49.45(9r)(d)(d) When reviewing prior authorization requests for complex rehabilitation technology items, the department and managed care plans shall act within 10 working days of receiving complete, clinically relevant written documentation necessary to make a determination.
49.45(9r)(dm)(dm) The department may not require a prescription or prior authorization to reimburse a provider for the repair of complex rehabilitation technology if the complex rehabilitation technology has been prescribed and reimbursed as provided in this subsection. This paragraph does not apply to the repair of complex rehabilitation technology if the complex rehabilitation technology is intended for use by an individual who is enrolled in a managed care organization.
49.45(9r)(e)(e) Except as provided in par. (dm), the department shall, consistent with this subsection and without imposing any additional requirements or restrictions under this subsection, reimburse a provider for a complex rehabilitation technology with prior authorization when prescribed by a physician, medically necessary, and used by a recipient of Medical Assistance who is a resident of a nursing home if the complex rehabilitation technology will do any of the following:
49.45(9r)(e)1.1. Contribute to the recipient’s independent completion of activities of daily living.
49.45(9r)(e)2.2. Support the recipient’s occupational, vocational, or psychosocial activities.
49.45(9r)(e)3.3. Provide the recipient the independent ability to move about the facility or to attain or retain self-care.
49.45(9r)(f)(f)
49.45(9r)(f)1.1. In this paragraph, “KU modifier” means a modifier used in the federal Medicare program related to an exemption from competitive bidding pricing.
49.45(9r)(f)2.2. For dates of service beginning on March 24, 2024, the department shall, for healthcare common procedure coding system codes relating to complex rehabilitation technology wheelchair repair and accessories, apply a reimbursement rate under the Medical Assistance program equivalent to the maximum fee paid in Wisconsin under the federal Medicare program, including fees under the KU modifier, if applicable.
49.45(9r)(f)3.3. Beginning July 1, 2025, and annually thereafter, the department shall submit to the chief clerk of each house of the legislature for distribution to the legislature under s. 13.172 (2) a report that includes all of the following information:
49.45(9r)(f)3.a.a. The total number of units.
49.45(9r)(f)3.b.b. The total number of claims.
49.45(9r)(f)3.c.c. The total number of claims per provider.
49.45(9r)(f)3.d.d. The average dollar amount of all paid claims.
49.45(9r)(f)3.e.e. The average dollar amount of claims paid per provider.
49.45(9r)(f)3.f.f. The total dollar amount paid per provider.
49.45(9r)(f)3.g.g. A calculation of the amount paid to the provider compared to the amount paid to the provider if the reimbursement were through fee-for-service under the Medical Assistance program under this subchapter.
49.45(9r)(f)3.h.h. The number of repairs done per unit during the last year.
49.45(9s)(9s)Disclosure. Any person who is an employee of, or an owner, partner, member, stockholder or investor in, any legal entity providing services which are reimbursed under this section, shall notify the department, on forms provided by the department for that purpose, if such person is an employee of, or an owner, partner, member, stockholder or investor in, any other legal entity providing services which are reimbursed under this section.
49.45(10)(10)Rule-making powers and duties. The department is authorized to promulgate such rules as are consistent with its duties in administering medical assistance. The department shall promulgate a rule defining the term “part-time intermittent care” for the purpose of s. 49.46.
49.45(11)(11)Penalty. Any person who receives or assists another in receiving assistance under this section, to which the recipient is not entitled, shall be subject to the penalties under ss. 946.91 and 946.93.
49.45(12)(12)Machine-readable medical assistance cards.
49.45(12)(b)(b) If the commissioner of insurance promulgates rules under s. 601.57 (2), 2021 stats., establishing a health insurance identification card system and its computerized support system, the department shall develop a plan to coordinate a system of machine-readable identification cards for medical assistance recipients with the systems established by the commissioner and shall submit the plan to the governor, and to the legislature under s. 13.172 (2), before issuing a request for proposals under par. (c).
49.45(12)(c)(c) The department shall request proposals for a system of machine-readable identification cards for medical assistance recipients and a computerized support system for the cards that will accept and respond to electronically conveyed requests from health care providers for information related to medical assistance recipients, such as eligibility, coverages and authorizations. The request for proposals shall specify that the systems are to be operating by January 1, 1997.
49.45(13)(13)Financial reports.
49.45(13)(a)(a) The department may require service providers to prepare and submit cost reports or financial reports for purposes of rate certification under Title XIX, cost verification, fee schedule determination or research and study purposes. These financial reports may include independently audited financial statements which shall include balance sheets and statements of revenues and expenses. The department may withhold reimbursement or may decrease or not increase reimbursement rates if a provider does not submit the reports required under this paragraph or if the costs on which the reimbursement rates are based cannot be verified from the provider’s cost or financial reports or records from which the reports are derived.
49.45(13)(b)(b) The department may require any provider who fails to submit a cost report or financial report under par. (a) within the period specified by the department to forfeit not less than $10 nor more than $100 for each day the provider fails to submit the report.
49.45(15)(15)Community care organization project guarantee. Upon termination of the community care organization demonstration projects in Barron, La Crosse and Milwaukee counties, any client who was receiving services through any of those projects may continue to receive the full range of community care organization services. The cost of the services shall continue to be paid by medical assistance.
49.45(15r)(15r)Emergency medical transportation reimbursement. The department shall submit a state plan amendment to the federal department of health and human services to allow payment of supplemental reimbursements under the Medical Assistance program under this subchapter to public ambulance service providers, as defined in s. 256.01 (3), for ground emergency medical transportation through certified public expenditures. For purposes of this subsection, any ambulance service provider that is owned by any municipality or group of municipalities, regardless of whether or not the ambulance service provider is organized as a nonprofit corporation, is considered a public ambulance service provider. If the state plan amendment under this subsection is approved, the department shall pay to an ambulance service provider that complies with a certified public expenditure arrangement, as established by the department, a supplemental reimbursement equal to the amount of federal financial participation for ground emergency medical transportation services in accordance with state and federal law and regulations, except that the total reimbursement under the Medical Assistance program for the transportation may not exceed the actual cost to the ambulance service provider of providing the transportation. If the federal department of health and human services disapproves the state plan amendment, the department may not pay the supplement under this subsection.