AB150,1065,2320 2. Except as provided in subd. 4., the department may require, as a condition
21of reimbursement, that providers of services charge the department the lesser of the
22following when claiming reimbursement for medical assistance services, unless a
23different price is set by contract:
AB150,1065,2424 a. The provider's best price for the service.
AB150,1065,2525 b. The provider's actual cost for the service.
AB150,1066,2
13. When a provider is required to charge the department a price under subd.
22., the department may not reimburse the provider for more than that amount.
AB150,1066,43 4. This paragraph does not apply to services under s. 49.46 (2) (a) 4. a., b., or
4c., (b) 6. e. or 8.
AB150, s. 2953 5Section 2953. 49.45 (5) of the statutes is amended to read:
AB150,1066,96 49.45 (5) Appeal. Any person whose application for medical assistance is
7denied or is not acted upon promptly or who believes that the payments made in the
8person's behalf have not been properly determined may file an appeal with the
9department pursuant to s. 49.50 (8) 49.21 (1).
AB150, s. 2954 10Section 2954. 49.45 (5m) (a) of the statutes is amended to read:
AB150,1066,1711 49.45 (5m) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
1220.435 (1) (b) and (o) the department shall distribute not more than $2,256,000 in
13each of fiscal years 1993-94 and 1994-95 year, to provide supplemental funds to
14rural hospitals that, as determined by the department, have high utilization of
15inpatient services by patients whose care is provided from governmental sources,
16except that the department may not distribute funds to a rural hospital to the extent
17that the distribution would exceed any limitation under 42 USC 1396b (i) (3).
AB150, s. 2955 18Section 2955. 49.45 (6b) (a) of the statutes is amended to read:
AB150,1066,2119 49.45 (6b) (a) Beginning in fiscal year 1994-95 1995-96, for relocations from
20the central Wisconsin center for the developmentally disabled, by $55.77 $232 per
21day.
AB150, s. 2956 22Section 2956. 49.45 (6b) (b) of the statutes is amended to read:
AB150,1066,2523 49.45 (6b) (b) Beginning in fiscal year 1994-95 1995-96, for relocations from
24the northern Wisconsin center for the developmentally disabled, by $49.06 $225 per
25day.
AB150, s. 2957
1Section 2957. 49.45 (6b) (c) of the statutes is amended to read:
AB150,1067,42 49.45 (6b) (c) Beginning in fiscal year 1994-95 1995-96, for relocations from
3the southern Wisconsin center for the developmentally disabled, by $48.37 $173 per
4day.
AB150, s. 2958 5Section 2958. 49.45 (6c) (d) 1. of the statutes is amended to read:
AB150,1067,256 49.45 (6c) (d) 1. No payment may be made under sub. (6m) to a facility or to
7an institution for mental diseases for the care of an individual who is otherwise
8eligible for medical assistance under s. 49.46 or 49.47, who has developmental
9disability or mental illness and for whom under par. (b) or (c) it is determined that
10he or she does not need facility care, unless it is determined that the individual
11requires active treatment for developmental disability or active treatment for
12mental illness and has continuously resided in a facility or institution for mental
13diseases for at least 30 months prior to the date of the determination. If that
14individual requires active treatment and has so continuously resided, he or she shall
15be offered the choice of receiving active treatment for developmental disability or
16active treatment for mental illness in the facility or institution for mental diseases
17or in an alternative setting. A facility resident who has developmental disability or
18mental illness, for whom under par. (c) it is determined that he or she does not need
19facility care and who has not continuously resided in a facility for at least 30 months
20prior to the date of the determination, may not continue to reside in the facility after
21December 31, 1993, and shall, if the department so determines, be relocated from the
22facility after March 31, 1990, and before December 31, 1993. The county department
23shall be responsible for securing alternative residence on behalf of an individual who
24is required to be relocated from a facility under this subdivision, and the facility shall
25cooperate with the county department in the relocation.
AB150, s. 2959
1Section 2959. 49.45 (6c) (d) 2. of the statutes is amended to read:
AB150,1068,82 49.45 (6c) (d) 2. Payment may be made under sub. (6m) to a facility or
3institution for mental diseases for the care of an individual who is otherwise eligible
4for medical assistance under s. 49.46 or 49.47 and who has developmental disability
5or mental illness and is determined under par. (b) or (c) to need facility care,
6regardless of whether it is determined under par. (b) or (c) that the individual does
7or does not require active treatment for developmental disability or active treatment
8for mental illness.
AB150, s. 2960 9Section 2960. 49.45 (6m) (ag) 3m. of the statutes is amended to read:
AB150,1068,1410 49.45 (6m) (ag) 3m. For state fiscal year 1993-94 1995-96, rates that shall be
11set by the department based on information from cost reports for the 1992 1994 fiscal
12year of the facility and for state fiscal year 1994-95 1996-97, rates that shall be set
13by the department based on information from cost reports for the 1993 1995 fiscal
14year of the facility.
AB150, s. 2961 15Section 2961. 49.45 (6m) (ag) 8. of the statutes is amended to read:
AB150,1069,216 49.45 (6m) (ag) 8. Calculation of total payments and supplementary payments
17to facilities that permits an increase in funds allocated under s. 20.435 (1) (b) and (o)
18for nursing home care provided medical assistance recipients over that paid for
19services provided in state fiscal year 1992-93 1994-95 of no more than 3.58% 4.25%
20during state fiscal year 1993-94 1995-96 and over that paid for services provided in
21state fiscal year 1993-94 1995-96 of no more than 3.57% 5% during state fiscal year
221994-95 1996-97, excluding increases in total payments attributable to increases in
23recipient utilization of facility care, payments for the provision of active treatment
24to facility residents with developmental disability or chronic mental illness and

1payments for preadmission screening of facility applicants and annual reviews of
2facility residents required under 42 USC 1396r (e).
AB150, s. 2962 3Section 2962. 49.45 (6m) (am) 5. of the statutes is amended to read:
AB150,1069,74 49.45 (6m) (am) 5. Allowable administrative and general costs, including costs
5related to the facility's overall management and administration and allowable
6expenses that are not recognized or reimbursed in other cost centers and including
7the costs of commercial estimators approved by the department under par. (ar) 6
.
AB150, s. 2963 8Section 2963. 49.45 (6m) (am) 5m. of the statutes is created to read:
AB150,1069,119 49.45 (6m) (am) 5m. Allowable interest expense of the facility, less interest
10income of the facility and less interest income of affiliated entities, to the extent
11required under the approved state plan for services under 42 USC 1396.
AB150, s. 2964 12Section 2964. 49.45 (6m) (ar) 1. c. of the statutes is amended to read:
AB150,1069,1813 49.45 (6m) (ar) 1. c. If a facility has an approved program for provision of
14service to emotionally disturbed or mentally retarded residents, residents dependent
15upon ventilators, or residents requiring supplemental skilled care due to complex
16medical conditions, a supplement to the direct care component of the facility rate
17under subd. 1. b. may be made to that facility according to a method developed by the
18department.
AB150, s. 2965 19Section 2965. 49.45 (6m) (ar) 6. of the statutes is amended to read:
AB150,1069,2520 49.45 (6m) (ar) 6. Capital payment shall be based on a replacement value for
21a facility, as. The replacement value shall be determined by a commercial estimator
22with which contracted for by the department has contracted for service, and paid for
23by the facility. The replacement value shall be
subject to limitations determined by
24the department, except that the department may not reduce final capital payment
25of a facility by more than $3.50 per patient day.
AB150, s. 2966
1Section 2966. 49.45 (6m) (av) 2. of the statutes is amended to read:
AB150,1070,62 49.45 (6m) (av) 2. The department shall compile an average payment rate for
3each facility based on that facility's rates for cost centers described under par. (am)
41. to 5. that were in effect on June 30 of the previous year, 1994. The department may
5develop a method for adjusting the facility's rate for the cost center under par. (am)
61. in compiling the average payment rate under this subdivision.
AB150, s. 2967 7Section 2967. 49.45 (6m) (av) 4. of the statutes is amended to read:
AB150,1070,128 49.45 (6m) (av) 4. If the facility's payment rate under subd. 1. is a decrease from
9its average payment rate from the previous year under subd. 2., and if the figure
10calculated under subd. 3. exceeds the payment rate for the facility under subd. 1., the
11facility's average payment rate shall be the greater of its average payment rate under
12subd. 2. or its rate under subd. 1.
AB150, s. 2968 13Section 2968. 49.45 (6m) (bm) 4. of the statutes is repealed.
AB150, s. 2969 14Section 2969. 49.45 (6m) (br) 1. of the statutes is amended to read:
AB150,1070,2115 49.45 (6m) (br) 1. Notwithstanding s. 20.435 (1) (cb), (3) (cd), (4) (de) or (eb) or
16(7) (b) or 20.445 (3) (de), the department shall reduce allocations of funds to counties
17in the amount of the disallowance from the appropriations under s. 20.435 (1) (cb),
18(3) (cd), (4) (de) or (eb) or (7) (b), or the department shall direct the department of
19industry, labor and human relations to reduce allocations of funds to counties in the
20amount of the disallowance from the appropriation under s. 20.445 (3) (de),
in
21accordance with s. 16.544 to the extent applicable.
AB150, s. 2970 22Section 2970. 49.45 (6m) (c) 6. of the statutes is created to read:
AB150,1070,2423 49.45 (6m) (c) 6. Provide, upon request, such information as the department
24considers necessary to determine allowable interest expenses under par. (am) 5m.
AB150, s. 2971 25Section 2971. 49.45 (6m) (h) of the statutes is amended to read:
AB150,1071,6
149.45 (6m) (h) The department may require by rule that all claims for payment
2of services provided facility residents under this chapter subchapter be submitted or
3countersigned by the respective facility administrator. The department may specify
4those categories of services for which payment will be made only if the services are
5rendered or authorized in writing by a primary health care provider designated by
6the recipient for the particular category of services.
AB150, s. 2972 7Section 2972. 49.45 (6m) (i) 1. of the statutes is amended to read:
AB150,1071,118 49.45 (6m) (i) 1. On or after October 1, 1981, unless subd. 1m. or 2. applies,
9medical assistance payment for inpatient nursing care may only be provided for
10persons eligible under s. 49.46 and receiving skilled, intermediate or limited levels
11of nursing care as these levels are defined under s. HSS 132.13, Wis. adm. code.
AB150, s. 2973 12Section 2973. 49.45 (6m) (i) 1m. of the statutes is created to read:
AB150,1071,1813 49.45 (6m) (i) 1m. After December 30, 1995, if a waiver is granted and remains
14in effect as specified in s. 49.47 (6) (am) 2., medical assistance payment for skilled
15nursing services, as specified in s. 49.46 (2) (a) 4. c., and for intermediate care
16services, as specified in s. 49.46 (2) (b) 6. a., may be provided for persons described
17under subd. 1. and for persons who meet the conditions specified in s. 49.47 (6) (am)
181. a. to d.
AB150, s. 2974 19Section 2974. 49.45 (6m) (L) of the statutes is created to read:
AB150,1071,2420 49.45 (6m) (L) For purposes of ss. 46.27 (11) (c) 7. and 46.277 (5) (e), the
21department shall, by July 1 annually, , determine the statewide reimbursement rate
22under this subsection and submit the figure to the department of administration for
23review. The department of administration shall approve the rate before the rate may
24be used under s. 46.27 (11) (c) 7. or 46.277 (5) (e).
AB150, s. 2975 25Section 2975. 49.45 (6t) of the statutes is created to read:
AB150,1072,7
149.45 (6t) County department operating deficit reduction. From the
2appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined
3under criteria developed by the department, incurred by a county department under
4s. 46.215, 46.22 or 46.23 for services provided under s. 49.46 (2) (a) 4. d. and (b) 6. f.,
5the department shall allocate up to $4,500,000 in each fiscal year to these county
6departments, as determined by the department, and shall perform all of the
7following:
AB150,1072,118 (a) For the reduction of operating deficits incurred by the county departments,
9estimate the availability of federal medicaid funds that may be matched to county
10funds that are expended for costs in excess of reimbursement for services provided
11under s. 49.46 (2) (a) 4. d. and (b) 6. f.
AB150,1072,1512 (b) Based on the amount estimated to be available under par. (a), develop a
13method, which need not be promulgated as rules under ch. 227, to distribute this
14allocation to the individual county departments under s. 46.215, 46.22 or 46.23 that
15have incurred operating deficits that shall include all of the following:
AB150,1072,1616 1. Development of criteria for determining operating deficits.
AB150,1072,1817 2. Agreement, by the county in which is located a county department that has
18an operating deficit, to provide funds to match federal medicaid funds.
AB150,1072,1919 3. Consideration of the size of a county department's operating deficit.
AB150,1072,2120 (c) Except as provided in par. (d), distribute the allocation under the
21distribution method that is developed.
AB150,1073,222 (d) If the federal department of health and human services approves for state
23expenditure in a fiscal year amounts under s. 20.435 (1) (o) that result in a lesser
24allocation amount than that allocated under this subsection or disallows use of the

1allocation of federal medicaid funds under par. (c), reduce allocations under this
2subsection and distribute on a prorated basis, as determined by the department.
AB150, s. 2976 3Section 2976. 49.45 (6u) (intro.) of the statutes is amended to read:
AB150,1073,104 49.45 (6u)Facility operating deficit reduction. (intro.) Except as provided
5in par. (g), from the appropriation under s. 20.435 (1) (o), for reduction of operating
6deficits, as defined under criteria developed by the department, incurred by a facility,
7as defined under sub. (6m) (a) 2., that is established under s. 49.14 (1) 49.70 (1) or
8that is owned and operated by a city, village or town, the department shall distribute
9to these facilities not more than $18,600,000 in each fiscal year, as determined by the
10department, and shall perform all of the following:
AB150, s. 2977 11Section 2977. 49.45 (6u) (b) 2. of the statutes is amended to read:
AB150,1073,1612 49.45 (6u) (b) 2. Agreement by the county in which is located the facility
13established under s. 49.14 (1) 49.70 (1) and agreement by the city, village or town that
14owns and operates the facility that the applicable county, city, village or town shall
15provide funds to match federal medical assistance matching funds under this
16subsection.
AB150, s. 2978 17Section 2978. 49.45 (6u) (b) 2m. of the statutes is amended to read:
AB150,1073,2118 49.45 (6u) (b) 2m. Identification by the county in which is located the facility
19established under s. 49.14 (1) 49.70 (1) of all county funds expended in each calendar
20year to operate the facility, and certification by the county to the department of this
21amount.
AB150, s. 2979 22Section 2979. 49.45 (6v) of the statutes is repealed.
AB150, s. 2980 23Section 2980. 49.45 (6w) (intro.) of the statutes is amended to read:
AB150,1074,524 49.45 (6w) Hospital operating deficit reduction. (intro.) From the
25appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined

1under criteria developed by the department, incurred by a hospital, as defined under
2s. 50.33 (2) (a) and (b), that is operated by the state, established under s. 49.16 or
3owned and operated by a city or village, the department shall allocate distribute,
4beginning July 1, 1996,
up to $3,300,000 $8,500,000 in each fiscal year to these
5hospitals, as determined by the department, and shall perform all of the following:
AB150, s. 2981 6Section 2981 . 49.45 (6w) (intro.) of the statutes, as affected by 1995 Wisconsin
7Act .... (this act), is amended to read:
AB150,1074,148 49.45 (6w)Hospital operating deficit reduction. (intro.) From the
9appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined
10under criteria developed by the department, incurred by a hospital, as defined under
11s. 50.33 (2) (a) and (b), that is operated by the state, established under s. 49.16 49.71
12or owned and operated by a city or village, the department shall distribute, beginning
13July 1, 1996, up to $8,500,000 in each fiscal year to these hospitals, as determined
14by the department, and shall perform all of the following:
****Note: This is reconciled s. 49.45 (6w) (intro.). This Section has been affected by drafts
with the following LRB numbers: -2153/1 and -2413/2.
AB150, s. 2982 15Section 2982. 49.45 (6w) (a) 2. of the statutes is amended to read:
AB150,1074,1616 49.45 (6w) (a) 2. County funds, for a hospital established under s. 49.16 49.71.
AB150, s. 2983 17Section 2983. 49.45 (6w) (b) 2. b. of the statutes is amended to read:
AB150,1074,1918 49.45 (6w) (b) 2. b. Agreement to provide matching funds by the county in
19which is located a hospital established under s. 49.16 49.71.
AB150, s. 2984 20Section 2984. 49.45 (6x) (a) of the statutes is amended to read:
AB150,1075,321 49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
2220.435 (1) (b) and (o) the department shall distribute not more than $4,748,000 in
23each of fiscal years 1993-94 and 1994-95 year, to provide funds to an essential access

1city hospital, except that the department may not allocate funds to an essential
2access city hospital to the extent that the allocation would exceed any limitation
3under 42 USC 1396b (i) (3).
AB150, s. 2985 4Section 2985. 49.45 (6y) (a) of the statutes is amended to read:
AB150,1075,105 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
620.435 (1) (b) and (o) the department shall distribute funding in each fiscal year to
7provide supplemental payment to county hospitals and to county mental health
8complexes, as determined by the department, for inpatient hospital services that are
9not in excess of the hospitals' customary charges for the services, as limited under
1042 USC 1396b (i) (3).
AB150, s. 2986 11Section 2986. 49.45 (7) (d) 4. of the statutes is amended to read:
AB150,1075,1512 49.45 (7) (d) 4. The department's determination of serious misconduct under
13this subsection shall be cause for terminating the facility's participation in the
14state-funded portion of the medical assistance program under ss. 49.45 to 49.47 this
15subchapter
.
AB150, s. 2987 16Section 2987. 49.45 (8) (title) of the statutes is amended to read:
AB150,1075,1817 49.45 (8) (title) Home Per-visit limits on home health services
18reimbursement.
AB150, s. 2988 19Section 2988. 49.45 (8e) of the statutes is created to read:
AB150,1075,2420 49.45 (8e) Monthly limits on home health, and private-duty nursing services
21reimbursement.
(a) Except as provided in par. (b), reimbursement under s. 20.435
22(1) (b) and (o) for home health and private-duty nursing services provided to a
23medical assistance recipient in a month may not exceed the average monthly cost of
24nursing home care, as determined by the department.
AB150,1075,2525 (b) This subsection does not apply to any of the following:
AB150,1076,1
11. A medical assistance recipient under the age of 22.
AB150,1076,32 2. A ventilator-dependent individual under s. 49.46 (2) (b) 6. m. or 49.47 (6) (a)
31.
AB150,1076,74 3. An individual not covered under subds. 1. and 2., if the department
5determines that the cost of providing the individual with nursing home care would
6exceed the cost of providing the individual with home health and private-duty
7nursing services.
****Note: This is reconciled s. 49.45 (8e). It has been affected by drafts with the following
LRB numbers: -1137/2 and-2408/1.
AB150, s. 2989 8Section 2989. 49.45 (8m) (intro.) of the statutes is amended to read:
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