AB100: Bill Text

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 b. of the statutes is repealed.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AB100, s. 1133 Section 1133. 49.45 (6t) of the statutes, as affected by 2003 Wisconsin Act 318, is repealed.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

AB100,565,13 49.497 (title) Recovery of incorrect medical assistance Medical Assistance or Badger Care payments.

AB100, s. 1168 Section 1168. 49.497 (1) of the statutes is renumbered 49.497 (1) (a) (intro.) and amended to read:

AB100,565,18 49.497 (1) (a) (intro.) The department may recover any payment made incorrectly for benefits specified under s. 49.46, 49.468 or 49.47 provided under this subchapter or s. 49.665 if the incorrect payment results from any of the following:

AB100,565,20 1. A misstatement or omission of fact by a person supplying information in an application for benefits under s. 49.46, 49.468 or 49.47 this subchapter or s. 49.665.

AB100,565,24 2. The department may also recover if a medical assistance failure of a Medical Assistance or Badger Care recipient or any other person responsible for giving information on the recipient's behalf fails to report the receipt of income or assets in an amount that would have affected the recipient's eligibility for benefits.

AB100,566,7 (b) The department's right of recovery is against any medical assistance Medical Assistance or Badger Care recipient to whom or on whose behalf the incorrect payment was made. The extent of recovery is limited to the amount of the benefits incorrectly granted. The county department under s. 46.215 or 46.22 or the governing body of a federally recognized American Indian tribe administering medical assistance Medical Assistance or Badger Care shall begin recovery actions on behalf of the department according to rules promulgated by the department.

AB100, s. 1169 Section 1169. 49.497 (1) (a) 3. of the statutes is created to read:

AB100,566,13 49.497 (1) (a) 3. The failure of a Medical Assistance or Badger Care recipient or any other person responsible for giving information on the recipient's behalf to report any change in the recipient's financial or nonfinancial situation or eligibility characteristics that would have affected the recipient's eligibility for benefits or the recipient's cost-sharing requirements.

AB100, s. 1170 Section 1170. 49.497 (1m) of the statutes is created to read:

AB100,566,24 49.497 (1m) (a) If, after notice that an incorrect payment was made, a recipient, or parent of a minor recipient, who is liable for repayment of an incorrect payment fails to repay the incorrect payment or enter into, or comply with, an agreement for repayment, the department may bring an action to enforce the liability or may issue an order to compel payment of the liability. Any person aggrieved by an order issued by the department under this paragraph may appeal the order as a contested case under ch. 227 by filing with the department a request for a hearing within 30 days after the date of the order. The only issue at hearing shall be the determination by the department that the person has not repaid the incorrect payment or entered into, or complied with, an agreement for repayment.

AB100,567,10 (b) If any recipient, or parent of a minor recipient, named in an order to compel payment issued under par. (a) fails to pay the department any amount due under the terms of the order and no contested case to review the order is pending and the time for filing for a contested case review has expired, the department may present a certified copy of the order to the circuit court for any county. The sworn statement of the secretary shall be evidence of the incorrect payment. The circuit court shall, without notice, render judgment in accordance with the order. A judgment rendered under this paragraph shall have the same effect and shall be entered in the judgment and lien docket and may be enforced in the same manner as if the judgment had been rendered in an action tried and determined by the circuit court.

AB100,567,12 (c) The recovery procedure under this subsection is in addition to any other recovery procedure authorized by law.

AB100, s. 1171 Section 1171. 49.497 (2) of the statutes is amended to read: