AB150-engrossed,994,116
49.45
(8m) Rates for respiratory care services. (intro.) Notwithstanding
a
7determination by the department of a maximum rate the limits under
sub. subs. (8)
,
8(8e) and (8f), the rates under sub. (8) and rates charged by providers under s. 49.46
9(2) (a) 4. d. that are not home health agencies, for reimbursement for respiratory care
10services for ventilator-dependent individuals under ss. 49.46 (2) (b) 6. m. and 49.47
11(6) (a) 1., shall be as follows:
AB150-engrossed,994,2213
49.45
(8v) Incentive-based pharmacy payment system. By January 1, 1996, the
14department shall establish a system of payment to pharmacies for legend and
15over-the-counter drugs provided to recipients of medical assistance that has
16financial incentives for pharmacists who perform services that result in savings to
17the medical assistance program. Under this system, the department shall establish
18a schedule of fees that is designed to ensure that any incentive payments made are
19equal to or less than the documented savings. The department may discontinue the
20system established under this subsection if the department determines, after
21performance of a study, that payments to pharmacists under the system exceed the
22documented savings under the system.
AB150-engrossed,995,3
149.45
(11) Penalty. Any person who receives or assists another in receiving
2assistance under this section, to which the recipient is not entitled, shall be subject
3to the penalties under s.
49.12 49.95.
AB150-engrossed,995,115
49.45
(12) (c) The department shall request proposals for a system of
6machine-readable identification cards for medical assistance recipients and a
7computerized support system for the cards that will accept and respond to
8electronically conveyed requests from health care providers for information related
9to medical assistance recipients, such as eligibility, coverages and authorizations.
10The request for proposals shall specify that the systems are to be operating by
11January 1,
1996 1997.
AB150-engrossed, s. 2993
12Section
2993. 49.45 (25) (am) of the statutes is renumbered 49.45 (25) (am)
13(intro.) and amended to read:
AB150-engrossed,995,1914
49.45
(25) (am) (intro.) Except as provided under pars. (be) and (bg) and sub.
15(24), case management services under s. 49.46 (2) (b) 9.
and (bm) are reimbursable
16under medical assistance only if provided to a medical assistance beneficiary who
17receives case management services from or through a certified case management
18provider in a county, city, village or town that elects, under par. (b), to make the
19services available and who
has meets at least one of the following conditions:
AB150-engrossed,995,20
201. Has a developmental disability, as defined under s. 51.01 (5) (a)
,.
AB150-engrossed,995,21
212. Has a chronic mental illness, as defined under s. 51.01 (3g)
, or.
AB150-engrossed,995,22
223. Has Alzheimer's disease, as defined under s. 46.87 (1) (a)
, is.
AB150-engrossed,995,23
234. Is an alcoholic, as defined under s. 51.01 (1)
, or.
AB150-engrossed,995,24
245. Is drug dependent, as defined under s. 51.01 (8)
, is.
AB150-engrossed,995,25
256. Is physically disabled, as defined by the department
, is.
AB150-engrossed,996,1
17. Is a severely emotionally disturbed child
, is.
AB150-engrossed,996,2
28. Is age 65 or over
or, after December 31, 1991, has.
AB150-engrossed,996,3
310. Has HIV infection, as defined in s. 252.01 (2).
AB150-engrossed,996,65
49.45
(25) (am) 9. Is a member of a family that has a child who is at risk of
6serious physical, mental or emotional dysfunction, as defined by the department.
AB150-engrossed,996,98
49.45
(25) (am) 11. Is a child who is eligible for early intervention services
9under s. 51.44.
AB150-engrossed,996,1111
49.45
(25) (am) 12. Is infected with tuberculosis.
AB150-engrossed,996,1313
49.45
(25) (am) 13. Is a child with asthma.
AB150-engrossed,996,2215
49.45
(25) (bg) An independent living center, as defined in s. 46.96 (1) (a), that
16is a certified case management provider may elect to provide case management
17services to one or more of the categories of medical assistance beneficiaries specified
18under par. (am). The amount of allowable charges for the services under the medical
19assistance program that is not provided by the federal government shall be paid from
20nonfederal, public funds received by the independent living center from a county,
21city, village or town or from funds distributed
under the appropriation under s.
2220.435 (5) (bm) or as a grant under s. 46.96.
AB150-engrossed,997,3
149.45
(25) (bm) (intro.) Case management services under this subsection may
2not be provided to a person under
the category of severely emotionally disturbed
3child par. (am) 7. unless any of the following is true:
AB150-engrossed,997,95
49.45
(34) Medical assistance manual. The department shall prepare a
6medical assistance manual that is clear, comprehensive and consistent with
ss. 49.43
7to 49.47 this subchapter and
42 USC 1396a to
1396u and shall, no later than July
81, 1992, provide the manual to counties for use by county employes who administer
9the medical assistance program.
AB150-engrossed,997,1111
49.45
(39) School medical services. (a)
Definitions. In this subsection:
AB150-engrossed,997,1512
1. "School" means a public school described under s. 115.01 (1) or a charter
13school, as defined in s. 115.001 (1). It includes school-operated early childhood
14programs for developmentally delayed and disabled 4-year-old and 5-year-old
15children.
AB150-engrossed,997,1816
2. "School medical services" means health care services that are provided in a
17school to children who are eligible for medical assistance and that are appropriate
18to a school setting, under rules promulgated by the department.
AB150-engrossed,998,319
(b)
Payment for school medical services. If a school district elects to provide
20school medical services and meets all requirements under par. (c), the department
21shall reimburse the school district for the federal share of allowable charges for the
22school medical services that it provides and for allowable administrative costs. The
23department shall promulgate rules establishing a methodology for making
24reimbursements under this paragraph. All other expenses for the school medical
25services shall be paid for by the school district with funds received from state or local
1taxes. The school district shall comply with all requirements of the federal
2department of health and human services for receiving federal financial
3participation.
AB150-engrossed,998,64
(c)
Certification and reporting requirements. The department shall promulgate
5rules establishing specific certification and reporting requirements with respect to
6school medical services under this subsection.
AB150-engrossed,998,108
49.45
(40) Periodic record matches. The department shall cooperate with the
9department of industry, labor and human relations in matching records of medical
10assistance recipients under s. 49.32 (7).
AB150-engrossed,998,1212
49.45
(41) Mental health crisis intervention services. (a) In this subsection:
AB150-engrossed,998,1613
1. "Mental health crisis intervention services" means services that are provided
14by a mental health crisis intervention program operated by, or under contract with,
15a county or municipality, if the county or municipality is certified as a medical
16assistance provider.
AB150-engrossed,998,1717
2. "Municipality" means a city, village or town.
AB150-engrossed,999,218
(b) If a county or municipality elects to become certified as a provider of mental
19health crisis intervention services, the county or municipality may provide mental
20health crisis intervention services under this subsection in the county or
21municipality to medical assistance recipients through the medical assistance
22program. A county or municipality that elects to provide the services shall pay the
23amount of the allowable charges for the services under the medical assistance
24program that is not provided by the federal government. The department shall
25reimburse the county or municipality under this subsection only for the amount of
1the allowable charges for those services under the medical assistance program that
2is provided by the federal government.
AB150-engrossed,999,64
49.45
(42) Personal care services. Personal care services under s. 49.46 (2)
5(b) 6. j. provided to an individual are reimbursable under medical assistance only if
6all of the following conditions are met:
AB150-engrossed,999,97
(a) The provider of the personal care services receives prior authorization from
8the department for all personal care services that are provided to the individual in
9excess of 50 hours in a calendar year.
AB150-engrossed,999,1110
(b) The individual is not eligible to receive home health aide services under
11medicare, as defined in sub. (3) (L) 1. b.
AB150-engrossed,999,1813
49.45
(43) Case management services for high-cost recipients. The
14department may establish a program to provide case management services for
15medical assistance recipients with high-cost chronic health conditions or high-cost
16catastrophic health conditions. If the department establishes a program to provide
17these case management services, the department shall provide reimbursement for
18providers of these case management services under the medical assistance program.
AB150-engrossed,999,2220
49.455
(4) (c) 1. For any year, the minimum monthly maintenance needs
21allowance equals the lesser of the amount determined under subd. 2., or the sum of
22the following:
AB150-engrossed,999,2323
a. One-twelfth of 200% of the poverty line for a family of 2 persons.
AB150-engrossed,999,2424
b. Any excess shelter allowance under par. (d).
AB150-engrossed,1000,4
12. The minimum monthly maintenance needs allowance in a year may not
2exceed $1,500 increased by the same percentage as the percentage increase in the
3consumer price index between September 1988 and September of the year before the
4year involved.
AB150-engrossed,1000,75
3. In making the calculation under subd. 1. a., when the poverty line is revised
6the department shall use the revised amount starting on the first day of the 2nd
7calendar quarter beginning after the date of publication of the revision.
AB150-engrossed,1000,109
49.455
(4) (d) The excess shelter allowance equals the amount by which 30%
10of the amount determined under par. (c) 1. a. is exceeded by the sum of the following:
AB150-engrossed,1000,1311
1. The community spouse's expenses for rent or mortgage principal and
12interest, taxes and insurance for his or her principal residence and, if the community
13spouse lives in a condominium or cooperative, any required maintenance charge.
AB150-engrossed,1000,18142. The standard utility allowance established under
7 USC 2014 (e), except that
15if the community spouse lives in a condominium or cooperative for which the
16maintenance charge includes utility expenses, the standard utility allowance under
177 USC 2014 (e) is reduced by the amount of the utility expenses included in the
18maintenance charge.
AB150-engrossed,1000,2320
49.455
(6) (b) 1. In
1989, $60,000; in a calendar year after 1989, $60,000 any
21year, $12,000 increased by the same percentage as the percentage increase in the
22consumer price index between September 1988 and September of the year before the
23calendar year involved.
AB150-engrossed,1000,2525
49.455
(6) (b) 1m. $50,000.
AB150-engrossed,1001,22
49.455
(6) (b) 2. The lesser of the following:
AB150-engrossed,1001,33
a. The spousal share computed under sub. (5) (a) 1.
AB150-engrossed,1001,64
b. In any year, $60,000 increased by the same percentage as the percentage
5increase in the consumer price index between September 1988 and September of the
6year before the year involved.
AB150-engrossed,1001,98
49.46
(1) (a) 4. Any person receiving benefits under s.
49.177 49.77 or federal
9Title XVI.
AB150-engrossed,1001,1311
49.46
(1) (a) 15. Any individual who is infected with tuberculosis and meets the
12income and resource eligibility requirements for the federal supplemental security
13program under
42 USC 1381 to
1383d.
AB150-engrossed,1001,1615
49.46
(1) (d) 4. A child who meets the conditions under
42 USC 1396a (e)
3. (3) 16shall be considered a recipient of benefits under s.
49.177 49.77 or federal Title XVI.
AB150-engrossed,1001,2318
49.46
(1) (e) If an application under s. 49.47 (3) shows that the person has
19income and resources within the limitations of s. 49.19, federal Title XVI or s.
49.177 2049.77, or that the person is an essential person, an accommodated person or a patient
21in a public medical institution, the person shall be granted the benefits enumerated
22under sub. (2) whether or not the person requests or receives a grant of any of such
23aids.
AB150-engrossed,1002,4
149.46
(2) (a) 2. Early and periodic screening and diagnosis, including case
2management services, of persons under 21 years of age and all medical treatment
3and dentists' services
specified in par. (b) 1. found necessary by this screening and
4diagnosis.
AB150-engrossed,1002,86
49.46
(2) (a) 4. d. Home health services
, subject to the limitations under s. 49.45
7(8), (8e) and (8f), or
nursing services, if a home health agency is unavailable
, nursing
8services, subject to the limitations under s. 49.45 (8e) and (8f).
AB150-engrossed, s. 3013
9Section
3013. 49.46 (2) (a) 4. g. of the statutes is renumbered 49.46 (2) (a) 4m.
10and amended to read:
AB150-engrossed,1002,1111
49.46
(2) (a) 4m.
Nurse midwifery
Nurse-midwifery services.
AB150-engrossed,1002,1615
49.46
(2) (b) 6. j. Personal care services
, subject to the limitations under s. 49.45
16(8e), (8f) and (42).