Amendment ASA1-SB55

SB55-ASA1,629,15 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b) and, (o), and (w), the department shall distribute funding in each fiscal year to supplement payment for services to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant under this chapter, if the department determines that the hospitals serve a disproportionate number of low-income patients with special needs. If no medical relief block grant under this chapter is awarded or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2). The department may not distribute funds under this subsection to the extent that the distribution would do any of the following:

SB55-ASA1, s. 1006 Section 1006. 49.45 (8) (b) of the statutes is amended to read:

SB55-ASA1,629,21 49.45 (8) (b) Reimbursement under s. 20.435 (4) (b) and, (o), and (w) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under par. (c).

SB55-ASA1, s. 1787m Section 1787m. 49.45 (22) of the statutes is amended to read:

SB55-ASA1,630,2 49.45 (22) (a) If the department contracts with health maintenance organizations for the provision of medical assistance it shall give special consideration to health maintenance organizations that provide or that contract to provide comprehensive, specialized health care services to pregnant teenagers.

SB55-ASA1,630,11 (b) If the department contracts with health maintenance organizations for the provision of medical assistance, the department shall determine which medical assistance recipients who have attained the age of 2 but have not attained the age of 6 and who are at risk for lead poisoning have not received lead screening from those health maintenance organizations. The department shall report annually to the appropriate standing committees of the legislature under s. 13.172 (3) on the percentage of medical assistance recipients under the age of 2 who received a lead screening test in that year provided by a health maintenance organization compared with the percentage that the department set as a goal for that year.

SB55-ASA1, s. 1787mg Section 1787mg. 49.45 (22) (c) of the statutes is created to read:

SB55-ASA1,630,22 49.45 (22) (c) If the department contracts with health maintenance organizations for the provision of medical assistance, each contract shall require a health maintenance organization to contract with at least the number of primary care providers, within a radius of 30 miles from the boundary of the area the health maintenance organization serves, that is sufficient to ensure that each medical assistance recipient who is eligible for medical assistance under s. 49.46 (1) (a) 1., 1g., 1m., 6., 9., 10., 11., 12., or 13. or 49.47 (4) (ag) 1. or 2. will be able to adequately access the health care services offered by the health maintenance organization. The department shall determine the number of primary care providers with whom each health maintenance organization is required to contract.

SB55-ASA1, s. 1007 Section 1007. 49.45 (24m) (intro.) of the statutes is amended to read:

SB55-ASA1,631,3 49.45 (24m) Home health care and personal care pilot program. (intro.) From the appropriations under s. 20.435 (4) (b) and, (o), and (w), in order to test the feasibility of instituting a system of reimbursement for providers of home health care and personal care services for medical assistance recipients that is based on competitive bidding, the department shall:

SB55-ASA1, s. 1008 Section 1008. 49.45 (30m) of the statutes is amended to read:

SB55-ASA1,631,7 49.45 (30m) Certain services for developmentally disabled. A county shall provide the portion of the services under s. 51.06 (1) (1m) (d) to individuals who are eligible for medical assistance that is not provided by the federal government.

SB55-ASA1, s. 1009 Section 1009. 49.45 (40) of the statutes is amended to read:

SB55-ASA1,631,12 49.45 (40) Periodic record matches. The If the department contracts with the department of workforce development under s. 49.197 (5), the department shall cooperate with the department of workforce development in matching records of medical assistance recipients under s. 49.32 (7).

SB55-ASA1, s. 1010 Section 1010. 49.45 (46) (b) of the statutes is amended to read:

SB55-ASA1,631,14 49.45 (46) (b) This subsection does not apply after July 1 June 30, 2003.

SB55-ASA1, s. 1011 Section 1011. 49.45 (48) of the statutes is created to read:

SB55-ASA1,631,20 49.45 (48) Payment of medicare part B outpatient hospital services coinsurances. The department shall include in the state plan for medical assistance a methodology for payment of the medicare part B outpatient hospital services coinsurance amounts that are authorized under ss. 49.46 (2) (c) 2., 4., and 5m., 49.468 (1) (b), and 49.47 (6) (a) 6. b., d., and f.

SB55-ASA1, s. 1012 Section 1012. 49.46 (1) (a) 1. of the statutes is amended to read:

SB55-ASA1,631,25 49.46 (1) (a) 1. Any person included in the Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources, would qualify for a grant of aid to families with dependent children and any person who does under s. 49.19.

SB55-ASA1,632,4 1g. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources, would qualify for a grant of aid to families with dependent children but who would not receive such the aid solely because of the application of s. 49.19 (11) (a) 7.

SB55-ASA1, s. 1797g Section 1797g. 49.46 (1) (a) 1. of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-ASA1,632,10 49.46 (1) (a) 1. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources or income, would qualify for a grant of aid to families with dependent children under s. 49.19 and whose income does not exceed the income limit under par. (ar).

