AB40, s. 1411 15Section 1411 . 49.197 (5) of the statutes, as affected by 2011 Wisconsin Act ....
16(this act), is amended to read:
AB40,652,2517 49.197 (5) Contracts for medical assistance and food stamps.
18Notwithstanding s. 49.845 (1) and (2), the department of health services may
19contract with the department to investigate suspected fraudulent activity on the
20part of recipients of medical assistance under subch. IV, food stamp benefits under
21the food stamp program under 7 USC 2011 to 2036,
and health care benefits under
22the Badger Care health care program under s. 49.665 and to conduct activities to
23reduce payment errors in the Medical Assistance program under subch. IV, the food
24stamp program under 7 USC 2011 to 2036,
and the Badger Care health care program
25under s. 49.665, as provided in this section.
AB40, s. 1412
1Section 1412. 49.22 (6) of the statutes is amended to read:
AB40,653,102 49.22 (6) The department shall establish, pursuant to federal and state laws,
3rules and regulations, a uniform system of fees for services provided under this
4section to individuals not receiving aid under s. 48.645, 49.19, 49.47, or 49.471;
5benefits under s. 49.148, 49.155, or 49.79 49.37; foster care maintenance payments
6under 42 USC 670 to 679a; or kinship care payments under s. 48.57 (3m) or
7long-term kinship care payments under s. 48.57 (3n). The system of fees may take
8into account an individual's ability to pay. Any fee paid and collected under this
9subsection may be retained by the county providing the service except for the fee
10specified in 42 USC 653 (e) (2) for federal parent locator services.
AB40, s. 1413 11Section 1413. 49.26 (1) (g) 12. of the statutes is repealed.
AB40, s. 1414 12Section 1414. 49.26 (1) (gm) 1. c. of the statutes is amended to read:
AB40,653,1513 49.26 (1) (gm) 1. c. Dropouts, as defined in s. 118.153 (1) (b) 115.001 (2m),
14including individuals who were dropouts and reenrolled in school in the same or
15immediately succeeding semester in which they dropped out of school.
AB40, s. 1415 16Section 1415. 49.265 (4) (a) of the statutes is amended to read:
AB40,653,1917 49.265 (4) (a) The department shall distribute the federal community services
18block grant funds received under 42 USC 9903 and deposited in credited to the
19appropriations appropriation account under s. 20.437 (1) (mc) and (md) (2) (mg).
AB40, s. 1416 20Section 1416. 49.32 (7) (b) of the statutes is amended to read:
AB40,654,421 49.32 (7) (b) The department shall conduct a program to periodically match the
22records of recipients of aid to families with dependent children under s. 49.19 and
23recipients of benefits under the supplemental nutrition assistance program under 7
24USC 2011
to 2036
and, if the department of health services contracts with the
25department under s. 49.197 (5), recipients of medical assistance under subch. IV and

1food stamp benefits under the food stamp program under 7 USC 2011 to 2036
with
2the records of recipients under those programs in other states. If an agreement with
3the other states can be obtained, matches with records of states contiguous to this
4state shall be conducted at least annually.
AB40, s. 1417 5Section 1417. 49.32 (7) (c) of the statutes is amended to read:
AB40,654,136 49.32 (7) (c) The department shall conduct a program to periodically match
7review the address records of recipients of aid to families with dependent children
8under s. 49.19 and recipients of benefits under the supplemental nutrition assistance
9program under 7 USC 2011 to 2036
and, if the department of health services
10contracts with the department under s. 49.197 (5), recipients of medical assistance
11under subch. IV and food stamp benefits under the food stamp program under 7 USC
122011
to 2036
to verify residency and to identify recipients receiving duplicate or
13fraudulent payments.
AB40, s. 1418 14Section 1418. 49.32 (7) (d) of the statutes is amended to read:
AB40,654,2315 49.32 (7) (d) The department, with assistance from the department of
16corrections, shall conduct a program to periodically match the records of persons
17confined in state correctional facilities with the records of recipients of aid to families
18with dependent children under s. 49.19 and benefits under the supplemental
19nutrition assistance program under 7 USC 2011 to 2036
and, if the department of
20health services contracts with the department under s. 49.197 (5), recipients of
21medical assistance under subch. IV and food stamp benefits under the food stamp
22program under 7 USC 2011 to 2036
to identify recipients who may be ineligible for
23benefits.
AB40, s. 1419 24Section 1419. 49.32 (10) (a) (intro.) of the statutes is amended to read:
AB40,655,6
149.32 (10) (a) (intro.) Each county department under s. 46.215, 46.22, or 46.23
2may release the current address of a recipient of food stamps supplemental nutrition
3assistance program benefits under s. 49.37
or of aid under s. 49.19, and each
4Wisconsin works agency may release the current address of a participant in
5Wisconsin works under ss. 49.141 to 49.161, to a law enforcement officer if the officer
6meets all of the following conditions:
AB40, s. 1420 7Section 1420. 49.35 (1) (bm) of the statutes is amended to read:
AB40,655,188 49.35 (1) (bm) All records of the department relating to aid provided under s.
949.19 or 49.39 are open to inspection at reasonable hours by members of the
10legislature who require the information contained in the records in pursuit of a
11specific state legislative purpose. All records of any county relating to aid provided
12under s. 49.19 or 49.39 are open to inspection at reasonable hours by members of the
13board of supervisors of the county or the governing body of a city, village or town
14located in the county who require the information contained in the records in pursuit
15of a specific county or municipal legislative purpose. The right to records access
16provided by this paragraph does not apply if access is prohibited by federal law or
17regulation or if this state is required to prohibit such access as a condition precedent
18to participation in a federal program in which this state participates.
AB40, s. 1421 19Section 1421. 49.37 (1m) of the statutes is created to read:
AB40,655,2320 49.37 (1m) Administration by department. The department shall administer,
21and may enter into contracts for the administration of, the supplemental nutrition
22assistance program in this state. Administration of the supplemental nutrition
23assistance program includes all of the following:
AB40,655,2424 (a) Receiving applications.
AB40,655,2525 (b) Determining eligibility.
AB40,656,1
1(c) Conducting fraud investigation and fraud prevention activities.
AB40,656,22 (d) Implementing error reduction procedures.
AB40,656,33 (e) Recovering overpayments of benefits.
AB40, s. 1422 4Section 1422. 49.43 (1e) of the statutes is amended to read:
AB40,656,105 49.43 (1e) "Accommodated person" means any person in a hospital or in a
6skilled nursing facility or intermediate care facility, as defined in Title XIX of the
7social security act, who would have been eligible for benefits under s. 49.19 or 49.77
849.39 or federal Title XVI if the person were not in such a hospital or facility, and any
9person in such an institution who can be found eligible for Title XIX under the social
10security act.
AB40, s. 1423 11Section 1423. 49.45 (2) (a) 3. of the statutes is amended to read:
AB40,656,1612 49.45 (2) (a) 3. Determine the eligibility of persons for medical assistance,
13rehabilitative, and social services under ss. 49.46, 49.468, 49.47, and 49.471 and
14rules and policies adopted by the department and may, under a contract under s.
1549.78 (2), delegate all, or any portion, of this function to the county department under
16s. 46.215, 46.22, or 46.23 or
a tribal governing body.
AB40, s. 1424 17Section 1424. 49.45 (3) (a) of the statutes is amended to read:
AB40,656,2218 49.45 (3) (a) Reimbursement shall be made to each county department under
19ss. 46.215, 46.22, and 46.23 for any administrative services performed in the Medical
20Assistance program on the basis of s. 49.78 (8). For purposes of reimbursement
21under this paragraph,
assessments completed under s. 46.27 (6) (a) are
22administrative services performed in the Medical Assistance program
.
AB40, s. 1425 23Section 1425. 49.45 (5) (b) 1. (intro.) of the statutes is amended to read:
AB40,657,1324 49.45 (5) (b) 1. (intro.) Upon receipt of a timely petition under par. (a) the
25department shall give the applicant or recipient reasonable notice and opportunity

1for a fair hearing. The department may make such additional investigation as it
2considers necessary. Notice of the hearing shall be given to the applicant or recipient
3and, if a county department under s. 46.215, 46.22, or 46.23 is responsible for making
4made the medical assistance determination, to the county clerk of the county. The
5county may be represented at such hearing. The department shall render its decision
6as soon as possible after the hearing and shall send a certified copy of its decision to
7the applicant or recipient, and to the county clerk, and to any county officer charged
8with administration of the Medical Assistance program. The decision of the
9department shall have the same effect as an order of a county officer charged with
10the administration of the Medical Assistance program
of the county that made the
11medical assistance determination
. The decision shall be final, but may be revoked
12or modified as altered conditions may require. The department shall deny a petition
13for a hearing or shall refuse to grant relief if:
AB40, s. 1426 14Section 1426. 49.45 (5) (b) 2. (intro.) of the statutes is amended to read:
AB40,657,2315 49.45 (5) (b) 2. (intro.) If a recipient requests a hearing within the timely notice
16period specified in 42 CFR 431.231 (c), medical assistance coverage shall not be
17suspended, reduced, or discontinued until a decision is rendered after the hearing
18but medical assistance payments made pending the hearing decision may be
19recovered by the department if the contested decision or failure to act is upheld. If
20a county department is responsible for making made the medical assistance
21determination, the department shall notify the county department of the county in
22which the recipient resides that the recipient has requested a hearing. Medical
23assistance coverage shall be suspended, reduced, or discontinued if:
AB40, s. 1427 24Section 1427. 49.45 (5m) (am) of the statutes is amended to read:
AB40,658,7
149.45 (5m) (am) Notwithstanding sub. (3) (e), from the appropriation accounts
2under s. 20.435 (4) (b), (gm), (o), (w) and (xc), the department shall distribute not
3more than $5,000,000 in each fiscal year, to provide supplemental funds to rural
4hospitals that, as determined by the department, have high utilization of inpatient
5services by patients whose care is provided from governmental sources, except that
6the department may not distribute funds to a rural hospital to the extent that the
7distribution would exceed any limitation under 42 USC 1396b (i) (3).
AB40, s. 1428 8Section 1428. 49.45 (6m) (a) 6. of the statutes is amended to read:
AB40,658,129 49.45 (6m) (a) 6. "Resource Utilization Groupings III" means a comparative
10resource utilization grouping that classifies each facility resident based on
11information obtained from performing, for the resident, a minimum data set
12assessment developed by the federal Centers for Medicare and Medicaid Services.
AB40, s. 1429 13Section 1429. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:
AB40,658,2014 49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this
15subsection made under s. 20.435 (4) (b), (gm), (o), (pa), or (w) shall, except as provided
16in pars. (bg), (bm), and (br), be determined according to a prospective payment
17system updated annually by the department. The payment system shall implement
18standards that are necessary and proper for providing patient care and that meet
19quality and safety standards established under subch. II of ch. 50 and ch. 150. The
20payment system shall reflect all of the following:
AB40, s. 1430 21Section 1430. 49.45 (6m) (ag) 3p. a. of the statutes is amended to read:
AB40,658,2422 49.45 (6m) (ag) 3p. a. The system shall may incorporate acuity measurements
23under the most recent Resource Utilization Groupings III methodology to determine
24factors for case-mix adjustment.
AB40, s. 1431 25Section 1431. 49.45 (6tw) of the statutes is amended to read:
AB40,659,7
149.45 (6tw) Payments to city health departments. From the appropriation
2account under s. 20.435 (7) (b), if the department selects the payment procedure
3under s. 49.45 (52) (a),
the department may make payments to local health
4departments, as defined under s. 250.01 (4) (a) 3. Payment under this subsection to
5such a local health department may not exceed on an annualized basis payment
6made by the department to the local health department under s. 49.45 (6t), 2003
7stats., for services provided by the local health department in 2002.
AB40, s. 1432 8Section 1432. 49.45 (6v) (b) of the statutes is amended to read:
AB40,659,149 49.45 (6v) (b) The department shall, each year, submit to the joint committee
10on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that
11provides information on the utilization of beds by recipients of medical assistance in
12facilities and a discussion and detailed projection of the likely balances,
13expenditures, encumbrances and carry over of currently appropriated amounts in
14the appropriation accounts under s. 20.435 (4) (b), (gm), and (o).
AB40, s. 1433 15Section 1433. 49.45 (6x) of the statutes is repealed.
AB40, s. 1434 16Section 1434. 49.45 (6y) (a) of the statutes is amended to read:
AB40,660,217 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriation accounts
18under s. 20.435 (4) (b), (gm), (o), and (w), the department may distribute funding in
19each fiscal year to provide supplemental payment to hospitals that enter into a
20contract under s. 49.02 (2) to provide health care services funded by a relief block
21grant, as determined by the department, for hospital services that are not in excess
22of the hospitals' customary charges for the services, as limited under 42 USC 1396b
23(i) (3). If no relief block grant is awarded under this chapter or if the allocation of
24funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the

1department may distribute funds to hospitals that have not entered into a contract
2under s. 49.02 (2).
AB40, s. 1435 3Section 1435. 49.45 (6z) (a) (intro.) of the statutes is amended to read:
AB40,660,154 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriation
5accounts under s. 20.435 (4) (b), (gm), (o), and (w), the department may distribute
6funding in each fiscal year to supplement payment for services to hospitals that enter
7into indigent care agreements, in accordance with the approved state plan for
8services under 42 USC 1396a, with relief agencies that administer the medical relief
9block grant under this chapter, if the department determines that the hospitals serve
10a disproportionate number of low-income patients with special needs. If no medical
11relief block grant under this chapter is awarded or if the allocation of funds to such
12hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department
13may distribute funds to hospitals that have not entered into indigent care
14agreements. The department may not distribute funds under this subsection to the
15extent that the distribution would do any of the following:
AB40, s. 1436 16Section 1436. 49.45 (8) (b) of the statutes is amended to read:
AB40,660,2117 49.45 (8) (b) Reimbursement under s. 20.435 (4) (b), (gm), (o), and (w) for home
18health services provided by a certified home health agency or independent nurse
19shall be made at the home health agency's or nurse's usual and customary fee per
20patient care visit, subject to a maximum allowable fee per patient care visit that is
21established under par. (c).
AB40, s. 1437 22Section 1437. 49.45 (8r) of the statutes is amended to read:
AB40,661,423 49.45 (8r) Payment for certain obstetric and gynecological care. The rate
24of payment for obstetric and gynecological care provided in primary care shortage
25areas, as defined in s. 36.60 37.60 (1) (cm), or provided to recipients of medical

1assistance who reside in primary care shortage areas, that is equal to 125% of the
2rates paid under this section to primary care physicians in primary care shortage
3areas, shall be paid to all certified primary care providers who provide obstetric or
4gynecological care to those recipients.
AB40, s. 1438 5Section 1438. 49.45 (19) (bm) of the statutes is amended to read:
AB40,661,86 49.45 (19) (bm) The department or the county department under s. 46.215 or
746.22
shall notify applicants of the requirements of this subsection at the time of
8application.
AB40, s. 1439 9Section 1439. 49.45 (24m) (intro.) of the statutes is amended to read:
AB40,661,1410 49.45 (24m) (intro.) From the appropriation accounts under s. 20.435 (4) (b),
11(gm), (o), and (w), in order to test the feasibility of instituting a system of
12reimbursement for providers of home health care and personal care services for
13medical assistance recipients that is based on competitive bidding, the department
14shall:
AB40, s. 1440 15Section 1440. 49.45 (24r) (a) of the statutes is renumbered 49.45 (24r).
AB40, s. 1441 16Section 1441. 49.45 (24r) (b) of the statutes is repealed.
AB40, s. 1442 17Section 1442. 49.45 (34) of the statutes is amended to read:
AB40,661,2218 49.45 (34) Medical assistance manual. The department shall prepare a
19medical assistance manual that is clear, comprehensive and consistent with this
20subchapter and 42 USC 1396a to 1396u and shall, no later than July 1, 1992, provide
21the manual to counties for use by county employees who administer the medical
22assistance program
.
AB40, s. 1443 23Section 1443. 49.45 (51) (a) of the statutes is amended to read:
AB40,662,624 49.45 (51) (a) By November 1 annually, the department shall provide to the
25department of revenue information concerning the estimated amounts of

1supplements payable from the appropriation accounts under s. 20.435 (4) (b) and
2(gm)
to specific local governmental units for the provision of transportation for
3medical care, as specified under s. 49.46 (2) (b) 3., during the fiscal year. Beginning
4November 1, 2004, the information that the department provides under this
5paragraph shall include any adjustments necessary to reflect actual claims
6submitted by service providers in the previous fiscal year.
AB40, s. 1444 7Section 1444. 49.45 (52) (title) of the statutes is amended to read:
AB40,662,88 49.45 (52) (title) Payment adjustments ; federal funding for certain services.
AB40, s. 1445 9Section 1445. 49.45 (52) of the statutes is renumbered 49.45 (52) (a) 1. and
10amended to read:
AB40,662,2411 49.45 (52) (a) 1. Beginning on January 1, 2003 If the department provides the
12notice under par. (c) selecting the payment procedure in this paragraph
, the
13department may, from the appropriation account under s. 20.435 (7) (b), make
14Medical Assistance payment adjustments to county departments under s. 46.215,
1546.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01
16(4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and
17(b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16., except for
18services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating
19in the early intervention program under s. 51.44. Payment adjustments under this
20subsection paragraph shall include the state share of the payments. The total of any
21payment adjustments under this subsection paragraph and Medical Assistance
22payments made from appropriation accounts under s. 20.435 (4) (b), (gm), (o), and
23(w), may not exceed applicable limitations on payments under 42 USC 1396a (a) (30)
24(A).
AB40, s. 1446 25Section 1446. 49.45 (52) (a) 2. of the statutes is created to read:
AB40,663,4
149.45 (52) (a) 2. The department may require a county department or local
2health department to submit a certified cost report that meets the requirements of
3the federal department of health and human services for covered services described
4in subd. 1.
AB40, s. 1447 5Section 1447. 49.45 (52) (b) of the statutes is created to read:
AB40,663,76 49.45 (52) (b) If the department provides the notice under par. (c) selecting the
7payment procedure in this paragraph, all of the following apply:
AB40,663,138 1. Annually, a county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437
9shall submit a certified cost report that meets the requirements of the federal
10department of health and human services for covered services under s. 49.46 (2) (a)
112. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13.,
1215., and 16., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided
13to children participating in the early intervention program under s. 51.44.
AB40,663,1714 2. For services described under subd. 1., the department shall base the amount
15of a claim for federal medical assistance funds on certified cost reports submitted by
16county departments under subd. 1. to the extent the reports comply with federal
17requirements.
AB40,663,2018 3. The department shall pay county departments a percentage of the federal
19funds claimed under subd. 2. for services described under subd. 1., which percentage
20is established in the most recent biennial budget.
AB40,663,2421 4. The department may pay a local health department, as defined in s. 250.01
22(4), that submits certified cost reports for services described under subd. 1. a
23percentage of the federal funds claimed for those services, which percentage is
24established in the most recent biennial budget.
AB40, s. 1448 25Section 1448. 49.45 (52) (c) of the statutes is created to read:
AB40,664,5
149.45 (52) (c) The department shall select a payment procedure under either
2par. (a) or (b) and may change which procedure under par. (a) or (b) is selected. The
3department shall notify each county department and local health department, as
4applicable, of the selected payment procedure before the date on which payment for
5services is made under that selected or newly selected procedure.
AB40, s. 1449 6Section 1449. 49.45 (53) of the statutes is amended to read:
AB40,664,107 49.45 (53) Payments for certain services. Beginning on January 1, 2003, the
8department may, from the appropriation account under s. 20.435 (7) (b), make
9Medical Assistance payments to providers for covered services under ss. 49.46 (2) (a)
104. d. and (b) 6. j. and m. and 49.471 (11) (f) that are provided before January 1, 2012.
AB40, s. 1450 11Section 1450. 49.46 (1) (a) 4. of the statutes is amended to read:
AB40,664,1312 49.46 (1) (a) 4. Any person receiving benefits under s. 49.77 49.39 or federal
13Title XVI.
AB40, s. 1451 14Section 1451. 49.46 (1) (a) 4m. of the statutes is amended to read:
AB40,664,1515 49.46 (1) (a) 4m. Any child for whom a payment is made under s. 49.775 49.395.
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