Amendment SSA1-SB44

SB44-SSA1, s. 1333 Section 1333. 49.45 (6m) (ag) 3r. of the statutes, as created by 2003 Wisconsin Act .... (this act), is amended to read:

SB44-SSA1,526,22 49.45 (6m) (ag) 3r. Flat-rate payment, as determined by the department, for all costs specified under par. (am) 1. a. and 2.

SB44-SSA1, s. 1333d Section 1333d. 49.45 (6m) (ag) 8. of the statutes is created to read:

SB44-SSA1,527,3 49.45 (6m) (ag) 8. Maintenance of the identical proportion of payment for direct care costs, as specified in par. (am) 1., to total payment for all costs specified in par. (am) as that made in state fiscal year 2002-03.

SB44-SSA1, s. 1334 Section 1334. 49.45 (6m) (am) 1. a. of the statutes is amended to read:

SB44-SSA1,527,9 49.45 (6m) (am) 1. a. Personal comfort supplies; medical supplies; over-the-counter drugs; and nonbillable services of a ward clerk, activity person, recreation person, social worker, volunteer coordinator, teacher for residents aged 22 and older, vocational counselor for residents aged 22 and older, religious person, therapy aide, therapy assistant, and counselor on resident living.

SB44-SSA1, s. 1335 Section 1335. 49.45 (6m) (am) 1. b. of the statutes is repealed.

SB44-SSA1, s. 1336 Section 1336. 49.45 (6m) (am) 1. bm. of the statutes is created to read:

SB44-SSA1,527,13 49.45 (6m) (am) 1. bm. Nonbillable services of a registered nurse, licensed practical nurse and nurse's assistant.

SB44-SSA1, s. 1337 Section 1337. 49.45 (6m) (am) 1. d. of the statutes is repealed.

SB44-SSA1, s. 1338 Section 1338. 49.45 (6m) (am) 1. e. of the statutes is repealed.

SB44-SSA1, s. 1339 Section 1339. 49.45 (6m) (am) 3. (intro.) of the statutes is renumbered 49.45 (6m) (am) 2. c. and amended to read:

SB44-SSA1,527,20 49.45 (6m) (am) 2. c. Allowable fuel and utility costs, including the facility expenses that the department determines are allowable for the provision of: electrical service, water and sewer services, and heat.

SB44-SSA1, s. 1340 Section 1340. 49.45 (6m) (am) 3. a. of the statutes is repealed.

SB44-SSA1, s. 1341 Section 1341. 49.45 (6m) (am) 3. b. of the statutes is repealed.

SB44-SSA1, s. 1342 Section 1342. 49.45 (6m) (am) 3. c. of the statutes is repealed.

SB44-SSA1, s. 1343 Section 1343. 49.45 (6m) (am) 4. of the statutes is amended to read:

SB44-SSA1,528,2 49.45 (6m) (am) 4. Net property Property tax or allowable municipal service costs incurred paid by the owner of the facility for the facility.

SB44-SSA1, s. 1344 Section 1344. 49.45 (6m) (am) 5. of the statutes is renumbered 49.45 (6m) (am) 2. d.

SB44-SSA1, s. 1346d Section 1346d. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:

SB44-SSA1,528,16 49.45 (6m) (ar) 1. a. The department shall establish standards for payment of allowable direct care costs under par. (am) 1. bm., 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. For facilities in Douglas, Pierce, and St. Croix counties, the department shall perform the adjustment by use of the wage index that is used by the federal department of health and human services for hospital reimbursement under 42 USC 1395 to 1395ggg.

SB44-SSA1, s. 1347 Section 1347. 49.45 (6m) (ar) 2. (intro.) and 2. a. of the statutes are consolidated, renumbered 49.45 (6m) (ar) 2. and amended to read:

SB44-SSA1,528,21 49.45 (6m) (ar) 2. For support service costs: 2. a. The, the department shall establish one or more standards for the payment of support service costs that take into account support service costs for a sample of all facilities within the state.

SB44-SSA1, s. 1348 Section 1348. 49.45 (6m) (ar) 2. b. of the statutes is repealed.

SB44-SSA1, s. 1349 Section 1349. 49.45 (6m) (ar) 2. d. of the statutes is repealed.

SB44-SSA1, s. 1350 Section 1350. 49.45 (6m) (ar) 3. of the statutes is repealed.

SB44-SSA1, s. 1351 Section 1351. 49.45 (6m) (ar) 5. of the statutes is repealed.

SB44-SSA1, s. 1352 Section 1352. 49.45 (6m) (av) 1. of the statutes is renumbered 49.45 (6m) (av) and amended to read:

SB44-SSA1,529,7 49.45 (6m) (av) The department shall calculate a payment rate for a facility by applying the criteria set forth under pars. (ag) 1. to 5. and 7., (am) 1. to 5. bm., 4., 5m. and 6., and (ar) 1. to 5., 4., and 6. to information from cost reports submitted by the facility, as affected by any adjustment for ancillary services and materials under par. (b).

SB44-SSA1, s. 1353 Section 1353. 49.45 (6m) (av) 2. of the statutes is repealed.

SB44-SSA1, s. 1354 Section 1354. 49.45 (6m) (av) 3. of the statutes is repealed.

SB44-SSA1, s. 1355 Section 1355. 49.45 (6m) (av) 4. of the statutes is repealed.

SB44-SSA1, s. 1356 Section 1356. 49.45 (6m) (av) 5. of the statutes is repealed.

SB44-SSA1, s. 1357 Section 1357. 49.45 (6m) (av) 5m. of the statutes is repealed.

SB44-SSA1, s. 1358 Section 1358. 49.45 (6m) (av) 6. of the statutes is repealed.

SB44-SSA1, s. 1359 Section 1359. 49.45 (6m) (bc) of the statutes is repealed.

SB44-SSA1, s. 1360 Section 1360. 49.45 (6t) of the statutes, as affected by 2001 Wisconsin Act 16, is renumbered 49.45 (6t) (a), and 49.45 (6t) (a) 2. (intro.), 3. and 4., as renumbered, are amended to read:

SB44-SSA1,529,22 49.45 (6t) (a) 2. (intro.) Based on the amount estimated to be available under par. (a) subd. 1., develop a method, which need not be promulgated as rules under ch. 227, to distribute this allocation to the individual county departments under s. 46.215, 46.22, 46.23 or 51.42 or to local health departments that have incurred operating deficits that shall include all of the following:

SB44-SSA1,529,24 3. Except as provided in par. (d) subd. 4., distribute the allocation under the distribution method that is developed.

SB44-SSA1,530,5 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) that result in a lesser allocation amount than that allocated under this subsection or disallows use of the allocation of federal medicaid funds under par. (c) subd. 3., reduce allocations under this subsection and distribute on a prorated basis, as determined by the department.

SB44-SSA1, s. 1361 Section 1361. 49.45 (6t) (b) of the statutes is created to read:

SB44-SSA1,530,8 49.45 (6t) (b) If 2003 Wisconsin Act .... (this act), section 9124 (8) (a) applies, this subsection does not apply.

SB44-SSA1, s. 1362 Section 1362. 49.45 (6tt) of the statutes is created to read:

SB44-SSA1,530,14 49.45 (6tt) Distributions to county departments and local health departments. From the appropriation under s. 20.435 (4) (w), the department may in each fiscal year distribute moneys to county departments under s. 46.215, 46.22, 46.23, or 51.42 or to local health departments, as defined in s. 250.01 (4), under a plan developed by the department.

SB44-SSA1, s. 1363 Section 1363. 49.45 (6u) (am) (intro.) of the statutes is amended to read:

SB44-SSA1,531,2 49.45 (6u) (am) (intro.) Notwithstanding sub. (6m), in state fiscal years in which less than $1 in federal financial participation relating to facilities is received under 42 CFR 433.51, from the appropriations under s. 20.435 (4) (o), (w), and (wm), for reduction of operating deficits, as defined under 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, and as payment to care management organizations, the department may not distribute to these facilities and to care management organizations more than $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:

SB44-SSA1, s. 1364 Section 1364. 49.45 (6u) (bm) of the statutes is repealed.

SB44-SSA1, s. 1365 Section 1365. 49.45 (6v) (b) of the statutes is amended to read:

SB44-SSA1,531,10 49.45 (6v) (b) 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), (gp), and (o).

SB44-SSA1, s. 1366 Section 1366. 49.45 (6x) (a) of the statutes is amended to read:

SB44-SSA1,531,17 49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriations appropriation accounts under s. 20.435 (4) (b), (gp), (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).

SB44-SSA1, s. 1367 Section 1367. 49.45 (6y) (a) of the statutes is amended to read:

SB44-SSA1,532,3 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations appropriation accounts under s. 20.435 (4) (b), (gp), (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).

SB44-SSA1, s. 1368 Section 1368. 49.45 (6y) (am) of the statutes is amended to read:

SB44-SSA1,532,12 49.45 (6y) (am) Notwithstanding sub. (3) (e), from the appropriations appropriation accounts under s. 20.435 (4) (b), (h), (gp), (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).

SB44-SSA1, s. 1369 Section 1369. 49.45 (6z) (a) (intro.) of the statutes is amended to read:

SB44-SSA1,532,24 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations appropriation accounts under s. 20.435 (4) (b), (gp), (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:

SB44-SSA1, s. 1372 Section 1372. 49.45 (8) (b) of the statutes is amended to read:

SB44-SSA1,533,5 49.45 (8) (b) Reimbursement under s. 20.435 (4) (b), (gp), (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).

SB44-SSA1, s. 1373 Section 1373. 49.45 (18) (intro.) of the statutes is renumbered 49.45 (18) (ac) and amended to read:

SB44-SSA1,533,19 49.45 (18) (ac) Except as provided in pars. (a) (am) to (d), and subject to par. (ag), any person eligible for medical assistance under s. 49.46, 49.468, or 49.47 shall pay up to the maximum amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided under s. 49.46 (2). The service provider shall collect the specified or allowable copayment, coinsurance , or deductible, unless the service provider determines that the cost of collecting the copayment, coinsurance, or deductible exceeds the amount to be collected. The department shall reduce payments to each provider by the amount of the specified or allowable copayment, coinsurance, or deductible. No provider may deny care or services because the recipient is unable to share costs, but an inability to share costs specified in this subsection does not relieve the recipient of liability for these costs. Liability under this subsection is limited by the following provisions:

SB44-SSA1, s. 1374 Section 1374. 49.45 (18) (a) of the statutes is renumbered 49.45 (18) (am).

SB44-SSA1, s. 1375 Section 1375. 49.45 (18) (ag) of the statutes is created to read:

SB44-SSA1,533,23 49.45 (18) (ag) Except as provided in pars. (am), (b), and (c), and subject to par. (d), a recipient specified in par. (ac) shall pay all of the following:

SB44-SSA1,533,25 1. A copayment of $1 for each prescription of a drug that bears only a generic name, as defined in s. 450.12 (1) (b).

SB44-SSA1,534,2 2. A copayment of $3 for each prescription of a drug that bears a brand name, as defined in s. 450.12 (1) (a).

SB44-SSA1, s. 1376 Section 1376. 49.45 (18) (d) of the statutes is amended to read:

SB44-SSA1,534,7 49.45 (18) (d) No person who designates a pharmacy or pharmacist as his or her sole provider of prescription drugs and who so uses that pharmacy or pharmacist is liable under this subsection for more than $5 $12 per month for prescription drugs received.

SB44-SSA1, s. 1377 Section 1377. 49.45 (19) (bm) of the statutes is amended to read:

SB44-SSA1,534,11 49.45 (19) (bm) The department or the county department under s. 46.215 or 46.22 shall notify applicants of the requirements of this subsection at the time of application.

SB44-SSA1, s. 1378 Section 1378. 49.45 (24m) (intro.) of the statutes is amended to read:

SB44-SSA1,534,17 49.45 (24m) Home health care and personal care pilot program. (intro.) From the appropriations appropriation accounts under s. 20.435 (4) (b), (gp), (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:

SB44-SSA1, s. 1379 Section 1379. 49.45 (25) (am) (intro.) of the statutes is amended to read:

SB44-SSA1,534,25 49.45 (25) (am) (intro.) Except as provided under pars. (be) and, (bg), and (bj) and sub. (24), case management services under s. 49.46 (2) (b) 9. and (bm) are reimbursable under medical assistance Medical Assistance only if provided to a medical assistance Medical Assistance beneficiary who receives case management services from or through a certified case management provider in a county, city, village, or town that elects, under par. (b), to make the services available and who meets at least one of the following conditions:

SB44-SSA1, s. 1380 Section 1380. 49.45 (25) (bj) of the statutes is created to read:

SB44-SSA1,535,9 49.45 (25) (bj) The department of corrections may elect to provide case management services under this subsection to persons who are under the supervision of that department under s. 938.183, 938.34 (4h), (4m), or (4n), or 938.357 (4), who are Medical Assistance beneficiaries, and who meet one or more of the conditions specified in par. (am). The amount of the allowable charges for those services under the Medical Assistance program that is not provided by the federal government shall be paid from the appropriation account under s. 20.410 (3) (hm), (ho), or (hr).

SB44-SSA1, s. 1381 Section 1381. 49.45 (25) (c) of the statutes is amended to read:

SB44-SSA1,535,15 49.45 (25) (c) Except as provided in pars. (b), (be) and, (bg), and (bj), the department shall reimburse a provider of case management services under this subsection only for the amount of the allowable charges for those services under the medical assistance Medical Assistance program that is provided by the federal government.