9,1391
Section
1391. 49.45 (6m) (ag) 8. of the statutes is repealed.
9,1392
Section
1392. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:
49.45 (6m) (ar) 1. a. The department shall establish standards for payment of allowable direct care costs, for facilities that do not primarily serve the developmentally disabled, that are not less than the median for 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 are not less than the median for 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.
9,1393
Section
1393. 49.45 (6m) (ar) 1. cm. of the statutes is amended to read:
49.45 (6m) (ar) 1. cm. Notwithstanding the limitations under par. (ag) 8., funding Funding distributed to facilities for the provision of active treatment to residents with a diagnosis of developmental disability shall be distributed in accordance with a method developed by the department which is consistent with a prudent buyer approach to payment for services.
9,1394
Section
1394. 49.45 (6m) (ar) 2. a. of the statutes is amended to read:
49.45 (6m) (ar) 2. a. The department shall establish one or more standards for the payment of support service costs that are not less than the median of take into account support service costs for a sample of all facilities within the state.
9,1395
Section
1395. 49.45 (6m) (ar) 3. a. of the statutes is amended to read:
49.45 (6m) (ar) 3. a. The department shall establish standards, adjusted for heating degree day variations in the state, for payment of fuel and utility costs that are not less than the median of take into account heating fuel and utility costs for a sample of all facilities within the state.
9,1396
Section
1396. 49.45 (6m) (ar) 4. of the statutes is amended to read:
49.45 (6m) (ar) 4. For net property taxes or municipal services, payment shall be made for those costs that range from the amount of the previous calendar year's tax or the amount of municipal service costs for a period specified by the department, subject to a maximum limit as determined by the department.
9,1397
Section
1397. 49.45 (6m) (ar) 5. a. of the statutes is amended to read:
49.45 (6m) (ar) 5. a. The department shall establish one or more standards for the payment of administrative and general costs that are not less than the median of
take into account administrative and general costs for a sample of all facilities within the state.
9,1398
Section
1398. 49.45 (6m) (ar) 6. of the statutes is amended to read:
49.45 (6m) (ar) 6. Capital payment shall be based on a replacement value for a facility. The replacement value shall be determined by a commercial estimator contracted for by the department and paid for by the facility. The replacement value shall be subject to limitations determined by the department, except that the department may not reduce final capital payment of a facility by more than $3.50 per patient day.
9,1399
Section
1399. 49.45 (6m) (av) 1. of the statutes is amended to read:
49.45 (6m) (av) 1. The department shall calculate a payment rate for a facility by applying the criteria set forth under pars. (ag) 1. to 5., and 7. and 8., (am) 1. to 5. and (ar) 1. to 5. to information from cost reports submitted by the facility.
9,1400
Section
1400. 49.45 (6m) (av) 5m. of the statutes is amended to read:
49.45 (6m) (av) 5m. Notwithstanding the limitations under par. (ag) 8., the The rate under subd. 1., 4. or 5. may be adjusted by the department to reflect payments for the provision of active treatment to facility residents with a diagnosis of developmental disability.
9,1401
Section
1401. 49.45 (6m) (bp) (intro.) of the statutes is amended to read:
49.45 (6m) (bp) (intro.) Notwithstanding pars. (ag) 3m., (am) 6. and (ar) 6., the department may establish payment methods based on actual costs for capital payment for a facility to which, after December 31, 1982, any of the following applies:
9,1402
Section
1402. 49.45 (6m) (br) 1. of the statutes is amended to read:
49.45 (6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435 (5) (4) (bt) or (bu) or (7) (b) or 20.445 (3) (dz), the department shall reduce allocations of funds to counties in the amount of the disallowance from the appropriation account under s. 20.435 (5) (4) (bt) or (bu) or (7) (b), or the department shall direct the department of workforce development to reduce allocations of funds to counties or Wisconsin works agencies in the amount of the disallowance from the appropriation account under s. 20.445 (3) (dz) or direct the department of corrections to reduce allocations of funds to counties in the amount of the disallowance from the appropriation account under s. 20.410 (3) (cd), in accordance with s. 16.544 to the extent applicable.
9,1403
Section
1403. 49.45 (6m) (c) 5. of the statutes is amended to read:
49.45 (6m) (c) 5. Admit only patients assessed or who waive or are exempt from the requirement of assessment under s. 46.27 (6) (a) or, if required under s. 50.035 (4n) or 50.04 (2h), who have been referred to a resource center.
9,1404
Section
1404. 49.45 (6t) (intro.) of the statutes is amended to read:
49.45
(6t) County department and local health department operating deficit reduction. (intro.) From the appropriation under s. 20.435
(5) (4) (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 or by a local health department, as defined in s. 250.01 (4), for services provided under s. 49.46 (2) (a) 4. d. and (b) 6. f., j., k. and L., 9. and 15., for case management services under s. 49.46 (2) (b) 12. and for mental health day treatment services for minors provided under the authorization under
42 USC 1396d (r) (5), the department shall allocate up to $4,500,000 in each fiscal year to these county departments, or local health departments as determined by the department, and shall perform all of the following:
9,1405
Section
1405. 49.45 (6t) (d) of the statutes is amended to read:
49.45 (6t) (d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (5) (4) (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.
9,1406
Section
1406. 49.45 (6u) (intro.) of the statutes is amended to read:
49.45 (6u) Supplemental payments to certain facilities. (intro.) Notwithstanding sub. (6m), from the appropriation under s. 20.435 (5) (4) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a facility, as defined under sub. (6m) (a) 3., that is established under s. 49.70 (1) or that is owned and operated by a city, village or town, the department may not distribute to these facilities more than $38,600,000 in each fiscal year, as determined by the department, except that the department shall also distribute for this same purpose from the appropriation under s. 20.435 (5) (4) (o) any additional federal medical assistance moneys that were not anticipated before enactment of the biennial budget act or other legislation affecting s. 20.435 (5) (4) (o) and that were not used to fund nursing home rate increases under sub. (6m) (ag) 8. The total amount that a county certifies under this subsection may not exceed 100% of otherwise-unreimbursed care. In distributing funds under this subsection, the department shall perform all of the following:
9,1407
Section
1407. 49.45 (6u) (d) of the statutes is amended to read:
49.45 (6u) (d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (5) (4) (o) that result in a lesser allocation amount than that allocated under this subsection, allocate not more than the lesser amount so approved by the federal department of health and human services.
9,1408
Section
1408. 49.45 (6u) (e) of the statutes is amended to read:
49.45 (6u) (e) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (5) (4) (o) that result in a lesser allocation amount than that allocated under this subsection, submit a revision of the method developed under par. (b) for approval by the joint committee on finance in that state fiscal year.
9,1409
Section
1409. 49.45 (6v) (b) of the statutes is amended to read:
49.45 (6v) (b) The department shall, each year, submit to the joint committee on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that provides information on the utilization of beds by recipients of medical assistance in facilities and a discussion and detailed projection of the likely balances, expenditures, encumbrances and carry over of currently appropriated amounts in the appropriation accounts under s. 20.435 (4) (b) and (o).
9,1410
Section
1410. 49.45 (6v) (c) of the statutes is amended to read:
49.45 (6v) (c) If the report specified in par. (b) indicates that utilization of beds by recipients of medical assistance in facilities decreased is less than estimates for that utilization reflected in the intentions of the joint committee on finance, legislature and governor, as expressed by them in the budget determinations, the department shall include a proposal to transfer moneys from the appropriation under s. 20.435 (5) (4) (b) to the appropriation under s. 20.435 (7) (bd) for the purpose of increasing funding for the community options program under s. 46.27. The amount proposed for transfer may not reduce the balance in the appropriation account under s. 20.435 (4) (b) below an amount necessary to ensure that that appropriation account will end the current fiscal year or the current fiscal biennium with a positive balance. The secretary shall transfer the amount identified under the proposal.
9,1411
Section
1411. 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 (5)
(4) (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. 49.71 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:
9,1412
Section
1412. 49.45 (6w) (d) of the statutes is amended to read:
49.45 (6w) (d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (5) (4) (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.
9,1413
Section
1413. 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
(5) (4) (b) and (o) the department shall distribute not more than $4,748,000 in each fiscal 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).
9,1414
Section
1414. 49.45 (6x) (d) of the statutes is amended to read:
49.45 (6x) (d) If the federal department of health and human services approves for state expenditure in any state fiscal year amounts under s. 20.435 (5) (4) (o) that result in a lesser distribution amount than that distributed under this subsection or disallows use of federal medicaid funds under par. (a), the department of health and family services shall reduce the distributions under this subsection.
9,1415
Section
1415. 49.45 (6y) (a) of the statutes is amended to read:
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435
(5) (4) (b) and (o) the department shall distribute funding in each fiscal year to provide supplemental payment to 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).
9,1416
Section
1416. 49.45 (6y) (am) of the statutes is created to read:
49.45
(6y) (am) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b), (h) and (o) the department shall distribute funding in each fiscal year to provide supplemental payments to hospitals that enter into contracts under s. 49.02 (2) with a county having a population of 500,000 or more 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).
9,1417
Section
1417. 49.45 (6y) (b) of the statutes is amended to read:
49.45 (6y) (b) The department need not promulgate as rules under ch. 227 the procedures, methods of distribution and criteria required for distribution under par. pars. (a) and (am).
9,1418
Section
1418. 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
(5) (4) (b) and (o) the department shall distribute funding in each fiscal year to supplement payment for services to 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. 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:
9,1418m
Section 1418m. 49.45 (7) (a) of the statutes is amended to read:
49.45
(7) (a) A recipient who is a patient in a public medical institution or an accommodated person and has a monthly income exceeding the payment rates established under
42 USC 1382 (e) may retain
$40 $45 unearned income or the amount of any pension paid under
38 USC 3203 (f), whichever is greater, per month for personal needs. Except as provided in s. 49.455 (4) (a), the recipient shall apply income in excess of
$40
$45 or the amount of any pension paid under
38 USC 3203 (f), whichever is greater, less any amount deducted under rules promulgated by the department, toward the cost of care in the facility.
9,1419
Section
1419. 49.45 (8) (b) of the statutes is amended to read:
49.45 (8) (b) Reimbursement under s. 20.435 (5) (4) (b) and (o) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under par. (c).
9,1424m
Section 1424m. 49.45 (22) of the statutes is amended to read:
49.45 (22) Medical assistance services provided by health maintenance organizations. If the department contracts with health maintenance organizations for the provision of medical assistance it shall give special consideration to health maintenance organizations that provide or that contract to provide comprehensive, specialized health care services to pregnant teenagers. If the department contracts with health maintenance organizations for the provision of medical assistance, the department shall determine which medical assistance recipients who have attained the age of 2 but have not attained the age of 6 and who are at risk for lead poisoning have not received lead screening from those health maintenance organizations. The department shall report annually to the appropriate standing committees of the legislature under s. 13.172 (3) on the percentage of medical assistance recipients under the age of 2 who received a lead screening test in that year provided by a health maintenance organization compared with the percentage that the department set as a goal for that year.
9,1426
Section
1426. 49.45 (24m) (intro.) of the statutes is amended to read:
49.45 (24m) Home health care and personal care pilot program. (intro.) From the appropriations under s. 20.435 (5) (4) (b) and (o), in order to test the feasibility of instituting a system of reimbursement for providers of home health care and personal care services for medical assistance recipients that is based on competitive bidding, the department shall:
9,1427g
Section 1427g. 49.45 (39) (a) 1. of the statutes is amended to read:
49.45 (39) (a) 1. "School" means a public school described under s. 115.01 (1) or, a charter school, as defined in s. 115.001 (1), the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School for the Deaf. It includes school-operated early childhood programs for developmentally delayed and disabled 4-year-old and 5-year-old children.
9,1427h
Section 1427h. 49.45 (39) (am) of the statutes is amended to read:
49.45 (39) (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 and (c). If the amendment to the state plan is approved, school districts and, cooperative educational service agencies and the department of public instruction on behalf of the Wisconsin Center for the Blind and Visually Impaired and the Wisconsin School for the Deaf claim reimbursement under pars. (b) to and (c). Paragraphs (b) to and (c) do not apply unless the amendment to the state plan is approved and in effect. The department shall submit to the federal department of health and human services an amendment to the state plan if necessary to permit the application of pars. (b) and (c) to the Wisconsin Center for the Blind and Visually Impaired and the Wisconsin School for the Deaf.
9,1427i
Section 1427i. 49.45 (39) (b) of the statutes is renumbered 49.45 (39) (b) 1. and amended to read:
49.45 (39) (b) 1. `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, as specified in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School for the Deaf elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the department of public instruction for 60% of the federal share of allowable charges for the school medical services that the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School for the Deaf provides and, as specified in subd. 2., for allowable administrative costs. A school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School for the Deaf may submit, and the department shall allow, claims for common carrier transportation costs as a school medical service unless the department receives notice from the federal health care financing administration that, under a change in federal policy, the claims are not allowed. If the department receives the notice, a school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School for the Deaf may submit, and the department shall allow, unreimbursed claims for common carrier transportation costs incurred before the date of the change in federal policy. The department shall promulgate rules establishing a methodology for making reimbursements under this paragraph. All other expenses for the school medical services provided by a school district or a cooperative educational service agency 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, the Wisconsin Center for the Blind and Visually Impaired, the Wisconsin School for the Deaf 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.
9,1427j
Section 1427j. 49.45 (39) (b) 2. of the statutes is created to read:
49.45 (39) (b) 2. `Payment for school medical services administrative costs.' The department shall reimburse a school district or a cooperative educational service agency specified under subd. 1. and shall reimburse the department of public instruction on behalf of the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School for the Deaf for 90% of the federal share of allowable administrative costs,
on a quarterly basis, using time studies, beginning in the first quarter of fiscal year 1999-2000. A school district or a cooperative education service agency may submit, and the department of health and family services shall allow, claims for administrative costs incurred during the period that is up to 24 months before the date of the claim, if allowable under federal law.
9,1428
Section
1428. 49.45 (46) of the statutes is created to read:
49.45 (46) Alcohol and other drug abuse residential treatment services. (a) If a county, city, town or village elects to become certified as a provider of alcohol and other drug abuse residential treatment services or to contract with a certified provider to provide the services, the county, city, town or village may provide directly or under contract alcohol and other drug abuse residential treatment services in facilities with fewer than 16 beds under this subsection in the county, city, town or village to medical assistance recipients through the medical assistance program. A county, city, town or village that elects to provide or to contract for 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, city, town or village 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.
(b) This subsection does not apply after July 1, 2003.
9,1429
Section
1429. 49.45 (47) of the statutes is created to read:
49.45 (47) Adult day care centers. (a) In this subsection, "adult day care center" means an entity that provides services for part of a day in a group setting to adults who need an enriched health-supportive or social experience and who may need assistance with activities of daily living, supervision or protection.
(b) No person may receive reimbursement under s. 46.27 (11) for the provision of services to clients in an adult day care center unless the adult day care center is certified by the department under sub. (2) (a) 11. as a provider of medical assistance.
(c) The biennial fee for the certification required under par. (b) of an adult day care center is $89, plus a biennial fee of $17.80 per client, based on the number of clients that the adult day care center is certified to serve. Fees collected under this paragraph shall be credited to the appropriation account under s. 20.435 (6) (jm).
(d) The department, by rule, may increase any fee specified in par. (c).
9,1430
Section
1430. 49.453 (4) (title) of the statutes is amended to read:
49.453 (4) (title) Irrevocable annuities
, promissory notes and similar transfers.
9,1431
Section
1431. 49.453 (4) (a) of the statutes is renumbered 49.453 (4) (a) (intro.) and amended to read:
49.453 (4) (a) (intro.) For the purposes of sub. (2), whenever a covered individual or his or her spouse, or another person acting on behalf of the covered individual or his or her spouse, transfers assets to an irrevocable annuity, or transfers assets by promissory note or similar instrument, in an amount that exceeds the expected value of the benefit, the covered individual or his or her spouse transfers assets for less than fair market value. A transfer to an annuity, or a transfer by promissory note or similar instrument, is not in excess of the expected value only if all of the following are true:
9,1432
Section
1432. 49.453 (4) (a) 1. and 2. of the statutes are created to read:
49.453 (4) (a) 1. a. The periodic payments back to the transferor include principal and interest that, at the time that the transfer is made, is at least at one of the following:
a. For an annuity, promissory note or similar instrument that is not specified under subd. 1. b. or par. (am), the applicable federal rate required under section
1274 (d) of the Internal Revenue Code, as defined in s. 71.01 (6).
b. For an annuity with a guaranteed life payment, the appropriate average of the applicable federal rates based on the expected length of the annuity minus 1.5%.
2. The terms of the instrument provide for a payment schedule that includes equal periodic payments, except that payments may be unequal if the interest payments are tied to an interest rate and the inequality is caused exclusively by fluctuations in that rate.
9,1432g
Section 1432g. 49.453 (4) (am) of the statutes is created to read:
