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:
AB150-engrossed,997,95
49.45
(34) Medical assistance manual. The department shall prepare a
6medical assistance manual that is clear, comprehensive and consistent with
ss. 49.43
7to 49.47 this subchapter and
42 USC 1396a to
1396u and shall, no later than July
81, 1992, provide the manual to counties for use by county employes who administer
9the medical assistance program.
AB150-engrossed,997,1111
49.45
(39) School medical services. (a)
Definitions. In this subsection:
AB150-engrossed,997,1512
1. "School" means a public school described under s. 115.01 (1) or a charter
13school, as defined in s. 115.001 (1). It includes school-operated early childhood
14programs for developmentally delayed and disabled 4-year-old and 5-year-old
15children.
AB150-engrossed,997,1816
2. "School medical services" means health care services that are provided in a
17school to children who are eligible for medical assistance and that are appropriate
18to a school setting, under rules promulgated by the department.
AB150-engrossed,998,319
(b)
Payment for school medical services. If a school district elects to provide
20school medical services and meets all requirements under par. (c), the department
21shall reimburse the school district for the federal share of allowable charges for the
22school medical services that it provides and for allowable administrative costs. The
23department shall promulgate rules establishing a methodology for making
24reimbursements under this paragraph. All other expenses for the school medical
25services shall be paid for by the school district with funds received from state or local
1taxes. The school district shall comply with all requirements of the federal
2department of health and human services for receiving federal financial
3participation.
AB150-engrossed,998,64
(c)
Certification and reporting requirements. The department shall promulgate
5rules establishing specific certification and reporting requirements with respect to
6school medical services under this subsection.
AB150-engrossed,998,108
49.45
(40) Periodic record matches. The department shall cooperate with the
9department of industry, labor and human relations in matching records of medical
10assistance recipients under s. 49.32 (7).
AB150-engrossed,998,1212
49.45
(41) Mental health crisis intervention services. (a) In this subsection:
AB150-engrossed,998,1613
1. "Mental health crisis intervention services" means services that are provided
14by a mental health crisis intervention program operated by, or under contract with,
15a county or municipality, if the county or municipality is certified as a medical
16assistance provider.
AB150-engrossed,998,1717
2. "Municipality" means a city, village or town.
AB150-engrossed,999,218
(b) If a county or municipality elects to become certified as a provider of mental
19health crisis intervention services, the county or municipality may provide mental
20health crisis intervention services under this subsection in the county or
21municipality to medical assistance recipients through the medical assistance
22program. A county or municipality that elects to provide the services shall pay the
23amount of the allowable charges for the services under the medical assistance
24program that is not provided by the federal government. The department shall
25reimburse the county or municipality under this subsection only for the amount of
1the allowable charges for those services under the medical assistance program that
2is provided by the federal government.
AB150-engrossed,999,64
49.45
(42) Personal care services. Personal care services under s. 49.46 (2)
5(b) 6. j. provided to an individual are reimbursable under medical assistance only if
6all of the following conditions are met:
AB150-engrossed,999,97
(a) The provider of the personal care services receives prior authorization from
8the department for all personal care services that are provided to the individual in
9excess of 50 hours in a calendar year.
AB150-engrossed,999,1110
(b) The individual is not eligible to receive home health aide services under
11medicare, as defined in sub. (3) (L) 1. b.
AB150-engrossed,999,1813
49.45
(43) Case management services for high-cost recipients. The
14department may establish a program to provide case management services for
15medical assistance recipients with high-cost chronic health conditions or high-cost
16catastrophic health conditions. If the department establishes a program to provide
17these case management services, the department shall provide reimbursement for
18providers of these case management services under the medical assistance program.