AB40: Bill Text

AB40, s. 1411 Section 1411 . 49.197 (5) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB40,652,25 49.197 (5) Contracts for medical assistance and food stamps. Notwithstanding s. 49.845 (1) and (2), the department of health services may contract with the department to investigate suspected fraudulent activity on the part of recipients of medical assistance under subch. IV, food stamp benefits under the food stamp program under 7 USC 2011 to 2036, and health care benefits under the Badger Care health care program under s. 49.665 and to conduct activities to reduce payment errors in the Medical Assistance program under subch. IV, the food stamp program under 7 USC 2011 to 2036, and the Badger Care health care program under s. 49.665, as provided in this section.

AB40, s. 1412 Section 1412. 49.22 (6) of the statutes is amended to read:

AB40,653,10 49.22 (6) The department shall establish, pursuant to federal and state laws, rules and regulations, a uniform system of fees for services provided under this section to individuals not receiving aid under s. 48.645, 49.19, 49.47, or 49.471; benefits under s. 49.148, 49.155, or 49.79 49.37; foster care maintenance payments under 42 USC 670 to 679a; or kinship care payments under s. 48.57 (3m) or long-term kinship care payments under s. 48.57 (3n). The system of fees may take into account an individual's ability to pay. Any fee paid and collected under this subsection may be retained by the county providing the service except for the fee specified in 42 USC 653 (e) (2) for federal parent locator services.

AB40, s. 1413 Section 1413. 49.26 (1) (g) 12. of the statutes is repealed.

AB40, s. 1414 Section 1414. 49.26 (1) (gm) 1. c. of the statutes is amended to read:

AB40,653,15 49.26 (1) (gm) 1. c. Dropouts, as defined in s. 118.153 (1) (b) 115.001 (2m), including individuals who were dropouts and reenrolled in school in the same or immediately succeeding semester in which they dropped out of school.

AB40, s. 1415 Section 1415. 49.265 (4) (a) of the statutes is amended to read:

AB40,653,19 49.265 (4) (a) The department shall distribute the federal community services block grant funds received under 42 USC 9903 and deposited in credited to the appropriations appropriation account under s. 20.437 (1) (mc) and (md) (2) (mg).

AB40, s. 1416 Section 1416. 49.32 (7) (b) of the statutes is amended to read:

AB40,654,4 49.32 (7) (b) The department shall conduct a program to periodically match the records of recipients of aid to families with dependent children under s. 49.19 and recipients of benefits under the supplemental nutrition assistance program under 7 USC 2011 to 2036 and, if the department of health services contracts with the department under s. 49.197 (5), recipients of medical assistance under subch. IV and food stamp benefits under the food stamp program under 7 USC 2011 to 2036 with the records of recipients under those programs in other states. If an agreement with the other states can be obtained, matches with records of states contiguous to this state shall be conducted at least annually.

AB40, s. 1417 Section 1417. 49.32 (7) (c) of the statutes is amended to read:

AB40,654,13 49.32 (7) (c) The department shall conduct a program to periodically match review the address records of recipients of aid to families with dependent children under s. 49.19 and recipients of benefits under the supplemental nutrition assistance program under 7 USC 2011 to 2036 and, if the department of health services contracts with the department under s. 49.197 (5), recipients of medical assistance under subch. IV and food stamp benefits under the food stamp program under 7 USC 2011 to 2036 to verify residency and to identify recipients receiving duplicate or fraudulent payments.

AB40, s. 1418 Section 1418. 49.32 (7) (d) of the statutes is amended to read:

AB40,654,23 49.32 (7) (d) The department, with assistance from the department of corrections, shall conduct a program to periodically match the records of persons confined in state correctional facilities with the records of recipients of aid to families with dependent children under s. 49.19 and benefits under the supplemental nutrition assistance program under 7 USC 2011 to 2036 and, if the department of health services contracts with the department under s. 49.197 (5), recipients of medical assistance under subch. IV and food stamp benefits under the food stamp program under 7 USC 2011 to 2036 to identify recipients who may be ineligible for benefits.

AB40, s. 1419 Section 1419. 49.32 (10) (a) (intro.) of the statutes is amended to read:

AB40,655,6 49.32 (10) (a) (intro.) Each county department under s. 46.215, 46.22, or 46.23 may release the current address of a recipient of food stamps supplemental nutrition assistance program benefits under s. 49.37 or of aid under s. 49.19, and each Wisconsin works agency may release the current address of a participant in Wisconsin works under ss. 49.141 to 49.161, to a law enforcement officer if the officer meets all of the following conditions:

AB40, s. 1420 Section 1420. 49.35 (1) (bm) of the statutes is amended to read:

AB40,655,18 49.35 (1) (bm) All records of the department relating to aid provided under s. 49.19 or 49.39 are open to inspection at reasonable hours by members of the legislature who require the information contained in the records in pursuit of a specific state legislative purpose. All records of any county relating to aid provided under s. 49.19 or 49.39 are open to inspection at reasonable hours by members of the board of supervisors of the county or the governing body of a city, village or town located in the county who require the information contained in the records in pursuit of a specific county or municipal legislative purpose. The right to records access provided by this paragraph does not apply if access is prohibited by federal law or regulation or if this state is required to prohibit such access as a condition precedent to participation in a federal program in which this state participates.

AB40, s. 1421 Section 1421. 49.37 (1m) of the statutes is created to read:

AB40,655,23 49.37 (1m) Administration by department. The department shall administer, and may enter into contracts for the administration of, the supplemental nutrition assistance program in this state. Administration of the supplemental nutrition assistance program includes all of the following:

AB40,655,24 (a) Receiving applications.

AB40,655,25 (b) Determining eligibility.

AB40,656,1 (c) Conducting fraud investigation and fraud prevention activities.

AB40,656,2 (d) Implementing error reduction procedures.

AB40,656,3 (e) Recovering overpayments of benefits.

AB40, s. 1422 Section 1422. 49.43 (1e) of the statutes is amended to read:

AB40,656,10 49.43 (1e) "Accommodated person" means any person in a hospital or in a skilled nursing facility or intermediate care facility, as defined in Title XIX of the social security act, who would have been eligible for benefits under s. 49.19 or 49.77 49.39 or federal Title XVI if the person were not in such a hospital or facility, and any person in such an institution who can be found eligible for Title XIX under the social security act.

AB40, s. 1423 Section 1423. 49.45 (2) (a) 3. of the statutes is amended to read:

AB40,656,16 49.45 (2) (a) 3. Determine the eligibility of persons for medical assistance, rehabilitative, and social services under ss. 49.46, 49.468, 49.47, and 49.471 and rules and policies adopted by the department and may, under a contract under s. 49.78 (2), delegate all, or any portion, of this function to the county department under s. 46.215, 46.22, or 46.23 or a tribal governing body.

AB40, s. 1424 Section 1424. 49.45 (3) (a) of the statutes is amended to read:

AB40,656,22 49.45 (3) (a) Reimbursement shall be made to each county department under ss. 46.215, 46.22, and 46.23 for any administrative services performed in the Medical Assistance program on the basis of s. 49.78 (8). For purposes of reimbursement under this paragraph, assessments completed under s. 46.27 (6) (a) are administrative services performed in the Medical Assistance program.

AB40, s. 1425 Section 1425. 49.45 (5) (b) 1. (intro.) of the statutes is amended to read:

AB40,657,13 49.45 (5) (b) 1. (intro.) Upon receipt of a timely petition under par. (a) the department shall give the applicant or recipient reasonable notice and opportunity for a fair hearing. The department may make such additional investigation as it considers necessary. Notice of the hearing shall be given to the applicant or recipient and, if a county department under s. 46.215, 46.22, or 46.23 is responsible for making made the medical assistance determination, to the county clerk of the county. The county may be represented at such hearing. The department shall render its decision as soon as possible after the hearing and shall send a certified copy of its decision to the applicant or recipient, and to the county clerk, and to any county officer charged with administration of the Medical Assistance program. The decision of the department shall have the same effect as an order of a county officer charged with the administration of the Medical Assistance program of the county that made the medical assistance determination. The decision shall be final, but may be revoked or modified as altered conditions may require. The department shall deny a petition for a hearing or shall refuse to grant relief if:

AB40, s. 1426 Section 1426. 49.45 (5) (b) 2. (intro.) of the statutes is amended to read:

AB40,657,23 49.45 (5) (b) 2. (intro.) If a recipient requests a hearing within the timely notice period specified in 42 CFR 431.231 (c), medical assistance coverage shall not be suspended, reduced, or discontinued until a decision is rendered after the hearing but medical assistance payments made pending the hearing decision may be recovered by the department if the contested decision or failure to act is upheld. If a county department is responsible for making made the medical assistance determination, the department shall notify the county department of the county in which the recipient resides that the recipient has requested a hearing. Medical assistance coverage shall be suspended, reduced, or discontinued if:

AB40, s. 1427 Section 1427. 49.45 (5m) (am) of the statutes is amended to read:

AB40,658,7 49.45 (5m) (am) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gm), (o), (w) and (xc), the department shall distribute not more than $5,000,000 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, except that the department may not distribute funds to a rural hospital to the extent that the distribution would exceed any limitation under 42 USC 1396b (i) (3).

AB40, s. 1428 Section 1428. 49.45 (6m) (a) 6. of the statutes is amended to read:

AB40,658,12 49.45 (6m) (a) 6. "Resource Utilization Groupings III" means a comparative resource utilization grouping that classifies each facility resident based on information obtained from performing, for the resident, a minimum data set assessment developed by the federal Centers for Medicare and Medicaid Services.

AB40, s. 1429 Section 1429. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:

AB40,658,20 49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this subsection made under s. 20.435 (4) (b), (gm), (o), (pa), or (w) 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:

AB40, s. 1430 Section 1430. 49.45 (6m) (ag) 3p. a. of the statutes is amended to read:

AB40,658,24 49.45 (6m) (ag) 3p. a. The system shall may incorporate acuity measurements under the most recent Resource Utilization Groupings III methodology to determine factors for case-mix adjustment.

AB40, s. 1431 Section 1431. 49.45 (6tw) of the statutes is amended to read:

AB40,659,7 49.45 (6tw) Payments to city health departments. From the appropriation account under s. 20.435 (7) (b), if the department selects the payment procedure under s. 49.45 (52) (a), the department may make payments to local health departments, as defined under s. 250.01 (4) (a) 3. Payment under this subsection to such a local health department may not exceed on an annualized basis payment made by the department to the local health department under s. 49.45 (6t), 2003 stats., for services provided by the local health department in 2002.

AB40, s. 1432 Section 1432. 49.45 (6v) (b) of the statutes is amended to read:

AB40,659,14 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), (gm), and (o).

AB40, s. 1433 Section 1433. 49.45 (6x) of the statutes is repealed.

AB40, s. 1434 Section 1434. 49.45 (6y) (a) of the statutes is amended to read:

AB40,660,2 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), the department 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).

AB40, s. 1435 Section 1435. 49.45 (6z) (a) (intro.) of the statutes is amended to read:

AB40,660,15 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), 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:

AB40, s. 1436 Section 1436. 49.45 (8) (b) of the statutes is amended to read:

AB40,660,21 49.45 (8) (b) Reimbursement under s. 20.435 (4) (b), (gm), (o), 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).

AB40, s. 1437 Section 1437. 49.45 (8r) of the statutes is amended to read:

AB40,661,4 49.45 (8r) Payment for certain obstetric and gynecological care. The rate of payment for obstetric and gynecological care provided in primary care shortage areas, as defined in s. 36.60 37.60 (1) (cm), or provided to recipients of medical assistance who reside in primary care shortage areas, that is equal to 125% of the rates paid under this section to primary care physicians in primary care shortage areas, shall be paid to all certified primary care providers who provide obstetric or gynecological care to those recipients.

AB40, s. 1438 Section 1438. 49.45 (19) (bm) of the statutes is amended to read:

AB40,661,8 49.45 (19) (bm) The department or the county department under s. 46.215 or 46.22 shall notify applicants of the requirements of this subsection at the time of application.

AB40, s. 1439 Section 1439. 49.45 (24m) (intro.) of the statutes is amended to read:

AB40,661,14 49.45 (24m) (intro.) From the appropriation accounts under s. 20.435 (4) (b), (gm), (o), 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:

AB40, s. 1440 Section 1440. 49.45 (24r) (a) of the statutes is renumbered 49.45 (24r).

AB40, s. 1441 Section 1441. 49.45 (24r) (b) of the statutes is repealed.

AB40, s. 1442 Section 1442. 49.45 (34) of the statutes is amended to read:

AB40,661,22 49.45 (34) Medical assistance manual. The department shall prepare a medical assistance manual that is clear, comprehensive and consistent with this subchapter and 42 USC 1396a to 1396u and shall, no later than July 1, 1992, provide the manual to counties for use by county employees who administer the medical assistance program.

AB40, s. 1443 Section 1443. 49.45 (51) (a) of the statutes is amended to read:

AB40,662,6 49.45 (51) (a) By November 1 annually, the department shall provide to the department of revenue information concerning the estimated amounts of supplements payable from the appropriation accounts under s. 20.435 (4) (b) and (gm) to specific local governmental units for the provision of transportation for medical care, as specified under s. 49.46 (2) (b) 3., during the fiscal year. Beginning November 1, 2004, the information that the department provides under this paragraph shall include any adjustments necessary to reflect actual claims submitted by service providers in the previous fiscal year.

AB40, s. 1444 Section 1444. 49.45 (52) (title) of the statutes is amended to read:

AB40,662,8 49.45 (52) (title) Payment adjustments ; federal funding for certain services.

AB40, s. 1445 Section 1445. 49.45 (52) of the statutes is renumbered 49.45 (52) (a) 1. and amended to read:

AB40,662,24 49.45 (52) (a) 1. Beginning on January 1, 2003 If the department provides the notice under par. (c) selecting the payment procedure in this paragraph, 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., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating in the early intervention program under s. 51.44. Payment adjustments under this subsection paragraph shall include the state share of the payments. The total of any payment adjustments under this subsection paragraph and Medical Assistance payments made from appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

AB40, s. 1446 Section 1446. 49.45 (52) (a) 2. of the statutes is created to read:

AB40,663,4 49.45 (52) (a) 2. The department may require a county department or local health department to submit a certified cost report that meets the requirements of the federal department of health and human services for covered services described in subd. 1.

AB40, s. 1447 Section 1447. 49.45 (52) (b) of the statutes is created to read:

AB40,663,7 49.45 (52) (b) If the department provides the notice under par. (c) selecting the payment procedure in this paragraph, all of the following apply:

AB40,663,13 1. Annually, a county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437 shall submit a certified cost report that meets the requirements of the federal department of health and human services 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., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating in the early intervention program under s. 51.44.

AB40,663,17 2. For services described under subd. 1., the department shall base the amount of a claim for federal medical assistance funds on certified cost reports submitted by county departments under subd. 1. to the extent the reports comply with federal requirements.

AB40,663,20 3. The department shall pay county departments a percentage of the federal funds claimed under subd. 2. for services described under subd. 1., which percentage is established in the most recent biennial budget.

AB40,663,24 4. The department may pay a local health department, as defined in s. 250.01 (4), that submits certified cost reports for services described under subd. 1. a percentage of the federal funds claimed for those services, which percentage is established in the most recent biennial budget.

AB40, s. 1448 Section 1448. 49.45 (52) (c) of the statutes is created to read:

AB40,664,5 49.45 (52) (c) The department shall select a payment procedure under either par. (a) or (b) and may change which procedure under par. (a) or (b) is selected. The department shall notify each county department and local health department, as applicable, of the selected payment procedure before the date on which payment for services is made under that selected or newly selected procedure.

AB40, s. 1449 Section 1449. 49.45 (53) of the statutes is amended to read:

AB40,664,10 49.45 (53) Payments for certain services. Beginning on January 1, 2003, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payments to providers for covered services under ss. 49.46 (2) (a) 4. d. and (b) 6. j. and m. and 49.471 (11) (f) that are provided before January 1, 2012.

AB40, s. 1450 Section 1450. 49.46 (1) (a) 4. of the statutes is amended to read:

AB40,664,13 49.46 (1) (a) 4. Any person receiving benefits under s. 49.77 49.39 or federal Title XVI.

AB40, s. 1451 Section 1451. 49.46 (1) (a) 4m. of the statutes is amended to read:

AB40,664,15 49.46 (1) (a) 4m. Any child for whom a payment is made under s. 49.775 49.395.