (f) The department may contract with or employ an attorney to
22probate estates to recover under this subsection the costs of care.
SB45, s. 1461
23Section
1461. 49.496 (5) of the statutes is amended to read:
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49.496
(5) Use of funds. From the appropriation under s. 20.435
(5) (4) (im),
25the department shall pay the amount of the payments under sub. (4) that is not paid
1from federal funds, shall pay to the federal government the amount of the funds
2recovered under this section equal to the amount of federal funds used to pay the
3benefits recovered under this section and shall spend the remainder of the funds
4recovered under this section for medical assistance benefits under this subchapter.
SB45, s. 1463
7Section
1463. 49.499 (1) to (3) of the statutes are renumbered 49.499 (1) (a)
8to (c).
SB45, s. 1464
9Section
1464. 49.499 (2m) of the statutes is created to read:
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49.499
(2m) From the appropriation under s. 20.435 (6) (g), the department
11may distribute funds for innovative projects designed to protect the health and
12property of a resident in a nursing facility, as defined in s. 49.498 (1) (i).
SB45, s. 1465
13Section
1465. 49.665 (1) (a) of the statutes is renumbered 49.665 (1) (e) and
14amended to read:
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49.665
(1) (e) "
Custodial parent
Parent" has the meaning given in s. 49.141 (1)
16(b) (j).
SB45, s. 1466
17Section
1466. 49.665 (1) (b) of the statutes is repealed and recreated to read:
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49.665
(1) (b) "Child" means a person who is under the age of 19.
SB45, s. 1467
19Section
1467. 49.665 (1) (d) of the statutes is amended to read:
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49.665
(1) (d) "Family" means a unit that consists of at least one
dependent 21child and his or her
custodial parent or parents
, all of whom reside in the same
22household. "Family" includes the spouse of an individual who is a
custodial parent
23if the spouse resides in the same household as the individual.
SB45, s. 1468
24Section
1468. 49.665 (1) (f) of the statutes is created to read:
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149.665
(1) (f) "State plan" means the state child health plan under
42 USC
21397aa (b).
SB45, s. 1469
3Section
1469. 49.665 (3) of the statutes is amended to read:
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49.665
(3) Administration. The department shall administer a program to
5provide the health services and benefits described in s. 49.46 (2) to
families persons 6that meet the eligibility requirements specified in sub. (4). The department shall
7promulgate rules setting forth the application procedures and appeal and grievance
8procedures. The department may promulgate rules limiting access to the program
9under this section to defined enrollment periods. The department may also
10promulgate rules establishing a method by which the department may purchase
11family coverage offered by the employer of a member of an eligible family
or by a
12member of a child's household under circumstances in which the department
13determines that purchasing that coverage would not be more costly than providing
14the coverage under this section.
SB45, s. 1470
15Section
1470. 49.665 (4) (a) 1. of the statutes is amended to read:
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49.665
(4) (a) 1. The family's income does not exceed 185% of the poverty line,
17except as provided in par. (at) and except that a family that is already receiving
18health care coverage under this section may have an income that does not exceed
19200% of the poverty line. The department shall establish by rule the criteria to be
20used to determine income.
SB45, s. 1471
21Section
1471. 49.665 (4) (am) of the statutes is created to read:
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49.665
(4) (am) A child who does not reside with his or her parent is eligible
23for health care coverage under this section if the child meets all of the following
24requirements:
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11. The child's income does not exceed 185% of the poverty line, except as
2provided in par. (at) and except that a child that is already receiving health care
3coverage under this section may have an income that does not exceed 200% of the
4poverty line. The department shall use the criteria established under par. (a) 1. to
5determine income under this subdivision.
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2. The child does not have access to employer-subsidized health care coverage.
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3. The child has not had access to employer-subsidized health care coverage
8within the time period established by the department under par. (a) 3. The
9department may establish exceptions to this subdivision.
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4. The child meets all other requirements established by the department by
11rule. In establishing other eligibility criteria, the department may not include any
12health condition requirements.
SB45, s. 1472
13Section
1472. 49.665 (4) (at) of the statutes is created to read:
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49.665
(4) (at) 1. The department shall establish by state plan amendment a
15lower maximum income level for the initial eligibility determination if funding under
16s. 20.435 (4) (bc), (jz) and (p) is insufficient to accommodate the projected enrollment
17levels for the health care program under this section. The adjustment may not be
18greater than necessary to ensure sufficient funding.
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2. If, after the department has established a lower maximum income level
20under subd. 1., projections indicate that funding under s. 20.435 (4) (bc), (jz) and (p)
21is sufficient to raise the level, the department shall, by state plan amendment, raise
22the maximum income level for initial eligibility, but not to exceed 185% of the poverty
23line.
SB45,753,2524
3. The department may not adjust the maximum income level of 200% of the
25poverty line for persons already receiving health care coverage under this section.
SB45, s. 1473
1Section
1473. 49.665 (4) (b) of the statutes is amended to read:
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49.665
(4) (b) Notwithstanding fulfillment of the eligibility requirements
3under this subsection,
a family no person is
not entitled to health care coverage under
4this section.