2001 Wisconsin Act 16

49.197 (1m) Fraud investigation. From the appropriations under s. 20.445 (3) (dz), (kx), (L), (md), (n), and (nL), the department shall establish a program to investigate suspected fraudulent activity on the part of recipients of medical assistance under subch. IV, aid to families with dependent children under s. 49.19 and the food stamp program under 7 USC 2011 to 2036 and, on the part of participants in the Wisconsin works program under ss. 49.141 to 49.161, and, if the department of health and family services contracts with the department under sub. (5), on the part of recipients of medical assistance under subch. IV and food stamp benefits under the food stamp program under 7 USC 2011 to 2036. The department's activities under this subsection may include, but are not limited to, comparisons of information provided to the department by an applicant and information provided by the applicant to other federal, state, and local agencies, development of an advisory welfare investigation prosecution standard, and provision of funds to county departments under ss. 46.215, 46.22, and 46.23 and to Wisconsin works agencies to encourage activities to detect fraud. The department shall cooperate with district attorneys regarding fraud prosecutions.

16,1724g Section 1724g. 49.197 (3) of the statutes is amended to read:

49.197 (3) State error reduction activities. The department shall conduct activities to reduce payment errors in medical assistance under subch. IV, Wisconsin works under ss. 49.141 to 49.161, aid to families with dependent children under s. 49.19 and the food stamp program under 7 USC 2011 to 2029. The department shall fund the activities under this section from the appropriation under s. 20.445 (3) (L).

16,1724m Section 1724m. 49.197 (3) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

49.197 (3) State error reduction activities. The department shall conduct activities to reduce payment errors in medical assistance under subch. IV, Wisconsin works under ss. 49.141 to 49.161, aid to families with dependent children under s. 49.19 and the food stamp program under 7 USC 2011 to 2029 and, if the department of health and family services contracts with the department under sub. (5), the medical assistance program under subch. IV and the food stamp program under 7 USC 2011 to 2036.

16,1725ag Section 1725ag. 49.197 (4) of the statutes is amended to read:

49.197 (4) County and tribal error reduction. The department shall provide funds from the appropriations under s. 20.445 (3) (dz), and (L) and (Lm) and federal matching funds from the appropriations under s. 20.445 (3) (md), (n) and (nL) to counties and governing bodies of federally recognized American Indian tribes administering medical assistance under subch. IV, aid to families with dependent children under s. 49.19 or the food stamp program under 7 USC 2011 to 2029 2036 to offset administrative costs of reducing payment errors in those programs.

16,1725am Section 1725am. 49.197 (4) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

49.197 (4) County and tribal error reduction. The If the department of health and family services contracts with the department under sub. (5), the department shall provide funds from the appropriations appropriation under s. 20.445 (3) (dz) and (L) and federal matching funds from the appropriations under s. 20.445 (3) (n) and (nL) (kx) to counties and governing bodies of federally recognized American Indian tribes administering medical assistance under subch. IV or the food stamp program under 7 USC 2011 to 2036 to offset administrative costs of reducing payment errors in those programs.

16,1725b Section 1725b. 49.197 (5) of the statutes is created to read:

49.197 (5) Contracts for medical assistance and food stamps. The department of health and family services may contract with the department to investigate suspected fraudulent activity on the part of recipients of medical assistance under subch. IV or recipients of food stamp benefits under the food stamp program under 7 USC 2011 to 2036 as provided in this section.

16,1725c Section 1725c. 49.22 (6) of the statutes is amended to read:

49.22 (6) The department shall establish, pursuant to federal and state laws, rules and regulations, a uniform system of fees for services provided under this section to individuals not receiving aid under s. 46.261, 49.19 or 49.47; benefits under s. 49.124, 49.148 or , 49.155, or 49.79; foster care maintenance payments under 42 USC 670 to 679a; or kinship care payments under s. 48.57 (3m) or long-term kinship care payments under s. 48.57 (3n). The system of fees may take into account an individual's ability to pay. Any fee paid and collected under this subsection may be retained by the county providing the service except for the fee specified in 42 USC 653 (e) (2) for federal parent locator services.

16,1726 Section 1726. 49.30 (2) of the statutes is amended to read:

49.30 (2) From the appropriation appropriations under s. 20.445 (3) (dz) and (md), the department shall reimburse a county or applicable tribal governing body or organization for any amount that the county or applicable tribal governing body or organization is required to pay under sub. (1). From the appropriation appropriations under s. 20.445 (3) (dz) and (md), the department shall reimburse a county or applicable tribal governing body or organization for cemetery expenses or for funeral and burial expenses for persons described under sub. (1) that the county or applicable tribal governing body or organization is not required to pay under subs. (1) and (1m) only if the department approves the reimbursement due to unusual circumstances.

16,1727 Section 1727. 49.32 (2) (d) of the statutes is amended to read:

49.32 (2) (d) The department shall disburse from state or federal funds or both the entire amount and charge the county for its share under s. 49.33 (8) and (9).

16,1728m Section 1728m. 49.32 (7) (b) of the statutes is amended to read:

49.32 (7) (b) The department shall conduct a program to periodically match the records of recipients of medical assistance under s. 49.46, 49.468 or 49.47, aid to families with dependent children under s. 49.19 and the food stamp program under 7 USC 2011 to 2029 and, if the department of health and family services contracts with the department under s. 49.197 (5), recipients of medical assistance under subch. IV and food stamp benefits under the food stamp program under 7 USC 2011 to 2036 with the records of recipients under those programs in other states. If an agreement with the other states can be obtained, matches with records of states contiguous to this state shall be conducted at least annually.

16,1729m Section 1729m. 49.32 (7) (c) of the statutes is amended to read:

49.32 (7) (c) The department shall conduct a program to periodically match the address records of recipients of medical assistance under s. 49.46, 49.468 or 49.47, aid to families with dependent children under s. 49.19 and the food stamp program under 7 USC 2011 to 2029 and, if the department of health and family services contracts with the department under s. 49.197 (5), recipients of medical assistance under subch. IV and food stamp benefits under the food stamp program under 7 USC 2011 to 2036 to verify residency and to identify recipients receiving duplicate or fraudulent payments.

16,1730b Section 1730b. 49.32 (7) (d) of the statutes is amended to read:

49.32 (7) (d) The department, with assistance from the department of corrections, shall conduct a program to periodically match the records of persons confined in state correctional facilities with the records of recipients of medical assistance under s. 49.46, 49.468 or 49.47, aid to families with dependent children under s. 49.19 and the food stamp program under 7 USC 2011 to 2029 and, if the department of health and family services contracts with the department under s. 49.197 (5), recipients of medical assistance under subch. IV and food stamp benefits under the food stamp program under 7 USC 2011 to 2036 to identify recipients who may be ineligible for benefits.

16,1730f Section 1730f. 49.32 (10) (a) (intro.) of the statutes is amended to read:

49.32 (10) (a) (intro.) Each county department under s. 46.215, 46.22, or 46.23 may release the current address of a recipient of food stamps or of aid under s. 49.19, and each Wisconsin works agency may release the current address of a participant in Wisconsin works under ss. 49.141 to 49.161 or, if administering the food stamp program, of a food stamp recipient, to a law enforcement officer if the officer meets all of the following conditions:

16,1731g Section 1731g. 49.33 (1) (b) of the statutes is amended to read:

49.33 (1) (b) "Income maintenance program" means aid to families with dependent children under s. 49.19, Wisconsin works under ss. 49.141 to 49.161, the medical assistance program under subch. IV of ch. 49, the badger care health care program under s. 49.665, the child care program under s. 49.155, or the food stamp program under 7 USC 2011 to 2029 2036.

16,1731gc Section 1731gc. 49.33 (1) (b) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

49.33 (1) (b) "Income maintenance program" means the medical assistance program under subch. IV of ch. 49, the badger care health care program under s. 49.665, the child care program under s. 49.155, or the food stamp program under 7 USC 2011 to 2036.

16,1731m Section 1731m. 49.33 (1) (c) of the statutes is repealed.

16,1731t Section 1731t. 49.33 (1) (cr) of the statutes is created to read:

49.33 (1) (cr) "Tribal governing body" means an elected governing body of a federally recognized American Indian tribe.

16,1732b Section 1732b. 49.33 (2) of the statutes is repealed and recreated to read:

49.33 (2) Contracts. (a) Annually, the department and the department of health and family services shall, jointly, contract with county departments under ss. 46.215, 46.22, and 46.23, and may, jointly, contract with tribal governing bodies, to reimburse the county departments and tribal governing bodies for the reasonable cost of administering the medical assistance program under subch. IV and the badger care health care program under s. 49.665.

(b) Annually, the department shall contract with county departments under ss. 46.215, 46.22, and 46.23, and may, jointly, contract with tribal governing bodies, to reimburse the county departments and tribal governing bodies for the reasonable cost of administering income maintenance programs, other than the medical assistance program under subch. IV and the badger care health care program under s. 49.665.

16,1732c Section 1732c. 49.33 (2) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is repealed and recreated to read:

49.33 (2) Contracts. Annually, the department of health and family services shall contract with county departments under ss. 46.215, 46.22, and 46.23, and may contract with tribal governing bodies, to reimburse the county departments and tribal governing bodies for the reasonable cost of administering income maintenance programs.

16,1737 Section 1737. 49.33 (8) (a) of the statutes is amended to read:

49.33 (8) (a) The From the appropriation accounts under ss. 20.445 (3) (dz), (kx), (md), and (nL) and subject to par. (b), the department shall reimburse each county and tribal governing body that contracts with the department and the department of health and family services under sub. (2) (a) for reasonable costs of income maintenance relating to the administration of the programs under this subchapter and subch. IV according to administering the medical assistance program under subch. IV and the badger care health care program under s. 49.665 and that contracts with the department under sub. (2) (b) for the reasonable costs of administering income maintenance programs other than the medical assistance program under subch. IV and the badger care health care program under s. 49.665. The amount of each reimbursement paid under this paragraph shall be calculated using a formula based on workload within the limits of available state and federal funds under s. 20.445 (3) (dz), (kx), (md), and (nL) by contract under s. 49.33 (2). The amount of reimbursement calculated under this paragraph and par. (b) is in addition to any reimbursement provided to a county or tribal governing body for fraud and error reduction under s. 49.197 (1m) and (4).

16,1737c Section 1737c. 49.33 (8) (a) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

49.33 (8) (a) From the appropriation accounts under ss. 20.445 (3) (dz), (kx), (md), and (nL) s. 20.435 (4) (bn) and (nn) and subject to par. (b), the department of health and family services shall reimburse each county and tribal governing body that contracts with the department and the department of health and family services under sub. (2) (a) for reasonable costs of administering the medical assistance program under subch. IV and the badger care health care program under s. 49.665 and that contracts with the department under sub. (2) (b) for the reasonable costs of administering income maintenance programs other than the medical assistance program under subch. IV and the badger care health care program under s. 49.665. The amount of each reimbursement paid under this paragraph shall be calculated using a formula based on workload within the limits of available state and federal funds under s. 20.445 (3) (dz), (kx), (md), and (nL) 20.435 (4) (bn) and (nn) by contract under s. 49.33 (2). The amount of reimbursement calculated under this paragraph and par. (b) is in addition to any reimbursement provided to a county or tribal governing body for fraud and error reduction under s. 49.197 (1m) and (4).

16,1738 Section 1738. 49.33 (8) (b) of the statutes is amended to read:

49.33 (8) (b) The department may adjust the amounts determined under par. (a) for workload changes and computer network activities performed by counties a county or tribal governing body and may reduce the amount of any reimbursement if federal reimbursement is withheld due to audits, quality control samples, or program reviews.

16,1739 Section 1739. 49.33 (9) of the statutes is repealed.

16,1740 Section 1740. 49.33 (10) (a) of the statutes is amended to read:

49.33 (10) (a) The Each county treasurer and each director of a county department under s. 46.215, 46.22, or 46.23 and each tribal governing body shall certify monthly under oath to the department in such manner as the department prescribes the claim of the county for state reimbursement under subs. sub. (8) and (9) and (a). The department shall review each claim of reimbursement and, if the department approves such the claim it, the department shall certify to the department of administration for reimbursement to the county for amounts due under these subsections sub. (8) (a) and payment claimed to be made to the counties monthly. The department may make advance payments prior to the beginning of each month equal to one-twelfth of the contracted amount.

16,1740am Section 1740am. 49.33 (10) (a) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

49.33 (10) (a) Each county treasurer and director of a county department under s. 46.215, 46.22, or 46.23 and each tribal governing body shall certify monthly under oath to the department of health and family services in such manner as the department of health and family services prescribes the claim of the county for state reimbursement under sub. (8) (a). The department of health and family services shall review each claim of reimbursement and, if the department of health and family services approves the claim, the department of health and family services shall certify to the department of administration for reimbursement to the county for amounts due under sub. (8) (a) and payment claimed to be made to the counties monthly. The department of health and family services may make advance payments prior to the beginning of each month equal to one-twelfth of the contracted amount.

16,1740bg Section 1740bg. 49.33 (10) (b) of the statutes is amended to read:

49.33 (10) (b) To facilitate prompt reimbursement the certificate of the department may be based on the certified statements of the county officers or tribal governing body executives filed under par. (a). Funds recovered from audit adjustments from a prior fiscal year may be included in subsequent certifications only to pay counties owed funds as a result of any audit adjustment. By September 30 annually, the department shall submit a report to the appropriate standing committees under s. 13.172 (3) on funds recovered and paid out during the previous calendar year as a result of audit adjustments.

16,1740bq Section 1740bq. 49.33 (10) (b) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

49.33 (10) (b) To facilitate prompt reimbursement the certificate of the department of health and family services may be based on the certified statements of the county officers or tribal governing body executives filed under par. (a). Funds recovered from audit adjustments from a prior fiscal year may be included in subsequent certifications only to pay counties owed funds as a result of any audit adjustment. By September 30 annually, the department of health and family services shall submit a report to the appropriate standing committees under s. 13.172 (3) on funds recovered and paid out during the previous calendar year as a result of audit adjustments.

16,1741 Section 1741. 49.36 (1) of the statutes is renumbered 49.36 (1) (intro.) and amended to read:

49.36 (1) (intro.) In this section, "custodial:

(a) "Custodial parent" means a parent who lives with his or her child for substantial periods of time.

16,1742 Section 1742. 49.36 (1) (b) of the statutes is created to read:

49.36 (1) (b) "Tribal governing body" means an elected tribal governing body of a federally recognized American Indian tribe or band.

16,1743 Section 1743. 49.36 (2) of the statutes is amended to read:

49.36 (2) The department may contract with any county, tribal governing body, or Wisconsin works agency to administer a work experience and job training program for parents who are not custodial parents and who fail to pay child support or to meet their children's needs for support as a result of unemployment or underemployment. The program may provide the kinds of work experience and job training services available from the program under s. 49.193, 1997 stats., or s. 49.147 (3) or (4). The program may also include job search and job orientation activities. The department shall fund the program from the appropriation under s. 20.445 (3) (dz).

16,1744 Section 1744. 49.36 (4) of the statutes is amended to read:

49.36 (4) When a person completes 16 weeks of participation in a program under this section, the county, tribal governing body, or Wisconsin works agency operating the program shall inform the clerk of courts, by affidavit, of that completion.

16,1745 Section 1745. 49.36 (5) of the statutes is amended to read:

49.36 (5) A person participating in work experience as part of the program under this section is considered an employee of the county, tribal governing body, or Wisconsin works agency administering the program under this section for purposes of worker's compensation benefits only.

16,1746 Section 1746. 49.36 (6) of the statutes is amended to read:

49.36 (6) A county, tribal governing body, or Wisconsin works agency administering the program under this section shall reimburse a person for reasonable transportation costs incurred because of participation in a program under this section up to a maximum of $25 per month.

16,1747 Section 1747. 49.36 (7) of the statutes is amended to read:

49.36 (7) The department shall pay a county, tribal governing body, or Wisconsin works agency not more than $400 for each person who participates in the program under this section in the region in which the county, tribal governing body, or Wisconsin works agency administers the program under this section. The county, tribal governing body, or Wisconsin works agency shall pay any additional costs of the program.

16,1748 Section 1748. 49.43 (8) of the statutes is amended to read:

49.43 (8) "Medical assistance" means any services or items under ss. 49.45 to 49.472 49.473, except s. 49.472 (6), and under ss. 49.49 to 49.497, or any payment or reimbursement made for such services or items.

16,1749 Section 1749. 49.45 (2) (a) 3. of the statutes is amended to read:

49.45 (2) (a) 3. Determine the eligibility of persons for medical assistance, rehabilitative, and social services under ss. 49.46, 49.468, and 49.47 and rules and policies adopted by the department and may shall, under a contract under s. 49.33 (2) (a), designate this function to the county department under s. 46.215, 46.22, or 46.23 or, to the extent permitted by federal law or a waiver from federal secretary of health and human services to a Wisconsin works agency a tribal governing body.

16,1750 Section 1750. 49.45 (2) (a) 3m. of the statutes is created to read:

49.45 (2) (a) 3m. If the department does not contract with the department of workforce development under s. 49.197 (5), establish a program to investigate suspected fraudulent activity on the part of recipients of medical assistance and establish a program to reduce errors in the payments of medical assistance.

16,1750d Section 1750d. 49.45 (2) (a) 10. of the statutes is renumbered 49.45 (2) (a) 10. a. and amended to read:

49.45 (2) (a) 10. a. After reasonable notice and opportunity for hearing, recover money improperly or erroneously paid, or overpayments to a provider either 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 by requiring the provider to make direct payment to the department or its fiscal intermediary.

16,1750f Section 1750f. 49.45 (2) (a) 10. b. of the statutes is created to read:

49.45 (2) (a) 10. b. Establish a deadline for payment of a recovery imposed under this subdivision and, if a provider fails to pay all of the amount to be recovered by the deadline, require payment, by the provider, of interest on any delinquent amount at the rate of 1% per month or fraction of a month from the date of the overpayment.

16,1750g Section 1750g. 49.45 (2) (a) 10. c. of the statutes is created to read:

49.45 (2) (a) 10. c. Promulgate rules to implement this subdivision.

16,1750h Section 1750h. 49.45 (2) (a) 11. of the statutes is renumbered 49.45 (2) (a) 11. a. and amended to read:

49.45 (2) (a) 11. a. Establish criteria for the certification of eligible providers of services under Title XIX of the social security act medical assistance and, except as provided in par. (b) 6m. and s. 49.48, and subject to par. (b) 7. and 8., certify such eligible providers who meet the criteria.

16,1750i Section 1750i. 49.45 (2) (a) 11. b. of the statutes is created to read:

49.45 (2) (a) 11. b. Promulgate rules to implement this subdivision.

16,1750j Section 1750j. 49.45 (2) (a) 12. of the statutes is renumbered 49.45 (2) (a) 12. a. and amended to read:

49.45 (2) (a) 12. a. 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 law statute or administrative rule and such violations are by law the violation is by statute, regulation, or rule grounds for decertification or suspension 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. 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.

16,1750k Section 1750k. 49.45 (2) (a) 12. b. of the statutes is created to read:

49.45 (2) (a) 12. b. Promulgate rules to implement this subdivision.

16,1750km Section 1750km. 49.45 (2) (a) 24. of the statutes is created to read:

49.45 (2) (a) 24. Promulgate rules that require that the written plan of care for persons receiving personal care services under medical assistance be reviewed by a registered nurse at least every 60 days. The rules shall provide that the written plan of care shall designate intervals for visits to the recipient's home by a registered nurse as part of the review of the plan of care. The designated intervals for visits shall be based on the individual recipient's needs, and each recipient shall be visited in his or her home by a registered nurse at least once in every 12-month period. The rules shall also provide that a visit to the recipient is also required if, in the course of the nurse's review of the plan of care, there is evidence that a change in the recipient's condition has occurred that may warrant a change in the plan of care.