49.45
(6m) (ar) 1. a. The department shall establish standards for payment of allowable direct care costs under par. (am) 1. bm., for facilities that do not primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state and separate standards for payment of allowable direct care costs, for facilities that primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state. The standards shall be adjusted by the department for regional labor cost variations. The department shall treat as a single labor region the counties of Dane, Dodge, Iowa, Columbia,
Richland, Sauk, and Rock and shall adjust payment so that the direct care cost targets of facilities in Dane, Iowa, Columbia, and Sauk counties are not reduced as a result of including facilities in Dodge
, Richland, and Rock Counties in this labor region. For facilities in Douglas, Dunn, Pierce, and St. Croix counties, the department shall perform the adjustment by use of the wage index that is used by the federal department of health and human services for hospital reimbursement under
42 USC 1395 to
1395ggg.
20,1046
Section
1046
. 49.45 (23) (a) of the statutes is amended to read:
49.45
(23) (a) The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to conduct a demonstration project to provide health care coverage
for basic primary and preventive care to adults who are under the age of 65, who have family incomes not to exceed
200 100 percent of the poverty line
before application of the 5 percent income disregard under 42 CFR 435.603 (d) and except as provided in s. 49.471 (4m), and who are not otherwise eligible for medical assistance under this subchapter, the Badger Care health care program under s. 49.665, or Medicare under
42 USC 1395 et seq. If the department creates a policy under sub. (2m) (c) 10., this paragraph does not apply to the extent that it conflicts with the policy.
20,1047
Section
1047. 49.45 (23) (a) of the statutes, as affected by
2011 Wisconsin Act 32 and 2013 Wisconsin Act .... (this act), is repealed and recreated to read:
49.45
(23) (a) The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to conduct a demonstration project to provide health care coverage to adults who are under the age of 65, who have family incomes not to exceed 100 percent of the poverty line before application of the 5 percent income disregard under
42 CFR 435.603 (d) and except as provided in s. 49.471 (4m), and who are not otherwise eligible for medical assistance under this subchapter, the Badger Care health care program under s. 49.665, or Medicare under
42 USC 1395 et seq.
20,1048
Section
1048
. 49.45 (23) (b) of the statutes is amended to read:
49.45 (23) (b) If the waiver is granted and in effect, the department may promulgate rules defining the health care benefit plan, including more specific eligibility requirements and cost-sharing requirements. Unless otherwise provided by the department by a policy created under sub. (2m) (c), cost sharing may include an annual enrollment fee, which may not exceed $75 per year. Notwithstanding s. 227.24 (3), the plan details under this subsection may be promulgated as an emergency rule under s. 227.24 without a finding of emergency. If the waiver is granted and in effect, the demonstration project under this subsection shall begin on January 1, 2009, or on the effective date of the waiver, whichever is later.
20,1049
Section
1049. 49.45 (23) (b) of the statutes, as affected by
2011 Wisconsin Act 32 and 2013 Wisconsin Act .... (this act), is repealed and recreated to read:
49.45 (23) (b) If the waiver is granted and in effect, the department may promulgate rules defining the health care benefit plan, including more specific eligibility requirements and cost-sharing requirements. Cost sharing may include an annual enrollment fee, which may not exceed $75 per year. Notwithstanding s. 227.24 (3), the plan details under this subsection may be promulgated as an emergency rule under s. 227.24 without a finding of emergency. If the waiver is granted and in effect, the demonstration project under this subsection shall begin on the effective date of the waiver.
20,1050
Section
1050. 49.45 (23) (c) of the statutes is created to read:
49.45
(23) (c) In addition to cost-sharing requirements established under par. (b), a childless adult who is eligible to receive benefits under this section; who is not disabled, pregnant, or American Indian, as Indian is defined in
42 CFR part 447, subpart A; and whose family income exceeds 133 percent of the poverty line shall pay a premium for coverage under the program under this subsection in an amount determined by the department that is based on a formula in which costs decrease for those with lower family incomes and that is no less than 3 percent of family income but no greater than 9.5 percent of family income.
20,1051
Section
1051. 49.45 (23) (d) of the statutes is created to read:
49.45 (23) (d) In determining income for purposes of eligibility under this subsection, the department shall apply s. 49.471 (7) (d) to the individual to the extent the federal department of health and human services approves, if approval is required.
20,1052
Section
1052. 49.45 (23) (e) of the statutes is created to read:
49.45
(23) (e) The department shall apply the definition of family income under s. 49.471 (1) (f) and the regulations defining household under
42 CFR 435.603 (f) to determinations of income for purposes of eligibility under this subsection.
20,1053
Section
1053. 49.45 (23) (f) of the statutes is created to read:
49.45 (23) (f) The department may provide services to individuals who are eligible under this subsection through a medical home initiative under sub. (24j).
20,1054
Section
1054. 49.45 (24j) of the statutes is created to read:
49.45 (24j) Medical home pilot projects. (a) The department may administer the medical home initiative as a service delivery mechanism to provide and coordinate care for individuals who are eligible for a Medical Assistance program under this subchapter that provides services under a fee-for-service model. The department may administer a medical home initiative to serve individuals who are members of any of the following populations:
1. Children who are in out-of-home care or are receiving adoption assistance under
42 USC 670 to
679c.
2. Pregnant women.
3. Individuals who are exiting mental health facilities or correctional facilities.
4. Individuals with a diagnosis of serious mental illness or substance abuse disorder.
5. Adults with two or more chronic medical conditions.
6. Other groups of individuals with conditions that the department determines would benefit from services through a medical home.
(b) The department shall provide to individuals through any medical home initiative administered under this subsection the benefits described under s. 49.46 (2) (a) and (b). The department may provide to individuals though any medical home initiative administered under this subsection benefits in addition to the standard plan benefits that are targeted to the population receiving services through the medical home.
(c) The department may elect to administer any medical home initiative under this subsection in a limited geographical area.
(d) The department may make an all-inclusive payment to the provider offering services through a medical home.
(e) If the federal department of health and human services approves the department's request to administer a medical home initiative, the department shall automatically enroll an individual who is eligible for a medical home initiative under this subsection in the medical home initiative. At any time after the first 6 months of enrollment in the medical home initiative, the individual who is enrolled in the medical home initiative may opt out of participation in the medical home initiative.
20,1054j
Section 1054j. 49.45 (25g) (c) of the statutes is amended to read:
49.45 (25g) (c) The department's proposal under par. (b) shall specify increases in reimbursement rates for providers that satisfy the conditions under par. (b), and shall provide for payment of a monthly per-patient care coordination fee to those providers. The department shall set the increases in reimbursement rates and the monthly per-patient care coordination fee so that together they provide sufficient incentive for providers to satisfy a condition under par. (b) 1. or 2. The proposal shall specify effective dates for the increases in reimbursement rates and the monthly per-patient care coordination fee that are no sooner than January 1, 2011. The increases in reimbursement rates and monthly per-patient care coordination fees that are not provided by the federal government shall be paid from the appropriation under. s. 20.435 (1) (am). If the department creates a policy under sub. (2m) (c) 4., this paragraph does not apply to the extent it conflicts with the policy.
20,1054k
Section 1054k. 49.45 (25g) (c) of the statutes, as affected by
2011 Wisconsin Act 32 and 2013 Wisconsin Act .... (this act), is repealed and recreated to read:
49.45 (25g) (c) The department's proposal under par. (b) shall specify increases in reimbursement rates for providers that satisfy the conditions under par. (b), and shall provide for payment of a monthly per-patient care coordination fee to those providers. The department shall set the increases in reimbursement rates and the monthly per-patient care coordination fee so that together they provide sufficient incentive for providers to satisfy a condition under par. (b) 1. or 2. The proposal shall specify effective dates for the increases in reimbursement rates and the monthly per-patient care coordination fee that are no sooner than January 1, 2011.
20,1056
Section
1056. 49.45 (30e) (d) of the statutes is created to read:
49.45 (30e) (d) Provision of services on regional basis. Notwithstanding par. (c) and subject to par. (e), in counties that elect to deliver the services under s. 49.46 (2) (b) 6. Lm. through the Medical Assistance program on a regional basis according to criteria established by the department, the department shall reimburse a provider of the services for the amount of the allowable charges for those services under the Medical Assistance program that is provided by the federal government and for the amount of the allowable charges that is not provided by the federal government.
20,1056b
Section 1056b. 49.45 (30e) (e) of the statutes is created to read:
49.45 (30e) (e) Report; release of funds. 1. Prior to implementing, and receiving funding for implementing, the regional basis provision of services under par. (d), the department shall submit to the joint committee on finance, no later than March 1, 2014, a request for the release of funds and a report on its proposal for implementation that includes all of the following:
a. A description of the criteria that the department will apply in its regionalization model.
b. A description of how the regions will be established and the degree of county participation in that process.
c. An updated list of the counties that have indicated, by the date of the report, that they will offer the services under s. 49.46 (2) (b) 6. Lm. through the Medical Assistance program on a regional basis according to the criteria established by the department.
d. An evaluation of the estimated long-term costs of the proposed regional model.
2. If the cochairpersons of the committee do not notify the department within 14 working days after the date that the department submits the report and the funding request that the committee has scheduled a meeting for the purpose of reviewing the proposal for implementation and the funding request, the funding shall be released and the department may implement its proposal for the regional basis provision of services on July 1, 2014. If, within 14 working days after the date that the department submits the report and the funding request, the cochairpersons notify the department that the committee has scheduled a meeting for the purpose of reviewing the proposal for implementation and the funding request, the funding shall be released, and the department may implement its proposal for the regional basis provision of services, only upon approval of the committee.
20,1057
Section
1057. 49.45 (30g) (a) 1. of the statutes is amended to read:
49.45 (30g) (a) 1. An approved amendment to the state medical assistance plan submitted under 42 USC 1396n (i) permits reimbursement for the services under s. 49.46 (2) (b) 6. Lo. in the manner provided under this subsection.
20,1058
Section
1058. 49.45 (30g) (a) 3. of the statutes is amended to read:
49.45 (30g) (a) 3. The individual, the community recovery services, and the community recovery services provider meet any condition set forth in the approved amendment to the medical assistance plan submitted under 42 USC 1396n (i).
20,1058k
Section 1058k. 49.45 (59) (b) of the statutes is amended to read:
49.45 (59) (b) Health maintenance organizations shall pay all of the moneys they receive under par. (a) to eligible hospitals, as defined in s. 50.38 (1), within 15 days after receiving the moneys. The department shall specify in contracts with health maintenance organizations to provide medical assistance a method that health maintenance organizations shall use to allocate the amounts received under par. (a) among eligible hospitals based on the number of discharges from inpatient stays and the number of outpatient visits for which the health maintenance organization paid such a hospital in the previous month for enrollees who are recipients of medical assistance, except enrollees who receive medical assistance under s. 49.45 (23). Payments under this paragraph shall be in addition to any amount that a health maintenance organization is required by agreement between the health maintenance organization and a hospital to pay the hospital for providing services to the health maintenance organization's enrollees.
20,1059
Section
1059. 49.453 (2) (a) (intro.) of the statutes is amended to read:
49.453
(2) (a)
Institutionalized individuals. (intro.) Except as provided in sub. (8), if an institutionalized individual or his or her spouse, or another person acting on behalf of the institutionalized individual or his or her spouse, transfers assets
; regardless of whether those assets, if retained, are excluded under 42 USC 1396p; for less than fair market value on or after the institutionalized individual's look-back date, the institutionalized individual is ineligible for medical assistance for the following services for the period specified under sub. (3):
20,1060
Section
1060. 49.453 (2) (b) (intro.) of the statutes is amended to read:
49.453
(2) (b)
Noninstitutionalized individuals. (intro.) Except as provided in sub. (8), if a noninstitutionalized individual or his or her spouse, or another person acting on behalf of the noninstitutionalized individual or his or her spouse, transfers assets
; regardless of whether those assets, if retained, are excluded under 42 USC 1396p; for less than fair market value on or after the noninstitutionalized individual's look-back date, the noninstitutionalized individual is ineligible for medical assistance for the following services for the period specified under sub. (3):
20,1061
Section
1061. 49.453 (3) (a) (intro.) of the statutes is amended to read:
49.453 (3) (a) (intro.) The period of ineligibility under this subsection begins on either of the following for an applicant for Medical Assistance:
20,1062
Section
1062. 49.453 (3) (ag) of the statutes is created to read:
49.453 (3) (ag) The period of ineligibility under this subsection for a transfer of assets made at the time the individual is receiving long-term care services through Medical Assistance begins on the first day of the month following the month in which the individual receives advance notice of the period of ineligibility.
20,1063
Section
1063. 49.453 (4c) (c) of the statutes is created to read:
49.453 (4c) (c) A promissory note in which the debtor is a presumptive heir of the lender or in which neither the lender nor debtor has any incentive to enforce repayment is considered cancelled upon the death of the lender for purposes of this section.
20,1064
Section
1064. 49.453 (8) (a) 1. of the statutes is amended to read:
49.453
(8) (a) 1. The assets are exempt under
42 USC 1396p (c) (2) (A), (B), or (C).
To make a satisfactory showing to the state under 42 USC 1396p (c) (2) (C) and adjust the ineligibility period under sub. (3), the individual shall demonstrate that all of the assets transferred for less than fair market value, or cash equal to the value of the assets transferred for less than fair market, have been returned to him or her.
20,1065
Section
1065. 49.455 (5) (title) of the statutes is amended to read:
49.455 (5) (title) Rules for treatment of resources; ineligibility.
20,1066
Section
1066. 49.455 (5) (d) of the statutes is amended to read:
49.455 (5) (d) During a continuous period of institutionalization, after an institutionalized spouse is determined to be eligible for medical assistance, no resources of the community spouse are considered to be available to the institutionalized spouse, except that a transfer of those resources or other assets by the community spouse within the first 5 years of eligibility of the institutionalized spouse may result in a period of ineligibility under s. 49.453 (2) and (3) for the institutionalized spouse.
20,1067
Section
1067. 49.455 (5) (e) of the statutes is created to read:
49.455 (5) (e) The department may deny to the institutionalized spouse eligibility for Medical Assistance if, when requested by the department, the institutionalized spouse and the community spouse do not provide the total value of their assets and information on income and resources to the extent required under federal Medicaid law or sign the application for Medical Assistance.
20,1068
Section
1068. 49.455 (8) (d) of the statutes is renumbered 49.455 (8) (d) 1. and amended to read:
49.455 (8) (d) 1. If either spouse establishes at a fair hearing that the community spouse resource allowance determined under sub. (6) (b) 1. to 2. or 4. without a fair hearing does not generate enough income to raise the community spouse's income to the minimum monthly maintenance needs allowance under sub. (4) (c), the department shall establish, under subd. 2., an amount to be used under sub. (6) (b) 3. that results in a community spouse resource allowance that generates enough income to raise the community spouse's income to the minimum monthly maintenance needs allowance under sub. (4) (c).
3. Except in exceptional cases which would result in financial duress for the community spouse, the department may not establish an amount to be used under sub. (6) (b) 3. unless the institutionalized spouse makes available to the community spouse the maximum monthly income allowance permitted under sub. (4) (b) or, if the institutionalized spouse does not have sufficient income to make available to the community spouse the maximum monthly income allowance permitted under sub. (4) (b), unless the institutionalized spouse makes all of his or her income, except for an amount equal to the sum of the personal needs allowance under sub. (4) (a) 1. and any family allowances under sub. (4) (a) 3. paid by the institutionalized spouse and the amount incurred as expenses for medical or remedial care for the institutionalized spouse under sub. (4) (a) 4., available to the community spouse as a community spouse monthly income allowance under sub. (4) (b).
20,1069
Section
1069. 49.455 (8) (d) 2. of the statutes is created to read:
49.455 (8) (d) 2. The department shall base the amount to be used under sub. (6) (b) 3. on the cost of a single premium lifetime annuity that pays monthly amounts that, combined with other available income, raises the community spouse's income to the minimum monthly maintenance needs allowance. Any resource, regardless of whether the resource generates income, may be transferred in an amount that, combined with the community spouse resource allowance calculated before the fair hearing, provides the community spouse with sufficient funds to purchase the annuity. The community spouse is not required to purchase an annuity to obtain this amount.
20,1070
Section
1070. 49.46 (1) (a) 15. of the statutes is amended to read:
49.46
(1) (a) 15. Any individual who is infected with tuberculosis and meets the income and resource eligibility requirements for the federal Supplemental Security Income program under
42 USC 1381 to
1383d.
For purposes of this subdivision, "income" has the meaning given for "family income" in s. 49.471 (1) (f).
20,1072
Section
1072. 49.46 (1) (c) (intro.) of the statutes is amended to read:
49.46 (1) (c) (intro.) Except as provided under par. (co) or (cr), a family that becomes ineligible for aid to families with dependent children under s. 49.19 because of increased income from employment or increased hours of employment or because of the expiration of the time during which the disregards under s. 49.19 (5) (a) 4. or 4m. or (am) apply shall receive medical assistance for:
20,1072b
Section 1072b. 49.46 (1) (c) (intro.) and 1. (intro.) of the statutes, as affected by 2013 Wisconsin Act .... (this act), are consolidated, renumbered 49.46 (1) (c) (intro.) and amended to read:
49.46 (1) (c) (intro.) Except as provided under par. (co) or (cr), a family that becomes ineligible for aid to families with dependent children under s. 49.19 because of increased income from employment or increased hours of employment or because of the expiration of the time during which the disregards under s. 49.19 (5) (a) 4. or 4m. or (am) apply shall receive medical assistance for: 1. Six 4 calendar months, or, if required under federal law, up to 12 months, following the month in which the family a parent, caretaker, or dependent child of the family becomes ineligible for aid to families with dependent children if all of the following apply:
20,1072d
Section 1072d. 49.46 (1) (c) 1. a. and b. of the statutes are renumbered 49.46 (1) (c) 1g. and 1r.
20,1072f
Section 1072f. 49.46 (1) (c) 1. c. and 2. of the statutes are repealed.
20,1073
Section
1073. 49.46 (1) (cg) of the statutes is amended to read:
49.46 (1) (cg) Medical Except as provided under par. (cr), medical assistance shall be provided to a dependent child, a relative with whom the child is living or the spouse of the relative, if the spouse meets the requirements of s. 49.19 (1) (c) 2. a. or b., for 4 calendar months beginning with the month in which the child, relative or spouse is ineligible for aid to families with dependent children because of the collection or increased collection of maintenance or support, if the child, relative or spouse received aid to families with dependent children in 3 or more of the 6 months immediately preceding the month in which that ineligibility begins.
20,1073y
Section 1073y. 49.46 (1) (co) of the statutes, as affected by 2013 Wisconsin Act .... (this act), is repealed.
20,1074
Section
1074. 49.46 (1) (co) 1. of the statutes is amended to read:
49.46 (1) (co) 1. Except as provided under subd. 2. or par. (cr), medical assistance shall be provided to a family for 12 consecutive calendar months following the month in which the family becomes ineligible for aid to families with dependent children because of increased income from employment, because the family no longer receives the earned income disregard under s. 49.19 (5) (a) 4. or 4m. or (am) due to the expiration of the time limit during which the disregards are applied or because of the application of the monthly employment time eligibility limitation under 45 CFR 233.100 (a) (1) (i).
20,1075
Section
1075. 49.46 (1) (co) 2. of the statutes is amended to read:
49.46 (1) (co) 2. If a waiver under subd. 3. is granted and except as provided in par. (cr), the department may select individuals to receive medical assistance benefits as provided under par. (c), rather than under subd. 1., as a control group for part or all of the period during which the waiver is in effect.
20,1076
Section
1076. 49.46 (1) (cr) of the statutes is created to read:
49.46 (1) (cr) To the extent approved by the federal department of health and human services, an individual or family described in par. (c), (cg), or (co) is not eligible for Medical Assistance if the federal department of health and human services approves a request from the department to deny all or some transitional Medical Assistance benefits to that individual or family, if approval is required. The department shall allow individuals who are receiving transitional Medical Assistance benefits on December 31, 2013, to continue to receive those benefits until their 12-month period ends, if required under federal law. If the federal department of health and human services approves the department's request to charge a premium to recipients of continued transitional Medical Assistance benefits, the department may charge a premium to any recipient of continued transitional Medical Assistance benefits whose income exceeds 100 percent of the poverty line.
