49.45(2)(a)7.
7. Cooperate with the federal authorities for the purpose of providing the assistance and services available under Title XIX to obtain the best financial reimbursement available to the state from federal funds.
49.45(2)(a)8.
8. Periodically report to the joint committee on finance concerning projected expenditures and alternative reimbursement and cost control policies in the medical assistance program.
49.45(2)(a)9.
9. Periodically set forth conditions of participation and reimbursement in a contract with provider of service under this section.
49.45(2)(a)10.
10. After reasonable notice and opportunity for hearing, recover money improperly or erroneously paid, or overpayments to a provider either by offsetting or adjusting amounts owed the provider under the program, crediting against a provider's future claims for reimbursement for other services or items furnished by the provider under the program, or by requiring the provider to make direct payment to the department or its fiscal intermediary.
49.45(2)(a)11.
11. Establish criteria for the certification of eligible providers of services under Title XIX of the social security act and, except as provided in
s. 49.48, certify such eligible providers.
49.45(2)(a)12.
12. Decertify or suspend under this subdivision a provider from the medical assistance program, if after giving reasonable notice and opportunity for hearing, the department finds that the provider has violated federal or state law or administrative rule and such violations are by law, regulation or rule grounds for decertification or suspension. No payment may be made under the medical assistance program with respect to any service or item furnished by the provider subsequent to decertification or during the period of suspension.
49.45(2)(a)12r.
12r. Notify the medical examining board, or any affiliated credentialing board attached to the medical examining board, of any decertification or suspension of a person holding a license granted by the board or the affiliated credentialing board if the grounds for the decertification or suspension include fraud or a quality of care issue.
49.45(2)(a)13.
13. Impose additional sanctions for noncompliance with the terms of provider agreements under
subd. 9. or certification criteria established under
subd. 11.
49.45(2)(a)14.
14. Assure due process in implementing
subds. 12. and
13. by providing written notice, a fair hearing and a written decision.
49.45(2)(a)15.
15. Routinely provide notification to persons eligible for medical assistance, or such persons' guardians, of the department's access to provider records.
49.45(2)(a)16.
16. Notify the joint committee on finance and appropriate standing committees in each house of the legislature prior to renewing, extending or amending the claims processing contract under the medical assistance program.
49.45(2)(a)17.
17. Notify the governor, the joint committee on legislative organization, the joint committee on finance and appropriate standing committees, as determined by the presiding officer of each house, if the appropriation under
s. 20.435 (5) (b) is insufficient to provide the state share of medical assistance.
49.45(2)(a)18.
18. Conduct outreach for the early and periodic screening, diagnosis and treatment program as required under
42 CFR 441. This activity is limited to persons under 21 years of age who have been determined to be eligible for medical assistance.
49.45(2)(a)20.
20. Submit a report, by May 1, 1991, and annually thereafter, to the joint committee on finance on the participation rates of children in the early and periodic screening and diagnosis program.
49.45(2)(a)22.
22. After consulting with counties, independent living centers, consumer organizations and home health agencies, periodically identify those barriers to the provision of personal care services under
s. 49.46 (2) (b) 6. j. which lead to a failure to respond to the needs and preferences of individuals who are eligible for these services and act to remove the barriers to the extent possible.
49.45(2)(a)23.
23. Promulgate rules that define "supportive services", "personal services" and "nursing services" provided in a certified residential care apartment complex, as defined under
s. 50.01 (1d), for purposes of reimbursement under
ss. 46.27 (11) (c) 7. and
46.277 (5) (e).
49.45(2)(a)24.
24. In consultation with hospitals, health maintenance organizations, county departments of social services and of human services and other interested parties, develop and, not later than January 1, 1999, implement a process for expediting medical assistance eligibility determinations for persons in urgent medical situations. The department shall promulgate any rules necessary for the implementation of that process.
49.45(2)(b)1.
1. Direct a county department under
s. 46.215,
46.22 or
46.23 to perform other functions, responsibilities and services, including any functions related to health maintenance organizations, limited service health organizations and preferred provider plans.
49.45(2)(b)2.
2. Contract with any organization whether or not organized for profit to administer, in full or in part, the benefits under the medical assistance program including prepaid health care. The department shall accept bids on contracts for administrative services and services evaluating the medical assistance program as provided in
ch. 16, but may accept the contract deemed most advantageous for claims processing services; or contract with any insurer authorized under the insurance code of this state to insure the program in full or in part and on behalf of the department. The department shall submit a report each December 31 to the governor, the joint committee on finance and the chief clerk of each house of the legislature, for distribution to the appropriate standing committees under
s. 13.172 (3), regarding the effectiveness of the management information system for monitoring and analyzing medical assistance expenditures.
49.45(2)(b)3.
3. Audit all claims filed by any contractor making the payment of benefits paid under
ss. 49.46 to
49.47 and make proper fiscal adjustments.
49.45(2)(b)4.
4. Audit claims filed by any provider of medical assistance, and as part of that audit, request of any such provider, and review, medical records of individuals who have received benefits under the medical assistance program.
49.45(2)(b)5.
5. Enter into contracts with providers who donate their services at no charge or who provide services for reduced payments.
49.45(3)(a)(a) Reimbursement shall be made to each county department under
ss. 46.215,
46.22 and
46.23 for the administrative services performed in the medical assistance program on the basis of
s. 49.33 (8). For purposes of reimbursement under this paragraph, assessments completed under
s. 46.27 (6) (a) are administrative services performed in the medical assistance program.
49.45(3)(am)1.1. From the appropriation under
s. 20.435 (1) (bm), the department shall make incentive payments to counties to encourage counties to identify medical assistance applicants and recipients who have other health care coverage and the providers of the health care coverage and give that information to the department.