LRBs0335/5
DAK&ISR:wlj&cmh:km
1999 - 2000 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO 1999 ASSEMBLY BILL 815
March 1, 2000 - Offered by Representatives Krusick, Huber, Balow, Black, Bock,
Carpenter, Hebl, La Fave, J. Lehman, Meyer, Miller, Musser, Plouff, Ryba,
Schooff, Wasserman and
Waukau.
AB815-ASA1,1,9
1An Act to amend 49.47 (4) (b) 2m. b., 49.47 (4) (b) 2r., 49.47 (4) (b) 2w., 49.47 (4)
2(b) 3., 49.47 (4) (c) 1., 49.47 (4) (c) 3. and 49.47 (4) (i) 2. (intro.); and
to create
320.435 (4) (bv), 20.435 (4) (j), 20.435 (4) (jb), 49.47 (4) (aq) and 49.688 of the
4statutes;
relating to: expanding medical assistance income eligibility
5requirements for elderly persons; requiring pharmacies and pharmacists, as a
6condition of medical assistance participation, to charge elderly, low-income
7persons for prescription drugs no more than specific amounts; requiring the
8department of health and family services to attempt to negotiate rebate
9agreements with drug manufacturers; and making appropriations.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB815-ASA1, s. 1
10Section
1. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
11the following amounts for the purposes indicated:
-
See PDF for table ![PDF](https://docs.legis.wisconsin.gov/assets/image/file_acrobat.gif)
AB815-ASA1, s. 2
1Section
2. 20.435 (4) (bv) of the statutes is created to read:
AB815-ASA1,2,42
20.435
(4) (bv)
Prescription drug assistance for elderly; aids. The amounts in
3the schedule for the program for prescription drug assistance for elderly persons
4under s. 49.688.
AB815-ASA1,2,96
20.435
(4) (j)
Prescription drug assistance for elderly; deductibles and
7manufacturer rebates. All moneys received from payments of monthly deductibles
8under s. 49.688 (5) and rebate payments by manufacturers under s. 49.688 (7), to be
9used for prescription drug assistance for elderly persons under s. 49.688.
AB815-ASA1, s. 4
10Section
4. 20.435 (4) (jb) of the statutes is created to read:
AB815-ASA1,2,1311
20.435
(4) (jb)
Prescription drug assistance for elderly; enrollment fees. All
12moneys received from payment of enrollment fees under s. 49.688 (2), to be used for
13administration of the program under s. 49.688.
AB815-ASA1, s. 5
14Section
5. 49.47 (4) (aq) of the statutes is created to read:
AB815-ASA1,3,215
49.47
(4) (aq) 1. Subject to subd. 2., an individual who does not meet the
16limitation on income under par. (c) is eligible for medical assistance if the individual
1is 65 years of age or older and the individual's income does not exceed 100% of the
2federal poverty level.
AB815-ASA1,3,63
2. If a federal waiver is necessary to provide medical assistance to individuals
4specified in subd. 1., the department shall request a waiver from the secretary of the
5federal department of health and human services before providing medical
6assistance under this paragraph.
AB815-ASA1, s. 6
7Section
6. 49.47 (4) (b) 2m. b. of the statutes is amended to read:
AB815-ASA1,3,108
49.47
(4) (b) 2m. b. For persons who are eligible under par. (a)
3. or 4.
or (aq),
9motor vehicles are exempt from consideration as an asset to the same extent as
10provided under
42 USC 1381 to
1385.
AB815-ASA1, s. 7
11Section
7. 49.47 (4) (b) 2r. of the statutes is amended to read:
AB815-ASA1,3,1512
49.47
(4) (b) 2r. For a person who is eligible under par. (a)
3. or 4.
or (aq), the
13value of any burial space or agreement representing the purchase of a burial space
14held for the purpose of providing a place for the burial of the person or any member
15of his or her immediate family.
AB815-ASA1, s. 8
16Section
8. 49.47 (4) (b) 2w. of the statutes is amended to read:
AB815-ASA1,3,1917
49.47
(4) (b) 2w. For a person who is eligible under par. (a)
3. or 4.
or (aq), life
18insurance with cash surrender values if the total face value of all life insurance
19policies is not more than $1,500.
AB815-ASA1, s. 9
20Section
9. 49.47 (4) (b) 3. of the statutes is amended to read:
AB815-ASA1,3,2521
49.47
(4) (b) 3. For a person who is eligible under par. (a)
3. or 4.
or (aq), funds
22set aside to meet the burial and related expenses of the person and his or her spouse
23in an amount not to exceed $1,500 each, minus the sum of the cash value of any life
24insurance excluded under subd. 2w. and the amount in any irrevocable burial trust
25under s. 445.125 (1) (a).
AB815-ASA1,4,122
49.47
(4) (c) 1. Except as provided in
par. pars. (am)
and (aq) and as limited by
3subd. 3., eligibility exists if income does not exceed 133 1/3% of the maximum aid to
4families with dependent children payment under s. 49.19 (11) for the applicant's
5family size or the combined benefit amount available under supplemental security
6income under
42 USC 1381 to
1383c and state supplemental aid under s. 49.77
7whichever is higher. In this subdivision "income" includes earned or unearned
8income that would be included in determining eligibility for the individual or family
9under s. 49.19 or 49.77, or for the aged, blind or disabled under
42 USC 1381 to
1385.
10"Income" does not include earned or unearned income which would be excluded in
11determining eligibility for the individual or family under s. 49.19 or 49.77, or for the
12aged, blind or disabled individual under
42 USC 1381 to
1385.
AB815-ASA1,4,1714
49.47
(4) (c) 3. Except as provided in
par. pars. (am)
and (aq), no person is
15eligible for medical assistance under this section if the person's income exceeds the
16maximum income levels that the U.S. department of health and human services sets
17for federal financial participation under
42 USC 1396b (f).
AB815-ASA1, s. 12
18Section
12. 49.47 (4) (i) 2. (intro.) of the statutes is amended to read:
AB815-ASA1,4,2119
49.47
(4) (i) 2. (intro.) Notwithstanding par. (b) 2r. and 3., a person who is
20described in par. (a)
3. or 4.
or (aq) is not eligible for benefits under this section if any
21of the following criteria is met:
AB815-ASA1,4,24
2349.688 Prescription drug assistance for low-income elderly persons.
24(1) In this section:
AB815-ASA1,5,2
1(a) "Poverty line" means the nonfarm federal poverty line for the continental
2United States, as defined by the federal department of labor under
42 USC 9902 (2).
AB815-ASA1,5,43
(b) "Prescription drug" means a prescription drug, as defined in s. 450.01 (20),
4that is included in the drugs specified under s. 49.46 (2) (b) 6. h.
AB815-ASA1,5,55
(c) "Prescription order" has the meaning given in s. 450.01 (21).
AB815-ASA1,5,12
6(2) A person who is at least 65 years of age, who is ineligible for medical
7assistance, whose income does not exceed 185% of the poverty line and who pays the
8program enrollment fee specified in sub. (3) (a) is eligible to purchase a prescription
9drug at the amount specified in sub. (6) (b). The person may apply to the department,
10on a form provided by the department together with program enrollment fee
11payment, for a determination of eligibility and issuance of a prescription drug card
12for purchase of prescription drugs under this section.
AB815-ASA1,5,13
13(3) Program participants shall pay all of the following:
AB815-ASA1,5,1414
(a) Annually, a program enrollment fee of $25.
AB815-ASA1,5,1515
(b) Monthly, a deductible of $40.
AB815-ASA1,5,1616
(c) Annually for prescription drugs, all of the following:
AB815-ASA1,5,1717
1. Fifty percent of the first $2,000 in charges, as specified in sub. (6) (a).
AB815-ASA1,5,1918
2. Thirty percent of the charges, as specified in sub. (6) (a), that exceed $2,000
19but that do not exceed $6,250.
AB815-ASA1,5,2120
3. One hundred percent of the charges, calculated at the retail price of the
21pharmacy or pharmacist, that exceed $6,250.
AB815-ASA1,5,25
22(4) The department shall devise and distribute a form for application for the
23program under sub. (2), shall determine eligibility of applicants and shall issue to
24eligible persons a prescription drug card for use in purchasing prescription drugs, as
25specified in sub. (5).
AB815-ASA1,6,8
1(5) Beginning April 1, 2001, as a condition of participation by a pharmacy or
2pharmacist in the program under ss. 49.45, 49.46 or 49.47, the pharmacy or
3pharmacist may not charge a person who presents a valid prescription order, a card
4indicating that he or she meets eligibility requirements under sub. (2) and payment,
5if applicable, of the monthly deductible amount specified in sub. (3) (b) an amount
6for a prescription drug under the order that exceeds the amount specified in sub. (6)
7(b). The pharmacy or pharmacist shall forward to the state treasurer, for deposit in
8the appropriation account under s. 20.435 (4) (j), the monthly deductible amount.
AB815-ASA1,6,12
9(6) (a) The charge for prescription drugs shall be calculated at the average
10wholesale price minus 10% or the maximum allowable cost, as determined by the
11department, whichever is less, plus a dispensing fee. The charge does not include a
12deductible, as specified in sub. (3) (b).
AB815-ASA1,6,1413
(b) The amounts that a pharmacy or pharmacist may charge a person specified
14in sub. (2) in a calendar year period for the prescription drugs are the following:
AB815-ASA1,6,1615
1. If applicable, a deductible, as specified in sub. (3) (b), for prescription drugs
16that are charged at the rate specified in par. (a).
AB815-ASA1,6,1817
2. Fifty percent of the first $2,000 in charges, as specified in par. (a), for the
18prescription drugs after the deductible, if applicable, is charged.
AB815-ASA1,6,2019
3. Thirty percent of the charges, as specified in par. (a), that exceed the amount
20specified in subd. 2. but that do not exceed $6, 250, for the prescription drugs.
AB815-ASA1,6,2221
4. One hundred percent of charges, calculated at the retail price of the
22pharmacy or pharmacist, that exceed $6,250, for the prescription drugs.
AB815-ASA1,7,223
(c) The department shall, for the purposes of par. (a), calculate and transmit
24to pharmacies and pharmacists that are certified providers of medical assistance
25amounts that may be used in calculating charges under par. (a). The department
1shall periodically update this information and transmit the updated amounts to
2pharmacies and pharmacists.
AB815-ASA1,7,7
3(7) The department or an entity with which the department contracts shall
4attempt to negotiate with a drug manufacturer that sells drugs for prescribed use in
5this state a rebate agreement that is modeled on the rebate agreement specified
6under
42 USC 1396r-8. The rebate agreement, if negotiated, shall include all of the
7following as requirements:
AB815-ASA1,7,118
(a) That the manufacturer shall make rebate payments for each prescription
9drug of the manufacturer that is prescribed for persons who are eligible under sub.
10(2), to the state treasurer to be credited to the appropriation under s. 20.435 (4) (j),
11each calendar quarter or according to a schedule established by the department.