AB68,744,2523
49.37
(2) Upon completion of the demonstration project under sub. (1) and by
24June 30,
2023 2024, the department of children and families shall conduct an
25evaluation of the demonstration project.
AB68,1006
1Section
1006. 49.43 (12) of the statutes is amended to read:
AB68,745,42
49.43
(12) “Spouse" means the
legal husband or wife of person to whom the
3beneficiary
is legally married, whether or not
the person is eligible for medical
4assistance.
AB68,1007
5Section
1007. 49.45 (2p) of the statutes is repealed.
AB68,1008
6Section
1008. 49.45 (2t) of the statutes is repealed.
AB68,1009
7Section
1009. 49.45 (3) (e) 11. of the statutes is amended to read:
AB68,745,228
49.45
(3) (e) 11. The department shall use a portion of the moneys collected
9under s. 50.38 (2) (a) to pay for services provided by eligible hospitals, as defined in
10s. 50.38 (1), other than critical access hospitals, under the Medical Assistance
11Program under this subchapter, including services reimbursed on a fee-for-service
12basis and services provided under a managed care system. For state fiscal year
132008-09, total payments required under this subdivision, including both the federal
14and state share of Medical Assistance, shall equal the amount collected under s.
1550.38 (2) (a) for fiscal year 2008-09 divided by 57.75 percent. For each state fiscal
16year after state fiscal year 2008-09, total payments required under this subdivision,
17including both the federal and state share of Medical Assistance, shall equal the
18amount collected under s. 50.38 (2) (a) for the fiscal year divided by 61.68 percent
,
19except that if the department has expanded eligibility under section 2001 (a) (1) (C)
20of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical
21Assistance program under this subchapter, the amount collected for the fiscal year
22shall be divided by 53.69 percent.
AB68,1010
23Section 1010
. 49.45 (3) (e) 12. of the statutes is amended to read:
AB68,746,924
49.45
(3) (e) 12. The department shall use a portion of the moneys collected
25under s. 50.38 (2) (b) to pay for services provided by critical access hospitals under
1the Medical Assistance Program under this subchapter, including services
2reimbursed on a fee-for-service basis and services provided under a managed care
3system. For each state fiscal year, total payments required under this subdivision,
4including both the federal and state share of Medical Assistance, shall equal the
5amount collected under s. 50.38 (2) (b) for the fiscal year divided by 61.68 percent
,
6except that if the department has expanded eligibility under section 2001 (a) (1) (C)
7of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical
8Assistance program under this subchapter, the amount collected for the fiscal year
9shall be divided by 53.69 percent.
AB68,1011
10Section
1011. 49.45 (3m) (a) (intro.) of the statutes is amended to read:
AB68,746,1711
49.45
(3m) (a) (intro.) Subject to par.
(c) (d) and notwithstanding sub. (3) (e),
12from the appropriations under s. 20.435 (4) (b) and (o), in each fiscal year, the
13department shall pay to hospitals that serve a disproportionate share of low-income
14patients an amount equal to the sum of $27,500,000, as the state share of payments,
15and the matching federal share of payments. The department may make a payment
16to a hospital under this subsection under the calculation method described in par. (b)
17if the hospital meets all of the following criteria:
AB68,1012
18Section
1012. 49.45 (3m) (cm) of the statutes is created to read:
AB68,746,2519
49.45
(3m) (cm) Notwithstanding the total amount of state share paid to
20hospitals under par. (a) and the limit paid to a single hospital under par. (b) 3. a., if
21the department has expanded eligibility under section 2001 (a) (1) (C) of the Patient
22Protection and Affordable Care Act, P.L.
111-148, for the Medical Assistance
23program under this subchapter, the department shall pay as the state share to
24hospitals $47,500,000 under par. (a) and pay no single hospital more than $7,950,000
25under par. (b) 3. a.
AB68,1013
1Section
1013. 49.45 (5g) of the statutes is created to read:
AB68,747,112
49.45
(5g) Payments to tribes. (a)
Tribal care coordination agreements. A
3tribal health care provider's care coordination agreement with a nontribal health
4care provider shall meet federal requirements, including that a service provided by
5the nontribal health care provider be at the request of the tribal health care provider
6on behalf of a tribal member who remains in the tribal health care provider's care
7according to the care coordination agreement; that both the tribal health care
8provider and nontribal health care provider are providers, as defined in s. 49.43 (10);
9that an established relationship exists between the tribal health care provider and
10the tribal member; and that the care be provided pursuant to a written care
11coordination agreement.
AB68,747,2112
(b)
Amount and distribution of payments. 1. From the appropriation account
13under s. 20.435 (4) (b), the department shall make payments to eligible governing
14bodies of federally recognized American Indian tribes or bands or tribal health care
15providers in an amount and manner determined by the department. The
16department shall determine payment amounts on the basis of the difference between
17the state share of medical assistance payments paid for services rendered to tribal
18members for whom a care coordination agreement with nontribal health care
19providers is in place and the state share of medical assistance payments that would
20have been paid for those services absent a care coordination agreement with
21nontribal partners.
AB68,747,2422
2. The department shall withhold from the payments under subd. 1. the state
23share of administrative costs associated with carrying out this subsection, not to
24exceed 10 percent of the amounts calculated in subd. 1.
AB68,748,3
13. Federally recognized American Indian tribes or bands may use funds paid
2under this subsection for health-related purposes. The department shall consult
3biennially with tribes to determine the timing and distribution of payments.
AB68,1014
4Section
1014. 49.45 (6m) (a) 6. of the statutes is repealed.
AB68,1015
5Section
1015. 49.45 (6m) (ag) 3p. a. to c. of the statutes are amended to read:
AB68,748,86
49.45
(6m) (ag) 3p. a. The system may incorporate acuity measurements
under
7the most recent Resource Utilization Groupings methodology to determine factors
8for case-mix adjustment.
AB68,748,129
b.
Four times annually, for For each facility resident who is a Medical
10Assistance recipient on March 31, June 30, September 30, or December 31, as
11applicable, the system shall determine the average case-mix index by use of the
12factors specified under subd. 3p. a.
AB68,748,1413
c. The system
shall may incorporate payment adjustments for dementia,
14behavioral needs, or other complex medical conditions.
AB68,1016
15Section
1016. 49.45 (6xm) of the statutes is created to read:
AB68,748,1916
49.45
(6xm) Pediatric inpatient supplement. (a) From the appropriations
17under s. 20.435 (4) (b), (o), and (w), the department shall, using a method determined
18by the department, distribute a total sum of $2,000,000 each state fiscal year to
19hospitals that meet all of the following criteria:
AB68,748,2020
1. The hospital is an acute care hospital located in this state.
AB68,748,2521
2. During the hospital's fiscal year, the inpatient days in the hospital's acute
22care pediatric units and intensive care pediatric units totaled more than 12,000 days,
23not including neonatal intensive care units. For purposes of this subsection, the
24hospital's fiscal year is the hospital's fiscal year that ended in the 2nd calendar year
25preceding the beginning of the state fiscal year.
AB68,749,8
1(b) Notwithstanding par. (a), from the appropriations under s. 20.435 (4) (b),
2(o), and (w), if the department has expanded eligibility under section 2001 (a) (1) (C)
3of the Patient Protection and Affordable Care Act, P.L.
111-148, for the Medical
4Assistance program under this subchapter, then the department may, using a
5method determined by the department, distribute an additional total sum of
6$7,500,000 in each state fiscal year to hospitals that are free-standing pediatric
7teaching hospitals located in Wisconsin that have a percentage calculated under s.
849.45 (3m) (b) 1. a. greater than 45 percent.
AB68,1017
9Section
1017. 49.45 (18) (ac) of the statutes is amended to read: