AB75: Bill Text

AB75, s. 1289 Section 1289. 49.45 (3) (e) 7. of the statutes is amended to read:

AB75,650,8 49.45 (3) (e) 7. The daily reimbursement or payment rate to a hospital for services provided to medical assistance recipients awaiting admission to a skilled nursing home, intermediate care facility, community-based residential facility, group home, foster home, treatment foster home or other custodial living arrangement may not exceed the maximum reimbursement or payment rate based on the average adjusted state skilled nursing facility rate, created under sub. (6m). This limited reimbursement or payment rate to a hospital commences on the date the department, through its own data or information provided by hospitals, determines that continued hospitalization is no longer medically necessary or appropriate during a period where when the recipient awaits placement in an alternate custodial living arrangement. The department may contract with a peer review organization, established under 42 USC 1320c to 1320c-10, to determine that continued hospitalization of a recipient is no longer necessary and that admission to an alternate custodial living arrangement is more appropriate for the continued care of the recipient. In addition, the department may contract with a peer review organization to determine the medical necessity or appropriateness of physician services or other services provided during the period when a hospital patient awaits placement in an alternate custodial living arrangement.

AB75, s. 1290 Section 1290. 49.45 (6b) of the statutes is amended to read:

AB75,650,21 49.45 (6b) Centers for the developmentally disabled. From the appropriation under s. 20.435 (2) (gk), the department may reimburse the cost of services provided by the centers for the developmentally disabled. Reimbursement to the centers for the developmentally disabled shall be reduced following each placement made under s. 46.275 that involves a relocation from a center for the developmentally disabled, by $225 per day, beginning in fiscal year 2002-03, and by $325 per day, beginning in fiscal year 2004 Beginning in fiscal year 2009-10, following each placement made under s. 46.275 that involves a relocation from a center for the developmentally disabled, the department shall reduce the reimbursement to the center by an amount, as determined by the department for each placement, that is equal to the nonfederal share of the costs for the placement under s. 46.275.

AB75, s. 1291 Section 1291. 49.45 (6m) (br) 1. of the statutes is amended to read:

AB75,651,6 49.45 (6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435 (4) (bt) or (7) (b) or 20.437 (2) (dz), the department shall reduce allocations of funds to counties in the amount of the disallowance from the appropriation account under s. 20.435 (4) (bt) or (7) (b), or the department shall direct the department of children and families to reduce allocations of funds to counties or Wisconsin Works agencies in the amount of the disallowance from the appropriation account under s. 20.437 (2) (dz) or direct the department of corrections to reduce allocations of funds to counties in the amount of the disallowance from the appropriation account under s. 20.410 (3) (cd), in accordance with s. 16.544 to the extent applicable.

AB75, s. 1292 Section 1292. 49.45 (6m) (e) of the statutes is repealed.

AB75, s. 1293 Section 1293. 49.45 (6u) (b) of the statutes is amended to read:

AB75,651,18 49.45 (6u) (b) Notwithstanding the limitation on the amount of disbursements under par. (am) (intro.), from the appropriation under s. 20.435 (4) (wm), the department shall, using the criteria specified in par. (am) 1. to 7., disburse any federal medical assistance funds that are received by the state as matching funds to federal financial participation for operating deficits incurred by a facility that is operated by a county, city, village, or town and that are in excess of the amount of match federal financial participation anticipated and budgeted as revenue in the biennial budget act, and any act that increases or decreases the amount appropriated for such operating deficits and that is effective after the biennial budget, for the fiscal year in which the funds are received.

AB75, s. 1294 Section 1294. 49.45 (6y) of the statutes is repealed.

AB75, s. 1295 Section 1295. 49.45 (6z) of the statutes is repealed.

AB75, s. 1296 Section 1296. 49.45 (8r) of the statutes is amended to read:

AB75,652,3 49.45 (8r) Payment for certain obstetric and gynecological care. The rate of payment for obstetric and gynecological care provided in primary care shortage areas, as defined in s. 560.183 36.60 (1) (cm), or provided to recipients of medical assistance who reside in primary care shortage areas, that is equal to 125% of the rates paid under this section to primary care physicians in primary care shortage areas, shall be paid to all certified primary care providers who provide obstetric or gynecological care to those recipients.

AB75, s. 1297 Section 1297. 49.45 (18) (am) of the statutes is renumbered 49.45 (18) (am) 1. and amended to read:

AB75,652,9 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.

AB75, s. 1298 Section 1298. 49.45 (18) (am) 2. of the statutes is created to read:

AB75,652,14 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.

AB75, s. 1299 Section 1299. 49.45 (18) (b) 2. of the statutes is amended to read:

AB75,652,19 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.

AB75, s. 1300 Section 1300. 49.45 (19m) of the statutes is created to read:

AB75,653,4 49.45 (19m) Incentive payments for identifying children with health insurance. From the appropriation under s. 20.435 (4) (bm), the department of health services may provide incentive payments to the department of children and families for identifying children who are receiving medical assistance benefits and who have health insurance coverage or access to health insurance coverage. The department of children and families may disclose to the department of health services information that it possesses or obtains that would assist the department of health services to identify children with medical assistance coverage who have health insurance coverage or access to health insurance coverage.

AB75, s. 1301 Section 1301. 49.45 (23) (b) of the statutes is amended to read:

AB75,653,13 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.

AB75, s. 1302 Section 1302. 49.45 (24r) of the statutes is renumbered 49.45 (24r) (a) and amended to read:

AB75,653,22 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.

AB75, s. 1303 Section 1303. 49.45 (24r) (b) of the statutes is created to read:

AB75,654,3 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.

AB75, s. 1304 Section 1304. 49.45 (25) (be) of the statutes is amended to read:

AB75,654,10 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).

AB75, s. 1305 Section 1305. 49.45 (25) (bg) of the statutes is amended to read:

AB75,654,19 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.

AB75, s. 1306 Section 1306. 49.45 (30g) of the statutes is created to read:

AB75,654,24 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:

AB75,655,3 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.

AB75,655,6 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.

AB75,655,9 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).

AB75,655,18 (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).

AB75,655,20 (c) Maintenance of effort. 1. Any funds used to reimburse counties under par. (b) may not be used to supplant funding from any other source.

AB75,655,25 2. No county providing community recovery services under this subsection may report less funding for other community mental health services under mental health for children and adults on the human service revenue reporting form than the county reported in the year prior to the year in which the county elected to provide community recovery services under s. 49.46 (2) (b) 6. Lo.

AB75,656,3 3. The department may enforce this subsection using contract remedies under s. 46.031 (2g) or (2r) or by adjusting community aids payments as provided under s. 46.40 (9) (d) 1. b.

AB75, s. 1307 Section 1307. 49.45 (30m) (am) of the statutes is renumbered 49.45 (30m) (am) 1.

AB75, s. 1308 Section 1308. 49.45 (30m) (am) 2. of the statutes is created to read:

AB75,656,12 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.

AB75, s. 1309 Section 1309. 49.45 (30r) of the statutes is created to read:

AB75,656,16 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.

AB75, s. 1310 Section 1310. 49.45 (41) (b) of the statutes is amended to read:

AB75,657,2 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.

AB75, s. 1311 Section 1311. 49.45 (42) of the statutes is renumbered 49.45 (42) (d).

AB75, s. 1312 Section 1312. 49.45 (42) (c) of the statutes is created to read:

AB75,657,7 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).

AB75, s. 1313 Section 1313. 49.45 (42) (d) 3. of the statutes is created to read:

AB75,657,10 49.45 (42) (d) 3. The provider of the personal care services is one of the following:

AB75,657,12 a. An independent living center meeting the criteria to receive a grant under s. 46.96.

AB75,657,13 b. A county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437.

AB75,657,15 c. A federally recognized American Indian tribe or band certified to provide services to medical assistance beneficiaries.

AB75,657,16 d. A home health agency licensed under s. 50.49.

AB75,657,18 e. Any other entity certified under sub. (2) (a) 11. to provide personal care services under s. 49.46 (2) (b) 6. j.

AB75, s. 1314 Section 1314. 49.45 (47) (c) of the statutes is amended to read:

AB75,657,22 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).

AB75, s. 1315 Section 1315. 49.45 (47) (e) of the statutes is created to read:

AB75,658,3 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.

AB75, s. 1316 Section 1316. 49.45 (52) of the statutes is amended to read:

AB75,658,16 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. 45.49 (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), (gp), (o), and (w) may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

AB75, s. 1317 Section 1317. 49.45 (54) of the statutes is created to read:

AB75,659,4 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. 45.49 (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).

AB75,659,16 (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).

AB75, s. 1318 Section 1318. 49.46 (1) (a) 5. of the statutes is amended to read:

AB75,659,20 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.

AB75, s. 1319 Section 1319. 49.46 (1) (a) 16. of the statutes is repealed.

AB75, s. 1320 Section 1320. 49.46 (1) (d) 1. of the statutes is amended to read:

AB75,660,3 49.46 (1) (d) 1. Children who are placed in licensed foster homes or licensed treatment foster homes by the department and who would be eligible for payment of aid to families with dependent children in foster homes or treatment foster homes except that their placement is not made by a county department under s. 46.215, 46.22, or 46.23 will be considered as recipients of aid to families with dependent children.

AB75, s. 1321 Section 1321. 49.46 (2) (b) 3. of the statutes is amended to read:

AB75,660,10 49.46 (2) (b) 3. Transportation by emergency medical vehicle to obtain emergency medical care, transportation by specialized medical vehicle to obtain medical care including the unloaded travel of the specialized medical vehicle necessary to provide that transportation, or, if authorized in advance by the county department under s. 46.215 or 46.22, transportation by common carrier or private motor vehicle to obtain medical care.

AB75, s. 1322 Section 1322. 49.46 (2) (b) 6. e. of the statutes is amended to read:

AB75,660,16 49.46 (2) (b) 6. e. Inpatient Subject to the limitation under s. 49.45 (30r), inpatient hospital, skilled nursing facility and intermediate care facility services for patients of any institution for mental diseases who are under 21 years of age, are under 22 years of age and who were receiving these services immediately prior to reaching age 21, or are 65 years of age or older.

AB75, s. 1323 Section 1323. 49.46 (2) (b) 6. Lo. of the statutes is created to read:

AB75,660,19 49.46 (2) (b) 6. Lo. Subject to the limitations under s. 49.45 (30g), community recovery services.

AB75, s. 1324 Section 1324. 49.46 (2) (b) 8. of the statutes is amended to read:

AB75,660,24 49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27 (11), 46.275, 46.277, 46.278, or 46.2785, 46.99, or under the family care benefit if a waiver is in effect under s. 46.281 (1d), or under the disabled children's long-term support program, as defined in s. 46.011 (1g).

AB75, s. 1325 Section 1325. 49.46 (2) (b) 17. of the statutes is created to read:

AB75,661,2 49.46 (2) (b) 17. Services under s. 49.45 (54) (b) for children participating in the early intervention program under s. 51.44, that are provided by a special educator.

AB75, s. 1326 Section 1326. 49.46 (2) (d) of the statutes is amended to read:

AB75,661,9 49.46 (2) (d) Benefits authorized under this subsection may not include payment for that part of any service payable through 3rd-party liability or any federal, state, county, municipal, or private benefit system to which the beneficiary is entitled. "Benefit system" does not include any public assistance program such as, but not limited to, Hill-Burton benefits under 42 USC 291c (e), in effect on April 30, 1980, or relief funded by a relief block grant.

AB75, s. 1327 Section 1327. 49.47 (4) (b) (intro.) of the statutes is amended to read:

AB75,661,14 49.47 (4) (b) (intro.) Eligibility exists if the applicant's property, subject to the exclusion of any amounts under the Long-Term Care Partnership Program established under s. 49.45 (31) or any amounts in an independence account, as defined in s. 49.472 (1) (c), does not exceed the following:

AB75, s. 1328 Section 1328. 49.471 (2) of the statutes is amended to read:

AB75,662,8 49.471 (2) Waiver and state plan amendments. The department shall request a waiver from, and submit amendments to the state Medical Assistance plan to, the secretary of the federal department of health and human services to implement BadgerCare Plus. If the state plan amendments are approved and a waiver that is substantially consistent with the provisions of this section, excluding sub. (2m), is granted and in effect, the department shall implement BadgerCare Plus beginning on January 1, 2008, the effective date of the state plan amendments, or the effective date of the waiver, whichever is latest. If the state plan amendments are approved but the terms of approval do not allow for federal funding of the cost of benefits for all or any part of one or more of the eligibility categories under sub. (4) (b), the department may at its discretion pay for the cost of benefits for all or any part of any group for which federal funding was denied exclusively with moneys from the appropriation under s. 20.435 (4) (b). If the state plan amendments are not approved or if a waiver that is substantially consistent with the provisions of this section, excluding sub. (2m), is not granted, BadgerCare Plus may not be implemented. If the state plan amendments are approved but approval is not continued or if a waiver that is substantially consistent with the provisions of this section, excluding sub. (2m), is granted but not continued in effect, BadgerCare Plus shall be discontinued.

AB75, s. 1329 Section 1329. 49.471 (3) (a) 1. of the statutes is amended to read: