SB55-ASA1-AA1,443,189
49.45
(21) (b)
If a transfer occurs
If, notwithstanding the prohibition under par.
10(ar), a person takes over the operation of a provider and the applicable amount under
11par.
(a) (ar) has not been repaid, the department may
, in addition to withholding
12certification as authorized under sub. (2) (b) 8., proceed against
either the transferor
13or the transferee the provider or the person. Within 30 days after
receiving the
14certified provider receives notice from the department, the
transferor or the
15transferee shall pay the amount
shall be repaid in full.
Upon failure to comply If the
16amount is not repaid in full, the department may bring an action to compel payment
.
17If a transferor fails to pay within 90 days after receiving notice from the department,
18the department, may proceed under sub. (2) (a) 12.
, or may do both.".
SB55-ASA1-AA1,444,221
49.45
(49) Prior authorization for legend drugs. If, after June 30, 2002, and
22before July 1, 2004, a manufacturer has in force a rebate agreement under s. 49.688
23(7), the department may not during that period expand the prior authorization
24requirements for prescription drugs manufactured by the manufacturer for which
1coverage is provided under s. 49.46 (2) (b) 6. h. beyond those prior authorization
2requirements that are in effect on July 1, 2002.".
SB55-ASA1-AA1,444,155
49.45
(53) Refund of medical relief and general relief. (a) If a service
6provider receives reimbursement under this section for a claim submitted by or on
7behalf of the service provider under the circumstance specified under s. 49.45 (2) (a)
82m. b., the service provider shall, as a condition of certification under sub. (2) (a) 11.,
9refund to the county that initially reimbursed the services as general relief or as
10medical relief, any medical relief under a relief block grant or any general relief paid
11to the service provider for the medical assistance-reimbursable services rendered.
12The county shall separately identify this refund and remit to the department for
13deposit in the appropriation account under s. 20.435 (4) (ib) an amount that
14represents the state's contribution toward the original medical relief or general relief
15paid.
SB55-ASA1-AA1,444,2116
(b) If the federal department of health and human services disallows payment
17to the state of federal financial participation for a claim submitted by or on behalf of
18a service provider under the circumstance specified under sub. (2) (a) 2m. b., the
19county shall remit to the department for deposit in the appropriation account under
20s. 20.435 (4) (ib) an amount that is equal to the amount of federal financial
21participation paid by the department to the service provider under par. (a).
SB55-ASA1-AA1,444,2222
(c) This subsection does not apply after June 30, 2005.".
SB55-ASA1-AA1,445,128
49.47
(4) (aq) 1. Subject to subd. 2., an individual who does not meet the
9limitation on income under par. (c) is eligible for medical assistance if the individual's
10income does not exceed 100% of the federal poverty level, and the individual is 65
11years of age or older or is blind or totally and permanently disabled, as defined under
12federal Title XVI.
SB55-ASA1-AA1,445,1613
2. If a federal waiver is necessary to provide medical assistance to individuals
14specified in subd. 1., the department shall request a waiver from the secretary of the
15federal department of health and human services before providing medical
16assistance under this paragraph.".
SB55-ASA1-AA1,445,2119
49.47
(4) (b) 2m. b. For persons who are eligible under par. (a) 3. or 4.
or (aq),
20motor vehicles are exempt from consideration as an asset to the same extent as
21provided under
42 USC 1381 to
1385.
SB55-ASA1-AA1,446,223
49.47
(4) (b) 2r. For a person who is eligible under par. (a) 3. or 4.
or (aq), the
24value of any burial space or agreement representing the purchase of a burial space
1held for the purpose of providing a place for the burial of the person or any member
2of his or her immediate family.
SB55-ASA1-AA1,446,64
49.47
(4) (b) 2w. For a person who is eligible under par. (a) 3. or 4.
or (aq), life
5insurance with cash surrender values if the total face value of all life insurance
6policies is not more than $1,500.
SB55-ASA1-AA1,446,128
49.47
(4) (b) 3. For a person who is eligible under par. (a) 3. or 4.
or (aq), funds
9set aside to meet the burial and related expenses of the person and his or her spouse
10in an amount not to exceed $1,500 each, minus the sum of the cash value of any life
11insurance excluded under subd. 2w. and the amount in any irrevocable burial trust
12under s. 445.125 (1) (a).
SB55-ASA1-AA1,446,2514
49.47
(4) (c) 1. Except as provided in
par. pars. (am)
and (aq) and as limited by
15subd. 3., eligibility exists if income does not exceed
133 1/3% 133.33% of the
16maximum aid to families with dependent children payment under s. 49.19 (11) for
17the applicant's family size or the combined benefit amount available under
18supplemental security income under
42 USC 1381 to
1383c and state supplemental
19aid under s. 49.77 whichever is higher. In this subdivision "income" includes earned
20or unearned income that would be included in determining eligibility for the
21individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled under
2242 USC 1381 to
1385. "Income" does not include earned or unearned income which
23would be excluded in determining eligibility for the individual or family under s.
2449.19 or 49.77, or for the aged, blind or disabled individual under
42 USC 1381 to
251385.".
SB55-ASA1-AA1,447,85
49.47
(4) (c) 3. Except as provided in
par. pars. (am)
and (aq), no person is
6eligible for medical assistance under this section if the person's income exceeds the
7maximum income levels that the U.S. department of health and human services sets
8for federal financial participation under
42 USC 1396b (f).
SB55-ASA1-AA1,447,1210
49.47
(4) (i) 2. (intro.) Notwithstanding par. (b) 2r. and 3., a person who is
11described in par. (a) 3. or 4.
or (aq) is not eligible for benefits under this section if any
12of the following criteria is met:".
SB55-ASA1-AA1,447,20
1549.4981 Comprehensive quality assessment pilot project. (1) If the
16department receives a waiver of federal medical assistance laws, as requested under
172001 Wisconsin Act .... (this act), section 9123 (19g), the department shall conduct
18a pilot project in the counties of Brown, Grant, Polk, and Waukesha under which
19nursing facilities shall apply to the department, under requirements specified by the
20department, to participate in the pilot project.
SB55-ASA1-AA1,448,10
21(2) If participation for a nursing facility is approved by the department under
22subsection (1), and if the nursing facility contracts to receive a comprehensive quality
23assessment, under standards and principles of comprehensive assessments of the
24quality of care provided to residents of nursing facilities, the nursing facility shall
1provide to the department a copy of a report by the assessment provider of each such
2assessment that is conducted. Each report shall include any findings of violations
3of state statutes or rules by the nursing facility that are discovered in the course of
4performance of the assessment. The nursing facility shall provide information that
5the department requests concerning any violations noted. The department may use
6the assessment report and information provided by the nursing facility as evidence
7to which s. 50.04 (4) applies or upon which an applicable forfeiture under s. 49.498
8(16) or 50.04 (5) may be assessed. Upon receipt of the assessment report, the
9department may, but is not required to, waive the requirement under s. 49.498 (13)
10for an annual survey of the nursing facility.".
SB55-ASA1-AA1,448,1513
49.496
(3) (f) The department may contract with or employ an attorney to
14probate estates to recover under this subsection the costs of care.
Any such contract
15is subject to the requirements of s. 20.930 (2) to (5).".
SB55-ASA1-AA1,449,1418
49.665
(5) (a) Except as provided in pars. (b) and (bm), a family, or child who
19does not reside with his or her parent, who receives health care coverage under this
20section shall pay a percentage of the cost of that coverage in accordance with a
21schedule established by the department by rule.
If
Except as provided in par. (am),
22if the schedule established by the department requires a family, or child who does not
23reside with his or her parent, to contribute more than 3% of the family's or child's
24income towards the cost of the health care coverage provided under this section, the
1department shall submit the schedule to the joint committee on finance for review
2and approval of the schedule. If the cochairpersons of the joint committee on finance
3do not notify the department within 14 working days after the date of the
4department's submittal of the schedule that the committee has scheduled a meeting
5to review the schedule, the department may implement the schedule. If, within 14
6days after the date of the department's submittal of the schedule, the cochairpersons
7of the committee notify the department that the committee has scheduled a meeting
8to review the schedule, the department may not require a family, or child who does
9not reside with his or her parent, to contribute more than 3% of the family's or child's
10income unless the joint committee on finance approves the schedule. The joint
11committee on finance may not approve and the department may not implement a
12schedule that requires a family or child to contribute more than 3.5% of the family's
13or child's income towards the cost of the health care coverage provided under this
14section.
SB55-ASA1-AA1,449,2316
49.665
(5) (am) No later than January 1, 2002, the department shall request
17a waiver from the federal secretary of health and human services to increase the
18maximum amount that a family, or child who does not reside with his or her parent,
19is required to pay under par. (a) to 5% of the family's or child's income. If the waiver
20is granted, the department shall increase the maximum amount that a family, or
21child who does not reside with his or her parent, is required to pay under par. (a) to
225% of the family's or child's income and is not required to receive approval from the
23joint committee on finance before increasing the maximum amount.".
SB55-ASA1-AA1,450,42
49.682
(6) The department may contract with or employ an attorney to probate
3estates to recover under this section the costs of care.
Any such contract is subject
4to the requirements of s. 20.930 (2) to (5).".
SB55-ASA1-AA1,450,8
749.688 Prescription drug assistance for low-income elderly persons.
8(1) In this section:
SB55-ASA1-AA1,450,99
(a) "Generic name" has the meaning given in s. 450.12 (1) (b).
SB55-ASA1-AA1,450,1110
(b) "Poverty line" means the nonfarm federal poverty line for the continental
11United States, as defined by the federal department of labor under
42 USC 9902 (2).
SB55-ASA1-AA1,450,1512
(c) "Prescription drug" means a prescription drug, as defined in s. 450.01 (20),
13that is included in the drugs specified under s. 49.46 (2) (b) 6. h. and that is
14manufactured by a manufacturer that enters into a rebate agreement in force under
15sub. (7).
SB55-ASA1-AA1,450,1616
(d) "Prescription order" has the meaning given in s. 450.01 (21).
SB55-ASA1-AA1,451,2
17(2) A person who is a resident, as defined in s. 27.01 (10) (a), of this state, who
18is at least 65 years of age, who is not a recipient of medical assistance, whose annual
19household income, as determined by the department, does not exceed 185% of the
20poverty line for a family the size of the person's eligible family, and who pays the
21program enrollment fee specified in sub. (3) (a) is eligible to purchase a prescription
22drug at the amounts specified in sub. (6) (b). The person may apply to the
23department, on a form provided by the department for a determination of eligibility
1and issuance of a prescription drug card for purchase of prescription drugs under this
2section.
SB55-ASA1-AA1,451,3
3(3) (a) Program participants shall pay all of the following:
SB55-ASA1-AA1,451,44
1. For each 12-month benefit period, a program enrollment fee of $25.
SB55-ASA1-AA1,451,55
2. For each 12-month benefit period, a deductible for each person of $840.
SB55-ASA1-AA1,451,66
3. After payment of the deductible under subd. 2., all of the following:
SB55-ASA1-AA1,451,87
a. A copayment of $10 for each prescription drug that bears only a generic
8name.
SB55-ASA1-AA1,451,109
b. A copayment of $20 for each prescription drug that does not bear only a
10generic name.
SB55-ASA1-AA1,451,1411
(b) Notwithstanding s. 49.002, if a person who is eligible under this section has
12other available coverage for payment of a prescription drug, this section applies only
13to costs for prescription drugs for the person that are not covered under the person's
14other available coverage.
SB55-ASA1-AA1,451,20
15(4) The department shall devise and distribute a form for application for the
16program under sub. (2), shall determine eligibility for each 12-month benefit period
17of applicants, and shall issue to eligible persons a prescription drug card for use in
18purchasing prescription drugs, as specified in sub. (5). The department shall
19promulgate rules that specify the criteria to be used to determine annual household
20income under sub. (2).
SB55-ASA1-AA1,452,2
21(5) Beginning July 1, 2002, as a condition of participation by a pharmacy or
22pharmacist in the program under s. 49.45, 49.46, or 49.47, the pharmacy or
23pharmacist may not charge a person who presents a valid prescription order and a
24card indicating that he or she meets eligibility requirements under sub. (2) an
1amount for a prescription drug under the order that exceeds the amounts specified
2in sub. (6) (b).
SB55-ASA1-AA1,452,5
3(6) (a) The charge for a prescription drug shall be calculated at the average
4wholesale price minus 5% or the maximum allowable cost, as determined by the
5department, whichever is less.
SB55-ASA1-AA1,452,76
(b) The amounts that a pharmacy or pharmacist may charge a person specified
7in sub. (2) in a 12-month period for a prescription drug are the following:
SB55-ASA1-AA1,452,118
1. If applicable, a deductible, as specified in sub. (3) (a) 2., for a prescription
9drug that is charged at the rate specified in par. (a), plus a dispensing fee that is equal
10to the dispensing fee permitted to be charged for prescription drugs for which
11coverage is provided under s. 49.46 (2) (b) 6. h.
SB55-ASA1-AA1,452,1312
2. After the deductible under subd. 1. is charged, the copayment, as applicable,
13that is specified in sub. (3) (a) 3. a. or b.
SB55-ASA1-AA1,452,1714
(c) The department shall calculate and transmit to pharmacies and
15pharmacists that are certified providers of medical assistance amounts that may be
16used in calculating charges under par. (a). The department shall periodically update
17this information and transmit the updated amounts to pharmacies and pharmacists.
SB55-ASA1-AA1,452,22
18(7) The department or an entity with which the department contracts may
19enter into a rebate agreement that is modeled on the rebate agreement specified
20under
42 USC 1396r-8 with a drug manufacturer that sells drugs for prescribed use
21in this state. The rebate agreement, if negotiated, shall include all of the following
22as requirements:
SB55-ASA1-AA1,453,223
(a) That the manufacturer shall make rebate payments for each prescription
24drug of the manufacturer that is prescribed for persons who are eligible under sub.
1(2), to the state treasurer to be credited to the appropriation under s. 20.435 (4) (j),
2each calendar quarter or according to a schedule established by the department.
SB55-ASA1-AA1,453,43
(b) That the amount of the rebate payment shall be determined by a method
4specified in
42 USC 1396r-8 (c).
SB55-ASA1-AA1,453,19
5(8) From the appropriation accounts under s. 20.435 (4) (bv) and (j), beginning
6July 1, 2002, the department shall, under a schedule that is identical to that used
7by the department for payment of pharmacy provider claims under medical
8assistance, provide to pharmacies and pharmacists payments for prescription drugs
9sold by the pharmacies or pharmacists to persons eligible under sub. (2) who have
10paid the deductible specified under sub. (3) (a) 2. The payment for each prescription
11drug under this subsection shall be at the rate specified in sub. (6) (a), minus the
12amount of a copayment charged under sub. (6) (b) 2., plus a dispensing fee, as
13specified in sub. (6) (b) 1. The department shall devise and distribute a form for
14reports by pharmacies and pharmacists under this subsection and may limit
15payment under this subsection to those prescription drugs for which payment claims
16are submitted by pharmacies or pharmacists directly to the department. The
17department may apply to the program under this section the same utilization and
18cost control procedures that apply under rules promulgated by the department to
19medical assistance under subch. IV.
SB55-ASA1-AA1,454,2
20(9) The department shall, under methods promulgated by the department by
21rule, monitor compliance by pharmacies and pharmacists that are certified providers
22of medical assistance with the requirements of sub. (5) and shall annually report to
23the legislature under s. 13.172 (2) concerning the compliance. The report shall
24include information on any pharmacies or pharmacists that discontinue
1participation as certified providers of medical assistance and the reasons given for
2the discontinuance.
SB55-ASA1-AA1,454,4
3(10) (a) The department shall promulgate rules relating to prohibitions on
4fraud that are substantially similar to applicable provisions under s. 49.49 (1) (a).
SB55-ASA1-AA1,454,85
(b) A person who is convicted of violating a rule promulgated by the department
6under par. (a) in connection with that person's furnishing of prescription drugs under
7this section may be fined not more than $25,000, or imprisoned for not more than 7
8years and 6 months, or both.
SB55-ASA1-AA1,454,119
(c) A person other than a person specified in par. (b) who is convicted of violating
10a rule promulgated by the department under par. (a) may be fined not more than
11$10,000, or imprisoned for not more than one year, or both.
SB55-ASA1-AA1,454,17
12(11) If federal law is amended to provide coverage for prescription drugs for
13outpatient care as a benefit under medicare or to provide similar coverage under
14another program, the department shall submit to appropriate standing committees
15of the legislature under s. 13.172 (3) a report that contains an analysis of the
16differences between such a federal program and the program under this section and
17that provides recommendations concerning alignment, if any, of the differences.
SB55-ASA1-AA1,454,22
18(12) After June 30, 2002, and before July 1, 2004, the department may not
19subject a manufacturer that enters into a rebate agreement under sub. (7) to prior
20authorization requirements for a prescription drug under this section that are an
21expansion of prior authorization requirements in effect under the medical assistance
22program on July 1, 2002.
SB55-ASA1-AA1,455,2
23(13) Except as provided in subs. (9) to (12), and except for the department's
24rule-making requirements and authority, the department may enter into a contract
1with an entity to perform the duties and exercise the powers of the department under
2this section.".
SB55-ASA1-AA1,455,136
49.85
(1) County department notification requirement. If a county
7department under s. 46.215, 46.22 or 46.23, a governing body of a federally
8recognized American Indian tribe or band or a Wisconsin works agency determines
9that the department of health and family services may recover an amount under s.
1049.497
or 49.793 or that the department of workforce development may recover an
11amount under s.
49.125, 49.161 or 49.195 (3), the county department
or, tribal 12governing body
, or Wisconsin works agency shall notify the affected department of
13the determination.".
