49.45(52)(a)1.1. If the department provides the notice under par.
(c) selecting the payment procedure in this paragraph, 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,
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., except for services specified under s.
49.46 (2) (b) 6. b. and
c. provided to children participating in the early intervention program under s.
51.44. Payment adjustments under this paragraph shall include the state share of the payments. The total of any payment adjustments under this paragraph and Medical Assistance payments made from appropriation accounts under s.
20.435 (4) (b),
(gm),
(o), and
(w), may not exceed applicable limitations on payments under
42 USC 1396a (a) (30) (A).
49.45(52)(a)2.
2. The department may require a county department or local health department to submit a certified cost report that meets the requirements of the federal department of health and human services for covered services described in subd.
1. 49.45(52)(b)
(b) If the department provides the notice under par.
(c) selecting the payment procedure in this paragraph, all of the following apply:
49.45(52)(b)1.
1. Annually, a county department under s.
46.215,
46.22,
46.23,
51.42, or
51.437 shall submit a certified cost report that meets the requirements of the federal department of health and human services 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., except for services specified under s.
49.46 (2) (b) 6. b. and
c. provided to children participating in the early intervention program under s.
51.44.
49.45(52)(b)2.
2. For services described under subd.
1., the department shall base the amount of a claim for federal medical assistance funds on certified cost reports submitted by county departments under subd.
1. to the extent the reports comply with federal requirements.
49.45(52)(b)3.
3. The department shall pay county departments a percentage of the federal funds claimed under subd.
2. for services described under subd.
1., which percentage is established in the most recent biennial budget.
49.45(52)(b)4.
4. The department may pay a local health department, as defined in s.
250.01 (4), that submits certified cost reports for services described under subd.
1. a percentage of the federal funds claimed for those services, which percentage is established in the most recent biennial budget.
49.45(52)(c)
(c) The department shall select a payment procedure under either par.
(a) or
(b) and may change which procedure under par.
(a) or
(b) is selected. The department shall notify each county department and local health department, as applicable, of the selected payment procedure before the date on which payment for services is made under that selected or newly selected procedure.
49.45(53m)
(53m) Coverage program for institutions for mental disease. Subject to any necessary waiver approval of the federal department of health and human services, or as otherwise permitted under federal law, the department may, if federal funding participation is available, provide Medical Assistance coverage of services provided in an institution for mental disease to persons ages 21 to 64.
49.45(54)
(54) Therapy for children participating in the birth to 3 program. 49.45(54)(a)(a)
Federal share for county expenditures. If a county certifies to the department that the amount the county expended to provide services specified under s.
49.46 (2) (b) 6. b. and
c. to children participating in the early intervention program under s.
51.44 exceeds the amount the county received as reimbursement under this section, based on reimbursement rates established by the department for those services, and the federal government pays the state the federal share of Medical Assistance for the amount by which the county expenditures exceed the reimbursement, the department may disburse the federal share to the county. A county that receives moneys under this paragraph shall expend the moneys for early intervention services under s.
51.44 or for services under the disabled children's long-term support program, as defined in s.
46.011 (1g).
49.45(54)(c)
(c)
Special services. From the appropriations under s.
20.435 (4) (b) and
(o) and
(7) (bt), the department may pay the costs of services provided under the early intervention program under s.
51.44 that are included in program participant's individualized family service plan and that were not authorized for payment under the state Medicaid plan or a department policy before July 1, 2017, including any services under the early intervention program under s.
51.44 that are delivered by a type of provider that becomes certified to provide Medical Assistance service on July 1, 2017, or after.
49.45(56)
(56) Disease management program. Based on the health conditions identified by the physical health risk assessments, if performed under sub.
(57), the department shall develop and implement, for Medical Assistance recipients, disease management programs. These programs shall have at least the following characteristics:
49.45(56)(a)
(a) The use of information science to improve health care delivery by summarizing a patient's health status and providing reminders for preventive measures.
49.45(56)(b)
(b) Educating health care providers on health care process improvement by developing best practice models.
49.45(56)(c)
(c) The improvement and expansion of care management programs to assist in standardization of best practices, patient education, support systems, and information gathering.
49.45(56)(d)
(d) Establishment of a system of provider compensation that is aligned with clinical quality, practice management, and cost of care.
49.45(56)(e)
(e) Focus on patient care interventions for certain chronic conditions, to reduce hospital admissions.
49.45(57)
(57) Physical health risk assessment. The department shall encourage each individual who is determined on or after October 27, 2007, to be eligible for Medical Assistance to receive a physical health risk assessment as part of the first physical examination the individual receives under Medical Assistance.
49.45(58)
(58) Program for all-inclusive care for the elderly. The department may administer the program of all-inclusive care for the elderly under
42 USC 1396u-4.
49.45(59)
(59) Health maintenance organization payments to hospitals. 49.45(59)(a)(a) The department shall, from the appropriation accounts under s.
20.435 (4) (xc) and
(xe), 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).
49.45(59)(b)
(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. 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.
49.45(59)(c)
(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.
49.45(59)(d)
(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.
49.45(59)(e)1.1. 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.