1. A city, town, or village in this state that has a population of less than 20,000 and that is at least 15 miles from any city, town, or village that has a population of at least 20,000.
2. An area in this state that is not an urbanized area, as defined by the federal bureau of the census.
(2) (a) The department shall establish and support physician residency positions to which one of the following applies:
1. The residency position is in a hospital that is located in a rural area or in a clinic staffed by physicians who admit patients to a hospital located in a rural area.
2. The residency position includes a rural rotation, begun after June 30, 2010, which consists of at least 8 weeks of training experience in a hospital that is located in a rural area or in a clinic staffed by physicians who admit patients to a hospital located in a rural area.
(b) In establishing and supporting residency positions under par. (a), the department shall give preference to residency programs that actively recruit graduates of the University of Wisconsin School of Medicine and Public Health and the Medical College of Wisconsin.
(3) Annually by December 1, the department shall submit a plan for increasing the number of physician residency programs that include a majority of training experience in a rural area to the Rural Wisconsin Health Cooperative, the Wisconsin Hospital Association, and the Wisconsin Medical Society. The plan shall include a detailed proposed budget for expending the moneys appropriated to the board under s. 20.285 (1) (qe) and demonstrate that the moneys do not supplant existing funding. The department shall consider comments made by the organizations in formulating its final budget.
(4) Annually by December 1, the department shall submit to the joint committee on finance a report that includes all of the following:
(a) The number of physician residency positions that existed in the 2009-10 fiscal year, and in each fiscal year beginning after the effective date of this paragraph .... [LRB inserts date], that included a majority of training experience in a rural area.
(b) 1. The number of such physician residency positions funded in whole or in part under this section in the previous fiscal year.
2. The eligibility criteria met by each such residency position and the hospital or clinic with which the position is affiliated.
3. The medical school attended by the physician filling each such residency position.
4. The year the Accreditation Council for Graduate Medical Education certified the residency position.
5. The reason the residency position had not been funded.
49.45 (3) (e) 11. The department shall use a portion of the moneys collected under s. 50.38 (2) (a) to pay for services provided by eligible hospitals, as defined in s. 50.38 (1), other than critical access hospitals, under the Medical Assistance Program under this subchapter, including services reimbursed on a fee-for-service basis and services provided under a managed care system. For state fiscal year 2008-09, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (a) for fiscal year 2008-09 divided by 57.75 percent. For each state fiscal year after state fiscal year 2008-09, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (a) for the fiscal year divided by 61.68 percent.
190,38
Section
38. 49.45 (3) (e) 12. of the statutes is created to read:
49.45 (3) (e) 12. The department shall use a portion of the moneys collected under s. 50.38 (2) (b) to pay for services provided by critical access hospitals under the Medical Assistance Program under this subchapter, including services reimbursed on a fee-for-service basis and services provided under a managed care system. For each state fiscal year, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (b) for the fiscal year divided by 61.68 percent.
49.45 (59) (a) The department shall, from the appropriation account accounts under s. 20.435 (4) (xc) and (xe), pay each health maintenance organization with which it contracts to provide medical assistance a monthly amount that the health maintenance organization shall use to make payments to hospitals under par. (b).
190,41
Section
41. 50.38 (2) of the statutes, as created by
2009 Wisconsin Act 2, is renumbered 50.38 (2) (a) and amended to read:
50.38 (2) (a) For the privilege of doing business in this state, there is imposed on each eligible hospital that is not a critical access hospital an assessment each state fiscal year that is equal to a uniform percentage, determined under sub. (3), of the hospital's gross patient revenues, as reported under s. 153.46 (5) and determined by the department. The assessments shall be deposited in the hospital assessment fund.
190,42
Section
42. 50.38 (2) (b) of the statutes is created to read:
50.38 (2) (b) For the privilege of doing business in this state, there is imposed on each critical access hospital an assessment each state fiscal year that is equal to a uniform percentage, determined under sub. (3), of the critical access hospital's gross inpatient revenues, as reported under s. 153.46 (5) and determined by the department. The assessments shall be deposited in the critical access hospital assessment fund.
50.38 (3) The department shall establish the percentage that is applicable under sub. (2) (a) and (b) so that the total amount of assessments collected under this section sub. (2) (a) in a state fiscal year is equal to the amount in the schedule under s. 20.005 (3) for the appropriation under s. 20.435 (4) (xc) for that fiscal year.
50.38 (4) Except as provided in sub. (5), each eligible hospital shall pay the applicable annual assessment under sub. (2) in 4 equal amounts that are due by September 30, December 31, March 31, and June 30 of each year.
50.38 (6) (a) 1. If the federal government does not provide federal financial participation under the federal Medicaid program for amounts collected under this section sub. (2) (a) that are used to make payments
required under s. 49.45 (3) (e) 11. or (5r), that are transferred under sub. (8) and used to make payments from the Medical Assistance trust fund, or that are transferred under sub. (9) and expended under under s. 20.435 (4) (jw), the department shall, from the fund from which the payment or expenditure was made, refund eligible hospitals
, other than critical access hospitals, the amount for which the federal government does not provide federal financial participation.
50.38 (6) (a) 2. If the department makes a refund under subd. 1. as result of failure to obtain federal financial participation under the federal Medicaid program for a payment required under s. 49.45 (3) (e) 11. or (5r) or a payment from the Medical Assistance trust fund, the department shall recoup the part of the payment for which the federal government does not provide federal financial participation.
50.38 (6) (b) On June 30 of each state fiscal year, the department shall, from the appropriation account under s. 20.435 (4) (xc), refund to eligible hospitals, other than critical access hospitals, the difference between the amount in the schedule under s. 20.005 (3) for that appropriation and the amount expended or encumbered from that appropriation in the fiscal year.
50.38 (6) (c) The department shall allocate any refund under this subsection to eligible hospitals
, other than critical access hospitals, in proportion to the percentage of the total assessments collected under sub. (2) (a) that each hospital paid.
190,49
Section
49. 50.38 (6m) of the statutes is created to read:
50.38 (6m) (a) 1. If the federal government does not provide federal financial participation under the federal Medicaid program for amounts collected under sub. (2) (b) that are used to make payments required under s. 49.45 (3) (e) 12. or that are transferred under sub. (10) and used to make payments from the Medical Assistance trust fund, the department shall, from the fund from which the payment or expenditure was made, refund critical access hospitals the amount for which the federal government does not provide federal financial participation.
2. If the department makes a refund under subd. 1. as result of failure to obtain federal financial participation under the federal Medicaid program for a payment required under s. 49.45 (3) (e) 12. or a payment from the Medical Assistance trust fund, the department shall recoup the part of the payment for which the federal government does not provide federal financial participation.
3. Moneys recouped under subd. 2. for payments made from the critical access hospital assessment fund shall be deposited in the critical access hospital assessment fund.
4. Moneys recouped under subd. 2. for payments made from the Medical Assistance trust fund shall be deposited in the Medical Assistance trust fund.
(b) On June 30 of each state fiscal year, the department shall, from the appropriation account under s. 20.435 (4) (xe), refund to critical access hospitals any unencumbered moneys in the critical access hospital assessment fund.
(c) The department shall allocate any refund under this subsection to critical access hospitals in proportion to the percentage of the total assessments collected under sub. (2) (b) that each critical access hospital paid.
50.38 (7) (d) The total amount of payment increases the department made, in connection with implementation of the hospital assessment assessments under sub. (2), for inpatient and outpatient hospital services that are reimbursed on a fee-for-service basis.
190,51
Section
51. 50.38 (8) of the statutes is amended to read:
50.38 (8) In each state fiscal year, the secretary of administration shall transfer from the hospital assessment fund to the Medical Assistance trust fund an amount equal to the amount in the schedule under s. 20.005 (3) for the appropriation under s. 20.435 (4) (xc) for that fiscal year minus the state share of payments to hospitals required under s. 49.45 (3) (e) 11., and minus any refunds paid to hospitals from the hospital assessment fund under sub. (6) (a) in that fiscal year.
190,52
Section
52. 50.38 (10) of the statutes is created to read:
50.38 (10) In each state fiscal year, the secretary of administration shall transfer from the critical access hospital assessment fund to the Medical Assistance trust fund an amount equal to the amount collected under sub. (2) (b) minus the state share of the amount required to be expended under s. 49.45 (3) (e) 12., minus the amounts appropriated under s. 20.285 (1) (qe) and (qj), and minus any refunds paid to critical access hospitals from the critical access hospital assessment fund under sub. (6m) (a) in that fiscal year.
190,53
Section
53.
Nonstatutory provisions.
(1) State plan amendment. The department of health services shall submit a state medicaid plan amendment to the secretary of the federal department of health and human services that provides for the critical access hospital assessment under section 50.38 (2) (b) of the statutes, as created by this act, and expenditure of revenue from the critical access hospital assessment as provided in this act. If the secretary of the federal department of health and human services disapproves the state medicaid plan amendment, the department of health services shall refund to critical access hospitals all of the moneys collected from the critical access hospital assessment in the fiscal biennium in which this subsection takes effect and, notwithstanding section 50.38 (2) (b) of the statutes, as created by this act, stop collecting moneys under the critical access hospital assessment.
(2) Budgeting practices. This act does not affect any requirements under section 16.46 of the statutes. The departments of administration and health services shall review, reestimate, and request general purpose revenue for payments to critical access hospitals under the Medical Assistance Program under subchapter IV of chapter 49 of the statutes as needed.
190,54
Section
54.
Fiscal changes.
(1) Medical assistance trust fund. In the schedule under section 20.005 (3) of the statutes for the appropriation to the department of health services under section 20.435 (4) (w) of the statutes, as affected by the acts of 2009, the dollar amount is increased by $3,680,500 for the second fiscal year of the fiscal biennium in which this subsection takes effect for the purposes for which the appropriation is made.
190,55
Section
55.
Initial applicability.
(1) The treatment of section 49.45 (3) (e) 12. of the statutes first applies to services provided by critical access hospitals on July 1, 2010.
190,56
Section
56.
Effective date.
(1) This act takes effect on July 1, 2010.
