AB995: Bill Text

This bill makes changes to current law regarding the following: 1) the requirements for a nursing home administrator license; 2) the requirements for a reciprocal nursing home administrator license that apply to persons licensed in other states; and 3) the requirement to be licensed as a nursing home administrator.

Under current law, a person must satisfy certain education requirements before he or she is allowed to take the examination for a nursing home administrator license. Specifically, he or she must complete a regular course of study, equivalent specialized courses, or a program of study that is considered adequate academic preparation for nursing home administration by the Nursing Home Administrator Examining Board. In addition, the examining board is required to develop and enforce standards regarding the supervised practical experience that is required for a person to be licensed as a nursing home administrator. A person may satisfy the supervised practical experience requirements before or after taking the examination.

This bill changes the requirements that a person must satisfy before taking the nursing home administrator examination. Under the bill, except as discussed below, a person must satisfy certain education and supervised practical experience requirements before he or she can take the examination. Regarding education, the bill requires, except as discussed below, a person to have either: 1) a bachelor's, master's, or doctoral degree with a health care administration or long-term care major; or 2) a bachelor's degree and completion of a specialized course in nursing home administration. The bill directs the Nursing Home Administrator Examining Board to promulgate rules establishing the supervised practical experience requirements. The rules must require a person to complete at least 2,000 hours in an internship, administrator-in-training program, or other structured program before he or she can take the examination. The 2,000 hours must be completed in any consecutive three-year period within the five-year period immediately preceding the date of application for the examination.

The bill creates an exception to the above requirements that apply to a person who was enrolled, at any time within the two-year period before the bill's general effective date, in a course of study that the Nursing Home Administrator Examining Board had considered adequate preparation at that time. The bill allows such a person to take the examination if he or she completes the course no later than two years after the bill's general effective date and if the person satisfies, no later than the same deadline, practical experience requirements specified in the bill.

Under current law, a person who has a nursing home administrator license in another state is eligible for a reciprocal nursing home administrator license if he or she satisfies certain requirements, including submitting satisfactory evidence of the person's qualifications to the Nursing Home Administrator Examining Board. This bill specifies the qualifications that a person must have to be eligible for a reciprocal license. Under the bill, an applicant for such a license must have a bachelor's degree or be certified as a nursing home administrator by the American College of Health Care Administrators and must have practiced as a nursing home administrator in good standing for at least 2,000 hours in any consecutive three-year period within the five-year period immediately preceding the date of application for the reciprocal license. Also, the applicant must not have an arrest or conviction record the circumstances of which substantially relate to nursing home administration. In addition, the person must pass an examination relating to state and federal laws governing the practice of nursing home administration.

Finally, current law prohibits a person from practicing as a nursing home administrator unless he or she is licensed by the Nursing Home Administrative Examining Board. This bill creates an exception for a person who acts in the capacity of an administrator of a nursing home operated by adherents of a church or religious denomination which subscribes to the act of healing by prayer and the principles of which do not include medical treatment. However, the exemption applies only if the person does not use any title implying that he or she is a nursing home administrator.

Currently, the DHFS administers a Community Integration Program (commonly known as "CIP II"), under which MA moneys are paid to counties to provide home and community-based services, under a waiver of federal Medicaid laws, to elderly and physically disabled persons who meet the level of care requirements for MA-reimbursed nursing home care or are relocated from facilities. DHFS must establish a uniform daily rate for CIP II and reimburse counties up to that rate for each person enrolled in CIP II. Under 2003 Wisconsin Act 33 (the biennial budget act), DHFS may provide enhanced reimbursement for CIP II services for a person who is relocated to the community from a nursing home by a county after July 16, 2003, if the nursing home bed used by the person is delicensed upon the person's relocation.

This bill authorizes DHFS to provide CIP II funding for home and community-based services to an MA-eligible person who relocates from a facility to the community. Reimbursement is not conditioned on delicensure of a nursing home bed upon the person's relocation. The funding begins on the date of the relocation and ends on the date that the person discontinues program participation or no longer meets the level of care requirements for MA reimbursement in a nursing home. Funding in the aggregate for these relocated persons may not exceed the total MA costs for the persons if served in nursing homes. DHFS may provide an enhanced reimbursement rate for the services. The total number of persons who may participate in this particular aspect of CIP II is not restricted by limitations on numbers participating in the remainder of CIP II.

The bill changes a prohibition under current law against price discrimination that applies to a seller who trades in prescription drugs for resale. Under current law, the prohibition applies to a seller who sells prescription drugs directly to consumers. Under the bill, the prohibition applies to a seller who sells to a "dispenser," which the bill defines as a person who delivers a prescription drug to an ultimate user for outpatient use, including an insurer that issues certain types of managed health care plans. Also included under the definition of "dispenser" is a hospital that directly or indirectly bills a patient for prescription drugs.

The prohibition on price discrimination under current law applies to prescription drugs on a list of therapeutically equivalent drugs published by the federal Food and Drug Administration (FDA). This bill provides that the prohibition applies to drugs included in the most current version of either of the following: 1) the FDA list; or 2) another publication specified in rules promulgated by the Department of Agriculture, Trade and Consumer Protection that identifies drug products approved on the basis of safety and effectiveness by the FDA under the federal Food, Drug, and Cosmetic Act.

This bill requires DHFS annually by April 1 to make available, on the DHFS website and, upon request, by mail, the current MA fee schedule for services of health care providers (as defined in the bill). The bill requires health care providers, annually by April 15, to provide to DHFS a statement of the providers' rates for health care services for the following May 1 to April 30. Health care providers must also inform DHFS, during this period, of any increase in any of their rates over the amounts provided to DHFS. The rates must be stated in a form, as determined by DHFS, that may include statement as a percentage of the MA fee schedule. In addition, health care providers, annually beginning on May 1, must post their rates on an Internet website, if the health care provider has such a website, and take reasonable steps to ensure that their health care services consumers are aware that rate information is available and are informed about how to obtain the information. Any increase in a health care provider's rates is chargeable only after the health care provider has notified DHFS and, if the health care provider has a website, has posted information on the website about the rate increase.

The bill requires insurers, annually by April 15, to provide to DHFS and to the insurers' insureds a statement of the insurers' rates of reimbursement for health care provider services for the following May 1 to April 30, stated as a percentage of the MA fee schedule. Insurers must also inform DHFS, during this period, of any increase in any of their rates over the amounts provided to DHFS.

DHFS may make available, on the DHFS website and, upon request, by mail, the health care provider rate and insurer reimbursement rate information, including increases, provided to DHFS. DHFS is also authorized to contract for the receipt and posting of this information and the current MA fee schedule for health care provider services, in accordance with DHFS request-for-proposal procedures.

Under current law, if the Department of Administration (DOA) has approved a joint application of a health care provider and a nonprofit agency, the health care provider acting within the scope of his or her licensure or certification may provide, without charge to low-income, uninsured persons at the agency, diagnostic tests, health education, office visits, patient advocacy, prescriptions, information about available health care resources, referrals to health care specialists, and, for dentists, simple tooth extractions and necessary related suturing. The health care provider, for the provision of these services, is a state agent of DHFS; as such, for a civil action arising out of an act committed in the lawful course of the health care provider's duties, certain time limitations for filing the action apply, legal counsel is provided to the health care provider, judgments against the health care provider are paid by the state, and amounts recoverable are capped at $250,000.

This bill expands the Volunteer Health Care Provider Program to authorize provision of services, without charge, from four-year-old kindergarten to grade six in a public elementary school, a charter school, or a private school participating in the Milwaukee Parental Choice Program (MPCP), if DOA approves the joint application of a health care provider and a school board or the governing body of a charter school or a private school participating in MPCP. After providing to the school board or relevant governing body proof of satisfactory completion of any relevant competency requirements, the volunteer health care provider may provide without charge to students from four-year-old kindergarten to grade six of the school, regardless of income, diagnostic tests; health education; information about available health care resources; office visits; patient advocacy; referrals to health care specialists; first aid for illness or injury; in compliance with the written instructions of a pupil's parent or guardian, the administration of any drug, other than a contraceptive drug, that may lawfully be sold over the counter; health screenings; any other health care services designated by the Department of Public Instruction (DPI); and, for dentists, simple tooth extractions and necessary related suturing. However, the volunteer health care provider may not provide emergency medical services, hospitalization, or surgery, except as designated by DPI by rule, and may not provide abortion referrals, contraceptives, or pregnancy tests.

Under current law, a health care plan must allow any provider to participate in the plan under the terms of the plan. However, this requirement does not apply to health maintenance organizations, limited service health organizations, or preferred provider plans, each of which is a health care plan that requires, or provides incentives for, its enrollees to obtain health care services from providers participating in the plan. "Participating" is defined as being under contract to provide health care services, items, or supplies to plan enrollees.

This bill requires any health care plan, including a health maintenance organization, limited service health organization, or preferred provider plan, to allow any provider to participate in the plan under the terms of the plan. The requirement only applies to a health maintenance organization, limited service health organization, or preferred provider plan, however, if the provider is located in the geographic service area of the plan. The bill also requires a health care plan that excludes a provider from participation in the plan to give the provider written notice of the reason for the exclusion.

Also under current law, a health maintenance organization, limited service health organization, or preferred provider plan that covers pharmaceutical services provided by one or more pharmacists who are not full-time salaried employees or partners of the organization or plan must provide an annual 30-day period during which any pharmacist may elect to participate in the organization or plan under its terms as a selected provider for at least one year. This bill expands that requirement. Under the bill, a health maintenance organization, limited service health organization, or preferred provider plan that covers health care services that are provided by one or more health care professionals who are not full-time salaried employees or partners of the organization or plan is required to provide an annual 30-day period during which any health care professional who provides those health care services and who is located in the geographic service area of the organization or plan may elect to participate in the organization or plan under its terms as a selected provider for at least one year.

Under current law, a group health insurance policy that provides coverage of any inpatient hospital services must cover those services for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems in the minimum amount of the lesser of: 1) the expenses of 30 days of inpatient services; or 2) $7,000 minus the applicable cost sharing under the policy or, if there is no cost sharing under the policy, $6,300 in equivalent benefits measured in services rendered. If a group health insurance policy provides coverage of any outpatient hospital services, it must cover those services for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems in the minimum amount of $2,000 minus the applicable cost sharing under the policy or, if there is no cost sharing under the policy, $1,800 in equivalent benefits measured in services rendered. If a group health insurance policy provides coverage of any inpatient or outpatient hospital services, it must cover the cost of transitional treatment arrangements (services, specified by rule by the commissioner of insurance, that are provided in a less restrictive manner than inpatient services but in a more intensive manner than outpatient services) for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems in the minimum amount of $3,000 minus the applicable cost sharing under the policy or, if there is no cost sharing under the policy, $2,700 in equivalent benefits measured in services rendered. If a group health insurance policy provides coverage for both inpatient and outpatient hospital services, the total coverage for all types of treatment for nervous and mental disorders and alcoholism and other drug abuse problems is not required to exceed $7,000, or the equivalent benefits measured in services rendered, in a policy year.

This bill specifies that the minimum coverage limits required for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems do not include costs incurred for prescription drugs and diagnostic testing. Diagnostic testing is defined in the bill as procedures used to exclude the existence of conditions other than nervous or mental disorders or alcoholism or other drug abuse problems. DHFS is authorized to specify, by rule, the diagnostic testing procedures that are not included under the coverage limits.

The bill provides that, if an insurer pays less than the amount that a provider charges, the required minimum coverage limits apply to the amount actually paid by the insurer rather than to the amount charged by the provider.

The bill changes the minimum amount of coverage that must be provided for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems on the basis of the change in the consumer price index for medical services since the coverage amounts in current law were enacted. Inpatient services must be covered in the minimum amount of the lesser of: 1) the expenses of 30 days of inpatient services; or 2) $16,800 minus the applicable cost sharing or, if there is no cost sharing under the policy, $15,100 in equivalent benefits measured in services rendered. Outpatient services must be covered in the minimum amount of $3,100 minus the applicable cost sharing or, if there is no cost sharing under the policy, $2,800 in equivalent benefits measured in services rendered. Transitional treatment arrangements must be covered in the minimum amount of $4,600 minus the applicable cost sharing or, if there is no cost sharing under the policy, $4,100 in equivalent benefits measured in services rendered. The total coverage for all types of treatment for nervous and mental disorders and alcoholism and other drug abuse problems is not required to exceed $16,800, or the equivalent benefits measured in services rendered, in a policy year.

The table below provides information on treatment category, current minimum coverage amount, year of enactment, and the proposed coverage amounts based on the increase in the federal cost-of-living for medical coverage "indexed" since the enactment of the current coverage amounts. - See PDF for table - See PDF for table

The bill also requires the DHFS to annually report to the governor and legislature on the change in coverage limits necessary to conform with the change in the federal consumer price index for medical costs.

Under current law, the treatment records of an individual who is treated for mental illness, developmental disabilities, alcoholism, or drug dependence must remain confidential, are privileged to the individual, and may be released only with the individual's informed written consent. However, numerous exceptions apply that permit the release of treatment records without informed written consent. One of the exceptions permits the release of information contained in a treatment record as to whether or not an individual is a patient at an inpatient facility; and the information may be released to the individual's parents, children, or spouse, to a law enforcement officer who is seeking to determine if the individual is on unauthorized absence from the facility, and to mental health professionals who are providing treatment to the individual.

This bill changes that exception to require that notice be provided as to whether or not an individual is a patient at an inpatient facility and, if no longer a patient, the facility to which the individual was transferred or other place, if known, at which the individual is located. This information must be released to the individual's siblings, as well as the individual's parents, children, or spouse, or to a law enforcement officer or mental health professional. However, the bill prohibits the release of the information to the individual's parents, children, siblings, or spouse if the individual has specifically named the person and requested that the information be withheld from him or her.

This bill also requires the DHFS fiscal intermediary for MA to maintain a separate unit for the processing of MA claims for dental services provided under MA.

For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB995, s. 1 Section 1. 20.435 (4) (b) of the statutes is amended to read:

AB995,12,16 20.435 (4) (b) Medical assistance program benefits. Biennially, the amounts in the schedule to provide the state share of medical assistance program benefits administered under s. 49.45, to provide medical assistance program benefits administered under s. 49.45 that are not also provided under par. (o), to fund the pilot project under s. 46.27 (9) and (10), to provide the facility payments under 1999 Wisconsin Act 9, section 9123 (9m), to fund services provided by resource centers under s. 46.283 and for services under the family care benefit under s. 46.284 (5). Notwithstanding s. 20.002 (1), the department may transfer from this appropriation to the appropriation under sub. (7) (kb) funds in the amount of and for the purposes specified in s. 46.485. Notwithstanding ss. 20.001 (3) (b) and 20.002 (1), the department may credit or deposit into this appropriation and may transfer between fiscal years funds that it transfers from the appropriation under sub. (7) (kb) for the purposes specified in s. 46.485 (3r). Notwithstanding s. 20.002 (1), the department may transfer from this appropriation to the appropriation account under sub. (7) (bd) funds in the amount and for the purposes specified in s. 49.45 (6v) (6L).

AB995, s. 2 Section 2. 20.435 (7) (bd) of the statutes is amended to read:

AB995,13,13 20.435 (7) (bd) Community options program; pilot projects; family care benefit. The amounts in the schedule for assessments, case planning, services, administration and risk reserve escrow accounts under s. 46.27, for pilot projects under s. 46.271 (1), to fund services provided by resource centers under s. 46.283 (5), for services under the family care benefit under s. 46.284 (5) and for the payment of premiums under s. 49.472 (5). If the department transfers funds to this appropriation from the appropriation account under sub. (4) (b), the amounts in the schedule for the fiscal year for which the transfer is made are increased by the amount of the transfer for the purposes specified in s. 49.45 (6v) (6L). Notwithstanding ss. 20.001 (3) (a) and 20.002 (1), the department may under this paragraph transfer moneys between fiscal years. Except for moneys authorized for transfer under this appropriation or under s. 46.27 (7) (fm) or (g), all moneys under this appropriation that are allocated under s. 46.27 and are not spent or encumbered by counties or by the department by December 31 of each year shall lapse to the general fund on the succeeding January 1 unless transferred to the next calendar year by the joint committee on finance.

AB995, s. 3 Section 3. 46.03 (44) of the statutes is created to read:

AB995,13,23 46.03 (44) Sexually transmitted disease treatment information. Promulgate a rule specifying the information that a physician, physician assistant, or advanced practice nurse prescriber may provide, in writing, to a patient under s. 448.035 (3) and encourage physicians, physician assistants, and advanced practice nurse prescribers to provide such information to a patient under s. 448.035 (3). The information shall consist of information about sexually transmitted diseases and their treatment and about the risk of drug allergies. The information shall also include a statement advising a person with questions about the information to contact his or her physician or local health department, as defined in s. 250.01 (4).

AB995, s. 4 Section 4. 46.277 (1) of the statutes is amended to read:

AB995,14,12 46.277 (1) Legislative intent. The intent of the program under this section is to provide home or community-based care to serve in a noninstitutional community setting a person who meets eligibility requirements under 42 USC 1396n (c) and is relocated from an institution other than a state center for the developmentally disabled or meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or an intermediate care facility, except that the number of persons who receive home or community-based care under this section is not intended, other than under sub. (4) (c), to exceed the number of nursing home beds that are delicensed as part of a plan submitted by the facility and approved by the department. The intent of the program is also that counties use all existing services for providing care under this section, including those services currently provided by counties.

AB995, s. 5 Section 5. 46.277 (1m) (a) of the statutes is renumbered 46.277 (1m) (ak).

AB995, s. 6 Section 6. 46.277 (1m) (ag) of the statutes is created to read:

AB995,14,16 46.277 (1m) (ag) "Delicensed" means deducted from the number of beds stated on a facility's license, as specified under s. 50.03 (4) (e).

AB995, s. 7 Section 7. 46.277 (2) (intro.) of the statutes is amended to read:

AB995,15,5 46.277 (2) Departmental powers and duties. (intro.) The department may request a waiver from the secretary of the federal department of health and human services, under 42 USC 1396n (c), authorizing the department to serve medical assistance recipients, who meet the level of care requirements for medical assistance reimbursement in a skilled nursing facility or an intermediate care facility, in their communities by providing home or community-based services as part of medical assistance. The Except under sub. (4) (c), the number of persons for whom the waiver is requested may not exceed the number of nursing home beds that are delicensed as part of a plan submitted by the facility and approved by the department. If the department requests a waiver, it shall include all assurances required under 42 USC 1396n (c) (2) in its request. If the department receives this waiver, it may request one or more 3-year extensions of the waiver under 42 USC 1396n (c) and shall perform the following duties:

AB995, s. 8 Section 8. 46.277 (3) (a) of the statutes is amended to read:

AB995,15,16 46.277 (3) (a) Sections 46.27 (3) (b) and 46.275 (3) (a) and (c) to (e) apply to county participation in this program, except that services provided in the program shall substitute for care provided a person in a skilled nursing facility or intermediate care facility who meets the level of care requirements for medical assistance reimbursement to that facility rather than for care provided at a state center for the developmentally disabled. The Except in sub. (4) (c), the number of persons who receive services provided by the program under this paragraph may not exceed the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.

AB995, s. 9 Section 9. 46.277 (3) (b) 1. of the statutes is amended to read:

AB995,15,21 46.277 (3) (b) 1. If Except under sub. (4) (c), if the provision of services under this section results in a decrease in the statewide nursing home bed limit under s. 150.31 (3), the facility affected by the decrease shall submit a plan for delicensing all or part of the facility that is approved by the department.

AB995, s. 10 Section 10. 46.277 (3) (b) 2. of the statutes is amended to read:

AB995,16,3 46.277 (3) (b) 2. Each county department participating in the program shall provide home or community-based care to persons eligible under this section, except that the number of persons who receive home or community-based care under this section may not exceed, other than under sub. (4) (c), the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.

AB995, s. 11 Section 11. 46.277 (4) (a) of the statutes is amended to read:

AB995,16,13 46.277 (4) (a) Any medical assistance recipient who meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or intermediate care facility is eligible to participate in the program, except that the number of participants may not exceed, other than under par. (c), the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department. Such a recipient may apply, or any person may apply on behalf of such a recipient, for participation in the program. Section 46.275 (4) (b) applies to participation in the program.

AB995, s. 12 Section 12. 46.277 (4) (b) of the statutes is amended to read:

AB995,16,22 46.277 (4) (b) To the extent authorized under 42 USC 1396n and except under par. (c), if a person discontinues participation in the program, a medical assistance recipient may participate in the program in place of the participant who discontinues if that recipient meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or intermediate care facility, except that the number of participants may not exceed the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.

AB995, s. 13 Section 13. 46.277 (4) (c) of the statutes is created to read:

AB995,17,9 46.277 (4) (c) The department may, under this paragraph, provide funding under this section for services for a medical assistance recipient who relocates from a facility to the community, beginning on the date of the relocation and ending on the date that the individual discontinues participation in the program or no longer meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or an intermediate care facility. Funding for medical assistance costs for individuals relocated under this paragraph may not exceed, in the aggregate, total medical assistance costs for the individuals if served in facilities. The total number of individuals who may participate in the program under this paragraph is not restricted by any otherwise applicable limitation on the number of individuals who may participate in the program under this section.

AB995, s. 14 Section 14. 46.277 (5) (g) of the statutes, as created by 2003 Wisconsin Act 33, is amended to read:

AB995,17,17 46.277 (5) (g) The department may provide enhanced reimbursement for services provided under this section to an individual who is relocated to the community from a nursing home by a county department on or after July 26, 2003, if the nursing home bed that was used by the individual is delicensed upon relocation of the individual or if the individual is relocated under sub. (4) (c). The department shall develop and utilize a formula to determine the enhanced reimbursement rate.

AB995, s. 15 Section 15. 46.277 (5g) (a) of the statutes is amended to read:

AB995,17,22 46.277 (5g) (a) The Except under sub. (4) (c), the number of persons served under this section may not exceed the number of nursing home beds that are delicensed as part of a plan submitted by the facility and approved by the department.

AB995, s. 16 Section 16. 49.45 (6ur) of the statutes is created to read:

AB995,18,5 49.45 (6ur) Physician order entry record system; incentive payments. From the appropriation accounts under s. 20.435 (4) (b) and (o), the department shall annually make an incentive payment to each hospital that establishes, by January 1, 2007, and thereafter continues to maintain a physician order entry record system for provided medical services that, at a minimum, include pharmacy, laboratory, ultrasonography, and radiology services. The incentive payment shall equal 1% of the Medical Assistance reimbursement to the hospital for the previous fiscal year.

AB995, s. 17 Section 17. 49.45 (6v) of the statutes is renumbered 49.45 (6L).

AB995, s. 18 Section 18. 49.45 (53) of the statutes is created to read:

AB995,18,10 49.45 (53) Fiscal intermediary; dental forms. The department's fiscal intermediary shall maintain a separate unit for the processing of claims for dental services received under this section.

AB995, s. 19 Section 19. 49.46 (1) (a) 1. of the statutes is amended to read:

AB995,18,14 49.46 (1) (a) 1. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources and subject to par. (ar), would qualify for a grant of aid to families with dependent children under s. 49.19.

AB995, s. 20 Section 20. 49.46 (1) (a) 1g. of the statutes is amended to read:

AB995,18,19 49.46 (1) (a) 1g. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources and subject to par. (ar), would qualify for a grant of aid to families with dependent children but who would not receive the aid solely because of the application of s. 49.19 (11) (a) 7.

AB995, s. 21 Section 21. 49.46 (1) (a) 1m. of the statutes is amended to read:

AB995,18,24 49.46 (1) (a) 1m. Any pregnant woman whose income, determined in accordance with par. (ar), does not exceed the standard of need under s. 49.19 (11) and whose pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th day after the last day of the pregnancy falls.

AB995, s. 22 Section 22. 49.46 (1) (a) 6. of the statutes is amended to read:

AB995,19,4 49.46 (1) (a) 6. Any person not described in pars. (c) to (e) who, without regard to the individual's resources and subject to par. (ar), would be considered, under federal law, to be receiving aid to families with dependent children for the purpose of determining eligibility for medical assistance.

AB995, s. 23 Section 23. 49.46 (1) (a) 9. of the statutes is amended to read:

AB995,19,8 49.46 (1) (a) 9. Any pregnant woman not described under subd. 1., 1g., or 1m. whose family income, determined in accordance with par. (ar), does not exceed 133% of the poverty line for a family the size of the woman's family.

AB995, s. 24 Section 24. 49.46 (1) (a) 10. of the statutes is amended to read:

AB995,19,12 49.46 (1) (a) 10. Any child not described under subd. 1. or 1g. who is under 6 years of age and whose family income, determined in accordance with par. (ar), does not exceed 133% of the poverty line for a family the size of the child's family.

AB995, s. 25 Section 25. 49.46 (1) (a) 11. of the statutes is amended to read:

AB995,19,22 49.46 (1) (a) 11. If a waiver under s. 49.665 is granted and in effect, any child not described under subd. 1. or 1g. who has attained the age of 6 but has not attained the age of 19 and whose family income, determined in accordance with par. (ar), does not exceed 100% of the poverty line for a family the size of the child's family. If a waiver under s. 49.665 is not granted or in effect, any child not described in subd. 1. or 1g. who was born after September 30,1983, who has attained the age of 6 but has not attained the age of 19 and whose family income, determined in accordance with par. (ar), does not exceed 100% of the poverty line for a family the size of the child's family.

AB995, s. 26 Section 26. 49.46 (1) (a) 12. of the statutes is amended to read:

AB995,20,3 49.46 (1) (a) 12. Any child not described under subd. 1. or 1g. who is under 19 years of age and whose income, determined in accordance with par. (ar), does not exceed the standard of need under s. 49.19 (11).

AB995, s. 27 Section 27 . 49.46 (1) (ar) of the statutes is created to read:

AB995,20,14 49.46 (1) (ar) 1. Except as provided in subd. 2. and except to the extent that the determination is inconsistent with 42 USC 1396a (a) (17), for purposes of determining under par. (a) 1., 1g., or 6. whether an individual would qualify for a grant of aid to families with dependent children under s. 49.19 or would be considered, under federal law, to be receiving aid to families with dependent children, or of determining whether an individual meets the income limits under par. (a) 1m., 9., 10., 11., or 12., "income" includes income that would be included in determining eligibility for aid to families with dependent children under s. 49.19 and excludes income that would be excluded in determining eligibility for aid to families with dependent children under s. 49.19.

AB995,20,21 2. Notwithstanding s. 49.19 (5), for purposes of determining under par. (a) 1., 1g., or 6. whether an individual would qualify for a grant of aid to families with dependent children under s. 49.19 or would be considered, under federal law, to be receiving aid to families with dependent children, or of determining whether an individual meets the income limits under par. (a) 1m., 9., 10., 11., or 12., (am), or (e), the department shall exclude from the calculation of farm or self-employment income any amounts claimed for depreciation for income tax purposes.

AB995, s. 28 Section 28. 49.46 (1) (e) of the statutes is amended to read:

AB995,21,4 49.46 (1) (e) If an application under s. 49.47 (3) shows that the individual individual's income, determined in accordance with par. (ar), meets the income limits under s. 49.19, or that the individual meets the income and resource requirements under federal Title XVI or s. 49.77, or that the individual is an essential person, an accommodated person, or a patient in a public medical institution, the individual shall be granted the benefits enumerated under sub. (2) whether or not the individual requests or receives a grant of any of such aids.

AB995, s. 29 Section 29. 49.46 (1) (L) of the statutes is repealed.

AB995, s. 30 Section 30. 49.47 (4) (am) 1. of the statutes is amended to read:

AB995,21,12 49.47 (4) (am) 1. A pregnant woman whose family income , determined in accordance with par. (cg), does not exceed 155% of the poverty line for a family the size of the woman's family, except that, if a waiver under par. (j) or a change in the approved state plan under s. 49.46 (1) (am) 2. is in effect, the income limit is 185% of the poverty line for a family the size of the woman's family in each state fiscal year after the 1994-95 state fiscal year.