Amendment MR8 SA1-AB1

AB1-SA1, s. 9ah Section 9ah. 25.17 (1) (gs) of the statutes is created to read:

AB1-SA1,3,17 25.17 (1) (gs) Hospital assessment fund (s. 25.772);

AB1-SA1, s. 9ai Section 9ai. 25.69 of the statutes, as affected by 2007 Wisconsin Act 20, is amended to read:

AB1-SA1,4,2 25.69 Permanent endowment fund. There is established a separate nonlapsible trust fund designated as the permanent endowment fund, consisting of all of the proceeds from the sale of the state's right to receive payments under the Attorneys General Master Tobacco Settlement Agreement of November 23, 1998, and all investment earnings on the proceeds. There is transferred from the permanent endowment fund to the Medical Assistance trust fund $50,000,000 $68,000,000 in each fiscal year.

AB1-SA1, s. 9aj Section 9aj. 25.772 of the statutes is created to read:

AB1-SA1,4,6 25.772 Hospital assessment fund. There is established a separate nonlapsible trust fund designated as the hospital assessment fund, to consist of all moneys received under s. 50.375 from assessments on hospitals.

AB1-SA1, s. 9ak Section 9ak. 46.27 (9) (a) of the statutes is amended to read:

AB1-SA1,4,16 46.27 (9) (a) The department may select up to 5 counties that volunteer to participate in a pilot project under which they will receive certain funds allocated for long-term care. The department shall allocate a level of funds to these counties equal to the amount that would otherwise be paid under s. 20.435 (4) (b), (gp), or (w), or (xd), to nursing homes for providing care because of increased utilization of nursing home services, as estimated by the department. In estimating these levels, the department shall exclude any increased utilization of services provided by state centers for the developmentally disabled. The department shall calculate these amounts on a calendar year basis under sub. (10).

AB1-SA1, s. 9aL Section 9aL. 46.27 (10) (a) 1. of the statutes is amended to read:

AB1-SA1,4,23 46.27 (10) (a) 1. The department shall determine for each county participating in the pilot project under sub. (9) a funding level of state medical assistance expenditures to be received by the county. This level shall equal the amount that the department determines would otherwise be paid under s. 20.435 (4) (b), (gp), or (w), or (xd), or because of increased utilization of nursing home services, as estimated by the department.

AB1-SA1, s. 9am Section 9am. 46.275 (5) (a) of the statutes is amended to read:

AB1-SA1,5,6 46.275 (5) (a) Medical Assistance reimbursement for services a county, or the department under sub. (3r), provides under this program is available from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd). If 2 or more counties jointly contract to provide services under this program and the department approves the contract, Medical Assistance reimbursement is also available for services provided jointly by these counties.

AB1-SA1, s. 9an Section 9an. 46.275 (5) (c) of the statutes is amended to read:

AB1-SA1,5,14 46.275 (5) (c) The total allocation under s. 20.435 (4) (b), (gp), (o), and (w), and (xd) to counties and to the department under sub. (3r) for services provided under this section may not exceed the amount approved by the federal department of health and human services. A county may use funds received under this section only to provide services to persons who meet the requirements under sub. (4) and may not use unexpended funds received under this section to serve other developmentally disabled persons residing in the county.

AB1-SA1, s. 9ao Section 9ao. 46.283 (5) of the statutes is amended to read:

AB1-SA1,5,20 46.283 (5) Funding. From the appropriation accounts under s. 20.435 (4) (b), (bm), (gp), (pa), and (w), and (xd) and (7) (b), (bd), and (md), the department may contract with organizations that meet standards under sub. (3) for performance of the duties under sub. (4) and shall distribute funds for services provided by resource centers.

AB1-SA1, s. 9ap Section 9ap. 46.284 (5) (a) of the statutes, as affected by 2007 Wisconsin Act 20, is amended to read:

AB1-SA1,6,4 46.284 (5) (a) From the appropriation accounts under s. 20.435 (4) (b), (g), (gp), (im), (o), and (w), and (xd) and (7) (b), (bd), and (g), the department shall provide funding on a capitated payment basis for the provision of services under this section. Notwithstanding s. 46.036 (3) and (5m), a care management organization that is under contract with the department may expend the funds, consistent with this section, including providing payment, on a capitated basis, to providers of services under the family care benefit.

AB1-SA1, s. 9aq Section 9aq. 46.485 (2g) (intro.) of the statutes is amended to read:

AB1-SA1,6,11 46.485 (2g) (intro.) From the appropriation accounts under s. 20.435 (4) (b) and (gp) (xd), the department may in each fiscal year transfer funds to the appropriation under s. 20.435 (7) (kb) for distribution under this section and from the appropriation account under s. 20.435 (7) (mb) the department may not shall distribute more than $1,330,500 in each fiscal year to applying counties in this state that meet all of the following requirements, as determined by the department:

AB1-SA1, s. 9ar Section 9ar. 46.513 of the statutes is repealed.

AB1-SA1, s. 9bd Section 9bd. 49.155 (6m) of the statutes is created to read:

AB1-SA1,6,14 49.155 (6m) Authorization for payment. (a) In this subsection:

AB1-SA1,6,15 1. "Certified provider" means a child care provider certified under s. 48.651.

AB1-SA1,6,19 2. "Child care administrative agency" means any agency that has a contract with the department to administer child care funds or any agency that has a subcontract to administer child care funds with an agency that has a contract with the department.

AB1-SA1,6,20 3. "Licensed provider" means a child care provider licensed under s. 48.65.

AB1-SA1,6,22 (b) A child care administrative agency shall authorize payment to child care providers as follows:

AB1-SA1,6,24 1. For a licensed provider, the child care administrative agency shall authorize payment based on authorized units of service, except as follows:

AB1-SA1,7,4 a. The child care administrative agency may authorize payment to a licensed provider based on units of service used by each child, up to the maximum number of authorized units, with the reimbursement rate increased by 10 percent to account for absent days, if the schedule of child care to be used is expected to vary widely.

AB1-SA1,7,8 b. The child care administrative agency may authorize payment to a licensed provider based on units of service used by each child, up to the maximum number of authorized units, if the child care administrative agency has documented 3 separate occasions on which the provider significantly overreported the attendance of a child.

AB1-SA1,7,11 2. For a certified provider, the child care administrative agency shall authorize payment for units of service used by each child, up to the maximum number of authorized units, except as provided in par. (c).

AB1-SA1,7,20 (c) A child care administrative agency may authorize payment to a licensed or certified provider to hold a slot for a child if the child's parent has a temporary break in employment and intends to return to work and to continue to use the services of the provider upon returning to work. The child care administrative agency may authorize payment for no more than 6 weeks if the absence is due to a medical reason and is documented by a physician or for no more than 4 weeks if the absence is due to another reason. The department and child care administrative agency may not consider payment for a temporary absence to be an overpayment if the parent intended to, but does not actually, return to work.

AB1-SA1, s. 9be Section 9be. 49.175 (1) (p) of the statutes, as affected by 2007 Wisconsin Act 20, is amended to read:

AB1-SA1,7,25 49.175 (1) (p) Direct child care services. For direct child care services under s. 49.155, $340,601,800 $359,201,800 in fiscal year 2007-08 and $355,352,000 in fiscal year 2008-09.

AB1-SA1, s. 9bf Section 9bf. 49.45 (2) (a) 17. of the statutes is amended to read:

AB1-SA1,8,6 49.45 (2) (a) 17. Notify the governor, the joint committee on legislative organization, the joint committee on finance and appropriate standing committees, as determined by the presiding officer of each house, if the appropriation accounts under s. 20.435 (4) (b) and (gp) (xd) are insufficient to provide the state share of medical assistance.

AB1-SA1, s. 9bg Section 9bg. 49.45 (5m) (ag) of the statutes is repealed.

AB1-SA1, s. 9bh Section 9bh. 49.45 (5m) (am) of the statutes is amended to read:

AB1-SA1,8,17 49.45 (5m) (am) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd), the department shall distribute not more than $2,256,000 $5,256,000 in each fiscal year 2007-08 and each fiscal year thereafter, to provide supplemental funds to rural hospitals that, as determined by the department, have high utilization of inpatient services by patients whose care is provided from governmental sources, and to provide supplemental funds to critical access hospitals, except that the department may not distribute funds to a rural hospital or to a critical access hospital to the extent that the distribution would exceed any limitation under 42 USC 1396b (i) (3).

AB1-SA1, s. 9bi Section 9bi. 49.45 (6m) (ag) (intro.) of the statutes, as affected by 2007 Wisconsin Act 97, is amended to read:

AB1-SA1,9,2 49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this subsection made under s. 20.435 (4) (b), (gp), (o), (pa), or (w), or (xd) 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:

AB1-SA1, s. 9bk Section 9bk. 49.45 (6v) (b) of the statutes is amended to read:

AB1-SA1,9,9 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), and (xd).

AB1-SA1, s. 9bL Section 9bL. 49.45 (6x) (a) of the statutes is amended to read:

AB1-SA1,9,16 49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd), 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).

AB1-SA1, s. 9bm Section 9bm. 49.45 (6y) (a) of the statutes is amended to read:

AB1-SA1,9,25 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd), the department shall may 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).

AB1-SA1, s. 9bn Section 9bn. 49.45 (6y) (am) of the statutes is amended to read:

AB1-SA1,10,10 49.45 (6y) (am) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (h), (gp), (o), and (w), and (xd), 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).

AB1-SA1, s. 9bp Section 9bp. 49.45 (6z) (a) (intro.) of the statutes, as affected by 2007 Wisconsin Act 20, is amended to read:

AB1-SA1,10,24 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd), the department may distribute funding in each fiscal year to supplement payment for services to hospitals that enter into indigent care agreements, in accordance with the approved state plan for services under 42 USC 1396a, with relief agencies that administer the medical 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 indigent care agreements. The department may not distribute funds under this subsection to the extent that the distribution would do any of the following:

AB1-SA1, s. 9bq Section 9bq. 49.45 (8) (b) of the statutes is amended to read:

AB1-SA1,11,5 49.45 (8) (b) Reimbursement under s. 20.435 (4) (b), (gp), (o), and (w), and (xd) 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).

AB1-SA1, s. 9br Section 9br. 49.45 (24m) (intro.) of the statutes is amended to read:

AB1-SA1,11,11 49.45 (24m) (intro.) From the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd), 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:

AB1-SA1, s. 9bt Section 9bt. 49.45 (52) of the statutes is amended to read:

AB1-SA1,11,23 49.45 (52) Payment adjustments. Beginning on January 1, 2003, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payment adjustments to county departments under s. 46.215, 46.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01 (4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16. Payment adjustments under this subsection shall include the state share of the payments. The total of any payment adjustments under this subsection and Medical Assistance payments made from appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd) may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

AB1-SA1, s. 9bu Section 9bu. 49.45 (58) of the statutes is created to read:

AB1-SA1,12,9 49.45 (58) Health maintenance organization payments to hospitals. (a) The department shall develop a methodology for calculating rate increases for inpatient and outpatient hospital services in connection with the assessment imposed on hospitals under s. 50.375. The methodology shall incorporate encounter data provided by health maintenance organizations and information that the department uses to calculate the capitated rates that the department pays health maintenance organizations for providing services to recipients of medical assistance. The department shall publicly disclose the methodology. The department shall review the methodology at least once every 12 months.

AB1-SA1,12,12 (b) The department shall require, as a term of contracts with health maintenance organizations to provide medical assistance services, that the health maintenance organization do all of the following:

AB1-SA1,12,15 1. Make monthly prospective payments, calculated using the methodology under par. (a), to hospitals that serve medical assistance recipients who are enrolled in the health maintenance organization.

AB1-SA1,12,19 2. Calculate the amounts that result from applying the rate increases that are derived using the methodology under par. (a) to services for recipients of medical assistance for which hospitals submit claims to the health maintenance organization.

AB1-SA1,12,24 3. Within 90 days after the end of each 6-month period, compare the amounts that the health maintenance organization paid hospitals under subd. 1. for the 6-month period with the amounts calculated under subd. 2. for services provided during that same period. If the amounts under subd. 2. exceed the amounts of the payments under subd. 1., pay hospitals the difference within 90 days.

AB1-SA1,13,5 (c) If the amounts that a health maintenance organization paid hospitals under par. (b) 1. for a 6-month period exceed the amounts calculated under par. (b) 2. for services provided during the same period, hospitals shall pay the health maintenance organization the difference within 90 days after the comparison of amounts under par. (b) 3. is completed.

AB1-SA1,13,12 (d) If the department determines that a health maintenance organization has not complied with a condition under par. (b), the department shall require the health maintenance organization to comply with the condition within 15 days after the department's determination. The department may terminate a contract with a health maintenance organization for failure to comply with a condition under par. (b). The department shall audit health maintenance organizations to determine whether they have complied with the conditions under par. (b).

AB1-SA1,13,21 (e) If a health maintenance organization and hospital cannot resolve the amount that a health maintenance organization owes a hospital under par. (b) 3. or that a hospital owes a health maintenance organization under par. (c), and either the health maintenance organization or the hospital, within 6 months after the end of the time period to which the disputed amount relates, requests that the department determine the amount owed, the department shall determine the amount within 90 days after the request is made. The health maintenance organization or hospital is, upon request, entitled to a contested case hearing under ch. 227 on the department's determination.

AB1-SA1, s. 9cb Section 9cb. 49.472 (6) (a) of the statutes is amended to read:

AB1-SA1,14,3 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account under s. 20.435 (4) (b), (gp), or (w), or (xd), the department shall, on the part of an individual who is eligible for medical assistance under sub. (3), pay premiums for or purchase individual coverage offered by the individual's employer if the department determines that paying the premiums for or purchasing the coverage will not be more costly than providing medical assistance.

AB1-SA1, s. 9cc Section 9cc. 49.472 (6) (b) of the statutes is amended to read:

AB1-SA1,14,8 49.472 (6) (b) If federal financial participation is available, from the appropriation account under s. 20.435 (4) (b), (gp), or (w), or (xd), the department may pay medicare Part A and Part B premiums for individuals who are eligible for medicare and for medical assistance under sub. (3).

AB1-SA1, s. 9cd Section 9cd. 49.473 (5) of the statutes is amended to read:

AB1-SA1,14,14 49.473 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b), (gp), and (o), and (xd), allowable charges to a provider who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who meets the requirements under sub. (2) for all benefits and services specified under s. 49.46 (2).

AB1-SA1, s. 9ce Section 9ce. 50.375 of the statutes is created to read:

AB1-SA1,14,22 50.375 Assessment. (1) Except as provided in subs. (2) and (7), for the privilege of doing business in this state, there is imposed on each hospital an annual assessment, based on the hospital's gross patient revenue, that each hospital shall pay quarterly by September 1, December 1, March 1, and June 1 of each year, beginning with the payment due by September 1, 2008, except that the entire annual assessment for fiscal year 2007-08 shall be paid by June 1, 2008. The assessments shall be deposited into the hospital assessment fund.

AB1-SA1,15,2 (2) At the discretion of the department, a hospital that is unable timely to make a payment by a date specified under sub. (1) may be allowed to make a delayed payment. A determination by the department that a hospital may not make a delayed payment under this subsection is final and is not subject to review under ch. 227.

AB1-SA1,15,5 (3) The amount of each hospital's assessment shall be based on the information that shall be provided to the department under s. 153.46 (5) or shall be based on any other source that is approved in the state plan for services under 42 USC 1396.

AB1-SA1,15,10 (4) The department shall verify the amount of each hospital's gross patient revenue and shall determine the amount of the assessment owed by each hospital based on a uniform rate that is applicable to total gross patient revenue that the department estimates will yield the amounts specified in the appropriation schedule under s. 20.005 (3) for the appropriation accounts under s. 20.435 (4) (xc) and (xd).

AB1-SA1,15,12 (5) The department shall levy, enforce, and collect the assessments under this section and shall develop and distribute forms necessary for these purposes.

AB1-SA1,15,19 (6) If the department determines that any portion of the revenue collected under sub. (5) to provide Medical Assistance program benefits and payment increases for inpatient and outpatient hospital services as fee for service or through health maintenance organizations or to support the Medical Assistance Program is not eligible for federal financial participation, the department will refund that amount of revenue to hospitals in proportion to each hospital's payment of the assessment.

AB1-SA1,15,21 (7) This section does not apply to a critical access hospital, as defined in s. 50.33 (1g), or to an institution for mental diseases, as defined in s. 46.011 (1m).

AB1-SA1,16,2 (8) Sections 77.59 (1) to (5), (6) (intro.), (a), and (c), and (7) to (10), 77.60 (1) to (7), (9), and (10), 77.61 (9) and (12) to (14), and 77.62, as they apply to the taxes under subch. III of ch. 77, apply to the assessment under this section, except that the amount of any assessment collected under sub. (1) shall be deposited in the hospital assessment fund.

AB1-SA1,16,5 (9) By December 31, 2008, and by every December 31 thereafter, the department shall report to the joint committee on finance all of the following information for the immediately previous state fiscal year:

AB1-SA1,16,6 (a) The total amount of assessments collected under this section.

AB1-SA1,16,8 (b) The total amount of assessments collected from each hospital under this section.

AB1-SA1,16,10 (c) The total amounts that the department determines were paid to health maintenance organizations for increased Medical Assistance payments to hospitals.

AB1-SA1,16,12 (d) The total amount of payments made to each hospital by health maintenance organizations under s. 49.45 (58) (b) 1.

AB1-SA1,16,16 (e) The total amount of Medical Assistance payments made to each hospital and the portion of the Medical Assistance capitated payments made to health maintenance organizations for inpatient and outpatient hospital services from appropriation accounts of general purpose revenues.

AB1-SA1,16,19 (f) The total amounts, including the amounts specified under par. (c), that the department determines were paid to health maintenance organizations for Medical Assistance payments to hospitals.

AB1-SA1,16,22 (g) The results of any audits conducted by the department under s. 49.45 (58) concerning Medical Assistance payments and any actions taken by the department as a result of such an audit.