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AB56-SA2,17,219 46.281 (1d) Waiver request. The department shall request from the secretary
20of the federal department of health and human services any waivers of federal
21medicaid laws necessary to permit the use of federal moneys to provide the family
22care benefit and the self-directed services option to recipients of medical assistance.
23The department shall implement any waiver that is approved and that is consistent
24with ss. 46.2805 to 46.2895. Regardless of whether a waiver is approved, the

1department may implement operation of resource centers, care management
2organizations, and the family care benefit.
AB56-SA2,462b 3Section 462b. 46.281 (1n) (d) of the statutes is repealed.
AB56-SA2,463b 4Section 463b. 46.281 (3) of the statutes is repealed.
AB56-SA2,464b 5Section 464b. 46.2825 of the statutes is repealed.
AB56-SA2,465b 6Section 465b. 46.283 (3) (f) of the statutes is amended to read:
AB56-SA2,17,127 46.283 (3) (f) Assistance to a person who is eligible for the family care benefit
8with respect to the person's choice of whether or not to enroll in the self-directed
9services option, as defined in s. 46.2899 (1),
a care management organization for the
10family care benefit or the Family Care Partnership program, or the program of
11all-inclusive care for the elderly
and, if so, which available long-term care program
12or
care management organization would best meet his or her needs.
AB56-SA2,466b 13Section 466b. 46.283 (4) (e) of the statutes is repealed.
AB56-SA2,467b 14Section 467b. 46.283 (4) (f) of the statutes is amended to read:
AB56-SA2,17,1815 46.283 (4) (f) Perform a functional screening and a financial and cost-sharing
16screening for any resident, as specified in par. (e), who requests a screening and
17assist any resident who is eligible and chooses to enroll in a care management
18organization or the self-directed services option to do so.
AB56-SA2,468b 19Section 468b. 46.283 (6) (b) 7. of the statutes is repealed.
AB56-SA2,469b 20Section 469b. 46.283 (6) (b) 9. of the statutes is amended to read:
AB56-SA2,17,2421 46.283 (6) (b) 9. Review the number and types of grievances and appeals
22concerning the long-term care system in the area served by related to the resource
23center, to determine if a need exists for system changes, and recommend system or
24other changes if appropriate.
AB56-SA2,470b 25Section 470b. 46.283 (6) (b) 10. of the statutes is repealed.
AB56-SA2,471b
1Section 471b. 46.285 (intro.) of the statutes is renumbered 46.285 and
2amended to read:
AB56-SA2,18,8 346.285 Operation of resource center and care management
4organization.
In order to meet federal requirements and assure federal financial
5participation in funding of the family care benefit, a county, a tribe or band, a
6long-term care district or an organization, including a private, nonprofit
7corporation, may not directly operate both a resource center and a care management
8organization, except as follows:.
AB56-SA2,472b 9Section 472b. 46.285 (1) of the statutes is repealed.
AB56-SA2,473b 10Section 473b. 46.285 (2) of the statutes is repealed.
AB56-SA2,474b 11Section 474b. 46.286 (3) (b) 2. a. of the statutes is repealed.
AB56-SA2,475b 12Section 475b. 46.287 (2) (a) 1. (intro.) of the statutes is amended to read:
AB56-SA2,18,1813 46.287 (2) (a) 1. (intro.) Except as provided in subd. 2., a client may contest any
14of the following applicable matters by filing, within 45 days of the failure of a resource
15center or care management organization county to act on the contested matter
16within the time frames specified by rule by the department or within 45 days after
17receipt of notice of a decision in a contested matter, a written request for a hearing
18under s. 227.44 to the division of hearings and appeals created under s. 15.103 (1):
AB56-SA2,476b 19Section 476b. 46.287 (2) (a) 1. d. of the statutes is renumbered 46.287 (2) (a)
201m. b.
AB56-SA2,477b 21Section 477b. 46.287 (2) (a) 1. e. of the statutes is repealed.
AB56-SA2,478b 22Section 478b. 46.287 (2) (a) 1. f. of the statutes is repealed.
AB56-SA2,479b 23Section 479b. 46.287 (2) (a) 1m. of the statutes is created to read:
AB56-SA2,19,524 46.287 (2) (a) 1m. Except as provided in subd. 2., a client may contest any of
25the following adverse benefit determinations by filing, within 90 days of the failure

1of a care management organization to act on a contested adverse benefit
2determination within the time frames specified by rule by the department or within
390 days after receipt of notice of a decision upholding the adverse benefit
4determination, a written request for a hearing under s. 227.44 to the division of
5hearings and appeals created under s. 15.103 (1):
AB56-SA2,19,96 a. Denial of functional eligibility under s. 46.286 (1) as a result of the care
7management organization's administration of the long-term care functional screen,
8including a change from a nursing home level of care to a non-nursing home level
9of care.
AB56-SA2,19,1210 c. Denial or limited authorization of a requested service, including
11determinations based on type or level of service, requirements or medical necessity,
12appropriateness, setting, or effectiveness of a covered benefit.
AB56-SA2,19,1513 d. Reduction, suspension, or termination of a previously authorized service,
14unless the service was only authorized for a limited amount or duration and that
15amount or duration has been completed.
AB56-SA2,19,1616 e. Denial, in whole or in part, of payment for a service.
AB56-SA2,19,1917 f. The failure of a care management organization to act within the time frames
18provided in 42 CFR 438.408 (b) (1) and (2) regarding the standard resolution of
19grievances and appeals.
AB56-SA2,19,2220 g. Denial of an enrollee's request to dispute financial liability, including
21copayments, premiums, deductibles, coinsurance, other cost sharing, and other
22member financial liabilities.
AB56-SA2,19,2523 h. Denial of an enrollee, who is a resident of a rural area with only one care
24management organization, to obtain services outside the care management
25organization's network of contracted providers.
AB56-SA2,20,6
1i. Development of a plan of care that is unacceptable to the enrollee because the
2plan of care requires the enrollee to live in a place that is unacceptable to the enrollee;
3the plan of care does not provide sufficient care, treatment, or support to meet the
4enrollee's needs and support the enrollee's identified outcomes; or the plan of care
5requires the enrollee to accept care, treatment, or support that is unnecessarily
6restrictive or unwanted by the enrollee.
AB56-SA2,20,77 j. Involuntary disenrollment from the care management organization.
AB56-SA2,480b 8Section 480b. 46.287 (2) (b) of the statutes is amended to read:
AB56-SA2,20,179 46.287 (2) (b) An enrollee may contest a decision, omission or action of a care
10management organization other than those specified in par. (a), or may contest the
11choice of service provider. In these instances, the enrollee shall first send a written
12request for review by the unit of the department that monitors care management
13organization contracts. This unit shall review and attempt to resolve the dispute.
141m. by filing a grievance with the care management organization. If the dispute
15grievance is not resolved to the satisfaction of the enrollee, he or she may request
16a hearing under the procedures specified in par. (a) 1. (intro.) that the department
17review the decision of the care management organization
.
AB56-SA2,481b 18Section 481b. 46.288 (2) (intro.) of the statutes is renumbered 46.288 (2) and
19amended to read:
AB56-SA2,20,2520 46.288 (2) Criteria and procedures for determining functional eligibility under
21s. 46.286 (1) (a), financial eligibility under s. 46.286 (1) (b), and cost sharing under
22s. 46.286 (2) (a). The rules for determining functional eligibility under s. 46.286 (1)
23(a) 1m. shall be substantially similar to eligibility criteria for receipt of the long-term
24support community options program under s. 46.27. Rules under this subsection
25shall include definitions of the following terms applicable to s. 46.286:
AB56-SA2,482b
1Section 482b. 46.288 (2) (d) to (j) of the statutes are repealed.
AB56-SA2,483b 2Section 483b. 46.2896 (1) (a) of the statutes is amended to read:
AB56-SA2,21,63 46.2896 (1) (a) “Long-term care program" means the long-term care program
4under s. 46.27, 46.275, 46.277, 46.278, or 46.2785; the family care program providing
5the benefit under s. 46.286; the Family Care Partnership program; or the long-term
6care program defined in s. 46.2899 (1).”.
AB56-SA2,21,7 767. Page 304, line 10: delete lines 10 to 18 and substitute:
AB56-SA2,21,8 8 Section 484p. 46.536 of the statutes is amended to read:
AB56-SA2,21,16 946.536 Mobile crisis team Crisis program enhancement grants. From
10the appropriation under s. 20.435 (5) (cf), the department shall award grants in the
11total amount of $250,000 in each fiscal biennium to counties or regions comprised of
12multiple counties to establish certified or enhance crisis programs that create mental
13health mobile crisis teams
to serve individuals having mental health crises in rural
14areas. The department shall award a grant under this section in an amount equal
15to one-half the amount of money the county or region provides to establish certified
16or enhance crisis programs that create mobile crisis teams.”.
AB56-SA2,21,17 1768. Page 304, line 19: after that line insert:
AB56-SA2,21,18 18 Section 485m. 46.854 of the statutes is created to read:
AB56-SA2,21,21 1946.854 Healthy aging grant program. From the appropriation under s.
2020.435 (1) (bk), the department shall award in each fiscal year a grant of $250,000
21to an entity that conducts programs in healthy aging.
AB56-SA2,485w 22Section 485w. 46.995 (4) of the statutes is created to read:
AB56-SA2,22,223 46.995 (4) The department shall ensure that any child who is eligible and who
24applies for the disabled children's long-term support program that is operating

1under a waiver of federal law receives services under the disabled children's
2long-term support program that is operating under a waiver of federal law.”.
AB56-SA2,22,3 369. Page 346, line 3: delete lines 3 to 5 and substitute:
AB56-SA2,22,6 4“(u) Prevention services. For services to prevent child abuse or neglect,
5$5,289,600 in each fiscal year $6,302,100 in fiscal year 2019-20 and $7,464,600 in
6fiscal year 2020-21
.”.
AB56-SA2,22,7 770. Page 348, line 15: after that line insert:
AB56-SA2,22,8 8 Section 652c. 49.45 (2p) of the statutes is repealed.
AB56-SA2,653t 9Section 653t. 49.45 (2t) of the statutes is repealed.”.
AB56-SA2,22,10 1071. Page 348, line 21: after that line insert:
AB56-SA2,22,11 11 Section 654f. 49.45 (3) (e) 11. of the statutes is amended to read:
AB56-SA2,22,2312 49.45 (3) (e) 11. The department shall use a portion of the moneys collected
13under s. 50.38 (2) (a) to pay for services provided by eligible hospitals, as defined in
14s. 50.38 (1), other than critical access hospitals, under the Medical Assistance
15Program under this subchapter, including services reimbursed on a fee-for-service
16basis and services provided under a managed care system. For state fiscal year
172008-09, total payments required under this subdivision, including both the federal
18and state share of Medical Assistance, shall equal the amount collected under s.
1950.38 (2) (a) for fiscal year 2008-09 divided by 57.75 percent. For each state fiscal
20year after state fiscal year 2008-09, total payments required under this subdivision,
21including both the federal and state share of Medical Assistance, shall equal the
22amount collected under s. 50.38 (2) (a) for the fiscal year divided by 61.68 53.69
23percent.
AB56-SA2,654h 24Section 654h. 49.45 (3) (e) 12. of the statutes is amended to read:
AB56-SA2,23,8
149.45 (3) (e) 12. The department shall use a portion of the moneys collected
2under s. 50.38 (2) (b) to pay for services provided by critical access hospitals under
3the Medical Assistance Program under this subchapter, including services
4reimbursed on a fee-for-service basis and services provided under a managed care
5system. For each state fiscal year, total payments required under this subdivision,
6including both the federal and state share of Medical Assistance, shall equal the
7amount collected under s. 50.38 (2) (b) for the fiscal year divided by 61.68 53.69
8percent.
AB56-SA2,657b 9Section 657b. 49.45 (3m) (a) (intro.) of the statutes is amended to read:
AB56-SA2,23,1610 49.45 (3m) (a) (intro.) Subject to par. (c) and notwithstanding sub. (3) (e), from
11the appropriations under s. 20.435 (4) (b) and (o), in each fiscal year, the department
12shall pay to hospitals that serve a disproportionate share of low-income patients an
13amount equal to the sum of $27,500,000 $56,500,000, as the state share of payments,
14and the matching federal share of payments. The department may make a payment
15to a hospital under this subsection under the calculation method described in par. (b)
16if the hospital meets all of the following criteria:
AB56-SA2,658b 17Section 658b. 49.45 (3m) (b) 3. a. of the statutes is amended to read:
AB56-SA2,23,2118 49.45 (3m) (b) 3. a. No single hospital receives more than $4,600,000
19$9,200,000, except that a hospital that is a free-standing pediatric teaching hospital
20located in Wisconsin that has a percentage calculated under subd. 1. a. greater than
2150 percent may receive up to $12,000,000 each fiscal year
.”.
AB56-SA2,23,23 2272. Page 348, line 23: delete the material beginning with that line and ending
23with page 349, line 11, and substitute:
AB56-SA2,24,14
1“49.45 (3p) (a) Subject to par. (c) and notwithstanding sub. (3) (e), from the
2appropriations under s. 20.435 (4) (b) and (o), in each fiscal year, the department
3shall pay to hospitals that would are not eligible for payments under sub. (3m) but
4that
meet the criteria under sub. (3m) (a) except that the hospitals do not provide
5obstetric services
1. and 2. and that, in the most recent year for which information
6is available, charged at least 6 percent of overall charges for services to the Medical
7Assistance program for services provided to Medical Assistance recipients
an
8amount equal to the sum of $250,000 $500,000, as the state share of payments, and
9the matching federal share of payments. The department may make a payment to
10a hospital under this subsection under a calculation method determined by the
11department that provides a fee-for-service supplemental payment that increases as
12the hospital's percentage of inpatient days for Medical Assistance recipients at the
13hospital
the total amount of the hospital's overall charges for services that are
14charges to the Medical Assistance program
increases.”.
AB56-SA2,24,16 1573. Page 349, line 12: delete the material beginning with that line and ending
16with page 351, line 15, and substitute:
AB56-SA2,24,17 17 Section 660b. 49.45 (5) (a) of the statutes is amended to read:
AB56-SA2,24,2318 49.45 (5) (a) Any person whose application for medical assistance is denied or
19is not acted upon promptly or who believes that the payments made in the person's
20behalf have not been properly determined or that his or her eligibility has not been
21properly determined may file an appeal with the department pursuant to par. (b).
22Review is unavailable if the decision or failure to act arose more than 45 days before
23submission of the petition for a hearing, except as provided in par. (ag) or (ar).
AB56-SA2,661b 24Section 661b. 49.45 (5) (ag) of the statutes is created to read:
AB56-SA2,25,6
149.45 (5) (ag) A person shall request a hearing within 90 days of the date of
2receipt of a notice from a care management organization or managed care
3organization upholding its adverse benefit determination relating to any of the
4following or within 90 days of the date the care management organization or
5managed care organization failed to act on the contested matter within the time
6specified by the department:
AB56-SA2,25,97 1. Denial or limited authorization of a requested services, including a
8determination based on the type or level of service, requirement for medical
9necessity, appropriateness, setting, or effectiveness of a covered benefit.
AB56-SA2,25,1210 2. Reduction, suspension, or termination of a previously authorized service,
11unless the service was only authorized for a limited amount or duration and that
12amount or duration has been completed.
AB56-SA2,25,1313 3. Denial, in whole or in part, of payment for a service.
AB56-SA2,25,1414 4. Failure to provide services in a timely manner.
AB56-SA2,25,1715 5. Failure of a care management organization or managed care organization
16to act within the time frames provided in 42 CFR 438.408 (b) (1) and (2) regarding
17the standard resolution of grievances and appeals.
AB56-SA2,25,2018 6. Denial of an enrollee's request to dispute financial liability, including
19copayments, premiums, deductibles, coinsurance, other cost sharing, and other
20member financial liabilities.
AB56-SA2,25,2321 7. Denial of an enrollee, who is a resident of a rural area with only one care
22management organization or managed care organization, to obtain services outside
23the organization's network of contracted providers.
AB56-SA2,662b 24Section 662b. 49.45 (5) (ar) of the statutes is created to read:
AB56-SA2,26,2
149.45 (5) (ar) If a federal regulation specifies a different time limit to request
2a hearing than par. (a) or (ag), the time limit in the federal regulation shall apply.
AB56-SA2,663b 3Section 663b. 49.45 (5) (b) 1. (intro.) of the statutes is amended to read:
AB56-SA2,26,174 49.45 (5) (b) 1. (intro.) Upon receipt of a timely petition under par. (a) the
5department shall give the applicant or recipient reasonable notice and opportunity
6for a fair hearing. The department may make such additional investigation as it
7considers necessary. Notice of the hearing shall be given to the applicant or recipient
8and, if a county department under s. 46.215, 46.22, or 46.23 is responsible for making
9the medical assistance determination, to the county clerk of the county. The county
10may be represented at such hearing. The department shall render its decision as
11soon as possible after the hearing and shall send a certified copy of its decision to the
12applicant or recipient, to the county clerk, and to any county officer charged with
13administration of the Medical Assistance program. The decision of the department
14shall have the same effect as an order of a county officer charged with the
15administration of the Medical Assistance program. The decision shall be final, but
16may be revoked or modified as altered conditions may require. The department shall
17deny a petition for a hearing or shall refuse to grant relief if:
AB56-SA2,664b 18Section 664b. 49.45 (5) (b) 1. d. of the statutes is created to read:
AB56-SA2,26,2219 49.45 (5) (b) 1. d. The issue is an adverse benefit determination described in
20par. (ag) 1. to 7. made by a care management organization or managed care
21organization and the person requesting the hearing has not exhausted the internal
22appeal procedure with the organization.”.
AB56-SA2,26,23 2374. Page 352, line 22: after that line insert:
AB56-SA2,26,24 24 Section 667b. 49.45 (6xm) of the statutes is created to read:
AB56-SA2,27,4
149.45 (6xm) Pediatric inpatient supplement. (a) From the appropriations
2under s. 20.435 (4) (b), (o), and (w), the department shall, using a method determined
3by the department, distribute a total sum of $2,000,000 each state fiscal year to
4hospitals that meet all of the following criteria:
AB56-SA2,27,55 1. The hospital is an acute care hospital located in this state.
AB56-SA2,27,106 2. During the hospital's fiscal year, the inpatient days in the hospital's acute
7care pediatric units and intensive care pediatric units totaled more than 12,000 days,
8not including neonatal intensive care units. For purposes of this subsection, the
9hospital's fiscal year is the hospital's fiscal year that ended in the 2nd calendar year
10preceding the beginning of the state fiscal year.
AB56-SA2,27,1511 (b) Notwithstanding par. (a), from the appropriations under s. 20.435 (4) (b),
12(o), and (w), the department may, using a method determined by the department,
13distribute an additional total sum of $10,000,000 in each state fiscal year to hospitals
14that are free-standing pediatric teaching hospitals located in Wisconsin that have
15a percentage calculated under s. 49.45 (3m) (b) 1. a. greater than 45 percent.
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