32,1395
Section
1395. 49.175 (1) (q) of the statutes is amended to read:
49.175 (1) (q) Child care state administration and child care licensing activities. For administration of child care programs under s. 49.155 and the allocation under s. 49.155 (1g) (c) for child care licensing activities, $8,534,700 $19,702,100 in fiscal year 2009-10 2011-12 and $8,889,700 $19,783,800 in fiscal year 2010-11 2012-13.
32,1396
Section
1396. 49.175 (1) (qm) of the statutes is amended to read:
49.175 (1) (qm) Quality care for quality kids. For the child care quality improvement activities specified in s. 49.155 (1g), $5,384,600 $13,486,700 in fiscal year 2009-10 2011-12 and $5,384,600 $13,169,400 in fiscal year 2010-11 2012-13.
32,1397
Section
1397. 49.175 (1) (r) of the statutes is amended to read:
49.175 (1) (r) Children of recipients of supplemental security income. For payments made under s. 49.775 for the support of the dependent children of recipients of supplemental security income, $29,899,800 in fiscal year 2009-10 and $29,933,200 $31,232,200 in each fiscal year thereafter.
32,1398
Section
1398. 49.175 (1) (s) of the statutes is amended to read:
49.175 (1) (s) Kinship care, long-term kinship care, and foster care assistance. For the kinship care and long-term kinship care programs under s. 48.57 (3m), (3n), and (3p) and for foster care for relatives under s. 48.62, $24,435,000 in fiscal year 2009-10 and $24,435,000 $21,375,800 in each fiscal year
2010-11.
32,1399
Section
1399. 49.175 (1) (v) of the statutes is created to read:
49.175
(1) (v)
Program improvement plan. For services provided under the child welfare program improvement plan developed under
45 CFR 1355.35, $680,400 in fiscal year 2011-12 and $1,360,800 in each fiscal year thereafter.
49.175 (1) (zh) Earned income tax credit supplement. For the transfer of moneys from the appropriation account under s. 20.437 (2) (md) to the appropriation account under s. 20.835 (2) (kf) for the earned income tax credit, $6,664,200 in fiscal year 2009-10 and $43,664,200 in each fiscal year 2010-11.
32,1402m
Section 1402m. 49.197 (1m) of the statutes is amended to read:
49.197
(1m) Fraud investigation. From the appropriations under s. 20.437 (2) (dz), (kx), (L), (mc), (md), (me), and (nL), the department shall establish a program to investigate suspected fraudulent activity on the part of recipients of aid to families with dependent children under s. 49.19, on the part of participants in the Wisconsin Works program under ss. 49.141 to 49.161, and, if the department of health services contracts with the department under sub. (5), on the part of recipients of medical assistance under subch. IV, food stamp benefits under the food stamp program under
7 USC 2011 to
2036, supplemental security income payments under s. 49.77, payments for the support of children of supplemental security income recipients under s. 49.775, and health care benefits under the Badger Care health care program under s. 49.665. 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
or multicounty consortia, as defined in s. 49.78 (1) (br), and to Wisconsin Works agencies to encourage activities to detect fraud. The department shall cooperate with district attorneys regarding fraud prosecutions.
32,1405g
Section 1405g. 49.197 (2) of the statutes is repealed and recreated to read:
49.197 (2) Incentive program for local fraud detection. (a) In this subsection:
1. "County department" means a county department under s. 46.22 or 46.23.
2. "Subsidy program" means the child care subsidy program under s. 49.155.
3. "Tribal governing body" means an elected governing body of a federally recognized American Indian tribe.
(b) 1. Subject to subd. 2., the department shall by rule establish an incentive program that, using moneys from the allocation under s. 49.175 (1) (p), rewards county departments, Wisconsin Works agencies, and tribal governing bodies that administer the subsidy program for identifying fraud in the subsidy program. The rules shall specify that a county department, Wisconsin Works agency, or tribal governing body shall receive, for identifying fraudulent activity under the subsidy program on the part of a child care provider, an amount equal to the average monthly subsidy payment per child during the prior fiscal year, multiplied by the number of children participating in the subsidy program for whom the provider provides care, multiplied by 1.5 months. A county department, Wisconsin Works agency, or tribal governing body may use payments received under this subsection for any purpose for which moneys under the Temporary Assistance for Needy Families block grant program may be used under federal law.
2. No later than January 1, 2012, the department shall submit its plan for the incentive program to the cochairpersons of the joint committee on finance for review by the committee. If the cochairpersons of the committee do not notify the department that the committee has scheduled a meeting for the purpose of reviewing the proposed plan within 14 working days after the date of the department's submittal, the department shall promulgate the rules for the incentive program in accordance with its proposed plan. If, within 14 working days after the date of the department's submittal, the cochairpersons of the committee notify the department that the committee has scheduled a meeting for the purpose of reviewing the proposed plan, the department may not promulgate the rules for the incentive program unless the committee approves the proposed plan. If the committee modifies and approves the proposed plan, the department may promulgate the rules for the incentive program only as modified by the committee.
32,1408m
Section 1408m. 49.197 (4) of the statutes is amended to read:
49.197
(4) County and tribal error reduction. If the department of health services contracts with the department under sub. (5), the department shall provide funds from the appropriation under s. 20.437 (2) (kx) to counties
, multicounty consortia, as defined in s. 49.78 (1) (br), and governing bodies of federally recognized American Indian tribes administering Medical Assistance under subch. IV, the food stamp program under
7 USC 2011 to
2036, the supplemental security income payments program under s. 49.77, the program providing payments for the support of children of supplemental security income recipients under s. 49.775, and the Badger Care health care program under s. 49.665 to offset administrative costs of reducing payment errors in those programs.
32,1415
Section
1415. 49.265 (4) (a) of the statutes is amended to read:
49.265
(4) (a) The department shall distribute the federal community services block grant funds received under
42 USC 9903 and
deposited in credited to the
appropriations appropriation account under s. 20.437
(1) (mc) and (md) (2) (mg).
32,1420m
Section 1420m. 49.43 (2r) of the statutes is created to read:
49.43 (2r) "County," "county department," and "county department under s. 46.215, 46.22, or 46.23" includes a multicounty consortium in accordance with a contract under s. 49.78 (2).
32,1422m
Section 1422m. 49.43 (8m) of the statutes is created to read:
49.43 (8m) "Multicounty consortium" has the meaning given in s. 49.78 (1) (br).
49.45
(2m) Authorization for modifications to programs; study. (a) In this subsection, "Medical Assistance program" includes any program operated under this subchapter, demonstration program operated under
42 USC 1315, and program operated under a waiver of federal law relating to medical assistance that is granted by the federal department of health and human services.
(b) The department shall study potential changes to the Medical Assistance state plan and to waivers of federal law relating to medical assistance obtained from the federal department of health and human services for all of the following purposes:
1. Increasing the cost effectiveness and efficiency of care and the care delivery system for Medical Assistance programs.
2. Limiting switching from private health insurance to Medical Assistance programs.
3. Ensuring the long-term viability and sustainability of Medical Assistance programs.
4. Advancing the accuracy and reliability of eligibility for Medical Assistance programs and claims determinations and payments.
5. Improving the health status of individuals who receive benefits under a Medical Assistance program.
6. Aligning Medical Assistance program benefit recipient and service provider incentives with health care outcomes.
7. Supporting responsibility and choice of medical assistance recipients.
(c) Subject to par. (d), if the department determines, as a result of the study under par. (b), that revision of existing statutes or rules would be necessary to advance a purpose described in par. (b) 1. to 7., the department may propose a policy that makes any of the following changes related to Medical Assistance programs:
1. Requires cost sharing from program benefit recipients up to the maximum allowed by federal law or a waiver of federal law.
2. Authorizes providers to deny care or services if a program benefit recipient is unable to share costs, to the extent allowed by federal law or waiver.
3. Modifies existing benefits or establishes various benefit packages and offers different packages to different groups of recipients.
4. Revises provider reimbursement models for particular services.
5. Mandates that program benefit recipients enroll in managed care.
6. Restricts or eliminates presumptive eligibility.
7. To the extent permitted by federal law, imposes restrictions on providing benefits to individuals who are not citizens of the United States.
8. Sets standards for establishing and verifying eligibility requirements.
9. Develops standards and methodologies to assure accurate eligibility determinations and redetermines continuing eligibility.
10. Reduces income levels for purposes of determining eligibility to the extent allowed by federal law or waiver and subject to the limitations under par. (e) 2.
(d) Before implementing a policy proposed under par. (c) that conflicts with a statute, and before submitting any amendment or waiver request under par. (e) that is necessary to implement any such policy, the department shall submit to the joint committee on finance the proposed amendment or waiver request and estimates of the projected cost savings associated with that amendment or waiver request. If the cochairpersons of the committee do not notify the department within 14 working days after the date of the department's submittal that the committee has scheduled a meeting for the purpose of reviewing the proposed amendment or waiver request, the proposed amendment or waiver request may be submitted to the federal department of health and human services. If, within 14 working days after the date of the department's submittal, the cochairpersons of the committee notify the department that the committee has scheduled a meeting for the purpose of reviewing the proposed amendment or waiver request, the proposed amendment or waiver requested may be submitted only on approval of the committee.
(e) 1. Subject to par. (d), the department shall submit an amendment to the state Medical Assistance plan or request a waiver of federal laws related to medical assistance, if necessary, to the extent necessary to implement any policy created under par. (c). If the federal department of health and human services does not allow the amendment or does not grant the waiver, the department may not implement the policy.
2. The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to have in effect eligibility standards, methodologies, and procedures under the state Medical Assistance plan or waivers of federal laws related to medical assistance that are more restrictive than those in place on March 23, 2010. If the waiver request does not receive federal approval before December 31, 2011, the department shall reduce income levels on July 1, 2012, for the purposes of determining eligibility to 133 percent of the federal poverty line for adults who are not pregnant and not disabled, to the extent permitted under
42 USC 1396a (gg), if the department follows the procedures under
42 USC 1396a (gg) (3).
(f) Within 90 days after the effective date of this paragraph .... [LRB inserts date], and every 90 days thereafter, the department shall submit to the joint committee on finance a report that contains all of the following information:
1. An updated description of any Medical Assistance program changes implemented by the department, including any amendments to the Medical Assistance state plan.
2. An updated estimate of the projected savings associated with any changes described under subd. 1.
3. An updated projection of the total Medical Assistance program benefit expenditures during the fiscal biennium and an analysis of how these projected expenditures compare to the funding provided in the 2011-13 biennial budget act.
32,1423m
Section 1423m. 49.45 (2m) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is repealed.
49.45 (3) (n) This subsection does not apply if the department creates a policy under sub. (2m) (c) 4., to the extent that the policy conflicts with this subsection.
32,1424q
Section 1424q. 49.45 (3) (n) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is repealed.
32,1427
Section
1427. 49.45 (5m) (am) of the statutes is amended to read:
49.45
(5m) (am) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b),
(gm), (o), (w) and (xc), the department shall distribute not more than $5,000,000 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, except that the department may not distribute funds to a rural hospital to the extent that the distribution would exceed any limitation under
42 USC 1396b (i) (3).
32,1428
Section
1428. 49.45 (6m) (a) 6. of the statutes is amended to read:
49.45 (6m) (a) 6. "Resource Utilization Groupings III" means a comparative resource utilization grouping that classifies each facility resident based on information obtained from performing, for the resident, a minimum data set assessment developed by the federal Centers for Medicare and Medicaid Services.
32,1429
Section
1429. 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), (gm), (o), (pa), or (w) 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:
32,1430
Section
1430. 49.45 (6m) (ag) 3p. a. of the statutes is amended to read:
49.45 (6m) (ag) 3p. a. The system shall may incorporate acuity measurements under the most recent Resource Utilization Groupings III methodology to determine factors for case-mix adjustment.
32,1430c
Section 1430c. 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 under par. (am) 1. bm., 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. The department shall treat as a single labor region the counties of Dane,
Dodge, Iowa, Columbia, Sauk, and Rock and shall adjust payment so that the direct care cost targets of facilities in Dane, Iowa, Columbia, and Sauk counties are not reduced as a result of including facilities in
Dodge and Rock
County Counties in this labor region. For facilities in Douglas,
Dunn, 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 (6m) (n) This subsection does not apply if the department creates a policy under sub. (2m) (c) 4., to the extent that the policy conflicts with this subsection.
32,1430e
Section 1430e. 49.45 (6m) (n) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is repealed.
32,1431
Section
1431. 49.45 (6tw) of the statutes is amended to read:
49.45 (6tw) Payments to city health departments. From the appropriation account under s. 20.435 (7) (b), if the department selects the payment procedure under s. 49.45 (52) (a), the department may make payments to local health departments, as defined under s. 250.01 (4) (a) 3. Payment under this subsection to such a local health department may not exceed on an annualized basis payment made by the department to the local health department under s. 49.45 (6t), 2003 stats., for services provided by the local health department in 2002.
32,1432
Section
1432. 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), (gm), and (o).
32,1433d
Section 1433d. 49.45 (6x) (a) of the statutes is renumbered 49.45 (6x) (a) (intro.) and amended to read:
49.45
(6x) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b),
(gm), (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 all of the following, except that the department may not allocate funds to
an essential access city a hospital to the extent that the allocation would exceed any limitation under
42 USC 1396b (i) (3)
.:
32,1433f
Section 1433f. 49.45 (6x) (a) 1. to 3. of the statutes are created to read:
49.45 (6x) (a) 1. Not more than $2,997,700 in fiscal year 2011-12 and not more than $2,988,700 in each fiscal year after fiscal year 2011-12 to an essential access city hospital that has previously received the supplemental payment for being an essential access city hospital.
2. Not more than $999,200 in fiscal year 2011-12 and not more than $996,200 in each fiscal year after fiscal year 2011-12 to a hospital that would qualify for an essential access city hospital supplemental payment, under the criteria described in the 2010-11 inpatient hospital state plan, except that the hospital did not meet the criteria to be an essential access city hospital during fiscal year 1995-96.
3. If the federal department of health and human services allows the payment, $300,000 from the appropriation account under s. 20.435 (4) (b) annually to a hospital that meets all of the following criteria:
a. The hospital is located in a city that has a municipal border that is also a state border.
b. The hospital has a Medical Assistance recipient patient mix that consists of at least 25 percent of residents from a state that borders this state.
c. The hospital is located in a city with a poverty level, as determined from the 2000 U.S. census, that is greater than 5 percent.
d. The hospital is located in a city with a population of less than 15,000 people.
32,1434
Section
1434. 49.45 (6y) (a) of the statutes is amended to read:
