AB75-SSA1, s. 1285 23Section 1285. 49.343 (3) of the statutes is amended to read:
AB75-SSA1,606,3
149.343 (3) Audit. The department may require an audit of any residential care
2center for children and youth or, group home, as described in sub. (1) or (1m), or child
3welfare agency
for the purpose of collecting federal funds.
AB75-SSA1, s. 1286 4Section 1286. 49.343 (4) of the statutes is created to read:
AB75-SSA1,606,65 49.343 (4) Rules. The department shall promulgate rules to implement this
6section. Those rules shall include rules providing for all of the following:
AB75-SSA1,606,107 (a) Standards for determining whether a proposed rate is appropriate to the
8level of services to be provided, the qualifications of a residential care center for
9children and youth, group home, or child welfare agency to provide those services,
10and the reasonable and necessary costs of providing those services.
AB75-SSA1,606,1111 (b) Factors for the department to consider in reviewing a proposed rate.
AB75-SSA1,606,1412 (c) Procedures for reviewing proposed rates, including rate resolution
13procedures for mediating an agreed to rate when negotiations fail to produce an
14agreed to rate.
AB75-SSA1, s. 1287 15Section 1287. 49.345 (14) (a) of the statutes is amended to read:
AB75-SSA1,607,216 49.345 (14) (a) Except as provided in pars. (b) and (c), liability of a person
17specified in sub. (2) or s. 49.32 (1) for care and maintenance of persons under 18 years
18of age in residential, nonmedical facilities such as group homes, foster homes,
19treatment foster homes, subsidized guardianship homes, and residential care
20centers for children and youth is determined in accordance with the cost-based fee
21established under s. 49.32 (1). The department shall bill the liable person up to any
22amount of liability not paid by an insurer under s. 632.89 (2) or (2m) or by other
233rd-party benefits, subject to rules that include formulas governing ability to pay
24established by the department under s. 49.32 (1). Any liability of the person not

1payable by any other person terminates when the person reaches age 18, unless the
2liable person has prevented payment by any act or omission.
AB75-SSA1, s. 1288 3Section 1288. 49.345 (14) (b) of the statutes is amended to read:
AB75-SSA1,607,114 49.345 (14) (b) Except as provided in par. (c), and subject to par. (cm), liability
5of a parent specified in sub. (2) or s. 49.32 (1) for the care and maintenance of the
6parent's minor child who has been placed by a court order under s. 48.355 or 48.357
7in a residential, nonmedical facility such as a group home, foster home, treatment
8foster home,
subsidized guardianship home, or residential care center for children
9and youth shall be determined by the court by using the percentage standard
10established by the department under s. 49.22 (9) and by applying the percentage
11standard in the manner established by the department under par. (g).
AB75-SSA1, s. 1289 12Section 1289. 49.45 (3) (e) 7. of the statutes is amended to read:
AB75-SSA1,608,513 49.45 (3) (e) 7. The daily reimbursement or payment rate to a hospital for
14services provided to medical assistance recipients awaiting admission to a skilled
15nursing home, intermediate care facility, community-based residential facility,
16group home, foster home, treatment foster home or other custodial living
17arrangement may not exceed the maximum reimbursement or payment rate based
18on the average adjusted state skilled nursing facility rate, created under sub. (6m).
19This limited reimbursement or payment rate to a hospital commences on the date the
20department, through its own data or information provided by hospitals, determines
21that continued hospitalization is no longer medically necessary or appropriate
22during a period where when the recipient awaits placement in an alternate custodial
23living arrangement. The department may contract with a peer review organization,
24established under 42 USC 1320c to 1320c-10, to determine that continued
25hospitalization of a recipient is no longer necessary and that admission to an

1alternate custodial living arrangement is more appropriate for the continued care of
2the recipient. In addition, the department may contract with a peer review
3organization to determine the medical necessity or appropriateness of physician
4services or other services provided during the period when a hospital patient awaits
5placement in an alternate custodial living arrangement.
