AB40: Bill Text

AB40,657,23 49.45 (5) (b) 2. (intro.) If a recipient requests a hearing within the timely notice period specified in 42 CFR 431.231 (c), medical assistance coverage shall not be suspended, reduced, or discontinued until a decision is rendered after the hearing but medical assistance payments made pending the hearing decision may be recovered by the department if the contested decision or failure to act is upheld. If a county department is responsible for making made the medical assistance determination, the department shall notify the county department of the county in which the recipient resides that the recipient has requested a hearing. Medical assistance coverage shall be suspended, reduced, or discontinued if:

AB40, s. 1427 Section 1427. 49.45 (5m) (am) of the statutes is amended to read:

AB40,658,7 49.45 (5m) (am) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gm), (o), (w) and (xc), the department shall distribute not more than $5,000,000 in each fiscal year, to provide supplemental funds to rural hospitals that, as determined by the department, have high utilization of inpatient services by patients whose care is provided from governmental sources, except that the department may not distribute funds to a rural hospital to the extent that the distribution would exceed any limitation under 42 USC 1396b (i) (3).

AB40, s. 1428 Section 1428. 49.45 (6m) (a) 6. of the statutes is amended to read:

AB40,658,12 49.45 (6m) (a) 6. "Resource Utilization Groupings III" means a comparative resource utilization grouping that classifies each facility resident based on information obtained from performing, for the resident, a minimum data set assessment developed by the federal Centers for Medicare and Medicaid Services.

AB40, s. 1429 Section 1429. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:

AB40,658,20 49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this subsection made under s. 20.435 (4) (b), (gm), (o), (pa), or (w) shall, except as provided in pars. (bg), (bm), and (br), be determined according to a prospective payment system updated annually by the department. The payment system shall implement standards that are necessary and proper for providing patient care and that meet quality and safety standards established under subch. II of ch. 50 and ch. 150. The payment system shall reflect all of the following:

AB40, s. 1430 Section 1430. 49.45 (6m) (ag) 3p. a. of the statutes is amended to read:

AB40,658,24 49.45 (6m) (ag) 3p. a. The system shall may incorporate acuity measurements under the most recent Resource Utilization Groupings III methodology to determine factors for case-mix adjustment.

AB40, s. 1431 Section 1431. 49.45 (6tw) of the statutes is amended to read:

AB40,659,7 49.45 (6tw) Payments to city health departments. From the appropriation account under s. 20.435 (7) (b), if the department selects the payment procedure under s. 49.45 (52) (a), the department may make payments to local health departments, as defined under s. 250.01 (4) (a) 3. Payment under this subsection to such a local health department may not exceed on an annualized basis payment made by the department to the local health department under s. 49.45 (6t), 2003 stats., for services provided by the local health department in 2002.

AB40, s. 1432 Section 1432. 49.45 (6v) (b) of the statutes is amended to read:

AB40,659,14 49.45 (6v) (b) The department shall, each year, submit to the joint committee on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that provides information on the utilization of beds by recipients of medical assistance in facilities and a discussion and detailed projection of the likely balances, expenditures, encumbrances and carry over of currently appropriated amounts in the appropriation accounts under s. 20.435 (4) (b), (gm), and (o).

AB40, s. 1433 Section 1433. 49.45 (6x) of the statutes is repealed.

AB40, s. 1434 Section 1434. 49.45 (6y) (a) of the statutes is amended to read:

AB40,660,2 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), the department may distribute funding in each fiscal year to provide supplemental payment to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2).

AB40, s. 1435 Section 1435. 49.45 (6z) (a) (intro.) of the statutes is amended to read:

AB40,660,15 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), the department may distribute funding in each fiscal year to supplement payment for services to hospitals that enter into indigent care agreements, in accordance with the approved state plan for services under 42 USC 1396a, with relief agencies that administer the medical relief block grant under this chapter, if the department determines that the hospitals serve a disproportionate number of low-income patients with special needs. If no medical relief block grant under this chapter is awarded or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into indigent care agreements. The department may not distribute funds under this subsection to the extent that the distribution would do any of the following:

AB40, s. 1436 Section 1436. 49.45 (8) (b) of the statutes is amended to read:

AB40,660,21 49.45 (8) (b) Reimbursement under s. 20.435 (4) (b), (gm), (o), and (w) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under par. (c).

AB40, s. 1437 Section 1437. 49.45 (8r) of the statutes is amended to read:

AB40,661,4 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. 36.60 37.60 (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.

AB40, s. 1438 Section 1438. 49.45 (19) (bm) of the statutes is amended to read:

AB40,661,8 49.45 (19) (bm) The department or the county department under s. 46.215 or 46.22 shall notify applicants of the requirements of this subsection at the time of application.

AB40, s. 1439 Section 1439. 49.45 (24m) (intro.) of the statutes is amended to read:

AB40,661,14 49.45 (24m) (intro.) From the appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), in order to test the feasibility of instituting a system of reimbursement for providers of home health care and personal care services for medical assistance recipients that is based on competitive bidding, the department shall:

AB40, s. 1440 Section 1440. 49.45 (24r) (a) of the statutes is renumbered 49.45 (24r).

AB40, s. 1441 Section 1441. 49.45 (24r) (b) of the statutes is repealed.

AB40, s. 1442 Section 1442. 49.45 (34) of the statutes is amended to read:

AB40,661,22 49.45 (34) Medical assistance manual. The department shall prepare a medical assistance manual that is clear, comprehensive and consistent with this subchapter and 42 USC 1396a to 1396u and shall, no later than July 1, 1992, provide the manual to counties for use by county employees who administer the medical assistance program.

AB40, s. 1443 Section 1443. 49.45 (51) (a) of the statutes is amended to read:

AB40,662,6 49.45 (51) (a) By November 1 annually, the department shall provide to the department of revenue information concerning the estimated amounts of supplements payable from the appropriation accounts under s. 20.435 (4) (b) and (gm) to specific local governmental units for the provision of transportation for medical care, as specified under s. 49.46 (2) (b) 3., during the fiscal year. Beginning November 1, 2004, the information that the department provides under this paragraph shall include any adjustments necessary to reflect actual claims submitted by service providers in the previous fiscal year.

AB40, s. 1444 Section 1444. 49.45 (52) (title) of the statutes is amended to read:

AB40,662,8 49.45 (52) (title) Payment adjustments ; federal funding for certain services.

AB40, s. 1445 Section 1445. 49.45 (52) of the statutes is renumbered 49.45 (52) (a) 1. and amended to read:

AB40,662,24 49.45 (52) (a) 1. Beginning on January 1, 2003 If the department provides the notice under par. (c) selecting the payment procedure in this paragraph, 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 paragraph shall include the state share of the payments. The total of any payment adjustments under this subsection paragraph and Medical Assistance payments made from appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

AB40, s. 1446 Section 1446. 49.45 (52) (a) 2. of the statutes is created to read:

AB40,663,4 49.45 (52) (a) 2. The department may require a county department or local health department to submit a certified cost report that meets the requirements of the federal department of health and human services for covered services described in subd. 1.

AB40, s. 1447 Section 1447. 49.45 (52) (b) of the statutes is created to read:

AB40,663,7 49.45 (52) (b) If the department provides the notice under par. (c) selecting the payment procedure in this paragraph, all of the following apply:

AB40,663,13 1. Annually, a county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437 shall submit a certified cost report that meets the requirements of the federal department of health and human services 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.

AB40,663,17 2. For services described under subd. 1., the department shall base the amount of a claim for federal medical assistance funds on certified cost reports submitted by county departments under subd. 1. to the extent the reports comply with federal requirements.

AB40,663,20 3. The department shall pay county departments a percentage of the federal funds claimed under subd. 2. for services described under subd. 1., which percentage is established in the most recent biennial budget.

AB40,663,24 4. The department may pay a local health department, as defined in s. 250.01 (4), that submits certified cost reports for services described under subd. 1. a percentage of the federal funds claimed for those services, which percentage is established in the most recent biennial budget.

AB40, s. 1448 Section 1448. 49.45 (52) (c) of the statutes is created to read:

AB40,664,5 49.45 (52) (c) The department shall select a payment procedure under either par. (a) or (b) and may change which procedure under par. (a) or (b) is selected. The department shall notify each county department and local health department, as applicable, of the selected payment procedure before the date on which payment for services is made under that selected or newly selected procedure.

AB40, s. 1449 Section 1449. 49.45 (53) of the statutes is amended to read:

AB40,664,10 49.45 (53) Payments for certain services. Beginning on January 1, 2003, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payments to providers for covered services under ss. 49.46 (2) (a) 4. d. and (b) 6. j. and m. and 49.471 (11) (f) that are provided before January 1, 2012.

AB40, s. 1450 Section 1450. 49.46 (1) (a) 4. of the statutes is amended to read:

AB40,664,13 49.46 (1) (a) 4. Any person receiving benefits under s. 49.77 49.39 or federal Title XVI.

AB40, s. 1451 Section 1451. 49.46 (1) (a) 4m. of the statutes is amended to read:

AB40,664,15 49.46 (1) (a) 4m. Any child for whom a payment is made under s. 49.775 49.395.

AB40, s. 1452 Section 1452. 49.46 (1) (d) 4. of the statutes is amended to read:

AB40,664,18 49.46 (1) (d) 4. A child who meets the conditions under 42 USC 1396a (e) (3) shall be considered a recipient of benefits under s. 49.77 49.39 or federal Title XVI.

AB40, s. 1453 Section 1453. 49.46 (1) (e) of the statutes is amended to read:

AB40,664,25 49.46 (1) (e) If an application under s. 49.47 (3) shows that the individual meets the income limits under s. 49.19 or meets the income and resource requirements under federal Title XVI or s. 49.77 49.39, or that the individual is an essential person, an accommodated person, or a patient in a public medical institution, the individual shall be granted the benefits enumerated under sub. (2) whether or not the individual requests or receives a grant of any of such aids.

AB40, s. 1454 Section 1454. 49.465 (2) (a) of the statutes is amended to read:

AB40,665,5 49.465 (2) (a) If the woman applies for benefits under s. 49.46 or 49.47 within the time required under sub. (4), the day on which the department or the county department under s. 46.215, 46.22 or 46.23 determines whether the woman is eligible for benefits under s. 49.46 or 49.47.

AB40, s. 1455 Section 1455. 49.468 (1) (b) of the statutes is amended to read:

AB40,665,23 49.468 (1) (b) For an elderly or disabled individual who is entitled to coverage under part Part A of medicare Medicare, entitled to coverage under part Part B of medicare Medicare, and who does not meet the eligibility criteria for medical assistance Medical Assistance under s. 49.46 (1), 49.465, 49.47 (4), or 49.471 but meets the limitations on income and resources under par. (d), medical assistance Medical Assistance shall pay the deductible and coinsurance portions of medicare Medicare services under 42 USC 1395 to 1395zz which that are not paid under 42 USC 1395 to 1395zz, including those medicare Medicare services that are not included in the approved state plan for services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under part Part A of medicare Medicare. Payment of coinsurance for a service under part Part B of medicare Medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, and payment of coinsurance for a service under Part A of Medicare may not exceed the allowable charge for the service under medical assistance Medical Assistance minus the medicare Medicare payment.

AB40, s. 1456 Section 1456. 49.468 (1) (c) of the statutes is amended to read:

AB40,666,13 49.468 (1) (c) For an elderly or disabled individual who is only entitled to coverage under part Part A of medicare Medicare and who does not meet the eligibility criteria for medical assistance Medical Assistance under s. 49.46 (1), 49.465, 49.47 (4), or 49.471 but meets the limitations on income and resources under par. (d), medical assistance Medical Assistance shall pay the deductible and coinsurance portions of medicare Medicare services under 42 USC 1395 to 1395i which that are not paid under 42 USC 1395 to 1395i, including those medicare Medicare services that are not included in the approved state plan for services under 42 USC 1396; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty for premiums under part Part A of medicare Medicare, if applicable. Payment of coinsurance for a service under Part A of Medicare may not exceed the allowable charge for the service under Medical Assistance minus the Medicare payment.

AB40, s. 1457 Section 1457. 49.47 (3) (b) of the statutes is amended to read:

AB40,666,17 49.47 (3) (b) The agency department shall promptly review the application and shall issue a certificate to the individual showing eligibility when eligibility has been established.

AB40, s. 1458 Section 1458. 49.47 (4) (c) 1. of the statutes is amended to read:

AB40,667,4 49.47 (4) (c) 1. Except as provided in par. (am) and as limited by subd. 3., eligibility exists if income does not exceed 133 1/3% of the maximum aid to families with dependent children payment under s. 49.19 (11) for the applicant's family size or the combined benefit amount available under supplemental security income under 42 USC 1381 to 1383c and state supplemental aid under s. 49.77 49.39, whichever is higher. In this subdivision "income" includes earned or unearned income that would be included in determining eligibility for the individual or family under s. 49.19 or 49.77 49.39, or for the aged, blind or disabled under 42 USC 1381 to 1385. "Income" does not include earned or unearned income which would be excluded in determining eligibility for the individual or family under s. 49.19 or 49.77 49.39, or for the aged, blind or disabled individual under 42 USC 1381 to 1385.

AB40, s. 1459 Section 1459. 49.47 (4) (i) 1. of the statutes is amended to read:

AB40,667,19 49.47 (4) (i) 1. The department shall request a waiver from the secretary of the federal department of health and human services to permit the application of subd. 2. The waiver shall request approval to implement the waiver on a statewide basis, unless the department of health services determines that statewide implementation of the waiver would present an obstacle to the approval of the waiver by the secretary of the federal department of health and human services, in which case the waiver shall request approval to implement the waiver in 48 pilot counties to be selected by the department of health services. Within 30 days after August 12, 1993, the department of regulation and licensing safety and professional services shall notify funeral directors licensed under ch. 445, cemetery associations, as defined in s. 157.061 (1r), and cemetery authorities, as defined in s. 157.061 (2), of the terms of the waiver required to be requested under this subdivision. If the waiver is approved by the secretary of the federal department of health and human services and if the waiver remains in effect, subd. 2. shall apply.

AB40, s. 1460 Section 1460. 49.471 (5) (b) 3. a. of the statutes is amended to read:

AB40,667,25 49.471 (5) (b) 3. a. If the woman or child applies for benefits under sub. (4) within the time required under par. (d), the benefits specified in subd. 1. or 2., whichever is applicable, end on the day on which the department or the county department under s. 46.215, 46.22, or 46.23 determines whether the woman or child is eligible for benefits under sub. (4).

AB40, s. 1461 Section 1461. 49.471 (7) (c) 4. of the statutes is amended to read:

AB40,668,3 49.471 (7) (c) 4. Not include in the calculation any income of an individual receiving benefits under s. 49.77 49.39 or federal Title XVI.

AB40, s. 1462 Section 1462. 49.472 (4) (a) 2. a. of the statutes is amended to read:

AB40,668,8 49.472 (4) (a) 2. a. A maintenance allowance established by the department by rule. The maintenance allowance may not be less than the sum of $20, the federal supplemental security income payment level determined under 42 USC 1382 (b) and the state supplemental payment determined under s. 49.77 (2m) 49.39 (2m).

AB40, s. 1463 Section 1463. 49.472 (6) (a) of the statutes is amended to read:

AB40,668,15 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account accounts under s. 20.435 (4) (b), (gm), or (w), the department shall, on the part of an individual who is eligible for medical assistance under sub. (3), pay premiums for or purchase individual coverage offered by the individual's employer if the department determines that paying the premiums for or purchasing the coverage will not be more costly than providing medical assistance.

AB40, s. 1464 Section 1464. 49.472 (6) (b) of the statutes is amended to read:

AB40,668,20 49.472 (6) (b) If federal financial participation is available, from the appropriation account accounts under s. 20.435 (4) (b), (gm), or (w), the department may pay medicare Part A and Part B premiums for individuals who are eligible for medicare and for medical assistance under sub. (3).

AB40, s. 1465 Section 1465. 49.473 (2) (intro.) of the statutes is amended to read:

AB40,668,24 49.473 (2) (intro.) 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:

AB40, s. 1466 Section 1466. 49.473 (3) (intro.) of the statutes is amended to read:

AB40,669,5 49.473 (3) (intro.) Prior to applying to the department or a county department for medical assistance, a woman is eligible for medical assistance as provided under sub. (5) beginning on the date on which a qualified entity determines, on the basis of preliminary information, that the woman meets the requirements specified in sub. (2) and ending on one of the following dates:

AB40, s. 1467 Section 1467. 49.473 (3) (a) of the statutes is amended to read:

AB40,669,10 49.473 (3) (a) If the woman applies to the department or a county department for medical assistance within the time limit required under sub. (4), the day on which the department or county department determines whether the woman meets the requirements under sub. (2).

AB40, s. 1468 Section 1468. 49.473 (3) (b) of the statutes is amended to read:

AB40,669,15 49.473 (3) (b) If the woman does not apply to the department or county department for medical assistance within the time limit required under sub. (4), the last day of the month following the month in which the qualified entity determines that the woman is eligible for medical assistance.

AB40, s. 1469 Section 1469. 49.473 (4) of the statutes is amended to read:

AB40,669,20 49.473 (4) A woman who a qualified entity determines under sub. (3) is eligible for medical assistance shall apply to the department or county department no later than the last day of the month following the month in which the qualified entity determines that the woman is eligible for medical assistance.