SB553: Bill Text

SB553,2,2 An Act to repeal 50.38 (1) (a); to renumber and amend 36.60 (2) (a) and 50.38 (2); to amend 20.435 (4) (w), 25.77 (11), 25.77 (12), 25.772, 36.60 (3), 36.60 (4) (intro.), 36.60 (5) (a), 36.60 (5) (b) (intro.), 36.60 (5) (b) 1., 36.60 (5) (b) 2., 36.60 (5) (b) 3., 36.60 (5) (b) 4., 36.60 (5) (b) 5., 36.60 (8) (b), 36.61 (3), 36.61 (5) (a), 36.61 (5) (b) (intro.), 36.61 (5) (b) 1., 36.61 (5) (b) 2., 36.61 (5) (b) 3., 36.61 (5) (b) 4., 36.61 (5) (b) 5., 49.45 (3) (e) 11., 49.45 (59) (a), 50.38 (3), 50.38 (4), 50.38 (6) (a) 1., 50.38 (6) (a) 2., 50.38 (6) (b), 50.38 (6) (c), 50.38 (7) (d) and 50.38 (8); and to create 20.285 (1) (qe), 20.285 (1) (qj), 20.435 (4) (xe), 25.17 (1) (cg), 25.774, 36.60 (1) (d), 36.60 (2) (a) 2., 36.60 (4m), 36.60 (8) (h), 36.61 (1) (e), 36.61 (7) (e), 36.63, 49.45 (3) (e) 12., 50.38 (2) (b), 50.38 (6m) and 50.38 (10) of the statutes; relating to: assessment on critical access hospitals; payments to critical access hospitals under the Medical Assistance Program; creating a rural physician residency assistance program; the physician, dentist, and health care provider loan assistance programs; and making appropriations.

Analysis by the Legislative Reference Bureau

Hospital Assessments

The state currently collects an assessment from hospitals based on their gross inpatient and outpatient revenues. The biennial budget act specifies the total amount of revenue to be collected from the assessment. The Department of Health Services (DHS) then sets the assessment rate, which is the same for all hospitals, at the percentage of gross patient revenue necessary to collect the total revenue amount specified in the biennial budget act. Critical access hospitals, psychiatric hospitals, and institutions for mental diseases are exempt from the assessment. A critical access hospital is, in general, a hospital that provides 24 hour a day emergency care, has 25 or fewer acute inpatient beds, and is located in a rural area in which there are no other hospitals.

Current law directs DHS to use a portion of the hospital assessment revenue to pay hospitals that are subject to the assessment for services provided under the Medical Assistance Program (MA). Like other provider payments under MA, the federal government pays a share of these MA payments to hospitals. Current law requires that the MA payments to hospitals from the assessment revenue, together with the federal share, equal the amount of the assessment revenue divided by 61.68 percent (i.e., 1.62 times the amount of assessment revenue). The remainder of the assessment revenue is appropriated for other MA expenditures.

This bill imposes an assessment on the gross inpatient revenues of critical access hospitals. The rate for the critical access hospital assessment is the same as the rate of the current hospital assessment. The bill requires that DHS use a portion of the critical access hospital assessment revenue to pay critical access hospitals for services provided under MA. Like the current hospital assessment, the bill requires that the MA payments to critical access hospitals from the critical access hospital assessment revenue, together with the federal share of payments, equal the amount of the critical access hospital assessment revenue divided by 61.68 percent. The bill annually appropriates $1,000,000 of critical access hospital assessment revenue for health care provider loans and rural physician residency assistance, described below. The remainder of critical access hospital assessment revenue is appropriated for other MA expenditures.

The provisions in the bill for payment to critical access hospitals under MA apply to services provided beginning July 1, 2010. The first critical access hospital assessment payments are due by September 30, 2010. The bill requires DHS to submit a state Medicaid plan amendment to the federal government to implement the critical access hospital assessment as provided for in the bill, and specifies that if the federal government disapproves the state plan amendment, DHS must discontinue the assessment on critical access hospitals and refund any critical access hospital assessment revenue collected in fiscal year 2010-11.

Health care provider loan programs

With certain exceptions, current law authorizes the Board of Regents of the University of Wisconsin System to repay, on behalf of certain physicians and dentists, up to $50,000 in educational loans if the physician or dentist agrees to practice for three years in certain areas of this state. Similarly, the board may repay, on behalf of certain health care providers (a dental hygienist, physician assistant, nurse-midwife, or nurse-practitioner), up to $25,000 in educational loans if the health care provider agrees to practice for three years in certain areas of this state.

This bill provides additional funds for these programs, from critical access hospital assessment revenues, for certain physicians, dentists, and health care providers who agree to practice in a rural area of this state. A rural area is a city, town, or village with a population of less than 20,000 that is at least 15 miles from any city, town, or village that has a population of at least 20,000, or an area that is not an urbanized area, as defined by the federal bureau of the census. The bill also increases the maximum amount of the loan repayment from $50,000 to $100,000 for a physician who agrees to practice in a rural area.

Rural physician residency assistance program

This bill directs the Department of Family Medicine in the University of Wisconsin School of Medicine and Public Health to establish and support certain physician residency positions at hospitals located in rural areas or at clinics staffed by physicians who admit patients to hospitals located in rural areas, or that include a rural rotation, begun after June 30, 2010, which consists of at least eight weeks of training experience in a hospital located in a rural area or in a clinic that is staffed by physicians who admit patients to a hospital located in a rural area. The positions are funded with revenue from the critical access hospital assessment.

The bill directs the department annually to 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 department must also annually submit to the Joint Committee on Finance a report indicating the number of physician residency positions that include a majority of training experience in a rural area of this state, and information about each such residency position.

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:

SB553, s. 1 Section 1. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table

SB553, s. 2 Section 2. 20.285 (1) (qe) of the statutes is created to read:

SB553,4,5 20.285 (1) (qe) Rural physician residency assistance program. Biennially, from the critical access hospital assessment fund, the amounts in the schedule for the department of family medicine in the University of Wisconsin School of Medicine and Public Health to establish and support physician residency positions under s. 36.63.

SB553, s. 3 Section 3. 20.285 (1) (qj) of the statutes is created to read:

SB553,4,10 20.285 (1) (qj) Physician and dentist and health care provider loan assistance programs; critical access hospital assessment fund. Biennially, from the critical access hospital assessment fund, the amounts in the schedule for loan repayments under ss. 36.60 and 36.61.

SB553, s. 4 Section 4. 20.435 (4) (w) of the statutes, as affected by 2009 Act Wisconsin 2, is amended to read:

SB553,5,4 20.435 (4) (w) Medical Assistance trust fund. From the Medical Assistance trust fund, biennially, the amounts in the schedule for meeting costs of medical assistance administered under ss. 46.27, 46.275 (5), 46.278 (6), 46.283 (5), 46.284 (5), 49.45, and 49.472 (6), for refunds under s. 50.38 (6) (a) and (6m) (a), and for administrative costs associated with augmenting the amount of federal moneys received under 42 CFR 433.51.

SB553, s. 5 Section 5. 20.435 (4) (xe) of the statutes is created to read:

SB553,5,12 20.435 (4) (xe) Critical access hospital assessment fund; hospital payments. From the critical access hospital assessment fund, all moneys received from the assessment under s. 50.38 (2) (b), except moneys appropriated under s. 20.285 (1) (qe) and (qj), to make payments to critical access hospitals required under s. 49.45 (3) (e) 12. for services provided under the Medical Assistance Program under subch. IV of ch. 49; to make refunds under s. 50.38 (6m); and to make the transfer under s. 50.38 (10).

SB553, s. 6 Section 6. 25.17 (1) (cg) of the statutes is created to read:

SB553,5,14 25.17 (1) (cg) Critical access hospital assessment fund (s. 25.774);

SB553, s. 7 Section 7. 25.77 (11) of the statutes, as created by 2009 Wisconsin Act 2, is amended to read:

SB553,5,17 25.77 (11) All moneys transferred under s. 50.38 (8) and (10).

SB553, s. 8 Section 8. 25.77 (12) of the statutes, as created by 2009 Wisconsin Act 2, is amended to read:

SB553,5,21 25.77 (12) All moneys recouped and deposited under s. 50.38 (6) (a) 4. and (6m) (a) 4.

SB553, s. 9 Section 9. 25.772 of the statutes, as created by 2009 Wisconsin Act 2, is amended to read:

SB553,6,3 25.772 Hospital assessment fund. There is established a separate nonlapsible trust fund designated as the hospital assessment fund, to consist of all moneys received under s. 50.38 (2) (a) from assessments on hospitals other than critical access hospitals and all moneys recouped and deposited under s. 50.38 (6) (a) 3.

SB553, s. 10 Section 10. 25.774 of the statutes is created to read:

SB553,6,9 25.774 Critical access hospital assessment fund. (1) There is established a separate nonlapsible trust fund designated as the critical access hospital assessment fund, to consist of all moneys received under s. 50.38 (2) (b) from assessments on critical access hospitals and all moneys recouped and deposited under s. 50.38 (6m) (a) 3.

SB553, s. 11 Section 11. 36.60 (1) (d) of the statutes is created to read:

SB553,6,11 36.60 (1) (d) "Rural area" has the meaning given in s. 36.63 (1) (c).

SB553, s. 12 Section 12. 36.60 (2) (a) of the statutes, as affected by 2009 Wisconsin Act 28, is renumbered 36.60 (2) (a) 1. and amended to read:

SB553,6,18 36.60 (2) (a) 1. The Except as provided in subd. 2., the board may repay, on behalf of a physician or dentist, up to $50,000 in educational loans obtained by the physician or dentist from a public or private lending institution for education in an accredited school of medicine or dentistry or for postgraduate medical or dental training.

SB553, s. 13 Section 13. 36.60 (2) (a) 2. of the statutes is created to read:

SB553,6,23 36.60 (2) (a) 2. The board may repay, on behalf of a physician who agrees under sub. (3) to practice in a rural area, up to $100,000 in educational loans obtained by the physician from a public or private lending institution for education in an accredited school of medicine or for postgraduate medical training.

SB553, s. 14 Section 14. 36.60 (3) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,7,10 36.60 (3) Agreement. (a) The board shall enter into a written agreement with the physician, in which the physician agrees to practice at least 32 clinic hours per week for 3 years in one or more eligible practice areas in this state or in a rural area, except that a physician specializing in psychiatry may only agree to practice psychiatry in a mental health shortage area or in a rural area and a physician in the expanded loan assistance program under sub. (9) may only agree to practice at a public or private nonprofit entity in a health professional shortage area. The physician shall also agree to care for patients who are insured or for whom health benefits are payable under medicare, medical assistance, or any other governmental program.

SB553,7,15 (am) The board shall enter into a written agreement with the dentist, in which the dentist agrees to practice at least 32 clinic hours per week for 3 years in one or more dental health shortage areas in this state or in a rural area. The dentist shall also agree to care for patients who are insured or for whom dental health benefits are payable under medicare, medical assistance, or any other governmental program.

SB553,7,18 (b) The agreement shall specify that the responsibility of the board to make the payments under the agreement is subject to the availability of funds in the appropriations under s. 20.285 (1) (jc) and, (ks), and (qj).

SB553, s. 15 Section 15. 36.60 (4) (intro.) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,7,23 36.60 (4) Loan repayment. (intro.) Principal Except as provided in sub. (4m), principal and interest due on loans, exclusive of any penalties, may be repaid by the board at the following rate:

SB553, s. 16 Section 16. 36.60 (4m) of the statutes is created to read:

SB553,8,3 36.60 (4m) Loan repayment; rural physicians. If a physician agrees under sub. (3) to practice in a rural area, principal and interest due on the loan, exclusive of any penalties, may be repaid by the board at the following rate:

SB553,8,5 (a) Up to 40 percent of the principal of the loan or $40,000, whichever is less, during the first year of participation in the program under this section.

SB553,8,8 (b) Up to an additional 40 percent of the principal of the loan or $40,000, whichever is less, during the 2nd year of participation in the program under this section.

SB553,8,11 (c) Up to an additional 20 percent of the principal of the loan or $20,000, whichever is less, during the 3rd year of participation in the program under this section.

SB553, s. 17 Section 17. 36.60 (5) (a) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,8,16 36.60 (5) (a) The obligation of the board to make payments under an agreement entered into under sub. (3) (b) is subject to the availability of funds in the appropriations under s. 20.285 (1) (jc) and, (ks), and (qj).

SB553, s. 18 Section 18. 36.60 (5) (b) (intro.) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,8,23 36.60 (5) (b) (intro.) If the cost of repaying the loans of all eligible applicants, when added to the cost of loan repayments scheduled under existing agreements, exceeds the total amount in the appropriations under s. 20.285 (1) (jc) and, (ks), and (qj), the board shall establish priorities among the eligible applicants based upon the following considerations:

SB553, s. 19 Section 19. 36.60 (5) (b) 1. of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,9,5 36.60 (5) (b) 1. The degree to which there is an extremely high need for medical care in the eligible practice area or, health professional shortage area, or rural area in which a physician desires to practice and the degree to which there is an extremely high need for dental care in the dental health shortage area or rural area in which a dentist desires to practice.

SB553, s. 20 Section 20. 36.60 (5) (b) 2. of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,9,11 36.60 (5) (b) 2. The likelihood that a physician will remain in the eligible practice area or, health professional shortage area, or rural area, and that a dentist will remain in the dental health shortage area or rural area, in which he or she desires to practice after the loan repayment period.

SB553, s. 21 Section 21. 36.60 (5) (b) 3. of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,9,16 36.60 (5) (b) 3. The per capita income of the eligible practice area or, health professional shortage area, or rural area in which a physician desires to practice and of the dental health shortage area or rural area in which a dentist desires to practice.

SB553, s. 22 Section 22. 36.60 (5) (b) 4. of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,9,24 36.60 (5) (b) 4. The financial or other support for physician recruitment and retention provided by individuals, organizations, or local governments in the eligible practice area or, health professional shortage area, or rural area in which a physician desires to practice and for dentist recruitment and retention provided by individuals, organizations, or local governments in the dental health shortage area or rural area in which a dentist desires to practice.

SB553, s. 23 Section 23. 36.60 (5) (b) 5. of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,10,7 36.60 (5) (b) 5. The geographic distribution of the physicians and dentists who have entered into loan repayment agreements under this section and the geographic distribution of the eligible practice areas, health professional shortage areas, and dental health shortage areas, and rural areas in which the eligible applicants desire to practice.

SB553, s. 24 Section 24. 36.60 (8) (b) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,10,12 36.60 (8) (b) Identify eligible practice areas and rural areas with an extremely high need for medical care and dental health shortage areas and rural areas with an extremely high need for dental care.

SB553, s. 25 Section 25. 36.60 (8) (h) of the statutes is created to read:

SB553,10,16 36.60 (8) (h) Notwithstanding subs. (3) (b) and (5) (a) and (b), ensure that moneys appropriated under s. 20.285 (1) (qj) are used under this section only to repay loans on behalf of physicians and dentists who agree to practice in a rural area.

SB553, s. 26 Section 26. 36.61 (1) (e) of the statutes is created to read:

SB553,10,18 36.61 (1) (e) "Rural area" has the meaning given in s. 36.63 (1) (c).

SB553, s. 27 Section 27. 36.61 (3) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,11,2 36.61 (3) Agreement. (a) The board shall enter into a written agreement with the health care provider. In the agreement, the health care provider shall agree to practice at least 32 clinic hours per week for 3 years in one or more eligible practice areas in this state or in a rural area, except that a health care provider in the expanded loan assistance program under sub. (8) who is not a dental hygienist may only agree to practice at a public or private nonprofit entity in a health professional shortage area.

SB553,11,5 (b) The agreement shall specify that the responsibility of the board to make the payments under the agreement is subject to the availability of funds in the appropriations under s. 20.285 (1) (jc) and, (ks), and (qj).

SB553, s. 28 Section 28. 36.61 (5) (a) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,11,10 36.61 (5) (a) The obligation of the board to make payments under an agreement entered into under sub. (3) is subject to the availability of funds in the appropriations under s. 20.285 (1) (jc) and, (ks), and (qj).

SB553, s. 29 Section 29. 36.61 (5) (b) (intro.) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,11,17 36.61 (5) (b) (intro.) If the cost of repaying the loans of all eligible applicants, when added to the cost of loan repayments scheduled under existing agreements, exceeds the total amount in the appropriations under s. 20.285 (1) (jc) and, (ks), and (qj), the board shall establish priorities among the eligible applicants based upon the following considerations:

SB553, s. 30 Section 30. 36.61 (5) (b) 1. of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,11,25 36.61 (5) (b) 1. The degree to which there is an extremely high need for medical care in the eligible practice area or, health professional shortage area, or rural area in which an eligible applicant who is not a dental hygienist desires to practice and the degree to which there is an extremely high need for dental care in the dental health shortage area or rural area in which an eligible applicant who is a dental hygienist desires to practice.

SB553, s. 31 Section 31. 36.61 (5) (b) 2. of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,12,5 36.61 (5) (b) 2. The likelihood that an eligible applicant will remain in the eligible practice area or, health professional shortage area, or rural area in which he or she desires to practice after the loan repayment period.

SB553, s. 32 Section 32. 36.61 (5) (b) 3. of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,12,10 36.61 (5) (b) 3. The per capita income of the eligible practice area or, health professional shortage area, or rural area in which an eligible applicant desires to practice.

SB553, s. 33 Section 33. 36.61 (5) (b) 4. of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB553,12,16 36.61 (5) (b) 4. The financial or other support for health care provider recruitment and retention provided by individuals, organizations or local governments in the eligible practice area or, health professional shortage area, or rural area in which an eligible applicant desires to practice.