SB44, s. 1336
18Section
1336. 49.45 (6m) (am) 1. bm. of the statutes is created to read:
SB44,602,2019
49.45
(6m) (am) 1. bm. Nonbillable services of a registered nurse, licensed
20practical nurse and nurse's assistant.
SB44, s. 1337
21Section
1337. 49.45 (6m) (am) 1. d. of the statutes is repealed.
SB44, s. 1338
22Section
1338. 49.45 (6m) (am) 1. e. of the statutes is repealed.
SB44, s. 1339
23Section
1339. 49.45 (6m) (am) 3. (intro.) of the statutes is renumbered 49.45
24(6m) (am) 2. c. and amended to read:
SB44,603,3
149.45
(6m) (am) 2. c. Allowable fuel and utility costs, including the facility
2expenses that the department determines are allowable for the provision of
: 3electrical service, water and sewer services, and heat.
SB44, s. 1340
4Section
1340. 49.45 (6m) (am) 3. a. of the statutes is repealed.
SB44, s. 1341
5Section
1341. 49.45 (6m) (am) 3. b. of the statutes is repealed.
SB44, s. 1342
6Section
1342. 49.45 (6m) (am) 3. c. of the statutes is repealed.
SB44, s. 1343
7Section
1343. 49.45 (6m) (am) 4. of the statutes is amended to read:
SB44,603,98
49.45
(6m) (am) 4.
Net property Property tax or
allowable municipal service
9costs
incurred paid by the owner of the facility for the facility.
SB44, s. 1344
10Section
1344. 49.45 (6m) (am) 5. of the statutes is renumbered 49.45 (6m) (am)
112. d.
SB44, s. 1345
12Section
1345
. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:
SB44,603,2213
49.45
(6m) (ar) 1. a. The department shall establish standards for payment of
14allowable direct care costs, for facilities that do not primarily serve the
15developmentally disabled, that take into account direct care costs for a sample of all
16of those facilities in this state and separate standards for payment of allowable direct
17care costs, for facilities that primarily serve the developmentally disabled, that take
18into account direct care costs for a sample of all of those facilities in this state. The
19standards shall be adjusted by the department for regional labor cost variations.
For
20facilities in Douglas, Pierce, and St. Croix counties, the department shall perform the
21adjustment by use of the wage index that is used by the federal department of health
22and human services for hospital reimbursement under 42 USC 1395 to 1395ggg. SB44, s. 1346
23Section
1346
. 49.45 (6m) (ar) 1. a. of the statutes, as affected by 2003
24Wisconsin Act .... (this act), is amended to read:
SB44,604,8
149.45
(6m) (ar) 1. a. The department shall establish standards for payment of
2allowable direct care costs
under par. (am) 1. bm., for facilities that do not primarily
3serve the developmentally disabled, that take into account direct care costs for a
4sample of all of those facilities in this state and separate standards for payment of
5allowable direct care costs, for facilities that primarily serve the developmentally
6disabled, that take into account direct care costs for a sample of all of those facilities
7in this state. The standards shall be adjusted by the department for regional labor
8cost variations.
SB44, s. 1347
9Section
1347. 49.45 (6m) (ar) 2. (intro.) and 2. a. of the statutes are
10consolidated, renumbered 49.45 (6m) (ar) 2. and amended to read:
SB44,604,1311
49.45
(6m) (ar) 2. For support service costs
: 2. a. The , the department shall
12establish one or more standards for the payment of support service costs that take
13into account support service costs for a sample of all facilities within the state.
SB44, s. 1348
14Section
1348. 49.45 (6m) (ar) 2. b. of the statutes is repealed.
SB44, s. 1349
15Section
1349. 49.45 (6m) (ar) 2. d. of the statutes is repealed.
SB44, s. 1350
16Section
1350. 49.45 (6m) (ar) 3. of the statutes is repealed.
SB44, s. 1351
17Section
1351. 49.45 (6m) (ar) 5. of the statutes is repealed.
SB44, s. 1352
18Section
1352. 49.45 (6m) (av) 1. of the statutes is renumbered 49.45 (6m) (av)
19and amended to read:
SB44,604,2420
49.45
(6m) (av) The department shall calculate a payment rate for a facility by
21applying the criteria set forth under pars. (ag) 1. to 5. and 7., (am) 1.
to 5. bm., 4., 5m.
22and 6., and (ar) 1.
to 5. , 4., and 6. to information from cost reports submitted by the
23facility
, as affected by any adjustment for ancillary services and materials under par.
24(b).
SB44, s. 1353
25Section
1353. 49.45 (6m) (av) 2. of the statutes is repealed.
SB44, s. 1354
1Section
1354. 49.45 (6m) (av) 3. of the statutes is repealed.
SB44, s. 1355
2Section
1355. 49.45 (6m) (av) 4. of the statutes is repealed.
SB44, s. 1356
3Section
1356. 49.45 (6m) (av) 5. of the statutes is repealed.
SB44, s. 1357
4Section
1357. 49.45 (6m) (av) 5m. of the statutes is repealed.
SB44, s. 1358
5Section
1358. 49.45 (6m) (av) 6. of the statutes is repealed.
SB44, s. 1359
6Section
1359. 49.45 (6m) (bc) of the statutes is repealed.
SB44, s. 1360
7Section
1360. 49.45 (6t) of the statutes, as affected by
2001 Wisconsin Act 16,
8is renumbered 49.45 (6t) (a), and 49.45 (6t) (a) (intro.), 1., 2. (intro.), 3. and 4., as
9renumbered, are amended to read:
SB44,605,1910
49.45
(6t) (a) (intro.) From the appropriation under s. 20.435 (4) (o), for
11reduction of operating deficits, as defined under criteria developed by the
12department, incurred by a county department under s. 46.215, 46.22, 46.23, or 51.42
13or by a local health department, as defined in s. 250.01 (4), for services provided
14under s. 49.46 (2) (a) 4. d. and (b) 6. f., fm., j., k.,
and L.,
and Lm., 9., and 15., for case
15management services under s. 49.46 (2) (b) 12. and for mental health day treatment
16services for minors provided under the authorization under
42 USC 1396d (r) (5), the
17department shall allocate moneys in each fiscal year to these county departments,
18or local health departments as determined by the department, and shall perform all
19of the following:
SB44,606,220
1. For the reduction of operating deficits incurred by the county departments
21or local health departments, estimate the availability of federal medicaid funds that
22may be matched to county, city, town, or village funds that are expended for costs in
23excess of reimbursement for services provided under s. 49.46 (2) (a) 4. d. and (b) 6.
24f., fm., j., k.,
and L.,
and Lm., 9., and 15., for case management services under s. 49.46
1(2) (b) 12. and for mental health day treatment services for minors provided under
2the authorization under
42 USC 1396d (r) (5).
SB44,606,73
2. (intro.) Based on the amount estimated to be available under
par. (a) subd.
41., develop a method, which need not be promulgated as rules under ch. 227, to
5distribute this allocation to the individual county departments under s. 46.215,
646.22, 46.23 or 51.42 or to local health departments that have incurred operating
7deficits that shall include all of the following:
SB44,606,98
3. Except as provided in
par. (d) subd. 4., distribute the allocation under the
9distribution method that is developed.
SB44,606,1410
4. If the federal department of health and human services approves for state
11expenditure in a fiscal year amounts under s. 20.435 (4) (o) that result in a lesser
12allocation amount than that allocated under this subsection or disallows use of the
13allocation of federal medicaid funds under
par. (c)
subd. 3., reduce allocations under
14this subsection and distribute on a prorated basis, as determined by the department.
SB44, s. 1361
15Section
1361. 49.45 (6t) (b) of the statutes is created to read:
SB44,606,1716
49.45
(6t) (b) If 2003 Wisconsin Act .... (this act), section 9124 (8) (a) applies,
17this subsection does not apply.
SB44, s. 1362
18Section
1362. 49.45 (6tt) of the statutes is created to read:
SB44,606,2419
49.45
(6tt) Distributions to county departments and local health
20departments. From the appropriation under s. 20.435 (4) (w), the department may
21in each fiscal year distribute moneys to county departments under s. 46.215, 46.22,
2246.23, or 51.42 or to local health departments, as defined in s. 250.01 (4), in amounts
23that are equal to the moneys received by these county departments or local health
24departments in calendar year 2002 under s. 49.45 (6t), 2001 stats.
SB44, s. 1363
25Section
1363. 49.45 (6u) (am) (intro.) of the statutes is amended to read:
SB44,607,12
149.45
(6u) (am) (intro.) Notwithstanding sub. (6m),
in state fiscal years in
2which less than $1 in federal financial participation relating to facilities is received
3under 42 CFR 433.51, from the appropriations under s. 20.435 (4) (o), (w), and (wm),
4for reduction of operating deficits, as defined under the methodology used by the
5department in December
, 2000, incurred by a facility that is established under s.
649.70 (1) or that is owned and operated by a city, village, or town,
and as payment
7to care management organizations, the department may not distribute to these
8facilities
and to care management organizations more than $37,100,000 in each
9fiscal year, as determined by the department. The total amount that a county
10certifies under this subsection may not exceed 100% of otherwise-unreimbursed
11care. In distributing funds under this subsection, the department shall perform all
12of the following:
SB44, s. 1364
13Section
1364. 49.45 (6u) (bm) of the statutes is repealed.
