AB274-SA2,4,2317 49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this
18subsection made under s. 20.435 (4) (b), (pa) or, (o), or (w) shall, except as provided
19in pars. (bg), (bm), and (br), be determined according to a prospective payment
20system updated annually by the department. The payment system shall implement
21standards that are necessary and proper for providing patient care and that meet
22quality and safety standards established under subch. II of ch. 50 and ch. 150. The
23payment system shall reflect all of the following:
AB274-SA2, s. 2k
1Section 2k. 49.45 (6u) of the statutes, as affected by 2001 Wisconsin Act ....
2(this act), is renumbered 49.45 (6u) (am), and 49.45 (6u) (am) (intro.) and 2. (intro.)
3and b., 3., 4., 5. and 6., as renumbered, are amended to read:
AB274-SA2,5,154 49.45 (6u) (am) (intro.) Notwithstanding sub. (6m), in state fiscal years in
5which less than $115,200,000 in federal financial participation relating to facilities
6is received under 42 CFR 433.51,
from the appropriation appropriations under s.
720.435 (4) (o) and (w), for reduction of operating deficits, as defined under criteria
8developed
the methodology used by the department in December, 2000, incurred by
9a facility, as defined under sub. (6m) (a) 3., that is established under s. 49.70 (1) or
10that is owned and operated by a city, village, or town, the department may not
11distribute to these facilities more than $40,100,000 $37,100,000 in each fiscal year,
12as determined by the department. The total amount that a county certifies under
13this subsection may not exceed 100% of otherwise-unreimbursed care. In
14distributing funds under this subsection, the department shall perform all of the
15following:
AB274-SA2,5,1816 2. (intro.) Based on the amount estimated available under par. (a) subd. 1.,
17develop a method to distribute this allocation to the individual facilities that have
18incurred operating deficits that shall include:
AB274-SA2,5,2219 b. Agreement by the county in which is located the facility established under
20s. 49.70 (1) and agreement by the city, village, or town that owns and operates the
21facility that the applicable county, city, village, or town shall provide funds to match
22federal medical assistance matching funds under this subsection paragraph.
AB274-SA2,5,2423 3. Distribute the allocation under the distribution method that is developed,
24unless a county has failed to comply with par. (b) 2m subd. 2. bm.
AB274-SA2,6,5
14. If the federal department of health and human services approves for state
2expenditure in a fiscal year amounts under s. 20.435 (4) (o) and (w) that result in a
3lesser allocation amount than that allocated under this subsection paragraph,
4allocate not more than the lesser amount so approved by the federal department of
5health and human services.
AB274-SA2,6,106 5. If the federal department of health and human services approves for state
7expenditure in a fiscal year amounts under s. 20.435 (4) (o) and (w) that result in a
8lesser allocation amount than that allocated under this subsection paragraph,
9submit a revision of the method developed under par. (b) subd. 2. for approval by the
10joint committee on finance in that state fiscal year.
AB274-SA2,6,1311 6. If the federal department of health and human services disallows use of the
12allocation of matching federal medical assistance funds distributed under par. (c)
13subd. 3., apply the requirements under sub. (6m) (br).".
AB274-SA2,6,14 146. Page 3, line 14: after that line insert:
AB274-SA2,6,15 15" Section 3d. 49.45 (6u) (ag) of the statutes is created to read:
AB274-SA2,6,1716 49.45 (6u) (ag) In this subsection, "facility" has the meaning given in sub. (6m)
17(a) 3.
AB274-SA2, s. 3e 18Section 3e. 49.45 (6u) (bm) of the statutes is created to read:
AB274-SA2,7,219 49.45 (6u) (bm) In state fiscal years in which $115,200,000 or more in federal
20financial participation relating to facilities is received under 42 CFR 433.51, from the
21appropriations under s. 20.435 (4) (o) and (w), for reduction of operating deficits, as
22defined under criteria developed by the department, incurred by a facility that is
23established under s. 49.70 (1) or that is owned and operated by a city, village, or town,
24the department may not distribute to these facilities more than $77,100,000 in each

1fiscal year, as determined by the department under a methodology as specified in the
2state plan for services under 42 USC 1396.
AB274-SA2, s. 3f 3Section 3f. 49.45 (6x) (a) of the statutes is amended to read:
AB274-SA2,7,94 49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
520.435 (4) (b) and, (o), and (w), the department shall distribute not more than
6$4,748,000 in each fiscal year, to provide funds to an essential access city hospital,
7except that the department may not allocate funds to an essential access city hospital
8to the extent that the allocation would exceed any limitation under 42 USC 1396b
9(i) (3).
AB274-SA2, s. 3g 10Section 3g. 49.45 (6y) (a) of the statutes is amended to read:
AB274-SA2,7,2011 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
1220.435 (4) (b) and, (o), and (w), the department shall distribute funding in each fiscal
13year to provide supplemental payment to hospitals that enter into a contract under
14s. 49.02 (2) to provide health care services funded by a relief block grant, as
15determined by the department, for hospital services that are not in excess of the
16hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3).
17If no relief block grant is awarded under this chapter or if the allocation of funds to
18such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the
19department may distribute funds to hospitals that have not entered into a contract
20under s. 49.02 (2).
AB274-SA2, s. 3h 21Section 3h. 49.45 (6y) (am) of the statutes is amended to read:
AB274-SA2,8,322 49.45 (6y) (am) Notwithstanding sub. (3) (e), from the appropriations under s.
2320.435 (4) (b), (h) and, (o), and (w), the department shall distribute funding in each
24fiscal year to provide supplemental payments to hospitals that enter into contracts
25under s. 49.02 (2) with a county having a population of 500,000 or more to provide

1health care services funded by a relief block grant, as determined by the department,
2for hospital services that are not in excess of the hospitals' customary charges for the
3services, as limited under 42 USC 1396b (i) (3).
AB274-SA2, s. 3i 4Section 3i. 49.45 (6z) (a) (intro.) of the statutes is amended to read:
AB274-SA2,8,155 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations
6under s. 20.435 (4) (b) and, (o), and (w), the department shall distribute funding in
7each fiscal year to supplement payment for services to hospitals that enter into a
8contract under s. 49.02 (2) to provide health care services funded by a relief block
9grant under this chapter, if the department determines that the hospitals serve a
10disproportionate number of low-income patients with special needs. If no medical
11relief block grant under this chapter is awarded or if the allocation of funds to such
12hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department
13may distribute funds to hospitals that have not entered into a contract under s. 49.02
14(2). The department may not distribute funds under this subsection to the extent
15that the distribution would do any of the following:
AB274-SA2, s. 3j 16Section 3j. 49.45 (8) (b) of the statutes is amended to read:
AB274-SA2,8,2117 49.45 (8) (b) Reimbursement under s. 20.435 (4) (b) and, (o), and (w) for home
18health services provided by a certified home health agency or independent nurse
19shall be made at the home health agency's or nurse's usual and customary fee per
20patient care visit, subject to a maximum allowable fee per patient care visit that is
21established under par. (c).
AB274-SA2, s. 3k 22Section 3k. 49.45 (24m) (intro.) of the statutes is amended to read:
AB274-SA2,9,223 49.45 (24m) Home health care and personal care pilot program. (intro.)
24From the appropriations under s. 20.435 (4) (b) and, (o), and (w), in order to test the
25feasibility of instituting a system of reimbursement for providers of home health care

1and personal care services for medical assistance recipients that is based on
2competitive bidding, the department shall:
AB274-SA2, s. 3L 3Section 3L. 49.472 (6) (a) of the statutes is amended to read:
AB274-SA2,9,94 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation under s.
520.435 (4) (b) or (w), the department shall, on the part of an individual who is eligible
6for medical assistance under sub. (3), pay premiums for or purchase individual
7coverage offered by the individual's employer if the department determines that
8paying the premiums for or purchasing the coverage will not be more costly than
9providing medical assistance.
AB274-SA2, s. 3m 10Section 3m. 49.472 (6) (b) of the statutes is amended to read:
AB274-SA2,9,1411 49.472 (6) (b) If federal financial participation is available, from the
12appropriation under s. 20.435 (4) (b) or (w), the department may pay medicare Part
13A and Part B premiums for individuals who are eligible for medicare and for medical
14assistance under sub. (3).
AB274-SA2, s. 3n 15Section 3n. 49.665 (4) (at) 1. a. of the statutes is amended to read:
AB274-SA2,9,2016 49.665 (4) (at) 1. a. Except as provided in subd. 1. b., the department shall
17establish a lower maximum income level for the initial eligibility determination if
18funding under s. 20.435 (4) (bc), (jz) and, (p), and (w) is insufficient to accommodate
19the projected enrollment levels for the health care program under this section. The
20adjustment may not be greater than necessary to ensure sufficient funding.
AB274-SA2, s. 13p 21Section 13p. 49.665 (4) (at) 2. of the statutes is amended to read:
AB274-SA2,9,2422 49.665 (4) (at) 2. If, after the department has established a lower maximum
23income level under subd. 1., projections indicate that funding under s. 20.435 (4) (bc),
24(jz) and, (p), and (w) is sufficient to raise the level, the department shall, by state plan

1amendment, raise the maximum income level for initial eligibility, but not to exceed
2185% of the poverty line.".
AB274-SA2,10,3 37. Page 3, line 18: delete "(intro.)".
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