49.45 (2) (b) 7. Require, as a condition of certification under par. (a) 11., all providers of a specific service that is among those enumerated under s. 49.46 (2) or 49.47 (6) (a), as specified in this subdivision, to file with the department a surety bond issued by a surety company licensed to do business in this state. Providers subject to this subdivision provide those services specified under s. 49.46 (2) or 49.47 (6) (a) for which providers have demonstrated significant potential to violate s. 49.49 (1) (a), (2) (a) or (b), (3), (3m) (a), (3p), (4) (a), or (4m) (a), to require recovery under par. (a) 10., or to need additional sanctions under par. (a) 13. The surety bond shall be payable to the department in an amount that the department determines is reasonable in view of amounts of former recoveries against providers of the specific service and the department's costs to pursue those recoveries. The department shall promulgate rules to implement this subdivision that specify all of the following:

a. Services under medical assistance for which providers have demonstrated significant potential to violate s. 49.49 (1) (a), (2) (a) or (b), (3), (3m) (a), (3p), (4) (a), or (4m) (a), to require recovery under par. (a) 10., or to need additional sanctions under par. (a) 13.

b. The amount or amounts of the surety bonds.

c. Terms of the surety bond, including amounts, if any, without interest to be refunded to the provider upon withdrawal or decertification from the medical assistance program.

49.45 (2) (b) 8. Require a person who takes over the operation, as defined in sub. (21) (ag), of a provider, to first obtain certification under par. (a) 11. for the operation of the provider, regardless of whether the person is currently certified. The department may withhold the certification required under this subdivision until any outstanding repayment under sub. (21) is made. The department shall promulgate rules to implement this subdivision.

49.45 (2) (b) 9. After providing reasonable notice and opportunity for a hearing, charge an assessment to a provider that repeatedly has been subject to recoveries under par. (a) 10. a. because of the provider's failure to follow identical or similar billing procedures or to follow other identical or similar program requirements. The assessment shall be used to defray in part the costs of audits and investigations by the department under sub. (3) (g) and may not exceed $1,000 or 200% of the amount of any such repeated recovery made, whichever is greater. The provider shall pay the assessment to the department within 10 days after receipt of notice of the assessment or the final decision after administrative hearing, whichever is later. The department may recover any part of an assessment not timely paid by offsetting the assessment against any medical assistance payment owed to the provider and may refer any such unpaid assessments not collected in this manner to the attorney general, who may proceed with collection under this subdivision. Failure to timely pay in any manner an assessment charged under this subdivision, other than an assessment that is offset against any medical assistance payment owed to the provider, is grounds for decertification under subd. 12. A provider's payment of an assessment does not relieve the provider of any other legal liability incurred in connection with the recovery for which the assessment is charged, but is not evidence of violation of a statute or rule. The department shall credit all assessments received under this subdivision to the appropriation account under s. 20.435 (4) (iL). The department shall promulgate rules to implement this subdivision.

49.45 (3) (g) 1. The secretary may appoint authorize personnel to audit or investigate and report to the department on any matter involving violations or complaints alleging violations of laws statutes, regulations, or rules applicable to Title XIX of the federal social security act or the medical assistance program and to perform such investigations or audits as are required to verify the actual provision of services or items available under the medical assistance program and the appropriateness and accuracy of claims for reimbursement submitted by providers participating in the program. Department employees appointed authorized by the secretary under this paragraph shall be issued, and shall possess at all times during which while they are performing their investigatory or audit functions under this section, identification , signed by the secretary which, that specifically designates the bearer as possessing the authorization to conduct medical assistance investigations or audits. Pursuant to Under the request of a designated person and upon presentation of that the person's authorization, providers and medical assistance recipients shall accord such the person access to any provider personnel, records, books, recipient medical records, or documents or other information needed. Under the written request of a designated person and upon presentation of the person's authorization, providers and recipients shall accord the person access to any needed patient health care records of a recipient. Authorized employees shall have authority to may hold hearings, administer oaths, take testimony, and perform all other duties necessary to bring such the matter before the department for final adjudication and determination.

49.45 (3) (g) 2. The department shall promulgate rules to implement this paragraph.

49.45 (3) (h) 1n. The department shall promulgate rules to implement this paragraph.

49.45 (3) (h) 1m. The failure or refusal of a person to purge himself or herself of contempt found under s. 885.12 and perform the act as required by law shall constitute provider to accord department auditors or investigators access as required under par. (g) to any provider personnel, records, books, patient health care records of medical assistance recipients, or documents or other information requested constitutes grounds for decertification or suspension of that person the provider from participation in the medical assistance program and no. No payment may be made for services rendered by that person subsequent to the provider following decertification or, during the period of suspension, or during any period of provider failure or refusal to accord access as required under par. (g).

49.45 (5m) (am) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b) and, (o), and (w), the department shall distribute not more than $2,256,000 in each fiscal year, to provide supplemental funds to rural hospitals that, as determined by the department, have high utilization of inpatient services by patients whose care is provided from governmental sources, and to provide supplemental funds to critical access hospitals, except that the department may not distribute funds to a rural hospital or to a critical access hospital to the extent that the distribution would exceed any limitation under 42 USC 1396b (i) (3).

49.45 (6b) Centers for the developmentally disabled. From the appropriation under s. 20.435 (2) (gk), the department may reimburse the cost of services provided by the centers for the developmentally disabled. Reimbursement to the centers for the developmentally disabled shall be reduced following each placement made under s. 46.275 that involves a relocation from a center for the developmentally disabled, by $184 $200 per day, beginning in fiscal year 1999-2000 2001-02, and by $190 $225 per day, beginning in fiscal year 2000-01 2002-03.

49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this subsection made under s. 20.435 (4) (b), (pa) or, (o), (w), or (wm) shall, except as provided in pars. (bg), (bm), and (br), be determined according to a prospective payment system updated annually by the department. The payment system shall implement standards that are necessary and proper for providing patient care and that meet quality and safety standards established under subch. II of ch. 50 and ch. 150. The payment system shall reflect all of the following:

49.45 (6t) County department and local health department operating deficit reduction. (intro.) From the appropriation under s. 20.435 (4) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a county department under s. 46.215, 46.22, 46.23, or 51.42 or by a local health department, as defined in s. 250.01 (4), for services provided under s. 49.46 (2) (a) 4. d. and (b) 6. f., fm., j., k. and, L., and Lm., 9. and, 15., and 18., for case management services under s. 49.46 (2) (b) 12. and for mental health day treatment services for minors provided under the authorization under 42 USC 1396d (r) (5), the department shall allocate up to $4,500,000 moneys in each fiscal year to these county departments, or local health departments as determined by the department, and shall perform all of the following:

49.45 (6t) County department and local health department operating deficit reduction. (intro.) From the appropriation under s. 20.435 (4) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a county department under s. 46.215, 46.22, 46.23, or 51.42 or by a local health department, as defined in s. 250.01 (4), for services provided under s. 49.46 (2) (a) 4. d. and (b) 6. f., fm., j., k., L., and Lm., 9., and 15., for case management services under s. 49.46 (2) (b) 12. and for mental health day treatment services for minors provided under the authorization under 42 USC 1396d (r) (5), the department shall allocate moneys in each fiscal year to these county departments, or local health departments as determined by the department, and shall perform all of the following:

49.45 (6t) (a) For the reduction of operating deficits incurred by the county departments or local health departments, estimate the availability of federal medicaid funds that may be matched to county, city, town, or village funds that are expended for costs in excess of reimbursement for services provided under s. 49.46 (2) (a) 4. d. and (b) 6. f., fm., j., k. and , L., and Lm., 9. and, 15., and 18., for case management services under s. 49.46 (2) (b) 12. and for mental health day treatment services for minor minors provided under the authorization under 42 USC 1396d (r) (5).

49.45 (6t) (a) For the reduction of operating deficits incurred by the county departments or local health departments, estimate the availability of federal medicaid funds that may be matched to county, city, town, or village funds that are expended for costs in excess of reimbursement for services provided under s. 49.46 (2) (a) 4. d. and (b) 6. f., fm., j., k., L., and Lm., 9., and 15., for case management services under s. 49.46 (2) (b) 12. and for mental health day treatment services for minors provided under the authorization under 42 USC 1396d (r) (5).

49.45 (6u) Supplemental payments to certain facilities. (intro.) Notwithstanding sub. (6m), from the appropriation under s. 20.435 (4) (o), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a facility, as defined under sub. (6m) (a) 3., that is established under s. 49.70 (1) or that is owned and operated by a city, village or town, the department may not distribute to these facilities more than $38,600,000 $40,100,000 in each fiscal year, as determined by the department, except that the department shall also distribute for this same purpose from the appropriation under s. 20.435 (4) (o) any additional federal medical assistance moneys that were not anticipated before enactment of the biennial budget act or other legislation affecting s. 20.435 (4) (o). The total amount that a county certifies under this subsection may not exceed 100% of otherwise-unreimbursed care. In distributing funds under this subsection, the department shall perform all of the following:

49.45 (6u) (am) (intro.) Notwithstanding sub. (6m), in state fiscal years in which less than $1 15,200,000 in federal financial participation relating to facilities is received under 42 CFR 433.51, from the appropriation appropriations under s. 20.435 (4) (o), (w), and (wm), for reduction of operating deficits, as defined under criteria developed the methodology used by the department in December, 2000, incurred by a facility that is established under s. 49.70 (1) or that is owned and operated by a city, village, or town, the department may not distribute to these facilities more than $40,100,000 $37,100,000 in each fiscal year, as determined by the department. The total amount that a county certifies under this subsection may not exceed 100% of otherwise-unreimbursed care. In distributing funds under this subsection, the department shall perform all of the following:

2. (intro.) Based on the amount estimated available under par. (a) subd. 1., develop a method to distribute this allocation to the individual facilities that have incurred operating deficits that shall include:

b. Agreement by the county in which is located the facility established under s. 49.70 (1) and agreement by the city, village, or town that owns and operates the facility that the applicable county, city, village, or town shall provide funds to match federal medical assistance matching funds under this subsection paragraph.

3. Distribute the allocation under the distribution method that is developed, unless a county has failed to comply with par. (b) 2m subd. 2. bm.

4. If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (4) (o) and (w) that result in a lesser allocation amount than that allocated under this subsection paragraph, allocate not more than the lesser amount so approved by the federal department of health and human services.

5. If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (4) (o) and (w) that result in a lesser allocation amount than that allocated under this subsection paragraph, submit a revision of the method developed under par. (b) subd. 2. for approval by the joint committee on finance in that state fiscal year.

6. If the federal department of health and human services disallows use of the allocation of matching federal medical assistance funds distributed under par. (c) subd. 3., apply the requirements under sub. (6m) (br).

49.45 (6u) (ag) In this subsection, "facility" has the meaning given in sub. (6m) (a) 3.

49.45 (6u) (bm) In state fiscal years in which $1 15,200,000 or more in federal financial participation relating to facilities is received under 42 CFR 433.51, from the appropriations under s. 20.435 (4) (o) and (w), for reduction of operating deficits, as defined under criteria developed by the department, incurred by a facility that is established under s. 49.70 (1) or that is owned and operated by a city, village, or town, the department may not distribute to these facilities more than $77,100,000 in each fiscal year, as determined by the department under a methodology as specified in the state plan for services under 42 USC 1396.

49.45 (6v) (b) The Beginning on October 1, 2003, and annually thereafter, the department shall, each year, submit to the joint committee on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that provides information on the utilization of beds by recipients of medical assistance in facilities and a discussion and detailed projection of the likely balances, expenditures, encumbrances and carry over of currently appropriated amounts in the appropriation accounts under s. 20.435 (4) (b) and (o) for the immediately prior 2 consecutive fiscal years.

49.45 (6v) (c) If the report specified in par. (b) indicates that utilization of beds by recipients of medical assistance in facilities is less than estimates for that utilization reflected in the intentions of the joint committee on finance, legislature and governor, as expressed by them in the budget determinations, the department shall include a proposal to transfer moneys from the appropriation under s. 20.435 (4) (b) to the appropriation under s. 20.435 (7) (bd) for the purpose of increasing funding for the community options program under s. 46.27. The amount proposed for transfer may not reduce the balance in the appropriation account under s. 20.435 (4) (b) below an amount necessary to ensure that that appropriation account will end the current fiscal year or the current fiscal biennium with a positive balance. The secretary shall transfer the amount identified under the proposal decreased during the most recently completed fiscal year from the utilization of beds by recipients of medical assistance in facilities in the next most recently completed fiscal year, the department shall multiply the difference between the number of days of care provided to the recipients in the facilities in each of those prior 2 consecutive fiscal years by the average daily costs of care in the facilities for the most recently completed fiscal year. The average daily costs of care shall be calculated by dividing the total of medical assistance expenditures for care in facilities for the most recently completed fiscal year by the total number of days of care provided in facilities in that fiscal year.

49.45 (6v) (d) If par. (c) applies and if the amount calculated under par. (c) is positive, the department's report under par. (b) shall include a proposal to transfer an amount equal to the portion of the amount calculated under par. (c) that is the state share of medical assistance expenditures from the appropriation account under s. 20.435 (4) (b) to the appropriation account under s. 20.435 (7) (bd) for the purpose of increasing funding for the long-term support community options program under s. 46.27. If the cochairpersons of the joint committee on finance do not notify the secretary within 14 working days after the date on which the department submits the proposal that the committee has scheduled a meeting for the purpose of reviewing the proposal, the secretary shall transfer the amount identified under the proposal. If, within 14 working days after the date on which the department submits the proposal, the cochairpersons of the joint committee on finance notify the secretary that the committee has scheduled a meeting for the purpose of reviewing the proposal, the secretary may transfer moneys from the appropriation account under s. 20.435 (4) (b) to the appropriation account under s. 20.435 (7) (bd) only as approved by the committee.

49.45 (6v) (e) Of the amount required to be transferred by the secretary under par. (d), 40% shall be expended for services as specified under s. 46.27 (7) and 60% shall be expended for services as specified under s. 46.27 (11).

49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b) and, (o), and (w), the department shall distribute not more than $4,748,000 in each fiscal year, to provide funds to an essential access city hospital, except that the department may not allocate funds to an essential access city hospital to the extent that the allocation would exceed any limitation under 42 USC 1396b (i) (3).

49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b) and, (o), and (w), the department shall distribute funding in each fiscal year to provide supplemental payment to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2).

49.45 (6y) (am) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b), (h) and, (o), and (w), the department shall distribute funding in each fiscal year to provide supplemental payments to hospitals that enter into contracts under s. 49.02 (2) with a county having a population of 500,000 or more to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3).

49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b) and, (o), and (w), the department shall distribute funding in each fiscal year to supplement payment for services to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant under this chapter, if the department determines that the hospitals serve a disproportionate number of low-income patients with special needs. If no medical relief block grant under this chapter is awarded or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2). The department may not distribute funds under this subsection to the extent that the distribution would do any of the following:

49.45 (8) (b) Reimbursement under s. 20.435 (4) (b) and, (o), and (w) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under par. (c).

49.45 (21) (title) Transfer of business, liability for Taking over provider's operation; repayments required.

49.45 (21) (ar) If any provider Before a person may take over the operation of a provider that is liable for repayment of improper or erroneous payments or overpayments under ss. 49.43 to 49.497 sells or otherwise transfers ownership of his or her business or all or substantially all of the assets of the business, the transferor and transferee are each liable for the repayment. Prior to final transfer, the transferee is responsible for contacting the department and ascertaining if the transferor, full repayment shall be made. Upon request, the department shall notify the provider or the person that intends to take over the operation of the provider as to whether the provider is liable under this paragraph.

49.45 (21) (ag) In this subsection, "take over the operation" means obtain, with respect to an aspect of a provider's business for which the provider has filed claims for medical assistance reimbursement, any of the following:

1. Ownership of the provider's business or all or substantially all of the assets of the business.

2. Majority control over decisions.

3. The right to any profits or income.

4. The right to contact and offer services to patients, clients, or residents served by the provider.

5. An agreement that the provider will not compete with the person at all or with respect to a patient, client, resident, service, geographical area, or other part of the provider's business.

6. The right to perform services that are substantially similar to services performed by the provider at the same location as those performed by the provider.

7. The right to use any distinctive name or symbol by which the provider is known in connection with services to be provided by the person.

49.45 (21) (b) If a transfer occurs If, notwithstanding the prohibition under par. (ar), a person takes over the operation of a provider and the applicable amount under par. (a) (ar) has not been repaid, the department may, in addition to withholding certification as authorized under sub. (2) (b) 8., proceed against either the transferor or the transferee the provider or the person. Within 30 days after receiving the certified provider receives notice from the department, the transferor or the transferee shall pay the amount shall be repaid in full. Upon failure to comply If the amount is not repaid in full, the department may bring an action to compel payment. If a transferor fails to pay within 90 days after receiving notice from the department, the department, may proceed under sub. (2) (a) 12., or may do both.

49.45 (21) (e) The department shall promulgate rules to implement this subsection.

49.45 (22) (a) If the department contracts with health maintenance organizations for the provision of medical assistance it shall give special consideration to health maintenance organizations that provide or that contract to provide comprehensive, specialized health care services to pregnant teenagers.

(b) If the department contracts with health maintenance organizations for the provision of medical assistance, the department shall determine which medical assistance recipients who have attained the age of 2 but have not attained the age of 6 and who are at risk for lead poisoning have not received lead screening from those health maintenance organizations. The department shall report annually to the appropriate standing committees of the legislature under s. 13.172 (3) on the percentage of medical assistance recipients under the age of 2 who received a lead screening test in that year provided by a health maintenance organization compared with the percentage that the department set as a goal for that year.

49.45 (22) (c) If the department contracts with health maintenance organizations for the provision of medical assistance, each contract shall require a health maintenance organization to contract with at least the number of primary care providers, within a radius of 30 miles from the boundary of the area the health maintenance organization serves, that is sufficient to ensure that each medical assistance recipient who is eligible for medical assistance under s. 49.46 (1) (a) 1., 1g., 1m., 6., 9., 10., 11., 12., or 13. or 49.47 (4) (ag) 1. or 2. will be able to adequately access the health care services offered by the health maintenance organization. The department shall determine the number of primary care providers with whom each health maintenance organization is required to contract.

49.45 (24m) Home health care and personal care pilot program. (intro.) From the appropriations under s. 20.435 (4) (b) and, (o), and (w), in order to test the feasibility of instituting a system of reimbursement for providers of home health care and personal care services for medical assistance recipients that is based on competitive bidding, the department shall: