49.45 (3) (a) Reimbursement shall be made to each county department under ss. 46.215, 46.22, and 46.23 for the any administrative services performed in the medical assistance Medical Assistance program on the basis of s. 49.33 49.78 (8). For purposes of reimbursement under this paragraph, assessments completed under s. 46.27 (6) (a) are administrative services performed in the medical assistance Medical Assistance program.
33,1314
Section
1314. 49.45 (3) (am) of the statutes is repealed.
33,1315
Section
1315. 49.45 (5) (b) 1. (intro.) of the statutes is amended to read:
49.45 (5) (b) 1. (intro.) Upon receipt of a timely petition under par. (a) the department shall give the applicant or recipient reasonable notice and opportunity for a fair hearing. The department may make such additional investigation as it considers necessary. Notice of the hearing shall be given to the applicant or recipient and to the county clerk or, if a Wisconsin works agency, if a county department under s. 46.215, 46.22, or 46.23 is responsible for making the medical assistance determination, the Wisconsin works agency to the county clerk of the county. The county or the Wisconsin works agency may be represented at such hearing. The department shall render its decision as soon as possible after the hearing and shall send a certified copy of its decision to the applicant or recipient, to the county clerk, and to the any county officer or the Wisconsin works agency charged with administration of the medical assistance Medical Assistance program. The decision of the department shall have the same effect as an order of the
a county officer or the Wisconsin works agency charged with the administration of the medical assistance Medical Assistance program. The decision shall be final, but may be revoked or modified as altered conditions may require. The department shall deny a petition for a hearing or shall refuse to grant relief if:
33,1316
Section
1316. 49.45 (5) (b) 2. (intro.) of the statutes is amended to read:
49.45
(5) (b) 2. (intro.) If a recipient requests a hearing within the timely notice period specified in
42 CFR 431.231 (c), medical assistance coverage shall not be suspended, reduced
, or discontinued until a decision is rendered after the hearing but medical assistance payments made pending the hearing decision may be recovered by the department if the contested decision or failure to act is upheld.
The department shall promptly notify the county department or, if a Wisconsin works agency If a county department is responsible for making the medical assistance determination, the
Wisconsin works agency department shall notify the county department of the county in which the recipient resides that the recipient has requested a hearing. Medical assistance coverage shall be suspended, reduced
, or discontinued if:
33,1318
Section
1318. 49.45 (5m) (am) of the statutes is amended to read:
49.45
(5m) (am) Notwithstanding sub. (3) (e), from the
appropriations appropriation accounts under s. 20.435 (4) (b),
(gp), (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).
33,1320
Section
1320. 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 $200 per day, beginning in fiscal year 2001-02, and by $225 per day, beginning in fiscal year 2002-03, and by $325 per day, beginning in fiscal year 2004
-05 .
33,1321
Section
1321. 49.45 (6c) (a) 6m. of the statutes is created to read:
49.45 (6c) (a) 6m. "Intermediate facility" has the meaning given in s. 46.279 (1) (a).
33,1322
Section
1322. 49.45 (6c) (b) of the statutes is amended to read:
49.45 (6c) (b) Preadmission screening. Except as provided in par. (e), beginning on August 9, 1989, every individual who applies for admission to a facility or to an institution for mental diseases shall be screened to determine if the individual has developmental disability or mental illness. Beginning on August 9, 1989, the
The department or an entity to which the department has delegated authority shall screen every individual who has been identified as having a developmental disability or mental illness to determine if the individual needs facility care. If the individual is determined to need facility care, the department or an entity to which the department has delegated authority shall also assess the individual to determine if he or she requires active treatment for developmental disability or active treatment for mental illness. If the department or entity determines that the individual requires active treatment for developmental disability, the department or entity shall determine whether the level of care required by the individual that is provided by a facility could be provided safely in an intermediate facility or under a plan that is developed under s. 46.279 (4).
33,1323
Section
1323. 49.45 (6c) (c) (intro.) of the statutes is amended to read:
49.45 (6c) (c) Resident review. (intro.) Except as provided in par. (e), the department or an entity to which the department has delegated authority shall review every resident of a facility or institution for mental diseases who has a developmental disability or mental illness and who has experienced a significant change in his or her physical or mental condition to determine if any all of the following applies:
33,1324
Section
1324. 49.45 (6c) (c) 1. of the statutes is amended to read:
49.45 (6c) (c) 1. The Whether the resident needs facility care.
33,1325
Section
1325. 49.45 (6c) (c) 2. of the statutes is amended to read:
49.45 (6c) (c) 2. The Whether the resident requires active treatment for developmental disability or active treatment for mental illness.
33,1326
Section
1326. 49.45 (6c) (c) 3. of the statutes is created to read:
49.45 (6c) (c) 3. If the department or entity determines under subd. 1. that the resident needs facility care and under subd. 2. that the resident requires active treatment for developmental disability, whether the level of care required by the resident that is provided by a facility could be provided safely in an intermediate facility or under a plan that is developed under s. 46.279 (4).
33,1327
Section
1327. 49.45 (6m) (a) 4. of the statutes is repealed.
33,1328
Section
1328. 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), (gp), (pa), (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:
33,1329
Section
1329. 49.45 (6m) (ag) 2. of the statutes is amended to read:
49.45 (6m) (ag) 2. Standards Except as provided in subd. 3r., standards established by the department that shall be based upon allowable costs incurred by facilities in the state as available from information submitted under par. (c) 3. and compiled by the department.
33,1330
Section
1330. 49.45 (6m) (ag) 3m. of the statutes is amended to read:
49.45 (6m) (ag) 3m. For each state fiscal year 1999-2000, rates that shall be set by the department based on information from cost reports for the 1998
most recently completed fiscal year of the facility and for state fiscal year 2000-01, rates that shall be set by the department based on information from cost reports for the 1999 fiscal year of the facility.
33,1331
Section
1331
. 49.45 (6m) (ag) 3m. of the statutes, as affected by 2003 Wisconsin Act .... (this act), is amended to read:
49.45 (6m) (ag) 3m. For each state fiscal year, rates that shall be set by the department based on information from cost reports for costs specified under par. (am) 1. bm., 4., 5m., and 6. for the most recently completed fiscal year of the facility.
33,1332
Section
1332. 49.45 (6m) (ag) 3r. of the statutes is created to read:
49.45 (6m) (ag) 3r. Flat-rate payment, as determined by the department, for costs specified under par. (am) 1. a. and 2.
33,1333
Section
1333. 49.45 (6m) (ag) 3r. of the statutes, as created by 2003 Wisconsin Act .... (this act), is amended to read:
49.45 (6m) (ag) 3r. Flat-rate payment, as determined by the department, for all costs specified under par. (am) 1. a. and 2.
33,1333d
Section 1333d. 49.45 (6m) (ag) 8. of the statutes is created to read:
49.45 (6m) (ag) 8. Maintenance of the identical proportion of payment for direct care costs, as specified in par. (am) 1., to total payment for all costs specified in par. (am) as that made in state fiscal year 2002-03.
33,1334
Section
1334. 49.45 (6m) (am) 1. a. of the statutes is amended to read:
49.45 (6m) (am) 1. a. Personal comfort supplies; medical supplies; over-the-counter drugs; and nonbillable services of a ward clerk, activity person, recreation person, social worker, volunteer coordinator, teacher for residents aged 22 and older, vocational counselor for residents aged 22 and older, religious person, therapy aide, therapy assistant, and counselor on resident living.
33,1335
Section
1335. 49.45 (6m) (am) 1. b. of the statutes is repealed.
33,1336
Section
1336. 49.45 (6m) (am) 1. bm. of the statutes is created to read:
49.45 (6m) (am) 1. bm. Nonbillable services of a registered nurse, licensed practical nurse and nurse's assistant.
33,1337
Section
1337. 49.45 (6m) (am) 1. d. of the statutes is repealed.
33,1338
Section
1338. 49.45 (6m) (am) 1. e. of the statutes is repealed.
33,1339
Section
1339. 49.45 (6m) (am) 3. (intro.) of the statutes is renumbered 49.45 (6m) (am) 2. c. and amended to read:
49.45 (6m) (am) 2. c. Allowable fuel and utility costs, including the facility expenses that the department determines are allowable for the provision of: electrical service, water and sewer services, and heat.
33,1340
Section
1340. 49.45 (6m) (am) 3. a. of the statutes is repealed.
33,1341
Section
1341. 49.45 (6m) (am) 3. b. of the statutes is repealed.
33,1342
Section
1342. 49.45 (6m) (am) 3. c. of the statutes is repealed.
33,1343
Section
1343. 49.45 (6m) (am) 4. of the statutes is amended to read:
49.45 (6m) (am) 4. Net property Property tax or allowable municipal service costs incurred paid by the owner of the facility for the facility.
33,1344
Section
1344. 49.45 (6m) (am) 5. of the statutes is renumbered 49.45 (6m) (am) 2. d.
33,1346d
Section 1346d. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:
49.45
(6m) (ar) 1. a. The department shall establish standards for payment of allowable direct care costs
under par. (am) 1. bm., for facilities that do not primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state and separate standards for payment of allowable direct care costs, for facilities that primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state. The standards shall be adjusted by the department for regional labor cost variations. For facilities in Douglas, Pierce, and St. Croix counties, the department shall perform the adjustment by use of the wage index that is used by the federal department of health and human services for hospital reimbursement under
42 USC 1395 to
1395ggg.
33,1347
Section
1347. 49.45 (6m) (ar) 2. (intro.) and 2. a. of the statutes are consolidated, renumbered 49.45 (6m) (ar) 2. and amended to read:
49.45 (6m) (ar) 2. For support service costs: 2. a. The, the department shall establish one or more standards for the payment of support service costs that take into account support service costs for a sample of all facilities within the state.
33,1348
Section
1348. 49.45 (6m) (ar) 2. b. of the statutes is repealed.
33,1349
Section
1349. 49.45 (6m) (ar) 2. d. of the statutes is repealed.
33,1350
Section
1350. 49.45 (6m) (ar) 3. of the statutes is repealed.
33,1351
Section
1351. 49.45 (6m) (ar) 5. of the statutes is repealed.
33,1352
Section
1352. 49.45 (6m) (av) 1. of the statutes is renumbered 49.45 (6m) (av) and amended to read:
49.45 (6m) (av) The department shall calculate a payment rate for a facility by applying the criteria set forth under pars. (ag) 1. to 5. and 7., (am) 1. to 5. bm., 4., 5m. and 6., and (ar) 1. to 5., 4., and 6. to information from cost reports submitted by the facility, as affected by any adjustment for ancillary services and materials under par. (b).
33,1353
Section
1353. 49.45 (6m) (av) 2. of the statutes is repealed.
33,1354
Section
1354. 49.45 (6m) (av) 3. of the statutes is repealed.
33,1355
Section
1355. 49.45 (6m) (av) 4. of the statutes is repealed.
33,1356
Section
1356. 49.45 (6m) (av) 5. of the statutes is repealed.
33,1357
Section
1357. 49.45 (6m) (av) 5m. of the statutes is repealed.
33,1358
Section
1358. 49.45 (6m) (av) 6. of the statutes is repealed.
33,1359
Section
1359. 49.45 (6m) (bc) of the statutes is repealed.
33,1360
Section
1360. 49.45 (6t) of the statutes, as affected by
2001 Wisconsin Act 16, is renumbered 49.45 (6t) (a), and 49.45 (6t) (a) 2. (intro.), 3. and 4., as renumbered, are amended to read:
49.45 (6t) (a) 2. (intro.) Based on the amount estimated to be available under par. (a) subd. 1., develop a method, which need not be promulgated as rules under ch. 227, to distribute this allocation to the individual county departments under s. 46.215, 46.22, 46.23 or 51.42 or to local health departments that have incurred operating deficits that shall include all of the following:
3. Except as provided in par. (d) subd. 4., distribute the allocation under the distribution method that is developed.
4. If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (4) (o) that result in a lesser allocation amount than that allocated under this subsection or disallows use of the allocation of federal medicaid funds under par. (c) subd. 3., reduce allocations under this subsection and distribute on a prorated basis, as determined by the department.
33,1361
Section
1361. 49.45 (6t) (b) of the statutes is created to read:
49.45 (6t) (b) If 2003 Wisconsin Act .... (this act), section 9124 (8) (a) applies, this subsection does not apply.
33,1362
Section
1362. 49.45 (6tt) of the statutes is created to read:
49.45 (6tt) Distributions to county departments and local health departments. From the appropriation under s. 20.435 (4) (w), the department may in each fiscal year distribute moneys to county departments under s. 46.215, 46.22, 46.23, or 51.42 or to local health departments, as defined in s. 250.01 (4), under a plan developed by the department.
33,1363
Section
1363. 49.45 (6u) (am) (intro.) of the statutes is amended to read:
49.45 (6u) (am) (intro.) Notwithstanding sub. (6m), in state fiscal years in which less than $1 in federal financial participation relating to facilities is received under 42 CFR 433.51, from the appropriations under s. 20.435 (4) (o), (w), and (wm), for reduction of operating deficits, as defined under the methodology used by the department in December, 2000, incurred by a facility that is established under s. 49.70 (1) or that is owned and operated by a city, village, or town, and as payment to care management organizations, the department may not distribute to these facilities and to care management organizations more than $37,100,000 in each fiscal year, as determined by the department. The total amount that a county certifies under this subsection may not exceed 100% of otherwise-unreimbursed care. In distributing funds under this subsection, the department shall perform all of the following:
33,1364
Section
1364. 49.45 (6u) (bm) of the statutes is repealed.
33,1365
Section
1365. 49.45 (6v) (b) of the statutes is amended to read:
49.45 (6v) (b) The department shall, each year, submit to the joint committee on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that provides information on the utilization of beds by recipients of medical assistance in facilities and a discussion and detailed projection of the likely balances, expenditures, encumbrances and carry over of currently appropriated amounts in the appropriation accounts under s. 20.435 (4) (b), (gp), and (o).
33,1366
Section
1366. 49.45 (6x) (a) of the statutes is amended to read:
49.45
(6x) (a) Notwithstanding sub. (3) (e), from the
appropriations appropriation accounts under s. 20.435 (4) (b),
(gp), (o), and (w), the department shall distribute not more than $4,748,000 in each fiscal year, to provide funds to an essential access city hospital, except that the department may not allocate funds to an essential access city hospital to the extent that the allocation would exceed any limitation under
42 USC 1396b (i) (3).
33,1367
Section
1367. 49.45 (6y) (a) of the statutes is amended to read:
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the
appropriations appropriation accounts under s. 20.435 (4) (b),
(gp), (o), and (w), the department shall distribute funding in each fiscal year to provide supplemental payment to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under
42 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the allocation of funds to such hospitals would exceed any limitation under
42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2).
33,1368
Section
1368. 49.45 (6y) (am) of the statutes is amended to read:
49.45
(6y) (am) Notwithstanding sub. (3) (e), from the
appropriations appropriation accounts under s. 20.435 (4) (b), (h),
(gp), (o), and (w), the department shall distribute funding in each fiscal year to provide supplemental payments to hospitals that enter into contracts under s. 49.02 (2) with a county having a population of 500,000 or more to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under
42 USC 1396b (i) (3).
33,1369
Section
1369. 49.45 (6z) (a) (intro.) of the statutes is amended to read:
