The cost of relocating the resident from the nursing facility to another nursing facility.
Maintenance of operation of a nursing facility pending correction of deficiencies or closure of the nursing facility.
Reimbursement of the resident for any personal funds of the resident that were misappropriated by the nursing facility staff or other persons holding an interest in the nursing facility.
History: 1989 a. 31
; 1997 a. 27
OTHER MEDICALLY RELATED SERVICES
AND SUPPORT PROGRAMS
In this subchapter:
"Department" means the department of health and family services.
"Secretary" means the secretary of health and family services.
History: 1995 a. 27
, 9126 (19)
NOTE: The bracketed number indicates the correct cross-reference. Corrective legislation is pending.
"Employer-subsidized health care coverage" means family coverage under a group health insurance plan offered by an employer for which the employer pays at least 80% of the cost, excluding any deductibles or copayments that may be required under the plan.
"Family" means a unit that consists of at least one dependent child and his or her custodial parent or parents. "Family" includes the spouse of an individual who is a custodial parent if the spouse resides in the same household as the individual.
The department of health and family services shall request a waiver from the secretary of the federal department of health and human services to permit the department of health and family services to implement, beginning not later than July 1, 1998, or the effective date of the waiver, whichever is later, a health care program under this section. If a waiver that is consistent with all of the provisions of this section is granted and in effect, the department of health and family services shall implement the program under this section. The department of health and family services may not implement the program under this section unless a waiver that is consistent with all of the provisions of this section is granted and in effect.
The department shall administer a program to provide the health services and benefits described in s. 49.46 (2)
to families that meet the eligibility requirements specified in sub. (4)
. The department shall promulgate rules setting forth the application procedures and appeal and grievance procedures. The department may promulgate rules limiting access to the program under this section to defined enrollment periods. The department may also promulgate rules establishing a method by which the department may purchase family coverage offered by the employer of a member of an eligible family under circumstances in which the department determines that purchasing that coverage would not be more costly than providing the coverage under this section.
A family is eligible for health care coverage under this section if the family meets all of the following requirements:
The family's income does not exceed 185% of the poverty line, except that a family that is already receiving health care coverage under this section may have an income that does not exceed 200% of the poverty line. The department shall establish by rule the criteria to be used to determine income.
The family does not have access to employer-subsidized health care coverage.
The family has not had access to employer-subsidized health care coverage within the time period established by the department by rule, but not to exceed 18 months, immediately preceding application for health care coverage under this section. The department may establish exceptions to this subdivision by rule.
The family meets all other requirements established by the department by rule. In establishing other eligibility criteria, the department may not include any health condition requirements.
Notwithstanding fulfillment of the eligibility requirements under this subsection, a family is not entitled to health care coverage under this section.
No family may be denied health care coverage under this section solely because of a health condition of any family member.
Except as provided in par. (b)
, a family that receives health care coverage under this section shall pay a percentage of the cost of that coverage in accordance with a schedule established by the department by rule. If the schedule established by the department requires a family to contribute more than 3% of the family's income towards the cost of the health care coverage provided under this section, the department shall submit the schedule to the joint committee on finance for review and approval of the schedule. If the cochairpersons of the joint committee on finance do not notify the department within 14 working days after the date of the department's submittal of the schedule that the committee has scheduled a meeting to review the schedule, the department may implement the schedule. If, within 14 days after the date of the department's submittal of the schedule, the cochairpersons of the committee notify the department that the committee has scheduled a meeting to review the schedule, the department may not require a family to contribute more than 3% of the family's income unless the joint committee on finance approves the schedule. The joint committee on finance may not approve and the department may not implement a schedule that requires a family to contribute more than 3.5% of the family's income towards the cost of the health care coverage provided under this section.
The department may not require a family with an income below 143% of the poverty line to contribute to the cost of health care coverage provided under this section.
The department may establish by rule requirements for wage withholding as a means of collecting the family's share of the cost of the health care coverage under this section.
(6) Annual report.
Not later than October 1 of each year, the department shall submit a report to the legislature under s. 13.172 (2)
that summarizes enrollment in and cost of the health care program under this section and any other information that the department determines is pertinent information regarding the program under this section.
History: 1997 a. 27
Aid for treatment of kidney disease. 49.68(1)
Declaration of policy.
The legislature finds that effective means of treating kidney failure are available, including dialysis or artificial kidney treatment or transplants. It further finds that kidney disease treatment is prohibitively expensive for the overwhelming portion of the state's citizens. It further finds that public and private insurance coverage is inadequate in many cases to cover the cost of adequate treatment at the proper time in modern facilities. The legislature finds, in addition, that the incidence of the disease in the state is not so great that public aid may not be provided to alleviate this serious problem for a relatively modest investment. Therefore, it is declared to be the policy of this state to assure that all persons are protected from the destructive cost of kidney disease treatment by one means or another.
In this section, "recombinant human erythropoietin" means a bioengineered glycoprotein that has the same biological effects in stimulating red blood cell production as does the glycoprotein erythropoietin that is produced by the human body.
(2) Duties of department.
The department shall:
Promulgate rules setting standards for operation and certification of dialysis and renal transplantation centers and home dialysis equipment and suppliers.
Promulgate rules setting standards for acceptance and certification of patients into the treatment phase of the program.
Promulgate rules concerning reasonable cost and length of treatment programs.
Aid in preparing educational programs and materials informing the public as to chronic renal disease and the prevention and treatment thereof.
(3) Aid to kidney disease patients. 49.68(3)(a)(a)
Any permanent resident of this state who suffers from chronic renal disease may be accepted into the dialysis treatment phase of the renal disease control program if the resident meets standards set by rule under sub. (2)
and s. 49.687
The state shall pay the cost of medical treatment 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 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 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.
Disbursement and collection of all funds under this subsection shall be by the department or by a fiscal intermediary, in accordance with a contract with a fiscal intermediary. The costs of the fiscal intermediary under this paragraph shall be paid from the appropriation under s. 20.435 (1) (a)
No aid may be granted under this subsection unless the recipient has no other form of aid available from the federal medicare program or from private health, accident, sickness, medical and hospital insurance coverage. If insufficient aid is available from other sources and if the recipient has paid an amount equal to the annual medicare deductible amount specified in subd. 2.
, the state shall pay the difference in cost to a qualified recipient. If at any time sufficient federal or private insurance aid becomes available during the treatment period, state aid shall be terminated or appropriately reduced. Any patient who is eligible for the federal medicare program shall register and pay the premium for medicare medical insurance coverage where permitted, and shall pay an amount equal to the annual medicare deductible amounts required under 42 USC 1395e
(b), prior to becoming eligible for state aid.
Aid under this subsection is only available after the patient pays an annual amount equal to the annual deductible amount required under the federal medicare program. This subdivision requires an inpatient who seeks aid first to pay an annual deductible amount equal to the annual medicare deductible amount specified under 42 USC 1395e
and requires an outpatient who seeks aid first to pay an annual deductible amount equal to the annual medicare deductible amount specified under 42 USC 1395L
State aids for services provided under this section shall be equal to 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 fee determination procedures. 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)
Recovery from estates. 49.682(1)(c)
"Home" means property in which a person has an ownership interest consisting of the person's dwelling and the land used and operated in connection with the dwelling.
Except as provided in par. (d)
, the department shall file a claim against the estate of a client or against the estate of the surviving spouse of a client for the amount of aid under s. 49.68
paid to or on behalf of the client.
The affidavit of a person designated by the secretary to administer this subsection is evidence of the amount of the claim.
The court shall reduce the amount of a claim under par. (a)
by up to $3,000 if necessary to allow the client's heirs or the beneficiaries of the client's will to retain the following personal property:
The decedent's wearing apparel and jewelry held for personal use.
Other tangible personal property not used in trade, agriculture or other business, not to exceed $1,000 in value.
A claim under par. (a)
is not allowable if the decedent has a surviving child who is under age 21 or disabled or a surviving spouse.
If the department's claim is not allowable because of par. (d)
and the estate includes an interest in a home, the court exercising probate jurisdiction shall, in the final judgment, assign the interest in the home subject to a lien in favor of the department for the amount described in par. (a)
. The personal representative shall record the final judgment as provided in s. 863.29
The department may not enforce the lien under par. (e)
as long as any of the following survive the decedent:
The department may enforce a lien under par. (e)
by foreclosure in the same manner as a mortgage on real property.
The department shall administer the program under this section and may contract with an entity to administer all or a portion of the program, including gathering and providing the department with information needed to recover payment of aid provided under s. 49.68
. All funds received under this subsection, net of any amount claimed under s. 867.035 (3)
, shall be remitted for deposit in the general fund.
The department may recover amounts under this section for the provision of aid provided under s. 49.68
paid on and after September 1, 1995.
The department may file a claim under sub. (2)
only with respect to a client who dies after September 1, 1995.
The department shall promulgate rules establishing standards for determining whether the application of this section would work an undue hardship in individual cases. If the department determines that the application of this section would work an undue hardship in a particular case, the department shall waive application of this section in that case.
History: 1995 a. 27
; Stats. 1995 s. 49.682; 1995 a. 225
Cystic fibrosis aids. 49.683(1)
The department may provide financial assistance for costs of medical care of persons over the age of 18 years with the diagnosis of cystic fibrosis who meet financial requirements established by the department by rule under s. 49.687 (1)
History: 1973 c. 300
; Stats. 1973 s. 146.35; 1973 c. 336
; Stats. 1973 s. 146.36; 1975 c. 39
; 1979 c. 34
s. 2102 (43) (a)
; 1983 a. 27
; Stats. 1983 s. 49.483; 1993 a. 16
; 1995 a. 27
; Stats. 1995 s. 49.683; 1997 a. 27
Hemophilia treatment services. 49.685(1)(a)
"Comprehensive hemophilia treatment center" means a center, and its satellite facilities, approved by the department, which provide services, including development of the maintenance program, to persons with hemophilia and other related congenital bleeding disorders.
"Hemophilia" means a bleeding disorder resulting from a genetically determined clotting factor abnormality or deficiency.
"Home care" means the self-infusion of a clotting factor on an outpatient basis by the patient or the infusion of a clotting factor to a patient on an outpatient basis by a person trained in such procedures.
"Maintenance program" means the individual's therapeutic and treatment regimen, including medical, dental, social and vocational rehabilitation including home health care.
"Net worth" means the sum of the value of liquid assets, real property, after excluding the first $10,000 of the full value of the home derived by dividing the assessed value by the assessment ratio of the taxation district.
"Physician director" means the medical director of the comprehensive hemophilia treatment center which is directly responsible for an individual's maintenance program.
(2) Assistance program.
The department shall establish a program of financial assistance to persons suffering from hemophilia and other related congenital bleeding disorders. The program shall assist such persons to purchase the blood derivatives and supplies necessary for home care. The program shall be administered through the comprehensive hemophilia treatment centers.
Any permanent resident of this state who suffers from hemophilia or other related congenital bleeding disorder may participate in the program if that person meets the requirements of this section and s. 49.687
and the standards set by rule under this section and s. 49.687
. The person shall enter into an agreement with the comprehensive hemophilia treatment center for a maintenance program to be followed by that person as a condition for continued eligibility. The physician director or a designee shall, at least once in each 6-month period, review the maintenance program and verify that the person is complying with the program.
(5) Recovery from other sources.
The department is responsible for payments for blood products and supplies used in home care by persons participating in the program. The department may enter into agreements with comprehensive hemophilia treatment centers under which the treatment center assumes the responsibility for recovery of the payments from a 3rd party, including any insurer.