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:
1. “School" means a public school described under s. 115.01 (1) or a charter school, as defined in s. 115.001 (1). It includes school-operated early childhood programs for developmentally delayed and disabled 4-year-old and 5-year-old children.
2. “School medical services" means health care services that are provided in a school to children who are eligible for medical assistance that are appropriate to a school setting, as provided in the amendment to the state medical assistance plan under par. (am).
(am) Plan amendment. No later than September 30, 1995, the department shall submit to the federal department of health and human services an amendment to the state medical assistance plan to permit the application of pars. (b) to (c). If the amendment to the state plan is approved,
the department shall implement an administrative system to permit school districts and cooperative educational service agencies
to claim reimbursement under pars. (b) to (c). If the amendment to the state plan is approved and in effect, the department shall implement an administrative system to permit reimbursement under pars. (b) to (c). Paragraphs (b) to (c) do not apply unless the amendment to the state plan is approved and in effect
and the department determines that the an administrative system to permit reimbursement under pars. (b) to (c) has been implemented.
(b) Payment for school medical services. If a school district or a cooperative educational service agency elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the school district or the cooperative educational service agency for 60% of the federal share of allowable charges for the school medical services that it provides and for allowable administrative costs. The department shall promulgate rules establishing a methodology for making reimbursements under this paragraph. All other expenses for the school medical services shall be paid for by the school district or the cooperative educational service agency with funds received from state or local taxes. The school district or the cooperative educational service agency shall comply with all requirements of the federal department of health and human services for receiving federal financial participation.
(c) Certification and reporting requirements. The department shall promulgate rules establishing specific certification and reporting requirements with respect to school medical services under this subsection.
27,3001
Section 3001
. 49.45 (40) of the statutes is created to read:
49.45 (40) Periodic record matches. The department shall cooperate with the department of industry, labor and human relations in matching records of medical assistance recipients under s. 49.32 (7).
27,3002b
Section 3002b. 49.45 (41) of the statutes is created to read:
49.45 (41) Mental health crisis intervention services. (a) In this subsection:
1. “Mental health crisis intervention services" means services that are provided by a mental health crisis intervention program operated by, or under contract with, a county or municipality, if the county or municipality is certified as a medical assistance provider.
2. “Municipality" means a city, village or town.
(b) If a county or municipality elects to become certified as a provider of mental health crisis intervention services, the county or municipality may provide mental health crisis intervention services under this subsection in the county or municipality to medical assistance recipients through the medical assistance program. A county or municipality that elects to provide the services shall pay the amount of the allowable charges for the services under the medical assistance program that is not provided by the federal government. The department shall reimburse the county or municipality under this subsection only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.
27,3002m
Section 3002m. 49.45 (42) of the statutes is created to read:
49.45 (42) Personal care services. Personal care services under s. 49.46 (2) (b) 6. j. provided to an individual are reimbursable under medical assistance only if all of the following conditions are met:
(a) The provider of the personal care services receives prior authorization from the department for all personal care services that are provided to the individual in excess of 50 hours in a calendar year.
(b) The individual is not eligible to receive home health aide services under medicare, as defined in sub. (3) (L) 1. b.
27,3002r
Section 3002r. 49.45 (43) of the statutes is created to read:
49.45 (43) Case management services for high-cost recipients. The department may establish a program to provide case management services for medical assistance recipients with high-cost chronic health conditions or high-cost catastrophic health conditions. If the department establishes a program to provide these case management services, the department shall provide reimbursement for providers of these case management services under the medical assistance program.
27,3003
Section 3003
. 49.455 (4) (c) of the statutes is repealed and recreated to read:
49.455 (4) (c) 1. For any year, the minimum monthly maintenance needs allowance equals the lesser of the amount determined under subd. 2., or the sum of the following:
a. One-twelfth of 200% of the poverty line for a family of 2 persons.
b. Any excess shelter allowance under par. (d).
2. The minimum monthly maintenance needs allowance in a year may not exceed $1,500 increased by the same percentage as the percentage increase in the consumer price index between September 1988 and September of the year before the year involved.
3. In making the calculation under subd. 1. a., when the poverty line is revised the department shall use the revised amount starting on the first day of the 2nd calendar quarter beginning after the date of publication of the revision.
27,3004
Section 3004
. 49.455 (4) (d) of the statutes is created to read:
49.455 (4) (d) The excess shelter allowance equals the amount by which 30% of the amount determined under par. (c) 1. a. is exceeded by the sum of the following:
1. The community spouse's expenses for rent or mortgage principal and interest, taxes and insurance for his or her principal residence and, if the community spouse lives in a condominium or cooperative, any required maintenance charge.
2. The standard utility allowance established under 7 USC 2014 (e), except that if the community spouse lives in a condominium or cooperative for which the maintenance charge includes utility expenses, the standard utility allowance under 7 USC 2014 (e) is reduced by the amount of the utility expenses included in the maintenance charge.
27,3005b
Section 3005b. 49.455 (6) (b) 1. of the statutes is amended to read:
49.455 (6) (b) 1. In 1989, $60,000; in a calendar year after 1989, $60,000 any year, $12,000 increased by the same percentage as the percentage increase in the consumer price index between September 1988 and September of the year before the calendar year involved.
27,3005d
Section 3005d. 49.455 (6) (b) 1m. of the statutes is created to read:
49.455 (6) (b) 1m. $50,000.
27,3006
Section 3006
. 49.455 (6) (b) 2. of the statutes is created to read:
49.455 (6) (b) 2. The lesser of the following:
a. The spousal share computed under sub. (5) (a) 1.
b. In any year, $60,000 increased by the same percentage as the percentage increase in the consumer price index between September 1988 and September of the year before the year involved.
27,3007
Section 3007
. 49.46 (1) (a) 4. of the statutes is amended to read:
49.46 (1) (a) 4. Any person receiving benefits under s. 49.177 49.77 or federal Title XVI.
27,3008
Section 3008
. 49.46 (1) (a) 15. of the statutes is created 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 program under 42 USC 1381 to 1383d.
27,3009
Section 3009
. 49.46 (1) (d) 4. of the statutes is amended to read:
49.46 (1) (d) 4. A child who meets the conditions under 42 USC 1396a (e) 3. (3) shall be considered a recipient of benefits under s. 49.177 49.77 or federal Title XVI.
27,3010
Section 3010
. 49.46 (1) (e) of the statutes is amended to read:
49.46 (1) (e) If an application under s. 49.47 (3) shows that the person has income and resources within the limitations of s. 49.19, federal Title XVI or s. 49.177 49.77, or that the person is an essential person, an accommodated person or a patient in a public medical institution, the person shall be granted the benefits enumerated under sub. (2) whether or not the person requests or receives a grant of any of such aids.
27,3011
Section 3011
. 49.46 (2) (a) 2. of the statutes is amended to read:
49.46 (2) (a) 2. Early and periodic screening and diagnosis, including case management services, of persons under 21 years of age and all medical treatment and dentists' services specified in par. (b) 1. found necessary by this screening and diagnosis.
27,3012
Section 3012
. 49.46 (2) (a) 4. d. of the statutes is amended to read:
49.46 (2) (a) 4. d. Home health services, subject to the limitations under s. 49.45 (8), (8e) and (8f), or nursing services, if a home health agency is unavailable
, nursing services, subject to the limitations under s. 49.45 (8e) and (8f).
