Amendment CA1-SSA1-SB55

SB55-SSA1-CA1,298,15 49.45 (2) (a) 10. b. Establish a deadline for payment of a recovery imposed under this subdivision and, if a provider fails to pay all of the amount to be recovered by the deadline, require payment, by the provider, of interest on any delinquent amount at the rate of 1% per month or fraction of a month from the date of the overpayment.

SB55-SSA1-CA1, s. 1750g Section 1750g. 49.45 (2) (a) 10. c. of the statutes is created to read:

SB55-SSA1-CA1,298,17 49.45 (2) (a) 10. c. Promulgate rules to implement this subdivision.

SB55-SSA1-CA1, s. 1750h Section 1750h. 49.45 (2) (a) 11. of the statutes is renumbered 49.45 (2) (a) 11. a. and amended to read:

SB55-SSA1-CA1,298,23 49.45 (2) (a) 11. a. Establish criteria for the certification of eligible providers of services under Title XIX of the social security act medical assistance and, except as provided in par. (b) 6m. and s. 49.48, and subject to par. (b) 7. and 8., certify such eligible providers who meet the criteria.

SB55-SSA1-CA1, s. 1750i Section 1750i. 49.45 (2) (a) 11. b. of the statutes is created to read:

SB55-SSA1-CA1,299,1 49.45 (2) (a) 11. b. Promulgate rules to implement this subdivision.

SB55-SSA1-CA1, s. 1750j Section 1750j. 49.45 (2) (a) 12. of the statutes is renumbered 49.45 (2) (a) 12. a. and amended to read:

SB55-SSA1-CA1,299,18 49.45 (2) (a) 12. a. Decertify or suspend under this subdivision a provider from or restrict a provider's participation in the medical assistance program, if after giving reasonable notice and opportunity for hearing, the department finds that the provider has violated a federal statute or regulation or a state law statute or administrative rule and such violations are by law the violation is by statute, regulation, or rule grounds for decertification or suspension restriction. The department shall suspend the provider pending the hearing under this subdivision if the department includes in its decertification notice findings that the provider's continued participation in the medical assistance program pending hearing is likely to lead to the irretrievable loss of public funds and is unnecessary to provide adequate access to services to medical assistance recipients. As soon as practicable after the hearing, the department shall issue a written decision. No payment may be made under the medical assistance program with respect to any service or item furnished by the provider subsequent to decertification or during the period of suspension.

SB55-SSA1-CA1, s. 1750k Section 1750k. 49.45 (2) (a) 12. b. of the statutes is created to read:

SB55-SSA1-CA1,299,20 49.45 (2) (a) 12. b. Promulgate rules to implement this subdivision.

SB55-SSA1-CA1, s. 1750L Section 1750L. 49.45 (2) (b) 6m. of the statutes is created to read:

SB55-SSA1-CA1,300,5 49.45 (2) (b) 6m. Limit the number of providers of particular services that may be certified under par. (a) 11. or the amount of resources, including employees and equipment, that a certified provider may use to provide particular services to medical assistance recipients, if the department finds that existing certified providers and resources provide services that are adequate in quality and amount to meet the need of medical assistance recipients for the particular services; and if the department finds that the potential for medical assistance fraud or abuse exists if additional providers are certified or additional resources are used by certified providers. The department shall promulgate rules to implement this subdivision.

SB55-SSA1-CA1, s. 1750n Section 1750n. 49.45 (2) (b) 7. of the statutes is created to read:

SB55-SSA1-CA1,300,18 49.45 (2) (b) 7. Require, as a condition of certification under par. (a) 11., all providers of a specific service that is among those enumerated under s. 49.46 (2) or 49.47 (6) (a), as specified in this subdivision, to file with the department a surety bond issued by a surety company licensed to do business in this state. Providers subject to this subdivision provide those services specified under s. 49.46 (2) or 49.47 (6) (a) for which providers have demonstrated significant potential to violate s. 49.49 (1) (a), (2) (a) or (b), (3), (3m) (a), (3p), (4) (a), or (4m) (a), to require recovery under par. (a) 10., or to need additional sanctions under par. (a) 13. The surety bond shall be payable to the department in an amount that the department determines is reasonable in view of amounts of former recoveries against providers of the specific service and the department's costs to pursue those recoveries. The department shall promulgate rules to implement this subdivision that specify all of the following:

SB55-SSA1-CA1,300,22 a. Services under medical assistance for which providers have demonstrated significant potential to violate s. 49.49 (1) (a), (2) (a) or (b), (3), (3m) (a), (3p), (4) (a), or (4m) (a), to require recovery under par. (a) 10., or to need additional sanctions under par. (a) 13.

SB55-SSA1-CA1,300,23 b. The amount or amounts of the surety bonds.

SB55-SSA1-CA1,301,3 c. Terms of the surety bond, including amounts, if any, without interest to be refunded to the provider upon withdrawal or decertification from the medical assistance program.

SB55-SSA1-CA1, s. 1750p Section 1750p. 49.45 (2) (b) 8. of the statutes is created to read:

SB55-SSA1-CA1,301,10 49.45 (2) (b) 8. Require a person who takes over the operation, as defined in sub. (21) (ag), of a provider, to first obtain certification under par. (a) 11. for the operation of the provider, regardless of whether the person is currently certified. The department may withhold the certification required under this subdivision until any outstanding repayment under sub. (21) is made. The department shall promulgate rules to implement this subdivision.

SB55-SSA1-CA1, s. 1750r Section 1750r. 49.45 (2) (b) 9. of the statutes is created to read:

SB55-SSA1-CA1,302,7 49.45 (2) (b) 9. After providing reasonable notice and opportunity for a hearing, charge an assessment to a provider that repeatedly has been subject to recoveries under par. (a) 10. a. because of the provider's failure to follow identical or similar billing procedures or to follow other identical or similar program requirements. The assessment shall be used to defray in part the costs of audits and investigations by the department under sub. (3) (g) and may not exceed $1,000 or 200% of the amount of any such repeated recovery made, whichever is greater. The provider shall pay the assessment to the department within 10 days after receipt of notice of the assessment or the final decision after administrative hearing, whichever is later. The department may recover any part of an assessment not timely paid by offsetting the assessment against any medical assistance payment owed to the provider and may refer any such unpaid assessments not collected in this manner to the attorney general, who may proceed with collection under this subdivision. Failure to timely pay in any manner an assessment charged under this subdivision, other than an assessment that is offset against any medical assistance payment owed to the provider, is grounds for decertification under subd. 12. A provider's payment of an assessment does not relieve the provider of any other legal liability incurred in connection with the recovery for which the assessment is charged, but is not evidence of violation of a statute or rule. The department shall credit all assessments received under this subdivision to the appropriation account under s. 20.435 (4) (iL). The department shall promulgate rules to implement this subdivision.

SB55-SSA1-CA1, s. 1750t Section 1750t. 49.45 (3) (g) of the statutes is renumbered 49.45 (3) (g) 1. and amended to read:

SB55-SSA1-CA1,303,6 49.45 (3) (g) 1. The secretary may appoint authorize personnel to audit or investigate and report to the department on any matter involving violations or complaints alleging violations of laws statutes, regulations, or rules applicable to Title XIX of the federal social security act or the medical assistance program and to perform such investigations or audits as are required to verify the actual provision of services or items available under the medical assistance program and the appropriateness and accuracy of claims for reimbursement submitted by providers participating in the program. Department employees appointed authorized by the secretary under this paragraph shall be issued, and shall possess at all times during which while they are performing their investigatory or audit functions under this section, identification, signed by the secretary which, that specifically designates the bearer as possessing the authorization to conduct medical assistance investigations or audits. Pursuant to Under the request of a designated person and upon presentation of that the person's authorization, providers and medical assistance recipients shall accord such the person access to any provider personnel, records, books, recipient medical records, or documents or other information needed. Under the written request of a designated person and upon presentation of the person's authorization, providers and recipients shall accord the person access to any needed patient health care records of a recipient. Authorized employees shall have authority to may hold hearings, administer oaths, take testimony, and perform all other duties necessary to bring such the matter before the department for final adjudication and determination.

SB55-SSA1-CA1, s. 1750td Section 1750td. 49.45 (3) (g) 2. of the statutes is created to read:

SB55-SSA1-CA1,303,9 49.45 (3) (g) 2. The department shall promulgate rules to implement this paragraph.

SB55-SSA1-CA1, s. 1750v Section 1750v. 49.45 (3) (h) 1. of the statutes is repealed.

SB55-SSA1-CA1, s. 1750vm Section 1750vm. 49.45 (3) (h) 1n. of the statutes is created to read:

SB55-SSA1-CA1,303,13 49.45 (3) (h) 1n. The department shall promulgate rules to implement this paragraph.

SB55-SSA1-CA1, s. 1750x Section 1750x. 49.45 (3) (h) 2. of the statutes is repealed.

SB55-SSA1-CA1, s. 1750z Section 1750z. 49.45 (3) (h) 3. of the statutes is renumbered 49.45 (3) (h) 1m. and amended to read:

SB55-SSA1-CA1,304,2 49.45 (3) (h) 1m. The failure or refusal of a person to purge himself or herself of contempt found under s. 885.12 and perform the act as required by law shall constitute provider to accord department auditors or investigators access as required under par. (g) to any provider personnel, records, books, patient health care records of medical assistance recipients, or documents or other information requested constitutes grounds for decertification or suspension of that person the provider from participation in the medical assistance program and no. No payment may be made for services rendered by that person subsequent to the provider following decertification or, during the period of suspension, or during any period of provider failure or refusal to accord access as required under par. (g).".

SB55-SSA1-CA1,304,3 954. Page 622, line 8: delete ", or (w)" and substitute ", (w), or (wm)".

SB55-SSA1-CA1,304,4 955. Page 622, line 14: delete lines 14 to 21.

SB55-SSA1-CA1,304,5 956. Page 624, line 21: delete "and (w)" and substitute ", (w), and (wm)".

SB55-SSA1-CA1,304,6 957. Page 627, line 2: after that line insert:

SB55-SSA1-CA1,304,7 " Section 1778d. 49.45 (6v) (b) of the statutes is amended to read:

SB55-SSA1-CA1,304,15 49.45 (6v) (b) The Beginning on October 1, 2003, and annually thereafter, 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) and (o) for the immediately prior 2 consecutive fiscal years.

SB55-SSA1-CA1, s. 1778h Section 1778h. 49.45 (6v) (c) of the statutes is amended to read:

SB55-SSA1-CA1,305,12 49.45 (6v) (c) If the report specified in par. (b) indicates that utilization of beds by recipients of medical assistance in facilities is less than estimates for that utilization reflected in the intentions of the joint committee on finance, legislature and governor, as expressed by them in the budget determinations, the department shall include a proposal to transfer moneys from the appropriation under s. 20.435 (4) (b) to the appropriation under s. 20.435 (7) (bd) for the purpose of increasing funding for the community options program under s. 46.27. The amount proposed for transfer may not reduce the balance in the appropriation account under s. 20.435 (4) (b) below an amount necessary to ensure that that appropriation account will end the current fiscal year or the current fiscal biennium with a positive balance. The secretary shall transfer the amount identified under the proposal decreased during the most recently completed fiscal year from the utilization of beds by recipients of medical assistance in facilities in the next most recently completed fiscal year, the department shall multiply the difference between the number of days of care provided to the recipients in the facilities in each of those prior 2 consecutive fiscal years by the average daily costs of care in the facilities for the most recently completed fiscal year. The average daily costs of care shall be calculated by dividing the total of medical assistance expenditures for care in facilities for the most recently completed fiscal year by the total number of days of care provided in facilities in that fiscal year.

SB55-SSA1-CA1, s. 1778p Section 1778p. 49.45 (6v) (d) of the statutes is created to read:

SB55-SSA1-CA1,306,4 49.45 (6v) (d) If par. (c) applies and if the amount calculated under par. (c) is positive, the department's report under par. (b) shall include a proposal to transfer an amount equal to the portion of the amount calculated under par. (c) that is the state share of medical assistance expenditures from the appropriation account under s. 20.435 (4) (b) to the appropriation account under s. 20.435 (7) (bd) for the purpose of increasing funding for the long-term support community options program under s. 46.27. If the cochairpersons of the joint committee on finance do not notify the secretary within 14 working days after the date on which the department submits the proposal that the committee has scheduled a meeting for the purpose of reviewing the proposal, the secretary shall transfer the amount identified under the proposal. If, within 14 working days after the date on which the department submits the proposal, the cochairpersons of the joint committee on finance notify the secretary that the committee has scheduled a meeting for the purpose of reviewing the proposal, the secretary may transfer moneys from the appropriation account under s. 20.435 (4) (b) to the appropriation account under s. 20.435 (7) (bd) only as approved by the committee.

SB55-SSA1-CA1, s. 1778r Section 1778r. 49.45 (6v) (e) of the statutes is created to read:

SB55-SSA1-CA1,306,8 49.45 (6v) (e) Of the amount required to be transferred by the secretary under par. (d), 40% shall be expended for services as specified under s. 46.27 (7) and 60% shall be expended for services as specified under s. 46.27 (11).".

SB55-SSA1-CA1,306,9 958. Page 628, line 21: after that line insert:

SB55-SSA1-CA1,306,10 " Section 1786g. 49.45 (21) (title) of the statutes is amended to read:

SB55-SSA1-CA1,306,12 49.45 (21) (title) Transfer of business, liability for Taking over provider's operation; repayments required.

SB55-SSA1-CA1, s. 1786h Section 1786h. 49.45 (21) (a) of the statutes is renumbered 49.45 (21) (ar) and amended to read:

SB55-SSA1-CA1,306,23 49.45 (21) (ar) If any provider Before a person may take over the operation of a provider that is liable for repayment of improper or erroneous payments or overpayments under ss. 49.43 to 49.497 sells or otherwise transfers ownership of his or her business or all or substantially all of the assets of the business, the transferor and transferee are each liable for the repayment. Prior to final transfer, the transferee is responsible for contacting the department and ascertaining if the transferor, full repayment shall be made. Upon request, the department shall notify the provider or the person that intends to take over the operation of the provider as to whether the provider is liable under this paragraph.

SB55-SSA1-CA1, s. 1786i Section 1786i. 49.45 (21) (ag) of the statutes is created to read:

SB55-SSA1-CA1,307,3 49.45 (21) (ag) In this subsection, "take over the operation" means obtain, with respect to an aspect of a provider's business for which the provider has filed claims for medical assistance reimbursement, any of the following:

SB55-SSA1-CA1,307,5 1. Ownership of the provider's business or all or substantially all of the assets of the business.

SB55-SSA1-CA1,307,6 2. Majority control over decisions.

SB55-SSA1-CA1,307,7 3. The right to any profits or income.

SB55-SSA1-CA1,307,9 4. The right to contact and offer services to patients, clients, or residents served by the provider.

SB55-SSA1-CA1,307,12 5. An agreement that the provider will not compete with the person at all or with respect to a patient, client, resident, service, geographical area, or other part of the provider's business.

SB55-SSA1-CA1,307,14 6. The right to perform services that are substantially similar to services performed by the provider at the same location as those performed by the provider.

SB55-SSA1-CA1,307,16 7. The right to use any distinctive name or symbol by which the provider is known in connection with services to be provided by the person.

SB55-SSA1-CA1, s. 1786j Section 1786j. 49.45 (21) (b) of the statutes is amended to read:

SB55-SSA1-CA1,308,2 49.45 (21) (b) If a transfer occurs If, notwithstanding the prohibition under par. (ar), a person takes over the operation of a provider and the applicable amount under par. (a) (ar) has not been repaid, the department may, in addition to withholding certification as authorized under sub. (2) (b) 8., proceed against either the transferor or the transferee the provider or the person. Within 30 days after receiving the certified provider receives notice from the department, the transferor or the transferee shall pay the amount shall be repaid in full. Upon failure to comply If the amount is not repaid in full, the department may bring an action to compel payment. If a transferor fails to pay within 90 days after receiving notice from the department, the department, may proceed under sub. (2) (a) 12. , or may do both.

SB55-SSA1-CA1, s. 1786k Section 1786k. 49.45 (21) (e) of the statutes is created to read:

SB55-SSA1-CA1,308,5 49.45 (21) (e) The department shall promulgate rules to implement this subsection.".

SB55-SSA1-CA1,308,6 959. Page 630, line 7: after that line insert:

SB55-SSA1-CA1,308,7 " Section 1789b. 49.45 (39) (a) 1. of the statutes is amended to read:

SB55-SSA1-CA1,308,12 49.45 (39) (a) 1. "School" means a public school described under s. 115.01 (1), a charter school, as defined in s. 115.001 (1), the Wisconsin Center for the Blind and Visually Impaired, or the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing. It includes school-operated early childhood programs for developmentally delayed and disabled 4-year-old and 5-year-old children.

SB55-SSA1-CA1, s. 1789c Section 1789c. 49.45 (39) (am) of the statutes is amended to read:

SB55-SSA1-CA1,309,2 49.45 (39) (am) Plan amendment. No later than September 30, 1995, the department shall submit to the federal department of health and human services an amendment to the state medical assistance plan to permit the application of pars. (b) and (c). If the amendment to the state plan is approved, school districts, cooperative educational service agencies, and the department of public instruction on behalf of the Wisconsin Center for the Blind and Visually Impaired and the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing claim reimbursement under pars. (b) and (c). Paragraphs (b) and (c) do not apply unless the amendment to the state plan is approved and in effect. The department shall submit to the federal department of health and human services an amendment to the state plan if necessary to permit the application of pars. (b) and (c) to the Wisconsin Center for the Blind and Visually Impaired and the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing.

SB55-SSA1-CA1, s. 1789d Section 1789d. 49.45 (39) (b) of the statutes is amended to read:

SB55-SSA1-CA1,310,12 49.45 (39) (b) School medical services. 1. `Payment for school medical services.' If a school district or a cooperative educational service agency elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the school district or the cooperative educational service agency for 60% of the federal share of allowable charges for the school medical services that it provides and, as specified in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the department of public instruction for 60% of the federal share of allowable charges for the school medical services that the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing provides and, as specified in subd. 2., for allowable administrative costs. A school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, claims for common carrier transportation costs as a school medical service unless the department receives notice from the federal health care financing administration that, under a change in federal policy, the claims are not allowed. If the department receives the notice, a school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired, or the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, unreimbursed claims for common carrier transportation costs incurred before the date of the change in federal policy. The department shall promulgate rules establishing a methodology for making reimbursements under this paragraph. All other expenses for the school medical services provided by a school district or a cooperative educational service agency shall be paid for by the school district or the cooperative educational service agency with funds received from state or local taxes. The school district, the Wisconsin Center for the Blind and Visually Impaired, the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing, or the cooperative educational service agency shall comply with all requirements of the federal department of health and human services for receiving federal financial participation.

SB55-SSA1-CA1,310,22 2. `Payment for school medical services administrative costs.' The department shall reimburse a school district or a cooperative educational service agency specified under subd. 1. and shall reimburse the department of public instruction on behalf of the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing for 90% of the federal share of allowable administrative costs, using time studies, beginning in fiscal year 1999-2000. A school district or a cooperative education educational service agency may submit, and the department of health and family services shall allow, claims for administrative costs incurred during the period that is up to 24 months before the date of the claim, if allowable under federal law.".

SB55-SSA1-CA1,310,23 960. Page 630, line 14: after that line insert:

SB55-SSA1-CA1,310,24 " Section 1791h. 49.45 (47) (c) of the statutes is amended to read:

SB55-SSA1-CA1,311,5 49.45 (47) (c) The biennial fee for the certification required under par. (b) of an adult day care center is $89, plus a biennial fee of $17.80 per client, based on the number of clients that the adult day care center is certified to serve $100. Fees collected under this paragraph shall be credited to the appropriation account under s. 20.435 (6) (jm).

SB55-SSA1-CA1, s. 1791i Section 1791i. 49.45 (47) (d) of the statutes is repealed.".

SB55-SSA1-CA1,311,7 961. Page 632, line 4: after that line insert:

SB55-SSA1-CA1,311,8 " Section 1799f. 49.46 (1) (a) 5m. of the statutes is created to read:

SB55-SSA1-CA1,311,11 49.46 (1) (a) 5m. Any individual who is at least 19 years of age but under 20 years of age and who, on his or her 18th birthday, was in foster care, or treatment foster care placement under ch. 48 or 938, as determined by the department.".

SB55-SSA1-CA1,311,12 962. Page 646, line 22: after that line insert:

SB55-SSA1-CA1,311,13 " Section 1838gb. 49.688 of the statutes is created to read:

SB55-SSA1-CA1,311,15 49.688 Prescription drug assistance for elderly persons. (1) In this section:

SB55-SSA1-CA1,311,16 (a) "Generic name" has the meaning given in s. 450.12 (1) (b).

SB55-SSA1-CA1,311,18 (b) "Poverty line" means the nonfarm federal poverty line for the continental United States, as defined by the federal department of labor under 42 USC 9902 (2).

SB55-SSA1-CA1,311,22 (c) "Prescription drug" means a prescription drug, as defined in s. 450.01 (20), that is included in the drugs specified under s. 49.46 (2) (b) 6. h. and that is manufactured by a drug manufacturer that enters into a rebate agreement in force under sub. (6).

SB55-SSA1-CA1,311,23 (d) "Prescription order" has the meaning given in s. 450.01 (21).

SB55-SSA1-CA1,312,4 (e) "Program payment rate" means the rate of payment made for the identical drug specified under s. 49.46 (2) (b) 6. h., plus 5%, plus a dispensing fee that is equal to the dispensing fee permitted to be charged for prescription drugs for which coverage is provided under s. 49.46 (2) (b) 6. h.

SB55-SSA1-CA1,312,6 (2) (a) A person to whom all of the following applies is eligible to purchase a prescription drug for the amounts specified in sub. (5) (a) 1. and 2.:

SB55-SSA1-CA1,312,7 1. The person is a resident, as defined in s. 27.01 (10) (a), of this state.

SB55-SSA1-CA1,312,8 2. The person is at least 65 years of age.

SB55-SSA1-CA1,312,9 3. The person is not a recipient of medical assistance.