SB44-SSA1, s. 1316
23Section
1316. 49.45 (5) (b) 2. (intro.) of the statutes is amended to read:
SB44-SSA1,523,924
49.45
(5) (b) 2. (intro.) If a recipient requests a hearing within the timely notice
25period specified in
42 CFR 431.231 (c), medical assistance coverage shall not be
1suspended, reduced
, or discontinued until a decision is rendered after the hearing
2but medical assistance payments made pending the hearing decision may be
3recovered by the department if the contested decision or failure to act is upheld.
The
4department shall promptly notify the county department or, if a Wisconsin works
5agency If a county department is responsible for making the medical assistance
6determination, the
Wisconsin works agency department shall notify the county
7department of the county in which the recipient resides that the recipient has
8requested a hearing. Medical assistance coverage shall be suspended, reduced
, or
9discontinued if:
SB44-SSA1,523,1911
49.45
(5m) (am) Notwithstanding sub. (3) (e), from the
appropriations 12appropriation accounts under s. 20.435 (4) (b),
(gp), (o), and (w), the department shall
13distribute not more than $2,256,000 in each fiscal year, to provide supplemental
14funds to rural hospitals that, as determined by the department, have high utilization
15of inpatient services by patients whose care is provided from governmental sources,
16and to provide supplemental funds to critical access hospitals, except that the
17department may not distribute funds to a rural hospital or to a critical access hospital
18to the extent that the distribution would exceed any limitation under
42 USC 1396b 19(i) (3).
SB44-SSA1,524,321
49.45
(6b) Centers for the developmentally disabled. From the
22appropriation under s. 20.435 (2) (gk), the department may reimburse the cost of
23services provided by the centers for the developmentally disabled. Reimbursement
24to the centers for the developmentally disabled shall be reduced following each
25placement made under s. 46.275 that involves a relocation from a center for the
1developmentally disabled, by
$200 per day, beginning in fiscal year 2001-02, and by 2$225 per day, beginning in fiscal year 2002-03
, and by $325 per day, beginning in
3fiscal year 2004-05.
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(6c) (a) 6m. "Intermediate facility" has the meaning given in s. 46.279
6(1) (a).
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(6c) (b)
Preadmission screening. Except as provided in par. (e),
beginning
9on August 9, 1989, every individual who applies for admission to a facility or to an
10institution for mental diseases shall be screened to determine if the individual has
11developmental disability or mental illness.
Beginning on August 9, 1989, the The 12department or an entity to which the department has delegated authority shall
13screen every individual who has been identified as having a developmental disability
14or mental illness to determine if the individual needs facility care. If the individual
15is determined to need facility care, the department or an entity to which the
16department has delegated authority shall also assess the individual to determine if
17he or she requires active treatment for developmental disability or active treatment
18for mental illness.
If the department or entity determines that the individual
19requires active treatment for developmental disability, the department or entity
20shall determine whether the level of care required by the individual that is provided
21by a facility could be provided safely in an intermediate facility or under a plan that
22is developed under s. 46.279 (4).
SB44-SSA1, s. 1323
23Section
1323. 49.45 (6c) (c) (intro.) of the statutes is amended to read:
SB44-SSA1,525,424
49.45
(6c) (c)
Resident review. (intro.) Except as provided in par. (e), the
25department or an entity to which the department has delegated authority shall
1review every resident of a facility or institution for mental diseases who has a
2developmental disability or mental illness and who has experienced a significant
3change in his or her physical or mental condition to determine
if any all of the
4following
applies:
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(6c) (c) 1.
The Whether the resident needs facility care.
SB44-SSA1,525,98
49.45
(6c) (c) 2.
The Whether the resident requires active treatment for
9developmental disability or active treatment for mental illness.
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49.45
(6c) (c) 3. If the department or entity determines under subd. 1. that the
12resident needs facility care and under subd. 2. that the resident requires active
13treatment for developmental disability, whether the level of care required by the
14resident that is provided by a facility could be provided safely in an intermediate
15facility or under a plan that is developed under s. 46.279 (4).
SB44-SSA1, s. 1328
17Section
1328. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:
SB44-SSA1,525,2418
49.45
(6m) (ag) (intro.) Payment for care provided in a facility under this
19subsection made under s. 20.435 (4) (b),
(gp), (pa), (o), (w), or (wm) shall, except as
20provided in pars. (bg), (bm), and (br), be determined according to a prospective
21payment system updated annually by the department. The payment system shall
22implement standards that are necessary and proper for providing patient care and
23that meet quality and safety standards established under subch. II of ch. 50 and ch.
24150. The payment system shall reflect all of the following:
SB44-SSA1,526,4
149.45
(6m) (ag) 2.
Standards
Except as provided in subd. 3r., standards 2established by the department that shall be based upon allowable costs incurred by
3facilities in the state as available from information submitted under par. (c) 3. and
4compiled by the department.
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(6m) (ag) 3m. For
each state fiscal year
1999-2000, rates that shall be
7set by the department based on information from cost reports for the
1998 most
8recently completed fiscal year of the facility
and for state fiscal year 2000-01, rates
9that shall be set by the department based on information from cost reports for the 101999 fiscal year of the facility.
SB44-SSA1, s. 1331
11Section
1331
. 49.45 (6m) (ag) 3m. of the statutes, as affected by 2003
12Wisconsin Act .... (this act), is amended to read:
SB44-SSA1,526,1513
49.45
(6m) (ag) 3m. For each state fiscal year, rates that shall be set by the
14department based on information from cost reports
for costs specified under par. (am)
151. bm., 4., 5m., and 6. for the most recently completed fiscal year of the facility.
SB44-SSA1, s. 1332
16Section
1332. 49.45 (6m) (ag) 3r. of the statutes is created to read:
SB44-SSA1,526,1817
49.45
(6m) (ag) 3r. Flat-rate payment, as determined by the department, for
18costs specified under par. (am) 1. a. and 2.
SB44-SSA1, s. 1333
19Section
1333. 49.45 (6m) (ag) 3r. of the statutes, as created by 2003 Wisconsin
20Act .... (this act), is amended to read:
SB44-SSA1,526,2221
49.45
(6m) (ag) 3r. Flat-rate payment
, as determined by the department, for
22all costs specified under par. (am) 1. a. and 2.
SB44-SSA1,527,3
149.45
(6m) (ag) 8. Maintenance of the identical proportion of payment for direct
2care costs, as specified in par. (am) 1., to total payment for all costs specified in par.
3(am) as that made in state fiscal year 2002-03.
SB44-SSA1, s. 1334
4Section
1334. 49.45 (6m) (am) 1. a. of the statutes is amended to read:
SB44-SSA1,527,95
49.45
(6m) (am) 1. a. Personal comfort supplies
; medical supplies;
6over-the-counter drugs; and nonbillable services of a ward clerk, activity person,
7recreation person, social worker, volunteer coordinator, teacher for residents aged 22
8and older, vocational counselor for residents aged 22 and older, religious person,
9therapy aide, therapy assistant, and counselor on resident living.
SB44-SSA1, s. 1336
11Section
1336. 49.45 (6m) (am) 1. bm. of the statutes is created to read:
SB44-SSA1,527,1312
49.45
(6m) (am) 1. bm. Nonbillable services of a registered nurse, licensed
13practical nurse and nurse's assistant.
SB44-SSA1, s. 1339
16Section
1339. 49.45 (6m) (am) 3. (intro.) of the statutes is renumbered 49.45
17(6m) (am) 2. c. and amended to read:
SB44-SSA1,527,2018
49.45
(6m) (am) 2. c. Allowable fuel and utility costs, including the facility
19expenses that the department determines are allowable for the provision of
: 20electrical service, water and sewer services, and heat.
SB44-SSA1,528,2
149.45
(6m) (am) 4.
Net property Property tax or
allowable municipal service
2costs
incurred paid by the owner of the facility for the facility.
SB44-SSA1, s. 1344
3Section
1344. 49.45 (6m) (am) 5. of the statutes is renumbered 49.45 (6m) (am)
42. d.
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49.45
(6m) (ar) 1. a. The department shall establish standards for payment of
7allowable direct care costs
under par. (am) 1. bm., for facilities that do not primarily
8serve the developmentally disabled, that take into account direct care costs for a
9sample of all of those facilities in this state and separate standards for payment of
10allowable direct care costs, for facilities that primarily serve the developmentally
11disabled, that take into account direct care costs for a sample of all of those facilities
12in this state. The standards shall be adjusted by the department for regional labor
13cost variations. For facilities in Douglas, Pierce, and St. Croix counties, the
14department shall perform the adjustment by use of the wage index that is used by
15the federal department of health and human services for hospital reimbursement
16under
42 USC 1395 to
1395ggg.
SB44-SSA1, s. 1347
17Section
1347. 49.45 (6m) (ar) 2. (intro.) and 2. a. of the statutes are
18consolidated, renumbered 49.45 (6m) (ar) 2. and amended to read:
SB44-SSA1,528,2119
49.45
(6m) (ar) 2. For support service costs
: 2. a. The, the department shall
20establish one or more standards for the payment of support service costs that take
21into account support service costs for a sample of all facilities within the state.
SB44-SSA1, s. 1352
1Section
1352. 49.45 (6m) (av) 1. of the statutes is renumbered 49.45 (6m) (av)
2and amended to read:
SB44-SSA1,529,73
49.45
(6m) (av) The department shall calculate a payment rate for a facility by
4applying the criteria set forth under pars. (ag) 1. to 5. and 7., (am) 1.
to 5. bm., 4., 5m.
5and 6., and (ar) 1.
to 5., 4., and 6. to information from cost reports submitted by the
6facility
, as affected by any adjustment for ancillary services and materials under par.
7(b).
SB44-SSA1, s. 1360
15Section
1360. 49.45 (6t) of the statutes, as affected by
2001 Wisconsin Act 16,
16is renumbered 49.45 (6t) (a), and 49.45 (6t) (a) 2. (intro.), 3. and 4., as renumbered,
17are amended to read:
SB44-SSA1,529,2218
49.45
(6t) (a) 2. (intro.) Based on the amount estimated to be available under
19par. (a) subd. 1., develop a method, which need not be promulgated as rules under
20ch. 227, to distribute this allocation to the individual county departments under s.
2146.215, 46.22, 46.23 or 51.42 or to local health departments that have incurred
22operating deficits that shall include all of the following:
SB44-SSA1,529,2423
3. Except as provided in
par. (d) subd. 4., distribute the allocation under the
24distribution method that is developed.
SB44-SSA1,530,5
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) that result in a lesser
3allocation amount than that allocated under this subsection or disallows use of the
4allocation of federal medicaid funds under
par. (c)
subd. 3., reduce allocations under
5this subsection and distribute on a prorated basis, as determined by the department.
SB44-SSA1,530,87
49.45
(6t) (b) If 2003 Wisconsin Act .... (this act), section 9124 (8) (a) applies,
8this subsection does not apply.
SB44-SSA1,530,1410
49.45
(6tt) Distributions to county departments and local health
11departments. From the appropriation under s. 20.435 (4) (w), the department may
12in each fiscal year distribute moneys to county departments under s. 46.215, 46.22,
1346.23, or 51.42 or to local health departments, as defined in s. 250.01 (4), under a plan
14developed by the department.
SB44-SSA1, s. 1363
15Section
1363. 49.45 (6u) (am) (intro.) of the statutes is amended to read:
SB44-SSA1,531,216
49.45
(6u) (am) (intro.) Notwithstanding sub. (6m),
in state fiscal years in
17which less than $1 in federal financial participation relating to facilities is received
18under 42 CFR 433.51, from the appropriations under s. 20.435 (4) (o), (w), and (wm),
19for reduction of operating deficits, as defined under the methodology used by the
20department in December
, 2000, incurred by a facility that is established under s.
2149.70 (1) or that is owned and operated by a city, village, or town,
and as payment
22to care management organizations, the department may not distribute to these
23facilities
and to care management organizations more than $37,100,000 in each
24fiscal year, as determined by the department. The total amount that a county
25certifies under this subsection may not exceed 100% of otherwise-unreimbursed
1care. In distributing funds under this subsection, the department shall perform all
2of the following:
SB44-SSA1,531,105
49.45
(6v) (b) The department shall, each year, submit to the joint committee
6on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that
7provides information on the utilization of beds by recipients of medical assistance in
8facilities and a discussion and detailed projection of the likely balances,
9expenditures, encumbrances and carry over of currently appropriated amounts in
10the appropriation accounts under s. 20.435 (4) (b)
, (gp), and (o).
SB44-SSA1,531,1712
49.45
(6x) (a) Notwithstanding sub. (3) (e), from the
appropriations 13appropriation accounts under s. 20.435 (4) (b),
(gp), (o), and (w), the department shall
14distribute not more than $4,748,000 in each fiscal year, to provide funds to an
15essential access city hospital, except that the department may not allocate funds to
16an essential access city hospital to the extent that the allocation would exceed any
17limitation under
42 USC 1396b (i) (3).
