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 Wisconsin Statutes (Last Updated: January 10, 2017)
 Chapter 49. Public Assistance And Children And Family Services
 SubChapter IV. MEDICAL ASSISTANCE

Section 49.43. Definitions.  

Latest version.
  •   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 435.1009 .
    (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.