AB150-engrossed, s. 2940
1Section
2940. 49.41 of the statutes, as affected by 1995 Wisconsin Act .... (this
2act), is renumbered 49.96 and amended to read:
AB150-engrossed,982,7
349.96 Assistance grants exempt from levy. All grants of aid to families with
4dependent children, payments made for social services, cash benefits paid by
5counties under s. 59.07 (154), and benefits under s.
49.177 49.77 or federal Title XVI,
6are exempt from every tax, and from execution, garnishment, attachment and every
7other process and shall be inalienable.
AB150-engrossed, s. 2941
8Section
2941. Subchapter IV (title) of chapter 49 [precedes 49.43] of the
9statutes is created to read:
AB150-engrossed,982,1211
Subchapter IV
12
Medical assistance
AB150-engrossed,982,1717
49.43
(3e) "Department" means the department of health and social services.
AB150-engrossed,982,2219
49.43
(10) "Provider" means a person, corporation, limited liability company,
20partnership, unincorporated business or professional association and any agent or
21employe thereof who provides medical assistance
under ss. 49.45 to 49.47, 49.49 and
2249.495.
AB150-engrossed,982,2424
49.43
(10s) "Secretary" means the secretary of health and social services.
AB150-engrossed,983,3
149.45
(2) (a) 15. Routinely provide notification to persons eligible for medical
2assistance
under ss. 49.46 to 49.47, or such persons' guardians, of the department's
3access to provider records.
AB150-engrossed,983,85
49.45
(2) (a) 23. Promulgate rules that define "supportive services", "personal
6services" and "nursing services" provided in a certified assisted living facility, as
7defined under s. 50.01 (1d), for purposes of reimbursement under ss. 46.27 (11) (c) 7.
8and 46.277 (5) (e).
AB150-engrossed,983,1310
49.45
(2) (b) 4. Audit claims filed by any provider of medical assistance, and as
11part of that audit, request of any such provider, and review, medical records of
12individuals who have received benefits under the medical assistance program
, or
13under s. 49.046.
AB150-engrossed,983,1915
49.45
(3) (a) Reimbursement shall be made to each county department under
16ss. 46.215, 46.22 and 46.23 for the administrative services performed in the medical
17assistance program on the basis of s.
49.52 49.33 (8). For purposes of reimbursement
18under this paragraph, assessments completed under s. 46.27 (6) (a) are
19administrative services performed in the medical assistance program.
AB150-engrossed,984,221
49.45
(3) (e) 7m. Notwithstanding subd. 7., the daily reimbursement or
22payment rate for services at a hospital established under s. 45.375 (1) provided to
23medical assistance recipients whose continued hospitalization is no longer medically
24necessary or appropriate during a period where the recipient awaits placement in an
1alternate custodial living arrangement shall be the skilled nursing facility rate paid
2to the facility created under s. 45.365 (1).
AB150-engrossed,984,74
49.45
(5) Appeal. Any person whose application for medical assistance is
5denied or is not acted upon promptly or who believes that the payments made in the
6person's behalf have not been properly determined may file an appeal with the
7department pursuant to s.
49.50 (8) 49.21 (1).
AB150-engrossed,984,159
49.45
(5m) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
1020.435 (1) (b) and (o) the department shall distribute not more than $2,256,000 in
11each
of fiscal
years 1993-94 and 1994-95 year, to provide supplemental funds to
12rural hospitals that, as determined by the department, have high utilization of
13inpatient services by patients whose care is provided from governmental sources,
14except that the department may not distribute funds to a rural hospital to the extent
15that the distribution would exceed any limitation under
42 USC 1396b (i) (3).
AB150-engrossed,984,1917
49.45
(6b) (a) Beginning in fiscal year
1994-95 1995-96, for relocations from
18the central Wisconsin center for the developmentally disabled, by
$55.77 $220 per
19day.
AB150-engrossed,984,2321
49.45
(6b) (b) Beginning in fiscal year
1994-95 1995-96, for relocations from
22the northern Wisconsin center for the developmentally disabled, by
$49.06 $214 per
23day.
AB150-engrossed,985,3
149.45
(6b) (c) Beginning in fiscal year
1994-95 1995-96, for relocations from
2the southern Wisconsin center for the developmentally disabled, by
$48.37 $164 per
3day.
AB150-engrossed,985,95
49.45
(6m) (ag) 3m. For state fiscal year
1993-94 1995-96, rates that shall be
6set by the department based on information from cost reports for the
1992 1994 fiscal
7year of the facility and for state fiscal year
1994-95
1996-97, rates that shall be set
8by the department based on information from cost reports for the
1993 1995 fiscal
9year of the facility.
AB150-engrossed,985,2111
49.45
(6m) (ag) 8. Calculation of total payments and supplementary payments
12to facilities that permits an increase in funds allocated under s. 20.435 (1) (b) and (o)
13for nursing home care provided medical assistance recipients over that paid for
14services provided in state fiscal year
1992-93 1994-95 of no more than
3.58% 4.25% 15during state fiscal year
1993-94 1995-96 and over that paid for services provided in
16state fiscal year
1993-94 1995-96 of no more than
3.57% 3.5% during state fiscal
17year
1994-95 1996-97, excluding increases in total payments attributable to
18increases in recipient utilization of facility care, payments for the provision of active
19treatment to facility residents with developmental disability or chronic mental
20illness and payments for preadmission screening of facility applicants and annual
21reviews of facility residents required under
42 USC 1396r (e).
AB150-engrossed,986,223
49.45
(6m) (am) 5. Allowable administrative and general costs, including costs
24related to the facility's overall management and administration and allowable
1expenses that are not recognized or reimbursed in other cost centers
and including
2the costs of commercial estimators approved by the department under par. (ar) 6.
AB150-engrossed,986,64
49.45
(6m) (am) 5m. Allowable interest expense of the facility, less interest
5income of the facility and less interest income of affiliated entities, to the extent
6required under the approved state plan for services under
42 USC 1396.
AB150-engrossed,986,138
49.45
(6m) (ar) 1. c. If a facility has an approved program for provision of
9service to
emotionally disturbed or mentally retarded residents, residents dependent
10upon ventilators, or residents requiring supplemental skilled care due to complex
11medical conditions, a supplement to the direct care component of the facility rate
12under subd. 1. b. may be made to that facility according to a method developed by the
13department.
AB150-engrossed,986,2015
49.45
(6m) (ar) 6. Capital payment shall be based on a replacement value for
16a facility
, as. The replacement value shall be determined by a commercial estimator
17with which contracted for by the department
has contracted for service, and
paid for
18by the facility. The replacement value shall be subject to limitations determined by
19the department, except that the department may not reduce final capital payment
20of a facility by more than $3.50 per patient day.
AB150-engrossed,987,222
49.45
(6m) (av) 2. The department shall compile an average payment rate for
23each facility based on that facility's rates for cost centers described under par. (am)
241. to 5. that were in effect on June 30
of the previous year, 1994. The department may
1develop a method for adjusting the facility's rate for the cost center under par. (am)
21. in compiling the average payment rate under this subdivision.
AB150-engrossed,987,84
49.45
(6m) (av) 4. If the facility's payment rate under subd. 1. is a decrease from
5its average payment rate
from the previous year under subd. 2., and if the figure
6calculated under subd. 3. exceeds the payment rate for the facility under subd. 1., the
7facility's average payment rate shall be the greater of its average payment rate under
8subd. 2. or its rate under subd. 1.
AB150-engrossed,987,1811
49.45
(6m) (br) 1. Notwithstanding s.
20.410 (3) (cd), 20.435
(3) (cd), (4) (de) or
12(eb) (1) (bt) or (bu) or (7) (b)
or 20.445 (3) (de), the department shall reduce allocations
13of funds to counties in the amount of the disallowance from the appropriations under
14s.
20.410 (3) (cd) or 20.435
(3) (cd), (4) (de) or (eb) (1) (bt) or (bu) or (7) (b)
, or the
15department shall direct the department of industry, labor and human relations to
16reduce allocations of funds to counties in the amount of the disallowance from the
17appropriation under s. 20.445 (3) (de), in accordance with s. 16.544 to the extent
18applicable.
AB150-engrossed,987,2120
49.45
(6m) (c) 6. Provide, upon request, such information as the department
21considers necessary to determine allowable interest expenses under par. (am) 5m.
AB150-engrossed,988,323
49.45
(6m) (h) The department may require by rule that all claims for payment
24of services provided facility residents under this
chapter subchapter be submitted or
25countersigned by the respective facility administrator. The department may specify
1those categories of services for which payment will be made only if the services are
2rendered or authorized in writing by a primary health care provider designated by
3the recipient for the particular category of services.
AB150-engrossed,988,105
49.45
(6m) (L) For purposes of ss. 46.27 (11) (c) 7. and 46.277 (5) (e), the
6department shall, by July 1 annually, determine the statewide medical assistance
7daily cost of nursing home care and submit the determination to the department of
8administration for review. The department of administration shall approve the
9determination before payment may be made under s. 46.27 (11) (c) 7. or 46.277 (5)
10(e).
AB150-engrossed,988,1812
49.45
(6t) County department operating deficit reduction. From the
13appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined
14under criteria developed by the department, incurred by a county department under
15s. 46.215, 46.22, 46.23 or 51.42 for services provided under s. 49.46 (2) (a) 4. d. and
16(b) 6. f., the department shall allocate up to $4,500,000 in each fiscal year to these
17county departments, as determined by the department, and shall perform all of the
18following:
AB150-engrossed,988,2219
(a) For the reduction of operating deficits incurred by the county departments,
20estimate the availability of federal medicaid funds that may be matched to county
21funds that are expended for costs in excess of reimbursement for services provided
22under s. 49.46 (2) (a) 4. d. and (b) 6. f.
AB150-engrossed,989,223
(b) Based on the amount estimated to be available under par. (a), develop a
24method, which need not be promulgated as rules under ch. 227, to distribute this
1allocation to the individual county departments under s. 46.215, 46.22, 46.23 or
251.42 that have incurred operating deficits that shall include all of the following:
AB150-engrossed,989,33
1. Development of criteria for determining operating deficits.
AB150-engrossed,989,54
2. Agreement, by the county in which is located a county department that has
5an operating deficit, to provide funds to match federal medicaid funds.
AB150-engrossed,989,66
3. Consideration of the size of a county department's operating deficit.
AB150-engrossed,989,87
(c) Except as provided in par. (d), distribute the allocation under the
8distribution method that is developed.
AB150-engrossed,989,139
(d) If the federal department of health and human services approves for state
10expenditure in a fiscal year amounts under s. 20.435 (1) (o) that result in a lesser
11allocation amount than that allocated under this subsection or disallows use of the
12allocation of federal medicaid funds under par. (c), reduce allocations under this
13subsection and distribute on a prorated basis, as determined by the department.
AB150-engrossed,989,2115
49.45
(6u) Facility operating deficit reduction. (intro.) Except as provided
16in par. (g), from the appropriation under s. 20.435 (1) (o), for reduction of operating
17deficits, as defined under criteria developed by the department, incurred by a facility,
18as defined under sub. (6m) (a) 2., that is established under s.
49.14 (1) 49.70 (1) or
19that is owned and operated by a city, village or town, the department shall distribute
20to these facilities not more than $18,600,000 in each fiscal year, as determined by the
21department, and shall perform all of the following:
AB150-engrossed,990,223
49.45
(6u) (b) 2. Agreement by the county in which is located the facility
24established under s.
49.14 (1) 49.70 (1) and agreement by the city, village or town that
25owns and operates the facility that the applicable county, city, village or town shall
1provide funds to match federal medical assistance matching funds under this
2subsection.
AB150-engrossed,990,74
49.45
(6u) (b) 2m. Identification by the county in which is located the facility
5established under s.
49.14 (1) 49.70 (1) of all county funds expended in each calendar
6year to operate the facility, and certification by the county to the department of this
7amount.
AB150-engrossed,990,1610
49.45
(6w) Hospital operating deficit reduction. (intro.) From the
11appropriation under s. 20.435 (1) (o), for reduction of operating deficits, as defined
12under criteria developed by the department, incurred by a hospital, as defined under
13s. 50.33 (2) (a) and (b), that is operated by the state, established under s.
49.16 49.71 14or owned and operated by a city or village, the department shall allocate up to
15$3,300,000 in each fiscal year to these hospitals, as determined by the department,
16and shall perform all of the following:
AB150-engrossed,990,1818
49.45
(6w) (a) 2. County funds, for a hospital established under s.
49.16 49.71.
AB150-engrossed,990,2120
49.45
(6w) (b) 2. b. Agreement to provide matching funds by the county in
21which is located a hospital established under s.
49.16
49.71.
AB150-engrossed,991,323
49.45
(6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
2420.435 (1) (b) and (o) the department shall distribute not more than $4,748,000 in
25each
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-engrossed,991,55
49.45
(6y) (title)
Supplemental funding for county certain hospitals.
AB150-engrossed,991,127
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
820.435 (1) (b) and (o) the department shall distribute funding in each fiscal year to
9provide supplemental payment to county hospitals and to county mental health
10complexes, as determined by the department, for
inpatient hospital services that are
11not in excess of the hospitals' customary charges for the services, as limited under
1242 USC 1396b (i) (3).
AB150-engrossed, s. 2985e
13Section 2985e. 49.45 (6y) (a) of the statutes, as affected by 1995 Wisconsin Act
14.... (this act), is amended to read:
AB150-engrossed,991,2415
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
1620.435 (1) (b) and (o) the department shall distribute funding in each fiscal year to
17provide supplemental payment to
county hospitals and to county mental health
18complexes hospitals that enter into a contract under s. 49.02 (2) to provide health
19care services funded by a relief block grant, as determined by the department, for
20hospital services that are not in excess of the hospitals' customary charges for the
21services, as limited under
42 USC 1396b (i) (3).
If no relief block grant is awarded
22under this chapter or if the allocation of funds to such hospitals would exceed any
23limitation under 42 USC 1396b (i) (3), the department may distribute funds to
24hospitals that have not entered into a contract under s. 49.02 (2).
