49.34(5m)(a)1.
1. "Provider" means a nonstock corporation organized under
ch. 181 that is a nonprofit corporation, as defined in
s. 181.0103 (17), and that contracts under this section to provide client services on the basis of a unit rate per client service.
49.34(5m)(a)2.
2. "Rate-based service" means a service or a group of services, as determined by the department, that is reimbursed through a prospectively set rate and that is distinguishable from other services or groups of services by the purpose for which funds are provided for that service or group of services and by the source of funding for that service or group of services.
49.34(5m)(b)1.1. Subject to
subds. 2. and
3., if revenue under a contract for the provision of a rate-based service exceeds allowable costs incurred in the contract period, the provider may retain from the surplus generated by that rate-based service up to 5% of the contract amount. A provider that retains a surplus under this subdivision shall use that retained surplus to cover a deficit between revenue and allowable costs incurred in any preceding or future contract period for the same rate-based service that generated the surplus or to address the programmatic needs of clients served by the same rate-based service that generated the surplus.
49.34(5m)(b)2.
2. Subject to
subd. 3., a provider may accumulate funds from more than one contract period under this paragraph, except that, if at the end of a contract period the amount accumulated from all contract periods for a rate-based service exceeds 10% of the amount of all current contracts for that rate-based service, the provider shall, at the request of a purchaser, return to that purchaser the purchaser's proportional share of that excess and use any of that excess that is not returned to a purchaser to reduce the provider's unit rate per client for that rate-based service in the next contract period. If a provider has held for 4 consecutive contract periods an accumulated reserve for a rate-based service that is equal to or exceeds 10% of the amount of all current contracts for that rate-based service, the provider shall apply 50% of that accumulated amount to reducing its unit rate per client for that rate-based service in the next contract period.
49.34(5m)(b)3.
3. If on December 31, 1995, the amount accumulated by a provider from all contract periods ending on or before that date for all rate-based services provided by the provider exceeds 10% of the provider's total contract amount for all rate-based services provided by the provider in 1995, the provider shall, at the request of a purchaser, return to that purchaser the purchaser's proportional share of that excess.
49.34(5m)(f)
(f) All providers that are subject to this subsection shall comply with any financial reporting and auditing requirements that the department may prescribe. Those requirements shall include a requirement that a provider provide to any purchaser and the department any information that the department needs to claim federal reimbursement for the cost of any services purchased from the provider and a requirement that a provider provide audit reports to any purchaser and the department according to standards specified in the provider's contract and any other standards that the department may prescribe.
49.34(6)
(6) Contracts may be renegotiated by the purchaser under conditions specified in the contract.
49.34(7)
(7) The service provider under this section may appeal decisions of the purchaser in accordance with terms and conditions of the contract and
ch. 68 or
227.
49.34 History
History: 1995 a. 27;
1997 a. 79.
49.35
49.35
Public assistance; supervisory functions of department. 49.35(1)(a)(a) The department shall supervise the administration of programs under this subchapter. The department shall submit to the federal authorities state plans for the administration of programs under this subchapter in such form and containing such information as the federal authorities require, and shall comply with all requirements prescribed to ensure their correctness.
49.35(1)(b)
(b) All records of the department and all county records relating to programs under this subchapter and aid under s.
49.18, 1971 stats., s.
49.20, 1971 stats., and s.
49.61, 1971 stats., as affected by
chapter 90, laws of 1973, shall be open to inspection at all reasonable hours by authorized representatives of the federal government. Notwithstanding
s. 48.396 (2), all county records relating to the administration of the services and public assistance specified in this paragraph shall be open to inspection at all reasonable hours by authorized representatives of the department.
49.35(1)(bm)
(bm) All records of the department relating to aid provided under
s. 49.19 are open to inspection at reasonable hours by members of the legislature who require the information contained in the records in pursuit of a specific state legislative purpose. All records of any county relating to aid provided under
s. 49.19 are open to inspection at reasonable hours by members of the board of supervisors of the county or the governing body of a city, village or town located in the county who require the information contained in the records in pursuit of a specific county or municipal legislative purpose. The right to records access provided by this paragraph does not apply if access is prohibited by federal law or regulation or if this state is required to prohibit such access as a condition precedent to participation in a federal program in which this state participates.
49.35(1)(c)
(c) The department may at any time audit all county records relating to the administration of the services and public assistance specified in this section and may at any time conduct administrative reviews of county departments under
ss. 46.215,
46.22 and
46.23. If the department conducts such an audit or administrative review in a county, the department shall furnish a copy of the audit or administrative review report to the chairperson of the county board of supervisors and the county clerk in a county with a single-county department or to the county boards of supervisors and the county clerks in counties with a multicounty department, and to the director of the county department under
s. 46.215,
46.22 or
46.23.
49.35(2)
(2) The county administration of all laws relating to programs under this subchapter shall be vested in the officers and agencies designated in the statutes.
49.35 History
History: 1995 a. 27.
49.36
49.36
Work experience program for noncustodial parents. 49.36(1)(a)
(a) "Custodial parent" means a parent who lives with his or her child for substantial periods of time.
49.36(1)(b)
(b) "Tribal governing body" means an elected tribal governing body of a federally recognized American Indian tribe or band.
49.36(2)
(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).
49.36(3)(a)(a) Except as provided in
par. (f), a person ordered to register under
s. 767.295 (2) (a) shall participate in a work experience program if services are available.
49.36(3)(b)
(b) A person may not be required to participate for more than 32 hours per week in the program under this section.
49.36(3)(c)
(c) A person may not be required to participate for more than 16 weeks during each 12-month period in a program under this section.
49.36(3)(d)
(d) If a person is required by a governmental entity to participate in another work or training program, the person may not be required to participate in a program under this section in a week for more than 32 hours minus the number of hours he or she is required to participate in the other work or training program in that week.
49.36(3)(e)
(e) If a person is employed, the person may not be required to participate in a program under this section in a week for more than 80% of the difference between 40 hours and the number of hours actually worked in the unsubsidized job during that week.
49.36(3)(f)
(f) A person who works, on average, 32 hours or more per week in an unsubsidized job is not required to participate in a program under this section.
49.36(4)
(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.
49.36(5)
(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.
49.36(6)
(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.
49.36(7)
(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.
49.38
49.38
Menominee Enterprises, Inc., bonds, acquisition. 49.38(1)(1) The department is authorized to exercise options to purchase securities assigned to the state of Wisconsin under s.
710.05, 1973 stats., at par value, or to accept an assignment of such securities, for the purpose of providing relief, public assistance or welfare aid under this section.
49.38(2)
(2) The department shall exercise the options to purchase such securities or accept an assignment of such securities when it finds that the owner of the securities is a resident of this state and is in need of public assistance, or who but for the ownership of such securities would qualify for public assistance. If the department exercises an option to purchase such security, the purchase price shall be paid out, at par value, as a relief payment. Where the department accepts an assignment of such security as provided in this section it shall pay out as relief an amount equal to the par value of the security assigned. The relief furnished, whether by money or otherwise, shall be at such times and in such amounts as will in the discretion of the department meet the needs of the recipient and protect the public. The department is authorized to exercise the options to purchase assigned to it in whole or in part, or to accept an assignment of such securities in whole or in part. The department is granted such authority as may be necessary and convenient to enable it to exercise the functions and perform the duties required of it by this section, including without limitation because of enumeration the authority to promulgate rules governing eligibility and the furnishing and paying of relief under this section, the authority to enter into suitable agreements with the owner of the security or other appropriate persons for the purpose of carrying out this section, and the authority to sell or transfer the securities or defend and prosecute all actions concerning it and pay all just claims against it and do all other things necessary for the protection, preservation and management of the securities.
49.38(3)
(3) If the relief, public assistance, or other welfare aid provided pursuant to this section is discontinued during the life of the person receiving such aid and the value of the securities transferred to the department exceed the total amount of assistance paid under this section, the excess of such property shall be returned to such person; and in the event of the person's death the excess shall be considered the property of such person for administration proceedings.
49.38(4)
(4) The department may make loans to the owner of such securities for relief and welfare purposes which loans shall be secured by pledges of the securities to the state. The department may by rule establish the purposes for which loans may be made, permissible interest rates and fees, time and manner in which the loan is paid out, time and manner of repayment, general procedures to be followed in making loans, the action which shall be taken if a borrower defaults on a loan, maximum amount which may be loaned to any one borrower, and any other rules necessary to carry out the purposes of this section.
49.38(5)
(5) Nothing in this section as created by
chapter 2, laws of Special Session of 1963, is in derogation of other rights and remedies provided by law.
49.38(6)
(6) On and after May 20, 1972, where the owner of such security is otherwise eligible for welfare assistance, such security shall be an exempt asset under the welfare law and shall not disqualify such person from receiving welfare assistance.
49.38 Note
NOTE: Ch. 303, 1971 laws, provided for returning to its original owners Menominee Enterprises, Inc. bonds assigned to the state as a condition for receiving public assistance.
49.385
49.385
No action against members of the Menominee Indian tribe in certain cases. No action shall be commenced under
s. 46.10 or
49.08 or any other provision of law for the recovery from assets distributed to members of the Menominee Indian tribe and others by the United States pursuant to
P.L. 83-399, as amended, for the value of relief or old-age assistance under s.
49.20, 1971 stats., as affected by
chapter 90, laws of 1973, and the value of maintenance in state institutions under
ch. 46, furnished prior to termination date as defined in s.
70.057 (1), 1967 stats., to any legally enrolled member of the Menominee Indian tribe, his or her dependents, or lawful distributees of such member under section 3, said
P.L. 83-399, as amended. For purposes of this section, "legally enrolled members of the Menominee Indian tribe" shall include only those persons whose names appear on "Final Roll-Menominee Indian Tribe of Wisconsin" as proclaimed by the secretary of the interior November 26, 1957, and published at pages 9951 et seq. of the federal register, Thursday, December 12, 1957.
49.385 History
History: 1973 c. 147,
243;
1983 a. 192;
1995 a. 27 s.
2768m; Stats. 1995 s. 49.385.
MEDICAL ASSISTANCE
49.43
49.43
Definitions. As used in
ss. 49.43 to
49.497 unless the context indicates otherwise:
49.43(1e)
(1e) "Accommodated person" means any person in a hospital or in a skilled nursing facility or intermediate care facility, as defined in Title XIX of the social security act, who would have been eligible for benefits under
s. 49.19 or
49.77 or federal Title XVI if the person were not in such a hospital or facility, and any person in such an institution who can be found eligible for Title XIX under the social security act.
49.43(1m)
(1m) "Charge" means the customary, usual and reasonable demand for payment as established prospectively, concurrently or retrospectively by the department for services, care or commodities which does not exceed the general level of charges by others who render such service or care, or provide such commodities, under similar or comparable circumstances within the community in which the charge is incurred.
49.43(2)
(2) "Cost" means the reasonable cost of services, care or commodities as determined by the principles of reimbursement used under
42 USC 1395 to
1395rr, in effect on April 30, 1980.
49.43(2m)
(2m) "Cost-effective" has the meaning given in
P.L. 101-508, section 4402 (a) (2).
49.43(3)
(3) "Dentist" means a person licensed to practice dentistry.
49.43(3e)
(3e) "Department" means the department of health and family services.
49.43(3r)
(3r) "Group health plan" has the meaning given in
P.L. 101-508, section 4402 (a) (2).
49.43(5)
(5) "Hospital" means an institution, approved by the appropriate state agency, providing 24-hour continuous nursing service to patients confined therein; which provides standard dietary, nursing, diagnostic and therapeutic facilities; and whose professional staff is composed only of physicians and surgeons, or of physicians and surgeons and doctors of dental surgery.
49.43(6)
(6) "Inpatient psychiatric hospital services for individuals 21 years of age or for individuals under 22 years of age who are receiving such service immediately prior to reaching age 21" has the same meaning as provided in section 1905 (h) of the federal social security act.
49.43(7)
(7) "Intermediate care facility" means either of the following:
49.43(7)(a)
(a) An institution or distinct part thereof, which is:
49.43(7)(a)1.
1. Licensed or approved under state law to provide, on a regular basis, health related care and services to individuals who do not require the degree of care and treatment which a hospital or skilled nursing home is designated to provide but who because of their mental or physical condition require care and services above the level of room and board, which can be made available to them only through institutional facilities; and
49.43(7)(a)2.
2. Qualifies as an "intermediate care facility" within the meaning of Title XIX of the social security act.
49.43(7)(b)
(b) A public institution, or distinct part thereof, which is:
49.43(7)(b)1.
1. Licensed or approved under state law for the mentally retarded or persons with related conditions, the primary purpose of which is to provide health or rehabilitative services for mentally retarded individuals according to rules promulgated by the department; and
49.43(7)(b)2.
2. Qualifies as an "intermediate care facility" within the meaning of Title XIX of the social security act.
49.43(8)
(8) "Medical assistance" means any services or items under
ss. 49.45 to
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.
49.43(9)
(9) "Physician" means a person licensed to practice medicine and surgery, and includes graduates of osteopathic colleges holding an unlimited license to practice medicine and surgery.
49.43(10)
(10) "Provider" means a person, corporation, limited liability company, partnership, unincorporated business or professional association and any agent or employee thereof who provides medical assistance.
49.43(10m)
(10m) "Public medical institution" has the meaning designated in Title XIX of the federal social security act.
49.43(10s)
(10s) "Secretary" means the secretary of health and family services.
49.43(11)
(11) "Skilled nursing home" means a facility or distinct part thereof, which:
49.43(11)(a)
(a) Is licensed or approved under state law for the accommodation of convalescents or other persons who are not acutely ill and not in need of hospital care;
49.43(11)(b)
(b) Employs sufficient registered nursing practitioners for supervision of those giving nursing care to patients; and
49.43(11)(c)
(c) Qualifies as a "skilled nursing facility" within the meaning of Title XIX of the social security act.
49.43(12)
(12) "Spouse" means the legal husband or wife of the beneficiary, whether or not eligible for medical assistance.
49.45
49.45
Medical assistance; administration. 49.45(1)
(1)
Purpose. To provide appropriate health care for eligible persons and obtain the most benefits available under Title XIX of the federal social security act, the department shall administer medical assistance, rehabilitative and other services to help eligible individuals and families attain or retain capability for independence or self-care as hereinafter provided.
49.45(2)(a)1.
1. Exercise responsibility relating to fiscal matters, the eligibility for benefits under standards set forth in
ss. 49.46 to
49.47 and general supervision of the medical assistance program.
49.45(2)(a)2.
2. Employ necessary personnel under the classified service for the efficient and economical performance of the program and shall supply residents of this state with information concerning the program and procedures.
49.45(2)(a)3.
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, under a contract under
s. 49.78 (2), delegate all, or any portion, of this function to the county department under
s. 46.215,
46.22, or
46.23 or a tribal governing body.
49.45(2)(a)3m.
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.
49.45(2)(a)4.
4. To the extent funds are available under
s. 20.435 (4) (bm), certify all proper charges and claims for administrative services to the department of administration for payment and the department of administration shall draw its warrant forthwith.
