AB133-SSA1,705,3
149.43
(8) "Medical assistance" means any services or items under ss. 49.45 to
249.47 49.472, except s. 49.472 (6), and
under ss. 49.49 to 49.497, or any payment or
3reimbursement made for such services or items.
AB133-SSA1,705,165
49.45
(2) (a) 3. Determine the eligibility of persons for medical assistance,
6rehabilitative and social services under ss. 49.46, 49.468 and 49.47 and rules and
7policies adopted by the department and may designate this function to the county
8department under s. 46.215, 46.22 or 46.23 or, to the extent permitted by federal law
9or a waiver from federal secretary of health and human services, to a Wisconsin
10works agency.
Any person who determines eligibility for medical assistance in a
11location other than in an office of the department or of a county department of human
12services or of social services shall be permitted to review and update information on
13existing records of an individual who is seeking from that person an eligibility
14determination for medical assistance, even if the individual's case was assigned to
15a different person as a result of the individual's seeking or receiving other public
16assistance.
AB133-SSA1,705,2118
49.45
(2) (a) 4. To the extent funds are available under s. 20.435
(1) (4) (bm),
19certify all proper charges and claims for administrative services to the department
20of administration for payment and the department of administration shall draw its
21warrant forthwith.
AB133-SSA1,706,223
49.45
(2) (a) 17. Notify the governor, the joint committee on legislative
24organization, the joint committee on finance and appropriate standing committees,
1as determined by the presiding officer of each house, if the appropriation under s.
220.435
(5) (4) (b) is insufficient to provide the state share of medical assistance.
AB133-SSA1,706,94
49.45
(3) (a) Reimbursement shall be made to each county department under
5ss. 46.215, 46.22 and 46.23 for the administrative services performed in the medical
6assistance program
on the basis of s. 49.33 (8) according to a formula based on
7workload. For purposes of reimbursement under this paragraph, assessments
8completed under s. 46.27 (6) (a) are administrative services performed in the medical
9assistance program.
AB133-SSA1,706,1311
49.45
(3) (ag) Reimbursement shall be made to each entity contracted with
12under s.
46.271 (2m) 46.281 (1) (d) for
assessments completed functional screens
13performed under s.
46.271 (2m) (a) 2. 46.281 (1) (d).
AB133-SSA1,706,1915
49.45
(3) (am) 1. From the appropriation under s. 20.435
(1) (4) (bm), the
16department shall make incentive payments to counties to encourage counties to
17identify medical assistance applicants and recipients who have other health care
18coverage and the providers of the health care coverage and give that information to
19the department.
AB133-SSA1,707,221
49.45
(3) (fm) The department shall seek, on behalf of dentists who are
22providers, federal reimbursement for the cost of any equipment that the department
23requires dentists to use to verify medical assistance eligibility electronically. If the
24department is successful in obtaining federal reimbursement of that expense, the
1department shall reimburse dentists who are providers for the portion of the cost of
2the equipment that is reimbursed by the federal government.
AB133-SSA1,707,54
49.45
(3) (j) Reimbursement for administrative contract costs under this
5section is limited to the funds available under s. 20.435
(1) (4) (bm).
AB133-SSA1, s. 1382
6Section
1382. 49.45 (5m) (a) of the statutes is renumbered 49.45 (5m) (am) and
7amended to read:
AB133-SSA1,707,158
49.45
(5m) (am) Notwithstanding sub. (3) (e), from the appropriations under
9s. 20.435
(5) (4) (b) and (o) the department shall distribute not more than $2,256,000
10in each fiscal year, to provide supplemental funds to rural hospitals that, as
11determined by the department, have high utilization of inpatient services by
12patients whose care is provided from governmental sources,
and to provide
13supplemental funds to critical access hospitals, except that the department may not
14distribute funds to a rural hospital
or to a critical access hospital to the extent that
15the distribution would exceed any limitation under
42 USC 1396b (i) (3).
AB133-SSA1,707,1817
49.45
(5m) (ag) In this subsection, "critical access hospital" has the meaning
18given in s. 50.33 (1g).
AB133-SSA1,707,2320
49.45
(5m) (b) The supplemental funding
for rural hospitals under par.
(a) (am) 21shall be based on the utilization, by recipients of medical assistance, of the total
22inpatient days of a rural hospital in relation to that utilization in other rural
23hospitals.
AB133-SSA1, s. 1385
24Section
1385. 49.45 (6b) (intro.) of the statutes is renumbered 49.45 (6b) and
25amended to read:
AB133-SSA1,708,7
149.45
(6b) Centers for the developmentally disabled. From the
2appropriation under s. 20.435 (2) (gk), the department may reimburse the cost of
3services provided by the centers for the developmentally disabled. Reimbursement
4to the centers for the developmentally disabled shall be reduced following each
5placement made under s. 46.275
which that involves a relocation from a center for
6the developmentally disabled,
as follows: by $184 per day, beginning in fiscal year
71999-2000, and by $190 per day, beginning in fiscal year 2000-01.
AB133-SSA1, s. 1389
11Section
1389. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:
AB133-SSA1,708,1812
49.45
(6m) (ag) (intro.) Payment for care provided in a facility under this
13subsection made under s. 20.435
(1) (p) or (5) (b)
(4) (b), (pa) or (o) shall, except as
14provided in pars. (bg), (bm) and (br), be determined according to a prospective
15payment system updated annually by the department. The payment system shall
16implement standards that are necessary and proper for providing patient care and
17that meet quality and safety standards established under subch. II of ch. 50 and ch.
18150. The payment system shall reflect all of the following:
AB133-SSA1,708,2420
49.45
(6m) (ag) 3m. For state fiscal year
1997-98 1999-2000, rates that shall
21be set by the department based on information from cost reports for the
1996 1998 22fiscal year of the facility and for state fiscal year
1998-99 2000-01, rates that shall
23be set by the department based on information from cost reports for the
1997 1999 24fiscal year of the facility.
AB133-SSA1,709,92
49.45
(6m) (ar) 1. a. The department shall establish standards for payment of
3allowable direct care costs, for facilities that do not primarily serve the
4developmentally disabled, that
are not less than the median for take into account 5direct care costs for a sample of all of those facilities in this state and separate
6standards for payment of allowable direct care costs, for facilities that primarily
7serve the developmentally disabled, that
are not less than the median for take into
8account direct care costs for a sample of all of those facilities in this state. The
9standards shall be adjusted by the department for regional labor cost variations.
AB133-SSA1,709,1511
49.45
(6m) (ar) 1. cm.
Notwithstanding the limitations under par. (ag) 8.,
12funding Funding distributed to facilities for the provision of active treatment to
13residents with a diagnosis of developmental disability shall be distributed in
14accordance with a method developed by the department which is consistent with a
15prudent buyer approach to payment for services.
AB133-SSA1,709,1917
49.45
(6m) (ar) 2. a. The department shall establish one or more standards for
18the payment of support service costs that
are not less than the median of take into
19account support service costs for a sample of all facilities within the state.
AB133-SSA1,709,2421
49.45
(6m) (ar) 3. a. The department shall establish standards, adjusted for
22heating degree day variations in the state, for payment of fuel and utility costs that
23are not less than the median of take into account heating fuel and utility costs for a
24sample of all facilities within the state.
AB133-SSA1,710,4
149.45
(6m) (ar) 4. For net property taxes or municipal services, payment shall
2be made for
those costs that range from the amount of the previous calendar year's
3tax or the amount of municipal service costs for a period specified by the department
,
4subject to a maximum limit as determined by the department.
AB133-SSA1,710,96
49.45
(6m) (ar) 5. a. The department shall establish one or more standards for
7the payment of administrative and general costs that
are not less than the median
8of take into account administrative and general costs for a sample of all facilities
9within the state.
AB133-SSA1,710,1611
49.45
(6m) (ar) 6. Capital payment shall be based on a replacement value for
12a facility. The replacement value shall be determined by a commercial estimator
13contracted for by the department and paid for by the facility. The replacement value
14shall be subject to limitations determined by the department
, except that the
15department may not reduce final capital payment of a facility by more than $3.50 per
16patient day.
AB133-SSA1,710,2018
49.45
(6m) (av) 1. The department shall calculate a payment rate for a facility
19by applying the criteria set forth under pars. (ag) 1. to 5.
, and 7.
and 8., (am) 1. to 5.
20and (ar) 1. to 5. to information from cost reports submitted by the facility.
AB133-SSA1,710,2522
49.45
(6m) (av) 5m.
Notwithstanding the limitations under par. (ag) 8., the The 23rate under subd. 1., 4. or 5. may be adjusted by the department to reflect payments
24for the provision of active treatment to facility residents with a diagnosis of
25developmental disability.
AB133-SSA1, s. 1401
1Section
1401. 49.45 (6m) (bp) (intro.) of the statutes is amended to read:
AB133-SSA1,711,42
49.45
(6m) (bp) (intro.) Notwithstanding pars.
(ag) 3m., (am) 6. and (ar) 6., the
3department may establish payment methods based on actual costs for capital
4payment for a facility to which, after December 31, 1982, any of the following applies:
AB133-SSA1,711,146
49.45
(6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435
(5) (4) (bt)
or (bu) 7or (7) (b) or 20.445 (3) (dz), the department shall reduce allocations of funds to
8counties in the amount of the disallowance from the appropriation account under s.
920.435
(5) (4) (bt)
or (bu) or (7) (b), or the department shall direct the department of
10workforce development to reduce allocations of funds to counties or Wisconsin works
11agencies in the amount of the disallowance from the appropriation account under s.
1220.445 (3) (dz) or direct the department of corrections to reduce allocations of funds
13to counties in the amount of the disallowance from the appropriation account under
14s. 20.410 (3) (cd), in accordance with s. 16.544 to the extent applicable.
AB133-SSA1,711,1816
49.45
(6m) (c) 5. Admit only patients assessed or who waive or are exempt from
17the requirement of assessment under s. 46.27 (6) (a)
or, if required under s. 50.035
18(4n) or 50.04 (2h), who have been referred to a resource center.
AB133-SSA1,712,520
49.45
(6t) County department and local health department operating
21deficit reduction. (intro.) From the appropriation under s. 20.435
(5) (4) (o), for
22reduction of operating deficits, as defined under criteria developed by the
23department, incurred by a county department under s. 46.215, 46.22, 46.23 or 51.42
24or by a local health department, as defined in s. 250.01 (4), for services provided
25under s. 49.46 (2) (a) 4. d. and (b) 6. f., j., k. and L., 9. and 15., for case management
1services under s. 49.46 (2) (b) 12. and for mental health day treatment services for
2minors provided under the authorization under
42 USC 1396d (r) (5), the department
3shall allocate up to $4,500,000 in each fiscal year to these county departments, or
4local health departments as determined by the department, and shall perform all of
5the following:
AB133-SSA1,712,117
49.45
(6t) (d) If the federal department of health and human services approves
8for state expenditure in a fiscal year amounts under s. 20.435
(5) (4) (o) that result
9in a lesser allocation amount than that allocated under this subsection or disallows
10use of the allocation of federal medicaid funds under par. (c), reduce allocations under
11this subsection and distribute on a prorated basis, as determined by the department.
AB133-SSA1,713,213
49.45
(6u) Supplemental payments to certain facilities. (intro.)
14Notwithstanding sub. (6m), from the appropriation under s. 20.435
(5) (4) (o), for
15reduction of operating deficits, as defined under criteria developed by the
16department, incurred by a facility, as defined under sub. (6m) (a) 3., that is
17established under s. 49.70 (1) or that is owned and operated by a city, village or town,
18the department may not distribute to these facilities more than $38,600,000 in each
19fiscal year, as determined by the department, except that the department shall also
20distribute for this same purpose from the appropriation under s. 20.435
(5) (4) (o) any
21additional federal medical assistance moneys that were not anticipated before
22enactment of the biennial budget act or other legislation affecting s. 20.435
(5) (4) (o)
23and that were not used to fund nursing home rate increases under sub. (6m) (ag) 8.
24The total amount that a county certifies under this subsection may not exceed 100%
1of otherwise-unreimbursed care. In distributing funds under this subsection, the
2department shall perform all of the following:
AB133-SSA1,713,84
49.45
(6u) (d) If the federal department of health and human services approves
5for state expenditure in a fiscal year amounts under s. 20.435
(5) (4) (o) that result
6in a lesser allocation amount than that allocated under this subsection, allocate not
7more than the lesser amount so approved by the federal department of health and
8human services.
AB133-SSA1,713,1410
49.45
(6u) (e) If the federal department of health and human services approves
11for state expenditure in a fiscal year amounts under s. 20.435
(5) (4) (o) that result
12in a lesser allocation amount than that allocated under this subsection, submit a
13revision of the method developed under par. (b) for approval by the joint committee
14on finance in that state fiscal year.
AB133-SSA1,713,2116
49.45
(6v) (b) The department shall, each year, submit to the joint committee
17on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that
18provides information on the utilization of beds by recipients of medical assistance in
19facilities
and a discussion and detailed projection of the likely balances,
20expenditures, encumbrances and carry over of currently appropriated amounts in
21the appropriation accounts under s. 20.435 (4) (b) and (o).
AB133-SSA1,714,923
49.45
(6v) (c) If the report specified in par. (b) indicates that utilization of beds
24by recipients of medical assistance in facilities
decreased is less than estimates for
25that utilization reflected in the intentions of the joint committee on finance,
1legislature and governor, as expressed by them in the budget determinations, the
2department shall include a proposal to transfer
moneys from the appropriation
3under s. 20.435
(5) (4) (b) to the appropriation under s. 20.435 (7) (bd) for the purpose
4of increasing funding for the community options program under s. 46.27.
The
5amount proposed for transfer may not reduce the balance in the appropriation
6account under s. 20.435 (4) (b) below an amount necessary to ensure that that
7appropriation account will end the current fiscal year or the current fiscal biennium
8with a positive balance. The secretary shall transfer the amount identified under the
9proposal.
AB133-SSA1,714,1711
49.45
(6w) Hospital operating deficit reduction. (intro.) From the
12appropriation under s. 20.435
(5) (4) (o), for reduction of operating deficits, as defined
13under criteria developed by the department, incurred by a hospital, as defined under
14s. 50.33 (2) (a) and (b), that is operated by the state, established under s. 49.71 or
15owned and operated by a city or village, the department shall allocate up to
16$3,300,000 in each fiscal year to these hospitals, as determined by the department,
17and shall perform all of the following:
AB133-SSA1,714,2319
49.45
(6w) (d) If the federal department of health and human services approves
20for state expenditure in a fiscal year amounts under s. 20.435
(5) (4) (o) that result
21in a lesser allocation amount than that allocated under this subsection or disallows
22use of the allocation of federal medicaid funds under par. (c), reduce allocations under
23this subsection and distribute on a prorated basis, as determined by the department.
AB133-SSA1,715,5
149.45
(6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
220.435
(5) (4) (b) and (o) the department shall distribute not more than $4,748,000
3in each fiscal year, to provide funds to an essential access city hospital, except that
4the department may not allocate funds to an essential access city hospital to the
5extent that the allocation would exceed any limitation under
42 USC 1396b (i) (3).
AB133-SSA1,715,117
49.45
(6x) (d) If the federal department of health and human services approves
8for state expenditure in any state fiscal year amounts under s. 20.435
(5) (4) (o) that
9result in a lesser distribution amount than that distributed under this subsection or
10disallows use of federal medicaid funds under par. (a), the department of health and
11family services shall reduce the distributions under this subsection.
AB133-SSA1,715,2213
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
1420.435
(5) (4) (b) and (o) the department shall distribute funding in each fiscal year
15to provide supplemental payment to hospitals that enter into a contract under s.
1649.02 (2) to provide health care services funded by a relief block grant, as determined
17by the department, for hospital services that are not in excess of the hospitals'
18customary charges for the services, as limited under
42 USC 1396b (i) (3). If no relief
19block grant is awarded under this chapter or if the allocation of funds to such
20hospitals would exceed any limitation under
42 USC 1396b (i) (3), the department
21may distribute funds to hospitals that have not entered into a contract under s. 49.02
22(2).
AB133-SSA1,716,524
49.45
(6y) (am) Notwithstanding sub. (3) (e), from the appropriations under s.
2520.435 (4) (b), (h) and (o) the department shall distribute funding in each fiscal year
1to provide supplemental payments to hospitals that enter into contracts under s.
249.02 (2) with a county having a population of 500,000 or more to provide health care
3services funded by a relief block grant, as determined by the department, for hospital
4services that are not in excess of the hospitals' customary charges for the services,
5as limited under
42 USC 1396b (i) (3).
AB133-SSA1,716,97
49.45
(6y) (b) The department need not promulgate as rules under ch. 227 the
8procedures, methods of distribution and criteria required for distribution under
par. 9pars. (a)
and (am).
AB133-SSA1, s. 1418
10Section
1418. 49.45 (6z) (a) (intro.) of the statutes is amended to read:
AB133-SSA1,716,2111
49.45
(6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations
12under s. 20.435
(5) (4) (b) and (o) the department shall distribute funding in each
13fiscal year to supplement payment for services to hospitals that enter into a contract
14under s. 49.02 (2) to provide health care services funded by a relief block grant under
15this chapter, if the department determines that the hospitals serve a
16disproportionate number of low-income patients with special needs. If no medical
17relief block grant under this chapter is awarded or if the allocation of funds to such
18hospitals would exceed any limitation under
42 USC 1396b (i) (3), the department
19may distribute funds to hospitals that have not entered into a contract under s. 49.02
20(2). The department may not distribute funds under this subsection to the extent
21that the distribution would do any of the following:
