109,119gk
Section 119gk. 49.152 (3) (b) of the statutes is renumbered 49.16 (3) (b) and amended to read:
49.16 (3) (b) If, following review under sub. (2), the Wisconsin works agency or the department determines that an individual's application was not acted upon with reasonable promptness or was improperly denied in whole or in part or that a participant's benefit was improperly modified or canceled, or was calculated incorrectly, the Wisconsin works agency shall restore the benefit to the level determined to be appropriate by the Wisconsin works agency or by the department grant the appropriate benefit, retroactive to the date on which the individual's application was first not acted upon with reasonable promptness or improperly denied in whole or in part or the individual's benefit was first improperly modified or canceled or incorrectly calculated.
49.175
(1) (z)
Community youth grant. For a competitive grant program administered by the department to fund programs that improve social, academic and employment skills of youth who are eligible to receive temporary assistance for needy families under
42 USC 601 et seq.,
$7,579,700 $7,829,700 in fiscal year 2001-02 and
$50,000 $300,000 fiscal year 2002-03.
49.175 (1) (zh) 2. `Taxable years 1999 and thereafter.' For the transfer of moneys from the appropriation account under s. 20.445 (3) (md) to the appropriation account under s. 20.835 (2) (kf) for the earned income tax credit, $51,244,500 in fiscal year 2001-02 and $52,200,000 $55,160,000 in fiscal year 2002-03.
49.195 (3) A county, tribal governing body, Wisconsin works agency or the department shall determine whether an overpayment has been made under s. 49.19, 49.148, 49.155 or 49.157 and, if so, the amount of the overpayment. The county, tribal governing body, Wisconsin works agency or department shall provide notice of the overpayment to the liable person. The department shall give that person an opportunity for a review following the procedure specified under s. 49.152 49.16, if the person received the overpayment under s. 49.141 to 49.161, and for a hearing under ch. 227. Notwithstanding s. 49.96, the department shall promptly recover all overpayments made under s. 49.19, 49.148, 49.155 or 49.157 that have not already been received under s. 49.161 or 49.19 (17) and shall promulgate rules establishing policies and procedures to administer this subsection. The rules shall include notification procedures similar to those established for child support collections.
109,120
Section 120. 49.195 (3n) (k) of the statutes is amended to read:
49.195 (3n) (k) Any person who removes, deposits or conceals or aids in removing, depositing or concealing any property upon which a levy is authorized under this subsection with intent to evade or defeat the assessment or collection of any debt may be fined not more than $5,000 or imprisoned for not more than 4 years and 6 months or both, is guilty of a Class H felony and shall be liable to the state for assessed the costs of prosecution.
109,121
Section 121. 49.195 (3n) (r) of the statutes is amended to read:
49.195 (3n) (r) No employer may discharge or otherwise discriminate with respect to the terms and conditions of employment against any employee by reason of the fact that his or her earnings have been subject to levy for any one levy or because of compliance with any provision of this subsection. Any person who violates this paragraph may be fined not more than $1,000 or imprisoned for not more than 2 years or both is guilty of a Class I felony.
109,121k
Section 121k. 49.26 (1) (h) 1. as. of the statutes is amended to read:
49.26 (1) (h) 1. as. The individual has failed to request a hearing or has failed to show good cause for not cooperating with case management efforts in a hearing. The hearing shall be requested and held under s. 49.152 49.16. The department shall determine by rule the criteria for good cause.
109,121pb
Section 121pb. 49.45 (2) (a) 9. of the statutes is amended to read:
49.45 (2) (a) 9. Periodically set forth conditions of participation and reimbursement in a contract with provider for contracts with providers of service under this section. The department shall promulgate rules that specify criteria for and required procedures for submittal of appropriate claims for reimbursement.
109,121pc
Section 121pc. 49.45 (2) (a) 10. a. of the statutes, as affected by
2001 Wisconsin Act 16, is renumbered 49.45 (2) (a) 10. and amended to read:
49.45 (2) (a) 10. After reasonable notice and opportunity for a hearing conducted as a class 2 proceeding under ch. 227, recover money improperly or erroneously paid or overpayments to a provider by offsetting or adjusting amounts owed the provider under the program, crediting against a provider's future claims for reimbursement for other services or items furnished by the provider under the program, or requiring the provider to make direct payment to the department or its fiscal intermediary.
109,121pf
Section 121pf. 49.45 (2) (a) 11. a. of the statutes, as affected by
2001 Wisconsin Act 16, is renumbered 49.45 (2) (a) 11. and amended to read:
49.45 (2) (a) 11. Establish criteria for the certification of eligible providers of medical assistance and, except as provided in par. (b) 6m. and s. 49.48, and subject to par. (b) 7. and 8., certify providers who meet the criteria.
109,121ph
Section 121ph. 49.45 (2) (a) 12. a. of the statutes, as affected by
2001 Wisconsin Act 16, is renumbered 49.45 (2) (a) 12. and amended to read:
49.45 (2) (a) 12. Decertify or suspend under this subdivision a provider from or restrict a provider's participation in the medical assistance program, if after giving reasonable notice and opportunity for hearing the department finds that the provider has violated a federal statute or regulation or a state statute or administrative rule and the violation is by statute, regulation, or rule grounds for decertification or restriction. The department shall suspend the provider pending the hearing under this subdivision if the department includes in its decertification notice findings that the provider's continued participation in the medical assistance program pending hearing is likely to lead to the irretrievable loss of public funds and is unnecessary to provide adequate access to services to medical assistance recipients. As soon as practicable after the hearing, the department shall issue a written decision suspension. No payment may be made under the medical assistance program with respect to any service or item furnished by the provider subsequent to decertification or during the period of suspension.
109,121pj
Section 121pj. 49.45 (2) (a) 14. of the statutes is amended to read:
49.45 (2) (a) 14. Assure due process in implementing subds. 12. and 13. by providing written notice, a fair hearing and a written decision and a hearing conducted as a class 2 proceeding under ch. 227.
49.45 (3) (g) The secretary may authorize personnel to audit or investigate and report to the department on any matter involving violations or complaints alleging violations of statutes, regulations, or rules applicable to the
medical assistance program and to perform such investigations or audits as are required to verify the actual provision of services or items available under the medical assistance program and the appropriateness and accuracy of claims for reimbursement submitted by providers participating in the program. Department employees authorized by the secretary under this paragraph shall be issued, and shall possess at all times while they are performing their investigatory or audit functions under this section, identification, signed by the secretary, that specifically designates the bearer as possessing the authorization to conduct medical assistance investigations or audits. Under the request of a designated person and upon presentation of the person's authorization, providers and medical assistance recipients shall accord the person access to any provider personnel, records, books, or documents or other information needed. Under the written request of a designated person and upon presentation of the person's authorization, providers and recipients shall accord the person access to any needed patient health care records of a recipient. Authorized employees may hold hearings, administer oaths, take testimony, and perform all other duties necessary to bring the matter before the department for final adjudication and determination.
109,121pr
Section 121pr. 49.45 (3) (h) 1. of the statutes is created to read:
49.45 (3) (h) 1. For purposes of any audit, investigation, examination, analysis, review, or other function authorized by law with respect to the medical assistance program, the secretary shall have the power to sign and issue subpoenas to any person requiring the production of any pertinent books, records, patient health care records, or other information. Subpoenas so issued shall be served by anyone authorized by the secretary by delivering a copy to the person named in the subpoena, or by registered mail or certified mail addressed to the person at his or her last-known residence or principal place of business. A verified return by the person serving the subpoena setting forth the manner of service, or, in the event service is by registered or certified mail, the return post-office receipt signed by the person served constitutes proof of service.
49.45 (3) (h) 3. The failure or refusal of a provider to accord department auditors or investigators access as required under par. (g) to any provider personnel, records, books, patient health care records of medical assistance recipients, or documents or other information requested constitutes person to purge himself or herself of contempt found under s. 885.12 and perform the act as required by law shall constitute grounds for decertification or suspension of the provider that person from participation in the medical assistance program. No payment may be made for services rendered by the provider that person following decertification
, or during the period of suspension, or during any period of provider failure or refusal to accord access as required under par. (g).
109,121pu
Section 121pu. 49.45 (3) (h) 2. of the statutes is created to read:
49.45 (3) (h) 2. In the event of contumacy or refusal to obey a subpoena issued under this paragraph and duly served upon any person, any judge in a court of record in the county in which the person was served may enforce the subpoena in accordance with s. 885.12.
109,121t
Section 121t. 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 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.
For facilities in Douglas, 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.
49.45 (21) (title) Taking over provider's operation Transfer of business, liability for; repayments required.
49.45 (21) (a) Before a person may take over the operation of a provider that is If any provider liable for repayment of improper or erroneous payments or overpayments under ss. 49.43 to 49.497, full repayment shall be made. Upon request, the department shall notify the provider or the person that intends to take over the operation of the provider as to whether the provider sells or otherwise transfers ownership of his or her business or all or substantially all of the assets of the business, the transferor and transferee are each liable for the repayment. Prior to final transfer, the transferee is responsible for contacting the department and ascertaining if the transferor is liable under this paragraph.
49.45 (21) (b) If, notwithstanding the prohibition under par. (ar), a person takes over the operation of a provider If a transfer occurs and the applicable amount under par. (ar) (a) has not been repaid, the department may, in addition to withholding certification as authorized under sub. (2) (b) 8., proceed against the provider or the person either the transferor or the transferee. Within 30 days after the certified provider receives receiving notice from the department, the transferor or the transferee shall pay the amount
shall be repaid in full. If the amount is not repaid in full Upon failure to comply, the department may bring an action to compel payment,. If a transferor fails to pay within 90 days after receiving notice from the department, the department may proceed under sub. (2) (a) 12., or may do both.
109,122
Section 122. 49.45 (49) of the statutes is created to read:
49.45 (49) Prescription drug prior authorization. (a) The secretary shall exercise his or her authority under s. 15.04 (1) (c) to create a prescription drug prior authorization committee to advise the department on issues related to prior authorization decisions made concerning presciption drugs on behalf of medical assistance recipients. The secretary shall appoint as members at least all of the following:
1. Two physicians, as defined in s. 448.01 (5), who are currently in practice.
2. Two pharmacists, as defined in s. 450.01 (15).
3. One advocate for recipients of medical assistance who has sufficient medical background, as determined by the department, to evaluate a prescription drug's clinical effectiveness.
(b) The prescription drug prior authorization committee shall accept information or commentary from representatives of the pharmaceutical manufacturing industry in the committee's review of prior authorization policies.
109,122c
Section 122c. 49.45 (50) of the statutes is created to read:
49.45 (50) Disease management. (a) In this subsection, "disease management" means an integrated and systematic approach for managing the health care needs of patients who are at risk of or are diagnosed with a specific disease, using all of the following:
1. Best practices.
2. Prevention strategies.
3. Clinical practice improvement.
4. Clinical interventions and protocols.
5. Outcomes research, information, and technology.
6. Other tools and resources to reduce overall costs and improve measurable outcomes.
(b) The department may contract with an entity, under the department's request-for-proposal procedures, to engage in disease management activities on behalf of recipients of medical assistance.
109,123
Section 123. 49.49 (1) (b) 1. of the statutes is amended to read:
49.49 (1) (b) 1. In the case of such a statement, representation, concealment, failure, or conversion by any person in connection with the furnishing by that person of items or services for which medical assistance is or may be made, a person convicted of violating 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 or imprisoned for not more than 7 years and 6 months or both.
109,124
Section 124. 49.49 (2) (a) of the statutes is amended to read:
49.49 (2) (a) Solicitation or receipt of remuneration. Any person who solicits or receives any remuneration, including any kickback, bribe, or rebate, directly or indirectly, overtly or covertly, in cash or in kind, 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 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 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 or imprisoned for not more than 7 years and 6 months or both.
109,125
Section 125. 49.49 (2) (b) of the statutes is amended to read:
49.49 (2) (b) Offer or payment of remuneration. Whoever offers or pays any remuneration including any kickback, bribe, or rebate directly or indirectly, overtly or covertly, in cash or in kind 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 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 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 or imprisoned for not more than 7 years and 6 months or both.
109,126
Section 126. 49.49 (3) of the statutes is amended to read:
49.49 (3) Fraudulent certification of facilities. No person may knowingly and wilfully make or cause to be made, or induce or seek 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. Violators of 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 or imprisoned for not more than 7 years and 6 months or both.
109,127
Section 127. 49.49 (3m) (b) of the statutes is amended to read:
49.49 (3m) (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 or imprisoned for not more than 7 years and 6 months or both.
109,128
Section 128. 49.49 (4) (b) of the statutes is amended to read:
49.49 (4) (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 or imprisoned for not more than 7 years and 6 months or both.
109,128g
Section 128g. 49.49 (6) of the statutes is amended to read:
49.49 (6) Recovery. In addition to other remedies available under this section, the court may award the department of justice the reasonable and necessary costs of investigation, an amount reasonably necessary to remedy the harmful effects of the violation and the reasonable and necessary expenses of prosecution, including attorney fees, from any person who violates this section. The department of justice shall deposit in the state treasury for deposit in the general fund all moneys that the court awards to the department or the state under this subsection. Ten percent of the money deposited in the general fund that was awarded under this subsection for the costs of investigation and the expenses of prosecution, including attorney fees, shall be credited to the appropriation account under s. 20.455 (1) (gh).
109,128m
Section 128m. 49.665 (4) (at) 1. b. of the statutes is amended to read:
49.665 (4) (at) 1. b. The department may not lower the maximum income level for initial eligibility unless the department first submits to the joint committee on finance its plans a plan for lowering the maximum income level and the committee approves the plan. If, within 14 days after submitting the plan the date on which the plan is submitted to the joint committee on finance, the cochairpersons of the committee do not notify the secretary that the committee has scheduled a meeting for the purpose of reviewing the plan, the department shall implement the plan is considered approved by the committee as proposed. If, within 14 days after the date on which the plan is submitted to the committee, the cochairpersons of the committee notify the secretary that the committee has scheduled a meeting to review the plan, the department may implement the plan only as approved by the committee.
109,128n
Section 128n. 49.665 (4) (at) 1. cm. of the statutes is created to read:
49.665 (4) (at) 1. cm. Notwithstanding s. 20.001 (3) (b), if, after reviewing the plan submitted under subd. 1. b., the joint committee on finance determines that the amounts appropriated under s. 20.435 (4) (bc), (jz), (p), and (x) are insufficient to accommodate the projected enrollment levels, the committee may transfer appropriated moneys from the general purpose revenue appropriation account of any state agency, as defined in s. 20.001 (1), other than a sum sufficient appropriation account, to the appropriation account under s. 20.435 (4) (bc) to supplement the health care program under this section if the committee finds that the transfer will eliminate unnecessary duplication of functions, result in more efficient and effective methods for performing programs, or more effectively carry out legislative intent, and that legislative intent will not be changed by the transfer.
109,128p
Section 128p. 49.665 (5m) of the statutes is created to read:
49.665 (5m) Information about badger care recipients. (a) In this subsection:
1. "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
2. "Insurer" has the meaning given in s. 600.03 (27).
