SB400: Bill Text

SB400, s. 221 Section 221. 49.475 (6) of the statutes is amended to read:

SB400,99,25 49.475 (6) Sharing information. The department of health services shall provide to the department of children and families, for purposes of the medical support liability program under s. 49.22 49.811, any information that the department of health services receives under this section. The department of children and families may allow a county child support agency under s. 59.53 (5) or a tribal child support agency access to the information, subject to the use and disclosure restrictions under s. 49.83 49.013, and shall consult with the department of health services regarding procedures and methods to adequately safeguard the confidentiality of the information provided under this subsection.

SB400, s. 222 Section 222. 49.49 (1) (title) and (a) (intro.) of the statutes are repealed.

SB400, s. 223 Section 223. 49.49 (1) (a) 1. to 4. of the statutes are renumbered 946.91 (2) (a) to (d) and amended to read:

SB400,100,11 946.91 (2) (a) Knowingly and willfully make Intentionally makes or cause causes to be made any false statement or representation of a material fact in any application for any Medical Assistance benefit or payment.

SB400,100,14 (b) Knowingly and willfully make Intentionally makes or cause causes to be made any false statement or representation of a material fact for use in determining rights to such eligibility for any Medical Assistance benefit or payment.

SB400,100,21 (c) Having knowledge of the occurrence of any event affecting the initial or continued right to eligibility for any such Medical Assistance benefit or payment or the initial or continued right to eligibility for any such benefit or payment of any other individual in whose behalf he or she has applied for or is receiving such benefit or payment, conceal conceals or fail fails to disclose such event with an intent to fraudulently to secure such benefit or payment either in a greater amount or quantity than is due or when no such benefit or payment is authorized.

SB400,101,2 (d) Having made application applied to receive any such Medical Assistance benefit or payment for the use and benefit of another and having received it, knowingly and willfully convert such converts the benefit or payment or any part thereof to a use other than for the use and that is not for the benefit of such other person.

SB400, s. 224 Section 224. 49.49 (1) (b) of the statutes is repealed.

SB400, s. 225 Section 225. 49.49 (1) (c) of the statutes is renumbered 49.49 (1d) and amended to read:

SB400,101,15 49.49 (1d) Damages. If any person is convicted under this subsection s. 946.91 (2), the state shall have a cause of action for relief against such person in an amount 3 times the amount of actual damages sustained as a result of any excess payments made in connection with the offense for which the conviction was obtained. Proof by the state of a conviction under this section s. 946.91 (2) in a civil action shall be conclusive regarding the state's right to damages and the only issue in controversy shall be the amount, if any, of the actual damages sustained. Actual damages shall consist of the total amount of excess payments, any part of which is paid by state funds. In any such civil action the state may elect to file a motion in expedition of the action. Upon receipt of the motion, the presiding judge shall expedite the action.

SB400, s. 226 Section 226. 49.49 (2) (title) and (2) (a) (title) of the statutes are repealed.

SB400, s. 227 Section 227 . 49.49 (2) (a) of the statutes is renumbered 946.91 (3) (a) and amended to read:

SB400,102,4 946.91 (3) (a) Any person who Whoever solicits or receives any remuneration, including any kickback, bribe, or rebate, directly or , indirectly, overtly, or covertly, in cash or in kind, money, goods, services, or any other thing of value in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a medical assistance Medical Assistance program, or in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under a medical assistance Medical Assistance program, is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.

SB400, s. 228 Section 228. 49.49 (2) (b) (title) of the statutes is repealed.

SB400, s. 229 Section 229 . 49.49 (2) (b) of the statutes is renumbered 946.91 (3) (b) and amended to read:

SB400,102,18 946.91 (3) (b) Whoever offers or pays any remuneration including any kickback, bribe, or rebate, directly or , indirectly, overtly, or covertly, in cash or in kind money, goods, services, or any other thing of value to any person to induce such person to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a medical assistance Medical Assistance program, or to purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any good, facility, service or item for which payment may be made in whole or in part under a medical assistance Medical Assistance program, is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.

SB400, s. 230 Section 230. 49.49 (2) (c) (title) of the statutes is repealed.

SB400, s. 231 Section 231. 49.49 (2) (c) of the statutes is renumbered 946.91 (3) (c) and amended to read:

SB400,102,22 946.91 (3) (c) This subsection shall does not apply to any of the following:

SB400,103,2 1. A discount or other reduction in price obtained by a provider of services or other entity under chs. 46 to 51 and 58 if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity under a medical assistance Medical Assistance program.

SB400,103,5 2. Any An amount paid by an employer to an employee who has a bona fide employment relationship with such employer for employment in the provision of covered items or services.

SB400, s. 232 Section 232. 49.49 (3) (title) of the statutes is repealed.

SB400, s. 233 Section 233 . 49.49 (3) of the statutes is renumbered 946.91 (4) and amended to read:

SB400,103,17 946.91 (4) No person may Whoever knowingly and willfully make makes or cause causes to be made, or induce induces or seek seeks to induce the making of, any false statement or representation of a material fact with respect to the conditions or operation of any institution or facility in order that such institution or facility may qualify either upon initial certification or upon recertification as a hospital, skilled nursing facility, intermediate care facility, or home health agency . A person who violates this subsection is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.

SB400, s. 234 Section 234. 49.49 (3m) (title) of the statutes is repealed.

SB400, s. 235 Section 235 . 49.49 (3m) (a) of the statutes is renumbered 946.91 (5), and 946.91 (5) (intro.), (a) and (b), as renumbered, are amended to read:

SB400,104,2 946.91 (5) (intro.) No provider may Whoever knowingly impose imposes upon a Medical Assistance recipient charges in addition to payments received for services under ss. 49.45 to 49.471 or knowingly impose imposes direct charges upon a recipient in lieu of obtaining payment under ss. 49.45 to 49.471 except under the following conditions is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000. This subsection does not apply to the following circumstances:

SB400,104,4 (a) Benefits or services are not provided under s. 49.46 (2) or 49.471 (11) and the Medical Assistance recipient is advised of this fact prior to receiving the service.

SB400,104,14 (b) If an An applicant is determined to be eligible retroactively under s. 49.46 (1) (1g) (b), 49.47 (4) (d), or 49.471 and, a provider bills the applicant directly for services and benefits rendered during the retroactive period, the provider shall the provider, upon notification of the applicant's retroactive eligibility, submit claims submits a claim for payment under s. 49.45 for covered services or benefits rendered to the recipient during the retroactive period. Upon receipt of payment under s. 49.45, the provider shall reimburse, and the provider reimburses the recipient or other person who has made prior payment to the provider for services provided to the recipient during the retroactive eligibility period, by the amount of the prior payment made 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 Section 236. 49.49 (3m) (b) of the statutes is repealed.

SB400, s. 237 Section 237. 49.49 (3p) (title) of the statutes is amended to read:

SB400,104,17 49.49 (3p) (title) Other prohibited provider charges.

SB400, s. 238 Section 238. 49.49 (4) (title) of the statutes is repealed.

SB400, s. 239 Section 239 . 49.49 (4) (a) and (b) of the statutes are consolidated, renumbered 946.91 (6) and amended to read:

SB400,105,9 946.91 (6) No person Whoever, in connection with the medical assistance Medical Assistance program when the cost of the services provided to the patient is paid for in whole or in part by the state, may knowingly and willfully charge, solicit, accept or receive intentionally charges, solicits, accepts, or receives, in addition to any amount otherwise required to be paid under a medical assistance Medical Assistance program, any gift, money, donation, or other consideration, other than a charitable, religious, or philanthropic contribution from an organization or from a person unrelated to the patient, as a precondition of admitting a patient to a hospital, skilled nursing facility, or intermediate care facility, or as a requirement for the patient's continued stay in such a facility. (b) A person who violates this subsection is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in 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 Section 240. 49.49 (7) (d) of the statutes is amended to read:

SB400,105,18 49.49 (7) (d) A commission's imposition of an assessment described under par. (b), a member's payment of the assessment as described under par. (c), and acceptance of the payment by the commission do not constitute conduct prohibited under sub. (4) 946.91 (6) or prohibited under s. DHS 106.04 (3), Wis. Adm. Code, in effect on May 26, 2010. It is the intent of the legislature to create a mechanism whereby 2 or more political subdivisions may share in the operation, use, and funding of a nursing home or intermediate care facility without violating 42 USC 1320a-7b (d) or 42 USC 1396a (a) (25) (C).

SB400, s. 241 Section 241. 49.493 (1) (b) of the statutes is amended to read:

SB400,105,21 49.493 (1) (b) "Medical benefits or assistance" means medical benefits under s. 49.02 49.803 or 253.05 or medical assistance.

SB400, s. 242 Section 242. 49.496 (4) (a) of the statutes is amended to read:

SB400,106,15 49.496 (4) (a) The department may require a county department under s. 46.215, 46.22, or 46.23 or the a tribal governing body of a federally recognized American Indian tribe administering medical assistance Medical Assistance to gather and provide the department with information needed to recover medical assistance under this section. Except as provided in par. (b), the department shall pay to a county department or tribal governing body an amount equal to 5% of the recovery collected by the department relating to a beneficiary for whom the county department or tribal governing body made the last determination of medical assistance Medical Assistance eligibility. A county department or tribal governing body may use funds received under this paragraph only to pay costs incurred under this paragraph and, if any amount remains, to pay for improvements to functions required under s. 49.78 49.003 (2). The department may withhold payments under this paragraph for failure to comply with the department's requirements under this paragraph. The department shall treat payments made under this paragraph as costs of administration of the Medical Assistance program.

SB400, s. 243 Section 243. Subchapter V (title) of chapter 49 [precedes 49.66] of the statutes is amended to read:

SB400,106,18 CHAPTER 49

SB400,106,19 SUBCHAPTER V

SB400,106,21 health; OTHER SUPPORT AND MEDICAL block grants

SB400, s. 244 Section 244. 49.685 (7) (a) 2. and 5. of the statutes are amended to read:

SB400,106,25 49.685 (7) (a) 2. In determining income, only the income of the patient and persons responsible for the patient's support under s. 49.90 49.039 may be considered.

SB400,107,2 5. In determining net worth, only the net worth of the patient and persons responsible for the patient's support under s. 49.90 49.039 will be considered.

SB400, s. 245 Section 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 Section 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 Section 247. 49.688 (9) (a) of the statutes is amended to read:

SB400,107,8 49.688 (9) (a) The department shall promulgate rules relating to prohibitions on fraud that are substantially similar to applicable provisions under s. 49.49 (1) (a) 946.91 (2).

Note: Modifies the cross-reference for medical assistance offenses in the senior care program statute.

SB400, s. 248 Section 248. 49.77 (1) of the statutes is renumbered 49.77 (1) (intro.) and amended to read:

SB400,107,11 49.77 (1) Definition Definitions. (intro.) In this section "secretary":

SB400,107,14 (m) Notwithstanding s. 49.66 (2), "secretary" means the secretary of the U.S. department of health and human services or the secretary of any other federal agency subsequently charged with the administration of federal Title XVI.

SB400, s. 249 Section 249. 49.77 (1) (b) of the statutes is created to read:

SB400,107,16 49.77 (1) (b) "Essential person" has the meaning given in s. 49.46 (1c).

SB400, s. 250 Section 250. 49.78 (title) of the statutes is renumbered 49.003 (title).

SB400, s. 251 Section 251. 49.78 (1) (intro.) and (b) of the statutes are renumbered 49.003 (1) (intro.) and (b).

SB400, s. 252 Section 252. 49.78 (1) (br), (1m), (1r), (2) (b), (2m) and (2r) of the statutes, as created by 2011 Wisconsin Act 32, are renumbered 49.003 (1) (br), (1m), (1r), (2) (b), (2m) and (2r).

SB400, s. 253 Section 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 Section 254. 49.78 (2) (title) and (a), (10) and (11) of the statutes, as affected by 2011 Wisconsin Act 32, are renumbered 49.003 (2) (title) and (a), (10) and (11).

SB400, s. 255 Section 255. 49.78 (4) to (7) of the statutes are renumbered 49.003 (4) to (7).

SB400, s. 256 Section 256. 49.78 (8) (title) and (b) of the statutes, as affected by 2011 Wisconsin Act 32, are renumbered 49.003 (8) (title) and (b).

SB400, s. 257 Section 257. 49.78 (8) (a) of the statutes, as affected by 2011 Wisconsin Act 32, is renumbered 49.003 (8) (a) and amended to read:

SB400,108,21 49.003 (8) (a) From the appropriations under s. 20.435 (4) (bn) and (nn) and subject to par. (b), the department shall provide funding to reimburse each multicounty consortium that contracts with the department under sub. (2) and each tribal governing body that contracts with the department under sub. (2m) for the costs of administering the income maintenance programs, including conducting fraud prevention activities, 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. 49.019 or 49.197 or 49.845.

SB400, s. 258 Section 258. 49.785 (1) (intro.) of the statutes is amended to read:

SB400,109,8 49.785 (1) (intro.) Except as provided in sub. (1m) and subject to s. 49.825 49.009, if any recipient specified in sub. (1c) dies and the estate of the deceased recipient is insufficient to pay the funeral, burial, and cemetery expenses of the deceased recipient, the department or county or applicable tribal governing body or organization responsible for burial of the recipient shall pay, to the person designated by the department or county department under s. 46.215, 46.22, or 46.23 or applicable tribal governing body or organization responsible for the burial of the recipient, all of the following:

SB400, s. 259 Section 259. 49.79 (title) of the statutes is amended to read:

SB400,109,11 49.79 (title) Food stamp Supplemental nutrition assistance program administration.

SB400, s. 260 Section 260. 49.79 (1) (intro.) of the statutes is amended to read:

SB400,109,14 49.79 (1) Definitions. (intro.) In this section and ss. 49.793, 49.796, and 49.797:

SB400, s. 261 Section 261. 49.79 (1) (c) of the statutes is renumbered 49.79 (1) (fg) and amended to read:

SB400,109,19 49.79 (1) (fg) "Food stamp Supplemental nutrition assistance program" means the federal food stamp supplemental nutrition assistance program under 7 USC 2011 to 2036.

SB400, s. 262 Section 262. 49.79 (1) (e) of the statutes, as created by 2011 Wisconsin Act 32, is amended to read:

SB400,109,23 49.79 (1) (e) "Multicounty consortium" has the meaning given in s. 49.78 49.003 (1) (br).

SB400, s. 263 Section 263. 49.79 (2), (5) (a), (6), (7), (8m) (a) and (b) and (9) (a) 2., 3. and 4. of the statutes are amended to read:

SB400,110,4 49.79 (2) Denial of eligibility. An individual who fails to comply with the work requirements of the employment and training program under sub. (9) is ineligible to participate in the food stamp supplemental nutrition assistance program as specified under sub. (9) (b).

SB400,110,20 (5) (a) The department shall require an applicant for, or recipient under, the food stamp supplemental nutrition assistance program to state in writing whether the applicant or recipient or any member of the applicant's or recipient's household has been convicted, in any state or federal court of a felony that has as an element possession, use, or distribution of a controlled substance. The department shall require an applicant or recipient, or member of the applicant's or recipient's household to submit to a test for use of a controlled substance as a condition of continued eligibility if, after August 22, 1996, but not more than 5 years prior to the date the written statement is made, the applicant or recipient or the member of the applicant's or recipient's household was convicted in any state or federal court of a felony that had as an element possession, use, or distribution of a controlled substance. If the test results are positive with respect to any individual, the department may not consider the needs of that individual in determining the household's eligibility for the food stamp supplemental nutrition assistance program for at least 12 months from the date of the test. The department shall, however, consider the income and resources of that individual to be available to the household.

SB400,110,24 (6) Ineligibility for fugitive felons. No person is eligible for the food stamp supplemental nutrition assistance program in a month in which that person is a fugitive felon under 7 USC 2015 (k) (1) or is violating a condition of probation, extended supervision, or parole imposed by a state or federal court.

SB400,111,8 (7) Simplified food stamp supplemental nutrition assistance program. The department shall develop a simplified food stamp supplemental nutrition assistance program that meets all of the requirements under P.L. 104-193, section 854 42 USC 2035, and shall submit the plan to the secretary of the federal department of agriculture for approval. If the secretary of the federal department of agriculture approves the plan, the department shall submit the plan to the secretary of administration for approval. If the secretary of administration approves the plan, the department may implement the plan.

SB400,111,12 (8m) (a) The department shall allow a prisoner who is applying for the food stamp supplemental nutrition assistance program from a correctional institution in anticipation of being released from the institution to use the address of the correctional institution as his or her address on the application.