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).
AB150-engrossed,992,2
149.45
(6z) (title)
Supplemental funding for certain hospitals serving
2low-income patients.
AB150-engrossed,992,154
49.45
(6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations
5under s. 20.435 (1) (b) and (o) the department shall distribute funding in each fiscal
6year to supplement payment for
inpatient services to
county hospitals and county
7mental health complexes that, as determined by the department,
hospitals that
8enter into a contract under s. 49.02 (2) to provide health care services funded by a
9relief block grant under this chapter, if the department determines that the hospitals 10serve a disproportionate number of low-income patients with special needs
, except
11that the. If no medical relief block grant under this chapter is awarded or if the
12allocation of funds to such hospitals would exceed any limitation under 42 USC
131396b (i) (3), the department may distribute funds to hospitals that have not entered
14into a contract under s. 49.02 (2). The department may not distribute funds under
15this subsection to the extent that the distribution would do any of the following:
AB150-engrossed,992,2017
49.45
(7) (d) 4. The department's determination of serious misconduct under
18this subsection shall be cause for terminating the facility's participation in the
19state-funded portion of the medical assistance program under
ss. 49.45 to 49.47 this
20subchapter.
AB150-engrossed,992,2322
49.45
(8) (title)
Home
Per-visit limits on home health services
23reimbursement.
AB150-engrossed,993,6
149.45
(8e) Monthly limits on home health, personal care and private-duty
2nursing services reimbursement. (a) Except as provided in par. (b), reimbursement
3under s. 20.435 (1) (b) and (o) for home health, personal care and private-duty
4nursing services provided to a medical assistance recipient in a month may not
5exceed the average monthly cost of nursing home care, as determined by the
6department.
AB150-engrossed,993,77
(b) This subsection does not apply to any of the following:
AB150-engrossed,993,88
1. A medical assistance recipient under the age of 22.
AB150-engrossed,993,109
2. A ventilator-dependent individual under s. 49.46 (2) (b) 6. m. or 49.47 (6) (a)
101.
AB150-engrossed,993,1311
3. Any individual, if the department determines that the cost of providing the
12individual with nursing home care would exceed the cost of providing the individual
13with home health, personal care and private-duty nursing services.
AB150-engrossed,993,1514
4. Any individual, if the department determines that nursing home care is not
15available for that individual.
AB150-engrossed,993,2117
49.45
(8f) Limits on reimbursement of providers of home health services. (a)
18For any home health, personal care or private-duty nursing service provided to a
19medical assistance recipient in a month, the department may require, as a condition
20of reimbursement, that the provider charge the department the lesser of the
21following for the service:
AB150-engrossed,993,2422
1. The amount that the federal medicare program reimburses for a service,
23separately identified under
42 CFR Part 413, including skilled nursing service, home
24health aid service and physical therapy service.
AB150-engrossed,993,2525
2. The provider's usual and customary charge for providing the service.
AB150-engrossed,994,2
13. A maximum reimbursement rate, determined by the department, for the
2service.
AB150-engrossed,994,43
(b) When a provider is required to charge the department a price under par. (a),
4the department may not reimburse the provider for more than that amount.
AB150-engrossed,994,116
49.45
(8m) Rates for respiratory care services. (intro.) Notwithstanding
a
7determination by the department of a maximum rate the limits under
sub. subs. (8)
,
8(8e) and (8f), the rates under sub. (8) and rates charged by providers under s. 49.46
9(2) (a) 4. d. that are not home health agencies, for reimbursement for respiratory care
10services for ventilator-dependent individuals under ss. 49.46 (2) (b) 6. m. and 49.47
11(6) (a) 1., shall be as follows:
AB150-engrossed,994,2213
49.45
(8v) Incentive-based pharmacy payment system. By January 1, 1996, the
14department shall establish a system of payment to pharmacies for legend and
15over-the-counter drugs provided to recipients of medical assistance that has
16financial incentives for pharmacists who perform services that result in savings to
17the medical assistance program. Under this system, the department shall establish
18a schedule of fees that is designed to ensure that any incentive payments made are
19equal to or less than the documented savings. The department may discontinue the
20system established under this subsection if the department determines, after
21performance of a study, that payments to pharmacists under the system exceed the
22documented savings under the system.
AB150-engrossed,995,3
149.45
(11) Penalty. Any person who receives or assists another in receiving
2assistance under this section, to which the recipient is not entitled, shall be subject
3to the penalties under s.
49.12 49.95.
AB150-engrossed,995,115
49.45
(12) (c) The department shall request proposals for a system of
6machine-readable identification cards for medical assistance recipients and a
7computerized support system for the cards that will accept and respond to
8electronically conveyed requests from health care providers for information related
9to medical assistance recipients, such as eligibility, coverages and authorizations.
10The request for proposals shall specify that the systems are to be operating by
11January 1,
1996 1997.
AB150-engrossed, s. 2993
12Section
2993. 49.45 (25) (am) of the statutes is renumbered 49.45 (25) (am)
13(intro.) and amended to read:
AB150-engrossed,995,1914
49.45
(25) (am) (intro.) Except as provided under pars. (be) and (bg) and sub.
15(24), case management services under s. 49.46 (2) (b) 9.
and (bm) are reimbursable
16under medical assistance only if provided to a medical assistance beneficiary who
17receives case management services from or through a certified case management
18provider in a county, city, village or town that elects, under par. (b), to make the
19services available and who
has meets at least one of the following conditions:
AB150-engrossed,995,20
201. Has a developmental disability, as defined under s. 51.01 (5) (a)
,.
AB150-engrossed,995,21
212. Has a chronic mental illness, as defined under s. 51.01 (3g)
, or.
AB150-engrossed,995,22
223. Has Alzheimer's disease, as defined under s. 46.87 (1) (a)
, is.
AB150-engrossed,995,23
234. Is an alcoholic, as defined under s. 51.01 (1)
, or.
AB150-engrossed,995,24
245. Is drug dependent, as defined under s. 51.01 (8)
, is.
AB150-engrossed,995,25
256. Is physically disabled, as defined by the department
, is.
AB150-engrossed,996,1
17. Is a severely emotionally disturbed child
, is.
AB150-engrossed,996,2
28. Is age 65 or over
or, after December 31, 1991, has.
AB150-engrossed,996,3
310. Has HIV infection, as defined in s. 252.01 (2).
AB150-engrossed,996,65
49.45
(25) (am) 9. Is a member of a family that has a child who is at risk of
6serious physical, mental or emotional dysfunction, as defined by the department.
AB150-engrossed,996,98
49.45
(25) (am) 11. Is a child who is eligible for early intervention services
9under s. 51.44.
AB150-engrossed,996,1111
49.45
(25) (am) 12. Is infected with tuberculosis.
AB150-engrossed,996,1313
49.45
(25) (am) 13. Is a child with asthma.
AB150-engrossed,996,2215
49.45
(25) (bg) An independent living center, as defined in s. 46.96 (1) (a), that
16is a certified case management provider may elect to provide case management
17services to one or more of the categories of medical assistance beneficiaries specified
18under par. (am). The amount of allowable charges for the services under the medical
19assistance program that is not provided by the federal government shall be paid from
20nonfederal, public funds received by the independent living center from a county,
21city, village or town or from funds distributed
under the appropriation under s.
2220.435 (5) (bm) or as a grant under s. 46.96.
AB150-engrossed,997,3
149.45
(25) (bm) (intro.) Case management services under this subsection may
2not be provided to a person under
the category of severely emotionally disturbed
3child par. (am) 7. unless any of the following is true: