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.
SB44-SSA1,528,166
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).
SB44-SSA1,532,319
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the
appropriations 20appropriation accounts under s. 20.435 (4) (b),
(gp), (o), and (w), the department shall
21distribute funding in each fiscal year to provide supplemental payment to hospitals
22that enter into a contract under s. 49.02 (2) to provide health care services funded
23by a relief block grant, as determined by the department, for hospital services that
24are not in excess of the hospitals' customary charges for the services, as limited under
2542 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the
1allocation of funds to such hospitals would exceed any limitation under
42 USC
21396b (i) (3), the department may distribute funds to hospitals that have not entered
3into a contract under s. 49.02 (2).
SB44-SSA1,532,125
49.45
(6y) (am) Notwithstanding sub. (3) (e), from the
appropriations 6appropriation accounts under s. 20.435 (4) (b), (h),
(gp), (o), and (w), the department
7shall distribute funding in each fiscal year to provide supplemental payments to
8hospitals that enter into contracts under s. 49.02 (2) with a county having a
9population of 500,000 or more to provide health care services funded by a relief block
10grant, as determined by the department, for hospital services that are not in excess
11of the hospitals' customary charges for the services, as limited under
42 USC 1396b 12(i) (3).
SB44-SSA1, s. 1369
13Section
1369. 49.45 (6z) (a) (intro.) of the statutes is amended to read:
SB44-SSA1,532,2414
49.45
(6z) (a) (intro.) Notwithstanding sub. (3) (e), from the
appropriations 15appropriation accounts under s. 20.435 (4) (b),
(gp), (o), and (w), the department shall
16distribute funding in each fiscal year to supplement payment for services to hospitals
17that enter into a contract under s. 49.02 (2) to provide health care services funded
18by a relief block grant under this chapter, if the department determines that the
19hospitals serve a disproportionate number of low-income patients with special
20needs. If no medical relief block grant under this chapter is awarded or if the
21allocation of funds to such hospitals would exceed any limitation under
42 USC
221396b (i) (3), the department may distribute funds to hospitals that have not entered
23into a contract under s. 49.02 (2). The department may not distribute funds under
24this subsection to the extent that the distribution would do any of the following:
SB44-SSA1,533,5
149.45
(8) (b) Reimbursement under s. 20.435 (4) (b),
(gp), (o), and (w) for home
2health services provided by a certified home health agency or independent nurse
3shall be made at the home health agency's or nurse's usual and customary fee per
4patient care visit, subject to a maximum allowable fee per patient care visit that is
5established under par. (c).
SB44-SSA1, s. 1373
6Section
1373. 49.45 (18) (intro.) of the statutes is renumbered 49.45 (18) (ac)
7and amended to read:
SB44-SSA1,533,198
49.45
(18) (ac) Except as provided in pars.
(a) (am) to (d),
and subject to par.
9(ag), any person eligible for medical assistance under s. 49.46, 49.468
, or 49.47 shall
10pay up to the maximum amounts allowable under
42 CFR 447.53 to
447.58 for
11purchases of services provided under s. 49.46 (2). The service provider shall collect
12the
specified or allowable copayment, coinsurance
, or deductible, unless the service
13provider determines that the cost of collecting the copayment, coinsurance
, or
14deductible exceeds the amount to be collected. The department shall reduce
15payments to each provider by the amount of the
specified or allowable copayment,
16coinsurance
, or deductible. No provider may deny care or services because the
17recipient is unable to share costs, but an inability to share costs specified in this
18subsection does not relieve the recipient of liability for these costs.
Liability under
19this subsection is limited by the following provisions:
SB44-SSA1, s. 1374
20Section
1374. 49.45 (18) (a) of the statutes is renumbered 49.45 (18) (am).
SB44-SSA1,533,2322
49.45
(18) (ag) Except as provided in pars. (am), (b), and (c), and subject to par.
23(d), a recipient specified in par. (ac) shall pay all of the following:
SB44-SSA1,533,2524
1. A copayment of $1 for each prescription of a drug that bears only a generic
25name, as defined in s. 450.12 (1) (b).
SB44-SSA1,534,2
12. A copayment of $3 for each prescription of a drug that bears a brand name,
2as defined in s. 450.12 (1) (a).
SB44-SSA1,534,74
49.45
(18) (d) No person who designates a pharmacy or pharmacist as his or
5her sole provider of prescription drugs and who so uses that pharmacy or pharmacist
6is liable under this subsection for more than
$5
$12 per month for prescription drugs
7received.
SB44-SSA1,534,119
49.45
(19) (bm) The
department or the county department under s. 46.215 or
1046.22 shall notify applicants of the requirements of this subsection at the time of
11application.
SB44-SSA1, s. 1378
12Section
1378. 49.45 (24m) (intro.) of the statutes is amended to read:
SB44-SSA1,534,1713
49.45
(24m) Home health care and personal care pilot program. (intro.)
14From the
appropriations appropriation accounts under s. 20.435 (4) (b),
(gp), (o), and
15(w), in order to test the feasibility of instituting a system of reimbursement for
16providers of home health care and personal care services for medical assistance
17recipients that is based on competitive bidding, the department shall:
SB44-SSA1, s. 1379
18Section
1379. 49.45 (25) (am) (intro.) of the statutes is amended to read:
SB44-SSA1,534,2519
49.45
(25) (am) (intro.) Except as provided under pars. (be)
and, (bg)
, and (bj) 20and sub. (24), case management services under s. 49.46 (2) (b) 9. and (bm) are
21reimbursable under
medical assistance Medical Assistance only if provided to a
22medical assistance Medical Assistance beneficiary who receives case management
23services from or through a certified case management provider in a county, city,
24village
, or town that elects, under par. (b), to make the services available and who
25meets at least one of the following conditions:
SB44-SSA1,535,92
49.45
(25) (bj) The department of corrections may elect to provide case
3management services under this subsection to persons who are under the
4supervision of that department under s. 938.183, 938.34 (4h), (4m), or (4n), or
5938.357 (4), who are Medical Assistance beneficiaries, and who meet one or more of
6the conditions specified in par. (am). The amount of the allowable charges for those
7services under the Medical Assistance program that is not provided by the federal
8government shall be paid from the appropriation account under s. 20.410 (3) (hm),
9(ho), or (hr).
SB44-SSA1,535,1511
49.45
(25) (c) Except as provided in pars. (b), (be)
and, (bg),
and (bj), the
12department shall reimburse a provider of case management services under this
13subsection only for the amount of the allowable charges for those services under the
14medical assistance Medical Assistance program that is provided by the federal
15government.
