Amendment ASA1-AB100

AB100-ASA1, s. 1524 Section 1524. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:

AB100-ASA1,825,25 49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this subsection made under s. 20.435 (1) (b), (o) or (p) or (5) (b) or (o) 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 which are reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities in order to provide care in conformity with this section, with federal regulations authorized under 42 USC 1396a (a) (13) (A), 1396a (a) (30), 1396b (i) (3), 1396L and 1396r (e) and with quality and safety standards established under subch. II of ch. 50 and ch. 150. In administering this payment system, the department shall allow costs it determines are necessary and proper for providing patient care. The payment system shall reflect all of the following:

AB100-ASA1, s. 1525 Section 1525. 49.45 (6m) (ag) 3m. of the statutes is amended to read:

AB100-ASA1,826,6 49.45 (6m) (ag) 3m. For state fiscal year 1995-96 1997-98, rates that shall be set by the department based on information from cost reports for the 1994 1996 fiscal year of the facility and for state fiscal year 1996-97 1998-99, rates that shall be set by the department based on information from cost reports for the 1995 1997 fiscal year of the facility.

AB100-ASA1, s. 1526 Section 1526. 49.45 (6m) (ag) 8. of the statutes is amended to read:

AB100-ASA1,826,25 49.45 (6m) (ag) 8. Calculation of total payments and supplementary payments to facilities that permits an aggregate increase in funds allocated under s. 20.435 (1) (5) (b) and (o) for nursing home care provided medical assistance recipients, including an increase resulting in adjustment of facility base rates and percentage increases over facility base rates, over that paid for services provided in state fiscal year 1994-95 1996-97 of no more than 4.25% 5.4% or $45,908,500, whichever is less, during state fiscal year 1995-96 and 1997-98; and calculation of total payments and supplementary payments to facilities that permits an aggregate increase in funds allocated under s. 20.435 (5) (b) and (o) for nursing home care provided medical assistance recipients, including a percentage increase over facility base rates, over that paid for services provided in state fiscal year 1995-96 1997-98 of no more than 3.5% or $25,077,700, whichever is less, during state fiscal year 1996-97, excluding 1998-99. Calculation of total payments and supplementary payments under this subdivision excludes increases in total payments attributable to increases in recipient utilization of facility care, payments for the provision of active treatment to facility residents with developmental disability or chronic mental illness and payments for preadmission screening of facility applicants and annual reviews of facility residents required under 42 USC 1396r (e).

AB100-ASA1, s. 1527 Section 1527. 49.45 (6m) (ap) of the statutes is created to read:

AB100-ASA1,827,6 49.45 (6m) (ap) If the bed occupancy of a nursing home is below the minimum patient day occupancy standards that are established by the department under par. (ar) (intro.), the department may approve a request by the nursing home to delicense any of the nursing home's licensed beds. If the department approves the nursing home's request, all of the following apply:

AB100-ASA1,827,8 1. The department shall delicense the number of beds in accordance with the nursing home's request.

AB100-ASA1,827,11 2. The department may not include the number of beds of the nursing home that the department delicenses under this paragraph in determining the costs per patient day under the minimum patient day occupancy standards under par. (ar).

AB100-ASA1,827,13 3. The nursing home may not use or sell a bed that is delicensed under this paragraph.

AB100-ASA1,827,21 4. a. Every 12 months following the delicensure of a bed under this paragraph, for which a nursing home has not resumed licensure under subd. 5., the department shall reduce the licensed bed capacity of the nursing home by 10% of all of the nursing home's beds that remain delicensed under this paragraph or by 25% of one bed, whichever is greater. The department shall reduce the statewide maximum number of licensed nursing home beds under s. 150.31 (1) (intro.) by the number or portion of a number of beds by which the nursing home's licensed bed capacity is reduced under this subdivision.

AB100-ASA1,827,24 b. Subdivision 4. a. does not apply during the period of any contract entered into by a nursing home prior to January 1, 1996, if the contract requires the nursing home to maintain its current licensed bed capacity.

AB100-ASA1,828,8 5. A nursing home retains the right to resume licensure of a bed of the nursing home that was delicensed under this paragraph unless the licensed bed capacity of the nursing home has been reduced by that bed under subd. 4. The nursing home may not resume licensure of a fraction of a bed. The nursing home may resume licensure 18 months after the nursing home notifies the department in writing that the nursing home intends to resume the licensure. If a nursing home resumes licensure of a bed under this subdivision, subd. 2 does not apply with respect to that bed.

AB100-ASA1,828,15 6. Subdivision 2. does not apply with respect to a nursing home described under subd. 4. b. that resumes licensure of a bed that was delicensed during the period that subd. 4. b. applied. The department shall recoup from the nursing home payments made to the nursing home during the period that subd. 4. b. applied to the extent that those payments exceed the amount the department would have paid during that same period had the nursing home not delicensed the beds the licensure of which was resumed.

AB100-ASA1, s. 1528 Section 1528. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:

AB100-ASA1,829,3 49.45 (6m) (ar) 1. a. The department shall establish standards for payment of allowable direct care costs, for facilities that do not primarily serve the developmentally disabled, that are at least 110% of not less than the median for direct care costs for a sample of all of those facilities that do not primarily serve the developmentally disabled in this state and separate standards for payment of allowable direct care costs, for facilities that primarily serve the developmentally disabled, that are at least 110% of not less than the median for direct care costs for a sample of all of those facilities primarily serving the developmentally disabled in this state. The standards shall be adjusted by the department for regional labor cost variations. The department may decrease the percentage established for the standards only if amounts available under par. (ag) (intro.) are insufficient to provide total payment under par. (am), less capital costs under subd. 6.

AB100-ASA1, s. 1529 Section 1529. 49.45 (6m) (br) 1. of the statutes, as affected by 1997 Wisconsin Act 3, is amended to read:

AB100-ASA1,829,15 49.45 (6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435 (1) (5) (bt) or (bu) or (7) (b) or 20.445 (3) (de) (dz), the department shall reduce allocations of funds to counties in the amount of the disallowance from the appropriations appropriation account under s. 20.410 (3) (cd) or 20.435 (1) (5) (bt) or (bu) or (7) (b), or the department shall direct the department of workforce development to reduce allocations of funds to counties or Wisconsin works agencies in the amount of the disallowance from the appropriation account under s. 20.445 (3) (de) or (dz) or direct the department of corrections to reduce allocations of funds to counties in the amount of the disallowance from the appropriation account under s. 20.410 (3) (cd), in accordance with s. 16.544 to the extent applicable.

AB100-ASA1, s. 1530 Section 1530. 49.45 (6s) of the statutes is repealed.

AB100-ASA1, s. 1531 Section 1531. 49.45 (6t) (intro.) of the statutes is amended to read:

AB100-ASA1,830,3 49.45 (6t) County department and local health department operating deficit reduction. (intro.) From the appropriation under s. 20.435 (1) (5) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a county department under s. 46.215, 46.22, 46.23 or 51.42 or by a local health department, as defined in s. 250.01 (4), for services provided under s. 49.46 (2) (a) 4. d. and (b) 6. f., j., k. and L., 9. and 15., for case management services under s. 49.46 (2) (b) 12. and for mental health day treatment services for minors provided under the authorization under 42 USC 1396d (r) (5), the department shall allocate up to $4,500,000 in each fiscal year to these county departments, or local health departments as determined by the department, and shall perform all of the following:

AB100-ASA1, s. 1532 Section 1532. 49.45 (6t) (d) of the statutes is amended to read:

AB100-ASA1,830,9 49.45 (6t) (d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (o) that result in a lesser allocation amount than that allocated under this subsection or disallows use of the allocation of federal medicaid funds under par. (c), reduce allocations under this subsection and distribute on a prorated basis, as determined by the department.

AB100-ASA1, s. 1533 Section 1533. 49.45 (6u) (intro.) of the statutes is amended to read:

AB100-ASA1,830,25 49.45 (6u) (title) Facility operating deficit reduction Supplemental payments to county homes. (intro.) Except as provided in par. (g) Notwithstanding sub. (6m), from the appropriation under s. 20.435 (1) (5) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a facility, as defined under sub. (6m) (a) 2. 3., that is established under s. 49.70 (1) or that is owned and operated by a city, village or town, the department shall may not distribute to these facilities not more than $18,600,000 $38,600,000 in each fiscal year, as determined by the department, and except that the department shall also distribute for this same purpose from the appropriation under s. 20.435 (5) (o) any additional federal medical assistance moneys that were not anticipated before enactment of the biennial budget act or other legislation affecting s. 20.435 (5) (o) and that were not used to fund nursing home rate increases under sub. (6m) (ag) 8. The total amount that a county certifies under this subsection may not exceed 100% of otherwise-unreimbursed care. In distributing funds under this subsection, the department shall perform all of the following:

AB100-ASA1, s. 1534 Section 1534. 49.45 (6u) (d) of the statutes is amended to read:

AB100-ASA1,831,6 49.45 (6u) (d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (o) that result in a lesser allocation amount than that allocated under this subsection, allocate not more than the lesser amount so approved by the federal department of health and human services.

AB100-ASA1, s. 1535 Section 1535. 49.45 (6u) (e) of the statutes is amended to read:

AB100-ASA1,831,12 49.45 (6u) (e) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (o) that result in a lesser allocation amount than that allocated under this subsection, submit a revision of the method developed under par. (b) for approval by the joint committee on finance in that state fiscal year.

AB100-ASA1, s. 1536 Section 1536. 49.45 (6u) (f) of the statutes is amended to read:

AB100-ASA1,831,16 49.45 (6u) (f) If the federal department of health and human services disallows use of the allocation of matching federal medical assistance funds distributed under par. (c), apply the requirements under sub. (6m) (br) shall apply.

AB100-ASA1, s. 1537 Section 1537. 49.45 (6u) (g) of the statutes is amended to read:

AB100-ASA1,831,22 49.45 (6u) (g) If a facility that is otherwise eligible for an allocation of funds under this section is found by the federal health care financing administration or the department to be an institution for mental diseases, as defined under 42 CFR 435.1009, the department may not allocate cease distributing to that facility funds under this section after the date on which the finding is made.

AB100-ASA1, s. 1538 Section 1538. 49.45 (6w) (intro.) of the statutes is amended to read:

AB100-ASA1,832,5 49.45 (6w) Hospital operating deficit reduction. (intro.) From the appropriation under s. 20.435 (1) (5) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a hospital, as defined under s. 50.33 (2) (a) and (b), that is operated by the state, established under s. 49.71 or owned and operated by a city or village, the department shall allocate up to $3,300,000 in each fiscal year to these hospitals, as determined by the department, and shall perform all of the following:

AB100-ASA1, s. 1539 Section 1539. 49.45 (6w) (d) of the statutes is amended to read:

AB100-ASA1,832,11 49.45 (6w) (d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (1) (5) (o) that result in a lesser allocation amount than that allocated under this subsection or disallows use of the allocation of federal medicaid funds under par. (c), reduce allocations under this subsection and distribute on a prorated basis, as determined by the department.

AB100-ASA1, s. 1540 Section 1540. 49.45 (6x) (a) of the statutes is amended to read:

AB100-ASA1,832,17 49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (5) (b) and (o) the department shall distribute not more than $4,748,000 in each fiscal year, to provide funds to an essential access city hospital, except that the department may not allocate funds to an essential access city hospital to the extent that the allocation would exceed any limitation under 42 USC 1396b (i) (3).

AB100-ASA1, s. 1541 Section 1541. 49.45 (6x) (d) of the statutes is amended to read:

AB100-ASA1,832,23 49.45 (6x) (d) If the federal department of health and human services approves for state expenditure in any state fiscal year amounts under s. 20.435 (1) (5) (o) that result in a lesser distribution amount than that distributed under this subsection or disallows use of federal medicaid funds under par. (a), the department of health and family services shall reduce the distributions under this subsection.

AB100-ASA1, s. 1542 Section 1542. 49.45 (6y) (a) of the statutes is amended to read:

AB100-ASA1,833,10 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (5) (b) and (o) the department shall distribute funding in each fiscal year to provide supplemental payment to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2).

AB100-ASA1, s. 1543 Section 1543. 49.45 (6z) (a) (intro.) of the statutes is amended to read:

AB100-ASA1,833,22 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (1) (5) (b) and (o) the department shall distribute funding in each fiscal year to supplement payment for services to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant under this chapter, if the department determines that the hospitals serve a disproportionate number of low-income patients with special needs. If no medical relief block grant under this chapter is awarded or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2). The department may not distribute funds under this subsection to the extent that the distribution would do any of the following:

AB100-ASA1, s. 1544 Section 1544. 49.45 (8) (b) of the statutes is amended to read:

AB100-ASA1,834,3 49.45 (8) (b) Reimbursement under s. 20.435 (1) (5) (b) and (o) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under par. (c).

AB100-ASA1, s. 1545 Section 1545. 49.45 (8e) of the statutes is repealed.

AB100-ASA1, s. 1546 Section 1546. 49.45 (8m) (intro.) of the statutes is amended to read:

AB100-ASA1,834,10 49.45 (8m) Rates for respiratory care services. (intro.) Notwithstanding the limits under subs. (8) and (8e) limit under sub. (8), the rates under sub. (8) and rates charged by providers under s. 49.46 (2) (a) 4. d. that are not home health agencies, for reimbursement for respiratory care services for ventilator-dependent individuals under ss. 49.46 (2) (b) 6. m. and 49.47 (6) (a) 1., shall be as follows:

AB100-ASA1, s. 1941b Section 1941b. 49.45 (8m) (a) of the statutes is amended to read:

AB100-ASA1,834,13 49.45 (8m) (a) For visits subsequent to an initial visit and for extended visits by a licensed registered nurse, $30 $30.60 per hour.

AB100-ASA1, s. 1941c Section 1941c. 49.45 (8m) (a) of the statutes, as affected by 1997 Wisconsin Act .... (this act), is amended to read:

AB100-ASA1,834,17 49.45 (8m) (a) For visits subsequent to an initial visit and for extended visits by a licensed registered nurse, $30.60 $31.21 per hour.

AB100-ASA1, s. 1941d Section 1941d. 49.45 (8m) (b) of the statutes is amended to read:

AB100-ASA1,834,20 49.45 (8m) (b) For visits subsequent to an initial visit and for extended visits by a licensed practical nurse, $20 $20.40 per hour.

AB100-ASA1, s. 1941e Section 1941e. 49.45 (8m) (b) of the statutes, as affected by 1997 Wisconsin Act .... (this act), is amended to read:

AB100-ASA1,834,24 49.45 (8m) (b) For visits subsequent to an initial visit and for extended visits by a licensed practical nurse, $20.40 $20.81 per hour.

AB100-ASA1, s. 1547 Section 1547. 49.45 (8r) of the statutes is amended to read:

AB100-ASA1,835,8 49.45 (8r) Payment for certain obstetric and gynecological care. The rate of payment for obstetric and gynecological care provided in primary care health professional shortage areas, as defined in s. 560.184 (1) (c) 560.183 (1) (cm), or provided to recipients of medical assistance who reside in primary care health professional shortage areas, that is equal to 125% of the rates paid under this section to primary care physicians in primary care health professional shortage areas, shall be paid to all certified primary care providers who provide obstetric or gynecological care to those recipients.

AB100-ASA1, s. 1942m Section 1942m. 49.45 (24g) of the statutes is created to read:

AB100-ASA1,835,22 49.45 (24g) Managed care for dental services pilot. (a) The department shall, in consultation with the Wisconsin Dental Association, develop a pilot project for the provision of dental services under a managed care system. The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to implement the pilot project developed under this subsection. If the waiver is granted and in effect, and if the department of health and family services determines that the costs of providing dental services under s. 49.46 (2) (b) 1. under the pilot project will not exceed the costs of providing those dental services in the absence of the pilot project, the department shall implement the pilot project in Ashland, Douglas, Bayfield and Iron counties for the period beginning no later than January 1, 1998, and ending on June 30, 1999. Only those dental services covered under s. 49.46 (2) (b) 1. may be covered under the pilot project.

AB100-ASA1,836,2 (b) In developing the pilot project under this subsection, the department shall provide that recipients who are subject to the pilot project are required to select a dental provider from among those dentists participating in the pilot project. The department shall also provide that, if a recipient does not make a selection, a dental provider will be assigned to the recipient.

AB100-ASA1,836,4 (c) If the department is able to implement the pilot project under this subsection, the department shall contract with a person to do all of the following:

AB100-ASA1,836,6 1. Accept a capitation payment from the department for each recipient who is subject to the pilot project.

AB100-ASA1,836,7 2. Enroll dentists to be participating providers under the pilot project.

AB100-ASA1,836,9 3. Coordinate with county departments to provide outreach and education to recipients and persons who are eligible to be recipients.

AB100-ASA1,836,12 4. Pay all allowable charges on a fee-for-service basis to participating dentists on behalf of recipients in the pilot counties for dental services received by those recipients.

AB100-ASA1, s. 1548 Section 1548. 49.45 (24m) (intro.) of the statutes is amended to read:

AB100-ASA1,836,18 49.45 (24m) Home health care and personal care pilot program. (intro.) From the appropriations under s. 20.435 (1) (5) (b) and (o), in order to test the feasibility of instituting a system of reimbursement for providers of home health care and personal care services for medical assistance recipients that is based on competitive bidding, the department shall:

AB100-ASA1, s. 1943c Section 1943c. 49.45 (24r) of the statutes is created to read:

AB100-ASA1,837,4 49.45 (24r) Family planning demonstration project. No later than January 1, 1998, the department shall request a waiver from the secretary of the federal department of health and human services to permit the department to conduct a demonstration project to provide family planning services under medical assistance to any woman between the ages of 15 and 44 whose family income does not exceed 185% of the poverty line for a family the size of the woman's family. If the waiver is granted, the department shall submit to the chief clerk of each house of the legislature, for distribution to the appropriate standing committees under s. 13.172 (3), proposed legislation to enable the department to implement the demonstration project.

AB100-ASA1, s. 1549 Section 1549. 49.45 (25) (am) 14. of the statutes is created to read:

AB100-ASA1,837,8 49.45 (25) (am) 14. Is a woman who is aged 45 to 64 and who is not a resident of a nursing home or otherwise receiving case management services under this paragraph.

AB100-ASA1, s. 1550 Section 1550. 49.45 (25) (b) of the statutes is amended to read:

AB100-ASA1,837,18 49.45 (25) (b) A county, city, village or , town or, in a county having a population of 500,000 or more, the department may elect to make case management services under this subsection available in the county, city, village or town to one or more of the categories of beneficiaries under par. (am) through the medical assistance program. A county, city, village or, town or, in a county having a population of 500,000 or more, the department that elects to make the services available shall reimburse a case management provider for the amount of the allowable charges for those services under the medical assistance program that is not provided by the federal government.

AB100-ASA1, s. 1551 Section 1551. 49.45 (25) (be) of the statutes is amended to read:

AB100-ASA1,837,25 49.45 (25) (be) A private nonprofit agency that is a certified case management provider may elect to provide case management services to medical assistance beneficiaries who have HIV infection, as defined in s. 252.01 (2). The amount of the allowable charges for those services under the medical assistance program that is not provided by the federal government shall be paid from the appropriation under s. 20.435 (1) (5) (am).

AB100-ASA1, s. 1946m Section 1946m. 49.45 (30e) of the statutes is created to read:

AB100-ASA1,838,5 49.45 (30e) Community-based psychosocial service programs. (a) When services are reimbursable. Services under s. 49.46 (2) (b) 6. Lm. provided to an individual are reimbursable under the medical assistance program only if all of the following conditions are met:

AB100-ASA1,838,8 1. Reimbursement for the services under s. 49.46 (2) (b) 6. Lm. in the manner provided under this subsection is permitted pursuant to federal law or pursuant to a waiver from the secretary of the federal department of health and human services.

AB100-ASA1,838,11 2. The county in which the individual resides elects to make the services under s. 49.46 (2) (b) 6. Lm. available in the county through the medical assistance program.

AB100-ASA1,838,14 3. The individual's psychosocial health needs require more than outpatient counseling, but less than the services provided by a community support program under s. 51.421.

AB100-ASA1,838,17 4. The psychosocial services are provided by a community-based psychosocial service program certified under rules promulgated by the department under par. (b) 3.

AB100-ASA1,838,19 (b) Rules. The department shall promulgate rules regarding all of the following:

AB100-ASA1,838,21 1. Standards for determining whether an individual is eligible under par. (a) 3.

AB100-ASA1,838,23 2. The scope of psychosocial services that may be provided under s. 49.46 (2) (b) 6. Lm.

AB100-ASA1,838,25 3. Requirements for certification of community-based psychosocial service programs.