AB100: Bill Text

AB100,551,18 49.45 (2) (a) 26. a. Impose on each health maintenance organization, as defined in s. 609.01 (2), with a contract under sub. (2) (b) 2. to provide health care to recipients of Medical Assistance or Badger Care, for the privilege of doing business in this state, an annual assessment of 6 percent of the health maintenance organization's gross revenues for the current calendar year. The assessment shall be deposited into the Medical Assistance trust fund. Each health maintenance organization subject to this subdivision shall file with the office of the commissioner of insurance annually, by March 1, a statement of the gross revenues for the health maintenance organization for the immediately preceding calendar year. If a health maintenance organization fails to file such a report by March 1, the department may withhold payment under this section until the report is filed. The department shall determine the amount of each health maintenance organization's assessment, based on the statement that the health maintenance organization files with the office of the commissioner of insurance. Each health maintenance organization shall pay one-fourth of the total assessment quarterly. For 2007 and every year thereafter, on March 31 payment is due based on estimated gross revenues for the health maintenance organization for the period January 1 to March 31 of that year, and the department may adjust the payment amount to ensure that payments made for the previous calendar year equaled an assessment of 6 percent of the health maintenance organization's actual gross revenues for the immediately preceding calendar year; on June 30 payment is due based on actual gross revenues for the health maintenance organization for the period January 1 to March 31 of that year; on September 30 payment is due based on actual gross revenues for the health maintenance organization for the period April 1 to June 30 of that year; and on December 31 payment is due based on actual gross revenues for the health maintenance organization for the period July 1 to September 30 of that year.

AB100,551,23 b. Sections 77.59 (1) to (5), (6) (intro.), (a), and (c), and (7) to (10), 77.60 (1) to (7), (9), and (10), 77.61 (9) and (12) to (14), and 77.62, as they apply to the taxes under subch. III of ch. 77, apply to the assessment under this subdivision, except that the amount of any assessment collected under subd. 26. a. shall be deposited into the Medical Assistance trust fund.

AB100,552,3 c. The department shall levy, enforce, and collect the assessment under this subdivision and shall develop and distribute forms necessary for levying and collection.

AB100,552,5 d. The department shall establish procedures and requirements for levying the assessment under this subdivision.

AB100,552,10 e. An affected health maintenance organization may contest an action by the department of health and family services under this subdivision by submitting a written request for a hearing to the division of hearings and appeals in the department of administration within 30 days after the date of the action by the department of health and family services.

AB100,552,13 f. Any order or determination made by the division of hearing and appeals in the department of administration under a hearing as specified in subd. 26. e. is subject to judicial review as prescribed under ch. 227.

AB100, s. 1124 Section 1124. 49.45 (3) (i) of the statutes is repealed.

AB100, s. 1125 Section 1125. 49.45 (5m) (am) of the statutes is amended to read:

AB100,552,23 49.45 (5m) (am) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w) (rm), the department shall distribute not more than $2,256,000 in each fiscal year, to provide supplemental funds to rural hospitals that, as determined by the department, have high utilization of inpatient services by patients whose care is provided from governmental sources, and to provide supplemental funds to critical access hospitals, except that the department may not distribute funds to a rural hospital or to a critical access hospital to the extent that the distribution would exceed any limitation under 42 USC 1396b (i) (3).

AB100, s. 1126 Section 1126. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:

AB100,553,7 49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this subsection made under s. 20.435 (4) (b), (gp), (pa), (o), (r), (rg), (w), or (wm) shall, except as provided in pars. (bg), (bm), and (br), be determined according to a prospective payment system updated annually by the department. The payment system shall implement standards that are necessary and proper for providing patient care and that meet quality and safety standards established under subch. II of ch. 50 and ch. 150. The payment system shall reflect all of the following:

AB100, s. 1127 Section 1127 . 49.45 (6m) (ag) (intro.) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:

AB100,553,16 49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this subsection made under s. 20.435 (4) (b), (gp), (pa), (o), (r), (rg), (w), or (wm) shall, except as provided in pars. (bg), (bm), and (br), be determined according to a prospective payment system updated annually by the department. The payment system shall implement standards that are necessary and proper for providing patient care and that meet quality and safety standards established under subch. II of ch. 50 and ch. 150. The payment system shall reflect all of the following:

AB100, s. 1128 Section 1128. 49.45 (6m) (ag) 3m. of the statutes is amended to read:

AB100,553,20 49.45 (6m) (ag) 3m. For each state fiscal year, rates that shall be set by the department based on information from cost reports for costs specified under par. (am) 1. bm., 4., 5m., and 6. for the most recently completed fiscal year of the facility.

AB100, s. 1129 Section 1129. 49.45 (6m) (ag) 3r. of the statutes is amended to read:

AB100,553,23 49.45 (6m) (ag) 3r. Flat-rate payment for all costs specified under par. (am) 1. a. and 2.

AB100, s. 1130 Section 1130. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:

AB100,554,11 49.45 (6m) (ar) 1. a. The department shall establish standards for payment of allowable direct care costs under par. (am) 1. bm., for facilities that do not primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state and separate standards for payment of allowable direct care costs, for facilities that primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state. The standards shall be adjusted by the department for regional labor cost variations. For facilities in Douglas, Pierce, and St. Croix counties, the department shall perform the adjustment by use of the wage index that is used by the federal department of health and human services for hospital reimbursement under 42 USC 1395 to 1395ggg.

AB100, s. 1131 Section 1131. 49.45 (6m) (ar) 1. b. of the statutes is repealed.

AB100, s. 1132 Section 1132. 49.45 (6m) (ar) 1. c. of the statutes is amended to read:

AB100,554,18 49.45 (6m) (ar) 1. c. If a facility has an approved program for provision of service to mentally retarded residents, residents dependent upon ventilators, or residents requiring supplemental skilled care due to complex medical conditions, a supplement to the direct care component of the facility rate under subd. 1. b. may be made to that facility according to a method developed by the department.

AB100, s. 1133 Section 1133. 49.45 (6t) of the statutes, as affected by 2003 Wisconsin Act 318, is repealed.

AB100, s. 1134 Section 1134. 49.45 (6v) (b) of the statutes is amended to read:

AB100,555,2 49.45 (6v) (b) The department shall, each year, submit to the joint committee on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that provides information on the utilization of beds by recipients of medical assistance in facilities and a discussion and detailed projection of the likely balances, expenditures, encumbrances, and carry over of currently appropriated amounts in the appropriation accounts under s. 20.435 (4) (b), (gp), and (o), (r), and (rg).

AB100, s. 1135 Section 1135 . 49.45 (6v) (b) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:

AB100,555,10 49.45 (6v) (b) The department shall, each year, submit to the joint committee on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that provides information on the utilization of beds by recipients of medical assistance in facilities and a discussion and detailed projection of the likely balances, expenditures, encumbrances and carry over of currently appropriated amounts in the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (r), and (rg).

AB100, s. 1136 Section 1136. 49.45 (6x) (a) of the statutes is amended to read:

AB100,555,17 49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w) (rm), the department shall distribute not more than $4,748,000 $6,248,000 in each fiscal year, to provide funds to an essential access city hospital, except that the department may not allocate funds to an essential access city hospital to the extent that the allocation would exceed any limitation under 42 USC 1396b (i) (3).

AB100, s. 1137 Section 1137. 49.45 (6y) (a) of the statutes is amended to read:

AB100,556,3 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), (r), (rg), and (w), the department shall distribute funding in each fiscal year to provide supplemental payment to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2).

AB100, s. 1138 Section 1138 . 49.45 (6y) (a) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:

AB100,556,15 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), (r), (rg), and (w), the department shall distribute funding in each fiscal year to provide supplemental payment to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2).

AB100, s. 1139 Section 1139. 49.45 (6y) (am) of the statutes is amended to read:

AB100,556,23 49.45 (6y) (am) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (h), (gp), (o), (r), (rg), and (w), the department shall distribute funding in each fiscal year to provide supplemental payments to hospitals that enter into contracts under s. 49.02 (2) with a county having a population of 500,000 or more to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3).

AB100, s. 1140 Section 1140 . 49.45 (6y) (am) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:

AB100,557,7 49.45 (6y) (am) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (h), (gp), (o), (r), (rg), and (w), the department shall distribute funding in each fiscal year to provide supplemental payments to hospitals that enter into contracts under s. 49.02 (2) with a county having a population of 500,000 or more to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3).

AB100, s. 1141 Section 1141. 49.45 (6z) (a) (intro.) of the statutes is amended to read:

AB100,557,19 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), (r), (rg), and (w), the department shall distribute funding in each fiscal year to supplement payment for services to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant under this chapter, if the department determines that the hospitals serve a disproportionate number of low-income patients with special needs. If no medical relief block grant under this chapter is awarded or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2). The department may not distribute funds under this subsection to the extent that the distribution would do any of the following:

AB100, s. 1142 Section 1142 . 49.45 (6z) (a) (intro.) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:

AB100,558,7 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), (r), (rg), and (w), the department shall distribute funding in each fiscal year to supplement payment for services to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant under this chapter, if the department determines that the hospitals serve a disproportionate number of low-income patients with special needs. If no medical relief block grant under this chapter is awarded or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2). The department may not distribute funds under this subsection to the extent that the distribution would do any of the following:

AB100, s. 1143 Section 1143. 49.45 (8) (b) of the statutes is amended to read:

AB100,558,13 49.45 (8) (b) Reimbursement under s. 20.435 (4) (b), (gp), (o), (r), (rg), and (w) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under par. (c).

AB100, s. 1144 Section 1144 . 49.45 (8) (b) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:

AB100,558,20 49.45 (8) (b) Reimbursement under s. 20.435 (4) (b), (gp), (o), (r), (rg), and (w) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under par. (c).

AB100, s. 1145 Section 1145. 49.45 (24m) (intro.) of the statutes is amended to read:

AB100,559,2 49.45 (24m) Home health care and personal care pilot program. (intro.) From the appropriation accounts under s. 20.435 (4) (b), (gp), (o), (r), (rg), and (w), in order to test the feasibility of instituting a system of reimbursement for providers of home health care and personal care services for medical assistance recipients that is based on competitive bidding, the department shall:

AB100, s. 1146 Section 1146 . 49.45 (24m) (intro.) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:

AB100,559,9 49.45 (24m) Home health care and personal care pilot program. (intro.) From the appropriation accounts under s. 20.435 (4) (b), (gp), (o), (r), (rg), and (w), in order to test the feasibility of instituting a system of reimbursement for providers of home health care and personal care services for medical assistance recipients that is based on competitive bidding, the department shall:

AB100, s. 1147 Section 1147. 49.45 (39) (b) 1. of the statutes is amended to read:

AB100,560,18 49.45 (39) (b) 1. `Payment for school medical services.' If a school district or a cooperative educational service agency elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the school district or the cooperative educational service agency for 60% of the federal share of allowable charges for the school medical services that it provides and, as specified in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the department of public instruction for 60% of the federal share of allowable charges for the school medical services that the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing provides and, as specified in subd. 2., for allowable administrative costs. A school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, claims for common carrier transportation costs as a school medical service unless the department receives notice from the federal health care financing administration that, under a change in federal policy, the claims are not allowed. If the department receives the notice, a school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired, or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, unreimbursed claims for common carrier transportation costs incurred before the date of the change in federal policy. The department shall promulgate rules establishing a methodology for making reimbursements under this paragraph. Except as provided in subd. 1m., all All other expenses for the school medical services provided by a school district or a cooperative educational service agency shall be paid for by the school district or the cooperative educational service agency with funds received from state or local taxes. The school district, the Wisconsin Center for the Blind and Visually Impaired, the Wisconsin Educational Services Program for the Deaf and Hard of Hearing, or the cooperative educational service agency shall comply with all requirements of the federal department of health and human services for receiving federal financial participation.

AB100, s. 1148 Section 1148. 49.45 (39) (b) 1m. of the statutes is repealed.

AB100, s. 1149 Section 1149. 49.45 (39) (b) 2. of the statutes is amended to read:

AB100,561,5 49.45 (39) (b) 2. `Payment for school medical services administrative costs.' The department shall reimburse a school district or a cooperative educational service agency specified under subds. subd. 1. and 1m. and shall reimburse the department of public instruction on behalf of the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing for 90% of the federal share of allowable administrative costs, using time studies, beginning in fiscal year 1999-2000. A school district or a cooperative educational service agency may submit, and the department of health and family services shall allow, claims for administrative costs incurred during the period that is up to 24 months before the date of the claim, if allowable under federal law.

AB100, s. 1150 Section 1150. 49.46 (1) (a) 5. of the statutes is amended to read:

AB100,561,9 49.46 (1) (a) 5. Any child in an adoption assistance, foster care, kinship care, long-term kinship care or, treatment foster care, or subsidized guardianship placement under ch. 48 or 938, as determined by the department.

AB100, s. 1151 Section 1151. 49.46 (1) (a) 5m. of the statutes is created to read:

AB100,561,13 49.46 (1) (a) 5m. Any person who is at least 18 years of age but under 20 years of age and who, on his or her 18th birthday, was in a foster care or treatment foster care placement under ch. 48 or 938, as determined by the department.

AB100, s. 1152 Section 1152. 49.46 (1) (a) 5m. of the statutes, as created by 2005 Wisconsin Act .... (this act), is amended to read:

AB100,561,18 49.46 (1) (a) 5m. Any person who is at least 18 years of age but under 20 21 years of age and who, on his or her 18th birthday, was in a foster care or treatment foster care placement under ch. 48 or 938, as determined by the department.

AB100, s. 1153 Section 1153. 49.46 (1) (a) 14. of the statutes is amended to read:

AB100,561,25 49.46 (1) (a) 14. Any person who would meet the financial and other eligibility requirements for home or community-based services under s. 46.27 (11) or, 46.277, or 46.2785 but for the fact that the person engages in substantial gainful activity under 42 USC 1382c (a) (3), if a waiver under s. 49.45 (38) is in effect or federal law permits federal financial participation for medical assistance coverage of the person and if funding is available for the person under s. 46.27 (11) or, 46.277, or 46.2785.

AB100, s. 1154 Section 1154. 49.46 (1) (a) 15. of the statutes is amended to read:

AB100,562,4 49.46 (1) (a) 15. Any individual who is infected with tuberculosis and meets the income and resource eligibility requirements for the federal supplemental security Supplemental Security Income program under 42 USC 1381 to 1383d.

AB100, s. 1155 Section 1155. 49.46 (2) (b) 3. of the statutes is renumbered 49.46 (2) (b) 3. a. and amended to read:

AB100,562,13 49.46 (2) (b) 3. a. Transportation by emergency medical vehicle to obtain emergency medical care, transportation by specialized medical vehicle to obtain medical care including the unloaded travel of the specialized medical vehicle necessary to provide that transportation or, if authorized in advance by the county department under s. 46.215 or 46.22, transportation by common carrier or private motor vehicle and, if transportation by other means is contraindicated, to obtain nonemergency medical care.

AB100, s. 1156 Section 1156. 49.46 (2) (b) 3. b. of the statutes is created to read:

AB100,562,18 49.46 (2) (b) 3. b. To obtain nonemergency medical services, except as provided in subd. 3. a., appropriate transportation that is provided through an entity with which the department has contracted to manage transportation services for the Medical Assistance program.

AB100, s. 1157 Section 1157. 49.46 (2) (b) 8. of the statutes is amended to read:

AB100,562,23 49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27 (11), 46.275, 46.277 or, 46.278, or 46.2785, under the family care benefit if a waiver is in effect under s. 46.281 (1) (c), or under a waiver requested under 2001 Wisconsin Act 16, section 9123 (16rs), or 2003 Wisconsin Act 33, section 9124 (8c).

AB100, s. 1158 Section 1158. 49.47 (4) (as) 1. of the statutes is amended to read:

AB100,563,5 49.47 (4) (as) 1. The person would meet the financial and other eligibility requirements for home or community-based services under s. 46.27 (11) or, 46.277, or 46.2785 or under the family care benefit if a waiver is in effect under s. 46.281 (1) (c) but for the fact that the person engages in substantial gainful activity under 42 USC 1382c (a) (3).

AB100, s. 1159 Section 1159. 49.47 (4) (as) 3. of the statutes is amended to read:

AB100,563,9 49.47 (4) (as) 3. Funding is available for the person under s. 46.27 (11) or, 46.277, or 46.2785 or under the family care benefit if a waiver is in effect under s. 46.281 (1) (c).

AB100, s. 1160 Section 1160. 49.472 (6) (a) of the statutes is amended to read:

AB100,563,16 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account under s. 20.435 (4) (b), (gp), (r), (rg), or (w), the department shall, on the part of an individual who is eligible for medical assistance under sub. (3), pay premiums for or purchase individual coverage offered by the individual's employer if the department determines that paying the premiums for or purchasing the coverage will not be more costly than providing medical assistance.

AB100, s. 1161 Section 1161 . 49.472 (6) (a) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:

AB100,563,24 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account under s. 20.435 (4) (b), (gp), (r), (rg), or (w), the department shall, on the part of an individual who is eligible for medical assistance under sub. (3), pay premiums for or purchase individual coverage offered by the individual's employer if the department determines that paying the premiums for or purchasing the coverage will not be more costly than providing medical assistance.

AB100, s. 1162 Section 1162. 49.472 (6) (b) of the statutes is amended to read:

AB100,564,4 49.472 (6) (b) If federal financial participation is available, from the appropriation account under s. 20.435 (4) (b), (gp), (r), (rg), or (w), the department may pay medicare Medicare Part A and Part B premiums for individuals who are eligible for medicare Medicare and for medical assistance under sub. (3).

AB100, s. 1163 Section 1163 . 49.472 (6) (b) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:

AB100,564,10 49.472 (6) (b) If federal financial participation is available, from the appropriation account under s. 20.435 (4) (b), (gp), (r), (rg), or (w), the department may pay Medicare Part A and Part B premiums for individuals who are eligible for Medicare and for medical assistance under sub. (3).

AB100, s. 1164 Section 1164. 49.473 (5) of the statutes is amended to read:

AB100,564,16 49.473 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b), (gp), and (o), (r), and (rg) allowable charges to a provider who is certified under s. 49.45 (2) (a) 11. for medical assistance Medical Assistance on behalf of a woman who meets the requirements under sub. (2) for all benefits and services specified under s. 49.46 (2).

AB100, s. 1165 Section 1165 . 49.473 (5) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:

AB100,564,23 49.473 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (r), and (rg) allowable charges to a provider who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who meets the requirements under sub. (2) for all benefits and services specified under s. 49.46 (2).

AB100, s. 1166 Section 1166. 49.475 (6) of the statutes is created to read:

AB100,565,10 49.475 (6) Sharing information. The department of health and family services shall provide to the department of workforce development, for purposes of the medical support liability program under s. 49.22, any information that the department of health and family services receives under this section. The department of workforce development may allow a county child support agency under s. 59.53 (5) or a tribal child support agency access to the information, subject to the use and disclosure restrictions under s. 49.83, and shall consult with the department of health and family services regarding procedures and methods to adequately safeguard the confidentiality of the information provided under this subsection.

AB100, s. 1167 Section 1167. 49.497 (title) of the statutes is amended to read: