49.473 (2) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), a woman is eligible for medical assistance as provided under sub. (5) if, after applying to the department or a county department, the department or a county department determines that she meets all of the following requirements:
32,1465p
Section 1465p. 49.473 (2) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.473 (2) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), a A woman is eligible for medical assistance as provided under sub. (5) if, after applying to the department or a county department, the department or a county department determines that she meets all of the following requirements:
49.473 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b), (gm), and (o), allowable charges to a provider who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who meets the requirements under sub. (2) for all benefits and services specified under s. 49.46 (2), unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c).
32,1470b
Section 1470b. 49.473 (5) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.473 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b), (gm), and (o), allowable charges to a provider who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who meets the requirements under sub. (2) for all benefits and services specified under s. 49.46 (2), unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c).
32,1477r
Section 1477r. 49.67 (3) (am) 2. b. of the statutes is amended to read:
49.67 (3) (am) 2. b. If the applicant is under 27 26 years of age, notice that he or she may be eligible for coverage as a dependent under his or her parent's health care plan in accordance with s. 632.885, and that his or her parent's plan must include coverage for services that are not covered under the plan under this section.
32,1478
Section
1478. 49.68 (3) (b) of the statutes is amended to read:
49.68 (3) (b) From the appropriation accounts under ss. 20.435 (4) (e) and (je), the state shall pay the cost of, at a rate determined by the department under par. (e), for medical treatment that is required as a direct result of chronic renal disease of certified patients from the date of certification, including the cost of administering recombinant human erythropoietin to appropriate patients, whether the treatment is rendered in an approved facility in the state or in a dialysis or transplantation center which that is approved as such by a contiguous state, subject to the conditions specified under par. (d). Approved facilities may include a hospital in-center dialysis unit or a nonhospital dialysis center which that is closely affiliated with a home dialysis program supervised by an approved facility. Aid shall also be provided for all reasonable expenses incurred by a potential living-related donor, including evaluation, hospitalization, surgical costs, and postoperative follow-up to the extent that these costs are not reimbursable under the federal medicare program or other insurance. In addition, all expenses incurred in the procurement, transportation, and preservation of cadaveric donor kidneys shall be covered to the extent that these costs are not otherwise reimbursable. All donor-related costs are chargeable to the recipient and reimbursable under this subsection.
32,1479
Section
1479. 49.68 (3) (e) of the statutes is amended to read:
49.68 (3) (e) State aids Payment for services provided under this section shall be equal to at a rate determined by the department that does not exceed the allowable charges under the federal Medicare program. In no case shall state rates for individual service elements exceed the federally defined allowable costs. The rate of charges for services not covered by public and private insurance shall not exceed the reasonable charges as established by medicare Medicare fee determination procedures. A person that provides to a patient a service for which aid is provided under this section shall accept the amount paid under this section for the service as payment in full and may not bill the patient for any amount by which the charge for the service exceeds the amount paid for the service under this section. The state may not pay for the cost of travel, lodging, or meals for persons who must travel to receive inpatient and outpatient dialysis treatment for kidney disease. This paragraph shall not apply to donor related costs as defined in par. (b).
32,1486m
Section 1486m. 49.78 (1) (br) of the statutes is created to read:
49.78 (1) (br) "Multicounty consortium" means a group of counties that is approved by the department under sub. (1m) to administer income maintenance programs.
32,1487m
Section 1487m. 49.78 (1m) of the statutes is created to read:
49.78 (1m) Multicounty consortia. (a) Except as provided in par. (c), each county with a population of less than 750,000 shall participate in a multicounty consortium that is approved by the department under par. (b).
(b) By October 31, 2011, the department shall approve multicounty consortia. The department may not approve more than 10 multicounty consortia.
(c) If a county with a population of less than 750,000 does not participate in a multicounty consortium or the department determines that a multicounty consortium does not satisfy the department's performance requirements, the department shall assume responsibility for administering income maintenance programs in that county or in the geographical area of the multicounty consortium. The department may provide income maintenance program administration under this paragraph by contracting with another multicounty consortium or by providing the administrative services with state resources and employees.
(d) If the department assumes responsibility for administering income maintenance programs in a county or in the geographical area of the multicounty consortium under par. (c), any county for which the department administers income maintenance programs shall pay to the department the amount that the county expended for the administration of income maintenance programs in calendar year 2009. For the purposes of this paragraph, Kenosha County expended $673,000 for the administration of income maintenance programs in calendar year 2009.
32,1488m
Section 1488m. 49.78 (1r) of the statutes is created to read:
49.78 (1r) Single county consortia. The department shall administer income maintenance programs in a county with a population of 750,000 or more as a single-county consortium, including the administrative functions specified in sub. (2) (b) 1.
32,1489m
Section 1489m. 49.78 (2) (title) of the statutes is amended to read:
49.78 (2) (title) Contracts with multicounty consortia.
32,1490m
Section 1490m. 49.78 (2) of the statutes is renumbered 49.78 (2) (a) and amended to read:
49.78 (2) (a) Annually, for the income maintenance program functions, if any, that the department delegates to a county or tribal governing body beginning with contracts for 2012, the department and county department under s. 46.215, 46.22, or 46.23 shall enter into a contract, and the department and tribal governing body may enter into a contract, for reimbursement of the county department or tribal governing body for the reasonable cost of administering with each multicounty consortium to administer income maintenance programs in the multicounty consortium's geographical area.
32,1491m
Section 1491m. 49.78 (2) (b) of the statutes is created to read:
49.78 (2) (b) A contract under par. (a) shall provide all of the following:
1. That the multicounty consortia shall be responsible for all of the following administrative functions related to income maintenance programs:
a. Operating and maintaining a call center.
b. Conducting application processing and eligibility determinations.
c. Conducting ongoing case management.
d. Providing lobby services.
2. That the department and multicounty consortia shall cooperate to provide the following administrative functions related to the income maintenance programs:
a. Conducting subrogation and benefit recovery efforts.
b. Participating in fair hearings.
c. Conducting fraud prevention and identification activities.
3. That the department will reimburse a multicounty consortium for services provided under the contract on a risk-adjusted case load basis.
32,1492m
Section 1492m. 49.78 (2m) of the statutes is created to read:
49.78 (2m) Administration by a tribal governing body. (a) A tribal governing body may administer income maintenance programs by electing to have the department administer the tribe's income maintenance programs or by providing the required administrative services and entering into a contract with the department for reimbursement under par. (b).
(b) Annually, for the income maintenance administrative program functions, if any, that the department delegates to a tribal governing body, the department and tribal governing body may enter into a contract, for reimbursement of the tribal governing body for the reasonable cost of administering income maintenance programs.
(c) The amount of each reimbursement paid under a contract entered into par. (b) shall be calculated using a formula based on workload within the limits of state and federal funds. The department may adjust reimbursement amounts determined under the contract for workload changes and computer network activities performed by a tribal governing body.
32,1493m
Section 1493m. 49.78 (2r) of the statutes is created to read:
49.78 (2r) Departmental administrative functions. The department shall perform all of the following administrative functions related to income maintenance programs:
(a) Providing income maintenance worker training.
(b) Performing 2nd-party reviews.
(c) Administering the funeral expenses program under s. 49.785.
(d) Providing information technology and licenses for call centers that are operated by multicounty consortia.
(e) Maintaining the client assistance reemployment and economic support system.
(f) Contracting with multicounty consortia under sub. (2), including establishing performance requirements.
(g) Contracting with tribal governing bodies under sub. (2m), including establishing performance requirements.
(h) Monitoring contracts with multicounty consortia and tribal governing bodies, including compliance with performance standards and federal and other reporting requirements.
(i) Operating a centralized document processing unit.
32,1494m
Section 1494m. 49.78 (8) (a) of the statutes is amended to read:
49.78 (8) (a) From the appropriation accounts appropriations under s. 20.435 (4) (bn) and (nn) and subject to par. (b), the department shall provide funding to reimburse each county multicounty consortium that contracts with the department under sub. (2) and each tribal governing body that contracts with the department under sub. (2) (2m) for reasonable the costs of administering the income maintenance programs, including conducting fraud prevention activities. The amount of each reimbursement paid under this paragraph shall be calculated using a formula based on workload within the limits of available state and federal funds under s. 20.435 (4) (bn) and (nn) by contract under sub. (2), in accordance with the terms of the applicable contract. The amount of reimbursement calculated under this paragraph and par. (b) is in addition to any reimbursement provided to a county, multicounty consortium, or tribal governing body for fraud and error reduction under s. 49.197 or 49.845.
32,1495m
Section 1495m. 49.78 (8) (b) of the statutes is amended to read:
49.78 (8) (b) The department may adjust the amounts determined under par. (a) for workload changes and computer network activities performed by a county or tribal governing body and may reduce the amount of any reimbursement if federal reimbursement is withheld due to audits, quality control samples, or program reviews.
32,1496m
Section 1496m. 49.78 (10) (title) of the statutes is amended to read:
49.78 (10) (title) County
Reimbursement certification.
32,1497m
Section 1497m. 49.78 (10) (a) of the statutes is amended to read:
49.78 (10) (a) Each county treasurer and director of a county department under s. 46.215, 46.22, or 46.23 An authorized representative from each multicounty consortium that contracts with the department under sub. (2) and each tribal governing body that contracts with the department under sub. (2) (2m) shall certify monthly under oath to the department in such manner as the department prescribes the claim of the county multicounty consortium or tribal governing body for state reimbursement under sub. (8) (a). The department shall review each claim of reimbursement and, if the department approves the claim, the department shall certify to the department of administration for reimbursement to the county multicounty consortium or tribal governing body for amounts due under sub. (8) (a) and payment claimed to be made to the counties multicounty consortia or tribal governing bodies monthly. The department may make advance payments prior to the beginning of each month equal to one-twelfth of the contracted amount.
32,1498m
Section 1498m. 49.78 (10) (b) of the statutes is amended to read:
49.78 (10) (b) To facilitate prompt reimbursement the certificate of the department may be based on the certified statements of the county officers authorized representatives of multicounty consortia or tribal governing body executives filed under par. (a). Funds recovered from audit adjustments from a prior fiscal year may be included in subsequent certifications only to pay counties or multicounty consortia owed funds as a result of any audit adjustment. By September 30 annually, the department shall submit a report to the appropriate standing committees under s. 13.172 (3) on funds recovered and paid out during the previous calendar year as a result of audit adjustments.
32,1499m
Section 1499m. 49.78 (11) (a) of the statutes is amended to read:
49.78 (11) (a) 1. The department, a county department under s. 46.215, 46.22, or 46.23, a multicounty consortium, or a tribal governing body may request from any person in this state information it determines appropriate and necessary for determining or verifying eligibility or benefits for a recipient under any income maintenance program. Unless access to the information is prohibited or restricted by law, or unless the person has good cause, as determined by the department in accordance with federal law and regulations, for refusing to cooperate, the person shall make a good faith effort to provide the information within 7 days after receiving a request under this paragraph. The department, county department, multicounty consortium, or tribal governing body, or employees of any of them, may not disclose information obtained under this subdivision for any purpose not connected with the administration of the income maintenance program for which the information was requested.
2. In conjunction with any request for information under subd. 1., including a request made by subpoena under par. (b), the department, county department, multicounty consortium, or tribal governing body shall advise the person of the time by which the information must be provided.
32,1500m
Section 1500m. 49.78 (11) (b) of the statutes is amended to read:
49.78 (11) (b) The department, a county department, a multicounty consortium, or a tribal governing body may issue a subpoena, in substantially the form authorized under s. 885.02, to compel the production of financial information or other documentary evidence for determining or verifying eligibility or benefits for a recipient under any income maintenance program.
32,1501m
Section 1501m. 49.78 (11) (c) 1. of the statutes is amended to read:
49.78 (11) (c) 1. Allowing access to financial or other records by the department, a county department, a multicounty consortium, or a tribal governing body in response to a request under par. (a) or a subpoena described in par. (b).
32,1502m
Section 1502m. 49.78 (11) (c) 2. of the statutes is amended to read:
49.78 (11) (c) 2. Disclosing information from financial or other records to the department, a county department, a multicounty consortium, or a tribal governing body in response to a request under par. (a) or a subpoena described in par. (b).
32,1503m
Section 1503m. 49.78 (11) (c) 3. of the statutes is amended to read:
49.78 (11) (c) 3. Any other action taken in good faith to comply with this subsection or a subpoena described in par. (b) or to comply with a request for information or access to records from the department, a county department, a multicounty consortium, or a tribal governing body for determining or verifying eligibility or benefits for a recipient under any income maintenance program.
32,1504m
Section 1504m. 49.785 (2) of the statutes is amended to read:
49.785 (2) From the appropriation under s. 20.435 (4) (bn) (br), the department shall reimburse a county or applicable tribal governing body or organization for any amount that the county or applicable tribal governing body or organization is required to pay under sub. (1) if the county or applicable tribal governing body or organization complies with sub. (3). From the appropriation under s. 20.435 (4) (bn) (br), the department shall reimburse a county or applicable tribal governing body or organization for cemetery expenses or for funeral and burial expenses for a person described under sub. (1) that the county or applicable tribal governing body or organization is not required to pay under subs. (1) and (1m) only if the department approves the reimbursement due to unusual circumstances and if the county or applicable tribal governing body or organization complies with sub. (3).
32,1505m
Section 1505m. 49.79 (1) (e) of the statutes is created to read:
49.79 (1) (e) "Multicounty consortium" has the meaning given in s. 49.78 (1) (br).
32,1506m
Section 1506m. 49.79 (3) of the statutes is amended to read:
49.79 (3) Liability for lost food coupons. (a) A county, multicounty consortium, or federally recognized American Indian tribe is liable for all food stamp coupons lost, misappropriated, or destroyed while under the county's, consortium's, or tribe's direct control, except as provided in par. (b).
(b) A county, multicounty consortium, or federally recognized American Indian tribe is not liable for food stamp coupons lost in natural disasters if it provides evidence acceptable to the department that the coupons were destroyed and not redeemed.
(c) A county, multicounty consortium, or federally recognized American Indian tribe is liable for food stamp coupons mailed to residents of the county or counties that are in the multicounty consortium or members of the tribe and lost in the mail due to incorrect information submitted to the department by the county or tribe.
32,1507m
Section 1507m. 49.79 (4) of the statutes is amended to read:
49.79 (4) Deductions from county income maintenance payments. The department shall withhold the value of food stamp losses for which a county, multicounty consortium, or federally recognized American Indian tribe is liable under sub. (3) from the payment to the county, multicounty consortium, or tribe under income maintenance contracts under s. 49.78 and reimburse the federal government from the funds withheld.
32,1534
Section
1534. 49.79 (8) of the statutes is amended to read:
49.79 (8) Benefits for qualified aliens. The department shall not provide benefits under this section to a qualified alien who is ineligible for benefits under this section solely because of the application of 9 USC 1612 or 1613 according to a plan approved by the federal department of agriculture. This subsection does not apply, except to the extent that federal food stamp benefits for qualified aliens are restored required by the federal government.
32,1535m
Section 1535m. 49.79 (9) (a) 1. of the statutes is amended to read:
49.79 (9) (a) 1. The department shall administer an employment and training program for recipients under the food stamp program and may contract under s. 49.78 with county departments under ss. 46.215, 46.22, and 46.23, multicounty consortia, and with tribal governing bodies to carry out the administrative functions. The department may contract, or a county department, multicounty consortium, or tribal governing body may subcontract, with a Wisconsin Works agency or another provider to administer the employment and training program under this subsection. Except as provided in subds. 2. and 3., the department may require able individuals who are 18 to 60 years of age who are not participants in a Wisconsin Works employment position to participate in the employment and training program under this subsection.