SB55-ASA1, s. 1797j Section 1797j. 49.46 (1) (a) 1g. of the statutes, as created by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-ASA1,632,17 49.46 (1) (a) 1g. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources or income, would qualify for a grant of aid to families with dependent children but who would not receive the aid solely because of the application of s. 49.19 (11) (a) 7. and whose income does not exceed the income limit under par. (ar).

SB55-ASA1, s. 1013 Section 1013. 49.46 (1) (a) 1m. of the statutes is amended to read:

SB55-ASA1,632,22 49.46 (1) (a) 1m. Any pregnant woman who meets the resource and whose income limits does not exceed the standard of need under s. 49.19 (4) (bm) and (es) (11) and whose pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th day after the last day of the pregnancy falls.

SB55-ASA1, s. 1798g Section 1798g. 49.46 (1) (a) 1m. of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-ASA1,633,4 49.46 (1) (a) 1m. Any pregnant woman whose income does not exceed the standard of need under s. 49.19 (11) income limit under par. (ar) and whose pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th day after the last day of the pregnancy falls.

SB55-ASA1, s. 1014 Section 1014. 49.46 (1) (a) 6. of the statutes is amended to read:

SB55-ASA1,633,9 49.46 (1) (a) 6. Any person not described in pars. (c) to (e) who is, without regard to the individual's resources, would be considered, under federal law, to be receiving aid to families with dependent children for the purpose of determining eligibility for medical assistance.

SB55-ASA1, s. 1800m Section 1800m. 49.46 (1) (a) 6. of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-ASA1,633,16 49.46 (1) (a) 6. Any person not described in pars. (c) to (e) who, without regard to the individual's resources or income, would be considered, under federal law, to be receiving aid to families with dependent children for the purpose of determining eligibility for medical assistance and whose income does not exceed the income limit under par. (ar).

SB55-ASA1, s. 1015 Section 1015. 49.46 (1) (a) 9. of the statutes is amended to read:

SB55-ASA1,633,20 49.46 (1) (a) 9. Any pregnant woman not described under subd. 1., 1g., or 1m. whose family income does not exceed 133% of the poverty line for a family the size of the woman's family.

SB55-ASA1, s. 1016 Section 1016. 49.46 (1) (a) 10. of the statutes is amended to read:

SB55-ASA1,633,24 49.46 (1) (a) 10. Any child not described under subd. 1. or 1g. who is under 6 years of age and whose family income does not exceed 133% of the poverty line for a family the size of the child's family.

SB55-ASA1, s. 1017 Section 1017. 49.46 (1) (a) 11. of the statutes is amended to read:

SB55-ASA1,634,8 49.46 (1) (a) 11. If a waiver under s. 49.665 is granted and in effect, any child not described under subd. 1. or 1g. who has attained the age of 6 but has not attained the age of 19 and whose family income does not exceed 100% of the poverty line for a family the size of the child's family. If a waiver under s. 49.665 is not granted or in effect, any child not described in subd. 1. or 1g. who was born after September 30,1983, who has attained the age of 6 but has not attained the age of 19 and whose family income does not exceed 100% of the poverty line for a family the size of the child's family.

SB55-ASA1, s. 1018 Section 1018. 49.46 (1) (a) 12. of the statutes is amended to read:

SB55-ASA1,634,12 49.46 (1) (a) 12. Any child not described under subd. 1. or 1g. who is under 19 years of age and who meets the resource and whose income limits does not exceed the standard of need under s. 49.19 (4) (11).

SB55-ASA1, s. 1804g Section 1804g. 49.46 (1) (a) 12. of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-ASA1,634,17 49.46 (1) (a) 12. Any child not described under subd. 1. or 1g. who is under 19 years of age and whose income does not exceed the standard of need under s. 49.19 (11) income limit under par. (ar).

SB55-ASA1, s. 1804m Section 1804m. 49.46 (1) (ar) of the statutes is created to read:

SB55-ASA1,634,24 49.46 (1) (ar) An individual is eligible to receive medical assistance under par. (a) 1., 1g., 1m., 6., and 12. if the individual's total income does not exceed the standard of need under s. 49.19 (11) (a) 1. a. increased by the same percentage as the percentage increase in the consumer price index, as defined in s. 49.455 (1) (b), between September 2001 and September of the year immediately before the year in which the individual's income is being determined.

SB55-ASA1, s. 1019 Section 1019. 49.46 (1) (e) of the statutes is amended to read:

SB55-ASA1,635,7 49.46 (1) (e) If an application under s. 49.47 (3) shows that the person has individual meets the income and resources within the limitations of limits under s. 49.19, or meets the income and resource requirements under federal Title XVI or s. 49.77, or that the person individual is an essential person, an accommodated person, or a patient in a public medical institution, the person individual shall be granted the benefits enumerated under sub. (2) whether or not the person individual requests or receives a grant of any of such aids.