SB44, s. 1365
14Section
1365. 49.45 (6v) (b) of the statutes is amended to read:
SB44,607,2015
49.45
(6v) (b) The department shall, each year, submit to the joint committee
16on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that
17provides information on the utilization of beds by recipients of medical assistance in
18facilities and a discussion and detailed projection of the likely balances,
19expenditures, encumbrances and carry over of currently appropriated amounts in
20the appropriation accounts under s. 20.435 (4) (b)
and
, (gp), (o)
, and (r).
SB44, s. 1366
21Section
1366. 49.45 (6x) (a) of the statutes is amended to read:
SB44,608,222
49.45
(6x) (a) Notwithstanding sub. (3) (e), from the
appropriations 23appropriation accounts under s. 20.435 (4) (b),
(gp), (o),
(r), and (w), the department
24shall distribute not more than $4,748,000 in each fiscal year, to provide funds to an
25essential access city hospital, except that the department may not allocate funds to
1an essential access city hospital to the extent that the allocation would exceed any
2limitation under
42 USC 1396b (i) (3).
SB44, s. 1367
3Section
1367. 49.45 (6y) (a) of the statutes is amended to read:
SB44,608,134
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the
appropriations 5appropriation accounts under s. 20.435 (4) (b),
(gp), (o),
(r), and (w), the department
6shall distribute funding in each fiscal year to provide supplemental payment to
7hospitals that enter into a contract under s. 49.02 (2) to provide health care services
8funded by a relief block grant, as determined by the department, for hospital services
9that are not in excess of the hospitals' customary charges for the services, as limited
10under
42 USC 1396b (i) (3). If no relief block grant is awarded under this chapter
11or if the allocation of funds to such hospitals would exceed any limitation under
42
12USC 1396b (i) (3), the department may distribute funds to hospitals that have not
13entered into a contract under s. 49.02 (2).
SB44, s. 1368
14Section
1368. 49.45 (6y) (am) of the statutes is amended to read:
SB44,608,2215
49.45
(6y) (am) Notwithstanding sub. (3) (e), from the
appropriations 16appropriation accounts under s. 20.435 (4) (b), (h),
(gp), (o),
(r), and (w), the
17department shall distribute funding in each fiscal year to provide supplemental
18payments to hospitals that enter into contracts under s. 49.02 (2) with a county
19having a population of 500,000 or more to provide health care services funded by a
20relief block grant, as determined by the department, for hospital services that are not
21in excess of the hospitals' customary charges for the services, as limited under
42
22USC 1396b (i) (3).
SB44, s. 1369
23Section
1369. 49.45 (6z) (a) (intro.) of the statutes is amended to read:
SB44,609,924
49.45
(6z) (a) (intro.) Notwithstanding sub. (3) (e), from the
appropriations 25appropriation accounts under s. 20.435 (4) (b),
(gp), (o),
(r), and (w), the department
1shall distribute funding in each fiscal year to supplement payment for services to
2hospitals that enter into a contract under s. 49.02 (2) to provide health care services
3funded by a relief block grant under this chapter, if the department determines that
4the hospitals serve a disproportionate number of low-income patients with special
5needs. If no medical relief block grant under this chapter is awarded or if the
6allocation of funds to such hospitals would exceed any limitation under
42 USC
71396b (i) (3), the department may distribute funds to hospitals that have not entered
8into a contract under s. 49.02 (2). The department may not distribute funds under
9this subsection to the extent that the distribution would do any of the following:
SB44, s. 1370
10Section
1370. 49.45 (6zb) of the statutes is created to read:
SB44,609,1711
49.45
(6zb) Supplemental payments to health maintenance organizations. 12From the appropriation under s. 20.435 (4) (wr), the department shall distribute
13funding in each fiscal year to a health maintenance organization, as defined under
14s. 609.01 (2), to supplement payment to the health maintenance organization under
15this section. The funding shall be to assist in meeting increasing costs, more intense
16use of services by Medical Assistance recipients, and other reimbursement needs
17that the department identifies.
SB44, s. 1371
18Section
1371. 49.45 (7) (a) of the statutes is amended to read:
SB44,610,219
49.45
(7) (a) A recipient who is a patient in a public medical institution or an
20accommodated person and has a monthly income exceeding the payment rates
21established under
42 USC 1382 (e) may retain
$45
$30 unearned income or the
22amount of any pension paid under
38 USC 3203 (f) 38 USC 5503 (d), whichever is
23greater, per month for personal needs. Except as provided in s. 49.455 (4) (a), the
24recipient shall apply income in excess of
$45 $30 or the amount of any pension paid
25under
38 USC 3203 (f) 38 USC 5503 (d), whichever is greater, less any amount
1deducted under rules promulgated by the department, toward the cost of care in the
2facility.
SB44, s. 1372
3Section
1372. 49.45 (8) (b) of the statutes is amended to read:
SB44,610,84
49.45
(8) (b) Reimbursement under s. 20.435 (4) (b),
(gp), (o),
(r), and (w) for
5home health services provided by a certified home health agency or independent
6nurse shall be made at the home health agency's or nurse's usual and customary fee
7per patient care visit, subject to a maximum allowable fee per patient care visit that
8is established under par. (c).
SB44, s. 1373
9Section
1373. 49.45 (18) (intro.) of the statutes is renumbered 49.45 (18) (ac)
10and amended to read:
SB44,610,2211
49.45
(18) (ac) Except as provided in pars.
(a) (am) to (d),
and subject to par.
12(ag), any person eligible for medical assistance under s. 49.46, 49.468
, or 49.47 shall
13pay up to the maximum amounts allowable under
42 CFR 447.53 to
447.58 for
14purchases of services provided under s. 49.46 (2). The service provider shall collect
15the
specified or allowable copayment, coinsurance
, or deductible, unless the service
16provider determines that the cost of collecting the copayment, coinsurance
, or
17deductible exceeds the amount to be collected. The department shall reduce
18payments to each provider by the amount of the
specified or allowable copayment,
19coinsurance
, or deductible. No provider may deny care or services because the
20recipient is unable to share costs, but an inability to share costs specified in this
21subsection does not relieve the recipient of liability for these costs.
Liability under
22this subsection is limited by the following provisions:
SB44, s. 1374
23Section
1374. 49.45 (18) (a) of the statutes is renumbered 49.45 (18) (am).
SB44, s. 1375
24Section
1375. 49.45 (18) (ag) of the statutes is created to read:
SB44,611,2
149.45
(18) (ag) Except as provided in pars. (am), (b), and (c), and subject to par.
2(d), a recipient specified in par. (ac) shall pay all of the following:
SB44,611,43
1. A copayment of $1 for each prescription of a drug that bears only a generic
4name, as defined in s. 450.12 (1) (b).
SB44,611,65
2. A copayment of $3 for each prescription of a drug that bears a brand name,
6as defined in s. 450.12 (1) (a).
SB44, s. 1376
7Section
1376. 49.45 (18) (d) of the statutes is amended to read:
SB44,611,118
49.45
(18) (d) No person who designates a pharmacy or pharmacist as his or
9her sole provider of prescription drugs and who so uses that pharmacy or pharmacist
10is liable under this subsection for more than
$5
$12 per month for prescription drugs
11received.
SB44, s. 1377
12Section
1377. 49.45 (19) (bm) of the statutes is amended to read:
SB44,611,1513
49.45
(19) (bm) The
department or the county department under s. 46.215 or
1446.22 shall notify applicants of the requirements of this subsection at the time of
15application.
SB44, s. 1378
16Section
1378. 49.45 (24m) (intro.) of the statutes is amended to read:
SB44,611,2117
49.45
(24m) Home health care and personal care pilot program. (intro.)
18From the
appropriations appropriation accounts under s. 20.435 (4) (b),
(gp), (o),
(r), 19and (w), in order to test the feasibility of instituting a system of reimbursement for
20providers of home health care and personal care services for medical assistance
21recipients that is based on competitive bidding, the department shall:
SB44, s. 1379
22Section
1379. 49.45 (25) (am) (intro.) of the statutes is amended to read:
SB44,612,423
49.45
(25) (am) (intro.) Except as provided under pars. (be)
and, (bg)
, and (bj) 24and sub. (24), case management services under s. 49.46 (2) (b) 9. and (bm) are
25reimbursable under
medical assistance Medical Assistance only if provided to a
1medical assistance Medical Assistance beneficiary who receives case management
2services from or through a certified case management provider in a county, city,
3village
, or town that elects, under par. (b), to make the services available and who
4meets at least one of the following conditions:
SB44, s. 1380
5Section
1380. 49.45 (25) (bj) of the statutes is created to read:
SB44,612,136
49.45
(25) (bj) The department of corrections may elect to provide case
7management services under this subsection to persons who are under the
8supervision of that department under s. 938.183, 938.34 (4h), (4m), or (4n), or
9938.357 (4), who are Medical Assistance beneficiaries, and who meet one or more of
10the conditions specified in par. (am). The amount of the allowable charges for those
11services under the Medical Assistance program that is not provided by the federal
12government shall be paid from the appropriation account under s. 20.410 (3) (hm),
13(ho), or (hr).
SB44, s. 1381
14Section
1381. 49.45 (25) (c) of the statutes is amended to read: