AB150,1058,98 (c) For proprietary agencies, contracts may include a percentage add-on for
9profit according to rules promulgated by the department.

AB150,1058,1510 (d) Reimbursement to an agency may be based on total costs agreed to by the
11parties regardless of the actual number of service units to be furnished, when the
12agency is entering into a contract for a new or expanded service that the purchaser
13recognizes will require a start-up period not to exceed 180 days. This
14reimbursement applies only if identified client needs necessitate the establishment
15of a new service or expansion of an existing service.

AB150,1058,1916 (e) If the purchaser finds it necessary to terminate a contract prior to the
17contract expiration date for reasons other than nonperformance by the provider, the
18actual cost incurred by the provider may be reimbursed in an amount determined by
19mutual agreement of the parties.

AB150,1058,2420 (f) Advance payments of up to one-twelfth of an annual contract may be
21allowed under the contract. If the advance payment exceeds $10,000, the provider
22shall supply a surety bond in an amount equal to the amount of the advance payment
23applied for. No surety bond is required if the provider is a state agency. The cost of
24the surety bond shall be allowable as an expense.

AB150,1059,2

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1(4) For purposes of this section and as a condition of reimbursement, each
2provider under contract shall:

AB150,1059,53 (a) Except as provided in this subsection, maintain a uniform double entry
4accounting system and a management information system which are compatible
5with cost accounting and control systems prescribed by the department.

AB150,1059,76 (b) Cooperate with the department and purchaser in establishing costs for
7reimbursement purposes.

AB150,1059,118 (c) Unless waived by the department, biennially, or annually if required under
9federal law, provide the purchaser with a certified financial and compliance audit
10report if the care and services purchased exceed $25,000. The audit shall follow
11standards that the department prescribes.

AB150,1059,1312 (d) Transfer a client from one category of care or service to another only with
13the approval of the purchaser.

AB150,1059,1714 (e) Charge a uniform schedule of fees as specified under s. 49.32 (1) unless
15waived by the purchaser with the approval of the department. Whenever providers
16recover funds attributed to the client, such funds shall offset the amount paid under
17the contract.

AB150,1059,20 18(5) Except as provided in sub. (5m), the purchaser shall recover from provider
19agencies money paid in excess of the conditions of the contract from subsequent
20payments made to the provider.

AB150,1059,21 21(5m) (a) In this subsection:

AB150,1059,2422 1. "Provider" means a nonprofit, nonstock corporation organized under ch. 181
23that contracts under this section to provide client services on the basis of a unit rate
24per client service.

AB150,1060,5

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12. "Rate-based service" means a service or a group of services, as determined
2by the department, that is reimbursed through a prospectively set rate and that is
3distinguishable from other services or groups of services by the purpose for which
4funds are provided for that service or group of services and by the source of funding
5for that service or group of services.

AB150,1060,136 (b) 1. Subject to subds. 2. and 3., if revenue under a contract for the provision
7of a rate-based service exceeds allowable costs incurred in the contract period, the
8provider may retain from the surplus generated by that rate-based service up to 5%
9of the contract amount. A provider that retains a surplus under this subdivision
10shall use that retained surplus to cover a deficit between revenue and allowable costs
11incurred in any preceding or future contract period for the same rate-based service
12that generated the surplus or to address the programmatic needs of clients served
13by the same rate-based service that generated the surplus.

AB150,1060,2514 2. Subject to subd. 3., a provider may accumulate funds from more than one
15contract period under this paragraph, except that, if at the end of a contract period
16the amount accumulated from all contract periods for a rate-based service exceeds
1710% of the amount of all current contracts for that rate-based service, the provider
18shall, at the request of a purchaser, return to that purchaser the purchaser's
19proportional share of that excess and use any of that excess that is not returned to
20a purchaser to reduce the provider's unit rate per client for that rate-based service
21in the next contract period. If a provider has held for 4 consecutive contract periods
22an accumulated reserve for a rate-based service that is equal to or exceeds 10% of
23the amount of all current contracts for that rate-based service, the provider shall
24apply 50% of that accumulated amount to reducing its unit rate per client for that
25rate-based service in the next contract period.

AB150,1061,6

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13. If on December 31, 1995, the amount accumulated by a provider from all
2contract periods ending on or before that date for all rate-based services provided by
3the provider exceeds 10% of the provider's total contract amount for all rate-based
4services provided by the provider in 1995, the provider shall, at the request of a
5purchaser, return to that purchaser the purchaser's proportional share of that
6excess.

AB150,1061,147 (f) All providers that are subject to this subsection shall comply with any
8financial reporting and auditing requirements that the department may prescribe.
9Those requirements shall include a requirement that a provider provide to any
10purchaser and the department any information that the department needs to claim
11federal reimbursement for the cost of any services purchased from the provider and
12a requirement that a provider provide audit reports to any purchaser and the
13department according to standards specified in the provider's contract and any other
14standards that the department may prescribe.

AB150,1061,16 15(6) Contracts may be renegotiated by the purchaser under conditions specified
16in the contract.

AB150,1061,18 17(7) The service provider under this section may appeal decisions of the
18purchaser in accordance with terms and conditions of the contract and ch. 68 or 227.

AB150,1061,25 2049.35 Public assistance; supervisory functions of department. (1) (a)
21The department shall supervise the administration of programs under this
22subchapter. The department shall submit to the federal authorities state plans for
23the administration of programs under this subchapter in such form and containing
24such information as the federal authorities require, and shall comply with all
25requirements prescribed to ensure their correctness.

AB150,1062,8

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1(b) All records of the department and all county records relating to programs
2under this subchapter and aid under s. 49.18, 1971 stats., s. 49.20, 1971 stats., and
3s. 49.61, 1971 stats., as affected by chapter 90, laws of 1973, shall be open to
4inspection at all reasonable hours by authorized representatives of the federal
5government. Notwithstanding s. 48.396 (2), all county records relating to the
6administration of the services and public assistance specified in this paragraph shall
7be open to inspection at all reasonable hours by authorized representatives of the
8department.

AB150,1062,199 (bm) All records of the department relating to aid provided under s. 49.19 are
10open to inspection at reasonable hours by members of the legislature who require the
11information contained in the records in pursuit of a specific state legislative purpose.
12All records of any county relating to aid provided under s. 49.19 are open to inspection
13at reasonable hours by members of the board of supervisors of the county or the
14governing body of a city, village or town located in the county who require the
15information contained in the records in pursuit of a specific county or municipal
16legislative purpose. The right to records access provided by this paragraph does not
17apply if access is prohibited by federal law or regulation or if this state is required
18to prohibit such access as a condition precedent to participation in a federal program
19in which this state participates.

AB150,1063,320 (c) The department may at any time audit all county records relating to the
21administration of the services and public assistance specified in this section and may
22at any time conduct administrative reviews of county departments under ss. 46.215,
2346.22 and 46.23. If the department conducts such an audit or administrative review
24in a county, the department shall furnish a copy of the audit or administrative review
25report to the chairperson of the county board of supervisors and the county clerk in

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1a county with a single-county department or to the county boards of supervisors and
2the county clerks in counties with a multicounty department, and to the director of
3the county department under s. 46.215, 46.22 or 46.23.

AB150,1063,5 4(2) The county administration of all laws relating to programs under this
5subchapter shall be vested in the officers and agencies designated in the statutes.

AB150,1063,11 749.41 Assistance grants exempt from levy. All grants of aid to families with
8dependent children, payments made for social services, cash benefits paid by
9counties under s. 59.07 (154), and benefits under ss. 49.032, 49.046 and s. 49.177 or
10federal Title XVI, are exempt from every tax, and from execution, garnishment,
11attachment and every other process and shall be inalienable.

AB150,1063,18 1449.96 Assistance grants exempt from levy. All grants of aid to families with
15dependent children, payments made for social services, cash benefits paid by
16counties under s. 59.07 (154), and benefits under s. 49.177 49.77 or federal Title XVI,
17are exempt from every tax, and from execution, garnishment, attachment and every
18other process and shall be inalienable.

AB150,1064,77 49.43 (3e) "Department" means the department of health and social services.

AB150,1064,129 49.43 (10) "Provider" means a person, corporation, limited liability company,
10partnership, unincorporated business or professional association and any agent or
11employe thereof who provides medical assistance under ss. 49.45 to 49.47, 49.49 and
1249.495.

AB150,1064,1414 49.43 (10s) "Secretary" means the secretary of health and social services.

AB150,1064,1816 49.45 (2) (a) 15. Routinely provide notification to persons eligible for medical
17assistance under ss. 49.46 to 49.47, or such persons' guardians, of the department's
18access to provider records.

AB150,1065,221 49.45 (2) (a) 23. Promulgate rules that define "supportive services", "personal
22services" and "nursing services" provided in an assisted living facility, as defined

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1under s. 50.02 (1d), for purposes of reimbursement under ss. 46.27 (11) (c) 7. and
246.277 (5) (e).

AB150,1065,74 49.45 (2) (b) 4. Audit claims filed by any provider of medical assistance, and as
5part of that audit, request of any such provider, and review, medical records of
6individuals who have received benefits under the medical assistance program, or
7under s. 49.046.

AB150,1065,139 49.45 (3) (a) Reimbursement shall be made to each county department under
10ss. 46.215, 46.22 and 46.23 for the administrative services performed in the medical
11assistance program on the basis of s. 49.52 49.33 (8). For purposes of reimbursement
12under this paragraph, assessments completed under s. 46.27 (6) (a) are
13administrative services performed in the medical assistance program.

AB150,1065,1915 49.45 (3) (cm) 1. In this paragraph, "best price" means, with respect to any
16service, the lowest price that a provider has accepted or agreed to accept as payment
17from any 3rd-party payer, including medicare, a self-insured plan and an insurer,
18as defined under s. 600.03 (27), for a like service provided to a customer during the
19same month that the service is provided.

AB150,1065,2320 2. Except as provided in subd. 4., the department may require, as a condition
21of reimbursement, that providers of services charge the department the lesser of the
22following when claiming reimbursement for medical assistance services, unless a
23different price is set by contract:

AB150,1065,2424 a. The provider's best price for the service.

AB150,1065,2525 b. The provider's actual cost for the service.

AB150,1066,2

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13. When a provider is required to charge the department a price under subd.
22., the department may not reimburse the provider for more than that amount.

AB150,1066,43 4. This paragraph does not apply to services under s. 49.46 (2) (a) 4. a., b., or
4c., (b) 6. e. or 8.

AB150,1066,96 49.45 (5) Appeal. Any person whose application for medical assistance is
7denied or is not acted upon promptly or who believes that the payments made in the
8person's behalf have not been properly determined may file an appeal with the
9department pursuant to s. 49.50 (8) 49.21 (1).

AB150,1066,1711 49.45 (5m) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
1220.435 (1) (b) and (o) the department shall distribute not more than $2,256,000 in
13each of fiscal years 1993-94 and 1994-95 year, to provide supplemental funds to
14rural hospitals that, as determined by the department, have high utilization of
15inpatient services by patients whose care is provided from governmental sources,
16except that the department may not distribute funds to a rural hospital to the extent
17that the distribution would exceed any limitation under 42 USC 1396b (i) (3).

AB150,1066,2119 49.45 (6b) (a) Beginning in fiscal year 1994-95 1995-96, for relocations from
20the central Wisconsin center for the developmentally disabled, by $55.77 $232 per
21day.

AB150,1066,2523 49.45 (6b) (b) Beginning in fiscal year 1994-95 1995-96, for relocations from
24the northern Wisconsin center for the developmentally disabled, by $49.06 $225 per
25day.

AB150,1067,42 49.45 (6b) (c) Beginning in fiscal year 1994-95 1995-96, for relocations from
3the southern Wisconsin center for the developmentally disabled, by $48.37 $173 per
4day.

AB150,1067,256 49.45 (6c) (d) 1. No payment may be made under sub. (6m) to a facility or to
7an institution for mental diseases for the care of an individual who is otherwise
8eligible for medical assistance under s. 49.46 or 49.47, who has developmental
9disability or mental illness and for whom under par. (b) or (c) it is determined that
10he or she does not need facility care, unless it is determined that the individual
11requires active treatment for developmental disability or active treatment for
12mental illness and has continuously resided in a facility or institution for mental
13diseases for at least 30 months prior to the date of the determination. If that
14individual requires active treatment and has so continuously resided, he or she shall
15be offered the choice of receiving active treatment for developmental disability or
16active treatment for mental illness in the facility or institution for mental diseases
17or in an alternative setting. A facility resident who has developmental disability or
18mental illness, for whom under par. (c) it is determined that he or she does not need
19facility care and who has not continuously resided in a facility for at least 30 months
20prior to the date of the determination, may not continue to reside in the facility after
21December 31, 1993, and shall, if the department so determines, be relocated from the
22facility after March 31, 1990, and before December 31, 1993. The county department
23shall be responsible for securing alternative residence on behalf of an individual who
24is required to be relocated from a facility under this subdivision, and the facility shall
25cooperate with the county department in the relocation.

AB150,1068,82 49.45 (6c) (d) 2. Payment may be made under sub. (6m) to a facility or
3institution for mental diseases for the care of an individual who is otherwise eligible
4for medical assistance under s. 49.46 or 49.47 and who has developmental disability
5or mental illness and is determined under par. (b) or (c) to need facility care,
6regardless of whether it is determined under par. (b) or (c) that the individual does
7or does not require active treatment for developmental disability or active treatment
8for mental illness.

AB150,1068,1410 49.45 (6m) (ag) 3m. For state fiscal year 1993-94 1995-96, rates that shall be
11set by the department based on information from cost reports for the 1992 1994 fiscal
12year of the facility and for state fiscal year 1994-95 1996-97, rates that shall be set
13by the department based on information from cost reports for the 1993 1995 fiscal
14year of the facility.

AB150,1069,216 49.45 (6m) (ag) 8. Calculation of total payments and supplementary payments
17to facilities that permits an increase in funds allocated under s. 20.435 (1) (b) and (o)
18for nursing home care provided medical assistance recipients over that paid for
19services provided in state fiscal year 1992-93 1994-95 of no more than 3.58% 4.25%
20during state fiscal year 1993-94 1995-96 and over that paid for services provided in
21state fiscal year 1993-94 1995-96 of no more than 3.57% 5% during state fiscal year
221994-95 1996-97, excluding increases in total payments attributable to increases in
23recipient utilization of facility care, payments for the provision of active treatment
24to facility residents with developmental disability or chronic mental illness and

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1payments for preadmission screening of facility applicants and annual reviews of
2facility residents required under 42 USC 1396r (e).

AB150,1069,74 49.45 (6m) (am) 5. Allowable administrative and general costs, including costs
5related to the facility's overall management and administration and allowable
6expenses that are not recognized or reimbursed in other cost centers and including
7the costs of commercial estimators approved by the department under par. (ar) 6.

AB150,1069,119 49.45 (6m) (am) 5m. Allowable interest expense of the facility, less interest
10income of the facility and less interest income of affiliated entities, to the extent
11required under the approved state plan for services under 42 USC 1396.

AB150,1069,1813 49.45 (6m) (ar) 1. c. If a facility has an approved program for provision of
14service to emotionally disturbed or mentally retarded residents, residents dependent
15upon ventilators, or residents requiring supplemental skilled care due to complex
16medical conditions, a supplement to the direct care component of the facility rate
17under subd. 1. b. may be made to that facility according to a method developed by the
18department.

AB150,1069,2520 49.45 (6m) (ar) 6. Capital payment shall be based on a replacement value for
21a facility, as. The replacement value shall be determined by a commercial estimator
22with which contracted for by the department has contracted for service, and paid for
23by the facility. The replacement value shall be subject to limitations determined by
24the department, except that the department may not reduce final capital payment
25of a facility by more than $3.50 per patient day.

AB150,1070,62 49.45 (6m) (av) 2. The department shall compile an average payment rate for
3each facility based on that facility's rates for cost centers described under par. (am)
41. to 5. that were in effect on June 30 of the previous year, 1994. The department may
5develop a method for adjusting the facility's rate for the cost center under par. (am)
61. in compiling the average payment rate under this subdivision.