49.45(3)(L)2.
2. The department may not pay a provider for a designated health service that is authorized under this section or
s. 49.46 or
49.47, that is provided as the result of a referral made to the provider by a physician and that, under
42 USC 1396b (s), if made on behalf of a beneficiary of medicare under the requirements of
42 USC 1395nn, as amended to August 10, 1993, would result in the denial of payment for the service under
42 USC 1395nn.
49.45(3)(L)3.
3. A provider shall submit to the department information concerning the ownership arrangements of the provider or the entity of which the provider is a part that corresponds to the information required of providers under
42 USC 1395nn (f), as amended to August 10, 1993.
49.45(3)(L)4.
4. Any person who fails to comply with
subd. 3. may be required to forfeit not more than $10,000. Each day of continued failure to comply constitutes a separate offense.
49.45(4)
(4) Information restricted. The use or disclosure of any information concerning applicants and recipients of medical assistance not connected with the administration of this section is prohibited.
49.45(5)(a)(a) Any person whose application for medical assistance is denied or is not acted upon promptly or who believes that the payments made in the person's behalf have not been properly determined or that his or her eligibility has not been properly determined may file an appeal with the department pursuant to
par. (b). Review is unavailable if the decision or failure to act arose more than 45 days before submission of the petition for a hearing.
49.45(5)(b)1.1. 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 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, 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. 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:
49.45(5)(b)1.b.
b. The sole issue in the petition concerns an automatic payment adjustment or change that affects an entire class of recipients and is the result of a change in state or federal law.
49.45(5)(b)1.c.
c. The petitioner abandons the petition. Abandonment occurs if the petitioner fails to appear in person or by representative at a scheduled hearing without good cause, as determined by the department.
49.45(5)(b)2.
2. 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 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:
49.45(5)(b)2.a.
a. The recipient is contesting a state or federal law or a change in state or federal law and not the determination of the payment made on the recipient's behalf.
49.45(5)(b)2.b.
b. The recipient is notified of a change in his or her medical assistance coverage while the hearing decision is pending but the recipient fails to request a hearing on the change.
49.45(5)(b)3.
3. The recipient shall be promptly informed in writing if medical assistance is to be suspended, reduced or terminated pending the hearing decision.
49.45(5m)
(5m) Supplemental funding for rural hospitals. 49.45(5m)(am)
(am) 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 $2,256,000 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).
49.45(5m)(b)
(b) The supplemental funding for rural hospitals under
par. (am) shall be based on the utilization, by recipients of medical assistance, of the total inpatient days of a rural hospital in relation to that utilization in other rural hospitals.
49.45(6b)
(6b) Centers for the developmentally disabled. From the appropriation under
s. 20.435 (2) (gk), the department may reimburse the cost of services provided by the centers for the developmentally disabled. Reimbursement to the centers for the developmentally disabled shall be reduced following each placement made under
s. 46.275 that involves a relocation from a center for the developmentally disabled, by $225 per day, beginning in fiscal year 2002-03, and by $325 per day, beginning in fiscal year 2004.
49.45(6c)
(6c) Preadmission screening and resident review.