AB40: Bill Text

AB40,661,14 49.45 (24m) (intro.) From the appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), in order to test the feasibility of instituting a system of reimbursement for providers of home health care and personal care services for medical assistance recipients that is based on competitive bidding, the department shall:

AB40, s. 1440 Section 1440. 49.45 (24r) (a) of the statutes is renumbered 49.45 (24r).

AB40, s. 1441 Section 1441. 49.45 (24r) (b) of the statutes is repealed.

AB40, s. 1442 Section 1442. 49.45 (34) of the statutes is amended to read:

AB40,661,22 49.45 (34) Medical assistance manual. The department shall prepare a medical assistance manual that is clear, comprehensive and consistent with this subchapter and 42 USC 1396a to 1396u and shall, no later than July 1, 1992, provide the manual to counties for use by county employees who administer the medical assistance program.

AB40, s. 1443 Section 1443. 49.45 (51) (a) of the statutes is amended to read:

AB40,662,6 49.45 (51) (a) By November 1 annually, the department shall provide to the department of revenue information concerning the estimated amounts of supplements payable from the appropriation accounts under s. 20.435 (4) (b) and (gm) to specific local governmental units for the provision of transportation for medical care, as specified under s. 49.46 (2) (b) 3., during the fiscal year. Beginning November 1, 2004, the information that the department provides under this paragraph shall include any adjustments necessary to reflect actual claims submitted by service providers in the previous fiscal year.

AB40, s. 1444 Section 1444. 49.45 (52) (title) of the statutes is amended to read:

AB40,662,8 49.45 (52) (title) Payment adjustments ; federal funding for certain services.

AB40, s. 1445 Section 1445. 49.45 (52) of the statutes is renumbered 49.45 (52) (a) 1. and amended to read:

AB40,662,24 49.45 (52) (a) 1. Beginning on January 1, 2003 If the department provides the notice under par. (c) selecting the payment procedure in this paragraph, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payment adjustments to county departments under s. 46.215, 46.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01 (4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating in the early intervention program under s. 51.44. Payment adjustments under this subsection paragraph shall include the state share of the payments. The total of any payment adjustments under this subsection paragraph and Medical Assistance payments made from appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

AB40, s. 1446 Section 1446. 49.45 (52) (a) 2. of the statutes is created to read:

AB40,663,4 49.45 (52) (a) 2. The department may require a county department or local health department to submit a certified cost report that meets the requirements of the federal department of health and human services for covered services described in subd. 1.

AB40, s. 1447 Section 1447. 49.45 (52) (b) of the statutes is created to read:

AB40,663,7 49.45 (52) (b) If the department provides the notice under par. (c) selecting the payment procedure in this paragraph, all of the following apply:

AB40,663,13 1. Annually, a county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437 shall submit a certified cost report that meets the requirements of the federal department of health and human services for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating in the early intervention program under s. 51.44.

AB40,663,17 2. For services described under subd. 1., the department shall base the amount of a claim for federal medical assistance funds on certified cost reports submitted by county departments under subd. 1. to the extent the reports comply with federal requirements.

AB40,663,20 3. The department shall pay county departments a percentage of the federal funds claimed under subd. 2. for services described under subd. 1., which percentage is established in the most recent biennial budget.

AB40,663,24 4. The department may pay a local health department, as defined in s. 250.01 (4), that submits certified cost reports for services described under subd. 1. a percentage of the federal funds claimed for those services, which percentage is established in the most recent biennial budget.

AB40, s. 1448 Section 1448. 49.45 (52) (c) of the statutes is created to read:

AB40,664,5 49.45 (52) (c) The department shall select a payment procedure under either par. (a) or (b) and may change which procedure under par. (a) or (b) is selected. The department shall notify each county department and local health department, as applicable, of the selected payment procedure before the date on which payment for services is made under that selected or newly selected procedure.

AB40, s. 1449 Section 1449. 49.45 (53) of the statutes is amended to read:

AB40,664,10 49.45 (53) Payments for certain services. Beginning on January 1, 2003, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payments to providers for covered services under ss. 49.46 (2) (a) 4. d. and (b) 6. j. and m. and 49.471 (11) (f) that are provided before January 1, 2012.

AB40, s. 1450 Section 1450. 49.46 (1) (a) 4. of the statutes is amended to read:

AB40,664,13 49.46 (1) (a) 4. Any person receiving benefits under s. 49.77 49.39 or federal Title XVI.

AB40, s. 1451 Section 1451. 49.46 (1) (a) 4m. of the statutes is amended to read:

AB40,664,15 49.46 (1) (a) 4m. Any child for whom a payment is made under s. 49.775 49.395.

AB40, s. 1452 Section 1452. 49.46 (1) (d) 4. of the statutes is amended to read:

AB40,664,18 49.46 (1) (d) 4. A child who meets the conditions under 42 USC 1396a (e) (3) shall be considered a recipient of benefits under s. 49.77 49.39 or federal Title XVI.

AB40, s. 1453 Section 1453. 49.46 (1) (e) of the statutes is amended to read:

AB40,664,25 49.46 (1) (e) If an application under s. 49.47 (3) shows that the individual meets the income limits under s. 49.19 or meets the income and resource requirements under federal Title XVI or s. 49.77 49.39, 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.

AB40, s. 1454 Section 1454. 49.465 (2) (a) of the statutes is amended to read:

AB40,665,5 49.465 (2) (a) If the woman applies for benefits under s. 49.46 or 49.47 within the time required under sub. (4), the day on which the department or the county department under s. 46.215, 46.22 or 46.23 determines whether the woman is eligible for benefits under s. 49.46 or 49.47.

AB40, s. 1455 Section 1455. 49.468 (1) (b) of the statutes is amended to read:

AB40,665,23 49.468 (1) (b) For an elderly or disabled individual who is entitled to coverage under part Part A of medicare Medicare, entitled to coverage under part Part B of medicare Medicare, and who does not meet the eligibility criteria for medical assistance Medical Assistance under s. 49.46 (1), 49.465, 49.47 (4), or 49.471 but meets the limitations on income and resources under par. (d), medical assistance Medical Assistance shall pay the deductible and coinsurance portions of medicare Medicare services under 42 USC 1395 to 1395zz which that are not paid under 42 USC 1395 to 1395zz, including those medicare Medicare services that are not included in the approved state plan for services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under part Part A of medicare Medicare. Payment of coinsurance for a service under part Part B of medicare Medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, and payment of coinsurance for a service under Part A of Medicare may not exceed the allowable charge for the service under medical assistance Medical Assistance minus the medicare Medicare payment.

AB40, s. 1456 Section 1456. 49.468 (1) (c) of the statutes is amended to read:

AB40,666,13 49.468 (1) (c) For an elderly or disabled individual who is only entitled to coverage under part Part A of medicare Medicare and who does not meet the eligibility criteria for medical assistance Medical Assistance under s. 49.46 (1), 49.465, 49.47 (4), or 49.471 but meets the limitations on income and resources under par. (d), medical assistance Medical Assistance shall pay the deductible and coinsurance portions of medicare Medicare services under 42 USC 1395 to 1395i which that are not paid under 42 USC 1395 to 1395i, including those medicare Medicare services that are not included in the approved state plan for services under 42 USC 1396; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty for premiums under part Part A of medicare Medicare, if applicable. Payment of coinsurance for a service under Part A of Medicare may not exceed the allowable charge for the service under Medical Assistance minus the Medicare payment.

AB40, s. 1457 Section 1457. 49.47 (3) (b) of the statutes is amended to read:

AB40,666,17 49.47 (3) (b) The agency department shall promptly review the application and shall issue a certificate to the individual showing eligibility when eligibility has been established.

AB40, s. 1458 Section 1458. 49.47 (4) (c) 1. of the statutes is amended to read:

AB40,667,4 49.47 (4) (c) 1. Except as provided in par. (am) and as limited by subd. 3., eligibility exists if income does not exceed 133 1/3% of the maximum aid to families with dependent children payment under s. 49.19 (11) for the applicant's family size or the combined benefit amount available under supplemental security income under 42 USC 1381 to 1383c and state supplemental aid under s. 49.77 49.39, whichever is higher. In this subdivision "income" includes earned or unearned income that would be included in determining eligibility for the individual or family under s. 49.19 or 49.77 49.39, or for the aged, blind or disabled under 42 USC 1381 to 1385. "Income" does not include earned or unearned income which would be excluded in determining eligibility for the individual or family under s. 49.19 or 49.77 49.39, or for the aged, blind or disabled individual under 42 USC 1381 to 1385.

AB40, s. 1459 Section 1459. 49.47 (4) (i) 1. of the statutes is amended to read:

AB40,667,19 49.47 (4) (i) 1. The department shall request a waiver from the secretary of the federal department of health and human services to permit the application of subd. 2. The waiver shall request approval to implement the waiver on a statewide basis, unless the department of health services determines that statewide implementation of the waiver would present an obstacle to the approval of the waiver by the secretary of the federal department of health and human services, in which case the waiver shall request approval to implement the waiver in 48 pilot counties to be selected by the department of health services. Within 30 days after August 12, 1993, the department of regulation and licensing safety and professional services shall notify funeral directors licensed under ch. 445, cemetery associations, as defined in s. 157.061 (1r), and cemetery authorities, as defined in s. 157.061 (2), of the terms of the waiver required to be requested under this subdivision. If the waiver is approved by the secretary of the federal department of health and human services and if the waiver remains in effect, subd. 2. shall apply.

AB40, s. 1460 Section 1460. 49.471 (5) (b) 3. a. of the statutes is amended to read:

AB40,667,25 49.471 (5) (b) 3. a. If the woman or child applies for benefits under sub. (4) within the time required under par. (d), the benefits specified in subd. 1. or 2., whichever is applicable, end on the day on which the department or the county department under s. 46.215, 46.22, or 46.23 determines whether the woman or child is eligible for benefits under sub. (4).

AB40, s. 1461 Section 1461. 49.471 (7) (c) 4. of the statutes is amended to read:

AB40,668,3 49.471 (7) (c) 4. Not include in the calculation any income of an individual receiving benefits under s. 49.77 49.39 or federal Title XVI.

AB40, s. 1462 Section 1462. 49.472 (4) (a) 2. a. of the statutes is amended to read:

AB40,668,8 49.472 (4) (a) 2. a. A maintenance allowance established by the department by rule. The maintenance allowance may not be less than the sum of $20, the federal supplemental security income payment level determined under 42 USC 1382 (b) and the state supplemental payment determined under s. 49.77 (2m) 49.39 (2m).

AB40, s. 1463 Section 1463. 49.472 (6) (a) of the statutes is amended to read:

AB40,668,15 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account accounts under s. 20.435 (4) (b), (gm), or (w), the department shall, on the part of an individual who is eligible for medical assistance under sub. (3), pay premiums for or purchase individual coverage offered by the individual's employer if the department determines that paying the premiums for or purchasing the coverage will not be more costly than providing medical assistance.

AB40, s. 1464 Section 1464. 49.472 (6) (b) of the statutes is amended to read:

AB40,668,20 49.472 (6) (b) If federal financial participation is available, from the appropriation account accounts under s. 20.435 (4) (b), (gm), or (w), the department may pay medicare Part A and Part B premiums for individuals who are eligible for medicare and for medical assistance under sub. (3).

AB40, s. 1465 Section 1465. 49.473 (2) (intro.) of the statutes is amended to read:

AB40,668,24 49.473 (2) (intro.) A woman is eligible for medical assistance as provided under sub. (5) if, after applying to the department or a county department, the department or a county department determines that she meets all of the following requirements:

AB40, s. 1466 Section 1466. 49.473 (3) (intro.) of the statutes is amended to read:

AB40,669,5 49.473 (3) (intro.) Prior to applying to the department or a county department for medical assistance, a woman is eligible for medical assistance as provided under sub. (5) beginning on the date on which a qualified entity determines, on the basis of preliminary information, that the woman meets the requirements specified in sub. (2) and ending on one of the following dates:

AB40, s. 1467 Section 1467. 49.473 (3) (a) of the statutes is amended to read:

AB40,669,10 49.473 (3) (a) If the woman applies to the department or a county department for medical assistance within the time limit required under sub. (4), the day on which the department or county department determines whether the woman meets the requirements under sub. (2).

AB40, s. 1468 Section 1468. 49.473 (3) (b) of the statutes is amended to read:

AB40,669,15 49.473 (3) (b) If the woman does not apply to the department or county department for medical assistance within the time limit required under sub. (4), the last day of the month following the month in which the qualified entity determines that the woman is eligible for medical assistance.

AB40, s. 1469 Section 1469. 49.473 (4) of the statutes is amended to read:

AB40,669,20 49.473 (4) A woman who a qualified entity determines under sub. (3) is eligible for medical assistance shall apply to the department or county department no later than the last day of the month following the month in which the qualified entity determines that the woman is eligible for medical assistance.

AB40, s. 1470 Section 1470. 49.473 (5) of the statutes is amended to read:

AB40,670,2 49.473 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b), (gm), and (o), allowable charges to a provider who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who meets the requirements under sub. (2) for all benefits and services specified under s. 49.46 (2).

AB40, s. 1471 Section 1471. 49.473 (6) (b) of the statutes is amended to read:

AB40,670,7 49.473 (6) (b) Inform the woman at the time of the determination that she is required to apply to the department or a county department for medical assistance no later than the last day of the month following the month in which the qualified entity determines that the woman is eligible for medical assistance.

AB40, s. 1472 Section 1472. 49.496 (4) (a) of the statutes is renumbered 49.496 (4) and amended to read:

AB40,670,24 49.496 (4) The department may require a county department under s. 46.215, 46.22, or 46.23 or the governing body of a federally recognized American Indian tribe administering medical assistance to gather and provide the department with information needed to recover medical assistance under this section. Except as provided in par. (b), the The department shall pay to a county department or tribal governing body an amount equal to 5% of the recovery collected by the department relating to a beneficiary for whom the county department or tribal governing body made the last determination of medical assistance eligibility. A county department or tribal governing body may use funds received under this paragraph subsection only to pay costs incurred under this paragraph subsection and, if any amount remains, to pay for improvements to functions required under s. 49.78 (2). The department may withhold payments under this paragraph subsection for failure to comply with the department's requirements under this paragraph subsection. The department shall treat payments made under this paragraph subsection as costs of administration of the Medical Assistance program.

AB40, s. 1473 Section 1473. 49.496 (4) (b) of the statutes is repealed.

AB40, s. 1474 Section 1474. 49.496 (5) of the statutes is amended to read:

AB40,671,7 49.496 (5) Use of funds. From the appropriation under s. 20.435 (4) (im), the department shall pay the amount of the payments under sub. (4) (a) that is not paid from federal funds, shall pay to the federal government the amount of the funds recovered under this section equal to the amount of federal funds used to pay the benefits recovered under this section, and shall spend the remainder of the funds recovered under this section for medical assistance benefits under this subchapter.

AB40, s. 1475 Section 1475. 49.497 (1) (b) of the statutes is amended to read:

AB40,671,15 49.497 (1) (b) The department's right of recovery is against any Medical Assistance or Badger Care recipient to whom or on whose behalf the incorrect payment was made. The extent of recovery is limited to the amount of the benefits incorrectly granted. The county department under s. 46.215 or 46.22 or the governing body of a federally recognized American Indian tribe administering Medical Assistance or Badger Care shall may begin recovery actions on behalf of the department according to rules promulgated by the department.

AB40, s. 1476 Section 1476. 49.497 (2) (a) of the statutes is renumbered 49.497 (2) and amended to read:

AB40,671,21 49.497 (2) Except as provided in par. (b), a A county or governing body of a federally recognized American Indian tribe may retain 15% of benefits provided under this subchapter or s. 49.665 that are recovered under this section due to the efforts of an employee or officer of the county or tribe.

AB40, s. 1477 Section 1477. 49.497 (2) (b) of the statutes is repealed.

AB40, s. 1478 Section 1478. 49.68 (3) (b) of the statutes is amended to read:

AB40,672,15 49.68 (3) (b) From the appropriation accounts under ss. 20.435 (4) (e) and (je), the state shall pay the cost of, at a rate determined by the department under par. (e), for medical treatment that is required as a direct result of chronic renal disease of certified patients from the date of certification, including the cost of administering recombinant human erythropoietin to appropriate patients, whether the treatment is rendered in an approved facility in the state or in a dialysis or transplantation center which that is approved as such by a contiguous state, subject to the conditions specified under par. (d). Approved facilities may include a hospital in-center dialysis unit or a nonhospital dialysis center which that is closely affiliated with a home dialysis program supervised by an approved facility. Aid shall also be provided for all reasonable expenses incurred by a potential living-related donor, including evaluation, hospitalization, surgical costs, and postoperative follow-up to the extent that these costs are not reimbursable under the federal medicare program or other insurance. In addition, all expenses incurred in the procurement, transportation, and preservation of cadaveric donor kidneys shall be covered to the extent that these costs are not otherwise reimbursable. All donor-related costs are chargeable to the recipient and reimbursable under this subsection.

AB40, s. 1479 Section 1479. 49.68 (3) (e) of the statutes is amended to read:

AB40,673,4 49.68 (3) (e) State aids Payment for services provided under this section shall be equal to at a rate determined by the department that does not exceed the allowable charges under the federal Medicare program. In no case shall state rates for individual service elements exceed the federally defined allowable costs. The rate of charges for services not covered by public and private insurance shall not exceed the reasonable charges as established by medicare Medicare fee determination procedures. A person that provides to a patient a service for which aid is provided under this section shall accept the amount paid under this section for the service as payment in full and may not bill the patient for any amount by which the charge for the service exceeds the amount paid for the service under this section. The state may not pay for the cost of travel, lodging, or meals for persons who must travel to receive inpatient and outpatient dialysis treatment for kidney disease. This paragraph shall not apply to donor related costs as defined in par. (b).

AB40, s. 1480 Section 1480. 49.688 (2) (a) 6. of the statutes is created to read:

AB40,673,9 49.688 (2) (a) 6. The person applies for and, if eligible, enrolls in Medicare under Part D of Title XVIII of the federal Social Security Act, 42 USC 1395w-101 to 1395w-153, if the secretary of the federal department of health and human services approves the condition on eligibility under this subdivision.

AB40, s. 1481 Section 1481. 49.688 (2) (b) of the statutes is amended to read:

AB40,673,17 49.688 (2) (b) A person to whom par. (a) 1. to 3. and, 5., and 6. applies, but whose annual household income, as determined by the department, exceeds 240% of the federal poverty line for a family the size of the persons' eligible family, is eligible to purchase a prescription drug at the amounts specified in sub. (5) (a) 4. only during the remaining amount of any 12-month period in which the person has first paid the annual deductible specified in sub. (3) (b) 2. a. in purchasing prescription drugs at the retail price and has then paid the annual deductible specified in sub. (3) (b) 2. b.

AB40, s. 1482 Section 1482. 49.77 of the statutes is renumbered 49.39, and 49.39 (6), as renumbered, is amended to read:

AB40,673,22 49.39 (6) Authority to administer; rules. The department shall administer this section and s. 49.775 49.395, and may promulgate rules to guide the administration of eligibility determinations and benefits payments.

AB40, s. 1483 Section 1483. 49.775 of the statutes is renumbered 49.395, and 49.395 (2) (a), (b), (bm) and (e) 1., as renumbered, are amended to read: