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.
16,1750L
Section 1750L. 49.45 (2) (b) 6m. of the statutes is created to read:
49.45 (2) (b) 6m. Limit the number of providers of particular services that may be certified under par. (a) 11. or the amount of resources, including employees and equipment, that a certified provider may use to provide particular services to medical assistance recipients, if the department finds that existing certified providers and resources provide services that are adequate in quality and amount to meet the need of medical assistance recipients for the particular services; and if the department finds that the potential for medical assistance fraud or abuse exists if additional providers are certified or additional resources are used by certified providers. The department shall promulgate rules to implement this subdivision.
16,1750n
Section 1750n. 49.45 (2) (b) 7. of the statutes is created to read:
49.45 (2) (b) 7. Require, as a condition of certification under par. (a) 11., all providers of a specific service that is among those enumerated under s. 49.46 (2) or 49.47 (6) (a), as specified in this subdivision, to file with the department a surety bond issued by a surety company licensed to do business in this state. Providers subject to this subdivision provide those services specified under s. 49.46 (2) or 49.47 (6) (a) for which providers have demonstrated significant potential to violate s. 49.49 (1) (a), (2) (a) or (b), (3), (3m) (a), (3p), (4) (a), or (4m) (a), to require recovery under par. (a) 10., or to need additional sanctions under par. (a) 13. The surety bond shall be payable to the department in an amount that the department determines is reasonable in view of amounts of former recoveries against providers of the specific service and the department's costs to pursue those recoveries. The department shall promulgate rules to implement this subdivision that specify all of the following:
a. Services under medical assistance for which providers have demonstrated significant potential to violate s. 49.49 (1) (a), (2) (a) or (b), (3), (3m) (a), (3p), (4) (a), or (4m) (a), to require recovery under par. (a) 10., or to need additional sanctions under par. (a) 13.
b. The amount or amounts of the surety bonds.
c. Terms of the surety bond, including amounts, if any, without interest to be refunded to the provider upon withdrawal or decertification from the medical assistance program.
16,1750p
Section 1750p. 49.45 (2) (b) 8. of the statutes is created to read:
49.45 (2) (b) 8. Require a person who takes over the operation, as defined in sub. (21) (ag), of a provider, to first obtain certification under par. (a) 11. for the operation of the provider, regardless of whether the person is currently certified. The department may withhold the certification required under this subdivision until any outstanding repayment under sub. (21) is made. The department shall promulgate rules to implement this subdivision.
16,1750r
Section 1750r. 49.45 (2) (b) 9. of the statutes is created to read:
49.45 (2) (b) 9. After providing reasonable notice and opportunity for a hearing, charge an assessment to a provider that repeatedly has been subject to recoveries under par. (a) 10. a. because of the provider's failure to follow identical or similar billing procedures or to follow other identical or similar program requirements. The assessment shall be used to defray in part the costs of audits and investigations by the department under sub. (3) (g) and may not exceed $1,000 or 200% of the amount of any such repeated recovery made, whichever is greater. The provider shall pay the assessment to the department within 10 days after receipt of notice of the assessment or the final decision after administrative hearing, whichever is later. The department may recover any part of an assessment not timely paid by offsetting the assessment against any medical assistance payment owed to the provider and may refer any such unpaid assessments not collected in this manner to the attorney general, who may proceed with collection under this subdivision. Failure to timely pay in any manner an assessment charged under this subdivision, other than an assessment that is offset against any medical assistance payment owed to the provider, is grounds for decertification under subd. 12. A provider's payment of an assessment does not relieve the provider of any other legal liability incurred in connection with the recovery for which the assessment is charged, but is not evidence of violation of a statute or rule. The department shall credit all assessments received under this subdivision to the appropriation account under s. 20.435 (4) (iL). The department shall promulgate rules to implement this subdivision.
16,1750t
Section 1750t. 49.45 (3) (g) of the statutes is renumbered 49.45 (3) (g) 1. and amended to read:
49.45 (3) (g) 1. The secretary may appoint authorize personnel to audit or investigate and report to the department on any matter involving violations or complaints alleging violations of laws statutes, regulations, or rules applicable to Title XIX of the federal social security act or 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 appointed authorized by the secretary under this paragraph shall be issued, and shall possess at all times
during which while they are performing their investigatory or audit functions under this section, identification
, signed by the secretary which, that specifically designates the bearer as possessing the authorization to conduct medical assistance investigations or audits. Pursuant to
Under the request of a designated person and upon presentation of that the person's authorization, providers and medical assistance recipients shall accord such the person access to any provider personnel, records, books, recipient medical records, 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 shall have authority to may hold hearings, administer oaths, take testimony, and perform all other duties necessary to bring such the matter before the department for final adjudication and determination.
16,1750td
Section 1750td. 49.45 (3) (g) 2. of the statutes is created to read:
49.45 (3) (g) 2. The department shall promulgate rules to implement this paragraph.
16,1750v
Section 1750v. 49.45 (3) (h) 1. of the statutes is repealed.
16,1750vm
Section 1750vm. 49.45 (3) (h) 1n. of the statutes is created to read:
49.45 (3) (h) 1n. The department shall promulgate rules to implement this paragraph.
16,1750x
Section 1750x. 49.45 (3) (h) 2. of the statutes is repealed.
16,1750z
Section 1750z. 49.45 (3) (h) 3. of the statutes is renumbered 49.45 (3) (h) 1m. and amended to read:
49.45 (3) (h) 1m. The failure or refusal of a person to purge himself or herself of contempt found under s. 885.12 and perform the act as required by law shall constitute 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 grounds for decertification or suspension of that person the provider from participation in the medical assistance program and no. No payment may be made for services rendered by that person subsequent to the provider 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).
16,1765
Section
1765. 49.45 (5m) (am) of the statutes is amended to read:
49.45
(5m) (am) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b)
and, (o)
, and (w), the department shall distribute not more than $2,256,000 in each fiscal year, to provide supplemental funds to rural hospitals that, as determined by the department, have high utilization of inpatient services by patients whose care is provided from governmental sources, and to provide supplemental funds to critical access hospitals, except that the department may not distribute funds to a rural hospital or to a critical access hospital to the extent that the distribution would exceed any limitation under
42 USC 1396b (i) (3).
16,1766
Section
1766. 49.45 (5r) of the statutes is repealed.
16,1767
Section
1767. 49.45 (6b) of the statutes is amended to read:
49.45 (6b) Centers for the developmentally disabled. From the appropriation under s. 20.435 (2) (gk), the department may reimburse the cost of services provided by the centers for the developmentally disabled. Reimbursement to the centers for the developmentally disabled shall be reduced following each placement made under s. 46.275 that involves a relocation from a center for the developmentally disabled, by $184
$200 per day, beginning in fiscal year 1999-2000 2001-02, and by $190 $225 per day, beginning in fiscal year 2000-01 2002-03.
16,1768
Section
1768. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:
49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this subsection made under s. 20.435 (4) (b), (pa) or, (o), (w), or (wm) shall, except as provided in pars. (bg), (bm), and (br), be determined according to a prospective payment system updated annually by the department. The payment system shall implement standards that are necessary and proper for providing patient care and that meet quality and safety standards established under subch. II of ch. 50 and ch. 150. The payment system shall reflect all of the following:
16,1771
Section
1771. 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 (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.,
fm., j., k.
and, L.,
and Lm., 9.
and, 15.,
and 18., 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 moneys in each fiscal year to these county departments, or local health departments as determined by the department, and shall perform all of the following:
16,1772
Section
1772. 49.45 (6t) (intro.) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is repealed and recreated to read:
49.45
(6t) County department and local health department operating deficit reduction. (intro.) From the appropriation under s. 20.435 (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., fm., j., k., L., and Lm., 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 moneys in each fiscal year to these county departments, or local health departments as determined by the department, and shall perform all of the following:
16,1773
Section
1773. 49.45 (6t) (a) of the statutes is amended to read:
49.45
(6t) (a) For the reduction of operating deficits incurred by the county departments or local health departments, estimate the availability of federal medicaid funds that may be matched to county, city, town
, or village 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.,
fm., j., k.
and
, L.,
and Lm., 9.
and, 15.,
and 18., for case management services under s. 49.46 (2) (b) 12. and for mental health day treatment services for
minor minors provided under the authorization under
42 USC 1396d (r) (5).
16,1774
Section
1774. 49.45 (6t) (a) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is repealed and recreated to read:
49.45
(6t) (a) For the reduction of operating deficits incurred by the county departments or local health departments, estimate the availability of federal medicaid funds that may be matched to county, city, town, or village 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., fm., j., k., L., and Lm., 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).
16,1776
Section
1776. 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 (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 $40,100,000 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 (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 (4) (o). 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:
16,1776m
Section 1776m. 49.45 (6u) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is renumbered 49.45 (6u) (am), and 49.45 (6u) (am) (intro.) and 2. (intro.) and b., 3., 4., 5. and 6., as renumbered, are amended to read:
49.45
(6u) (am) (intro.) Notwithstanding sub. (6m),
in state fiscal years in which less than $1
15,200,000 in federal financial participation relating to facilities is received under 42 CFR 433.51, from the
appropriation appropriations under s. 20.435 (4) (o)
, (w), and (wm), for reduction of operating deficits, as defined under
criteria developed the methodology used by the department
in December, 2000, incurred by a facility 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
$40,100,000 $37,100,000 in each fiscal year, as determined by the department. 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:
2. (intro.) Based on the amount estimated available under par. (a) subd. 1., develop a method to distribute this allocation to the individual facilities that have incurred operating deficits that shall include:
b. Agreement by the county in which is located the facility established under s. 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 paragraph.
3. Distribute the allocation under the distribution method that is developed, unless a county has failed to comply with par. (b) 2m subd. 2. bm.
4. If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (4) (o) and (w) that result in a lesser allocation amount than that allocated under this subsection paragraph, allocate not more than the lesser amount so approved by the federal department of health and human services.
5. If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (4) (o) and (w) that result in a lesser allocation amount than that allocated under this subsection paragraph, submit a revision of the method developed under par. (b) subd. 2. for approval by the joint committee on finance in that state fiscal year.
6. If the federal department of health and human services disallows use of the allocation of matching federal medical assistance funds distributed under par. (c)
subd. 3., apply the requirements under sub. (6m) (br).
16,1777
Section
1777. 49.45 (6u) (ag) of the statutes is created to read:
49.45 (6u) (ag) In this subsection, "facility" has the meaning given in sub. (6m) (a) 3.
16,1778
Section
1778. 49.45 (6u) (bm) of the statutes is created to read:
49.45
(6u) (bm) In state fiscal years in which $1
15,200,000 or more in federal financial participation relating to facilities is received under
42 CFR 433.51, from the appropriations under s. 20.435 (4) (o) and (w), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a facility 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 $77,100,000 in each fiscal year, as determined by the department under a methodology as specified in the state plan for services under
42 USC 1396.
16,1778d
Section 1778d. 49.45 (6v) (b) of the statutes is amended to read:
49.45 (6v) (b) The Beginning on October 1, 2003, and annually thereafter, 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) for the immediately prior 2 consecutive fiscal years.
16,1778h
Section 1778h. 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 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 (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 decreased during the most recently completed fiscal year from the utilization of beds by recipients of medical assistance in facilities in the next most recently completed fiscal year, the department shall multiply the difference between the number of days of care provided to the recipients in the facilities in each of those prior 2 consecutive fiscal years by the average daily costs of care in the facilities for the most recently completed fiscal year. The average daily costs of care shall be calculated by dividing the total of medical assistance expenditures for care in facilities for the most recently completed fiscal year by the total number of days of care provided in facilities in that fiscal year.
16,1778p
Section 1778p. 49.45 (6v) (d) of the statutes is created to read:
49.45 (6v) (d) If par. (c) applies and if the amount calculated under par. (c) is positive, the department's report under par. (b) shall include a proposal to transfer an amount equal to the portion of the amount calculated under par. (c) that is the state share of medical assistance expenditures from the appropriation account under s. 20.435 (4) (b) to the appropriation account under s. 20.435 (7) (bd) for the purpose of increasing funding for the long-term support community options program under s. 46.27. If the cochairpersons of the joint committee on finance do not notify the secretary within 14 working days after the date on which the department submits the proposal that the committee has scheduled a meeting for the purpose of reviewing the proposal, the secretary shall transfer the amount identified under the proposal. If, within 14 working days after the date on which the department submits the proposal, the cochairpersons of the joint committee on finance notify the secretary that the committee has scheduled a meeting for the purpose of reviewing the proposal, the secretary may transfer moneys from the appropriation account under s. 20.435 (4) (b) to the appropriation account under s. 20.435 (7) (bd) only as approved by the committee.
16,1778r
Section 1778r. 49.45 (6v) (e) of the statutes is created to read:
49.45 (6v) (e) Of the amount required to be transferred by the secretary under par. (d), 40% shall be expended for services as specified under s. 46.27 (7) and 60% shall be expended for services as specified under s. 46.27 (11).
16,1779
Section
1779. 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 (4) (b)
and, (o)
, and (w), 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).
16,1780
Section
1780. 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 (4) (b)
and, (o)
, and (w), 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).
16,1781
Section
1781. 49.45 (6y) (am) of the statutes is amended to read:
49.45
(6y) (am) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b), (h)
and, (o)
, and (w), 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).
16,1782
Section
1782. 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 (4) (b)
and, (o)
, and (w), 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:
16,1783
Section
1783. 49.45 (8) (b) of the statutes is amended to read:
49.45 (8) (b) Reimbursement under s. 20.435 (4) (b) and, (o), and (w) 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).
16,1786g
Section 1786g. 49.45 (21) (title) of the statutes is amended to read:
49.45 (21) (title) Transfer of business, liability for Taking over provider's operation; repayments required.
16,1786h
Section 1786h. 49.45 (21) (a) of the statutes is renumbered 49.45 (21) (ar) and amended to read:
49.45 (21) (ar) If any provider Before a person may take over the operation of a provider that is liable for repayment of improper or erroneous payments or overpayments under ss. 49.43 to 49.497 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, 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 is liable under this paragraph.
16,1786i
Section 1786i. 49.45 (21) (ag) of the statutes is created to read:
49.45 (21) (ag) In this subsection, "take over the operation" means obtain, with respect to an aspect of a provider's business for which the provider has filed claims for medical assistance reimbursement, any of the following:
1. Ownership of the provider's business or all or substantially all of the assets of the business.
2. Majority control over decisions.
3. The right to any profits or income.
4. The right to contact and offer services to patients, clients, or residents served by the provider.
