49.665(4)(am)2.
2. The child does not have access to employer-subsidized health care coverage.
49.665(4)(am)3.
3. The child has not had access to employer-subsidized health care coverage within the time period established by the department under
par. (a) 3. The department may establish exceptions to this subdivision.
49.665(4)(am)4.
4. The child meets all other requirements established by the department by rule. In establishing other eligibility criteria, the department may not include any health condition requirements.
49.665(4)(at)1.a.a. Except as provided in
subd. 1. b., the department shall establish a lower maximum income level for the initial eligibility determination if funding under
s. 20.435 (4) (bc),
(jz) and
(p) is insufficient to accommodate the projected enrollment levels for the health care program under this section. The adjustment may not be greater than necessary to ensure sufficient funding.
49.665(4)(at)1.b.
b. The department may not lower the maximum income level for initial eligibility unless the department first submits to the joint committee on finance its plans for lowering the maximum income level and the committee approves the plan. If, within 14 days after submitting the plan to the joint committee on finance, the cochairpersons of the committee do not notify the secretary that the committee has scheduled a meeting for the purpose of reviewing the plan, the plan is considered approved by the committee.
49.665(4)(at)2.
2. If, after the department has established a lower maximum income level under
subd. 1., projections indicate that funding under
s. 20.435 (4) (bc),
(jz) and
(p) is sufficient to raise the level, the department shall, by state plan amendment, raise the maximum income level for initial eligibility, but not to exceed 185% of the poverty line.
49.665(4)(at)3.
3. The department may not adjust the maximum income level of 200% of the poverty line for persons already receiving health care coverage under this section.
49.665(4)(b)
(b) Notwithstanding fulfillment of the eligibility requirements under this subsection, no person is entitled to health care coverage under this section.
49.665(4)(c)
(c) No person may be denied health care coverage under this section solely because of a health condition of that person or of any family member of that person.
49.665(5)(a)(a) Except as provided in
pars. (b) and
(bm), a family, or child who does not reside with his or her parent, who 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, or child who does not reside with his or her parent, to contribute more than 3% of the family's or child'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, or child who does not reside with his or her parent, to contribute more than 3% of the family's or child'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 or child to contribute more than 3.5% of the family's or child's income towards the cost of the health care coverage provided under this section.
49.665(5)(b)
(b) The department may not require a family, or child who does not reside with his or her parent, with an income below 150% of the poverty line to contribute to the cost of health care coverage provided under this section.
49.665(5)(bm)
(bm) If the federal department of health and human services notifies the department of health and family services that Native Americans may not be required to contribute to the cost of the health care coverage provided under this section, the department of health and family services may not require Native Americans to contribute to the cost of health care coverage under this section.
49.665(5)(c)
(c) 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.
49.665(6)
(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.
49.665 History
History: 1997 a. 27,
237;
1999 a. 9.
49.68
49.68
Aid for treatment of kidney disease. 49.68(1)
(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.
49.68(1m)
(1m) 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.
49.68(2)
(2) Duties of department. The department shall:
49.68(2)(a)
(a) Promulgate rules setting standards for operation and certification of dialysis and renal transplantation centers and home dialysis equipment and suppliers.
49.68(2)(b)
(b) Promulgate rules setting standards for acceptance and certification of patients into the treatment phase of the program.
49.68(2)(c)
(c) Promulgate rules concerning reasonable cost and length of treatment programs.
49.68(2)(d)
(d) Aid in preparing educational programs and materials informing the public as to chronic renal disease and the prevention and treatment thereof.
49.68(3)
(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.
49.68(3)(b)
(b) 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.
49.68(3)(c)
(c) 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).
49.68(3)(d)1.1. 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 and
1395L (b), prior to becoming eligible for state aid.
49.68(3)(d)2.
2. 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 (b).
49.68(3)(e)
(e) 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).
49.682
49.682
Recovery from estates. 49.682(1)(c)
(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.
49.682(2)(a)(a) 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,
49.683 or
49.685 paid to or on behalf of the client.
49.682(2)(b)
(b) The affidavit of a person designated by the secretary to administer this subsection is evidence of the amount of the claim.
49.682(2)(c)
(c) The court shall reduce the amount of a claim under
par. (a) by up to the amount specified in
s. 861.33 (2) if necessary to allow the client's heirs or the beneficiaries of the client's will to retain the following personal property:
49.682(2)(c)1.
1. The decedent's wearing apparel and jewelry held for personal use.
49.682(2)(c)3.
3. Other tangible personal property not used in trade, agriculture or other business, not to exceed in value the amount specified in
s. 861.33 (1) (a) 4.
49.682(2)(d)
(d) 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.
49.682(2)(e)1.1. 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 or summary findings and order, 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 or petitioner for summary settlement or summary assignment of the estate shall record the final judgment as provided in
s. 863.29,
867.01 (3) (h) or
867.02 (2) (h).
49.682(2)(e)2.
2. If the department's claim is not allowable because of
par. (d), the estate includes an interest in a home and the personal representative closes the estate by sworn statement under
s. 865.16, the personal representative shall stipulate in the statement that the home is assigned subject to a lien in favor of the department for the amount described in
par. (a). The personal representative shall record the statement in the same manner as described in
s. 863.29, as if the statement were a final judgment.
49.682(2)(f)
(f) The department may not enforce the lien under
par. (e) as long as any of the following survive the decedent:
49.682(2)(g)
(g) The department may enforce a lien under
par. (e) by foreclosure in the same manner as a mortgage on real property.
49.682(3)
(3) 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,
49.683 or
49.685. 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.
49.682(4)(a)(a) The department may recover amounts under this section for the provision of aid provided under
s. 49.68,
49.683 or
49.685 paid on and after September 1, 1995.
49.682(4)(b)
(b) The department may file a claim under
sub. (2) only with respect to a client who dies after September 1, 1995.
49.682(5)
(5) 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.
49.682(6)
(6) The department may contract with or employ an attorney to probate estates to recover under this section the costs of care.
49.682 History
History: 1995 a. 27 ss.
3044b to
3044j; Stats. 1995 s. 49.682;
1995 a. 225 ss.
127,
128;
1999 a. 9.
49.683
49.683
Cystic fibrosis aids. 49.683(1)
(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).
49.683 History
History: 1973 c. 300; Stats. 1973 s. 146.35;
1973 c. 336 s.
55; Stats. 1973 s. 146.36;
1975 c. 39;
1979 c. 34 s.
2102 (43) (a);
1983 a. 27 s.
1562; Stats. 1983 s. 49.483;
1993 a. 16,
449;
1995 a. 27 ss.
3045,
3046,
3047; Stats. 1995 s. 49.683;
1997 a. 27;
1999 a. 9.
49.685
49.685
Hemophilia treatment services. 49.685(1)(a)
(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.
49.685(1)(c)
(c) "Hemophilia" means a bleeding disorder resulting from a genetically determined clotting factor abnormality or deficiency.
49.685(1)(d)
(d) "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.
49.685(1)(e)
(e) "Maintenance program" means the individual's therapeutic and treatment regimen, including medical, dental, social and vocational rehabilitation including home health care.
49.685(1)(f)
(f) "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.
49.685(1)(g)
(g) "Physician director" means the medical director of the comprehensive hemophilia treatment center which is directly responsible for an individual's maintenance program.
49.685(2)
(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.
49.685(4)
(4) Eligibility. 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.
49.685(5)
(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.
49.685(6)(a)(a) The department shall, by rule, establish a reasonable cost for blood products and supplies used in home care as a basis of reimbursement under this section.
49.685(6)(b)
(b) Reimbursement shall not be made under this section for any blood products or supplies which are not purchased from or provided by a comprehensive hemophilia treatment center, or a source approved by the treatment center. Reimbursement shall not be made under this section for any portion of the costs of blood products or supplies which are payable under any other state or federal program or under any grant, contract and any other contractual arrangement.
49.685(6)(c)
(c) The reasonable cost, determined under
par. (a), of blood products and supplies used in home care for which reimbursement is not prohibited under
par. (b), shall be reimbursed under this section after deduction of the patient's liability, determined under
sub. (7).
49.685(7)(a)1.1. The percentage of the patient's liability for the reasonable costs for blood products and supplies which are determined to be eligible for reimbursement under
sub. (6) shall be based upon the income and the size of the person's family unit, according to standards to be established by the department under
s. 49.687.
49.685(7)(a)2.
2. In determining income, only the income of the patient and persons responsible for the patient's support under
s. 49.90 may be considered.
49.685(7)(a)4.
4. In determining family size, only persons who are related to the patient as parent, spouse, legal dependent or, if under the age of 18, as brother or sister may be considered.
49.685(7)(a)5.
5. In determining net worth, only the net worth of the patient and persons responsible for the patient's support under
s. 49.90 will be considered.
49.685(7)(b)
(b) Individual liability shall be determined at the time of initial treatment and shall be redetermined annually or upon the patient's notification to the department of a change in family size or financial condition.
49.685(8)
(8) Department's duties. The department shall:
