SB400,98,324
2. A child who is under 6 years of age and whose family income does not exceed
25155% of the poverty line for a family the size of the child's family, except that if a
1waiver under par. (j) or a change in the approved state plan under s. 49.46
(1) (1g) 2(am) 2. is in effect, the income limit is 185% of the poverty line for a family the size
3of the child's family in each state fiscal year after the 1994-95 state fiscal year.
SB400, s. 216
4Section
216. 49.47 (4) (j) of the statutes is amended to read:
SB400,98,105
49.47
(4) (j) If the change in the approved state plan under s. 49.46
(1) (1g) (am)
62. is denied, the department shall request a waiver from the secretary of the federal
7department of health and human services to allow the use of federal matching funds
8to provide medical assistance coverage under par. (am) 1. and 2. to individuals whose
9family incomes do not exceed 185% of the poverty line in each state fiscal year after
10the 1994-95 state fiscal year.
SB400, s. 217
11Section
217. 49.471 (3) (a) 1., 2. and 3. of the statutes are amended to read:
SB400,98,1912
49.471
(3) (a) 1. Notwithstanding ss. 49.46
(1) (1g), 49.465, 49.47 (4), and
1349.665 (4), if the amendments to the state plan under sub. (2) are approved and a
14waiver under sub. (2) that is substantially consistent with the provisions of this
15section, excluding sub. (2m), is granted and in effect, an individual described in sub.
16(4) (a) or (b) or (5) is not eligible under s. 49.46, 49.465, 49.47, or 49.665 for Medical
17Assistance or BadgerCare health program benefits. The eligibility of an individual
18described in sub. (4) (a) or (b) or (5) for Medical Assistance benefits shall be
19determined under this section.
SB400,98,2220
2. Notwithstanding subd. 1., an individual who is eligible for
medical
21assistance Medical Assistance under s. 49.46
(1) (1g) (a) 3. or 4. may not receive
22benefits under this section.
SB400,99,223
3. Notwithstanding subd. 1., an individual described in sub. (4) (a) or (b) or (5)
24who is eligible for
medical assistance Medical Assistance under s. 49.46
(1) (1g) (a)
15., 6m., 14., 14m., or 15. or (d) or 49.47 (4) (a) or (as) may receive
medical assistance 2Medical Assistance benefits under this section or under s. 49.46 or 49.47.
SB400, s. 218
3Section
218. 49.471 (4) (a) 7. of the statutes is amended to read:
SB400,99,64
49.471
(4) (a) 7. Individuals who qualify for a
medical assistance Medical
5Assistance eligibility extension under s. 49.46
(1) (1g) (c), (cg), or (co) when their
6income increases above the poverty line.
SB400, s. 219
7Section
219. 49.4715 of the statutes is created to read:
SB400,99,16
849.4715 Reimbursement; retroactive eligibility. If an applicant is
9determined to be eligible retroactively under s. 49.46 (1g) (b), 49.47 (4) (d), or 49.471
10and a provider bills the applicant directly for services and benefits rendered during
11the retroactive period, the provider shall, upon notification of the applicant's
12retroactive eligibility, submit claims for payment under s. 49.45 for covered services
13or benefits rendered to the recipient during the retroactive period. Upon receipt of
14payment under s. 49.45, the provider shall reimburse the recipient or other person
15who has made prior payment to the provider for services provided to the recipient
16during the retroactive eligibility period, by the amount of the prior payment made.
SB400, s. 220
17Section
220. 49.473 (2) (a) of the statutes is amended to read:
SB400,99,2018
49.473
(2) (a) The woman is not eligible for
medical assistance Medical
19Assistance under ss. 49.46
(1) (1g) and (1m), 49.465, 49.468, 49.47, 49.471, and
2049.472, and is not eligible for health care coverage under s. 49.665.
SB400, s. 221
21Section
221. 49.475 (6) of the statutes is amended to read:
SB400,99,2522
49.475
(6) Sharing information. The department of health services shall
23provide to the department of children and families, for purposes of the medical
24support liability program under s.
49.22 49.811, any information that the
25department of health services receives under this section. The department of
1children and families may allow a county child support agency under s. 59.53 (5) or
2a tribal child support agency access to the information, subject to the use and
3disclosure restrictions under s.
49.83 49.013, and shall consult with the department
4of health services regarding procedures and methods to adequately safeguard the
5confidentiality of the information provided under this subsection.
SB400, s. 222
6Section
222. 49.49 (1) (title) and (a) (intro.) of the statutes are repealed.
SB400, s. 223
7Section
223. 49.49 (1) (a) 1. to 4. of the statutes are renumbered 946.91 (2) (a)
8to (d) and amended to read:
SB400,100,119
946.91
(2) (a)
Knowingly and willfully make Intentionally makes or
cause 10causes to be made any false statement or representation of a material fact in any
11application for any
Medical Assistance benefit or payment.
SB400,100,1412
(b)
Knowingly and willfully make Intentionally makes or
cause causes to be
13made any false statement or representation of a material fact for use in determining
14rights to such eligibility for any Medical Assistance benefit or payment.
SB400,100,2115
(c) Having knowledge of the occurrence of any event affecting the initial or
16continued
right to eligibility for any
such Medical Assistance benefit or payment or
17the initial or continued
right to eligibility for any such benefit or payment of any
18other individual in whose behalf he or she has applied for or is receiving such benefit
19or payment,
conceal conceals or
fail fails to disclose such event with an intent
to 20fraudulently
to secure such benefit or payment either in a greater amount or
21quantity than is due or when no such benefit or payment is authorized.
SB400,101,222
(d) Having
made application applied to receive any
such Medical Assistance 23benefit or payment for the use and benefit of another and having received it,
24knowingly and willfully
convert such converts the benefit or payment or any part
1thereof to a use
other than for the use and
that is not for the benefit of such other
2person.
SB400, s. 224
3Section
224. 49.49 (1) (b) of the statutes is repealed.
SB400, s. 225
4Section
225. 49.49 (1) (c) of the statutes is renumbered 49.49 (1d) and
5amended to read:
SB400,101,156
49.49
(1d) Damages. If any person is convicted under
this subsection s. 946.91
7(2), the state shall have a cause of action for relief against such person in an amount
83 times the amount of actual damages sustained as a result of any excess payments
9made in connection with the offense for which the conviction was obtained. Proof by
10the state of a conviction under
this section s. 946.91 (2) in a civil action shall be
11conclusive regarding the state's right to damages and the only issue in controversy
12shall be the amount, if any, of the actual damages sustained. Actual damages shall
13consist of the total amount of excess payments, any part of which is paid by state
14funds. In any such civil action the state may elect to file a motion in expedition of
15the action. Upon receipt of the motion, the presiding judge shall expedite the action.
SB400, s. 226
16Section
226. 49.49 (2) (title) and (2) (a) (title) of the statutes are repealed.
SB400, s. 227
17Section
227
. 49.49 (2) (a) of the statutes is renumbered 946.91 (3) (a) and
18amended to read:
SB400,102,419
946.91
(3) (a)
Any person who Whoever solicits or receives
any remuneration,
20including any kickback, bribe, or rebate, directly
or
, indirectly, overtly
, or covertly,
in
21cash or in kind, money, goods, services, or any other thing of value in return for
22referring an individual to a person for the furnishing or arranging for the furnishing
23of any item or service for which payment may be made in whole or in part under a
24medical assistance Medical Assistance program, or in return for purchasing, leasing,
25ordering, or arranging for or recommending purchasing, leasing, or ordering any
1good, facility, service, or item for which payment may be made in whole or in part
2under a
medical assistance Medical Assistance program, is guilty of a Class H felony,
3except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the
4person may be fined not more than $25,000.
SB400, s. 228
5Section
228. 49.49 (2) (b) (title) of the statutes is repealed.
SB400, s. 229
6Section
229
. 49.49 (2) (b) of the statutes is renumbered 946.91 (3) (b) and
7amended to read:
SB400,102,188
946.91
(3) (b) Whoever offers or pays
any remuneration including any
9kickback, bribe, or rebate, directly
or
, indirectly, overtly
, or covertly,
in cash or in kind 10money, goods, services, or any other thing of value to any person to induce such
11person to refer an individual to a person for the furnishing or arranging for the
12furnishing of any item or service for which payment may be made in whole or in part
13under a
medical assistance Medical Assistance program, or to purchase, lease, order,
14or arrange for or recommend purchasing, leasing, or ordering any good, facility,
15service or item for which payment may be made in whole or in part under a
medical
16assistance Medical Assistance program, is guilty of a Class H felony, except that,
17notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be
18fined not more than $25,000.
SB400, s. 230
19Section
230. 49.49 (2) (c) (title) of the statutes is repealed.
SB400, s. 231
20Section
231. 49.49 (2) (c) of the statutes is renumbered 946.91 (3) (c) and
21amended to read:
SB400,102,2222
946.91
(3) (c) This subsection
shall
does not apply to
any of the following:
SB400,103,223
1. A discount or other reduction in price obtained by a provider of services or
24other entity under chs. 46 to 51 and 58 if the reduction in price is properly disclosed
1and appropriately reflected in the costs claimed or charges made by the provider or
2entity under a
medical assistance Medical Assistance program.
SB400,103,53
2.
Any An amount paid by an employer to an employee who has a bona fide
4employment relationship with such employer for employment in the provision of
5covered items or services.
SB400, s. 232
6Section
232. 49.49 (3) (title) of the statutes is repealed.
SB400, s. 233
7Section
233
. 49.49 (3) of the statutes is renumbered 946.91 (4) and amended
8to read:
SB400,103,179
946.91
(4) No person may Whoever knowingly and willfully
make makes or
10cause causes to be made, or
induce induces or
seek seeks to induce the making of, any
11false statement or representation of a material fact with respect to the conditions or
12operation of any institution or facility in order that such institution or facility may
13qualify either upon initial certification or upon recertification as a hospital, skilled
14nursing facility, intermediate care facility, or home health agency
. A person who
15violates this subsection is guilty of a Class H felony, except that, notwithstanding the
16maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than
17$25,000.
SB400, s. 234
18Section
234. 49.49 (3m) (title) of the statutes is repealed.
SB400, s. 235
19Section
235
. 49.49 (3m) (a) of the statutes is renumbered 946.91 (5), and
20946.91 (5) (intro.), (a) and (b), as renumbered, are amended to read:
SB400,104,221
946.91
(5) (intro.)
No provider may
Whoever knowingly
impose imposes upon
22a
Medical Assistance recipient charges in addition to payments received for services
23under ss. 49.45 to 49.471 or knowingly
impose imposes direct charges upon a
24recipient in lieu of obtaining payment under ss. 49.45 to 49.471
except under the
25following conditions is guilty of a Class H felony, except that, notwithstanding the
1maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than
2$25,000. This subsection does not apply to the following circumstances:
SB400,104,43
(a) Benefits or services are not provided under s. 49.46 (2) or 49.471 (11) and
4the
Medical Assistance recipient is advised of this fact prior to receiving the service.
SB400,104,145
(b)
If an An applicant is determined to be eligible retroactively under s. 49.46
6(1) (1g) (b), 49.47 (4) (d), or 49.471
and, a provider bills the applicant directly for
7services and benefits rendered during the retroactive period,
the provider shall the
8provider, upon notification of the applicant's retroactive eligibility,
submit claims 9submits a claim for payment under s. 49.45 for covered services or benefits rendered
10to the recipient during the retroactive period
. Upon receipt of payment under s.
1149.45, the provider shall reimburse, and the provider reimburses the recipient or
12other person who has made prior payment to the provider for services provided to the
13recipient during the retroactive eligibility period, by the amount of the prior payment
14made
upon receipt of payment under 49.45.
Note: Moves a provision requiring a recipient who is eligible retroactively for
medical assistance benefits to be reimbursed for any eligible payments made to a
provider.
SB400, s. 236
15Section
236. 49.49 (3m) (b) of the statutes is repealed.
SB400, s. 237
16Section
237. 49.49 (3p) (title) of the statutes is amended to read:
SB400,104,1717
49.49
(3p) (title)
Other prohibited provider charges.
SB400, s. 238
18Section
238. 49.49 (4) (title) of the statutes is repealed.
SB400, s. 239
19Section
239
. 49.49 (4) (a) and (b) of the statutes are consolidated, renumbered
20946.91 (6) and amended to read:
SB400,105,921
946.91
(6) No person Whoever, in connection with the
medical assistance 22Medical Assistance program when the cost of the services provided to the patient is
23paid for in whole or in part by the state,
may knowingly and willfully charge, solicit,
1accept or receive intentionally charges, solicits, accepts, or receives, in addition to
2any amount otherwise required to be paid under a
medical assistance Medical
3Assistance program, any gift, money, donation
, or other consideration, other than a
4charitable, religious
, or philanthropic contribution from an organization or from a
5person unrelated to the patient, as a precondition of admitting a patient to a hospital,
6skilled nursing facility
, or intermediate care facility, or as a requirement for the
7patient's continued stay in such a facility
. (b) A person who violates this subsection 8is guilty of a Class H felony, except that, notwithstanding the maximum fine specified
9in s. 939.50 (3) (h), the person may be fined not more than $25,000.
Note: Sections 227
, 229, 233
, 235, and 239 move criminal penalties relating to
medical assistance to s. 946.91. Also, see Section 461.
SB400, s. 240
10Section
240. 49.49 (7) (d) of the statutes is amended to read:
SB400,105,1811
49.49
(7) (d) A commission's imposition of an assessment described under par.
12(b), a member's payment of the assessment as described under par. (c), and
13acceptance of the payment by the commission do not constitute conduct prohibited
14under
sub. (4) 946.91 (6) or prohibited under s. DHS 106.04 (3), Wis. Adm. Code, in
15effect on May 26, 2010. It is the intent of the legislature to create a mechanism
16whereby 2 or more political subdivisions may share in the operation, use, and
17funding of a nursing home or intermediate care facility without violating
42 USC
181320a-7b (d) or
42 USC 1396a (a) (25) (C).
SB400, s. 241
19Section
241. 49.493 (1) (b) of the statutes is amended to read:
SB400,105,2120
49.493
(1) (b) "Medical benefits or assistance" means medical benefits under
21s.
49.02 49.803 or 253.05 or medical assistance.
SB400, s. 242
22Section
242. 49.496 (4) (a) of the statutes is amended to read:
SB400,106,15
149.496
(4) (a) The department may require a county department under s.
246.215, 46.22, or 46.23 or
the a tribal governing body
of a federally recognized
3American Indian tribe administering
medical assistance Medical Assistance to
4gather and provide the department with information needed to recover medical
5assistance under this section. Except as provided in par. (b), the department shall
6pay to a county department or tribal governing body an amount equal to 5% of the
7recovery collected by the department relating to a beneficiary for whom the county
8department or tribal governing body made the last determination of
medical
9assistance Medical Assistance eligibility. A county department or tribal governing
10body may use funds received under this paragraph only to pay costs incurred under
11this paragraph and, if any amount remains, to pay for improvements to functions
12required under s.
49.78 49.003 (2). The department may withhold payments under
13this paragraph for failure to comply with the department's requirements under this
14paragraph. The department shall treat payments made under this paragraph as
15costs of administration of the Medical Assistance program.
SB400, s. 243
16Section
243. Subchapter V (title) of chapter 49 [precedes 49.66] of the statutes
17is amended to read:
SB400,106,1818
CHAPTER 49
SB400,106,1919
SUBCHAPTER V
SB400,106,21
20health; OTHER SUPPORT AND MEDICAL
21block grants
SB400, s. 244
22Section
244. 49.685 (7) (a) 2. and 5. of the statutes are amended to read:
SB400,106,2523
49.685
(7) (a) 2. In determining income, only the income of the patient and
24persons responsible for the patient's support under s.
49.90 49.039 may be
25considered.
SB400,107,2
15. In determining net worth, only the net worth of the patient and persons
2responsible for the patient's support under s.
49.90
49.039 will be considered.
SB400, s. 245
3Section
245. 49.686 (1) (f) of the statutes is repealed.
Note: Repeals a definition for the term "residence", which is defined at the
beginning of the chapter, in s. 49.001 (6).
SB400, s. 246
4Section
246. 49.688 (1) (b) of the statutes is repealed.
Note: Repeals a definition for the term "poverty line", which is defined at the
beginning of the chapter, in s. 49.001 (5).
SB400, s. 247
5Section
247. 49.688 (9) (a) of the statutes is amended to read:
SB400,107,86
49.688
(9) (a) The department shall promulgate rules relating to prohibitions
7on fraud that are substantially similar to applicable provisions under s.
49.49 (1) (a) 8946.91 (2).
Note: Modifies the cross-reference for medical assistance offenses in the senior
care program statute.
SB400, s. 248
9Section
248. 49.77 (1) of the statutes is renumbered 49.77 (1) (intro.) and
10amended to read:
SB400,107,1111
49.77
(1) Definition
Definitions. (intro.) In this section
"secretary":
SB400,107,14
12(m) Notwithstanding s. 49.66 (2), "secretary" means the secretary of the U.S.
13department of health and human services or the secretary of any other federal
14agency subsequently charged with the administration of federal Title XVI.
SB400, s. 249
15Section
249. 49.77 (1) (b) of the statutes is created to read:
SB400,107,1616
49.77
(1) (b) "Essential person" has the meaning given in s. 49.46 (1c).
SB400, s. 250
17Section
250. 49.78 (title) of the statutes is renumbered 49.003 (title).
SB400, s. 251
18Section
251. 49.78 (1) (intro.) and (b) of the statutes are renumbered 49.003
19(1) (intro.) and (b).
SB400, s. 252
1Section
252. 49.78 (1) (br), (1m), (1r), (2) (b), (2m) and (2r) of the statutes, as
2created by
2011 Wisconsin Act 32, are renumbered 49.003 (1) (br), (1m), (1r), (2) (b),
3(2m) and (2r).
SB400, s. 253
4Section
253. 49.78 (1) (cr) of the statutes is repealed.
Note: Repeals a definition for the term "tribal governing body", which is created
in Section 70 of the bill.
SB400, s. 254
5Section
254. 49.78 (2) (title) and (a), (10) and (11) of the statutes, as affected
6by
2011 Wisconsin Act 32, are renumbered 49.003 (2) (title) and (a), (10) and (11).
SB400, s. 255
7Section
255. 49.78 (4) to (7) of the statutes are renumbered 49.003 (4) to (7).
SB400,108,2112
49.003
(8) (a) From the appropriations under s. 20.435 (4) (bn) and (nn) and
13subject to par. (b), the department shall provide funding to reimburse each
14multicounty consortium that contracts with the department under sub. (2) and each
15tribal governing body that contracts with the department under sub. (2m) for the
16costs of administering the income maintenance programs, including conducting
17fraud prevention activities, in accordance with the terms of the applicable contract.
18The amount of reimbursement calculated under this paragraph and par. (b) is in
19addition to any reimbursement provided to a county, multicounty consortium, or
20tribal governing body for fraud and error reduction under s.
49.019 or 49.197
or
2149.845.
SB400, s. 258
22Section
258. 49.785 (1) (intro.) of the statutes is amended to read:
SB400,109,8
149.785
(1) (intro.) Except as provided in sub. (1m) and subject to s.
49.825 249.009, if any recipient specified in sub. (1c) dies and the estate of the deceased
3recipient is insufficient to pay the funeral, burial, and cemetery expenses of the
4deceased recipient, the department or county or applicable tribal governing body or
5organization responsible for burial of the recipient shall pay, to the person
6designated by the department or county department under s. 46.215, 46.22, or 46.23
7or applicable tribal governing body or organization responsible for the burial of the
8recipient, all of the following:
SB400, s. 259
9Section
259. 49.79 (title) of the statutes is amended to read: