9,648
Section
648. 49.257 of the statutes is created to read:
49.257 Milwaukee child care grant program. (1) In this section, “child care provider” has the meaning given in s. 49.155 (1) (ag).
(2) From the allocation under s. 49.175 (1) (p), the department may award grants to child care providers to support access to high-quality child care for families that reside in a geographic area with high-poverty levels, as identified by the department, in the city of Milwaukee. A grant under this section may be used for start-up costs, ongoing operational costs, including subsidy payments for eligible families, and quality improvement activities. A child care provider that is awarded a grant under this subsection shall contribute matching funds equal to 25 percent of the amount awarded. The matching contribution may be in the form of money or in-kind goods or services.
(3) From the allocation under s. 49.175 (1) (qm), the department may award grants to any of the following to improve overall child care quality in the geographic area identified under sub. (2):
(a) Child care providers and employees of child care providers.
(b) Educational institutions for the purpose of educating employees of child care providers.
9,650m
Section 650m. 49.36 (7) of the statutes is amended to read:
49.36 (7) The department shall pay a county, tribal governing body, or Wisconsin works agency not more than $400 $800 for each person who participates in the program under this section in the region in which the county, tribal governing body, or Wisconsin works agency administers the program under this section. The county, tribal governing body, or Wisconsin works agency shall pay any additional costs of the program.
9,651
Section
651. 49.45 (2) (a) 23. of the statutes is amended to read:
49.45 (2) (a) 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 (6d), for purposes of reimbursement under ss. 46.27 (11) (c) 7. and
s. 46.277 (5) (e).
9,654
Section
654. 49.45 (3) (a) of the statutes is amended to read:
49.45 (3) (a) Reimbursement shall be made to each county department under ss. 46.215, 46.22, and 46.23 for any administrative services performed in the Medical Assistance program on the basis of s. 49.78 (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.
9,659
Section
659. 49.45 (3p) (a) of the statutes is amended to read:
49.45 (3p) (a) Subject to par. (c) and notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b) and (o), in each fiscal year, the department shall pay to hospitals that would are not eligible for payments under sub. (3m) but that meet the criteria under sub. (3m) (a) except that the hospitals do not provide obstetric services 1. and 2. and that, in the most recent year for which information is available, charged at least 6 percent of overall charges for services to the Medical Assistance program for services provided to Medical Assistance recipients an amount equal to the sum of $250,000 $2,250,000, as the state share of payments, and the matching federal share of payments. The department may make a payment to a hospital under this subsection under a calculation method determined by the department that provides a fee-for-service supplemental payment that increases as the hospital's percentage of inpatient days for Medical Assistance recipients at the hospital the total amount of the hospital's overall charges for services that are charges to the Medical Assistance program increases.
9,660
Section
660. 49.45 (5) (a) of the statutes is amended to read:
49.45 (5) (a) Any person whose application for medical assistance is denied or is not acted upon promptly or who believes that the payments made in the person's behalf have not been properly determined or that his or her eligibility has not been properly determined may file an appeal with the department pursuant to par. (b). Review is unavailable if the decision or failure to act arose more than 45 days before submission of the petition for a hearing, except as provided in par. (ag) or (ar).
9,661
Section
661. 49.45 (5) (ag) of the statutes is created to read:
49.45 (5) (ag) A person shall request a hearing within 90 days of the date of receipt of a notice from a care management organization or managed care organization upholding its adverse benefit determination relating to any of the following or within 90 days of the date the care management organization or managed care organization failed to act on the contested matter within the time specified by the department:
1. Denial or limited authorization of a requested services, including a determination based on the type or level of service, requirement for medical necessity, appropriateness, setting, or effectiveness of a covered benefit.
2. Reduction, suspension, or termination of a previously authorized service, unless the service was only authorized for a limited amount or duration and that amount or duration has been completed.
3. Denial, in whole or in part, of payment for a service.
4. Failure to provide services in a timely manner.
5. Failure of a care management organization or managed care organization to act within the time frames provided in 42 CFR 438.408 (b) (1) and (2) regarding the standard resolution of grievances and appeals.
6. Denial of an enrollee's request to dispute financial liability, including copayments, premiums, deductibles, coinsurance, other cost sharing, and other member financial liabilities.
7. Denial of an enrollee, who is a resident of a rural area with only one care management organization or managed care organization, to obtain services outside the organization's network of contracted providers.
9,662
Section
662. 49.45 (5) (ar) of the statutes is created to read:
49.45 (5) (ar) If a federal regulation specifies a different time limit to request a hearing than par. (a) or (ag), the time limit in the federal regulation shall apply.
9,663
Section
663. 49.45 (5) (b) 1. (intro.) of the statutes is amended to read:
49.45 (5) (b) 1. (intro.) Upon receipt of a timely petition under par. (a) the department shall give the applicant or recipient reasonable notice and opportunity for a fair hearing. The department may make such additional investigation as it considers necessary. Notice of the hearing shall be given to the applicant or recipient and, if a county department under s. 46.215, 46.22, or 46.23 is responsible for making the medical assistance determination, to the county clerk of the county. The county may be represented at such hearing. The department shall render its decision as soon as possible after the hearing and shall send a certified copy of its decision to the applicant or recipient, to the county clerk, and to any county officer charged with administration of the Medical Assistance program. The decision of the department shall have the same effect as an order of a county officer charged with the administration of the Medical Assistance program. The decision shall be final, but may be revoked or modified as altered conditions may require. The department shall deny a petition for a hearing or shall refuse to grant relief if: