Amendment SSA1-SB55

SB55-SSA1, s. 1768 Section 1768. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:

SB55-SSA1,623,13 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), 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:

SB55-SSA1, s. 1769 Section 1769. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:

SB55-SSA1,623,21 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 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.

SB55-SSA1, s. 1771 Section 1771. 49.45 (6t) (intro.) of the statutes is amended to read:

SB55-SSA1,624,8 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:

SB55-SSA1, s. 1772 Section 1772. 49.45 (6t) (intro.) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is repealed and recreated to read:

SB55-SSA1,624,21 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:

SB55-SSA1, s. 1773 Section 1773. 49.45 (6t) (a) of the statutes is amended to read:

SB55-SSA1,625,5 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).

SB55-SSA1, s. 1774 Section 1774. 49.45 (6t) (a) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is repealed and recreated to read:

SB55-SSA1,625,14 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).

SB55-SSA1, s. 1775 Section 1775. 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:

SB55-SSA1,626,3 49.45 (6u) (am) (intro.) Notwithstanding sub. (6m), in state fiscal years in which less than $115,200,000 in federal financial participation relating to facilities is received under 42 CFR 433.51, from the appropriation appropriations under s. 20.435 (4) (o) and (w), 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:

SB55-SSA1,626,6 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:

SB55-SSA1,626,10 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.

SB55-SSA1,626,12 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.

SB55-SSA1,626,17 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.

SB55-SSA1,626,22 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.

SB55-SSA1,626,25 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).

SB55-SSA1, s. 1776 Section 1776. 49.45 (6u) (intro.) of the statutes is amended to read:

SB55-SSA1,627,14 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:

SB55-SSA1, s. 1777 Section 1777. 49.45 (6u) (ag) of the statutes is created to read:

SB55-SSA1,627,17 49.45 (6u) (ag) In this subsection, "facility" has the meaning given in sub. (6m) (a) 3.

SB55-SSA1, s. 1778 Section 1778. 49.45 (6u) (bm) of the statutes is created to read:

SB55-SSA1,628,2 49.45 (6u) (bm) In state fiscal years in which $115,200,000 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.

SB55-SSA1, s. 1779 Section 1779. 49.45 (6x) (a) of the statutes is amended to read:

SB55-SSA1,628,9 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).

SB55-SSA1, s. 1780 Section 1780. 49.45 (6y) (a) of the statutes is amended to read:

SB55-SSA1,628,20 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).

SB55-SSA1, s. 1781 Section 1781. 49.45 (6y) (am) of the statutes is amended to read:

SB55-SSA1,629,3 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).

SB55-SSA1, s. 1782 Section 1782. 49.45 (6z) (a) (intro.) of the statutes is amended to read:

SB55-SSA1,629,15 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:

SB55-SSA1, s. 1783 Section 1783. 49.45 (8) (b) of the statutes is amended to read:

SB55-SSA1,629,21 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).

SB55-SSA1, s. 1787m Section 1787m. 49.45 (22) of the statutes is amended to read:

SB55-SSA1,630,2 49.45 (22) (a) If the department contracts with health maintenance organizations for the provision of medical assistance it shall give special consideration to health maintenance organizations that provide or that contract to provide comprehensive, specialized health care services to pregnant teenagers.

SB55-SSA1,630,11 (b) If the department contracts with health maintenance organizations for the provision of medical assistance, the department shall determine which medical assistance recipients who have attained the age of 2 but have not attained the age of 6 and who are at risk for lead poisoning have not received lead screening from those health maintenance organizations. The department shall report annually to the appropriate standing committees of the legislature under s. 13.172 (3) on the percentage of medical assistance recipients under the age of 2 who received a lead screening test in that year provided by a health maintenance organization compared with the percentage that the department set as a goal for that year.

SB55-SSA1, s. 1787mg Section 1787mg. 49.45 (22) (c) of the statutes is created to read:

SB55-SSA1,630,22 49.45 (22) (c) If the department contracts with health maintenance organizations for the provision of medical assistance, each contract shall require a health maintenance organization to contract with at least the number of primary care providers, within a radius of 30 miles from the boundary of the area the health maintenance organization serves, that is sufficient to ensure that each medical assistance recipient who is eligible for medical assistance under s. 49.46 (1) (a) 1., 1g., 1m., 6., 9., 10., 11., 12., or 13. or 49.47 (4) (ag) 1. or 2. will be able to adequately access the health care services offered by the health maintenance organization. The department shall determine the number of primary care providers with whom each health maintenance organization is required to contract.

SB55-SSA1, s. 1788 Section 1788. 49.45 (24m) (intro.) of the statutes is amended to read:

SB55-SSA1,631,3 49.45 (24m) Home health care and personal care pilot program. (intro.) From the appropriations under s. 20.435 (4) (b) and, (o), and (w), 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:

SB55-SSA1, s. 1789 Section 1789. 49.45 (30m) of the statutes is amended to read:

SB55-SSA1,631,7 49.45 (30m) Certain services for developmentally disabled. A county shall provide the portion of the services under s. 51.06 (1) (1m) (d) to individuals who are eligible for medical assistance that is not provided by the federal government.

SB55-SSA1, s. 1790 Section 1790. 49.45 (40) of the statutes is amended to read:

SB55-SSA1,631,12 49.45 (40) Periodic record matches. The If the department contracts with the department of workforce development under s. 49.197 (5), the department shall cooperate with the department of workforce development in matching records of medical assistance recipients under s. 49.32 (7).

SB55-SSA1, s. 1791 Section 1791. 49.45 (46) (b) of the statutes is amended to read:

SB55-SSA1,631,14 49.45 (46) (b) This subsection does not apply after July 1 June 30, 2003.

SB55-SSA1, s. 1792 Section 1792. 49.45 (48) of the statutes is created to read:

SB55-SSA1,631,20 49.45 (48) Payment of medicare part B outpatient hospital services coinsurances. The department shall include in the state plan for medical assistance a methodology for payment of the medicare part B outpatient hospital services coinsurance amounts that are authorized under ss. 49.46 (2) (c) 2., 4., and 5m., 49.468 (1) (b), and 49.47 (6) (a) 6. b., d., and f.

SB55-SSA1, s. 1797 Section 1797. 49.46 (1) (a) 1. of the statutes is amended to read:

SB55-SSA1,631,25 49.46 (1) (a) 1. Any person included in the Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources, would qualify for a grant of aid to families with dependent children and any person who does under s. 49.19.

SB55-SSA1,632,4 1g. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources, would qualify for a grant of aid to families with dependent children but who would not receive such the aid solely because of the application of s. 49.19 (11) (a) 7.

SB55-SSA1, s. 1797g Section 1797g. 49.46 (1) (a) 1. of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-SSA1,632,10 49.46 (1) (a) 1. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources or income, would qualify for a grant of aid to families with dependent children under s. 49.19 and whose income does not exceed the income limit under par. (ar).

SB55-SSA1, s. 1797j Section 1797j. 49.46 (1) (a) 1g. of the statutes, as created by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-SSA1,632,17 49.46 (1) (a) 1g. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources or income, would qualify for a grant of aid to families with dependent children but who would not receive the aid solely because of the application of s. 49.19 (11) (a) 7. and whose income does not exceed the income limit under par. (ar).

SB55-SSA1, s. 1798 Section 1798. 49.46 (1) (a) 1m. of the statutes is amended to read:

SB55-SSA1,632,22 49.46 (1) (a) 1m. Any pregnant woman who meets the resource and whose income limits does not exceed the standard of need under s. 49.19 (4) (bm) and (es) (11) and whose pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th day after the last day of the pregnancy falls.

SB55-SSA1, s. 1798g Section 1798g. 49.46 (1) (a) 1m. of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-SSA1,633,4 49.46 (1) (a) 1m. Any pregnant woman whose income does not exceed the standard of need under s. 49.19 (11) income limit under par. (ar) and whose pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th day after the last day of the pregnancy falls.

SB55-SSA1, s. 1800 Section 1800. 49.46 (1) (a) 6. of the statutes is amended to read:

SB55-SSA1,633,9 49.46 (1) (a) 6. Any person not described in pars. (c) to (e) who is, without regard to the individual's resources, would be considered, under federal law, to be receiving aid to families with dependent children for the purpose of determining eligibility for medical assistance.

SB55-SSA1, s. 1800m Section 1800m. 49.46 (1) (a) 6. of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-SSA1,633,16 49.46 (1) (a) 6. Any person not described in pars. (c) to (e) who, without regard to the individual's resources or income, would be considered, under federal law, to be receiving aid to families with dependent children for the purpose of determining eligibility for medical assistance and whose income does not exceed the income limit under par. (ar).

SB55-SSA1, s. 1801 Section 1801. 49.46 (1) (a) 9. of the statutes is amended to read:

SB55-SSA1,633,20 49.46 (1) (a) 9. Any pregnant woman not described under subd. 1., 1g., or 1m. whose family income does not exceed 133% of the poverty line for a family the size of the woman's family.

SB55-SSA1, s. 1802 Section 1802. 49.46 (1) (a) 10. of the statutes is amended to read:

SB55-SSA1,633,24 49.46 (1) (a) 10. Any child not described under subd. 1. or 1g. who is under 6 years of age and whose family income does not exceed 133% of the poverty line for a family the size of the child's family.

SB55-SSA1, s. 1803 Section 1803. 49.46 (1) (a) 11. of the statutes is amended to read:

SB55-SSA1,634,8 49.46 (1) (a) 11. If a waiver under s. 49.665 is granted and in effect, any child not described under subd. 1. or 1g. who has attained the age of 6 but has not attained the age of 19 and whose family income does not exceed 100% of the poverty line for a family the size of the child's family. If a waiver under s. 49.665 is not granted or in effect, any child not described in subd. 1. or 1g. who was born after September 30,1983, who has attained the age of 6 but has not attained the age of 19 and whose family income does not exceed 100% of the poverty line for a family the size of the child's family.

SB55-SSA1, s. 1804 Section 1804. 49.46 (1) (a) 12. of the statutes is amended to read:

SB55-SSA1,634,12 49.46 (1) (a) 12. Any child not described under subd. 1. or 1g. who is under 19 years of age and who meets the resource and whose income limits does not exceed the standard of need under s. 49.19 (4) (11).

SB55-SSA1, s. 1804g Section 1804g. 49.46 (1) (a) 12. of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-SSA1,634,17 49.46 (1) (a) 12. Any child not described under subd. 1. or 1g. who is under 19 years of age and whose income does not exceed the standard of need under s. 49.19 (11) income limit under par. (ar).

SB55-SSA1, s. 1804m Section 1804m. 49.46 (1) (ar) of the statutes is created to read:

SB55-SSA1,634,24 49.46 (1) (ar) An individual is eligible to receive medical assistance under par. (a) 1., 1g., 1m., 6., and 12. if the individual's total income does not exceed the standard of need under s. 49.19 (11) (a) 1. a. increased by the same percentage as the percentage increase in the consumer price index, as defined in s. 49.455 (1) (b), between September 2001 and September of the year immediately before the year in which the individual's income is being determined.

SB55-SSA1, s. 1805 Section 1805. 49.46 (1) (e) of the statutes is amended to read:

SB55-SSA1,635,7 49.46 (1) (e) If an application under s. 49.47 (3) shows that the person has individual meets the income and resources within the limitations of limits under s. 49.19, or meets the income and resource requirements under federal Title XVI or s. 49.77, or that the person individual is an essential person, an accommodated person, or a patient in a public medical institution, the person individual shall be granted the benefits enumerated under sub. (2) whether or not the person individual requests or receives a grant of any of such aids.

SB55-SSA1, s. 1805d Section 1805d. 49.46 (1) (e) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-SSA1,635,15 49.46 (1) (e) If an application under s. 49.47 (3) shows that the individual meets the income limits under s. 49.19 par. (ar) or meets the income and resource requirements under federal Title XVI or s. 49.77, or that the individual is an essential person, an accommodated person, or a patient in a public medical institution, the individual shall be granted the benefits enumerated under sub. (2) whether or not the individual requests or receives a grant of any of such aids.

SB55-SSA1, s. 1806 Section 1806. 49.46 (2) (b) 18. of the statutes is amended to read:

SB55-SSA1,635,19 49.46 (2) (b) 18. Alcohol or other drug abuse residential treatment services of no more than 45 days per treatment episode, under s. 49.45 (46). This subdivision does not apply after July 1 June 30, 2003.

SB55-SSA1, s. 1807 Section 1807. 49.46 (2) (c) 2. of the statutes is amended to read:

SB55-SSA1,636,8 49.46 (2) (c) 2. For an individual who is entitled to coverage under part A of medicare, entitled to coverage under part B of medicare, meets the eligibility criteria under sub. (1) and meets the limitation on income under subd. 6., medical assistance shall include payment of the deductible and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to 1395zz, including those medicare services that are not included in the approved state plan for services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under part A of medicare. Payment of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-SSA1, s. 1808 Section 1808. 49.46 (2) (c) 4. of the statutes is amended to read:

SB55-SSA1,636,20 49.46 (2) (c) 4. For an individual who is entitled to coverage under part A of medicare, entitled to coverage under part B of medicare and meets the eligibility criteria for medical assistance under sub. (1), but does not meet the limitation on income under subd. 6., medical assistance shall include payment of the deductible and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to 1395zz, including those medicare services that are not included in the approved state plan for services under 42 USC 1396. Payment of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-SSA1, s. 1809 Section 1809. 49.46 (2) (c) 5m. of the statutes is amended to read: