Amendment JR2 SA2-SSA1-AB1

AB1-SSA1-SA2, s. 121ph Section 121ph. 49.45 (2) (a) 12. a. of the statutes, as affected by 2001 Wisconsin Act 16, is renumbered 49.45 (2) (a) 12. and amended to read:

AB1-SSA1-SA2,187,7 49.45 (2) (a) 12. Decertify or suspend under this subdivision a provider from or restrict a provider's participation in the medical assistance program, if after giving reasonable notice and opportunity for hearing the department finds that the provider has violated a federal statute or regulation or a state statute or administrative rule and the violation is by statute, regulation, or rule grounds for decertification or restriction. The department shall suspend the provider pending the hearing under this subdivision if the department includes in its decertification notice findings that the provider's continued participation in the medical assistance program pending hearing is likely to lead to the irretrievable loss of public funds and is unnecessary to provide adequate access to services to medical assistance recipients. As soon as practicable after the hearing, the department shall issue a written decision suspension. No payment may be made under the medical assistance program with respect to any service or item furnished by the provider subsequent to decertification or during the period of suspension.

AB1-SSA1-SA2, s. 121pi Section 121pi. 49.45 (2) (a) 12. b. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pj Section 121pj. 49.45 (2) (a) 14. of the statutes is amended to read:

AB1-SSA1-SA2,187,13 49.45 (2) (a) 14. Assure due process in implementing subds. 12. and 13. by providing written notice, a fair hearing and a written decision and a hearing conducted as a class 2 proceeding under ch. 227.

AB1-SSA1-SA2, s. 121pk Section 121pk. 49.45 (2) (b) 6m. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pL Section 121pL. 49.45 (2) (b) 7. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pm Section 121pm. 49.45 (2) (b) 8. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pn Section 121pn. 49.45 (2) (b) 9. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pp Section 121pp. 49.45 (3) (g) 1. of the statutes, as affected by 2001 Wisconsin Act 16, is renumbered 49.45 (3) (g) and amended to read:

AB1-SSA1-SA2,188,18 49.45 (3) (g) The secretary may authorize personnel to audit or investigate and report to the department on any matter involving violations or complaints alleging violations of statutes, regulations, or rules applicable to the medical assistance program and to perform such investigations or audits as are required to verify the actual provision of services or items available under the medical assistance program and the appropriateness and accuracy of claims for reimbursement submitted by providers participating in the program. Department employees authorized by the secretary under this paragraph shall be issued, and shall possess at all times while they are performing their investigatory or audit functions under this section, identification, signed by the secretary, that specifically designates the bearer as possessing the authorization to conduct medical assistance investigations or audits. Under the request of a designated person and upon presentation of the person's authorization, providers and medical assistance recipients shall accord the person access to any provider personnel, records, books, or documents or other information needed. Under the written request of a designated person and upon presentation of the person's authorization, providers and recipients shall accord the person access to any needed patient health care records of a recipient. Authorized employees may hold hearings, administer oaths, take testimony, and perform all other duties necessary to bring the matter before the department for final adjudication and determination.

AB1-SSA1-SA2, s. 121pq Section 121pq. 49.45 (3) (g) 2. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pr Section 121pr. 49.45 (3) (h) 1. of the statutes is created to read:

AB1-SSA1-SA2,189,7 49.45 (3) (h) 1. For purposes of any audit, investigation, examination, analysis, review, or other function authorized by law with respect to the medical assistance program, the secretary shall have the power to sign and issue subpoenas to any person requiring the production of any pertinent books, records, patient health care records, or other information. Subpoenas so issued shall be served by anyone authorized by the secretary by delivering a copy to the person named in the subpoena, or by registered mail or certified mail addressed to the person at his or her last-known residence or principal place of business. A verified return by the person serving the subpoena setting forth the manner of service, or, in the event service is by registered or certified mail, the return post-office receipt signed by the person served constitutes proof of service.

AB1-SSA1-SA2, s. 121ps Section 121ps. 49.45 (3) (h) 1m. of the statutes, as affected by 2001 Wisconsin Act 16, is renumbered 49.45 (3) (h) 3. and amended to read:

AB1-SSA1-SA2,189,19 49.45 (3) (h) 3. The failure or refusal of a provider to accord department auditors or investigators access as required under par. (g) to any provider personnel, records, books, patient health care records of medical assistance recipients, or documents or other information requested constitutes person to purge himself or herself of contempt found under s. 885.12 and perform the act as required by law shall constitute grounds for decertification or suspension of the provider that person from participation in the medical assistance program. No payment may be made for services rendered by the provider that person following decertification, or during the period of suspension, or during any period of provider failure or refusal to accord access as required under par. (g).

AB1-SSA1-SA2, s. 121pt Section 121pt. 49.45 (3) (h) 1n. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pu Section 121pu. 49.45 (3) (h) 2. of the statutes is created to read:

AB1-SSA1-SA2,190,2 49.45 (3) (h) 2. In the event of contumacy or refusal to obey a subpoena issued under this paragraph and duly served upon any person, any judge in a court of record in the county in which the person was served may enforce the subpoena in accordance with s. 885.12.

AB1-SSA1-SA2, s. 121pv Section 121pv. 49.45 (21) (title) of the statutes, as affected by 2001 Wisconsin Act 16, is amended to read:

AB1-SSA1-SA2,190,6 49.45 (21) (title) Taking over provider's operation Transfer of business, liability for; repayments required.

AB1-SSA1-SA2, s. 121pw Section 121pw. 49.45 (21) (ag) of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pwj Section 121pwj. 49.45 (21) (ar) of the statutes, as affected by 2001 Wisconsin Act 16, is renumbered 49.45 (21) (a) and amended to read:

AB1-SSA1-SA2,190,19 49.45 (21) (a) Before a person may take over the operation of a provider that is If any provider liable for repayment of improper or erroneous payments or overpayments under ss. 49.43 to 49.497, full repayment shall be made. Upon request, the department shall notify the provider or the person that intends to take over the operation of the provider as to whether the provider sells or otherwise transfers ownership of his or her business or all or substantially all of the assets of the business, the transferor and transferee are each liable for the repayment. Prior to final transfer, the transferee is responsible for contacting the department and ascertaining if the transferor is liable under this paragraph.

AB1-SSA1-SA2, s. 121px Section 121px. 49.45 (21) (b) of the statutes, as affected by 2001 Wisconsin Act 16, is amended to read:

AB1-SSA1-SA2,191,6 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.

AB1-SSA1-SA2, s. 121py Section 121py. 49.45 (21) (e) of the statutes, as created by 2001 Wisconsin Act 16, is repealed.".

AB1-SSA1-SA2,191,10 159. Page 38, line 21: delete the material beginning with that line and ending with page 39, line 10, and substitute:

AB1-SSA1-SA2,191,11 " Section 122b. 49.45 (49) of the statutes is created to read:

AB1-SSA1-SA2,191,12 49.45 (49) Prescription drug prior authorization. (a) In this subsection:

AB1-SSA1-SA2,191,14 1. "Average manufacturer price" has the meaning given in 42 USC 1396r-8 (k) (1).

AB1-SSA1-SA2,191,15 2. "HIV infection" has the meaning given in s. 252.01 (2).

AB1-SSA1-SA2,191,16 3. "Institution for mental diseases" has the meaning given in s. 46.011 (1m).

AB1-SSA1-SA2,191,18 4. "Intermediate care facility for the mentally retarded" has the meaning given in s. 46.278 (1m) (am).

AB1-SSA1-SA2,191,19 5. "Nursing home" has the meaning given in s. 50.01 (3).

AB1-SSA1-SA2,191,20 6. "Pharmacist" has the meaning given in s. 450.01 (15).

AB1-SSA1-SA2,191,21 7. "Physician" has the meaning given in s. 448.01 (5).

AB1-SSA1-SA2,191,23 8. "Preferred prescription drug list" means a list of prescription drugs to which prior authorization does not apply.

AB1-SSA1-SA2,191,24 9. "Prescription drug" has the meaning given in s. 450.01 (20).

AB1-SSA1-SA2,192,3 (b) Except for all of the following, beginning July 1, 2003, the department shall subject all prescription drugs that are prescribed for medical assistance recipients to requirements of prior authorization:

AB1-SSA1-SA2,192,5 1. Prescription drugs that are used to treat mental illness, including anxiety, depression, or psychosis, or to treat HIV infection.

AB1-SSA1-SA2,192,8 2. Prescription drugs that are prescribed for residents of nursing homes, of institutions for mental diseases, and of intermediate care facilities for the mentally retarded.

AB1-SSA1-SA2,192,10 3. Prescription drugs that are included in a preferred prescription drug list of the department under par. (f).

AB1-SSA1-SA2,192,13 (c) The secretary shall exercise his or her authority under s. 15.04 (1) (c) to create a prescription drug prior authorization committee and shall appoint as members at least all of the following:

AB1-SSA1-SA2,192,14 1. Two physicians who are currently in practice.

AB1-SSA1-SA2,192,15 2. Two pharmacists.

AB1-SSA1-SA2,192,18 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.

AB1-SSA1-SA2,192,20 (d) The prescription drug prior authorization committee appointed under par. (c) shall do all of the following:

AB1-SSA1-SA2,192,25 1. Review the department's prior authorization policies and advise the department on issues related to prior authorization decisions made concerning prescription drugs on behalf of medical assistance recipients. In making its review under this subdivision, the committee shall accept information or commentary from representatives of the pharmaceutical manufacturing industry.

AB1-SSA1-SA2,193,4 2. Consider the clinical efficacy, safety, and cost effectiveness of prescription drugs and develop and provide to the department a recommended preferred prescription drug list. In initially developing and subsequently revising the preferred prescription drug list, the committee shall do all of the following:

AB1-SSA1-SA2,193,7 a. Ensure that the manufacturers of prescription drugs that agree to provide a supplemental rebate, as specified in par. (h), have an opportunity to present evidence supporting inclusion of a product on the list.

AB1-SSA1-SA2,193,9 b. At least every 12 months, review all prescription drug classes included in the department's list of preferred prescription drugs under par. (f).

AB1-SSA1-SA2,193,12 c. From the department's list of preferred prescription drugs under par. (f), recommend additions or deletions that permit cost-saving, medically appropriate drug therapies for medical assistance recipients.

AB1-SSA1-SA2,193,14 (e) The department shall do all of the following on behalf of the prescription drug prior authorization committee:

AB1-SSA1-SA2,193,18 1. If the department has received timely notice that a drug or any of its uses has received approval by the federal food and drug administration under a priority new drug application, ensure that the drug will be reviewed by the committee at the committee's earliest regularly scheduled meeting.

AB1-SSA1-SA2,193,21 2. If the department has received notice from a drug manufacturer of a new drug product, schedule, to the extent possible, a product review for the product by the committee at the committee's earliest regularly scheduled meeting.

AB1-SSA1-SA2,193,24 (f) 1. After considering all of the following, the department may, beginning July 1, 2002, adopt a preferred prescription drug list and shall disseminate the list to all appropriate providers of medical assistance:

AB1-SSA1-SA2,194,2 a. The recommendation of the prescription drug prior authorization committee under par. (d) 2.

AB1-SSA1-SA2,194,3 b. The clinical efficacy of a prescription drug.

AB1-SSA1-SA2,194,5 c. The price of competing products minus payment of any rebate made under 42 USC 1396r-8 and par. (h).

AB1-SSA1-SA2,194,6 d. If par. (h) 4. applies.

AB1-SSA1-SA2,194,10 2. The department shall periodically update the preferred prescription drug list, based on the department's consideration of recommendations of the prescription drug prior authorization committee and shall disseminate the changes to appropriate providers.

AB1-SSA1-SA2,194,12 3. The department shall make the preferred prescription drug list under subd. 1. and the updates under subd. 2. publicly available.

AB1-SSA1-SA2,194,18 (g) A medical assistance recipient may contest the decision of the department to deny prior authorization for a prescription drug that is excluded from the preferred prescription drug list under par. (f) by filing, within 45 days after denial of coverage for a prescription drug that is subject to prior authorization, a written request for a hearing under s. 227.44 to the division of hearings and appeals created under s. 15.103 (1).

AB1-SSA1-SA2,194,20 (h) 1. If a manufacturer of a prescription drug pays a rebate under 42 USC 1396r-8, one of the following applies:

AB1-SSA1-SA2,195,2 a. If the rebate is less than 15.1%, the department may enter into an arrangement with the manufacturer that requires the manufacturer to provide a supplemental rebate to the department in an amount that, together with the rebate paid under 42 USC 1396r-8, equals at least 15.1% of the average manufacturer price for the manufacturer's prescription drug products that are provided to medical assistance recipients, except that the department may determine that a specific prescription drug is competitive at a lower rebate percentage.

AB1-SSA1-SA2,195,9 b. If the rebate is at least 15.1%, the department may enter into an arrangement with the manufacturer that requires the manufacturer to provide a supplemental rebate to the department in an amount that, together with the rebate paid under 42 USC 1396r-8, equals at least 25.1% of the average manufacturer price for the manufacturer's prescription drug products that are provided to medical assistance recipients, except that the department may determine that a specific prescription drug is competitive at a lower rebate percentage.

AB1-SSA1-SA2,195,11 2. Payment of rebates under subd. 1. shall be used to offset expenditures under s. 20.435 (4) (b), (bc), (bv), (o), and (p).

AB1-SSA1-SA2,195,19 3. The supplemental rebate under subd. 1. a. or b. may include, at the discretion of the department, a program benefit that offsets a medical assistance cost, including a disease management program, a drug product donation program, a drug utilization control program, a program of prescriber and beneficiary counseling and education, or a program to reduce medical assistance fraud and abuse, or may include a cash rebate. The department may request from the federal secretary of health and human services a waiver of federal medicaid laws necessary to permit the department of health and family services to implement this subdivision.

AB1-SSA1-SA2,195,23 4. If a manufacturer of prescription drugs agrees to pay the minimum supplemental rebate rate under subd. 1. a. or b., the department shall consider including a prescription drug of the manufacturer in the preferred prescription drug list under par. (f).

AB1-SSA1-SA2,196,9 (i) Trade secrets, amounts of rebates or supplemental rebates, percentages of rebate rates, and pricing of prescription drugs by prescription drug manufacturers that are contained in records of the department or the department's agent with respect to a supplemental rebate negotiation or supplemental rebate agreement under par. (h) 1. are not public records under subch. II of ch. 19 and shall be kept confidential in accordance with 42 USC 1396r-8 (b) (3) (D). Those portions of meetings of the prior authorization prescription drug advisory committee at which trade secrets, amounts of rebates or supplemental rebates, percentages of rebate rates, and pricing of prescription drugs by prescription drug manufacturers are not subject to subch. V of ch. 19 and shall be kept confidential in accordance with 42 USC 1396r-8 (b) (3) (D).

AB1-SSA1-SA2,196,11 (j) The department may enter into a contract with an entity to perform the duties and exercise the powers of the department under pars. (h) 1. a. and b.

AB1-SSA1-SA2,196,17 (k) Annually, by January 15, the department shall submit to appropriate standing committees of the legislature under s. 13.172 (3) and to the governor a report on the implementation of the department of the program under this subsection, including any progress made in implementing cost-containment measures under medical assistance and its effect on expenditures under medical assistance for prescription drugs.

AB1-SSA1-SA2, s. 122c Section 122c. 49.45 (50) of the statutes is created to read:

AB1-SSA1-SA2,196,24 49.45 (50) Right to appeal prescription drug coverage decision. The department shall inform each medical assistance recipient of his or her right, under sub. (49) (g), to contest a decision by the department to deny prior authorization for a prescription drug that is excluded from the preferred prescription drug list under sub. (49) (f), if the decision results in denial of coverage to the recipient for the prescription drug.".

AB1-SSA1-SA2,197,1 160. Page 46, line 20: after that line insert:

AB1-SSA1-SA2,197,3 " Section 145g. 49.85 (2) (a) of the statutes, as affected by 2001 Wisconsin Act 16, is amended to read:

AB1-SSA1-SA2,197,11 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.

AB1-SSA1-SA2, s. 145h Section 145h. 49.85 (3) (a) 1. of the statutes, as affected by 2001 Wisconsin Act 16, is amended to read:

AB1-SSA1-SA2,197,17 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.".

AB1-SSA1-SA2,197,18 161. Page 47, line 25: after that line insert:

AB1-SSA1-SA2,197,19 " Section 148f. 50.375 of the statutes is created to read:

AB1-SSA1-SA2,197,21 50.375 Emergency contraception for alleged victims of sexual assault. (1) In this section:

AB1-SSA1-SA2,198,4 (a) "Emergency contraception" means a drug, medicine, oral hormonal compound, mixture, preparation, instrument, article, or device that is approved by the federal food and drug administration that prevents a pregnancy after sexual intercourse. "Emergency contraception" does not include a drug, medicine, oral hormonal compound, mixture, preparation, instrument, article, or device of any nature that is prescribed to terminate the pregnancy of a woman who is known by the prescribing licensed health care provider to be pregnant.

AB1-SSA1-SA2,198,5 (b) "Sexual assault" means a violation of s. 940.225 (1), (2), or (3).

AB1-SSA1-SA2,198,7 (2) A hospital that provides emergency services to an alleged victim of sexual assault shall, after obtaining the consent of the victim, do all of the following:

AB1-SSA1-SA2,198,9 (a) Provide to the victim medically and factually accurate and unbiased written and oral information about emergency contraception.

AB1-SSA1-SA2,198,11 (b) Orally inform the victim of her option to receive emergency contraception at the hospital.

AB1-SSA1-SA2,198,13 (c) Provide emergency contraception immediately at the hospital to the victim if she requests it.