SB55-ASA1, s. 1805d Section 1805d. 49.46 (1) (e) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-ASA1,635,15 49.46 (1) (e) If an application under s. 49.47 (3) shows that the individual meets the income limits under s. 49.19 par. (ar) or meets the income and resource requirements under federal Title XVI or s. 49.77, or that the individual is an essential person, an accommodated person, or a patient in a public medical institution, the individual shall be granted the benefits enumerated under sub. (2) whether or not the individual requests or receives a grant of any of such aids.

SB55-ASA1, s. 1020 Section 1020. 49.46 (2) (b) 18. of the statutes is amended to read:

SB55-ASA1,635,19 49.46 (2) (b) 18. Alcohol or other drug abuse residential treatment services of no more than 45 days per treatment episode, under s. 49.45 (46). This subdivision does not apply after July 1 June 30, 2003.

SB55-ASA1, s. 1021 Section 1021. 49.46 (2) (c) 2. of the statutes is amended to read:

SB55-ASA1,636,8 49.46 (2) (c) 2. For an individual who is entitled to coverage under part A of medicare, entitled to coverage under part B of medicare, meets the eligibility criteria under sub. (1) and meets the limitation on income under subd. 6., medical assistance shall include payment of the deductible and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to 1395zz, including those medicare services that are not included in the approved state plan for services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under part A of medicare. Payment of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-ASA1, s. 1022 Section 1022. 49.46 (2) (c) 4. of the statutes is amended to read:

SB55-ASA1,636,20 49.46 (2) (c) 4. For an individual who is entitled to coverage under part A of medicare, entitled to coverage under part B of medicare and meets the eligibility criteria for medical assistance under sub. (1), but does not meet the limitation on income under subd. 6., medical assistance shall include payment of the deductible and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to 1395zz, including those medicare services that are not included in the approved state plan for services under 42 USC 1396. Payment of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-ASA1, s. 1023 Section 1023. 49.46 (2) (c) 5m. of the statutes is amended to read:

SB55-ASA1,637,5 49.46 (2) (c) 5m. For an individual who is only entitled to coverage under part B of medicare and meets the eligibility criteria under sub. (1), but does not meet the limitation on income under subd. 6., medical assistance shall include payment of the deductible and coinsurance portions of medicare services under 42 USC 1395j to 1395w, including those medicare services that are not included in the approved state plan for services under 42 USC 1396. Payment of coinsurance for a service under part B of medicare, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-ASA1, s. 1024 Section 1024. 49.468 (1) (b) of the statutes is amended to read:

SB55-ASA1,637,20 49.468 (1) (b) For an elderly or disabled individual who is entitled to coverage under part A of medicare, entitled to coverage under part B of medicare and who does not meet the eligibility criteria for medical assistance under s. 49.46 (1), 49.465 or 49.47 (4) but meets the limitations on income and resources under par. (d), medical assistance shall pay the deductible and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to 1395zz, including those medicare services that are not included in the approved state plan for services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under part A of medicare. Payment of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-ASA1, s. 1025 Section 1025. 49.47 (4) (a) 1. of the statutes is amended to read:

SB55-ASA1,637,24 49.47 (4) (a) 1. Under 18 21 years of age or, if the person and resides in an intermediate care facility, skilled nursing facility, or inpatient psychiatric hospital, under 21 years of age.

SB55-ASA1, s. 1026 Section 1026. 49.47 (4) (a) 2. of the statutes is renumbered 49.47 (4) (ag) 2.

SB55-ASA1, s. 1027 Section 1027 . 49.47 (4) (ag) (intro.) of the statutes is created to read:

SB55-ASA1,638,4 49.47 (4) (ag) (intro.) Any individual whose income does not exceed the limits under par. (c) and who complies with par. (cm) is eligible for medical assistance under this section if the individual is one of the following:

SB55-ASA1, s. 1028 Section 1028 . 49.47 (4) (ag) 1. of the statutes is created to read:

SB55-ASA1,638,6 49.47 (4) (ag) 1. Under the age of 18.

SB55-ASA1, s. 1029 Section 1029. 49.47 (4) (b) 2m. a. of the statutes is amended to read:

SB55-ASA1,638,13 49.47 (4) (b) 2m. a. For persons who are eligible under par. (a) 1. or 2., one vehicle is exempt from consideration as an asset. A 2nd vehicle is exempt from consideration as an asset only if the department determines that it is necessary for the purpose of employment or to obtain medical care. The equity value of any nonexempt vehicles owned by the applicant is an asset for the purposes of determining eligibility for medical assistance under this section.

SB55-ASA1, s. 1815g Section 1815g. 49.47 (4) (c) 1. of the statutes is renumbered 49.47 (4) (c) 1. (intro.) and amended to read:

SB55-ASA1,638,17 49.47 (4) (c) 1. (intro.) Except as provided in par. (am) and as limited by subd. 3., eligibility exists if income does not exceed 133 1/3% of the greater of the following:

SB55-ASA1,638,23 a. An amount equal to the maximum aid to families with dependent children payment under s. 49.19 (11) (a) 1. a. for the applicant's family size or increased by the same percentage as the percentage increase in the consumer price index, as defined in s. 49.455 (1) (b), between September 2001 and September of the year immediately before the year in which the individual's income is being determined and multiplied by 133 1/3%.

SB55-ASA1,639,7 b. An amount equal to the combined benefit amount available under supplemental security income under 42 USC 1381 to 1383c and state supplemental aid under s. 49.77 whichever is higher. In this subdivision "income" includes earned or unearned income that would be included in determining eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled under 42 USC 1381 to 1385. "Income" does not include earned or unearned income which would be excluded in determining eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled individual under 42 USC 1381 to 1385.

SB55-ASA1, s. 1815j Section 1815j. 49.47 (4) (c) 1m. of the statutes is created to read:

SB55-ASA1,639,16 49.47 (4) (c) 1m. For purposes of determining whether an individual's income meets the income requirements under subd. 1., "income" includes all of the individual's earned or unearned income that would be included in determining eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind, or disabled under 42 USC 1381 to 1385, and "income" does not include earned or unearned income that would be excluded in determining eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind, or disabled individual under 42 USC 1381 to 1385.

SB55-ASA1, s. 1030 Section 1030. 49.47 (6) (a) 6. b. of the statutes is amended to read:

SB55-ASA1,640,4 49.47 (6) (a) 6. b. An individual who is entitled to coverage under part A of medicare, entitled to coverage under part B of medicare, meets the eligibility criteria under sub. (4) (a) and meets the income limitation, the deductible and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to 1395zz, including those medicare services that are not included in the approved state plan for services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under part A of medicare. Payment of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-ASA1, s. 1031 Section 1031. 49.47 (6) (a) 6. d. of the statutes is amended to read:

SB55-ASA1,640,15 49.47 (6) (a) 6. d. An individual who is entitled to coverage under part A of medicare, entitled to coverage under part B of medicare and meets the eligibility criteria for medical assistance under sub. (4) (a) but does not meet the income limitation, the deductible and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to 1395zz, including those medicare services that are not included in the approved state plan for services under 42 USC 1396. Payment of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-ASA1, s. 1032 Section 1032. 49.47 (6) (a) 6. f. of the statutes is amended to read:

SB55-ASA1,640,25 49.47 (6) (a) 6. f. For an individual who is only entitled to coverage under part B of medicare and meets the eligibility criteria under sub. (4), but does not meet the income limitation, medical assistance shall include payment of the deductible and coinsurance portions of medicare services under 42 USC 1395j to 1395w, including those medicare services that are not included in the approved state plan for services under 42 USC 1396. Payment of coinsurance for a service under part B of medicare, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-ASA1, s. 1033 Section 1033. 49.47 (6) (a) 7. of the statutes is amended to read:

SB55-ASA1,641,5 49.47 (6) (a) 7. Beneficiaries eligible under sub. (4) (a) 2. (ag) 2. or (am) 1., for services under s. 49.46 (2) (a) and (b) that are related to pregnancy, including postpartum services and family planning services, as defined in s. 253.07 (1) (b), or related to other conditions which may complicate pregnancy.

SB55-ASA1, s. 1034 Section 1034. 49.472 (6) (a) of the statutes is amended to read:

SB55-ASA1,641,12 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation under s. 20.435 (4) (b) or (w), the department shall, on the part of an individual who is eligible for medical assistance under sub. (3), pay premiums for or purchase individual coverage offered by the individual's employer if the department determines that paying the premiums for or purchasing the coverage will not be more costly than providing medical assistance.

SB55-ASA1, s. 1035 Section 1035. 49.472 (6) (b) of the statutes is amended to read:

SB55-ASA1,641,17 49.472 (6) (b) If federal financial participation is available, from the appropriation under s. 20.435 (4) (b) or (w), the department may pay medicare Part A and Part B premiums for individuals who are eligible for medicare and for medical assistance under sub. (3).

SB55-ASA1, s. 1036 Section 1036. 49.473 of the statutes is created to read:

SB55-ASA1,641,20 49.473 Medical assistance; women diagnosed with breast or cervical cancer. (1) In this section:

SB55-ASA1,641,22 (a) "County department" means a county department under s. 46.215, 46.22, or 46.23.