49.43 Definitions. As used in ss. 49.43 to 49.497 unless the context indicates otherwise:
(1e) “Accommodated person" means any person in a hospital or in a skilled nursing facility or intermediate care facility, as defined in Title XIX of the social security act, who would have been eligible for benefits under s. 49.19 or 49.77 or federal Title XVI if the person were not in such a hospital or facility, and any person in such an institution who can be found eligible for Title XIX under the social security act.
(1m) “Charge" means the customary, usual and reasonable demand for payment as established prospectively, concurrently or retrospectively by the department for services, care or commodities which does not exceed the general level of charges by others who render such service or care, or provide such commodities, under similar or comparable circumstances within the community in which the charge is incurred.
(2) “Cost" means the reasonable cost of services, care or commodities as determined by the principles of reimbursement used under 42 USC 1395 to 1395rr, in effect on April 30, 1980.
(2m) “Cost-effective" has the meaning given in P.L. 101-508, section 4402 (a) (2).
(2r) “County," “county department," and “county department under s. 46.215, 46.22, or 46.23" includes a multicounty consortium in accordance with a contract under s. 49.78 (2).
(3) “Dentist" means a person licensed to practice dentistry.
(3e) “Department" means the department of health services.
(3m) “Developmentally disabled" has the meaning specified in s. 51.01 (5).
(3r) “Group health plan" has the meaning given in P.L. 101-508, section 4402 (a) (2).
(4) “Home health agency" has the meaning specified in s. 50.49 (1) (a).
(5) “Hospital" means an institution, approved by the appropriate state agency, providing 24-hour continuous nursing service to patients confined therein; which provides standard dietary, nursing, diagnostic and therapeutic facilities; and whose professional staff is composed only of physicians and surgeons, or of physicians and surgeons and doctors of dental surgery.
(6) “Inpatient psychiatric hospital services for individuals 21 years of age or for individuals under 22 years of age who are receiving such service immediately prior to reaching age 21" has the same meaning as provided in section 1905 (h) of the federal social security act.
(6m) “Institution for mental diseases" has the meaning specified in 42 CFR 435.1010.
(7) “Intermediate care facility" means either of the following:
(a) An institution or distinct part thereof, which is:
1. Licensed or approved under state law to provide, on a regular basis, health related care and services to individuals who do not require the degree of care and treatment which a hospital or skilled nursing home is designated to provide but who because of their mental or physical condition require care and services above the level of room and board, which can be made available to them only through institutional facilities; and
2. Qualifies as an “intermediate care facility" within the meaning of Title XIX of the social security act.
(b) A public institution, or distinct part thereof, which is:
1. Licensed or approved under state law for individuals with an intellectual disability or persons with related conditions, the primary purpose of which is to provide health or rehabilitative services for individuals with an intellectual disability according to rules promulgated by the department; and
2. Qualifies as an “intermediate care facility" within the meaning of Title XIX of the social security act.
(8) “Medical assistance" means any services or items under ss. 49.45 to 49.473, except s. 49.472 (6), and under ss. 49.49 to 49.497, or any payment or reimbursement made for such services or items.
(8m) “Multicounty consortium" has the meaning given in s. 49.78 (1) (br).
(9) “Physician" means a person licensed to practice medicine and surgery, and includes graduates of osteopathic colleges holding an unlimited license to practice medicine and surgery.
(10) “Provider" means a person, corporation, limited liability company, partnership, unincorporated business or professional association and any agent or employee thereof who provides medical assistance.
(10m) “Public medical institution" has the meaning designated in Title XIX of the federal social security act.
(10s) “Secretary" means the secretary of health services.
(10v) “Serious and persistent mental illness" has the meaning given in s. 51.01 (14t).
(11) “Skilled nursing home" means a facility or distinct part thereof, which:
(a) Is licensed or approved under state law for the accommodation of convalescents or other persons who are not acutely ill and not in need of hospital care;
(b) Employs sufficient registered nursing practitioners for supervision of those giving nursing care to patients; and
(c) Qualifies as a “skilled nursing facility" within the meaning of Title XIX of the social security act.
(12) “Spouse" means the legal husband or wife of the beneficiary, whether or not eligible for medical assistance.
History: 1977 c. 29 ss. 583m, 591; 1977 c. 418 s. 929 (18); 1979 c. 221; 1981 c. 20 s. 2202 (20) (m); 1981 c. 93; 1983 a. 189; 1987 a. 27; 1987 a. 403 s. 256; 1987 a. 413; 1991 a. 39; 1993 a. 27, 99, 112, 437; 1995 s. 27 ss. 2649, 2661, 2943 to 2946, 9126 (19); 1999 a. 9; 2001 a. 16; 2005 a. 264; 2007 a. 20 s. 9121 (6) (a); 2011 a. 32, 126; 2021 a. 248.
Structure Wisconsin Statutes & Annotations
Wisconsin Statutes & Annotations
Chapter 49 - Public assistance and children and family services.
49.02 - Relief block grant administration.
49.029 - Block grants to tribal governing bodies; medical relief.
49.08 - Recovery of relief and other assistance.
49.114 - Contract powers of the department.
49.131 - Electronic transfer of benefits.
49.134 - Child care resource and referral service grants.
49.136 - Child care start-up and expansion.
49.137 - Child care quality improvement.
49.1375 - Early childhood excellence initiative.
49.138 - Emergency assistance for families with needy children.
49.1385 - Grants for services for homeless and runaway youth.
49.139 - Emergency shelter funding.
49.141 - Wisconsin works; general provisions.
49.143 - Wisconsin works; agency contracts.
49.145 - Wisconsin works; eligibility for employment positions.
49.1452 - Payment of support arrears.
49.1455 - Child support demonstration project.
49.147 - Wisconsin works; work programs and job access loans.
49.1473 - Wisconsin works; domestic abuse screening and training.
49.148 - Wisconsin works; wages and benefits.
49.149 - Wisconsin works; education and training.
49.15 - Wisconsin works; 2-parent families.
49.151 - Wisconsin works; sanctions.
49.1515 - Determining nonparticipation.
49.152 - Review of agency decisions.
49.153 - Notice before taking certain actions.
49.155 - Wisconsin Shares; child care subsidy.
49.157 - Wisconsin works; transportation assistance.
49.159 - Wisconsin works; noncustodial and minor and other custodial parents.
49.161 - Wisconsin works; overpayments.
49.162 - Substance abuse screening and testing for certain work experience programs.
49.163 - Transform Milwaukee Jobs program and Transitional Jobs program.
49.1635 - Wisconsin Trust Account Foundation.
49.165 - Domestic abuse grants.
49.167 - Alcohol and other drug abuse treatment grant program.
49.175 - Public assistance and local assistance allocations.
49.19 - Aid to families with dependent children.
49.197 - Fraud investigation and reduction and error reduction.
49.22 - Child and spousal support; establishment of paternity; medical liability.
49.225 - Ordering genetic tests.
49.227 - Program for publication of delinquent child support obligors.
49.24 - Child support incentive payments.
49.25 - Incentive payments for identifying children with health insurance.
49.255 - Case management incentive payments.
49.257 - Milwaukee child care grant program.
49.265 - Community action agencies.
49.273 - Research, investigations.
49.275 - Cooperation with federal government.
49.32 - Department; powers and duties.
49.325 - County department budgets and contracts.
49.34 - Purchase of care and services.
49.343 - Rates for residential care centers, group homes, and child welfare agencies.
49.348 - Recidivism reduction program.
49.35 - Public assistance; supervisory functions of department.
49.36 - Work experience program for noncustodial parents.
49.37 - Offender reentry demonstration project.
49.38 - Menominee Enterprises, Inc., bonds, acquisition.
49.385 - No action against members of the Menominee Indian tribe in certain cases.
49.45 - Medical assistance; administration.
49.452 - Counting promissory notes as assets for certain Medical Assistance programs.
49.453 - Divestment of assets.
49.454 - Treatment of trust amounts.
49.455 - Protection of income and resources of couple for maintenance of community spouse.
49.46 - Medical assistance; recipients of social security aids.
49.463 - Ineligibility for noncompliance with child support determinations and obligations.
49.465 - Presumptive medical assistance eligibility.
49.468 - Expanded medicare buy-in.
49.47 - Medical assistance; medically indigent.
49.472 - Medical assistance purchase plan.
49.475 - Information about assistance program beneficiaries; electronic submission of claims.
49.49 - Medical assistance offenses.
49.493 - Benefits under uninsured health plans.
49.496 - Recovery of correct medical assistance payments.
49.498 - Requirements for skilled nursing facilities.
49.499 - Nursing facility resident protection.
49.68 - Aid for treatment of kidney disease.
49.682 - Recovery from estates; disease aids and funeral expenses.
49.683 - Cystic fibrosis aids.
49.685 - Hemophilia treatment services.
49.686 - AZT and pentamidine reimbursement program.
49.687 - Disease aids; patient requirements; rebate agreements; cost containment.
49.688 - Prescription drug assistance for elderly persons.
49.70 - County home; establishment.
49.703 - County homes; commitments; admissions.
49.71 - County hospitals; establishment.
49.713 - County hospitals; admissions.
49.72 - County infirmaries; establishment.
49.723 - County infirmaries, admissions; standards.
49.726 - County infirmaries; cost of treatment, care and maintenance of patients.
49.729 - County infirmaries; fees and expenses of proceedings.
49.73 - Residential care institutions; establishment.
49.74 - Institutions subject to chapter 150.
49.76 - Department duties relating to hunger prevention.
49.77 - State supplemental payments.
49.775 - Payments for the support of children of supplemental security income recipients.
49.776 - Payment of support arrears.
49.78 - Income maintenance administration.
49.79 - Food stamp administration.
49.791 - Substance abuse screening, testing, and treatment for employment and training programs.
49.793 - Recovery of food stamps.
49.796 - Food stamp reinstatement.
49.797 - Electronic benefit transfer.
49.81 - Public assistance recipients' bill of rights.
49.82 - Administration of public assistance programs.
49.823 - Public benefit database review.
49.825 - Department administration in Milwaukee County.
49.826 - Administration of child care provider services in certain counties.
49.83 - Limitation on giving information.
49.835 - Statements in applications.
49.84 - Verification of public assistance applications.
49.845 - Fraud investigation and error reduction.
49.846 - Jurisdiction of the department of justice.
49.847 - Recovery of incorrect payments under certain public assistance programs.
49.849 - Recovery of correct payments under certain public assistance programs.
49.852 - Delinquent support payments; pension plans.
49.853 - Financial record matching program.
49.854 - Liens against property for delinquent support payments.
49.855 - Certification of delinquent payments.
49.856 - Notification of delinquent payments.
49.858 - General provisions related to administrative support enforcement.
49.86 - Disbursement of funds and facsimile signatures.
49.89 - Third party liability.