SB490: Bill Text

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB490, s. 1 Section 1. 13.101 (18) of the statutes is created to read:

SB490,4,4 13.101 (18) Notwithstanding sub. (4), the committee may not transfer moneys from the appropriation accounts under s. 20.435 (4) (xc), (xd), or (xe) to another appropriation account.

SB490, s. 2 Section 2. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table

SB490, s. 3 Section 3. 20.435 (4) (gp) of the statutes is repealed.

SB490, s. 4 Section 4. 20.435 (4) (xc) of the statutes is created to read:

SB490,5,9 20.435 (4) (xc) Hospital assessment fund; hospital payments and refunds. Biennially, from the medical assessment trust fund, the amounts in the schedule for increased payments and refunds to hospitals and for higher capitated payment rates under s. 49.45 (58) (a), as the Medical Assistance nonfederal share, in order to increase payment rates in excess of the aggregate inpatient and outpatient hospital payment rates in effect in fiscal year 2007-08 for services provided by hospitals under the Medical Assistance program administered under subch. IV of ch. 49 and the Badger Care health care program under s. 49.665.

SB490, s. 5 Section 5. 20.435 (4) (xd) of the statutes is created to read:

SB490,5,15 20.435 (4) (xd) Hospital assessment fund; Medical Assistance and Badger Care program benefits. Biennially, from the hospital assessment fund, the amounts in the schedule to provide a portion of the state share of Medical Assistance program benefits administered under subch. IV of ch. 49 and to provide a portion of the costs of benefits under the Badger Care health care program under s. 49.665.

SB490, s. 6 Section 6. 20.435 (4) (xe) of the statutes is created to read:

SB490,5,25 20.435 (4) (xe) Hospital assessment fund; transfer. From the hospital assessment fund, a sum sufficient, equal to $60,000,000 in the 2008-09 fiscal year, to be transferred to the injured patients and families compensation fund on December 1, 2008; equal to $65,000,000 in the 2009-10 fiscal year, to be transferred to the injured patients and families compensation fund on December 1, 2009; equal to $65,000,000 in the 2010-11 fiscal year, to be transferred to the injured patients and families compensation fund on December 1, 2010; and equal to $10,000,000 in the 2011-12 fiscal year, to be transferred to the injured patients and families compensation fund on December 1, 2011.

SB490, s. 7 Section 7. 20.435 (4) (xe) of the statutes, as created by 2007 Wisconsin Act .... (this act), is repealed.

SB490, s. 8 Section 8. 25.17 (1) (gs) of the statutes is created to read:

SB490,6,4 25.17 (1) (gs) Hospital assessment fund (s. 25.772);

SB490, s. 9 Section 9. 25.772 of the statutes is created to read:

SB490,6,8 25.772 Hospital assessment fund. There is established a separate nonlapsible trust fund designated as the hospital assessment fund, to consist of all moneys received under s. 50.375 from assessments on hospitals.

SB490, s. 10 Section 10. 46.27 (9) (a) of the statutes is amended to read:

SB490,6,18 46.27 (9) (a) The department may select up to 5 counties that volunteer to participate in a pilot project under which they will receive certain funds allocated for long-term care. The department shall allocate a level of funds to these counties equal to the amount that would otherwise be paid under s. 20.435 (4) (b), (gp), or (w), or (xd), to nursing homes for providing care because of increased utilization of nursing home services, as estimated by the department. In estimating these levels, the department shall exclude any increased utilization of services provided by state centers for the developmentally disabled. The department shall calculate these amounts on a calendar year basis under sub. (10).

SB490, s. 11 Section 11. 46.27 (10) (a) 1. of the statutes is amended to read:

SB490,6,25 46.27 (10) (a) 1. The department shall determine for each county participating in the pilot project under sub. (9) a funding level of state medical assistance expenditures to be received by the county. This level shall equal the amount that the department determines would otherwise be paid under s. 20.435 (4) (b), (gp), or (w), or (xd), or because of increased utilization of nursing home services, as estimated by the department.

SB490, s. 12 Section 12. 46.275 (5) (a) of the statutes is amended to read:

SB490,7,7 46.275 (5) (a) Medical Assistance reimbursement for services a county, or the department under sub. (3r), provides under this program is available from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd). If 2 or more counties jointly contract to provide services under this program and the department approves the contract, Medical Assistance reimbursement is also available for services provided jointly by these counties.

SB490, s. 13 Section 13. 46.275 (5) (c) of the statutes is amended to read:

SB490,7,15 46.275 (5) (c) The total allocation under s. 20.435 (4) (b), (gp), (o), and (w), and (xd) to counties and to the department under sub. (3r) for services provided under this section may not exceed the amount approved by the federal department of health and human services. A county may use funds received under this section only to provide services to persons who meet the requirements under sub. (4) and may not use unexpended funds received under this section to serve other developmentally disabled persons residing in the county.

SB490, s. 14 Section 14. 46.283 (5) of the statutes is amended to read:

SB490,7,21 46.283 (5) Funding. From the appropriation accounts under s. 20.435 (4) (b), (bm), (gp), (pa), and (w), and (xd) and (7) (b), (bd), and (md), the department may contract with organizations that meet standards under sub. (3) for performance of the duties under sub. (4) and shall distribute funds for services provided by resource centers.

SB490, s. 15 Section 15. 46.284 (5) (a) of the statutes, as affected by 2007 Wisconsin Act 20, is amended to read:

SB490,8,5 46.284 (5) (a) From the appropriation accounts under s. 20.435 (4) (b), (g), (gp), (im), (o), and (w), and (xd) and (7) (b), (bd), and (g), the department shall provide funding on a capitated payment basis for the provision of services under this section. Notwithstanding s. 46.036 (3) and (5m), a care management organization that is under contract with the department may expend the funds, consistent with this section, including providing payment, on a capitated basis, to providers of services under the family care benefit.

SB490, s. 16 Section 16. 46.485 (2g) (intro.) of the statutes is amended to read:

SB490,8,12 46.485 (2g) (intro.) From the appropriation accounts under s. 20.435 (4) (b) and (gp) (xd), the department may in each fiscal year transfer funds to the appropriation under s. 20.435 (7) (kb) for distribution under this section and from the appropriation account under s. 20.435 (7) (mb) the department may not shall distribute more than $1,330,500 in each fiscal year to applying counties in this state that meet all of the following requirements, as determined by the department:

SB490, s. 17 Section 17. 49.45 (2) (a) 17. of the statutes is amended to read:

SB490,8,18 49.45 (2) (a) 17. Notify the governor, the joint committee on legislative organization, the joint committee on finance and appropriate standing committees, as determined by the presiding officer of each house, if the appropriation accounts under s. 20.435 (4) (b) and (gp) (xd) are insufficient to provide the state share of medical assistance.

SB490, s. 18 Section 18. 49.45 (5m) (ag) of the statutes is repealed.

SB490, s. 19 Section 19. 49.45 (5m) (am) of the statutes is amended to read:

SB490,9,5 49.45 (5m) (am) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), (xc), (xd), and (w), the department shall distribute not more than $2,256,000 in each fiscal year 2007-08 and not more than $5,256,000 in fiscal year 2008-09 and each fiscal year thereafter, 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).

SB490, s. 20 Section 20. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:

SB490,9,13 49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this subsection made under s. 20.435 (4) (b), (gp), (o), (pa), or (w), or (xd) 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:

SB490, s. 21 Section 21. 49.45 (6v) (b) of the statutes is amended to read:

SB490,9,20 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), and (xd).

SB490, s. 22 Section 22. 49.45 (6x) (a) of the statutes is amended to read:

SB490,9,25 49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd), the department shall distribute not more than $4,748,000 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).

SB490, s. 23 Section 23. 49.45 (6y) (a) of the statutes is amended to read:

SB490,10,13 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd), the department shall may 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).

SB490, s. 24 Section 24. 49.45 (6y) (am) of the statutes is amended to read:

SB490,10,21 49.45 (6y) (am) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (h), (gp), (o), and (w), and (xd), 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).

SB490, s. 25 Section 25. 49.45 (6z) (a) (intro.) of the statutes, as affected by 2007 Wisconsin Act 20, is amended to read:

SB490,11,10 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd), the department may distribute funding in each fiscal year to supplement payment for services to hospitals that enter into indigent care agreements, in accordance with the approved state plan for services under 42 USC 1396a, with relief agencies that administer the medical 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 indigent care agreements. The department may not distribute funds under this subsection to the extent that the distribution would do any of the following:

SB490, s. 26 Section 26. 49.45 (8) (b) of the statutes is amended to read:

SB490,11,16 49.45 (8) (b) Reimbursement under s. 20.435 (4) (b), (gp), (o), and (w), and (xd) 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).

SB490, s. 27 Section 27. 49.45 (24m) (intro.) of the statutes is amended to read:

SB490,11,22 49.45 (24m) (intro.) From the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd), 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:

SB490, s. 28 Section 28. 49.45 (52) of the statutes is amended to read:

SB490,12,9 49.45 (52) Payment adjustments. Beginning on January 1, 2003, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payment adjustments to county departments under s. 46.215, 46.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01 (4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16. Payment adjustments under this subsection shall include the state share of the payments. The total of any payment adjustments under this subsection and Medical Assistance payments made from appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd) may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

SB490, s. 29 Section 29. 49.45 (58) of the statutes is created to read:

SB490,12,25 49.45 (58) Health maintenance organization payments to hospitals. (a) The department shall establish a schedule of amounts that each health maintenance organization that contracts with the department to provide medical assistance services or services under s. 49.665 for a capitated payment rate shall pay monthly to each hospital that serves recipients of medical assistance services or recipients of services under s. 49.665. The amounts shall be based on any increase in the capitated rate that the department pays a health maintenance organization, which increase is intended to cover inpatient and outpatient hospital services and which is associated with the assessment imposed on hospitals under s. 50.375. The department shall use the information that it uses to calculate the capitated rates that the department pays health maintenance organizations and encounter data that is provided by the health maintenance organizations to calculate the amounts in the schedule. The department shall disclose publicly the methodology it uses to calculate the amounts in the schedule. The department shall recalculate the amounts in the schedule at least once every 12 months.

SB490,13,4 (b) The department shall require, as a term of contracts with health maintenance organizations to provide medical assistance services or services under s. 49.665 for a capitated payment rate, that the health maintenance organization do all of the following:

SB490,13,5 1. Monthly pay hospitals the applicable amounts in the schedule under par. (a).

SB490,13,11 2. For each hospital to which the health maintenance organization makes payments under subd. 1., calculate the amount that results from applying the rate increase derived using the methodology under par. (a) to services for which the hospital submits claims to the health maintenance organization for providing inpatient and outpatient services to recipients of medical assistance and recipients of services under s. 49.665.

SB490,13,17 3. Every 6 months, and for each hospital to which the health maintenance organization makes payments under subd. 1, compare the amount that the health maintenance organization paid the hospital under subd. 1. for the previous 6 months with the amount calculated under subd. 2. for services provided during that same period, and, if the amount under subd. 2. exceeds the amount of the payments under subd. 1., pay the hospital the difference within 90 days.

SB490,13,22 (c) If the total payments that a health maintenance organization made to a hospital under par. (b) 1. for a 6 month period exceed the amount calculated under par. (b) 2. for services provided during that same period, the hospital shall pay the health maintenance organization the difference within 90 days after the end of the 6-month period.

SB490,14,5 (d) If the department determines that a health maintenance organization has not complied with a condition under par. (b), the department shall require the health maintenance organization to comply with the condition within 15 days after the department's determination. The department may terminate a contract with a health maintenance organization to provide medical assistance services or services under s. 49.665 for a capitated payment rate for failure to comply with a condition under par. (b). The department may audit health maintenance organizations to determine whether they have complied with the conditions under par. (b).

SB490,14,14 (e) If a health maintenance organization and hospital cannot resolve the amount that a health maintenance organization owes a hospital under par. (b) 3. or that a hospital owes a health maintenance organization under par. (c), and either the health maintenance organization or the hospital, within 6 months after the end of the time period to which the disputed amount relates, requests that the department determine the amount owed, the department shall determine the amount within 90 days after the request is made. The health maintenance organization or hospital is, upon request, entitled to a contested case hearing under ch. 227 on the department's determination.

SB490, s. 30 Section 30. 49.472 (6) (a) of the statutes is amended to read:

SB490,14,21 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account under s. 20.435 (4) (b), (gp), or (w), or (xd), 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.

SB490, s. 31 Section 31. 49.472 (6) (b) of the statutes is amended to read:

SB490,15,2 49.472 (6) (b) If federal financial participation is available, from the appropriation account under s. 20.435 (4) (b), (gp), or (w), or (xd), 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).

SB490, s. 32 Section 32. 49.473 (5) of the statutes is amended to read:

SB490,15,8 49.473 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b), (gp), and (o), and (xd), 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).

SB490, s. 33 Section 33. 50.375 of the statutes is created to read:

SB490,15,15 50.375 Assessment. (1) Except as provided in subs. (2) and (7), for the privilege of doing business in this state, there is imposed on each hospital an annual assessment, based on the hospital's gross patient revenue, that each hospital shall pay quarterly before September 30, December 31, March 31, and June 30 of each year, beginning with the payment due before September 30, 2008. The assessments shall be deposited into the hospital assessment fund.

SB490,15,20 (2) At the discretion of the department, a hospital that is unable timely to make a payment by a date specified under sub. (1) may be allowed to make a delayed payment. A determination by the department that a hospital may not make a delayed payment under this subsection is final and is not subject to review under ch. 227.

SB490,15,23 (3) The amount of each hospital's assessment shall be based on the information that shall be provided to the department under s. 153.46 (5) or shall be based on any other source that is approved in the state plan for services under 42 USC 1396.

SB490,16,4 (4) The department shall verify the amount of each hospital's gross patient revenue and shall determine the amount of the assessment owed by each hospital based on a uniform rate that is applicable to total gross patient revenue that the department estimates will yield the amounts specified in the appropriation schedule under s. 20.005 (3) for the appropriation accounts under s. 20.435 (4) (xc), (xd), and (xe).

SB490,16,6 (5) The department shall levy, enforce, and collect the assessments under this section and shall develop and distribute forms necessary for these purposes.

SB490,16,11 (6) If the department determines that any portion of the revenue needed to provide Medical Assistance payment increases for inpatient and outpatient hospital services as fee for service or through health maintenance organizations is not eligible for federal financial participation, the department will refund that amount of revenue to hospitals in proportion to each hospital's payment of the assessment.

SB490,16,13 (7) This section does not apply to a critical access hospital, as defined in s. 50.33 (1g), or to an institution for mental diseases, as defined in s. 46.011 (1m).

SB490,16,18 (8) 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 section, except that the amount of any assessment collected under sub. (1) shall be deposited in the Medical Assistance trust fund.

SB490,16,21 (9) By December 31, 2009, and by every December 31 thereafter, the department shall report to the joint committee on finance all of the following information for the immediately previous state fiscal year:

SB490,16,22 (a) The total amount of assessments collected under this section.

SB490,16,24 (b) The total amount of assessments collected from each hospital under this section.

SB490,17,2 (c) The total amounts that the department determines were paid to health maintenance organizations for increased Medical Assistance payments to hospitals.

SB490,17,4 (d) The total amount of payments made to each hospital by health maintenance organizations under s. 49.45 (58) (b) 1.

SB490,17,8 (e) The total amount of Medical Assistance payments made to each hospital and the portion of the Medical Assistance capitated payments made to health maintenance organizations for inpatient and outpatient hospital services from appropriation accounts of general purpose revenues.

SB490,17,9 (f) The total amounts obtained under pars. (c) and (e).

SB490,17,12 (g) The results of any audits conducted by the department under s. 49.45 (58) concerning Medical Assistance payments and any actions taken by the department as a result of such an audit.

SB490, s. 34 Section 34. 50.375 (4) of the statutes, as created by 2007 Wisconsin Act .... (this act), is amended to read:

SB490,17,20 50.375 (4) The department shall verify the amount of each hospital's gross patient revenue and shall determine the amount of the assessment owed by each hospital based on a uniform rate that is applicable to total gross patient revenue that the department estimates will yield the amounts specified in the appropriation schedule under s. 20.005 (3) for the appropriation accounts under s. 20.435 (4) (xc), and (xd), and (xe).

SB490, s. 35 Section 35. 146.99 of the statutes is repealed.

SB490, s. 36 Section 36. Effective dates. This act takes effect on July 1, 2008, except as follows: