49.45 (21) (b) If, notwithstanding the prohibition under par. (ar), a person takes over the operation of a provider If a transfer occurs and the applicable amount under par. (ar) (a) has not been repaid, the department may, in addition to withholding certification as authorized under sub. (2) (b) 8., proceed against the provider or the person either the transferor or the transferee. Within 30 days after the certified provider receives receiving notice from the department, the transferor or the transferee shall pay the amount
shall be repaid in full. If the amount is not repaid in full Upon failure to comply, the department may bring an action to compel payment,. If a transferor fails to pay within 90 days after receiving notice from the department, the department may proceed under sub. (2) (a) 12., or may do both.
109,122
Section 122. 49.45 (49) of the statutes is created to read:
49.45 (49) Prescription drug prior authorization. (a) The secretary shall exercise his or her authority under s. 15.04 (1) (c) to create a prescription drug prior authorization committee to advise the department on issues related to prior authorization decisions made concerning presciption drugs on behalf of medical assistance recipients. The secretary shall appoint as members at least all of the following:
1. Two physicians, as defined in s. 448.01 (5), who are currently in practice.
2. Two pharmacists, as defined in s. 450.01 (15).
3. One advocate for recipients of medical assistance who has sufficient medical background, as determined by the department, to evaluate a prescription drug's clinical effectiveness.
(b) The prescription drug prior authorization committee shall accept information or commentary from representatives of the pharmaceutical manufacturing industry in the committee's review of prior authorization policies.
109,122c
Section 122c. 49.45 (50) of the statutes is created to read:
49.45 (50) Disease management. (a) In this subsection, "disease management" means an integrated and systematic approach for managing the health care needs of patients who are at risk of or are diagnosed with a specific disease, using all of the following:
1. Best practices.
2. Prevention strategies.
3. Clinical practice improvement.
4. Clinical interventions and protocols.
5. Outcomes research, information, and technology.
6. Other tools and resources to reduce overall costs and improve measurable outcomes.
(b) The department may contract with an entity, under the department's request-for-proposal procedures, to engage in disease management activities on behalf of recipients of medical assistance.
109,123
Section 123. 49.49 (1) (b) 1. of the statutes is amended to read:
49.49 (1) (b) 1. In the case of such a statement, representation, concealment, failure, or conversion by any person in connection with the furnishing by that person of items or services for which medical assistance is or may be made, a person convicted of violating this subsection is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000 or imprisoned for not more than 7 years and 6 months or both.
109,124
Section 124. 49.49 (2) (a) of the statutes is amended to read:
49.49 (2) (a) Solicitation or receipt of remuneration. Any person who solicits or receives any remuneration, including any kickback, bribe, or rebate, directly or indirectly, overtly or covertly, in cash or in kind, in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a medical assistance program, or in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under a medical assistance program, is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000 or imprisoned for not more than 7 years and 6 months or both.
109,125
Section 125. 49.49 (2) (b) of the statutes is amended to read:
49.49 (2) (b) Offer or payment of remuneration. Whoever offers or pays any remuneration including any kickback, bribe, or rebate directly or indirectly, overtly or covertly, in cash or in kind to any person to induce such person to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a medical assistance program, or to purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any good, facility, service or item for which payment may be made in whole or in part under a medical assistance program, is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000 or imprisoned for not more than 7 years and 6 months or both.
109,126
Section 126. 49.49 (3) of the statutes is amended to read:
49.49 (3) Fraudulent certification of facilities. No person may knowingly and wilfully make or cause to be made, or induce or seek to induce the making of, any false statement or representation of a material fact with respect to the conditions or operation of any institution or facility in order that such institution or facility may qualify either upon initial certification or upon recertification as a hospital, skilled nursing facility, intermediate care facility, or home health agency. Violators of A person who violates this subsection is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000 or imprisoned for not more than 7 years and 6 months or both.
109,127
Section 127. 49.49 (3m) (b) of the statutes is amended to read:
49.49 (3m) (b) A person who violates this subsection is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000 or imprisoned for not more than 7 years and 6 months or both.
109,128
Section 128. 49.49 (4) (b) of the statutes is amended to read:
49.49 (4) (b) A person who violates this subsection is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000 or imprisoned for not more than 7 years and 6 months or both.
109,128g
Section 128g. 49.49 (6) of the statutes is amended to read:
49.49 (6) Recovery. In addition to other remedies available under this section, the court may award the department of justice the reasonable and necessary costs of investigation, an amount reasonably necessary to remedy the harmful effects of the violation and the reasonable and necessary expenses of prosecution, including attorney fees, from any person who violates this section. The department of justice shall deposit in the state treasury for deposit in the general fund all moneys that the court awards to the department or the state under this subsection. Ten percent of the money deposited in the general fund that was awarded under this subsection for the costs of investigation and the expenses of prosecution, including attorney fees, shall be credited to the appropriation account under s. 20.455 (1) (gh).
109,128m
Section 128m. 49.665 (4) (at) 1. b. of the statutes is amended to read:
49.665 (4) (at) 1. 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 a plan for lowering the maximum income level and the committee approves the plan. If, within 14 days after submitting the plan the date on which the plan is submitted 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 department shall implement the plan is considered approved by the committee as proposed. If, within 14 days after the date on which the plan is submitted to the committee, the cochairpersons of the committee notify the secretary that the committee has scheduled a meeting to review the plan, the department may implement the plan only as approved by the committee.
109,128n
Section 128n. 49.665 (4) (at) 1. cm. of the statutes is created to read:
49.665 (4) (at) 1. cm. Notwithstanding s. 20.001 (3) (b), if, after reviewing the plan submitted under subd. 1. b., the joint committee on finance determines that the amounts appropriated under s. 20.435 (4) (bc), (jz), (p), and (x) are insufficient to accommodate the projected enrollment levels, the committee may transfer appropriated moneys from the general purpose revenue appropriation account of any state agency, as defined in s. 20.001 (1), other than a sum sufficient appropriation account, to the appropriation account under s. 20.435 (4) (bc) to supplement the health care program under this section if the committee finds that the transfer will eliminate unnecessary duplication of functions, result in more efficient and effective methods for performing programs, or more effectively carry out legislative intent, and that legislative intent will not be changed by the transfer.
109,128p
Section 128p. 49.665 (5m) of the statutes is created to read:
49.665 (5m) Information about badger care recipients. (a) In this subsection:
1. "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
2. "Insurer" has the meaning given in s. 600.03 (27).
(b) An insurer that issues or delivers a disability insurance policy that provides coverage to a resident of this state shall provide to the department, upon the department's request, information contained in the insurer's records regarding all of the following:
1. Information that the department needs to identify recipients of badger care who satisfy any of the following:
a. Are eligible for benefits under a disability insurance policy.
b. Would be eligible for benefits under a disability insurance policy if the recipient were enrolled as a dependent of a person insured under the disability insurance policy.
2. Information required for submittal of claims under the insurer's disability insurance policy.
3. The types of benefits provided by the disability insurance policy.
(c) Upon requesting an insurer to provide the information under par. (b), the department shall enter into a written agreement with the insurer that satisfies all of the following:
1. Identifies in detail the information to be disclosed.
2. Includes provisions that adequately safeguard the confidentiality of the information to be disclosed.
(d) 1. An insurer shall provide the information requested under par. (b) within 180 days after receiving the department's request if it is the first time that the department has requested the insurer to disclose information under this subsection.
2. An insurer shall provide the information requested under par. (b) within 30 days after receiving the department's request if the department has previously requested the insurer to disclose information under this subsection.
3. If an insurer fails to comply with subd. 1. or 2., the department may notify the commissioner of insurance, and the commissioner of insurance may initiate enforcement proceedings against the insurer under s. 601.41 (4) (a).
49.688 (2) (a) 3. The person is not a recipient of medical assistance or, as a recipient, does not receive prescription drug coverage.
49.688 (3) (d) Notwithstanding s. 49.002, if a person who is eligible under this section has other available coverage for payment of a prescription drug, this section applies only to costs for prescription drugs for the persons person that are not covered under the person's other available coverage.
109,140r
Section 140r. 49.688 (8m) of the statutes is created to read:
49.688 (8m) (a) In this subsection:
1. "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
2. "Insurer" has the meaning given in s. 600.03 (27).
(b) An insurer that issues or delivers a disability insurance policy that provides coverage to a resident of this state shall provide to the department, upon the department's request, information contained in the insurer's records regarding all of the following:
1. Information that the department needs to identify eligible persons under this section who satisfy any of the following:
a. Are eligible for benefits under a disability insurance policy.
b. Would be eligible for benefits under a disability insurance policy if the eligible person were enrolled as a dependent of a person insured under the disability insurance policy.
2. Information required for submittal of claims under the insurer's disability insurance policy.
3. The types of benefits provided by the disability insurance policy.
(c) Upon requesting an insurer to provide the information under par. (b), the department shall enter into a written agreement with the insurer that satisfies all of the following:
1. Identifies in detail the information to be disclosed.
2. Includes provisions that adequately safeguard the confidentiality of the information to be disclosed.
(d) 1. An insurer shall provide the information requested under par. (b) within 180 days after receiving the department's request if it is the first time that the department has requested the insurer to disclose information under this subsection.
2. An insurer shall provide the information requested under par. (b) within 30 days after receiving the department's request if the department has previously requested the insurer to disclose information under this subsection.
3. If an insurer fails to comply with subd. 1. or 2., the department may notify the commissioner of insurance, and the commissioner of insurance may initiate enforcement proceedings against the insurer under s. 601.41 (4) (a).
49.688 (9) (b) A person who is convicted of violating a rule promulgated by the department under par. (a) in connection with that person's furnishing of prescription drugs under this section is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000, or imprisoned for not more than 7 years and 6 months, or both.
49.688 (9) (c) A person other than a person specified in par. (b) who is convicted of violating a rule promulgated by the department under par. (a) may be fined not more than $10,000, or imprisoned in the county jail for not more than one year, or both.
49.795 (8) (a) 2. If the value of the food coupons exceeds $100, but is less than $5,000, a person who violates this section may be fined not more than $10,000 or imprisoned for not more than 7 years and 6 months or both is guilty of a Class I felony.
49.795 (8) (b) 2. If the value of the food coupons exceeds $100, but is less than $5,000, a person who violates this section may be fined not more than $10,000 or imprisoned for not more than 7 years and 6 months or both is guilty of a Class H felony.
49.795 (8) (c) For any offense under this section, if the value of the food coupons is $5,000 or more, a person who violates this section may be fined not more than $250,000 or imprisoned for not more than 30 years or both is guilty of a Class G felony.
49.85 (2) (a) At least annually, the department of health and family services shall certify to the department of revenue the amounts that, based on the notifications received under sub. (1) and on other information received by the department of health and family services, the department of health and family services has determined that it may recover under s. 49.45 (2) (a) 10. or 49.497, except that the department of health and family services may not certify an amount under this subsection unless it has met the notice requirements under sub. (3) and unless its determination has either not been appealed or is no longer under appeal.
49.85 (3) (a) 1. Inform the person that the department of health and family services intends to certify to the department of revenue an amount that the department of health and family services has determined to be due under s. 49.45 (2) (a) 10. or 49.497, for setoff from any state tax refund that may be due the person.
109,146
Section 146. 49.95 (1) of the statutes is renumbered 49.95 (1) (intro.) and amended to read:
49.95 (1) (intro.) Any person who, with intent to secure public assistance under this chapter, whether for himself or herself or for some other person, wilfully makes any false representations may, if is subject to the following penalties:
(a) If the value of the assistance so secured does not exceed $300, the person may be required to forfeit not more than $1,000; if.
(b) If the value of the assistance exceeds $300 but does not exceed $1,000, the person may be fined not more than $250 or imprisoned for not more than 6 months or both; if.
