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.
AB40, s. 1452 16Section 1452. 49.46 (1) (d) 4. of the statutes is amended to read:
AB40,664,1817 49.46 (1) (d) 4. A child who meets the conditions under 42 USC 1396a (e) (3)
18shall be considered a recipient of benefits under s. 49.77 49.39 or federal Title XVI.
AB40, s. 1453 19Section 1453. 49.46 (1) (e) of the statutes is amended to read:
AB40,664,2520 49.46 (1) (e) If an application under s. 49.47 (3) shows that the individual meets
21the income limits under s. 49.19 or meets the income and resource requirements
22under federal Title XVI or s. 49.77 49.39, or that the individual is an essential person,
23an accommodated person, or a patient in a public medical institution, the individual
24shall be granted the benefits enumerated under sub. (2) whether or not the
25individual requests or receives a grant of any of such aids.
AB40, s. 1454
1Section 1454. 49.465 (2) (a) of the statutes is amended to read:
AB40,665,52 49.465 (2) (a) If the woman applies for benefits under s. 49.46 or 49.47 within
3the time required under sub. (4), the day on which the department or the county
4department under s. 46.215, 46.22 or 46.23
determines whether the woman is
5eligible for benefits under s. 49.46 or 49.47.
AB40, s. 1455 6Section 1455. 49.468 (1) (b) of the statutes is amended to read:
AB40,665,237 49.468 (1) (b) For an elderly or disabled individual who is entitled to coverage
8under part Part A of medicare Medicare, entitled to coverage under part Part B of
9medicare Medicare, and who does not meet the eligibility criteria for medical
10assistance
Medical Assistance under s. 49.46 (1), 49.465, 49.47 (4), or 49.471 but
11meets the limitations on income and resources under par. (d), medical assistance
12Medical Assistance shall pay the deductible and coinsurance portions of medicare
13Medicare services under 42 USC 1395 to 1395zz which that are not paid under 42
14USC 1395
to 1395zz, including those medicare Medicare services that are not
15included in the approved state plan for services under 42 USC 1396; the monthly
16premiums payable under 42 USC 1395v; the monthly premiums, if applicable, under
1742 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums
18under part Part A of medicare Medicare. Payment of coinsurance for a service under
19part Part B of medicare Medicare under 42 USC 1395j to 1395w, other than payment
20of coinsurance for outpatient hospital services, and payment of coinsurance for a
21service under Part A of Medicare
may not exceed the allowable charge for the service
22under medical assistance Medical Assistance minus the medicare Medicare
23payment.
AB40, s. 1456 24Section 1456. 49.468 (1) (c) of the statutes is amended to read:
AB40,666,13
149.468 (1) (c) For an elderly or disabled individual who is only entitled to
2coverage under part Part A of medicare Medicare and who does not meet the
3eligibility criteria for medical assistance Medical Assistance under s. 49.46 (1),
449.465, 49.47 (4), or 49.471 but meets the limitations on income and resources under
5par. (d), medical assistance Medical Assistance shall pay the deductible and
6coinsurance portions of medicare Medicare services under 42 USC 1395 to 1395i
7which that are not paid under 42 USC 1395 to 1395i, including those medicare
8Medicare services that are not included in the approved state plan for services under
942 USC 1396; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and
10the late enrollment penalty for premiums under part Part A of medicare Medicare,
11if applicable. Payment of coinsurance for a service under Part A of Medicare may not
12exceed the allowable charge for the service under Medical Assistance minus the
13Medicare payment.
AB40, s. 1457 14Section 1457. 49.47 (3) (b) of the statutes is amended to read:
AB40,666,1715 49.47 (3) (b) The agency department shall promptly review the application and
16shall issue a certificate to the individual showing eligibility when eligibility has been
17established.
AB40, s. 1458 18Section 1458. 49.47 (4) (c) 1. of the statutes is amended to read:
AB40,667,419 49.47 (4) (c) 1. Except as provided in par. (am) and as limited by subd. 3.,
20eligibility exists if income does not exceed 133 1/3% of the maximum aid to families
21with dependent children payment under s. 49.19 (11) for the applicant's family size
22or the combined benefit amount available under supplemental security income
23under 42 USC 1381 to 1383c and state supplemental aid under s. 49.77 49.39,
24whichever is higher. In this subdivision "income" includes earned or unearned
25income that would be included in determining eligibility for the individual or family

1under s. 49.19 or 49.77 49.39, or for the aged, blind or disabled under 42 USC 1381
2to 1385. "Income" does not include earned or unearned income which would be
3excluded in determining eligibility for the individual or family under s. 49.19 or 49.77
449.39, or for the aged, blind or disabled individual under 42 USC 1381 to 1385.
AB40, s. 1459 5Section 1459. 49.47 (4) (i) 1. of the statutes is amended to read:
AB40,667,196 49.47 (4) (i) 1. The department shall request a waiver from the secretary of the
7federal department of health and human services to permit the application of subd.
82. The waiver shall request approval to implement the waiver on a statewide basis,
9unless the department of health services determines that statewide implementation
10of the waiver would present an obstacle to the approval of the waiver by the secretary
11of the federal department of health and human services, in which case the waiver
12shall request approval to implement the waiver in 48 pilot counties to be selected by
13the department of health services. Within 30 days after August 12, 1993, the
14department of regulation and licensing safety and professional services shall notify
15funeral directors licensed under ch. 445, cemetery associations, as defined in s.
16157.061 (1r), and cemetery authorities, as defined in s. 157.061 (2), of the terms of
17the waiver required to be requested under this subdivision. If the waiver is approved
18by the secretary of the federal department of health and human services and if the
19waiver remains in effect, subd. 2. shall apply.
AB40, s. 1460 20Section 1460. 49.471 (5) (b) 3. a. of the statutes is amended to read:
AB40,667,2521 49.471 (5) (b) 3. a. If the woman or child applies for benefits under sub. (4)
22within the time required under par. (d), the benefits specified in subd. 1. or 2.,
23whichever is applicable, end on the day on which the department or the county
24department under s. 46.215, 46.22, or 46.23
determines whether the woman or child
25is eligible for benefits under sub. (4).
AB40, s. 1461
1Section 1461. 49.471 (7) (c) 4. of the statutes is amended to read:
AB40,668,32 49.471 (7) (c) 4. Not include in the calculation any income of an individual
3receiving benefits under s. 49.77 49.39 or federal Title XVI.
AB40, s. 1462 4Section 1462. 49.472 (4) (a) 2. a. of the statutes is amended to read:
AB40,668,85 49.472 (4) (a) 2. a. A maintenance allowance established by the department by
6rule. The maintenance allowance may not be less than the sum of $20, the federal
7supplemental security income payment level determined under 42 USC 1382 (b) and
8the state supplemental payment determined under s. 49.77 (2m) 49.39 (2m).
AB40, s. 1463 9Section 1463. 49.472 (6) (a) of the statutes is amended to read:
AB40,668,1510 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account
11accounts under s. 20.435 (4) (b), (gm), or (w), the department shall, on the part of an
12individual who is eligible for medical assistance under sub. (3), pay premiums for or
13purchase individual coverage offered by the individual's employer if the department
14determines that paying the premiums for or purchasing the coverage will not be more
15costly than providing medical assistance.
AB40, s. 1464 16Section 1464. 49.472 (6) (b) of the statutes is amended to read:
AB40,668,2017 49.472 (6) (b) If federal financial participation is available, from the
18appropriation account accounts under s. 20.435 (4) (b), (gm), or (w), the department
19may pay medicare Part A and Part B premiums for individuals who are eligible for
20medicare and for medical assistance under sub. (3).
AB40, s. 1465 21Section 1465. 49.473 (2) (intro.) of the statutes is amended to read:
AB40,668,2422 49.473 (2) (intro.) A woman is eligible for medical assistance as provided under
23sub. (5) if, after applying to the department or a county department, the department
24or a county department determines that she meets all of the following requirements:
AB40, s. 1466 25Section 1466. 49.473 (3) (intro.) of the statutes is amended to read:
AB40,669,5
149.473 (3) (intro.) Prior to applying to the department or a county department
2for medical assistance, a woman is eligible for medical assistance as provided under
3sub. (5) beginning on the date on which a qualified entity determines, on the basis
4of preliminary information, that the woman meets the requirements specified in sub.
5(2) and ending on one of the following dates:
AB40, s. 1467 6Section 1467. 49.473 (3) (a) of the statutes is amended to read:
AB40,669,107 49.473 (3) (a) If the woman applies to the department or a county department
8for medical assistance within the time limit required under sub. (4), the day on which
9the department or county department determines whether the woman meets the
10requirements under sub. (2).
AB40, s. 1468 11Section 1468. 49.473 (3) (b) of the statutes is amended to read:
AB40,669,1512 49.473 (3) (b) If the woman does not apply to the department or county
13department
for medical assistance within the time limit required under sub. (4), the
14last day of the month following the month in which the qualified entity determines
15that the woman is eligible for medical assistance.
AB40, s. 1469 16Section 1469. 49.473 (4) of the statutes is amended to read:
AB40,669,2017 49.473 (4) A woman who a qualified entity determines under sub. (3) is eligible
18for medical assistance shall apply to the department or county department no later
19than the last day of the month following the month in which the qualified entity
20determines that the woman is eligible for medical assistance.
Loading...
Loading...