Assessment on critical access hospitals; payments to critical access hospitals under the Medical Assistance Program; creating a rural physician residency assistance program; the physician, dentist, and health care provider loan assistance programs; and making appropriations

This bill imposes an assessment on the gross inpatient revenues of critical access hospitals. The rate for the critical access hospital assessment is the same as the rate of the current hospital assessment. The bill requires that DHS use a portion of the critical access hospital assessment revenue to pay critical access hospitals for services provided under MA. Like the current hospital assessment, the bill requires that the MA payments to critical access hospitals from the critical access hospital assessment revenue, together with the federal share of payments, equal the amount of the critical access hospital assessment revenue divided by 61.68 percent. The bill annually appropriates $1,000,000 of critical access hospital assessment revenue for health care provider loans and rural physician residency assistance, described below.

The remainder of critical access hospital assessment revenue is appropriated for other MA expenditures.

The provisions in the bill for payment to critical access hospitals under MA apply to services provided beginning July 1, 2010. The first critical access hospital assessment payments are due by September 30, 2010. The bill requires DHS to submit a state Medicaid plan amendment to the federal government to implement the critical access hospital assessment as provided for in the bill, and specifies that if the federal government disapproves the state plan amendment, DHS must discontinue the assessment on critical access hospitals and refund any critical access hospital assessment revenue collected in fiscal year 2010-11.

Health care provider loan programs With certain exceptions, current law authorizes the Board of Regents of the University of Wisconsin System to repay, on behalf of certain physicians and dentists, up to $50,000 in educational loans if the physician or dentist agrees to practice for three years in certain areas of this state. Similarly, the board may repay, on behalf of certain health care providers (a dental hygienist, physician assistant, nurse-midwife, or nurse-practitioner), up to $25,000 in educational loans if the health care provider agrees to practice for three years in certain areas of this state.

This bill provides additional funds for these programs, from critical access hospital assessment revenues, for certain physicians, dentists, and health care providers who agree to practice in a rural area of this state. A rural area is a city, town, or village with a population of less than 20,000 that is at least 15 miles from any city, town, or village that has a population of at least 20,000, or an area that is not an urbanized area, as defined by the federal bureau of the census. The bill also increases the maximum amount of the loan repayment from $50,000 to $100,000 for a physician who agrees to practice in a rural area.

Rural physician residency assistance program This bill directs the Department of Family Medicine in the University of Wisconsin School of Medicine and Public Health to establish and support certain physician residency positions at hospitals located in rural areas or at clinics staffed by physicians who admit patients to hospitals located in rural areas, or that include a rural rotation, begun after June 30, 2010, which consists of at least eight weeks of training experience in a hospital located in a rural area or in a clinic that is staffed by physicians who admit patients to a hospital located in a rural area. The positions are funded with revenue from the critical access hospital assessment.

The bill directs the department annually to submit a plan for increasing the number of physician residency programs that include a majority of training experience in a rural area to the Rural Wisconsin Health Cooperative, the Wisconsin Hospital Association, and the Wisconsin Medical Society. The department must also annually submit to the Joint Committee on Finance a report indicating the number of physician residency positions that include a majority of training experience in a rural area of this state, and information about each such residency position.