This bill changes the audit report requirement so that it applies to care and services that exceed $100,000, or any higher threshold amount determined by DHFS.
For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 46.036 (4) (c) of the statutes is amended to read:
46.036 (4) (c) Unless waived by the department, biennially, or annually if required under federal law, provide the purchaser with a certified financial and compliance audit report if the care and services purchased exceed $25,000 $100,000 or any higher threshold amount determined by the department. The audit shall follow standards that the department prescribes. A purchaser may waive the requirements of this paragraph for any family-operated group home, as defined under par. (a), from which it purchases services.
SECTION 2. 301.08 (2) (d) 3. of the statutes is amended to read:
301.08 (2) (d) 3. Unless waived by the department, biennially, or annually if required under federal law, provide the purchaser with a certified financial and compliance audit report if the care and services purchased exceed $100,000 or any higher threshold amount determined by the department. The audit shall follow standards that the department prescribes. A purchaser may waive the requirements of this subdivision as provided in s. 46.036 (4) (c).
SECTION 9321. Initial applicability; Health and Family Services.
(1) SERVICE PROVIDER AUDIT REQUIREMENT. The treatment of sections 46.036 (4) (c) (by SECTION 1) and 301.08 (2) (d) 3. (by SECTION 2) of the statutes first applies to contracts entered into or renewed on the effective date of this subsection.
****NOTE: This is reconciled SECTION 9321 (1). This subsection has been affected by drafts with the following LRB numbers: -0243/1 and -1261/2.
(End)
LRB-0244LRB-0244/1
DAK:kjf:rs
2007 - 2008 LEGISLATURE
DOA:......Milioto, BB0027 - Nursing home and C-BRF licensure law changes
For 2007-09 Budget -- Not Ready For Introduction
2007 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
health and human services
Health
Currently, DHFS may issue to nursing homes notices of violations of licensure laws and notations in biennial reports; may impose a plan of correction or reject a nursing home's plan of correction; and may assess forfeitures to nursing homes. A nursing home contests these actions by sending, within ten days after receipt of notice, a written request for a hearing to the Division of Hearings and Appeals that is attached to DOA. This bill changes the time period within which a nursing home may contest these DHFS actions to 60 days.
Currently, DHFS may place a monitor in, and the secretary of health and family services may petition for appointment of a receiver for, a nursing home or community-based residential facility (C-BRF) when any of several conditions (for example, operating without a license or in the event of an emergency) exist. This bill specifies two additional conditions for placement of a monitor or petitioning for appointment of a receiver: 1) DHFS or the nursing home or C-BRF determines that estimated operating expenses of the nursing home or C-BRF significantly exceed anticipated revenues; and 2) the nursing home or C-BRF or its operator has been charged with or convicted of Medical Assistance (MA) fraud, fraud under the federal Medicare Program, or the abuse or neglect of patients or residents of the nursing home or C-BRF. The bill also permits a monitor placed in a nursing home or C-BRF to assist in financial management.
For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 50.04 (4) (e) 1. of the statutes is amended to read:
50.04 (4) (e) 1. If a nursing home desires to contest any department action under this subsection, it shall send a written request for a hearing under s. 227.44 to the division of hearings and appeals created under s. 15.103 (1) within 10 60 days of receipt of notice of the contested action. Department action that is subject to a hearing under this subsection includes service of a notice of a violation of this subchapter or rules promulgated under this subchapter, a notation in the report under sub. (3) (b), imposition of a plan of correction and rejection of a nursing home's plan of correction, but does not include a correction order. Upon the request of the nursing home, the division shall grant a stay of the hearing under this paragraph until the department assesses a forfeiture, so that its hearing under this paragraph is consolidated with the forfeiture appeal hearing held under sub. (5) (e). All agency action under this subsection arising out of a violation, deficiency or rejection and imposition of a plan of correction shall be the subject of a single hearing. Unless a stay is granted under this paragraph, the division shall commence the hearing within 30 days of the request for hearing, within 30 days of the department's acceptance of a nursing home's plan of correction or within 30 days of the department's imposition of a plan of correction, whichever is later. The division shall send notice to the nursing home in conformance with s. 227.44. Issues litigated at the hearing may not be relitigated at subsequent hearings under this paragraph arising out of the same violation or deficiency.
SECTION 2. 50.04 (5) (e) of the statutes is amended to read:
50.04 (5) (e) Forfeiture appeal hearing. A nursing home may contest an assessment of forfeiture by sending, within 10 60 days after receipt of notice of a contested action, a written request for hearing under s. 227.44 to the division of hearings and appeals created under s. 15.103 (1). The administrator of the division may designate a hearing examiner to preside over the case and recommend a decision to the administrator under s. 227.46. The decision of the administrator of the division shall be the final administrative decision. The division shall commence the hearing within 30 days of receipt of the request for hearing and shall issue a final decision within 15 days after the close of the hearing. Proceedings before the division are governed by ch. 227. In any petition for judicial review of a decision by the division, the party, other than the petitioner, who was in the proceeding before the division shall be the named respondent.
SECTION 3. 50.05 (1) (dg) of the statutes is created to read:
50.05 (1) (dg) "Medicare" means 42 USC 1395 to 1395hhh.
SECTION 4. 50.05 (2) (g) of the statutes is created to read:
50.05 (2) (g) The department or the facility determines that estimated operating expenditures of the facility significantly exceed anticipated revenues for the facility.
SECTION 5. 50.05 (2) (h) of the statutes is created to read:
50.05 (2) (h) The facility or facility's operator has been charged with or convicted of an offense specified under s. 49.49 or 940.295, or a Medicare violation under 42 USC 1320a-7a, 1320a-7b, or 1320a-8.
SECTION 6. 50.05 (3) of the statutes is amended to read:
50.05 (3) MONITOR. In any situation described in sub. (2), the department may place a person to act as monitor in the facility. The monitor shall observe operation of the facility, assist the facility by advising it on how to comply with state regulations, and shall submit a written report periodically to the department on the operation of the facility. The monitor may assist in the financial management of the facility. The department may require payment by the operator or controlling person of the facility for the costs of placement of a person to act as monitor in the facility.
SECTION 9321. Initial applicability; Health and Family Services.
(1) NURSING HOME CONTESTED ACTION OR FORFEITURE TIME LIMITS. The treatment of section 50.04 (4) (e) 1. and (5) (e) of the statutes first applies to a violation of subchapter I of chapter 50 of the statutes or of a rule promulgated under subchapter I of chapter 50 of the statutes that is committed on the effective date of this subsection.
(End)
LRB-0246LRB-0246/2
DAK:jld:jf
2007 - 2008 LEGISLATURE
DOA:......Rhodes, BB0006 - Birth to 3 Program carry-over
For 2007-09 Budget -- Not Ready For Introduction
2007 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
health and human services
Mental illness, alcoholism, and developmental disabilities
Currently, the general purpose revenues (GPR) appropriation account from which DHFS provides moneys for early intervention services for infants and toddlers with disabilities (commonly known as the "Birth to Three Program") is an annual appropriation but permits transfer of funds between fiscal years. Funds distributed by DHFS to counties but not encumbered by December 31 of each year must lapse to the general fund on the next January 1 unless carried forward to the next calendar year by JCF.
This bill deletes from the DHFS appropriation account for the Birth to Three Program the requirement that funds distributed but not encumbered by December 31 of each year lapse to the general fund on the next January 1; deletes the fiscal year transfer authorization; and makes the appropriation account continuing.
For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 20.435 (7) (bt) of the statutes is amended to read:
20.435 (7) (bt) Early intervention services for infants and toddlers with disabilities. The As a continuing appropriation, the amounts in the schedule for the early intervention services under s. 51.44. Notwithstanding ss. 20.001 (3) (a) and 20.002 (1), the department may transfer funds between fiscal years under this paragraph. All funds distributed by the department under s. 51.44 but not encumbered by December 31 of each year shall lapse to the general fund on the next January 1 unless carried forward to the next calendar year by the joint committee on finance.
****NOTE: This SECTION involves a change in an appropriation that must be reflected in the revised schedule in s. 20.005, stats.
(End)
LRB-0247LRB-0247/1
DAK:kjf:rs
2007 - 2008 LEGISLATURE
DOA:......Rhodes, BB0007 - Group home revolving loan fund repeal
For 2007-09 Budget -- Not Ready For Introduction
2007 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
health and human services
Mental illness, alcoholism, and developmental disabilities
Currently, DHFS administers a fund, known as the "group home revolving loan fund," to make limited two-year loans to applying nonprofit organizations to establish housing programs for individuals who are recovering from alcohol or other drug abuse. This bill eliminates the group home revolving loan fund.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 20.435 (6) (gd) of the statutes is repealed.
****NOTE: This SECTION involves a change in an appropriation that must be reflected in the revised schedule in s. 20.005, stats.
SECTION 2. 46.976 of the statutes is repealed.
(End)
LRB-0248LRB-0248/3
DAK&PJK:jld:pg
2007 - 2008 LEGISLATURE
DOA:......Pink, BB0012 - Third-party liability; sharing health data
For 2007-09 Budget -- Not Ready For Introduction
2007 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
health and human services
Public assistance
Under current law, DHFS provides financial assistance for the cost of medical care to persons with chronic kidney disease, cystic fibrosis, and hemophilia; this assistance is collectively referred to as the Chronic Disease Program. DHFS also provides payments to pharmacies and pharmacists for providing prescriptions to elderly persons at reduced rates; this program is referred to as Senior Care.
This bill requires health insurers, self-insured plans, service benefits plans, and pharmacy benefits managers (third parties) to provide to DHFS information from their records to enable DHFS to identify persons receiving benefits under the Chronic Disease Program and Senior Care who are eligible, or would be eligible as dependents, for health care coverage from a third party. These third parties may receive compensation for providing the information, must provide the information within certain deadlines, and may be subject to enforcement proceedings for noncompliance. The third parties must accept assignment to DHFS of a right of an individual to receive payment from the third party for a health care item or service for which payment under the Chronic Disease Program or Senior Care has been made. Third parties must also accept the right of DHFS to recover any third-party payment made for which assignment had not been accepted. A third party must respond to an inquiry by DHFS concerning a claim for payment of a health care item or service if the inquiry is made within 36 months after the item or service is provided. Further, third parties must agree not to deny a DHFS claim on the basis of certain circumstances, if submitted less than 36 months after the health care item or service is provided and if action by DHFS to enforce its rights is commenced less than 72 months after DHFS submits the claim.
Medical Assistance
Currently, DHFS may obtain from insurers information DHFS needs to identify a recipient of Medical Assistance (MA) who is eligible for benefits under a disability insurance policy or, if enrolled as the dependent of a beneficiary, would be eligible for benefits; claims submittal information; and types of benefits provided under the policy. DHFS must enter into an agreement with the insurer that identifies the information to be disclosed, safeguards confidentiality, and specifies how the insurer's reasonable costs will be determined and paid from state general purpose revenues and federal moneys. Insurers must provide the information within specified deadlines, and the commissioner of insurance may initiate enforcement proceedings for noncompliance.
This bill expands the sources from which DHFS may receive health care services coverage information about MA recipients to include entities that are responsible for payment of a claim for a health care item or service and makes available compensation for providing the information. The sources, termed "third parties," include, in addition to insurers, self-insured plans, service benefits plans, and pharmacy benefits managers. The bill authorizes DHFS to notify the attorney general of third parties, other than insurers, that fail to provide information requested.
Under the bill, third parties must accept assignment to DHFS of a right of an individual to receive payment from the third party for a health care item or service for which payment under MA, or under a program administered under MA under a federal waiver, has been made. Third parties must also accept the right of DHFS to recover any third-party payment made for which assignment had not been accepted. A third party must respond to an inquiry by DHFS concerning a claim for payment of a health care item or service if the inquiry is made within 36 months after the item or service is provided. Further, third parties must agree not to deny a DHFS claim on the basis of certain circumstances, if submitted less than 36 months after the health care item or service is provided and if action by DHFS to enforce its rights is commenced less than 72 months after DHFS submits the claim.
Lastly, the bill applies the information recovery, acceptance of assignment, recovery of third-party payment, and compensation provisions of current law and as affected by this bill so as to enable DHFS also to identify Badger Care health care program recipients who are eligible, or who would be eligible as dependents, for health care coverage from a third party.
Health
Currently, DHFS administers the Well-Woman Program, under which certain medical services related to breast cancer, cervical cancer, and multiple sclerosis and certain general medical services are provided to underinsured and uninsured women of low income.
This bill requires health insurers, self-insured plans, service benefits plans, and pharmacy benefits managers (third parties) to provide to DHFS information from their records to enable DHFS to identify persons receiving benefits under the Well-Woman Program who are eligible, or would be eligible as dependents, for health care coverage from a third party. These third parties may receive compensation for providing the information, must provide the information within certain deadlines, and may be subject to enforcement proceedings for noncompliance. The third parties must accept assignment to DHFS of a right of an individual to receive payment from the third party for a health care item or service for which payment under the Well-Woman Program has been made. Third parties must also accept the right of DHFS to recover any third-party payment made for which assignment had not been accepted. A third party must respond to an inquiry by DHFS concerning a claim for payment of a health care item or service if the inquiry is made within 36 months after the item or service is provided. Further, third parties must agree not to deny a DHFS claim on the basis of certain circumstances, if submitted less than 36 months after the health care item or service is provided and if action by DHFS to enforce its rights is commenced less than 72 months after DHFS submits the claim.
Other health and family services
Currently, DHFS administers Family Care, a program that provides a flexible benefit of long-term care and services to certain persons who are at least 18 years of age, meet functional and financial eligibility requirements, and have a physical or developmental disability or degenerative brain disorder.
This bill requires health insurers, self-insured plans, service benefits plans, and pharmacy benefits managers (third parties) to provide to DHFS information from their records to enable DHFS to identify persons receiving benefits under Family Care who are eligible, or would be eligible as dependents, for health care coverage from a third party. These third parties may receive compensation for providing the information, must provide the information within certain deadlines, and may be subject to enforcement proceedings for noncompliance. The third parties must accept assignment to DHFS of a right of an individual to receive payment from the third party for a health care item or service for which payment under Family Care has been made. Third parties must also accept the right of DHFS to recover any third-party payment made for which assignment had not been accepted. A third party must respond to an inquiry by DHFS concerning a claim for payment of a health care item or service if the inquiry is made within 36 months after the item or service is provided. Further, third parties must agree not to deny a DHFS claim on the basis of certain circumstances, if submitted less than 36 months after the health care item or service is provided and if action by DHFS to enforce its rights is commenced less than 72 months after DHFS submits the claim.
Under current law, DHFS may request from health insurers information to enable DHFS to identify Medical Assistance recipients who are eligible, or who would be eligible as dependents, for health insurance coverage. An insurer that receives a request must provide the information within a certain period of time. Under the bill, DHFS must provide any information that it receives from a health insurer, self-insured plan, service benefit plan, and pharmacy benefits manager to DWD for purposes of DWD's program related to child and spousal support, paternity establishment, and medical support liability. DWD may allow county and tribal child support agencies access to the information, subject to use and disclosure restrictions under current law, and must consult with DHFS regarding procedures to safeguard the confidentiality of the information.
For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.