AB75-SSA1, s. 1289m 6Section 1289m. 49.45 (3) (e) 10r. of the statutes is created to read:
AB75-SSA1,608,137 49.45 (3) (e) 10r. All facilities listed in a certificate of approval issued to a
8free-standing pediatric teaching hospital under s. 50.35 are a hospital for purposes
9of reimbursement under this section. Notwithstanding this subdivision, the
10department shall use physician clinic reimbursement rates to reimburse the
11facilities under this section for types of services for which, before July 1, 2009, the
12department reimbursed the facilities using physician clinic reimbursement rates, as
13determined by the department.
AB75-SSA1, s. 1290 14Section 1290. 49.45 (6b) of the statutes is amended to read:
AB75-SSA1,609,215 49.45 (6b) Centers for the developmentally disabled. From the
16appropriation under s. 20.435 (2) (gk), the department may reimburse the cost of
17services provided by the centers for the developmentally disabled. Reimbursement
18to the centers for the developmentally disabled shall be reduced following each
19placement made under s. 46.275 that involves a relocation from a center for the
20developmentally disabled, by $225 per day, beginning in fiscal year 2002-03, and by
21$325 per day, beginning in fiscal year 2004
Beginning in fiscal year 2009-10,
22following each placement made under s. 46.275 that involves a relocation from a
23center for the developmentally disabled, the department shall reduce the
24reimbursement to the center by an amount, as determined by the department for

1each placement, that is equal to the nonfederal share of the costs for the placement
2under s. 46.275
.
AB75-SSA1, s. 1291 3Section 1291. 49.45 (6m) (br) 1. of the statutes is amended to read:
AB75-SSA1,609,124 49.45 (6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435 (4) (bt) or (7) (b)
5or 20.437 (2) (dz), the department shall reduce allocations of funds to counties in the
6amount of the disallowance from the appropriation account under s. 20.435 (4) (bt)
7or
(7) (b), or the department shall direct the department of children and families to
8reduce allocations of funds to counties or Wisconsin Works agencies in the amount
9of the disallowance from the appropriation account under s. 20.437 (2) (dz) or direct
10the department of corrections to reduce allocations of funds to counties in the amount
11of the disallowance from the appropriation account under s. 20.410 (3) (cd), in
12accordance with s. 16.544 to the extent applicable.
AB75-SSA1, s. 1292 13Section 1292. 49.45 (6m) (e) of the statutes is repealed.
AB75-SSA1, s. 1293 14Section 1293. 49.45 (6u) (b) of the statutes is amended to read:
AB75-SSA1,609,2215 49.45 (6u) (b) Notwithstanding the limitation on the amount of disbursements
16under par. (am) (intro.), from the appropriation under s. 20.435 (4) (wm), the
17department shall, using the criteria specified in par. (am) 1. to 7., disburse any
18federal medical assistance funds that are received by the state as matching funds to
19federal financial participation for operating deficits incurred by a facility that is
20operated by a county, city, village, or town and that are in excess of the amount of
21match federal financial participation anticipated and budgeted as revenue in the
22biennial budget act for the fiscal year in which the funds are received.
AB75-SSA1, s. 1294c 23Section 1294c. 49.45 (6y) (a) of the statutes, as affected by 2009 Wisconsin Act
242
, is repealed.
AB75-SSA1, s. 1294d
1Section 1294d. 49.45 (6y) (am) of the statutes, as affected by 2009 Wisconsin
2Act 2
, is repealed.
AB75-SSA1, s. 1294h 3Section 1294h. 49.45 (6y) (b) of the statutes is repealed.
AB75-SSA1, s. 1295 4Section 1295. 49.45 (6z) of the statutes, as affected by 2009 Wisconsin Act 2,
5is repealed.
AB75-SSA1, s. 1296 6Section 1296. 49.45 (8r) of the statutes is amended to read:
AB75-SSA1,610,137 49.45 (8r) Payment for certain obstetric and gynecological care. The rate
8of payment for obstetric and gynecological care provided in primary care shortage
9areas, as defined in s. 560.183 36.60 (1) (cm), or provided to recipients of medical
10assistance who reside in primary care shortage areas, that is equal to 125% of the
11rates paid under this section to primary care physicians in primary care shortage
12areas, shall be paid to all certified primary care providers who provide obstetric or
13gynecological care to those recipients.
AB75-SSA1, s. 1297 14Section 1297. 49.45 (18) (am) of the statutes is renumbered 49.45 (18) (am)
151. and amended to read:
AB75-SSA1,610,1916 49.45 (18) (am) 1. No Except as provided in subd. 2., no person is liable under
17this subsection for services provided through prepayment contracts. This paragraph
18does not apply to a person who is eligible for the benefits under s. 49.46 (2) (a) and
19(b) under s. 49.471.
AB75-SSA1, s. 1298 20Section 1298. 49.45 (18) (am) 2. of the statutes is created to read:
AB75-SSA1,610,2421 49.45 (18) (am) 2. A person who is eligible for the benefits under s. 49.46 (2) (a)
22and (b) under s. 49.471 is liable under this subsection for services provided through
23a prepayment contract in the amounts and according to the procedures specified by
24the department.
AB75-SSA1, s. 1299 25Section 1299. 49.45 (18) (b) 2. of the statutes is amended to read:
AB75-SSA1,611,4
149.45 (18) (b) 2. Any service provided to a person who is less than 18 years old.
2This subdivision does not apply if the person's family income exceeds 100 percent of
3the poverty line and he or she is eligible for the benefits under s. 49.46 (2) (a) and (b)
4under s. 49.471.
AB75-SSA1, s. 1301 5Section 1301. 49.45 (23) (b) of the statutes is amended to read:
AB75-SSA1,611,136 49.45 (23) (b) If the waiver is granted and in effect, the department may
7promulgate rules defining the health care benefit plan, including more specific
8eligibility requirements and cost-sharing requirements. Cost sharing may include
9an annual enrollment fee, which may not exceed $75 per year.
Notwithstanding s.
10227.24 (3), the plan details under this subsection may be promulgated as an
11emergency rule under s. 227.24 without a finding of emergency. If the waiver is
12granted and in effect, the demonstration project under this subsection shall begin on
13January 1, 2009, or on the effective date of the waiver, whichever is later.
AB75-SSA1, s. 1301e 14Section 1301e. 49.45 (24g) of the statutes is created to read:
AB75-SSA1,611,1715 49.45 (24g) Physician practice payment pilot. (a) The department shall
16develop a proposal to increase medical assistance reimbursement to providers to
17which at least one of the following applies:
AB75-SSA1,611,1918 1. The provider is recognized by the National Committee on Quality Assurance
19as a Patient-Centered Medical Home.
AB75-SSA1,611,2120 2. The secretary determines that the provider performs well with respect to all
21of the following aspects of care:
AB75-SSA1,611,2222 a. Adoption of written standards for patient access and patient communication.
AB75-SSA1,611,2423 b. Use of data to show that standards for patient access and patient
24communication are satisfied.
AB75-SSA1,611,2525 c. Use of paper or electronic charting tools to organize clinical information.
AB75-SSA1,612,2
1d. Use of data to identify diagnoses and conditions among the provider's
2patients that have a lasting detrimental effect on health.
AB75-SSA1,612,43 e. Adoption and implementation of guidelines that are based on evidence for
4treatment and management of at least 3 chronic conditions.
AB75-SSA1,612,55 f. Active support of patient self-management.
AB75-SSA1,612,76 g. Systematic tracking of patient test results and systematic identification of
7abnormal patient test results.
AB75-SSA1,612,88 h. Systematic tracking of referrals using a paper or electronic system.
AB75-SSA1,612,119 i. Measuring the quality of the performance of the physician practice and of
10individual physicians within the practice, including with respect to provision of
11clinical services, patient outcomes, and patient safety.
AB75-SSA1,612,1312 j. Reporting to members of the physician practice and to other persons on the
13quality of the performance of the physician practice and of individual physicians.
AB75-SSA1,612,2114 (c) The department's proposal under par. (a) shall specify increases in
15reimbursement rates for providers that satisfy the conditions under par. (a) 1. or 2.,
16and shall provide for payment of a monthly per-patient care coordination fee to those
17providers. The department shall set the increases in reimbursement rates and the
18monthly per-patient care coordination fee so that together they provide sufficient
19incentive for providers to satisfy a condition under par. (a) 1. or 2. The proposal shall
20specify effective dates for the increases in reimbursement rates and the monthly
21per-patient care coordination fee that are no sooner than July 1, 2011.
AB75-SSA1,613,1322 (d) By the date that is 60 days after the effective date of this paragraph .... [LRB
23inserts date], the department shall submit the proposal under par. (a) to the joint
24committee on finance. If the cochairpersons of the committee do not notify the
25department within 14 working days after the date of the department's submittal that

1the committee has scheduled a meeting for the purpose of reviewing the proposal, the
2department shall, subject to approval by the U.S. department of health and human
3services of any required waiver of federal law relating to medical assistance and any
4required amendment to the state plan for medical assistance under 42 USC 1396a,
5implement the proposal beginning January 1, 2010. If, within 14 working days after
6the date of the department's submittal, the cochairpersons of the committee notify
7the department that the committee has scheduled a meeting for the purpose of
8reviewing the proposal, the department may implement the proposal only upon
9approval of the committee. If the committee reviews the proposal and approves it,
10the department shall, subject to approval by the U.S. department of health and
11human services of any required waiver of federal law relating to medical assistance
12and any required amendment to the state plan for medical assistance under 42 USC
131396a
, implement the proposal beginning January 1, 2010.
AB75-SSA1,614,214 (e) By the first day of the 39th month beginning after the effective date of this
15paragraph .... [LRB inserts date], the department shall, if it was required under par.
16(d) to increase reimbursement to providers that satisfy a condition under par. (a) 1.
17or 2., submit a report to the joint committee on finance on whether the increased
18reimbursement results in net cost reductions for the Medical Assistance program
19under this subchapter and a recommendation as to whether to continue the
20increased reimbursement. If the cochairpersons of the committee do not notify the
21department within 14 working days after the date of the department's submittal that
22the committee has scheduled a meeting for the purpose of reviewing the report and
23recommendation, the department may implement its recommendation. If, within 14
24working days after the date of the department's submittal, the cochairpersons of the
25committee notify the department that the committee has scheduled a meeting for the

1purpose of reviewing the report and recommendation, the department may
2discontinue the increased reimbursement only upon the approval of the committee.
AB75-SSA1, s. 1302 3Section 1302. 49.45 (24r) of the statutes is renumbered 49.45 (24r) (a) and
4amended to read:
AB75-SSA1,614,115 49.45 (24r) (a) The department shall request a implement any waiver from
6granted by the secretary of the federal department of health and human services to
7permit the department to conduct a demonstration project to provide family
8planning, as defined in s. 253.07 (1) (a), under medical assistance to any woman
9between the ages of 15 and 44 whose family income does not exceed 200% of the
10poverty line for a family the size of the woman's family. The department shall
11implement any waiver granted.
AB75-SSA1, s. 1303 12Section 1303. 49.45 (24r) (b) of the statutes is created to read:
AB75-SSA1,614,1713 49.45 (24r) (b) The department may request an amended waiver from the
14secretary to permit the department to conduct a demonstration project to provide
15family planning to any man between the ages of 15 and 44 whose family income does
16not exceed 200 percent of the poverty line for a family the size of the man's family.
17If the amended waiver is granted, the department may implement the waiver.
AB75-SSA1, s. 1304 18Section 1304. 49.45 (25) (be) of the statutes is amended to read:
AB75-SSA1,614,2419 49.45 (25) (be) A private nonprofit agency that is a certified case management
20provider may elect to provide case management services to medical assistance
21beneficiaries who have HIV infection, as defined in s. 252.01 (2). The amount of the
22allowable charges for those services under the medical assistance program that is not
23provided by the federal government shall be paid from the appropriation account
24under s. 20.435 (5) (1) (am).
AB75-SSA1, s. 1305 25Section 1305. 49.45 (25) (bg) of the statutes is amended to read:
AB75-SSA1,615,8
149.45 (25) (bg) An independent living center, as defined in s. 46.96 (1) (ah), that
2is a certified case management provider and satisfies the criteria in s. 46.96 (3m) (a)
31. to 3. and (am)
may elect to provide case management services to one or more of the
4categories of medical assistance beneficiaries specified under par. (am). The amount
5of allowable charges for the services under the medical assistance program that is
6not provided by the federal government shall be paid from nonfederal, public funds
7received by the independent living center from a county, city, village or town or from
8funds distributed as a grant under s. 46.96.
AB75-SSA1, s. 1305r 9Section 1305r. 49.45 (30f) of the statutes is created to read:
AB75-SSA1,615,2310 49.45 (30f) Psychotherapy and alcohol and other drug abuse services. The
11department shall include licensed mental health professionals, as defined in s.
12632.89 (1) (dm), and licensed psychologists, as defined in s. 455.01 (4), as providers
13of psychotherapy and of alcohol and other drug abuse services. Except for services
14provided under sub. (30e), the department may not require that licensed mental
15health professionals or licensed psychologists be supervised; may not require that
16clinical psychotherapy or alcohol and other drug abuse services be provided under
17a certified program; and, notwithstanding subs. (9) and (9m), may not require that
18a physician or other health care provider first prescribe psychotherapy or alcohol and
19other drug abuse services to be provided by a licensed mental health professional or
20licensed psychologist before the professional or psychologist may provide the
21services to the recipient. This subsection does not affect the department's powers
22under ch. 50 or 51 to establish requirements for facilities that are licensed, certified,
23or operated by the department.
AB75-SSA1, s. 1306 24Section 1306. 49.45 (30g) of the statutes is created to read:
AB75-SSA1,616,4
149.45 (30g) Community recovery services. (a) When services are reimbursable.
2Community recovery services under s. 49.46 (2) (b) 6. Lo. provided to an individual
3are reimbursable under the Medical Assistance program only if all of the following
4conditions are met:
AB75-SSA1,616,75 1. An approved amendment to the state medical assistance plan submitted
6under 42 USC 1396n (i) permits reimbursement for the services under s. 49.46 (2)
7(b) 6. Lo. in the manner provided under this subsection.
AB75-SSA1,616,108 2. The county in which the individual resides elects to provide the community
9recovery services under s. 49.46 (2) (b) 6. Lo. through the Medical Assistance
10program.
AB75-SSA1,616,1311 3. The individual, the community recovery services, and the community
12recovery services provider meet any condition set forth in the approved amendment
13to the medical assistance plan submitted under 42 USC 1396n (i).
AB75-SSA1,616,2214 (b) Limit on the amount of reimbursement. If community recovery services are
15reimbursable under par. (a), the department shall reimburse each participating
16county for the portion of the federal share of allowable charges for the community
17recovery services provided by the county that exceeds that county's proportionate
18share of $600,000 in fiscal year 2010-2011 and for 95 percent of the federal share of
19allowable charges for the community recovery services provided by the county in
20each fiscal year thereafter. The portion of the federal share of allowable charges not
21reimbursed to counties shall be transferred to the appropriation account under s.
2220.435 (5) (kx).
AB75-SSA1, s. 1307 23Section 1307. 49.45 (30m) (am) of the statutes is renumbered 49.45 (30m) (am)
241.
AB75-SSA1, s. 1308 25Section 1308. 49.45 (30m) (am) 2. of the statutes is created to read:
AB75-SSA1,617,6
149.45 (30m) (am) 2. For individuals receiving the family care benefit under s.
246.286, the care management organization that manages the family care benefit for
3the recipient shall pay the portion of the payment that is not covered by the federal
4government for services that are described under par. (a) 1. and are covered services
5under the family care benefit; the department shall pay the remainder of the portion
6of the payment that is not covered by the federal government.
AB75-SSA1, s. 1309 7Section 1309. 49.45 (30r) of the statutes is created to read:
AB75-SSA1,617,108 49.45 (30r) Services in a mental health institute. A county shall provide the
9portion of payment that is not provided by the federal government for services under
10s. 49.46 (2) (b) 6. e. in a mental health institute under s. 51.05.
AB75-SSA1, s. 1310 11Section 1310. 49.45 (41) (b) of the statutes is amended to read:
AB75-SSA1,617,2112 49.45 (41) (b) If a county elects to become certified as a provider of mental
13health crisis intervention services, the county may provide mental health crisis
14intervention services under this subsection in the county to medical assistance
15recipients through the medical assistance program. A county that elects to provide
16the services shall pay the amount of the allowable charges for the services under the
17medical assistance program that is not provided by the federal government. The
18From the appropriation account under s. 20.435 (5) (bL), the department shall
19reimburse the county under this subsection only for the amount of the allowable
20charges for those services under the medical assistance program that is provided by
21the federal government.
AB75-SSA1, s. 1311 22Section 1311. 49.45 (42) of the statutes is renumbered 49.45 (42) (d).
AB75-SSA1, s. 1312 23Section 1312. 49.45 (42) (c) of the statutes is created to read:
AB75-SSA1,618,3
149.45 (42) (c) The department may charge a fee to certify a provider of personal
2care services described under par. (d) 3. e. Fees collected under this paragraph shall
3be credited to the appropriation account under s. 20.435 (6) (jm).
AB75-SSA1, s. 1313 4Section 1313. 49.45 (42) (d) 3. of the statutes is created to read:
AB75-SSA1,618,65 49.45 (42) (d) 3. The provider of the personal care services is one of the
6following:
AB75-SSA1,618,87 a. An independent living center meeting the criteria to receive a grant under
8s. 46.96.
AB75-SSA1,618,99 b. A county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437.
AB75-SSA1,618,1110 c. A federally recognized American Indian tribe or band certified to provide
11services to medical assistance beneficiaries.
AB75-SSA1,618,1212 d. A home health agency licensed under s. 50.49.
AB75-SSA1,618,1413 e. Any other entity certified under sub. (2) (a) 11. to provide personal care
14services under s. 49.46 (2) (b) 6. j.
AB75-SSA1, s. 1313k 15Section 1313k. 49.45 (44) of the statutes is amended to read:
AB75-SSA1,619,316 49.45 (44) Prenatal, postpartum and young child care coordination.
17Providers in Milwaukee County that are certified to provide care coordination
18services under s. 49.46 (2) (b) 12. may be certified to provide to medical assistance
19recipients prenatal and postpartum care coordination services and care coordination
20services for children who have not attained the age of 7. Providers in the city of
21Racine that are certified to provide care coordination services under s. 49.46 (2) (b)
2212. and are participating in a program under s. 253.16 may be certified to provide to
23medical assistance recipients prenatal and postpartum care coordination services
24and care coordination services for children who have not attained the age of 2.
A
25provider of those care coordination services shall provide to a person receiving those

1services the information relating to shaken baby syndrome and impacted babies
2required under s. 253.15 (6). The department shall provide reimbursement for those
3care coordination services only if at least one of the following conditions is met:
AB75-SSA1,619,74 (a) The recipient is a resident of Milwaukee County or the city of Racine and
5has received services under s. 49.46 (2) (b) 12. and is pregnant or has given birth
6within 8 weeks after the individual ceased to receive services under s. 49.46 (2) (b)
712.
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