March 20, 2008 - Offered by Committee on Finance.
AB1-SA1,1,21
At the locations indicated, amend the bill, as shown by assembly
bill 1, as
2follows:
AB1-SA1,1,4
4"
Section 1g. 13.101 (18) of the statutes is created to read:
AB1-SA1,1,75
13.101
(18) Notwithstanding sub. (4), the committee may not transfer moneys
6from the appropriation account under s. 20.435 (4) (xc) to another appropriation
7account.".
AB1-SA1,1,10
9"
Section 6m. 20.005 (3) (schedule) of the statutes: at the appropriate place,
10insert the following amounts for the purposes indicated:
-
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AB1-SA1,2,5
5"
Section 9ac. 20.435 (4) (gp) of the statutes is repealed.
AB1-SA1, s. 9ad
6Section 9ad. 20.435 (4) (xc) of the statutes is created to read:
AB1-SA1,2,137
20.435
(4) (xc)
Hospital assessment fund; hospital payments and refunds. 8Biennially, from the medical assessment trust fund, the amounts in the schedule for
9increased payments and refunds to hospitals and for higher capitated payment rates
10under s. 49.45 (58) (a), as the Medical Assistance nonfederal share, in order to
11increase payment rates in excess of the aggregate inpatient and outpatient hospital
12payment rates in effect in fiscal year 2006-07 for services provided by hospitals
13under the Medical Assistance program administered under subch. IV of ch. 49.
AB1-SA1, s. 9ae
14Section 9ae. 20.435 (4) (xd) of the statutes is created to read:
AB1-SA1,3,4
120.435
(4) (xd)
Hospital assessment fund; Medical Assistance program benefits. 2Biennially, from the hospital assessment fund, the amounts in the schedule to
3provide a portion of the state share of Medical Assistance program benefits
4administered under subch. IV of ch. 49.
AB1-SA1, s. 9af
5Section 9af. 20.566 (1) (ho) of the statutes is created to read:
AB1-SA1,3,96
20.566
(1) (ho)
Collections under multistate streamlined sales tax project. From
7moneys collected under the multistate streamlined sales tax project as provided
8under s. 73.03 (28e), a sum sufficient to pay the dues necessary to participate in the
9governing board of the multistate streamlined sales tax project.
AB1-SA1, s. 9ag
10Section 9ag. 20.866 (2) (uur) of the statutes is amended to read:
AB1-SA1,3,1511
20.866
(2) (uur)
Transportation; state highway rehabilitation projects. From
12the capital improvement fund, a sum sufficient for the department of transportation
13to fund state highway rehabilitation projects, as provided under s. 84.95. The state
14may contract public debt in an amount not to exceed
$250,000,000 $300,000,000 for
15this purpose.
AB1-SA1, s. 9ah
16Section 9ah. 25.17 (1) (gs) of the statutes is created to read:
AB1-SA1,3,1717
25.17
(1) (gs) Hospital assessment fund (s. 25.772);
AB1-SA1,4,2
2025.69 Permanent endowment fund. There is established a separate
21nonlapsible trust fund designated as the permanent endowment fund, consisting of
22all of the proceeds from the sale of the state's right to receive payments under the
23Attorneys General Master Tobacco Settlement Agreement of November 23, 1998,
24and all investment earnings on the proceeds. There is transferred from the
1permanent endowment fund to the Medical Assistance trust fund
$50,000,000 2$68,000,000 in each fiscal year.
AB1-SA1,4,6
425.772 Hospital assessment fund. There is established a separate
5nonlapsible trust fund designated as the hospital assessment fund, to consist of all
6moneys received under s. 50.375 from assessments on hospitals.
AB1-SA1, s. 9ak
7Section 9ak. 46.27 (9) (a) of the statutes is amended to read:
AB1-SA1,4,168
46.27
(9) (a) The department may select up to 5 counties that volunteer to
9participate in a pilot project under which they will receive certain funds allocated for
10long-term care. The department shall allocate a level of funds to these counties
11equal to the amount that would otherwise be paid under s. 20.435 (4) (b),
(gp), or (w)
,
12or (xd), to nursing homes for providing care because of increased utilization of
13nursing home services, as estimated by the department. In estimating these levels,
14the department shall exclude any increased utilization of services provided by state
15centers for the developmentally disabled. The department shall calculate these
16amounts on a calendar year basis under sub. (10).
AB1-SA1, s. 9aL
17Section 9aL. 46.27 (10) (a) 1. of the statutes is amended to read:
AB1-SA1,4,2318
46.27
(10) (a) 1. The department shall determine for each county participating
19in the pilot project under sub. (9) a funding level of state medical assistance
20expenditures to be received by the county. This level shall equal the amount that the
21department determines would otherwise be paid under s. 20.435 (4) (b),
(gp), or (w)
,
22or (xd), or because of increased utilization of nursing home services, as estimated by
23the department.
AB1-SA1, s. 9am
24Section 9am. 46.275 (5) (a) of the statutes is amended to read:
AB1-SA1,5,6
146.275
(5) (a) Medical Assistance reimbursement for services a county, or the
2department under sub. (3r), provides under this program is available from the
3appropriation accounts under s. 20.435 (4) (b),
(gp), (o),
and (w)
, and (xd). If 2 or more
4counties jointly contract to provide services under this program and the department
5approves the contract, Medical Assistance reimbursement is also available for
6services provided jointly by these counties.
AB1-SA1, s. 9an
7Section 9an. 46.275 (5) (c) of the statutes is amended to read:
AB1-SA1,5,148
46.275
(5) (c) The total allocation under s. 20.435 (4) (b),
(gp), (o),
and (w)
, and
9(xd) to counties and to the department under sub. (3r) for services provided under
10this section may not exceed the amount approved by the federal department of health
11and human services. A county may use funds received under this section only to
12provide services to persons who meet the requirements under sub. (4) and may not
13use unexpended funds received under this section to serve other developmentally
14disabled persons residing in the county.
AB1-SA1, s. 9ao
15Section 9ao. 46.283 (5) of the statutes is amended to read:
AB1-SA1,5,2016
46.283
(5) Funding. From the appropriation accounts under s. 20.435 (4) (b),
17(bm),
(gp), (pa),
and (w)
, and (xd) and (7) (b), (bd), and (md), the department may
18contract with organizations that meet standards under sub. (3) for performance of
19the duties under sub. (4) and shall distribute funds for services provided by resource
20centers.
AB1-SA1,6,423
46.284
(5) (a) From the appropriation accounts under s. 20.435 (4) (b), (g),
(gp), 24(im), (o),
and (w)
, and (xd) and (7) (b), (bd), and (g), the department shall provide
25funding on a capitated payment basis for the provision of services under this section.
1Notwithstanding s. 46.036 (3) and (5m), a care management organization that is
2under contract with the department may expend the funds, consistent with this
3section, including providing payment, on a capitated basis, to providers of services
4under the family care benefit.
AB1-SA1, s. 9aq
5Section 9aq. 46.485 (2g) (intro.) of the statutes is amended to read:
AB1-SA1,6,116
46.485
(2g) (intro.) From the appropriation accounts under s. 20.435 (4) (b) and
7(gp) (xd), the department may in each fiscal year transfer funds to the appropriation
8under s. 20.435 (7) (kb) for distribution under this section and from the appropriation
9account under s. 20.435 (7) (mb) the department
may not shall distribute
more than 10$1,330,500 in each fiscal year to applying counties in this state that meet all of the
11following requirements, as determined by the department:
AB1-SA1, s. 9bd
13Section 9bd. 49.155 (6m) of the statutes is created to read:
AB1-SA1,6,1414
49.155
(6m) Authorization for payment. (a) In this subsection:
AB1-SA1,6,1515
1. "Certified provider" means a child care provider certified under s. 48.651.
AB1-SA1,6,1916
2. "Child care administrative agency" means any agency that has a contract
17with the department to administer child care funds or any agency that has a
18subcontract to administer child care funds with an agency that has a contract with
19the department.
AB1-SA1,6,2020
3. "Licensed provider" means a child care provider licensed under s. 48.65.
AB1-SA1,6,2221
(b) A child care administrative agency shall authorize payment to child care
22providers as follows:
AB1-SA1,6,2423
1. For a licensed provider, the child care administrative agency shall authorize
24payment based on authorized units of service, except as follows:
AB1-SA1,7,4
1a. The child care administrative agency may authorize payment to a licensed
2provider based on units of service used by each child, up to the maximum number of
3authorized units, with the reimbursement rate increased by 10 percent to account
4for absent days, if the schedule of child care to be used is expected to vary widely.
AB1-SA1,7,85
b. The child care administrative agency may authorize payment to a licensed
6provider based on units of service used by each child, up to the maximum number of
7authorized units, if the child care administrative agency has documented 3 separate
8occasions on which the provider significantly overreported the attendance of a child.
AB1-SA1,7,119
2. For a certified provider, the child care administrative agency shall authorize
10payment for units of service used by each child, up to the maximum number of
11authorized units, except as provided in par. (c).
AB1-SA1,7,2012
(c) A child care administrative agency may authorize payment to a licensed or
13certified provider to hold a slot for a child if the child's parent has a temporary break
14in employment and intends to return to work and to continue to use the services of
15the provider upon returning to work. The child care administrative agency may
16authorize payment for no more than 6 weeks if the absence is due to a medical reason
17and is documented by a physician or for no more than 4 weeks if the absence is due
18to another reason. The department and child care administrative agency may not
19consider payment for a temporary absence to be an overpayment if the parent
20intended to, but does not actually, return to work.
AB1-SA1,7,2523
49.175
(1) (p)
Direct child care services. For direct child care services under s.
2449.155,
$340,601,800 $359,201,800 in fiscal year 2007-08 and $355,352,000 in fiscal
25year 2008-09.
AB1-SA1, s. 9bf
1Section 9bf. 49.45 (2) (a) 17. of the statutes is amended to read:
AB1-SA1,8,62
49.45
(2) (a) 17. Notify the governor, the joint committee on legislative
3organization, the joint committee on finance and appropriate standing committees,
4as determined by the presiding officer of each house, if the appropriation accounts
5under s. 20.435 (4) (b) and
(gp) (xd) are insufficient to provide the state share of
6medical assistance.
AB1-SA1, s. 9bh
8Section 9bh. 49.45 (5m) (am) of the statutes is amended to read:
AB1-SA1,8,179
49.45
(5m) (am) Notwithstanding sub. (3) (e), from the appropriation accounts
10under s. 20.435 (4) (b),
(gp), (o),
and (w),
and (xd), the department shall distribute not
11more than
$2,256,000 $5,256,000 in
each fiscal year
2007-08 and each fiscal year
12thereafter, to provide supplemental funds to rural hospitals that, as determined by
13the department, have high utilization of inpatient services by patients whose care
14is provided from governmental sources,
and to provide supplemental funds to critical
15access hospitals, except that the department may not distribute funds to a rural
16hospital
or to a critical access hospital to the extent that the distribution would
17exceed any limitation under
42 USC 1396b (i) (3).
AB1-SA1,9,220
49.45
(6m) (ag) (intro.) Payment for care provided in a facility under this
21subsection made under s. 20.435 (4) (b),
(gp), (o), (pa),
or (w)
, or (xd) shall, except as
22provided in pars. (bg), (bm), and (br), be determined according to a prospective
23payment system updated annually by the department. The payment system shall
24implement standards that are necessary and proper for providing patient care and
1that meet quality and safety standards established under subch. II of ch. 50 and ch.
2150. The payment system shall reflect all of the following:
AB1-SA1, s. 9bk
3Section 9bk. 49.45 (6v) (b) of the statutes is amended to read:
AB1-SA1,9,94
49.45
(6v) (b) The department shall, each year, submit to the joint committee
5on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that
6provides information on the utilization of beds by recipients of medical assistance in
7facilities and a discussion and detailed projection of the likely balances,
8expenditures, encumbrances and carry over of currently appropriated amounts in
9the appropriation accounts under s. 20.435 (4) (b),
(gp), and (o)
, and (xd).
AB1-SA1, s. 9bL
10Section 9bL. 49.45 (6x) (a) of the statutes is amended to read:
AB1-SA1,9,1611
49.45
(6x) (a) Notwithstanding sub. (3) (e), from the appropriation accounts
12under s. 20.435 (4) (b),
(gp), (o),
and (w)
, and (xd), the department shall distribute not
13more than $4,748,000 in each fiscal year, to provide funds to an essential access city
14hospital, except that the department may not allocate funds to an essential access
15city hospital to the extent that the allocation would exceed any limitation under
42
16USC 1396b (i) (3).
AB1-SA1, s. 9bm
17Section 9bm. 49.45 (6y) (a) of the statutes is amended to read:
AB1-SA1,9,2518
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the appropriation accounts
19under s. 20.435 (4) (b),
(gp), (o),
and (w)
, and (xd), the department
shall
may 20distribute funding in each fiscal year to provide supplemental payment to hospitals
21that enter into a contract under s. 49.02 (2) to provide health care services funded
22by a relief block grant, as determined by the department, for hospital services that
23are not in excess of the hospitals' customary charges for the services, as limited under
2442 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the
25allocation of funds to such hospitals would exceed any limitation under
42 USC
11396b (i) (3), the department may distribute funds to hospitals that have not entered
2into a contract under s. 49.02 (2).
AB1-SA1, s. 9bn
3Section 9bn. 49.45 (6y) (am) of the statutes is amended to read:
AB1-SA1,10,104
49.45
(6y) (am) Notwithstanding sub. (3) (e), from the appropriation accounts
5under s. 20.435 (4) (b), (h),
(gp), (o),
and (w)
, and (xd), the department shall distribute
6funding in each fiscal year to provide supplemental payments to hospitals that enter
7into contracts under s. 49.02 (2) with a county having a population of 500,000 or more
8to provide health care services funded by a relief block grant, as determined by the
9department, for hospital services that are not in excess of the hospitals' customary
10charges for the services, as limited under
42 USC 1396b (i) (3).
AB1-SA1,10,2413
49.45
(6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriation
14accounts under s. 20.435 (4) (b),
(gp), (o),
and (w)
, and (xd), the department may
15distribute funding in each fiscal year to supplement payment for services to hospitals
16that enter into indigent care agreements, in accordance with the approved state plan
17for services under
42 USC 1396a, with relief agencies that administer the medical
18relief block grant under this chapter, if the department determines that the hospitals
19serve a disproportionate number of low-income patients with special needs. If no
20medical relief block grant under this chapter is awarded or if the allocation of funds
21to such hospitals would exceed any limitation under
42 USC 1396b (i) (3), the
22department may distribute funds to hospitals that have not entered into indigent
23care agreements. The department may not distribute funds under this subsection
24to the extent that the distribution would do any of the following:
AB1-SA1, s. 9bq
25Section 9bq. 49.45 (8) (b) of the statutes is amended to read:
AB1-SA1,11,5
149.45
(8) (b) Reimbursement under s. 20.435 (4) (b),
(gp), (o),
and (w)
, and (xd) 2for home health services provided by a certified home health agency or independent
3nurse shall be made at the home health agency's or nurse's usual and customary fee
4per patient care visit, subject to a maximum allowable fee per patient care visit that
5is established under par. (c).
AB1-SA1, s. 9br
6Section 9br. 49.45 (24m) (intro.) of the statutes is amended to read:
AB1-SA1,11,117
49.45
(24m) (intro.) From the appropriation accounts under s. 20.435 (4) (b),
8(gp), (o),
and (w)
, and (xd), in order to test the feasibility of instituting a system of
9reimbursement for providers of home health care and personal care services for
10medical assistance recipients that is based on competitive bidding, the department
11shall:
AB1-SA1, s. 9bt
12Section 9bt. 49.45 (52) of the statutes is amended to read:
AB1-SA1,11,2313
49.45
(52) Payment adjustments. Beginning on January 1, 2003, the
14department may, from the appropriation account under s. 20.435 (7) (b), make
15Medical Assistance payment adjustments to county departments under s. 46.215,
1646.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01
17(4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and
18(b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16. Payment
19adjustments under this subsection shall include the state share of the payments.
20The total of any payment adjustments under this subsection and Medical Assistance
21payments made from appropriation accounts under s. 20.435 (4) (b),
(gp), (o),
and (w)
,
22and (xd) may not exceed applicable limitations on payments under
42 USC 1396a (a)
23(30) (A).
AB1-SA1, s. 9bu
24Section 9bu. 49.45 (58) of the statutes is created to read:
AB1-SA1,12,9
149.45
(58) Health maintenance organization payments to hospitals. (a) The
2department shall develop a methodology for calculating rate increases for inpatient
3and outpatient hospital services in connection with the assessment imposed on
4hospitals under s. 50.375. The methodology shall incorporate encounter data
5provided by health maintenance organizations and information that the department
6uses to calculate the capitated rates that the department pays health maintenance
7organizations for providing services to recipients of medical assistance. The
8department shall publicly disclose the methodology. The department shall review
9the methodology at least once every 12 months.
AB1-SA1,12,1210
(b) The department shall require, as a term of contracts with health
11maintenance organizations to provide medical assistance services, that the health
12maintenance organization do all of the following:
AB1-SA1,12,1513
1. Make monthly prospective payments, calculated using the methodology
14under par. (a), to hospitals that serve medical assistance recipients who are enrolled
15in the health maintenance organization.
AB1-SA1,12,1916
2. Calculate the amounts that result from applying the rate increases that are
17derived using the methodology under par. (a) to services for recipients of medical
18assistance for which hospitals submit claims to the health maintenance
19organization.
AB1-SA1,12,2420
3. Within 90 days after the end of each 6-month period, compare the amounts
21that the health maintenance organization paid hospitals under subd. 1. for the
226-month period with the amounts calculated under subd. 2. for services provided
23during that same period. If the amounts under subd. 2. exceed the amounts of the
24payments under subd. 1., pay hospitals the difference within 90 days.
AB1-SA1,13,5
1(c) If the amounts that a health maintenance organization paid hospitals under
2par. (b) 1. for a 6-month period exceed the amounts calculated under par. (b) 2. for
3services provided during the same period, hospitals shall pay the health
4maintenance organization the difference within 90 days after the comparison of
5amounts under par. (b) 3. is completed.
AB1-SA1,13,126
(d) If the department determines that a health maintenance organization has
7not complied with a condition under par. (b), the department shall require the health
8maintenance organization to comply with the condition within 15 days after the
9department's determination. The department may terminate a contract with a
10health maintenance organization for failure to comply with a condition under par.
11(b). The department shall audit health maintenance organizations to determine
12whether they have complied with the conditions under par. (b).
AB1-SA1,13,2113
(e) If a health maintenance organization and hospital cannot resolve the
14amount that a health maintenance organization owes a hospital under par. (b) 3. or
15that a hospital owes a health maintenance organization under par. (c), and either the
16health maintenance organization or the hospital, within 6 months after the end of
17the time period to which the disputed amount relates, requests that the department
18determine the amount owed, the department shall determine the amount within 90
19days after the request is made. The health maintenance organization or hospital is,
20upon request, entitled to a contested case hearing under ch. 227 on the department's
21determination.
AB1-SA1, s. 9cb
22Section 9cb. 49.472 (6) (a) of the statutes is amended to read:
AB1-SA1,14,323
49.472
(6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account
24under s. 20.435 (4) (b),
(gp), or (w)
, or (xd), the department shall, on the part of an
25individual who is eligible for medical assistance under sub. (3), pay premiums for or
1purchase individual coverage offered by the individual's employer if the department
2determines that paying the premiums for or purchasing the coverage will not be more
3costly than providing medical assistance.
AB1-SA1, s. 9cc
4Section 9cc. 49.472 (6) (b) of the statutes is amended to read: