SB62: Bill Text

SB62, s. 35 Section 35. 46.27 (10) (a) 1. of the statutes is amended to read:

SB62,25,16 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) because of increased utilization of nursing home services, as estimated by the department.

SB62, s. 36 Section 36. 46.275 (5) (a) of the statutes is amended to read:

SB62,25,23 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). 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.

SB62, s. 37 Section 37. 46.275 (5) (c) of the statutes is amended to read:

SB62,26,7 46.275 (5) (c) The total allocation under s. 20.435 (4) (b), (gp), (o), and (w) 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.

SB62, s. 38 Section 38. 46.283 (5) of the statutes is amended to read:

SB62,26,12 46.283 (5) Funding. From the appropriation accounts under s. 20.435 (4) (b), (bm), (gp), (pa), and (w) 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.

SB62, s. 39 Section 39. 46.284 (5) (a) of the statutes is amended to read:

SB62,26,20 46.284 (5) (a) From the appropriation accounts under s. 20.435 (4) (b), (g), (gp), (im), (o), and (w) 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.

SB62, s. 40 Section 40. 46.485 (2g) (intro.) of the statutes is amended to read:

SB62,27,2 46.485 (2g) (intro.) From the appropriation accounts account under s. 20.435 (4) (b) and (gp), 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 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:

SB62, s. 41 Section 41. 46.513 of the statutes is repealed.

SB62, s. 42 Section 42. 49.149 (4) of the statutes is repealed.

SB62, s. 43 Section 43. 49.175 (1) (i) of the statutes is amended to read:

SB62,27,7 49.175 (1) (i) Emergency assistance. For emergency assistance under s. 49.138, $6,000,000 in each fiscal year 2007-08 and $7,000,000 in fiscal year 2008-09.

SB62, s. 44 Section 44. 49.175 (1) (p) of the statutes is amended to read:

SB62,27,11 49.175 (1) (p) Direct child care services. For direct child care services under s. 49.155, $359,201,800 in fiscal year 2007-08 and $355,352,000 $375,736,400 in fiscal year 2008-09.

SB62, s. 45 Section 45. 49.175 (1) (q) of the statutes is amended to read:

SB62,27,15 49.175 (1) (q) Child care state administration. For administration of child care services under s. 49.155 (1g) (b), $1,765,600 in fiscal year 2007-08 and $1,600,300 $2,437,800 in fiscal year 2008-09.

SB62, s. 46 Section 46. 49.45 (2) (a) 17. of the statutes is repealed.

SB62, s. 47 Section 47. 49.45 (3) (e) 8. of the statutes is repealed.

SB62, s. 48 Section 48. 49.45 (3) (e) 10m. of the statutes is created to read:

SB62,27,21 49.45 (3) (e) 10m. All facilities listed in a certificate of approval issued to the University of Wisconsin Hospitals and Clinics Authority under s. 50.35 are a hospital for purposes of reimbursement under this section.

SB62, s. 49 Section 49. 49.45 (3) (e) 11. of the statutes is created to read:

SB62,28,8 49.45 (3) (e) 11. The department shall use a portion of the moneys collected under s. 50.38 to pay for services provided by eligible hospitals, as defined in s. 50.38 (1), under the Medical Assistance Program under this subchapter, including services reimbursed on a fee-for-service basis and services provided under a managed care system. For state fiscal year 2008-09, total payments under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) for fiscal year 2008-09 divided by 57.75 percent. For each state fiscal year after state fiscal year 2008-09, total payments under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) for the fiscal year divided by 61.68 percent.

SB62, s. 50 Section 50 . 49.45 (5m) (am) of the statutes is amended to read:

SB62,28,18 49.45 (5m) (am) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w) and (xc), the department shall distribute not more than $2,256,000 $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, 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).

SB62, s. 51 Section 51 . 49.45 (5r) of the statutes is created to read:

SB62,28,25 49.45 (5r) Supplemental funding for uncompensated care. Notwithstanding sub. (3) (e), from the appropriation account under s. 20.435 (4) (w), the department shall distribute $3,000,000 in each fiscal year to the University of Wisconsin Hospital and Clinics for care that is not otherwise compensated, except that the department may not make payments that exceed limitations based on customary charges under 42 USC 1396b (i) (3).

SB62, s. 52 Section 52. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:

SB62,29,8 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) 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:

SB62, s. 53 Section 53. 49.45 (6v) (b) of the statutes is amended to read:

SB62,29,15 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).

SB62, s. 54 Section 54. 49.45 (6x) (a) of the statutes is amended to read:

SB62,29,22 49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), 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).

SB62, s. 55 Section 55 . 49.45 (6y) (a) of the statutes is amended to read:

SB62,30,8 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), 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).

SB62, s. 56 Section 56. 49.45 (6y) (am) of the statutes is amended to read:

SB62,30,16 49.45 (6y) (am) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (h), (gp), (o), and (w), 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).

SB62, s. 57 Section 57. 49.45 (6y) (ap) of the statutes is created to read:

SB62,30,23 49.45 (6y) (ap) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (o) and (xc), the department shall distribute not more than $8,000,000 in each fiscal year as supplemental payments to hospitals that satisfy the criteria established by the American College of Surgeons for classification as a Level I adult trauma center, except that the department may not make payments that exceed limitations based on customary charges under 42 USC 1396b (i) (3).

SB62, s. 58 Section 58 . 49.45 (6y) (ar) of the statutes is created to read:

SB62,31,5 49.45 (6y) (ar) Notwithstanding sub. (3) (e), the department may, from the appropriation account under s. 20.435 (4) (xc), make supplemental payments to hospitals based on hospital performance, in accordance with a payment methodology developed by the department, except that the department may not make payments that exceed limitations based on customary charges under 42 USC 1396b (i) (3).

SB62, s. 59 Section 59. 49.45 (6z) (a) (intro.) of the statutes is amended to read:

SB62,31,18 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriation accounts under s. 20.435 (4) (b), (gp), (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:

SB62, s. 60 Section 60. 49.45 (8) (b) of the statutes is amended to read:

SB62,31,24 49.45 (8) (b) Reimbursement under s. 20.435 (4) (b), (gp), (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).

SB62, s. 61 Section 61. 49.45 (24m) (intro.) of the statutes is amended to read:

SB62,32,5 49.45 (24m) (intro.) From the appropriation accounts under s. 20.435 (4) (b), (gp), (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:

SB62, s. 62 Section 62. 49.45 (52) of the statutes is amended to read:

SB62,32,16 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), may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

SB62, s. 63 Section 63. 49.45 (59) of the statutes is created to read:

SB62,32,22 49.45 (59) Health maintenance organization payments to hospitals. (a) The department shall, from the appropriation account under s. 20.435 (4) (xc), pay each health maintenance organization with which it contracts to provide medical assistance a monthly amount that the health maintenance organization shall use to make payments to hospitals under par. (b).

SB62,33,10 (b) Health maintenance organizations shall pay all of the moneys they receive under par. (a) to eligible hospitals, as defined in s. 50.38 (1), within 15 days after receiving the moneys. The department shall specify in contracts with health maintenance organizations to provide medical assistance a method that health maintenance organizations shall use to allocate the amounts received under par. (a) among eligible hospitals based on the number of discharges from inpatient stays and the number of outpatient visits for which the health maintenance organization paid such a hospital in the previous month for enrollees who are recipients of medical assistance, except enrollees who receive medical assistance under s. 49.45 (23). Payments under this paragraph shall be in addition to any amount that a health maintenance organization is required by agreement between the health maintenance organization and a hospital to pay the hospital for providing services to the health maintenance organization's enrollees.

SB62,33,14 (c) Each health maintenance organization that provides medical assistance shall report to the department each month the amount it paid each hospital under par. (b) and the percentage of the total payments it made under par. (b) that it paid to each hospital.

SB62,33,19 (d) Each health maintenance organization that provides medical assistance shall report monthly to each hospital to which the health maintenance organization makes payments under par. (b) such information regarding the payments that the department specifies in its contract with the health maintenance organization to provide medical assistance.

SB62,33,23 (e) 1. If the department determines that a health maintenance organization has not complied with a requirement under pars. (b) to (d), the department shall order the health maintenance organization to comply with the requirement within 15 days after the department's determination of noncompliance.

SB62,34,3 2. The department may terminate a contract with a health maintenance organization to provide medical assistance if the health maintenance organization fails to comply with a requirement under pars. (b) to (d).

SB62,34,6 3. The department may audit a health maintenance organization to determine whether the health maintenance organization has complied with the requirements under pars. (b) to (d).

SB62,34,11 (f) The department shall specify in contracts with health maintenance organizations to provide medical assistance the method for adjusting payments under par. (b) to correct a health maintenance organization's inaccurate counting of inpatient discharges or outpatient visits in calculating a monthly payment to a hospital under par. (b).

SB62,34,20 (g) If a health maintenance organization and hospital do not agree on the amount of a monthly payment that the health maintenance organization is required to pay the hospital under par. (b), either the health maintenance organization or the hospital, within 6 months after the first day of the month in which the payment is due, may request that the department determine the amount of the payment. The department shall determine the amount of the payment within 60 days after the request for a determination 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.

SB62, s. 64 Section 64. 49.472 (6) (a) of the statutes is amended to read:

SB62,35,2 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account under s. 20.435 (4) (b), (gp), or (w), 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.

SB62, s. 65 Section 65. 49.472 (6) (b) of the statutes is amended to read:

SB62,35,7 49.472 (6) (b) If federal financial participation is available, from the appropriation account under s. 20.435 (4) (b), (gp), or (w), 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).

SB62, s. 66 Section 66. 49.473 (5) of the statutes is amended to read:

SB62,35,13 49.473 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b), (gp), and (o), 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).

SB62, s. 67 Section 67. 49.857 (1) (d) 12. of the statutes is amended to read:

SB62,35,17 49.857 (1) (d) 12. A license or certificate of registration issued under ss. 138.09, 138.12, 217.06, 218.0101 to 218.0163, 218.02, 218.04, 218.05, 224.72, 224.725, 224.93 or subch. IV of ch. 551.

SB62, s. 68 Section 68. 50.35 of the statutes is amended to read:

SB62,36,12 50.35 Application and approval. Application for approval to maintain a hospital shall be made to the department on forms provided by the department. On receipt of an application, the department shall, except as provided in s. 50.498, issue a certificate of approval if the applicant and hospital facilities meet the requirements established by the department. The department shall issue a single certificate of approval for the University of Wisconsin Hospitals and Clinics Authority that applies to all of the Authority's inpatient and outpatient hospital facilities that meet the requirements established by the department and for which the Authority requests approval. Except as provided in s. 50.498, this approval shall be in effect until, for just cause and in the manner herein prescribed, it is suspended or revoked. The certificate of approval may be issued only for the premises and persons or governmental unit named in the application and is not transferable or assignable. The department shall withhold, suspend or revoke approval for a failure to comply with s. 165.40 (6) (a) 1. or 2., but, except as provided in s. 50.498, otherwise may not withhold, suspend or revoke approval unless for a substantial failure to comply with ss. 50.32 to 50.39 or the rules and standards adopted by the department after giving a reasonable notice, a fair hearing and a reasonable opportunity to comply. Failure by a hospital to comply with s. 50.36 (3m) shall be considered to be a substantial failure to comply under this section.

SB62, s. 69 Section 69. 50.38 of the statutes is created to read:

SB62,36,15 50.38 Hospital assessment. (1) In this section "eligible hospital" means a hospital that is not any of the following:

SB62,36,16 (a) A critical access hospital.

SB62,36,17 (b) An institution for mental diseases, as defined in s. 46.011 (1m).

SB62,36,20 (c) A general psychiatric hospital for which the department has issued a certificate of approval under s. 50.35 that applies only to the psychiatric hospital, and that is not a satellite of an acute care hospital.

SB62,36,25 (2) For the privilege of doing business in this state, there is imposed on each eligible hospital an assessment each state fiscal year that is equal to a uniform percentage, determined under sub. (3), of the hospital's gross patient revenues, as reported under s. 153.46 (5) and determined by the department. The assessments shall be deposited in the hospital assessment fund.

SB62,37,4 (3) The department shall establish the percentage under sub. (2) so that the total amount of assessments collected under this section in a state fiscal year is equal to the amount in the schedule under s. 20.005 (3) for the appropriation under s. 20.435 (4) (xc) for that fiscal year.

SB62,37,7 (4) Except as provided in sub. (5), each eligible hospital shall pay the annual assessment under sub. (2) in 4 equal amounts that are due by September 30, December 31, March 31, and June 30 of each year.

SB62,37,12 (5) At the discretion of the department, a hospital that is unable timely to make a payment by a date specified under sub. (4) 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.

SB62,37,20 (6) (a) 1. If the federal government does not provide federal financial participation under the federal Medicaid program for amounts collected under this section that are used to make payments under s. 49.45 (3) (e) 11. or (5r), that are transferred under sub. (8) and used to make payments from the Medical Assistance trust fund, or that are transferred under sub. (9) and expended under under s. 20.435 (4) (jw), the department shall, from the fund from which the payment or expenditure was made, refund hospitals the amount for which the federal government does not provide federal financial participation.

SB62,37,25 2. If the department makes a refund under subd. 1. as result of failure to obtain federal financial participation under the federal Medicaid program for a payment under s. 49.45 (3) (e) 11. or (5r) or a payment from the Medical Assistance trust fund, the department shall recoup the part of the payment for which the federal government does not provide federal financial participation.

SB62,38,2 3. Moneys recouped under subd. 2. for payments made from the hospital assessment fund shall be deposited in the hospital assessment fund.

SB62,38,4 4. Moneys recouped under subd. 2. for payments made from the Medical Assistance trust fund shall be deposited in the Medical Assistance trust fund.

SB62,38,8 (b) On June 30 of each state fiscal year, the department shall, from the appropriation account under s. 20.435 (4) (xc), refund to hospitals the difference between the amount in the schedule under s. 20.005 (3) for that appropriation and the amount expended or encumbered from that appropriation in the fiscal year.

SB62,38,11 (c) The department shall allocate any refund under this subsection to hospitals in proportion to the percentage of the total assessments collected under sub. (2) that each hospital paid.

SB62,38,14 (7) By January 1 of each year the department shall report to the joint committee on finance all of the following information for the state fiscal year ending the previous June 30:

SB62,38,15 (a) The amount each eligible hospital paid under sub. (2).