Hospital Assessments
The state currently collects an assessment from hospitals based on their gross
inpatient and outpatient revenues. The biennial budget act specifies the total
amount of revenue to be collected from the assessment. The Department of Health
Services (DHS) then sets the assessment rate, which is the same for all hospitals, at
the percentage of gross patient revenue necessary to collect the total revenue amount
specified in the biennial budget act. Critical access hospitals, psychiatric hospitals,
and institutions for mental diseases are exempt from the assessment. A critical
access hospital is, in general, a hospital that provides 24 hour a day emergency care,
has 25 or fewer acute inpatient beds, and is located in a rural area in which there are
no other hospitals.
Current law directs DHS to use a portion of the hospital assessment revenue
to pay hospitals that are subject to the assessment for services provided under the
Medical Assistance Program (MA). Like other provider payments under MA, the
federal government pays a share of these MA payments to hospitals. Current law
requires that the MA payments to hospitals from the assessment revenue, together
with the federal share, equal the amount of the assessment revenue divided by 61.68
percent (i.e., 1.62 times the amount of assessment revenue). The remainder of the
assessment revenue is appropriated for other MA expenditures.
This bill imposes an assessment on the gross inpatient revenues of critical
access hospitals. The rate for the critical access hospital assessment is the same as
the rate of the current hospital assessment. The bill requires that DHS use a portion
of the critical access hospital assessment revenue to pay critical access hospitals for
services provided under MA. Like the current hospital assessment, the bill requires
that the MA payments to critical access hospitals from the critical access hospital
assessment revenue, together with the federal share of payments, equal the amount
of the critical access hospital assessment revenue divided by 61.68 percent. The bill
annually appropriates $1,000,000 of critical access hospital assessment revenue for
health care provider loans and rural physician residency assistance, described below.
The remainder of critical access hospital assessment revenue is appropriated for
other MA expenditures.
The provisions in the bill for payment to critical access hospitals under MA
apply to services provided beginning July 1, 2010. The first critical access hospital
assessment payments are due by September 30, 2010. The bill requires DHS to
submit a state Medicaid plan amendment to the federal government to implement
the critical access hospital assessment as provided for in the bill, and specifies that
if the federal government disapproves the state plan amendment, DHS must
discontinue the assessment on critical access hospitals and refund any critical access
hospital assessment revenue collected in fiscal year 2010-11.
Health care provider loan programs
With certain exceptions, current law authorizes the Board of Regents of the
University of Wisconsin System to repay, on behalf of certain physicians and
dentists, up to $50,000 in educational loans if the physician or dentist agrees to
practice for three years in certain areas of this state. Similarly, the board may repay,
on behalf of certain health care providers (a dental hygienist, physician assistant,
nurse-midwife, or nurse-practitioner), up to $25,000 in educational loans if the
health care provider agrees to practice for three years in certain areas of this state.
This bill provides additional funds for these programs, from critical access
hospital assessment revenues, for certain physicians, dentists, and health care
providers who agree to practice in a rural area of this state. A rural area is a city,
town, or village with a population of less than 20,000 that is at least 15 miles from
any city, town, or village that has a population of at least 20,000, or an area that is
not an urbanized area, as defined by the federal bureau of the census. The bill also
increases the maximum amount of the loan repayment from $50,000 to $100,000 for
a physician who agrees to practice in a rural area.
Rural physician residency assistance program
This bill directs the Department of Family Medicine in the University of
Wisconsin School of Medicine and Public Health to establish and support certain
physician residency positions at hospitals located in rural areas or at clinics staffed
by physicians who admit patients to hospitals located in rural areas, or that include
a rural rotation, begun after June 30, 2010, which consists of at least eight weeks of
training experience in a hospital located in a rural area or in a clinic that is staffed
by physicians who admit patients to a hospital located in a rural area. The positions
are funded with revenue from the critical access hospital assessment.
The bill directs the department annually to submit a plan for increasing the
number of physician residency programs that include a majority of training
experience in a rural area to the Rural Wisconsin Health Cooperative, the Wisconsin
Hospital Association, and the Wisconsin Medical Society. The department must also
annually submit to the Joint Committee on Finance a report indicating the number
of physician residency positions that include a majority of training experience in a
rural area of this state, and information about each such residency position.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB553, s. 1
1Section
1. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
2the following amounts for the purposes indicated:
-
See PDF for table ![PDF](https://docs.legis.wisconsin.gov/assets/image/file_acrobat.gif)
SB553, s. 2
1Section
2. 20.285 (1) (qe) of the statutes is created to read:
SB553,4,52
20.285
(1) (qe)
Rural physician residency assistance program. Biennially, from
3the critical access hospital assessment fund, the amounts in the schedule for the
4department of family medicine in the University of Wisconsin School of Medicine and
5Public Health to establish and support physician residency positions under s. 36.63.
SB553, s. 3
6Section
3. 20.285 (1) (qj) of the statutes is created to read:
SB553,4,107
20.285
(1) (qj)
Physician and dentist and health care provider loan assistance
8programs; critical access hospital assessment fund. Biennially, from the critical
9access hospital assessment fund, the amounts in the schedule for loan repayments
10under ss. 36.60 and 36.61.
SB553, s. 4
11Section
4. 20.435 (4) (w) of the statutes, as affected by 2009 Act Wisconsin 2,
12is amended to read:
SB553,5,413
20.435
(4) (w)
Medical Assistance trust fund. From the Medical Assistance
14trust fund, biennially, the amounts in the schedule for meeting costs of medical
1assistance administered under ss. 46.27, 46.275 (5), 46.278 (6), 46.283 (5), 46.284 (5),
249.45, and 49.472 (6), for refunds under s. 50.38 (6) (a)
and (6m) (a), and for
3administrative costs associated with augmenting the amount of federal moneys
4received under
42 CFR 433.51.
SB553, s. 5
5Section
5. 20.435 (4) (xe) of the statutes is created to read:
SB553,5,126
20.435
(4) (xe)
Critical access hospital assessment fund; hospital payments. 7From the critical access hospital assessment fund, all moneys received from the
8assessment under s. 50.38 (2) (b), except moneys appropriated under s. 20.285 (1) (qe)
9and (qj),
to make payments to critical access hospitals required under s. 49.45 (3) (e)
1012. for services provided under the Medical Assistance Program under subch. IV of
11ch. 49; to make refunds under s. 50.38
(6m); and to make the transfer under s. 50.38
12(10).
SB553, s. 6
13Section
6. 25.17 (1) (cg) of the statutes is created to read:
SB553,5,1414
25.17
(1) (cg) Critical access hospital assessment fund (s. 25.774);
SB553,5,1717
25.77
(11) All moneys transferred under s. 50.38 (8)
and (10).
SB553,5,2120
25.77
(12) All moneys recouped and deposited under s. 50.38 (6) (a)
4. and (6m)
21(a) 4.
SB553,6,3
2425.772 Hospital assessment fund. There is established a separate
25nonlapsible trust fund designated as the hospital assessment fund, to consist of all
1moneys received under s. 50.38 (2)
(a) from assessments on hospitals
other than
2critical access hospitals and all moneys recouped and deposited under s. 50.38 (6) (a)
33.
SB553, s. 10
4Section
10. 25.774 of the statutes is created to read:
SB553,6,9
525.774 Critical access hospital assessment fund. (1) There is established
6a separate nonlapsible trust fund designated as the critical access hospital
7assessment fund, to consist of all moneys received under s. 50.38 (2) (b) from
8assessments on critical access hospitals and all moneys recouped and deposited
9under s. 50.38 (6m) (a) 3.
SB553, s. 11
10Section
11. 36.60 (1) (d) of the statutes is created to read:
SB553,6,1111
36.60
(1) (d) "Rural area" has the meaning given in s. 36.63 (1) (c).
SB553,6,1814
36.60
(2) (a) 1.
The Except as provided in subd. 2., the board may repay, on
15behalf of a physician or dentist, up to $50,000 in educational loans obtained by the
16physician or dentist from a public or private lending institution for education in an
17accredited school of medicine or dentistry or for postgraduate medical or dental
18training.
SB553, s. 13
19Section
13. 36.60 (2) (a) 2. of the statutes is created to read:
SB553,6,2320
36.60
(2) (a) 2. The board may repay, on behalf of a physician who agrees under
21sub. (3) to practice in a rural area, up to $100,000 in educational loans obtained by
22the physician from a public or private lending institution for education in an
23accredited school of medicine or for postgraduate medical training.
SB553,7,10
136.60
(3) Agreement. (a) The board shall enter into a written agreement with
2the physician, in which the physician agrees to practice at least 32 clinic hours per
3week for 3 years in one or more eligible practice areas in this state
or in a rural area,
4except that a physician specializing in psychiatry may only agree to practice
5psychiatry in a mental health shortage area
or in a rural area and a physician in the
6expanded loan assistance program under sub. (9) may only agree to practice at a
7public or private nonprofit entity in a health professional shortage area. The
8physician shall also agree to care for patients who are insured or for whom health
9benefits are payable under medicare, medical assistance, or any other governmental
10program.
SB553,7,1511
(am) The board shall enter into a written agreement with the dentist, in which
12the dentist agrees to practice at least 32 clinic hours per week for 3 years in one or
13more dental health shortage areas in this state
or in a rural area. The dentist shall
14also agree to care for patients who are insured or for whom dental health benefits are
15payable under medicare, medical assistance, or any other governmental program.
SB553,7,1816
(b) The agreement shall specify that the responsibility of the board to make the
17payments under the agreement is subject to the availability of funds in the
18appropriations under s. 20.285 (1) (jc)
and, (ks)
, and (qj).
SB553,7,2321
36.60
(4) Loan repayment. (intro.)
Principal Except as provided in sub. (4m),
22principal and interest due on loans, exclusive of any penalties, may be repaid by the
23board at the following rate:
SB553, s. 16
24Section
16. 36.60 (4m) of the statutes is created to read:
SB553,8,3
136.60
(4m) Loan repayment; rural physicians. If a physician agrees under sub.
2(3) to practice in a rural area, principal and interest due on the loan, exclusive of any
3penalties, may be repaid by the board at the following rate:
SB553,8,54
(a) Up to 40 percent of the principal of the loan or $40,000, whichever is less,
5during the first year of participation in the program under this section.
SB553,8,86
(b) Up to an additional 40 percent of the principal of the loan or $40,000,
7whichever is less, during the 2nd year of participation in the program under this
8section.
SB553,8,119
(c) Up to an additional 20 percent of the principal of the loan or $20,000,
10whichever is less, during the 3rd year of participation in the program under this
11section.
SB553,8,1614
36.60
(5) (a) The obligation of the board to make payments under an agreement
15entered into under sub. (3) (b) is subject to the availability of funds in the
16appropriations under s. 20.285 (1) (jc)
and, (ks)
, and (qj).
SB553,8,2319
36.60
(5) (b) (intro.) If the cost of repaying the loans of all eligible applicants,
20when added to the cost of loan repayments scheduled under existing agreements,
21exceeds the total amount in the appropriations under s. 20.285 (1) (jc)
and, (ks)
, and
22(qj), the board shall establish priorities among the eligible applicants based upon the
23following considerations:
SB553,9,5
136.60
(5) (b) 1. The degree to which there is an extremely high need for medical
2care in the eligible practice area
or, health professional shortage area
, or rural area 3in which a physician desires to practice and the degree to which there is an extremely
4high need for dental care in the dental health shortage area
or rural area in which
5a dentist desires to practice.
SB553,9,118
36.60
(5) (b) 2. The likelihood that a physician will remain in the eligible
9practice area
or, health professional shortage area
, or rural area, and that a dentist
10will remain in the dental health shortage area
or rural area, in which he or she
11desires to practice after the loan repayment period.
SB553,9,1614
36.60
(5) (b) 3. The per capita income of the eligible practice area
or, health
15professional shortage area
, or rural area in which a physician desires to practice and
16of the dental health shortage area
or rural area in which a dentist desires to practice.
SB553,9,2419
36.60
(5) (b) 4. The financial or other support for physician recruitment and
20retention provided by individuals, organizations, or local governments in the eligible
21practice area
or, health professional shortage area
, or rural area in which a physician
22desires to practice and for dentist recruitment and retention provided by individuals,
23organizations, or local governments in the dental health shortage area
or rural area 24in which a dentist desires to practice.
SB553,10,73
36.60
(5) (b) 5. The geographic distribution of the physicians and dentists who
4have entered into loan repayment agreements under this section and the geographic
5distribution of the eligible practice areas, health professional shortage areas,
and 6dental health shortage areas
, and rural areas in which the eligible applicants desire
7to practice.
SB553,10,1210
36.60
(8) (b) Identify eligible practice areas
and rural areas with an extremely
11high need for medical care and dental health shortage areas
and rural areas with an
12extremely high need for dental care.
SB553, s. 25
13Section
25. 36.60 (8) (h) of the statutes is created to read:
SB553,10,1614
36.60
(8) (h) Notwithstanding subs. (3) (b) and (5) (a) and (b), ensure that
15moneys appropriated under s. 20.285 (1) (qj) are used under this section only to repay
16loans on behalf of physicians and dentists who agree to practice in a rural area.
SB553, s. 26
17Section
26. 36.61 (1) (e) of the statutes is created to read:
SB553,10,1818
36.61
(1) (e) "Rural area" has the meaning given in s. 36.63 (1) (c).
SB553,11,221
36.61
(3) Agreement. (a) The board shall enter into a written agreement with
22the health care provider. In the agreement, the health care provider shall agree to
23practice at least 32 clinic hours per week for 3 years in one or more eligible practice
24areas in this state
or in a rural area, except that a health care provider in the
25expanded loan assistance program under sub. (8) who is not a dental hygienist may
1only agree to practice at a public or private nonprofit entity in a health professional
2shortage area.
SB553,11,53
(b) The agreement shall specify that the responsibility of the board to make the
4payments under the agreement is subject to the availability of funds in the
5appropriations under s. 20.285 (1) (jc)
and, (ks)
, and (qj).
SB553,11,108
36.61
(5) (a) The obligation of the board to make payments under an agreement
9entered into under sub. (3) is subject to the availability of funds in the appropriations
10under s. 20.285 (1) (jc)
and, (ks)
, and (qj).
SB553,11,1713
36.61
(5) (b) (intro.) If the cost of repaying the loans of all eligible applicants,
14when added to the cost of loan repayments scheduled under existing agreements,
15exceeds the total amount in the appropriations under s. 20.285 (1) (jc)
and, (ks)
, and
16(qj), the board shall establish priorities among the eligible applicants based upon the
17following considerations:
SB553,11,2520
36.61
(5) (b) 1. The degree to which there is an extremely high need for medical
21care in the eligible practice area
or, health professional shortage area
, or rural area 22in which an eligible applicant who is not a dental hygienist desires to practice and
23the degree to which there is an extremely high need for dental care in the dental
24health shortage area
or rural area in which an eligible applicant who is a dental
25hygienist desires to practice.
SB553,12,53
36.61
(5) (b) 2. The likelihood that an eligible applicant will remain in the
4eligible practice area
or, health professional shortage area
, or rural area in which he
5or she desires to practice after the loan repayment period.
SB553,12,108
36.61
(5) (b) 3. The per capita income of the eligible practice area
or, health
9professional shortage area
, or rural area in which an eligible applicant desires to
10practice.
SB553,12,1613
36.61
(5) (b) 4. The financial or other support for health care provider
14recruitment and retention provided by individuals, organizations or local
15governments in the eligible practice area
or, health professional shortage area
, or
16rural area in which an eligible applicant desires to practice.
SB553,12,2219
36.61
(5) (b) 5. The geographic distribution of the health care providers who
20have entered into loan repayment agreements under this section and the geographic
21location of the eligible practice area
or, health professional shortage area
, or rural
22area in which an eligible applicant desires to practice.
SB553, s. 35
23Section
35. 36.61 (7) (e) of the statutes is created to read:
SB553,13,3
136.61
(7) (e) Notwithstanding subs. (3) (b) and (5) (a) and (b), ensure that
2moneys appropriated under s. 20.285 (1) (qj) are used under this section only to repay
3loans on behalf of health care providers who agree to practice in a rural area.