SB553,13,3
136.61 (7) (e) Notwithstanding subs. (3) (b) and (5) (a) and (b), ensure that
2moneys appropriated under s. 20.285 (1) (qj) are used under this section only to repay
3loans on behalf of health care providers who agree to practice in a rural area.
SB553, s. 36 4Section 36. 36.63 of the statutes is created to read:
SB553,13,5 536.63 Rural physician residency assistance program. (1) In this section:
SB553,13,76 (a) "Department" means the department of family medicine in the University
7of Wisconsin School of Medicine and Public Health.
SB553,13,108 (b) "Physician" means a physician, as defined in s. 448.01 (5), who specializes
9in family practice, general surgery, internal medicine, obstetrics, pediatrics or
10psychiatry.
SB553,13,1111 (c) "Rural area" means any of the following:
SB553,13,1412 1. A city, town, or village in this state that has a population of less than 20,000
13and that is at least 15 miles from any city, town, or village that has a population of
14at least 20,000.
SB553,13,1615 2. An area in this state that is not an urbanized area, as defined by the federal
16bureau of the census.
SB553,13,18 17(2) (a) The department shall establish and support physician residency
18positions to which one of the following applies:
SB553,13,2019 1. The residency position is in a hospital that is located in a rural area or in a
20clinic staffed by physicians who admit patients to a hospital located in a rural area.
SB553,13,2421 2. The residency position includes a rural rotation, begun after June 30, 2010,
22which consists of at least 8 weeks of training experience in a hospital that is located
23in a rural area or in a clinic staffed by physicians who admit patients to a hospital
24located in a rural area.
SB553,14,4
1(b) In establishing and supporting residency positions under par. (a), the
2department shall give preference to residency programs that actively recruit
3graduates of the University of Wisconsin School of Medicine and Public Health and
4the Medical College of Wisconsin.
SB553,14,12 5(3) Annually by December 1, the department shall submit a plan for increasing
6the number of physician residency programs that include a majority of training
7experience in a rural area to the Rural Wisconsin Health Cooperative, the Wisconsin
8Hospital Association, and the Wisconsin Medical Society. The plan shall include a
9detailed proposed budget for expending the moneys appropriated to the board under
10s. 20.285 (1) (qe) and demonstrate that the moneys do not supplant existing funding.
11The department shall consider comments made by the organizations in formulating
12its final budget.
SB553,14,14 13(4) Annually by December 1, the department shall submit to the joint
14committee on finance a report that includes all of the following:
SB553,14,1715 (a) The number of physician residency positions that existed in the 2009-10
16fiscal year, and in each fiscal year beginning after the effective date of this paragraph
17.... [LRB inserts date], that included a majority of training experience in a rural area.
SB553,14,1918 (b) 1. The number of such physician residency positions funded in whole or in
19part under this section in the previous fiscal year.
SB553,14,2120 2. The eligibility criteria met by each such residency position and the hospital
21or clinic with which the position is affiliated.
SB553,14,2322 3. The medical school attended by the physician filling each such residency
23position.
SB553,14,2524 4. The year the Accreditation Council for Graduate Medical Education certified
25the residency position.
SB553,15,1
15. The reason the residency position had not been funded.
SB553, s. 37 2Section 37. 49.45 (3) (e) 11. of the statutes, as created by 2009 Wisconsin Act
32
, is amended to read:
SB553,15,144 49.45 (3) (e) 11. The department shall use a portion of the moneys collected
5under s. 50.38 (2) (a) to pay for services provided by eligible hospitals, as defined in
6s. 50.38 (1), other than critical access hospitals, under the Medical Assistance
7Program under this subchapter, including services reimbursed on a fee-for-service
8basis and services provided under a managed care system. For state fiscal year
92008-09, total payments required under this subdivision, including both the federal
10and state share of Medical Assistance, shall equal the amount collected under s.
1150.38 (2) (a) for fiscal year 2008-09 divided by 57.75 percent. For each state fiscal
12year after state fiscal year 2008-09, total payments required under this subdivision,
13including both the federal and state share of Medical Assistance, shall equal the
14amount collected under s. 50.38 (2) (a) for the fiscal year divided by 61.68 percent.
SB553, s. 38 15Section 38. 49.45 (3) (e) 12. of the statutes is created to read:
SB553,15,2216 49.45 (3) (e) 12. The department shall use a portion of the moneys collected
17under s. 50.38 (2) (b) to pay for services provided by critical access hospitals under
18the Medical Assistance Program under this subchapter, including services
19reimbursed on a fee-for-service basis and services provided under a managed care
20system. For each state fiscal year, total payments required under this subdivision,
21including both the federal and state share of Medical Assistance, shall equal the
22amount collected under s. 50.38 (2) (b) for the fiscal year divided by 61.68 percent.
SB553, s. 39 23Section 39. 49.45 (59) (a) of the statutes, as created by 2009 Wisconsin Act 2,
24is amended to read:
SB553,16,4
149.45 (59) (a) The department shall, from the appropriation account accounts
2under s. 20.435 (4) (xc) and (xe), pay each health maintenance organization with
3which it contracts to provide medical assistance a monthly amount that the health
4maintenance organization shall use to make payments to hospitals under par. (b).
SB553, s. 40 5Section 40. 50.38 (1) (a) of the statutes, as created by 2009 Wisconsin Act 2,
6is repealed.
SB553, s. 41 7Section 41. 50.38 (2) of the statutes, as created by 2009 Wisconsin Act 2, is
8renumbered 50.38 (2) (a) and amended to read:
SB553,16,149 50.38 (2) (a) For the privilege of doing business in this state, there is imposed
10on each eligible hospital that is not a critical access hospital an assessment each state
11fiscal year that is equal to a uniform percentage, determined under sub. (3), of the
12hospital's gross patient revenues, as reported under s. 153.46 (5) and determined by
13the department. The assessments shall be deposited in the hospital assessment
14fund.
SB553, s. 42 15Section 42. 50.38 (2) (b) of the statutes is created to read:
SB553,16,2116 50.38 (2) (b) For the privilege of doing business in this state, there is imposed
17on each critical access hospital an assessment each state fiscal year that is equal to
18a uniform percentage, determined under sub. (3), of the critical access hospital's
19gross inpatient revenues, as reported under s. 153.46 (5) and determined by the
20department. The assessments shall be deposited in the critical access hospital
21assessment fund.
SB553, s. 43 22Section 43. 50.38 (3) of the statutes, as created by 2009 Wisconsin Act 2, is
23amended to read:
SB553,17,224 50.38 (3) The department shall establish the percentage that is applicable
25under sub. (2) (a) and (b) so that the total amount of assessments collected under this

1section
sub. (2) (a) in a state fiscal year is equal to the amount in the schedule under
2s. 20.005 (3) for the appropriation under s. 20.435 (4) (xc) for that fiscal year.
SB553, s. 44 3Section 44. 50.38 (4) of the statutes, as created by 2009 Wisconsin Act 2, is
4amended to read:
SB553,17,75 50.38 (4) Except as provided in sub. (5), each eligible hospital shall pay the
6applicable annual assessment under sub. (2) in 4 equal amounts that are due by
7September 30, December 31, March 31, and June 30 of each year.
SB553, s. 45 8Section 45. 50.38 (6) (a) 1. of the statutes, as created by 2009 Wisconsin Act
92
, is amended to read:
SB553,17,1810 50.38 (6) (a) 1. If the federal government does not provide federal financial
11participation under the federal Medicaid program for amounts collected under this
12section
sub. (2) (a) that are used to make payments required under s. 49.45 (3) (e) 11.
13or (5r), that are transferred under sub. (8) and used to make payments from the
14Medical Assistance trust fund, or that are transferred under sub. (9) and expended
15under under s. 20.435 (4) (jw), the department shall, from the fund from which the
16payment or expenditure was made, refund eligible hospitals, other than critical
17access hospitals,
the amount for which the federal government does not provide
18federal financial participation.
SB553, s. 46 19Section 46. 50.38 (6) (a) 2. of the statutes, as created by 2009 Wisconsin Act
202
, is amended to read:
SB553,17,2521 50.38 (6) (a) 2. If the department makes a refund under subd. 1. as result of
22failure to obtain federal financial participation under the federal Medicaid program
23for a payment required under s. 49.45 (3) (e) 11. or (5r) or a payment from the Medical
24Assistance trust fund, the department shall recoup the part of the payment for which
25the federal government does not provide federal financial participation.
SB553, s. 47
1Section 47. 50.38 (6) (b) of the statutes, as created by 2009 Wisconsin Act 2,
2is amended to read:
SB553,18,73 50.38 (6) (b) On June 30 of each state fiscal year, the department shall, from
4the appropriation account under s. 20.435 (4) (xc), refund to eligible hospitals, other
5than critical access hospitals,
the difference between the amount in the schedule
6under s. 20.005 (3) for that appropriation and the amount expended or encumbered
7from that appropriation in the fiscal year.
SB553, s. 48 8Section 48. 50.38 (6) (c) of the statutes, as created by 2009 Wisconsin Act 2,
9is amended to read:
SB553,18,1310 50.38 (6) (c) The department shall allocate any refund under this subsection
11to eligible hospitals, other than critical access hospitals, in proportion to the
12percentage of the total assessments collected under sub. (2) (a) that each hospital
13paid.
SB553, s. 49 14Section 49. 50.38 (6m) of the statutes is created to read:
SB553,18,2115 50.38 (6m) (a) 1. If the federal government does not provide federal financial
16participation under the federal Medicaid program for amounts collected under sub.
17(2) (b) that are used to make payments required under s. 49.45 (3) (e) 12. or that are
18transferred under sub. (10) and used to make payments from the Medical Assistance
19trust fund, the department shall, from the fund from which the payment or
20expenditure was made, refund critical access hospitals the amount for which the
21federal government does not provide federal financial participation.
SB553,19,222 2. If the department makes a refund under subd. 1. as result of failure to obtain
23federal financial participation under the federal Medicaid program for a payment
24required under s. 49.45 (3) (e) 12. or a payment from the Medical Assistance trust

1fund, the department shall recoup the part of the payment for which the federal
2government does not provide federal financial participation.
SB553,19,53 3. Moneys recouped under subd. 2. for payments made from the critical access
4hospital assessment fund shall be deposited in the critical access hospital
5assessment fund.
SB553,19,76 4. Moneys recouped under subd. 2. for payments made from the Medical
7Assistance trust fund shall be deposited in the Medical Assistance trust fund.
SB553,19,108 (b) On June 30 of each state fiscal year, the department shall, from the
9appropriation account under s. 20.435 (4) (xe), refund to critical access hospitals any
10unencumbered moneys in the critical access hospital assessment fund.
SB553,19,1311 (c) The department shall allocate any refund under this subsection to critical
12access hospitals in proportion to the percentage of the total assessments collected
13under sub. (2) (b) that each critical access hospital paid.
SB553, s. 50 14Section 50. 50.38 (7) (d) of the statutes, as created by 2009 Wisconsin Act 2,
15is amended to read:
SB553,19,1916 50.38 (7) (d) The total amount of payment increases the department made, in
17connection with implementation of the hospital assessment assessments under sub.
18(2), for inpatient and outpatient hospital services that are reimbursed on a
19fee-for-service basis.
SB553, s. 51 20Section 51. 50.38 (8) of the statutes is amended to read:
SB553,20,221 50.38 (8) In each state fiscal year, the secretary of administration shall transfer
22from the hospital assessment fund to the Medical Assistance trust fund an amount
23equal to the amount in the schedule under s. 20.005 (3) for the appropriation under
24s. 20.435 (4) (xc) for that fiscal year minus the state share of payments to hospitals

1required under s. 49.45 (3) (e) 11., and minus any refunds paid to hospitals from the
2hospital assessment fund under sub. (6) (a) in that fiscal year.
SB553, s. 52 3Section 52. 50.38 (10) of the statutes is created to read:
SB553,20,104 50.38 (10) In each state fiscal year, the secretary of administration shall
5transfer from the critical access hospital assessment fund to the Medical Assistance
6trust fund an amount equal to the amount collected under sub. (2) (b) minus the state
7share of the amount required to be expended under s. 49.45 (3) (e) 12., minus the
8amounts appropriated under s. 20.285 (1) (qe) and (qj), and minus any refunds paid
9to critical access hospitals from the critical access hospital assessment fund under
10sub. (6m) (a) in that fiscal year.
SB553, s. 53 11Section 53. Nonstatutory provisions.
SB553,20,2212 (1) State plan amendment. The department of health services shall submit a
13state medicaid plan amendment to the secretary of the federal department of health
14and human services that provides for the critical access hospital assessment under
15section 50.38 (2) (b) of the statutes, as created by this act, and expenditure of revenue
16from the critical access hospital assessment as provided in this act. If the secretary
17of the federal department of health and human services disapproves the state
18medicaid plan amendment, the department of health services shall refund to critical
19access hospitals all of the moneys collected from the critical access hospital
20assessment in the fiscal biennium in which this subsection takes effect and,
21notwithstanding section 50.38 (2) (b) of the statutes, as created by this act, stop
22collecting moneys under the critical access hospital assessment.
SB553,21,223 (2) Budgeting practices. This act does not affect any requirements under
24section 16.46 of the statutes. The departments of administration and health services
25shall review, reestimate, and request general purpose revenue for payments to

1critical access hospitals under the Medical Assistance Program under subchapter IV
2of chapter 49 of the statutes as needed.
SB553, s. 54 3Section 54. Fiscal changes.
SB553,21,84 (1) Medical assistance trust fund. In the schedule under section 20.005 (3)
5of the statutes for the appropriation to the department of health services under
6section 20.435 (4) (w) of the statutes, as affected by the acts of 2009, the dollar amount
7is increased by $3,680,500 for the second fiscal year of the fiscal biennium in which
8this subsection takes effect for the purposes for which the appropriation is made.
SB553, s. 55 9Section 55. Initial applicability.
SB553,21,1110 (1) The treatment of section 49.45 (3) (e) 12. of the statutes first applies to
11services provided by critical access hospitals on July 1, 2010.
SB553, s. 56 12Section 56. Effective date.
SB553,21,1313 (1) This act takes effect on July 1, 2010.
SB553,21,1414 (End)
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