2001 Wisconsin Act 16

49.33 (1) (b) "Income maintenance program" means the medical assistance program under subch. IV of ch. 49, the badger care health care program under s. 49.665, the child care program under s. 49.155, or the food stamp program under 7 USC 2011 to 2036.

16,1731m Section 1731m. 49.33 (1) (c) of the statutes is repealed.

16,1731t Section 1731t. 49.33 (1) (cr) of the statutes is created to read:

49.33 (1) (cr) "Tribal governing body" means an elected governing body of a federally recognized American Indian tribe.

16,1732b Section 1732b. 49.33 (2) of the statutes is repealed and recreated to read:

49.33 (2) Contracts. (a) Annually, the department and the department of health and family services shall, jointly, contract with county departments under ss. 46.215, 46.22, and 46.23, and may, jointly, contract with tribal governing bodies, to reimburse the county departments and tribal governing bodies for the reasonable cost of administering the medical assistance program under subch. IV and the badger care health care program under s. 49.665.

(b) Annually, the department shall contract with county departments under ss. 46.215, 46.22, and 46.23, and may, jointly, contract with tribal governing bodies, to reimburse the county departments and tribal governing bodies for the reasonable cost of administering income maintenance programs, other than the medical assistance program under subch. IV and the badger care health care program under s. 49.665.

16,1732c Section 1732c. 49.33 (2) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is repealed and recreated to read:

49.33 (2) Contracts. Annually, the department of health and family services shall contract with county departments under ss. 46.215, 46.22, and 46.23, and may contract with tribal governing bodies, to reimburse the county departments and tribal governing bodies for the reasonable cost of administering income maintenance programs.

16,1737 Section 1737. 49.33 (8) (a) of the statutes is amended to read:

49.33 (8) (a) The From the appropriation accounts under ss. 20.445 (3) (dz), (kx), (md), and (nL) and subject to par. (b), the department shall reimburse each county and tribal governing body that contracts with the department and the department of health and family services under sub. (2) (a) for reasonable costs of income maintenance relating to the administration of the programs under this subchapter and subch. IV according to administering the medical assistance program under subch. IV and the badger care health care program under s. 49.665 and that contracts with the department under sub. (2) (b) for the reasonable costs of administering income maintenance programs other than the medical assistance program under subch. IV and the badger care health care program under s. 49.665. The amount of each reimbursement paid under this paragraph shall be calculated using a formula based on workload within the limits of available state and federal funds under s. 20.445 (3) (dz), (kx), (md), and (nL) by contract under s. 49.33 (2). The amount of reimbursement calculated under this paragraph and par. (b) is in addition to any reimbursement provided to a county or tribal governing body for fraud and error reduction under s. 49.197 (1m) and (4).

16,1737c Section 1737c. 49.33 (8) (a) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

49.33 (8) (a) From the appropriation accounts under ss. 20.445 (3) (dz), (kx), (md), and (nL) s. 20.435 (4) (bn) and (nn) and subject to par. (b), the department of health and family services shall reimburse each county and tribal governing body that contracts with the department and the department of health and family services under sub. (2) (a) for reasonable costs of administering the medical assistance program under subch. IV and the badger care health care program under s. 49.665 and that contracts with the department under sub. (2) (b) for the reasonable costs of administering income maintenance programs other than the medical assistance program under subch. IV and the badger care health care program under s. 49.665. The amount of each reimbursement paid under this paragraph shall be calculated using a formula based on workload within the limits of available state and federal funds under s. 20.445 (3) (dz), (kx), (md), and (nL) 20.435 (4) (bn) and (nn) by contract under s. 49.33 (2). The amount of reimbursement calculated under this paragraph and par. (b) is in addition to any reimbursement provided to a county or tribal governing body for fraud and error reduction under s. 49.197 (1m) and (4).

16,1738 Section 1738. 49.33 (8) (b) of the statutes is amended to read:

49.33 (8) (b) The department may adjust the amounts determined under par. (a) for workload changes and computer network activities performed by counties a county or tribal governing body and may reduce the amount of any reimbursement if federal reimbursement is withheld due to audits, quality control samples, or program reviews.

16,1739 Section 1739. 49.33 (9) of the statutes is repealed.

16,1740 Section 1740. 49.33 (10) (a) of the statutes is amended to read:

49.33 (10) (a) The Each county treasurer and each director of a county department under s. 46.215, 46.22, or 46.23 and each tribal governing body shall certify monthly under oath to the department in such manner as the department prescribes the claim of the county for state reimbursement under subs. sub. (8) and (9) and (a). The department shall review each claim of reimbursement and, if the department approves such the claim it, the department shall certify to the department of administration for reimbursement to the county for amounts due under these subsections sub. (8) (a) and payment claimed to be made to the counties monthly. The department may make advance payments prior to the beginning of each month equal to one-twelfth of the contracted amount.

16,1740am Section 1740am. 49.33 (10) (a) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

49.33 (10) (a) Each county treasurer and director of a county department under s. 46.215, 46.22, or 46.23 and each tribal governing body shall certify monthly under oath to the department of health and family services in such manner as the department of health and family services prescribes the claim of the county for state reimbursement under sub. (8) (a). The department of health and family services shall review each claim of reimbursement and, if the department of health and family services approves the claim, the department of health and family services shall certify to the department of administration for reimbursement to the county for amounts due under sub. (8) (a) and payment claimed to be made to the counties monthly. The department of health and family services may make advance payments prior to the beginning of each month equal to one-twelfth of the contracted amount.

16,1740bg Section 1740bg. 49.33 (10) (b) of the statutes is amended to read:

49.33 (10) (b) To facilitate prompt reimbursement the certificate of the department may be based on the certified statements of the county officers or tribal governing body executives filed under par. (a). Funds recovered from audit adjustments from a prior fiscal year may be included in subsequent certifications only to pay counties owed funds as a result of any audit adjustment. By September 30 annually, the department shall submit a report to the appropriate standing committees under s. 13.172 (3) on funds recovered and paid out during the previous calendar year as a result of audit adjustments.

16,1740bq Section 1740bq. 49.33 (10) (b) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

49.33 (10) (b) To facilitate prompt reimbursement the certificate of the department of health and family services may be based on the certified statements of the county officers or tribal governing body executives filed under par. (a). Funds recovered from audit adjustments from a prior fiscal year may be included in subsequent certifications only to pay counties owed funds as a result of any audit adjustment. By September 30 annually, the department of health and family services shall submit a report to the appropriate standing committees under s. 13.172 (3) on funds recovered and paid out during the previous calendar year as a result of audit adjustments.

16,1741 Section 1741. 49.36 (1) of the statutes is renumbered 49.36 (1) (intro.) and amended to read:

49.36 (1) (intro.) In this section, "custodial:

(a) "Custodial parent" means a parent who lives with his or her child for substantial periods of time.

16,1742 Section 1742. 49.36 (1) (b) of the statutes is created to read:

49.36 (1) (b) "Tribal governing body" means an elected tribal governing body of a federally recognized American Indian tribe or band.

16,1743 Section 1743. 49.36 (2) of the statutes is amended to read:

49.36 (2) The department may contract with any county, tribal governing body, or Wisconsin works agency to administer a work experience and job training program for parents who are not custodial parents and who fail to pay child support or to meet their children's needs for support as a result of unemployment or underemployment. The program may provide the kinds of work experience and job training services available from the program under s. 49.193, 1997 stats., or s. 49.147 (3) or (4). The program may also include job search and job orientation activities. The department shall fund the program from the appropriation under s. 20.445 (3) (dz).

16,1744 Section 1744. 49.36 (4) of the statutes is amended to read:

49.36 (4) When a person completes 16 weeks of participation in a program under this section, the county, tribal governing body, or Wisconsin works agency operating the program shall inform the clerk of courts, by affidavit, of that completion.

16,1745 Section 1745. 49.36 (5) of the statutes is amended to read:

49.36 (5) A person participating in work experience as part of the program under this section is considered an employee of the county, tribal governing body, or Wisconsin works agency administering the program under this section for purposes of worker's compensation benefits only.

16,1746 Section 1746. 49.36 (6) of the statutes is amended to read:

49.36 (6) A county, tribal governing body, or Wisconsin works agency administering the program under this section shall reimburse a person for reasonable transportation costs incurred because of participation in a program under this section up to a maximum of $25 per month.

16,1747 Section 1747. 49.36 (7) of the statutes is amended to read:

49.36 (7) The department shall pay a county, tribal governing body, or Wisconsin works agency not more than $400 for each person who participates in the program under this section in the region in which the county, tribal governing body, or Wisconsin works agency administers the program under this section. The county, tribal governing body, or Wisconsin works agency shall pay any additional costs of the program.

16,1748 Section 1748. 49.43 (8) of the statutes is amended to read:

49.43 (8) "Medical assistance" means any services or items under ss. 49.45 to 49.472 49.473, except s. 49.472 (6), and under ss. 49.49 to 49.497, or any payment or reimbursement made for such services or items.

16,1749 Section 1749. 49.45 (2) (a) 3. of the statutes is amended to read:

49.45 (2) (a) 3. Determine the eligibility of persons for medical assistance, rehabilitative, and social services under ss. 49.46, 49.468, and 49.47 and rules and policies adopted by the department and may shall, under a contract under s. 49.33 (2) (a), designate this function to the county department under s. 46.215, 46.22, or 46.23 or, to the extent permitted by federal law or a waiver from federal secretary of health and human services to a Wisconsin works agency a tribal governing body.

16,1750 Section 1750. 49.45 (2) (a) 3m. of the statutes is created to read:

49.45 (2) (a) 3m. If the department does not contract with the department of workforce development under s. 49.197 (5), establish a program to investigate suspected fraudulent activity on the part of recipients of medical assistance and establish a program to reduce errors in the payments of medical assistance.

16,1750d Section 1750d. 49.45 (2) (a) 10. of the statutes is renumbered 49.45 (2) (a) 10. a. and amended to read:

49.45 (2) (a) 10. a. After reasonable notice and opportunity for hearing, recover money improperly or erroneously paid, or overpayments to a provider either by offsetting or adjusting amounts owed the provider under the program, crediting against a provider's future claims for reimbursement for other services or items furnished by the provider under the program, or by requiring the provider to make direct payment to the department or its fiscal intermediary.

16,1750f Section 1750f. 49.45 (2) (a) 10. b. of the statutes is created to read:

49.45 (2) (a) 10. b. Establish a deadline for payment of a recovery imposed under this subdivision and, if a provider fails to pay all of the amount to be recovered by the deadline, require payment, by the provider, of interest on any delinquent amount at the rate of 1% per month or fraction of a month from the date of the overpayment.

16,1750g Section 1750g. 49.45 (2) (a) 10. c. of the statutes is created to read:

49.45 (2) (a) 10. c. Promulgate rules to implement this subdivision.

16,1750h Section 1750h. 49.45 (2) (a) 11. of the statutes is renumbered 49.45 (2) (a) 11. a. and amended to read:

49.45 (2) (a) 11. a. Establish criteria for the certification of eligible providers of services under Title XIX of the social security act medical assistance and, except as provided in par. (b) 6m. and s. 49.48, and subject to par. (b) 7. and 8., certify such eligible providers who meet the criteria.

16,1750i Section 1750i. 49.45 (2) (a) 11. b. of the statutes is created to read:

49.45 (2) (a) 11. b. Promulgate rules to implement this subdivision.

16,1750j Section 1750j. 49.45 (2) (a) 12. of the statutes is renumbered 49.45 (2) (a) 12. a. and amended to read:

49.45 (2) (a) 12. a. Decertify or suspend under this subdivision a provider from or restrict a provider's participation in the medical assistance program, if after giving reasonable notice and opportunity for hearing, the department finds that the provider has violated a federal statute or regulation or a state law statute or administrative rule and such violations are by law the violation is by statute, regulation, or rule grounds for decertification or suspension restriction. The department shall suspend the provider pending the hearing under this subdivision if the department includes in its decertification notice findings that the provider's continued participation in the medical assistance program pending hearing is likely to lead to the irretrievable loss of public funds and is unnecessary to provide adequate access to services to medical assistance recipients. As soon as practicable after the hearing, the department shall issue a written decision. No payment may be made under the medical assistance program with respect to any service or item furnished by the provider subsequent to decertification or during the period of suspension.

16,1750k Section 1750k. 49.45 (2) (a) 12. b. of the statutes is created to read:

49.45 (2) (a) 12. b. Promulgate rules to implement this subdivision.

16,1750km Section 1750km. 49.45 (2) (a) 24. of the statutes is created to read:

49.45 (2) (a) 24. Promulgate rules that require that the written plan of care for persons receiving personal care services under medical assistance be reviewed by a registered nurse at least every 60 days. The rules shall provide that the written plan of care shall designate intervals for visits to the recipient's home by a registered nurse as part of the review of the plan of care. The designated intervals for visits shall be based on the individual recipient's needs, and each recipient shall be visited in his or her home by a registered nurse at least once in every 12-month period. The rules shall also provide that a visit to the recipient is also required if, in the course of the nurse's review of the plan of care, there is evidence that a change in the recipient's condition has occurred that may warrant a change in the plan of care.

16,1750L Section 1750L. 49.45 (2) (b) 6m. of the statutes is created to read:

49.45 (2) (b) 6m. Limit the number of providers of particular services that may be certified under par. (a) 11. or the amount of resources, including employees and equipment, that a certified provider may use to provide particular services to medical assistance recipients, if the department finds that existing certified providers and resources provide services that are adequate in quality and amount to meet the need of medical assistance recipients for the particular services; and if the department finds that the potential for medical assistance fraud or abuse exists if additional providers are certified or additional resources are used by certified providers. The department shall promulgate rules to implement this subdivision.

16,1750n Section 1750n. 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) 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) or 49.47 (6) (a) for which providers have demonstrated significant potential to violate s. 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 in an amount that the department determines is reasonable in view of amounts of former recoveries against providers of the specific service and the department's costs to pursue those recoveries. The department shall promulgate rules to implement this subdivision that specify all of the following:

a. Services under medical assistance for which providers have demonstrated significant potential to violate s. 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.

16,1750p Section 1750p. 49.45 (2) (b) 8. of the statutes is created to read:

49.45 (2) (b) 8. Require a person who takes over the operation, as defined in sub. (21) (ag), of a provider, to first obtain certification under par. (a) 11. for the operation of the provider, regardless of whether the person is currently certified. The department may withhold the certification required under this subdivision until any outstanding repayment under sub. (21) is made. The department shall promulgate rules to implement this subdivision.

16,1750r Section 1750r. 49.45 (2) (b) 9. of the statutes is created to read:

49.45 (2) (b) 9. After providing reasonable notice and opportunity for a hearing, charge an assessment to a provider that repeatedly has been subject to recoveries under par. (a) 10. a. because of the provider's failure to follow identical or similar billing procedures or to follow other identical or similar program requirements. The assessment shall be used to defray in part the costs of audits and investigations by the department under sub. (3) (g) and may not exceed $1,000 or 200% of the amount of any such repeated recovery made, whichever is greater. The provider shall pay the assessment to the department within 10 days after receipt of notice of the assessment or the final decision after administrative hearing, whichever is later. The department may recover any part of an assessment not timely paid by offsetting the assessment against any medical assistance payment owed to the provider and may refer any such unpaid assessments not collected in this manner to the attorney general, who may proceed with collection under this subdivision. Failure to timely pay in any manner an assessment charged under this subdivision, other than an assessment that is offset against any medical assistance payment owed to the provider, is grounds for decertification under subd. 12. A provider's payment of an assessment does not relieve the provider of any other legal liability incurred in connection with the recovery for which the assessment is charged, but is not evidence of violation of a statute or rule. The department shall credit all assessments received under this subdivision to the appropriation account under s. 20.435 (4) (iL). The department shall promulgate rules to implement this subdivision.

16,1750t Section 1750t. 49.45 (3) (g) of the statutes is renumbered 49.45 (3) (g) 1. and amended to read:

49.45 (3) (g) 1. 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 employees 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 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 accord the person access to any needed patient health care records of a recipient. Authorized employees 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.

16,1750td Section 1750td. 49.45 (3) (g) 2. of the statutes is created to read:

49.45 (3) (g) 2. The department shall promulgate rules to implement this paragraph.

16,1750v Section 1750v. 49.45 (3) (h) 1. of the statutes is repealed.

16,1750vm Section 1750vm. 49.45 (3) (h) 1n. of the statutes is created to read:

49.45 (3) (h) 1n. The department shall promulgate rules to implement this paragraph.

16,1750x Section 1750x. 49.45 (3) (h) 2. of the statutes is repealed.

16,1750z Section 1750z. 49.45 (3) (h) 3. of the statutes is renumbered 49.45 (3) (h) 1m. and amended to read:

49.45 (3) (h) 1m. 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 to accord department auditors or investigators access as required under par. (g) 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. No payment may be made for services rendered by that person subsequent to the provider following decertification or, during the period of suspension, or during any period of provider failure or refusal to accord access as required under par. (g).

16,1765 Section 1765. 49.45 (5m) (am) of the statutes is amended to read:

49.45 (5m) (am) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b) and, (o), and (w), 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).

16,1766 Section 1766. 49.45 (5r) of the statutes is repealed.

16,1767 Section 1767. 49.45 (6b) of the statutes is 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 that involves a relocation from a center for the developmentally disabled, by $184 $200 per day, beginning in fiscal year 1999-2000 2001-02, and by $190 $225 per day, beginning in fiscal year 2000-01 2002-03.

16,1768 Section 1768. 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 (4) (b), (pa) or, (o), (w), or (wm) 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: