49.45 (18) (am) 1. No Except as provided in subd. 2., no person is liable under this subsection for services provided through prepayment contracts. This paragraph does not apply to a person who is eligible for the benefits under s. 49.46 (2) (a) and (b) under s. 49.471.
28,1298
Section
1298. 49.45 (18) (am) 2. of the statutes is created to read:
49.45 (18) (am) 2. A person who is eligible for the benefits under s. 49.46 (2) (a) and (b) under s. 49.471 is liable under this subsection for services provided through a prepayment contract in the amounts and according to the procedures specified by the department.
28,1299
Section
1299. 49.45 (18) (b) 2. of the statutes is amended to read:
49.45 (18) (b) 2. Any service provided to a person who is less than 18 years old. This subdivision does not apply if the person's family income exceeds 100 percent of the poverty line and he or she is eligible for the benefits under s. 49.46 (2) (a) and (b) under s. 49.471.
28,1301
Section
1301. 49.45 (23) (b) of the statutes is amended to read:
49.45 (23) (b) If the waiver is granted and in effect, the department may promulgate rules defining the health care benefit plan, including more specific eligibility requirements and cost-sharing requirements. Cost sharing may include an annual enrollment fee, which may not exceed $75 per year. Notwithstanding s. 227.24 (3), the plan details under this subsection may be promulgated as an emergency rule under s. 227.24 without a finding of emergency. If the waiver is granted and in effect, the demonstration project under this subsection shall begin on January 1, 2009, or on the effective date of the waiver, whichever is later.
28,1301c
Section 1301c. 49.45 (24d) of the statutes is created to read:
49.45 (24d) Primary care provider; managed care organizations. (a) In this subsection, "managed care organization" includes a health maintenance organization, a limited service health organization, and a preferred provider plan.
(b) In a contract with a managed care organization to provide medical assistance, the department shall require the managed care organization to assign to each enrollee who receives medical assistance a primary care provider.
(c) The managed care organization under contract under par. (b) shall pay to the primary care provider a monthly fee per each patient who is a recipient of medical assistance for care coordination.
28,1301e
Section 1301e. 49.45 (24g) of the statutes is created to read:
49.45 (24g) Physician practice payment pilot. (a) The department shall develop a proposal to increase medical assistance reimbursement to providers to which at least one of the following applies:
1. The provider is recognized by the National Committee on Quality Assurance as a Patient-Centered Medical Home.
2. The secretary determines that the provider performs well with respect to all of the following aspects of care:
a. Adoption of written standards for patient access and patient communication.
b. Use of data to show that standards for patient access and patient communication are satisfied.
c. Use of paper or electronic charting tools to organize clinical information.
d. Use of data to identify diagnoses and conditions among the provider's patients that have a lasting detrimental effect on health.
e. Adoption and implementation of guidelines that are based on evidence for treatment and management of at least 3 chronic conditions.
f. Active support of patient self-management.
g. Systematic tracking of patient test results and systematic identification of abnormal patient test results.
h. Systematic tracking of referrals using a paper or electronic system.
i. Measuring the quality of the performance of the physician practice and of individual physicians within the practice, including with respect to provision of clinical services, patient outcomes, and patient safety.
j. Reporting to members of the physician practice and to other persons on the quality of the performance of the physician practice and of individual physicians.
(c) The department's proposal under par. (a) shall specify increases in reimbursement rates for providers that satisfy the conditions under par. (a) 1. or 2., and shall provide for payment of a monthly per-patient care coordination fee to those providers. The department shall set the increases in reimbursement rates and the monthly per-patient care coordination fee so that together they provide sufficient incentive for providers to satisfy a condition under par. (a) 1. or 2. The proposal shall specify effective dates for the increases in reimbursement rates and the monthly per-patient care coordination fee that are no sooner than July 1, 2011.
(d)
By the date that is 60 days after the effective date of this paragraph .... [LRB inserts date], the department shall submit the proposal under par. (a) to the joint committee on finance. If the cochairpersons of the committee do not notify the department within 14 working days after the date of the department's submittal that the committee has scheduled a meeting for the purpose of reviewing the proposal, the department shall, subject to approval by the U.S. department of health and human services of any required waiver of federal law relating to medical assistance and any required amendment to the state plan for medical assistance under
42 USC 1396a, implement the proposal beginning January 1, 2010. If, within 14 working days after the date of the department's submittal, the cochairpersons of the committee notify the department that the committee has scheduled a meeting for the purpose of reviewing the proposal, the department may implement the proposal only upon approval of the committee. If the committee reviews the proposal and approves it, the department shall, subject to approval by the U.S. department of health and human services of any required waiver of federal law relating to medical assistance and any required amendment to the state plan for medical assistance under
42 USC 1396a, implement the proposal beginning January 1, 2010.
(e) By the first day of the 39th month beginning after the effective date of this paragraph .... [LRB inserts date], the department shall, if it was required under par. (d) to increase reimbursement to providers that satisfy a condition under par. (a) 1. or 2., submit a report to the joint committee on finance on whether the increased reimbursement results in net cost reductions for the Medical Assistance program under this subchapter and a recommendation as to whether to continue the increased reimbursement. If the cochairpersons of the committee do not notify the department within 14 working days after the date of the department's submittal that the committee has scheduled a meeting for the purpose of reviewing the report and recommendation, the department may implement its recommendation. If, within 14 working days after the date of the department's submittal, the cochairpersons of the committee notify the department that the committee has scheduled a meeting for the purpose of reviewing the report and recommendation, the department may discontinue the increased reimbursement only upon the approval of the committee.
28,1302
Section
1302. 49.45 (24r) of the statutes is renumbered 49.45 (24r) (a) and amended to read:
49.45 (24r) (a) The department shall request a implement any waiver from granted by the secretary of the federal department of health and human services to permit the department to conduct a demonstration project to provide family planning, as defined in s. 253.07 (1) (a), under medical assistance to any woman between the ages of 15 and 44 whose family income does not exceed 200% of the poverty line for a family the size of the woman's family. The department shall implement any waiver granted.
28,1303
Section
1303. 49.45 (24r) (b) of the statutes is created to read:
49.45 (24r) (b) The department may request an amended waiver from the secretary to permit the department to conduct a demonstration project to provide family planning to any man between the ages of 15 and 44 whose family income does not exceed 200 percent of the poverty line for a family the size of the man's family. If the amended waiver is granted, the department may implement the waiver.
28,1304
Section
1304. 49.45 (25) (be) of the statutes is amended to read:
49.45 (25) (be) A private nonprofit agency that is a certified case management provider may elect to provide case management services to medical assistance beneficiaries who have HIV infection, as defined in s. 252.01 (2). The amount of the allowable charges for those services under the medical assistance program that is not provided by the federal government shall be paid from the appropriation account under s. 20.435 (5) (1) (am).
28,1305
Section
1305. 49.45 (25) (bg) of the statutes is amended to read:
49.45 (25) (bg) An independent living center, as defined in s. 46.96 (1) (ah), that is a certified case management provider and satisfies the criteria in s. 46.96 (3m) (a) 1. to 3. and (am) may elect to provide case management services to one or more of the categories of medical assistance beneficiaries specified under par. (am). The amount of allowable charges for the services under the medical assistance program that is not provided by the federal government shall be paid from nonfederal, public funds received by the independent living center from a county, city, village or town or from funds distributed as a grant under s. 46.96.
28,1305r
Section 1305r. 49.45 (30f) of the statutes is created to read:
49.45 (30f) Psychotherapy and alcohol and other drug abuse services. The department shall include licensed mental health professionals, as defined in s. 632.89 (1) (dm), and licensed psychologists, as defined in s. 455.01 (4), as providers of psychotherapy and of alcohol and other drug abuse services. Except for services provided under sub. (30e), the department may not require that licensed mental health professionals or licensed psychologists be supervised; may not require that clinical psychotherapy or alcohol and other drug abuse services be provided under a certified program; and, notwithstanding subs. (9) and (9m), may not require that a physician or other health care provider first prescribe psychotherapy or alcohol and other drug abuse services to be provided by a licensed mental health professional or licensed psychologist before the professional or psychologist may provide the services to the recipient. This subsection does not affect the department's powers under ch. 50 or 51 to establish requirements for facilities that are licensed, certified, or operated by the department.
28,1306
Section
1306. 49.45 (30g) of the statutes is created to read:
49.45 (30g) Community recovery services. (a) When services are reimbursable. Community recovery services under s. 49.46 (2) (b) 6. Lo. provided to an individual are reimbursable under the Medical Assistance program only if all of the following conditions are met:
1. An approved amendment to the state medical assistance plan submitted under
42 USC 1396n (i) permits reimbursement for the services under s. 49.46 (2) (b) 6. Lo. in the manner provided under this subsection.
2. The county in which the individual resides elects to provide the community recovery services under s. 49.46 (2) (b) 6. Lo. through the Medical Assistance program.
3. The individual, the community recovery services, and the community recovery services provider meet any condition set forth in the approved amendment to the medical assistance plan submitted under
42 USC 1396n (i).
(b) Limit on the amount of reimbursement. If community recovery services are reimbursable under par. (a), the department shall reimburse each participating county for the portion of the federal share of allowable charges for the community recovery services provided by the county that exceeds that county's proportionate share of $600,000 in fiscal year 2010-2011 and for 95 percent of the federal share of allowable charges for the community recovery services provided by the county in each fiscal year thereafter. The portion of the federal share of allowable charges not reimbursed to counties shall be transferred to the appropriation account under s. 20.435 (5) (kx).
28,1307
Section
1307. 49.45 (30m) (am) of the statutes is renumbered 49.45 (30m) (am) 1.
28,1308
Section
1308. 49.45 (30m) (am) 2. of the statutes is created to read:
49.45 (30m) (am) 2. For individuals receiving the family care benefit under s. 46.286, the care management organization that manages the family care benefit for the recipient shall pay the portion of the payment that is not covered by the federal government for services that are described under par. (a) 1. and are covered services under the family care benefit; the department shall pay the remainder of the portion of the payment that is not covered by the federal government.
28,1309
Section
1309. 49.45 (30r) of the statutes is created to read:
49.45 (30r) Services in a mental health institute. A county shall provide the portion of payment that is not provided by the federal government for services under s. 49.46 (2) (b) 6. e. in a mental health institute under s. 51.05.
28,1310
Section
1310. 49.45 (41) (b) of the statutes is amended to read:
49.45 (41) (b) If a county elects to become certified as a provider of mental health crisis intervention services, the county may provide mental health crisis intervention services under this subsection in the county to medical assistance recipients through the medical assistance program. A county that elects to provide the services shall pay the amount of the allowable charges for the services under the medical assistance program that is not provided by the federal government. The From the appropriation account under s. 20.435 (5) (bL), the department shall reimburse the county under this subsection only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.
28,1311
Section
1311. 49.45 (42) of the statutes is renumbered 49.45 (42) (d).
28,1312
Section
1312. 49.45 (42) (c) of the statutes is created to read:
49.45 (42) (c) The department may charge a fee to certify a provider of personal care services described under par. (d) 3. e. Fees collected under this paragraph shall be credited to the appropriation account under s. 20.435 (6) (jm).
28,1313
Section
1313. 49.45 (42) (d) 3. of the statutes is created to read:
49.45 (42) (d) 3. The provider of the personal care services is one of the following:
a. An independent living center meeting the criteria to receive a grant under s. 46.96.
b. A county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437.
c. A federally recognized American Indian tribe or band certified to provide services to medical assistance beneficiaries.
d. A home health agency licensed under s. 50.49.
e. Any other entity certified under sub. (2) (a) 11. to provide personal care services under s. 49.46 (2) (b) 6. j.
28,1313h
Section 1313h. 49.45 (43m) of the statutes is created to read:
49.45 (43m) Case management for children with medically complex conditions. The department shall provide case management services to an individual who is under 19 years of age and who is a recipient of medical assistance and who has a medically complex condition.
28,1313k
Section 1313k. 49.45 (44) of the statutes is amended to read:
49.45 (44) Prenatal, postpartum and young child care coordination. Providers in Milwaukee County that are certified to provide care coordination services under s. 49.46 (2) (b) 12. may be certified to provide to medical assistance recipients prenatal and postpartum care coordination services and care coordination services for children who have not attained the age of 7. Providers in the city of Racine that are certified to provide care coordination services under s. 49.46 (2) (b) 12. and are participating in a program under s. 253.16 may be certified to provide to medical assistance recipients prenatal and postpartum care coordination services and care coordination services for children who have not attained the age of 2. A provider of those care coordination services shall provide to a person receiving those services the information relating to shaken baby syndrome and impacted babies required under s. 253.15 (6). The department shall provide reimbursement for those care coordination services only if at least one of the following conditions is met:
(a) The recipient is a resident of Milwaukee County or the city of Racine and has received services under s. 49.46 (2) (b) 12. and is pregnant or has given birth within 8 weeks after the individual ceased to receive services under s. 49.46 (2) (b) 12.
(b) The recipient is a resident of Milwaukee County or the city of Racine, is pregnant and has received a risk assessment approved by the department.
(c) The recipient is a resident of Milwaukee County or the city of Racine, has given birth within the 8 weeks immediately preceding the request for services under s. 49.46 (2) (b) 12m. and has received a risk assessment approved by the department.
28,1313p
Section 1313p. 49.45 (44g) of the statutes is created to read:
49.45 (44g) Prenatal care coordination; managed care organizations. (a) In this subsection, "managed care organization" includes a health maintenance organization, a limited service health organization, and a preferred provider plan.
(b) In a contract with a managed care organization to provide medical assistance, the department shall require the managed care organization to provide or contract with a prenatal care coordination program to serve recipients of medical assistance.
(c) The managed care organization under contract under par. (b) shall ensure that each enrollee who is pregnant and who is a recipient of medical assistance is enrolled in the prenatal care coordination program under par. (b).
28,1314
Section
1314. 49.45 (47) (c) of the statutes is amended to read:
49.45 (47) (c) The biennial fee for the certification required under par. (b) of an adult day care center is $100 $127. Fees collected under this paragraph shall be credited to the appropriation account under s. 20.435 (6) (jm).
28,1315
Section
1315. 49.45 (47) (e) of the statutes is created to read:
49.45 (47) (e) If the department takes enforcement action against an adult day care center for violating a certification requirement established under s. 49.45 (2) (a) 11., and the department subsequently conducts an on-site inspection of the adult day care center to review the adult day care center's action to correct the violation, the department may impose a $200 inspection fee on the adult day care center.
28,1315n
Section 1315n. 49.45 (50m) of the statutes is created to read:
49.45 (50m) Chronic disease management; managed care organizations. (a) In this subsection, "managed care organization" includes a health maintenance organization, a limited service health organization, and a preferred provider plan.
(b) In a contract with a managed care organization to provide medical assistance, the department shall require the managed care organization to provide a chronic disease management and case coordination program for every recipient of medical assistance diagnosed with diabetes, asthma, congestive heart failure, coronary artery disease, or a primary or secondary behavioral health diagnosis, including substance abuse and depression.
49.45
(52) Payment adjustments. Beginning on January 1, 2003, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payment adjustments to county departments under s. 46.215, 46.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01 (4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16
, except for services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating in the early intervention program under s. 51.44. Payment adjustments under this subsection shall include the state share of the payments. The total of any payment adjustments under this subsection and Medical Assistance payments made from appropriation accounts under s. 20.435 (4) (b), (o), and (w), may not exceed applicable limitations on payments under
42 USC 1396a (a) (30) (A).
28,1317
Section
1317. 49.45 (54) of the statutes is created to read:
49.45 (54) Therapy for children participating in the birth to 3 program. (a) Federal share for county expenditures. If a county certifies to the department that the amount the county expended to provide services specified under s. 49.46 (2) (b) 6. b. and c. to children participating in the early intervention program under s. 51.44 exceeds the amount the county received as reimbursement under this section, based on reimbursement rates established by the department for those services, and the federal government pays the state the federal share of Medical Assistance for the amount by which the county expenditures exceed the reimbursement, the department may disburse the federal share to the county. A county that receives moneys under this paragraph shall expend the moneys for early intervention services under s. 51.44 or for services under the disabled children's long-term support program, as defined in s. 46.011 (1g).
(b) Services provided by special educators. If a county provides services to assess and promote skill acquisition to children who are participating in the early intervention program under s. 51.44 and the services are provided by a special educator who is a certified provider of medical assistance, the department shall reimburse the county the federal share of medical assistance for the county's allowable charges for providing the services. The county shall pay the the remaining expenses for the services. The department shall promulgate rules establishing certification requirements for special educators who provide service under this paragraph, and requirements for county reporting of expenditures for services under this paragraph. A county that receives moneys under this paragraph shall expend the moneys for early intervention services under s. 51.44 or for services under the disabled children's long-term support program, as defined in s. 46.011 (1g).
28,1317n
Section 1317n. 49.45 (60) of the statutes is created to read:
49.45 (60) Dental services in southeastern Wisconsin. Beginning on January 1, 2010, the department shall provide dental benefits under this subchapter in Kenosha, Milwaukee, Racine, and Waukesha counties on a fee-for-service basis.
28,1318
Section
1318. 49.46 (1) (a) 5. of the statutes is amended to read:
49.46 (1) (a) 5. Any child in an adoption assistance, foster care, treatment foster care, or subsidized guardianship placement under ch. 48 or 938, as determined by the department.
28,1320
Section
1320. 49.46 (1) (d) 1. of the statutes is amended to read:
