Wisconsin Legislature: 27,2985

49.45 (6m) (h) The department may require by rule that all claims for payment of services provided facility residents under this chapter subchapter be submitted or countersigned by the respective facility administrator. The department may specify those categories of services for which payment will be made only if the services are rendered or authorized in writing by a primary health care provider designated by the recipient for the particular category of services.

27,2974b Section 2974b. 49.45 (6m) (L) of the statutes is created to read:

49.45 (6m) (L) For purposes of ss. 46.27 (11) (c) 7. and 46.277 (5) (e), the department shall, by July 1 annually, determine the statewide medical assistance daily cost of nursing home care and submit the determination to the department of administration for review. The department of administration shall approve the determination before payment may be made under s. 46.27 (11) (c) 7. or 46.277 (5) (e).

27,2975 Section 2975 . 49.45 (6t) of the statutes is created to read:

49.45 (6t) County department operating deficit reduction. From the appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a county department under s. 46.215, 46.22, 46.23 or 51.42 for services provided under s. 49.46 (2) (a) 4. d. and (b) 6. f., the department shall allocate up to $4,500,000 in each fiscal year to these county departments, as determined by the department, and shall perform all of the following:

(a) For the reduction of operating deficits incurred by the county departments, estimate the availability of federal medicaid funds that may be matched to county funds that are expended for costs in excess of reimbursement for services provided under s. 49.46 (2) (a) 4. d. and (b) 6. f.

(b) Based on the amount estimated to be available under par. (a), develop a method, which need not be promulgated as rules under ch. 227, to distribute this allocation to the individual county departments under s. 46.215, 46.22, 46.23 or 51.42 that have incurred operating deficits that shall include all of the following:

1. Development of criteria for determining operating deficits.

2. Agreement, by the county in which is located a county department that has an operating deficit, to provide funds to match federal medicaid funds.

3. Consideration of the size of a county department's operating deficit.

(d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (1) (o) that result in a lesser allocation amount than that allocated under this subsection or disallows use of the allocation of federal medicaid funds under par. (c), reduce allocations under this subsection and distribute on a prorated basis, as determined by the department.

27,2976 Section 2976 . 49.45 (6u) (intro.) of the statutes is amended to read:

49.45 (6u) Facility operating deficit reduction. (intro.) Except as provided in par. (g), from the appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a facility, as defined under sub. (6m) (a) 2., that is established under s. 49.14 (1) 49.70 (1) or that is owned and operated by a city, village or town, the department shall distribute to these facilities not more than $18,600,000 in each fiscal year, as determined by the department, and shall perform all of the following:

27,2977 Section 2977 . 49.45 (6u) (b) 2. of the statutes is amended to read:

49.45 (6u) (b) 2. Agreement by the county in which is located the facility established under s. 49.14 (1) 49.70 (1) and agreement by the city, village or town that owns and operates the facility that the applicable county, city, village or town shall provide funds to match federal medical assistance matching funds under this subsection.

27,2978 Section 2978 . 49.45 (6u) (b) 2m. of the statutes is amended to read:

49.45 (6u) (b) 2m. Identification by the county in which is located the facility established under s. 49.14 (1) 49.70 (1) of all county funds expended in each calendar year to operate the facility, and certification by the county to the department of this amount.

27,2979 Section 2979 . 49.45 (6v) of the statutes is repealed.

27,2981b Section 2981b. 49.45 (6w) (intro.) of the statutes is amended to read:

49.45 (6w) Hospital operating deficit reduction. (intro.) From the appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a hospital, as defined under s. 50.33 (2) (a) and (b), that is operated by the state, established under s. 49.16 49.71 or owned and operated by a city or village, the department shall allocate up to $3,300,000 in each fiscal year to these hospitals, as determined by the department, and shall perform all of the following:

27,2982 Section 2982 . 49.45 (6w) (a) 2. of the statutes is amended to read:

49.45 (6w) (a) 2. County funds, for a hospital established under s. 49.16 49.71.

27,2983 Section 2983 . 49.45 (6w) (b) 2. b. of the statutes is amended to read:

49.45 (6w) (b) 2. b. Agreement to provide matching funds by the county in which is located a hospital established under s. 49.16 49.71.

27,2984 Section 2984 . 49.45 (6x) (a) of the statutes is amended to read:

49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (b) and (o) the department shall distribute not more than $4,748,000 in each of fiscal years 1993-94 and 1994-95 year, to provide funds to an essential access city hospital, except that the department may not allocate funds to an essential access city hospital to the extent that the allocation would exceed any limitation under 42 USC 1396b (i) (3).

27,2984r Section 2984r. 49.45 (6y) (title) of the statutes is amended to read:

49.45 (6y) (title) Supplemental funding for county certain hospitals.

27,2985 Section 2985 . 49.45 (6y) (a) of the statutes is amended to read:

27,2985e Section 2985e. 49.45 (6y) (a) of the statutes, as affected by 1995 Wisconsin Act .... (this act), is amended to read:

49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (b) and (o) the department shall distribute funding in each fiscal year to provide supplemental payment to county hospitals and to county mental health complexes 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).

27,2985m Section 2985m. 49.45 (6z) (title) of the statutes is amended to read:

49.45 (6z) (title) Supplemental funding for certain hospitals serving low-income patients.

27,2985s Section 2985s. 49.45 (6z) (a) (intro.) of the statutes is amended to read:

49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (b) and (o) the department shall distribute funding in each fiscal year to supplement payment for inpatient services to county hospitals and county mental health complexes that, as determined by the department, hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant under this chapter, if the department determines that the hospitals serve a disproportionate number of low-income patients with special needs, except that the. 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 a contract under s. 49.02 (2). The department may not distribute funds under this subsection to the extent that the distribution would do any of the following:

27,2986 Section 2986 . 49.45 (7) (d) 4. of the statutes is amended to read:

49.45 (7) (d) 4. The department's determination of serious misconduct under this subsection shall be cause for terminating the facility's participation in the state-funded portion of the medical assistance program under ss. 49.45 to 49.47 this subchapter.

27,2987 Section 2987 . 49.45 (8) (title) of the statutes is amended to read:

49.45 (8) (title) Home Per-visit limits on home health services reimbursement.

27,2988 Section 2988 . 49.45 (8e) of the statutes is created to read:

49.45 (8e) Monthly limits on home health, personal care and private-duty nursing services reimbursement. (a) Except as provided in par. (b), reimbursement under s. 20.435 (1) (b) and (o) for home health, personal care and private-duty nursing services provided to a medical assistance recipient in a month may not exceed the average monthly cost of nursing home care, as determined by the department.

(b) This subsection does not apply to any of the following:

1. A medical assistance recipient under the age of 22.

2. A ventilator-dependent individual under s. 49.46 (2) (b) 6. m. or 49.47 (6) (a) 1.

3. Any individual, if the department determines that the cost of providing the individual with nursing home care would exceed the cost of providing the individual with home health, personal care and private-duty nursing services.

4. Any individual, if the department determines that nursing home care is not available for that individual.

27,2988b Section 2988b. 49.45 (8f) of the statutes is created to read:

49.45 (8f) Limits on reimbursement of providers of home health services. (a) For any home health, personal care or private-duty nursing service provided to a medical assistance recipient in a month, the department may require, as a condition of reimbursement, that the provider charge the department the lesser of the following for the service:

1. The amount that the federal medicare program reimburses for a service, separately identified under 42 CFR Part 413, including skilled nursing service, home health aid service and physical therapy service.

2. The provider's usual and customary charge for providing the service.

3. A maximum reimbursement rate, determined by the department, for the service.

(b) When a provider is required to charge the department a price under par. (a), the department may not reimburse the provider for more than that amount.

27,2989 Section 2989 . 49.45 (8m) (intro.) of the statutes is amended to read:

49.45 (8m) Rates for respiratory care services. (intro.) Notwithstanding a determination by the department of a maximum rate the limits under sub. subs. (8), (8e) and (8f), the rates under sub. (8) and rates charged by providers under s. 49.46 (2) (a) 4. d. that are not home health agencies, for reimbursement for respiratory care services for ventilator-dependent individuals under ss. 49.46 (2) (b) 6. m. and 49.47 (6) (a) 1., shall be as follows:

27,2989d Section 2989d. 49.45 (8v) of the statutes is created to read:

49.45 (8v) Incentive-based pharmacy payment system. By January 1, 1996, the department shall establish a system of payment to pharmacies for legend and over-the-counter drugs provided to recipients of medical assistance that has financial incentives for pharmacists who perform services that result in savings to the medical assistance program. Under this system, the department shall establish a schedule of fees that is designed to ensure that any incentive payments made are equal to or less than the documented savings. The department may discontinue the system established under this subsection if the department determines, after performance of a study, that payments to pharmacists under the system exceed the documented savings under the system.

27,2990 Section 2990 . 49.45 (11) of the statutes is amended to read:

49.45 (11) Penalty. Any person who receives or assists another in receiving assistance under this section, to which the recipient is not entitled, shall be subject to the penalties under s. 49.12 49.95.

27,2991 Section 2991 . 49.45 (12) (c) of the statutes is amended to read:

49.45 (12) (c) The department shall request proposals for a system of machine-readable identification cards for medical assistance recipients and a computerized support system for the cards that will accept and respond to electronically conveyed requests from health care providers for information related to medical assistance recipients, such as eligibility, coverages and authorizations. The request for proposals shall specify that the systems are to be operating by January 1, 1996 1997.

27,2993 Section 2993 . 49.45 (25) (am) of the statutes is renumbered 49.45 (25) (am) (intro.) and amended to read:

49.45 (25) (am) (intro.) Except as provided under pars. (be) and (bg) and sub. (24), case management services under s. 49.46 (2) (b) 9. and (bm) are reimbursable under medical assistance only if provided to a medical assistance beneficiary who receives case management services from or through a certified case management provider in a county, city, village or town that elects, under par. (b), to make the services available and who has meets at least one of the following conditions:

1. Has a developmental disability, as defined under s. 51.01 (5) (a),.

2. Has a chronic mental illness, as defined under s. 51.01 (3g), or.

3. Has Alzheimer's disease, as defined under s. 46.87 (1) (a), is.

4. Is an alcoholic, as defined under s. 51.01 (1), or.

5. Is drug dependent, as defined under s. 51.01 (8), is.

6. Is physically disabled, as defined by the department, is.

7. Is a severely emotionally disturbed child , is.

8. Is age 65 or over or, after December 31, 1991, has.

10. Has HIV infection, as defined in s. 252.01 (2).

27,2994 Section 2994 . 49.45 (25) (am) 9. of the statutes is created to read:

49.45 (25) (am) 9. Is a member of a family that has a child who is at risk of serious physical, mental or emotional dysfunction, as defined by the department.

27,2995 Section 2995 . 49.45 (25) (am) 11. of the statutes is created to read:

49.45 (25) (am) 11. Is a child who is eligible for early intervention services under s. 51.44.

27,2996 Section 2996 . 49.45 (25) (am) 12. of the statutes is created to read:

49.45 (25) (am) 12. Is infected with tuberculosis.

27,2996m Section 2996m. 49.45 (25) (am) 13. of the statutes is created to read:

49.45 (25) (am) 13. Is a child with asthma.

27,2997 Section 2997 . 49.45 (25) (bg) of the statutes is amended to read:

49.45 (25) (bg) An independent living center, as defined in s. 46.96 (1) (a), that is a certified case management provider may elect to provide case management services to one or more of the categories of medical assistance beneficiaries specified under par. (am). The amount of allowable charges for the services under the medical assistance program that is not provided by the federal government shall be paid from nonfederal, public funds received by the independent living center from a county, city, village or town or from funds distributed under the appropriation under s. 20.435 (5) (bm) or as a grant under s. 46.96.

27,2998 Section 2998 . 49.45 (25) (bm) (intro.) of the statutes is amended to read:

49.45 (25) (bm) (intro.) Case management services under this subsection may not be provided to a person under the category of severely emotionally disturbed child par. (am) 7. unless any of the following is true:

27,2999 Section 2999 . 49.45 (34) of the statutes is amended to read:

49.45 (34) Medical assistance manual. The department shall prepare a medical assistance manual that is clear, comprehensive and consistent with ss. 49.43 to 49.47 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 employes who administer the medical assistance program.

27,3000 Section 3000 . 49.45 (39) of the statutes is created to read:

49.45 (39) School medical services. (a) Definitions. In this subsection: