To participate in tier II, an applicant must also have implemented or must
commit itself to implementing an environmental management system. The
applicant must specify objectives for improving its environmental performance or for
voluntarily restoring, enhancing, or preserving natural resources. The applicant
must also commit itself to conducting annual audits of its environmental
management system and to submitting reports to DNR on those audits.
The bill requires DNR to provide public recognition to an entity that
participates in tier II of the Green Tier Program. The bill also requires DNR to assign
one of its employees to serve as the contact with DNR for a participant in tier II for
all licenses and permits that the participant must obtain from DNR. After a
participant in tier II implements an environmental management system, DNR must
conduct inspections of the participant's facilities that are covered under green tier
at the lowest frequency that is permitted under DNR's rules.
An entity or a group of entities may participate in tier III of the Green Tier
Program. If a group applies, all of the requirements for participation apply to all of
the members of the group. A participant in tier III enters into a green tier contract
with DNR. The contract specifies the participant's commitments and the incentives
that will be provided to the participant.
At the time of application for tier III, more than ten years must have elapsed
since the applicant was convicted of a criminal violation of an environmental law that
resulted in substantial harm to public health or the environment or that presented
an imminent threat to public health or the environment; more than five years must
have elapsed since a civil judgment was entered against the applicant for a violation
of an environmental law that resulted in substantial harm to public health or the
environment; and more than two years must have elapsed since the applicant was
prosecuted or issued a citation for violating an environmental law.
To participate in tier III, an applicant must have implemented an
environmental management system. The applicant must commit itself to having an
outside auditor conduct annual audits of the environmental management system
and to submitting reports on those audits to DNR. The applicant must also commit
itself to annually conducting audits of its compliance with environmental laws and
to submitting the results of those audits to DNR.
Finally, to participate in tier III, an applicant must demonstrate that it has a
record of superior environmental performance and describe the measures that it
proposes to take to maintain and improve its superior environmental performance.
"Superior environmental performance" means that an entity minimizes the negative
effects of its pollutants on the environment or human health to an extent that is
greater than is required by law or that an entity voluntarily engages in restoring,
enhancing, or preserving natural resources.
If DNR determines that an applicant qualifies for participation in tier III, DNR
may enter into negotiations with the applicant about a green tier contract. DNR may
permit interested third parties to participate in the negotiations. If the parties reach
an agreement, they may enter into a green tier contract with a term of not more than
five years, subject to renewal for terms of not more than five years each. The bill
authorizes DNR to promulgate rules specifying incentives that may be provided to
participants in tier III.
The bill establishes a grant program under which the department of commerce
makes grants to nongovernmental organizations to help those organizations develop
the capacity to participate as interested third parties in the Green Tier Program and
makes grants to assist in the development of environmental management systems.
Other environment
Under current law, a registrant is required to pay an environmental impact fee
of $6 upon registering a new motor vehicle with DOT or upon applying for a new
certificate of title following a transfer of a vehicle. The environmental impact fees
are credited to the environmental fund and are earmarked for environmental
management activities. Currently, the law requiring a registrant to pay an
environmental impact fee expires on June 30, 2001. This bill extends that expiration
date to September 30, 2003.
Under current law, DNR may characterize a solid waste as a special waste
available for beneficial use in a public works project and must maintain a public list
of those special wastes. Currently, a contracting agency in a public works project may
require the use of those special wastes in a public works project. Current law grants
immunity from liability to any person who used those special wastes in a public
works project if that use occurred while performing work under the contract for the
public works project, the contract permitted or required the use of those special
wastes, and the use conformed to the contract provisions. Current law makes the
immunity inapplicable to reckless, wanton, or intentional misconduct or if death or
injury of an individual resulted from the use. Under current law, DNR may grant
a research waiver or an exemption from the requirements regarding the disposal or
recycling of high-volume industrial wastes and certain other solid wastes.
Under this bill, solid wastes that DNR has exempted from the disposal
requirement are considered special wastes and DNR may characterize them as
suitable for use in public works projects. The bill requires DNR to maintain a list of
special wastes that are suitable for use in specified types of public works projects.
Under the bill, the current provisions regarding liability apply to the use of those
listed special wastes in public works projects if the conditions established for their
use are met.
Current law generally requires a person to obtain a construction permit from
DNR before beginning construction of a stationary source of air pollution. This bill
authorizes DNR to issue a general construction permit, which may cover numerous
similar stationary sources of air pollution.
Under current law, the owner or operator of a stationary source of air pollution
who must obtain an air pollution control permit from DNR is required to pay an
annual fee to DNR. The amount of the fee is required to be based, among other
things, on actual emissions of pollutants from the source in the preceding five years,
using a five-year rolling average. Under this bill, the fee must be based on actual
emissions of pollutants from the source in the preceding year, rather than the
preceding five years.
This bill requires DNR to award grants to assist local governmental units to
establish regional recycling programs.
health and human services
Medical assistance
Under current federal and state law, medical assistance (MA) is a
jointly-funded, federal-state program to provide health care services to eligible
low-income individuals; federal medicaid funds (known as "federal financial
participation") are provided to match state funds expended for MA. Prescription
drug manufacturers enter into agreements with the federal government to provide
rebates for prescription drugs purchased under MA. Under current state law,
pharmacies and pharmacists that are certified providers of MA services are
reimbursed at a rate established by DHFS for providing certain prescription drugs
to MA recipients.
Under this bill, DHFS must request from the federal department of health and
human services a waiver of federal medicaid laws to permit DHFS to conduct a
project to expand MA eligibility solely for the purpose of purchasing prescription
drugs for persons who are at least 65, who have not had outpatient prescription drug
coverage from any source other than MA for 12 months, and whose annual household
incomes do not exceed 185% of the federal poverty line. If the waiver is granted, an
eligible person with a household income of up to 155% of the federal poverty line,
after paying a $25 annual enrollment fee and after paying specified deductible
amounts for prescription drugs calculated at the pharmacy discount rate, would be
entitled to purchase prescription drugs for copayment amounts specified in the bill.
A pharmacy or pharmacist who sells a drug at the reduced price would receive
reimbursement for the difference between the copayment and the pharmacy
discount rate amount from state general purpose revenues and federal medicaid
moneys. Persons with household incomes over 155% but less than 186% of the
federal poverty line, however, would only be eligible to purchase prescription drugs
at the pharmacy discount rate. Under the bill, this project may not be implemented
if the federal government creates a national prescription drug benefit program for
seniors that would provide similar benefits to a similar population. In addition,
DHFS must first secure approval from DOA and JCF.
The bill requires that DOA and DHFS work to develop, in conjunction with
other states and with associations, a multistate purchasing group to negotiate with
prescription drug manufacturers for MA prescription drug rebate agreements for
greater rebates for prescription drugs than those achievable under federal law.
Under the bill, DOA must also contract with a private entity to administer a discount
program for the purchase of prescription drugs that would be generally available to
anyone, regardless of age or income.
The bill requires that DHFS work with DOA to contract with a private entity
for the bulk purchase and mail order delivery of prescription drugs for MA recipients
who voluntarily participate in the discount program and who have chronic
conditions. Further, DHFS and DOA must promote private prescription drug
assistance plans that offer free and reduced-price drugs and prescription drug
discounts to members. DHFS must inform tribes, certain health centers, and other
entities that are eligible for a federal prescription drug discount program about the
program and provide technical assistance to the entities in applying for and
implementing benefits under the program.
Under current law, DWD administers the eligibility determination aspect of
MA; DHFS administers all other aspects of MA. Currently, DWD contracts with
county departments of social services or human services (county departments) to
determine the eligibility of individuals for MA. Under these contracts, DWD
reimburses the county departments for the reasonable costs of determining the
eligibility of individuals for each program. The amount that is reimbursed to each
county department is calculated using a formula based on each county's workload
and the amount of available state and federal moneys. DWD is also required to
investigate suspected fraudulent activity on the part of individuals who receive MA
benefits and to reduce errors in the payment of benefits.
This bill requires DWD and DHFS, jointly, to contract with county departments
to reimburse the county departments for the reasonable costs of determining the
eligibility of individuals for MA. Under the bill, only DWD makes the payments for
reimbursement to the county departments but the payments are funded, in part, by
an appropriation to DHFS. The bill requires DHFS to establish its own program to
investigate possible fraud on the part of MA recipients and to reduce errors in the
payments of MA or, in the alternative, to contract with DWD to conduct these
activities.
Under current federal medicaid law, nonfederal public funds transferred to the
state and expended for MA purposes may be considered as the state's share for the
purpose of claiming federal financial participation.
This bill creates an MA trust fund. The fund consists of 1) moneys received as
federal financial participation to match public moneys transferred to the state or
certified by DHFS as the state share of financial participation for MA payments
related to nursing homes; and 2) public moneys transferred to the state or certified
by DHFS as the state and federal share of financial participation for MA payments
related to nursing homes. The moneys in the MA trust fund are appropriated to
DHFS to meet the costs of MA and the administrative costs associated with
augmenting federal financial participation.
Under current law, in each fiscal year DHFS may distribute up to $38,600,000
received as federal financial participation to supplement MA payments to reduce the
operating deficits of county, city, village, or town nursing homes. DHFS must also
distribute for this purpose additional moneys received as federal financial
participation that were not anticipated before enactment of the biennial budget act
or before enactment of other legislation that affects the appropriation of such federal
moneys.
As of July 1, 2000, this bill retroactively eliminates the requirement that DHFS
distribute for this purpose additional, unanticipated moneys received as federal
financial participation and increases, to up to $40,100,000, the amount of federal
financial participation that may be distributed.
Under current law, DHFS administers the Badger Care Health Care Program
(BadgerCare) under a waiver from the federal department of health and human
services. BadgerCare provides health care coverage to certain low-income families
and to certain low-income children who do not reside with a parent. As a condition
of eligibility for BadgerCare, a family or child must be without access to
employer-subsidized health care coverage for a period specified by DHFS by rule.
This bill requires DHFS to request a waiver from the federal department to
extend the period a family or child is required to be without access to
employer-subsidized health care coverage to be eligible for BadgerCare to six
months except under certain circumstances. The bill also requires DHFS to request
a second waiver to permit DHFS, prior to enrolling a family or child in BadgerCare,
to verify whether the family or child has had access to employer-subsidized health
care.
Under current law, DHFS certifies persons that meet certain criteria as MA
providers and pays for services and items that MA recipients receive from the
providers. Currently, DHFS is authorized or required to enforce numerous
sanctions, including decertification or suspension from MA, against providers who
fail to comply with MA requirements or to whom MA payments have been improperly
or erroneously made or overpayments have been made. To implement these
sanctions, DHFS must provide written notice, a fair hearing, and a written decision.
Currently, fraud in applications for, rights to, and conversion of MA benefits or
payments is prohibited. These prohibitions are punishable by fines and
imprisonment. Also under current law, if a provider who is liable for repayment of
improper or erroneous MA payments or overpayments sells or otherwise transfers
ownership of his or her business, the seller and transferee are each liable for the
repayment. The transferee must contact DHFS and ascertain whether the seller has
an outstanding amount owing. DHFS may bring an action to compel payment
against either the seller or transferee if a sale or other transfer occurs, and the
amount has not been repaid.
This bill authorizes DHFS, after providing reasonable notice and the
opportunity for a hearing, to charge a fee to an MA provider that has repeatedly been
subject to recoveries of MA payments because of the provider's failure to follow
billing procedures or to follow other MA requirements. The fee must be used to
defray the costs of audits and investigations by DHFS of federal medicaid or MA
violations and to verify that services have been provided and the appropriateness
and accuracy of reimbursement claims. The fee may not exceed $1,000 or 200% of
the amount of any recovery, whichever is greater. The bill permits DHFS to recover
any part of such a fee that is not timely paid by offsetting the fee against any MA
payment owed to the provider. Failure to timely pay a fee is grounds for MA
decertification.
The bill authorizes DHFS to require certain MA providers, as a condition of
certification, to file with DHFS a surety bond, payable to DHFS, that would
reasonably pay the amount of a recovery and DHFS's costs to pursue recovery of
overpayments or to investigate and pursue allegations of false claims or statements.
The bill also authorizes DHFS to limit the number of providers of particular services
that may receive MA certification or limit the amount of resources, including
employees and equipment, that a certified provider may use to provide MA services
and items.
The bill changes numerous provisions relating to procedures for the recovery
by DHFS of MA overpayments or improper or erroneous payments, including all of
the following:
1. Hearing requirements are eliminated and, instead, a provider has the
opportunity to present information and argument to DHFS staff.
2. A deadline for the payment of recoveries is established, and payment of
interest on delinquent amounts is required.
The bill eliminates DHFS's general authority to suspend a provider, but instead
authorizes DHFS, if certain criteria are met, to suspend certification for a provider
pending a hearing on whether the provider must be decertified for violation of federal
or state laws.
The bill requires providers to allow DHFS access to provider records and
specifies that a provider's failure to provide access constitutes grounds for
decertification.
With respect to liability for repayment of improper or erroneous payments or
overpayments of a provider who sells or transfers ownership of his or her business,
the bill eliminates provisions that confer liability on both the transferor and the
transferee. Under the bill, before a person may take over the operation of an MA
provider, the person must obtain MA certification with respect to the provider's
operation, regardless of whether the person is currently certified. Also, before a
person may take over the operation of an MA provider that is liable for repayment
of improper or erroneous MA payments or overpayments, full repayment must be
made. Upon request, DHFS must notify the person or provider as to whether the
provider is liable. If, notwithstanding the prohibition, the person takes over the
provider's operation, and the outstanding repayment is not made, DHFS may
withhold certification from the person and may proceed against the provider or
person. If the repayment is not paid in full within 30 days after DHFS provides notice
to the certified provider, DHFS may bring an action to compel payment, to decertify
a provider, or to do both.
Under current law, DHFS receives federal funding to conduct a breast and
cervical cancer early detection program. This program provides individuals with
breast and cervical cancer screening, referrals, education, and outreach. This bill
expands MA to provide MA to women who are under the age of 65, who require
treatment for breast or cervical cancer, who have been screened for breast or cervical
cancer under the breast and cervical cancer early detection program, and who are not
otherwise eligible for MA or any other health care coverage.
Currently, the long-term support Community Options Program (COP)
provides functionality assessments of, and home and community-based care to,
among others, elderly and disabled persons as an alternative to institutionalized
care. One part of COP (often referred to as COP-Regular) is funded by state general
purpose revenues and the other part (often referred to as COP-Waiver) is funded
jointly by federal medicaid and state MA moneys under a waiver of federal medicaid
laws. Also under MA under a waiver of federal medicaid laws, a Community
Integration Program (often referred to as CIP II) provides home and
community-based services and continuity of care for persons relocated from
institutions, other than the state centers for the developmentally disabled, and for
persons who meet requirements for MA reimbursement in nursing homes.
Currently, funds under COP-Waiver and CIP II may not be used to provide
services in a C-BRF that has more than four beds unless the C-BRF has five to eight
beds and DHFS approves the C-BRF. This bill changes restrictions on the use of
COP-Waiver and CIP II funds for providing services in a C-BRF to permit use of the
funds in a C-BRF that has five to 20 beds if DHFS approves.
Currently, DHFS operates three Community Integration Programs (CIPs) as
part of MA. These programs provide home and community-based services to
individuals who are relocated from institutions such as state centers for the
developmentally disabled or nursing homes, or who meet the criteria for
reimbursement under MA for nursing home care. DHFS also administers the Family
Support Program, which provides assistance, including home and community-based
services, to families with a disabled child, and a program that provides early
intervention services to certain eligible children. These two programs are not part
of MA and are funded with GPR.
This bill requires DHFS to request a waiver of federal medicaid laws from the
federal department of health and human services to provide to disabled individuals
who are under 24 years of age, under one program, with unified administration and
service delivery, the services offered under COP-Waiver, CIPs, the Family Support
Program, and the Early Intervention Program. If DHFS receives the waiver, DHFS
must seek enactment of legislation to implement the waiver within the limits of
available federal, state, and county funds.
Under current law, an individual who meets the requirements under one of the
following categories is eligible for MA:
1. AFDC-MA. This category includes individuals who meet the income, asset,
and non-financial requirements for the federal Aid to Families with Dependent
Children (AFDC) Program that were in effect on July 16, 1996. Generally,
individuals who meet the AFDC requirements are certain children under 19 years
of age, their caretaker relatives, and pregnant women in the eighth or ninth month
of pregnancy.
2. AFDC-related MA. This category includes individuals who meet the income
and asset requirements of the AFDC program that were in effect on July 16, 1996,
but who would not have received an AFDC payment and who are either children
under 19 years of age, their caretaker relatives, or pregnant. Also eligible under this
category are children under the age of 18 and pregnant women whose incomes do not
exceed 133.33% of the maximum payment under the AFDC program, and whose
assets do not exceed certain asset limits.
This bill eliminates the asset requirements for the AFDC-MA and
AFDC-related MA categories so that an individual who meets the other
requirements under one of those categories is eligible for MA.
Under current law, DHFS excludes certain assets when determining whether
certain individuals meet the specific asset limits to qualify for MA. One of the assets
that is excluded is up to $2,500 in an irrevocable burial trust. This bill increases the
amount of such assets that are excluded to $3,300 on January 1, 2003.
Currently, DHFS is required to recover the following from the estate of an MA
recipient who is not survived by a spouse or a child who is under 21 or disabled:
1. The amount of MA paid on behalf of the recipient while the recipient resided
in a hospital and was required to contribute to the cost of care or resided in a nursing
home.
2. The amount of MA paid on behalf of a recipient after the recipient reached
age 55 for home-based or community-based services, community-supported living,
personal care services, or hospital and prescription drug services.
This bill expands the types of services that are subject to the Estate Recovery
Program to include all health care services for which MA was paid on behalf of a
recipient after the recipient reached age 55. The bill requires that, if these health
care services were provided by a managed care organization, under the Program of
All-Inclusive Care for the Elderly (PACE) that provides health and social services
to low-income elderly individuals at home, or under the Wisconsin Partnership
Program, which provides health care and long-term care services to low-income
elderly and disabled individuals, DHFS must calculate the amount of MA as the
capitation rate that was paid on behalf of the recipient. If the health care services
were provided under the Family Care Program, DHFS must calculate the amount
of MA as the cost of the health care services that were paid for with MA. For all other
services provided, DHFS is required to calculate the amount of MA on a
fee-for-service basis.
Under current law, to recover the amount of MA paid on behalf of MA recipients,
DHFS may place a lien on the home of a recipient under certain circumstances. This
bill authorizes DHFS to place a lien on any other real property in which an MA
recipient has an interest if DHFS may currently place a lien on the recipient's home.
Under current law, medicare part A and part B beneficiaries who are MA
recipients with incomes at or below 100% of the federal poverty line or who are
elderly or disabled persons with low incomes and resources receive payment for
medicare deductible and coinsurance amounts, monthly medicare premiums, and,
if applicable, late enrollment penalties for medicare part A premiums. (Medicare
part A provides inpatient hospital coverage for persons who are aged 65 or disabled,
and medicare part B provides coverage for outpatient services for those persons.) MA
recipients whose incomes are above 100% of the federal poverty line receive MA
payment of medicare deductible and coinsurance amounts; if they are beneficiaries
of only medicare part A or part B, they receive MA payment of the applicable
medicare part A or part B deductible and coinsurance amounts. However, for all of
these MA recipients, MA payment for the coinsurance for a service under medicare
part B may not exceed the allowable charge for the service under MA minus the
medicare payment amount.
Under this bill, MA recipients and elderly or disabled persons with low incomes
and resources may receive MA payments for their coinsurance for medicare part B
outpatient hospital services that exceed the MA allowable charge for the services.
The bill requires that DHFS include in the state plan for MA a methodology for
payment of the medicare part B outpatient hospital services coinsurance amounts.
Currently, one of the factors that determines the amounts paid to nursing
homes for care provided to MA recipients is the variation in regional labor costs. This
bill eliminates that factor.
Under current law, beginning July 1, 2000, DHFS must distribute state GPR
and federal medicaid moneys as a supplemental payment to a hospital for which MA
revenues were at least 8% of the hospital's total revenues in the most recent year
before the year of distribution. This bill eliminates these supplemental payments.
Health
Under current law, DHFS licenses, certifies, approves, or registers, and
otherwise regulates numerous health care services providers, including hospitals,
nursing homes, C-BRFs, adult family homes, residential care apartment complexes,
rural medical centers, home health agencies, and hospices. Currently, the sanctions
that DHFS may bring against those facilities or services that violate applicable
standards of care or provisions of licensure, certification, approval, or registration
include denial of licensure, issuance of departmental orders, required submittal of
a plan of correction, assessment of forfeitures (civil penalties), suspension of
admissions, imposition of conditional licensure, and suspension or revocation of
licensure. Facilities or services on which sanctions are imposed may appeal the
sanctions in hearings conducted by DOA. Decisions that result from these hearings
are subject to judicial review.
With certain exceptions, this bill makes uniform the sanctions that DHFS may
impose on hospitals, nursing homes, C-BRFs, licensed adult family homes,
residential care apartment complexes, rural medical centers, home health agencies,
and hospices that violate conditions of licensure, certification, approval, or
registration or applicable standards of care. The bill specifies procedures for
requesting a hearing to contest imposition of a sanction. The bill eliminates DHFS's
authority to suspend a license, certification, approval, or registration. Under the bill,
if DHFS provides a C-BRF, hospital, or home health agency with written notice of
the grounds for a sanction, an explanation of the types of sanctions that DHFS may
impose, and an explanation of the appeal process, DHFS may order that the C-BRF,
hospital, or home health agency do any of the following: 1) if operating without a
license or approval, cease operation; 2) terminate the employment of any person who
operated or permitted operation of a C-BRF, hospital, or home health agency for
which a license or approval was revoked; 3) stop violating a provision of licensure or
approval; 4) for a C-BRF only, submit a plan of correction for violation of a provision
of licensure or approval; 5) for a C-BRF only, implement and comply with a plan of
correction that is approved or developed by DHFS; 6) for a nursing home, C-BRF, or
hospital only, suspend new admissions until all violations are corrected; or 7) provide
training in one or more specific areas for staff members. In addition, if DHFS
provides the same type of written notice, DHFS may impose any of the following:
1. Except for nursing homes, a daily forfeiture of not less than $10 nor more
than $2,000 for each violation, with each day of violation being a separate offense;
the amount of the forfeiture and payment deadlines are specified by DHFS by rule.
2. Under specified circumstances, for all facilities or services, revocation of
licensure, certification, approval, or registration.
The bill requires that licensed nursing homes, C-BRFs, and hospices, if they
are in substantial noncompliance, as defined by DHFS by rule, with respect to
applicable state or federal requirements, demonstrate that they are fit and qualified
to operate.
Under current law, DHFS may, after meeting certain procedural requirements,
issue a conditional license for up to one year to a nursing home and may revoke any
outstanding license of the nursing home for certain violations of standards of care.
This bill authorizes DHFS to issue a conditional license, certification, approval, or
registration that is similar to a conditional approval of a nursing home, to any health
care facility or service that violates standards of care or provisions of licensure.
Under current law, DHFS may issue provisional licenses for home health
agencies, rural medical centers, and hospices that have not previously been licensed,
that are not in operation at the time the application for licensure is made, or that are
temporarily unable to comply with standards of care. DHFS also may issue
probationary licenses for nursing homes and C-BRFs that have not previously been
licensed and are not operating at the time the license application is made. This bill
eliminates provisions relating to provisional licenses for rural medical centers, and,
for home health agencies and hospices, changes the term "provisional" to
"probationary." In addition, the bill decreases from 24 months to 12 months the
period of validity of a hospice probationary license.
Currently, DHFS distributes funds to provide various services for persons with
or at risk of contracting acquired immunodeficiency syndrome (AIDS). This bill also
requires that DHFS provide funds for testing for and prevention of infections related
to AIDS, including hepatitis C virus infection, on behalf of the persons who receive
AIDS services.
