SB55-SSA1, s. 1804m 18Section 1804m. 49.46 (1) (ar) of the statutes is created to read:
SB55-SSA1,634,2419 49.46 (1) (ar) An individual is eligible to receive medical assistance under par.
20(a) 1., 1g., 1m., 6., and 12. if the individual's total income does not exceed the standard
21of need under s. 49.19 (11) (a) 1. a. increased by the same percentage as the
22percentage increase in the consumer price index, as defined in s. 49.455 (1) (b),
23between September 2001 and September of the year immediately before the year in
24which the individual's income is being determined.
SB55-SSA1, s. 1805 25Section 1805. 49.46 (1) (e) of the statutes is amended to read:
SB55-SSA1,635,7
149.46 (1) (e) If an application under s. 49.47 (3) shows that the person has
2individual meets the
income and resources within the limitations of limits under s.
349.19, or meets the income and resource requirements under federal Title XVI or s.
449.77, or that the person individual is an essential person, an accommodated person,
5or a patient in a public medical institution, the person individual shall be granted
6the benefits enumerated under sub. (2) whether or not the person individual requests
7or receives a grant of any of such aids.
SB55-SSA1, s. 1805d 8Section 1805d. 49.46 (1) (e) of the statutes, as affected by 2001 Wisconsin Act
9.... (this act), is amended to read:
SB55-SSA1,635,1510 49.46 (1) (e) If an application under s. 49.47 (3) shows that the individual meets
11the income limits under s. 49.19 par. (ar) or meets the income and resource
12requirements under federal Title XVI or s. 49.77, or that the individual is an essential
13person, an accommodated person, or a patient in a public medical institution, the
14individual shall be granted the benefits enumerated under sub. (2) whether or not
15the individual requests or receives a grant of any of such aids.
SB55-SSA1, s. 1806 16Section 1806. 49.46 (2) (b) 18. of the statutes is amended to read:
SB55-SSA1,635,1917 49.46 (2) (b) 18. Alcohol or other drug abuse residential treatment services of
18no more than 45 days per treatment episode, under s. 49.45 (46). This subdivision
19does not apply after July 1 June 30, 2003.
SB55-SSA1, s. 1807 20Section 1807. 49.46 (2) (c) 2. of the statutes is amended to read:
SB55-SSA1,636,821 49.46 (2) (c) 2. For an individual who is entitled to coverage under part A of
22medicare, entitled to coverage under part B of medicare, meets the eligibility criteria
23under sub. (1) and meets the limitation on income under subd. 6., medical assistance
24shall include payment of the deductible and coinsurance portions of medicare
25services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to

11395zz, including those medicare services that are not included in the approved state
2plan for services under 42 USC 1396; the monthly premiums payable under 42 USC
31395v
; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late
4enrollment penalty, if applicable, for premiums under part A of medicare. Payment
5of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w,
6other than payment of coinsurance for outpatient hospital services,
may not exceed
7the allowable charge for the service under medical assistance minus the medicare
8payment.
SB55-SSA1, s. 1808 9Section 1808. 49.46 (2) (c) 4. of the statutes is amended to read:
SB55-SSA1,636,2010 49.46 (2) (c) 4. For an individual who is entitled to coverage under part A of
11medicare, entitled to coverage under part B of medicare and meets the eligibility
12criteria for medical assistance under sub. (1), but does not meet the limitation on
13income under subd. 6., medical assistance shall include payment of the deductible
14and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which
15are not paid under 42 USC 1395 to 1395zz, including those medicare services that
16are not included in the approved state plan for services under 42 USC 1396. Payment
17of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w,
18other than payment of coinsurance for outpatient hospital services,
may not exceed
19the allowable charge for the service under medical assistance minus the medicare
20payment.
SB55-SSA1, s. 1809 21Section 1809. 49.46 (2) (c) 5m. of the statutes is amended to read:
SB55-SSA1,637,522 49.46 (2) (c) 5m. For an individual who is only entitled to coverage under part
23B of medicare and meets the eligibility criteria under sub. (1), but does not meet the
24limitation on income under subd. 6., medical assistance shall include payment of the
25deductible and coinsurance portions of medicare services under 42 USC 1395j to

11395w, including those medicare services that are not included in the approved state
2plan for services under 42 USC 1396. Payment of coinsurance for a service under
3part B of medicare, other than payment of coinsurance for outpatient hospital
4services,
may not exceed the allowable charge for the service under medical
5assistance minus the medicare payment.
SB55-SSA1, s. 1810 6Section 1810. 49.468 (1) (b) of the statutes is amended to read:
SB55-SSA1,637,207 49.468 (1) (b) For an elderly or disabled individual who is entitled to coverage
8under part A of medicare, entitled to coverage under part B of medicare and who does
9not meet the eligibility criteria for medical assistance under s. 49.46 (1), 49.465 or
1049.47 (4) but meets the limitations on income and resources under par. (d), medical
11assistance shall pay the deductible and coinsurance portions of medicare services
12under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to 1395zz,
13including those medicare services that are not included in the approved state plan
14for services under 42 USC 1396; the monthly premiums payable under 42 USC
151395v
; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late
16enrollment penalty, if applicable, for premiums under part A of medicare. Payment
17of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w,
18other than payment of coinsurance for outpatient hospital services,
may not exceed
19the allowable charge for the service under medical assistance minus the medicare
20payment.
SB55-SSA1, s. 1811 21Section 1811. 49.47 (4) (a) 1. of the statutes is amended to read:
SB55-SSA1,637,2422 49.47 (4) (a) 1. Under 18 21 years of age or, if the person and resides in an
23intermediate care facility, skilled nursing facility, or inpatient psychiatric hospital,
24under 21 years of age
.
SB55-SSA1, s. 1812 25Section 1812. 49.47 (4) (a) 2. of the statutes is renumbered 49.47 (4) (ag) 2.
SB55-SSA1, s. 1813
1Section 1813 . 49.47 (4) (ag) (intro.) of the statutes is created to read:
SB55-SSA1,638,42 49.47 (4) (ag) (intro.) Any individual whose income does not exceed the limits
3under par. (c) and who complies with par. (cm) is eligible for medical assistance under
4this section if the individual is one of the following:
SB55-SSA1, s. 1814 5Section 1814 . 49.47 (4) (ag) 1. of the statutes is created to read:
SB55-SSA1,638,66 49.47 (4) (ag) 1. Under the age of 18.
SB55-SSA1, s. 1815 7Section 1815. 49.47 (4) (b) 2m. a. of the statutes is amended to read:
SB55-SSA1,638,138 49.47 (4) (b) 2m. a. For persons who are eligible under par. (a) 1. or 2., one
9vehicle is exempt from consideration as an asset. A 2nd vehicle is exempt from
10consideration as an asset only if the department determines that it is necessary for
11the purpose of employment or to obtain medical care. The equity value of any
12nonexempt vehicles owned by the applicant is an asset for the purposes of
13determining eligibility for medical assistance under this section.
SB55-SSA1, s. 1815g 14Section 1815g. 49.47 (4) (c) 1. of the statutes is renumbered 49.47 (4) (c) 1.
15(intro.) and amended to read:
SB55-SSA1,638,1716 49.47 (4) (c) 1. (intro.) Except as provided in par. (am) and as limited by subd.
173., eligibility exists if income does not exceed 133 1/3% of the greater of the following:
SB55-SSA1,638,23 18a. An amount equal to the maximum aid to families with dependent children
19payment under s. 49.19 (11) (a) 1. a. for the applicant's family size or increased by the
20same percentage as the percentage increase in the consumer price index, as defined
21in s. 49.455 (1) (b), between September 2001 and September of the year immediately
22before the year in which the individual's income is being determined and multiplied
23by 133 1/3%.
SB55-SSA1,639,7 24b. An amount equal to the combined benefit amount available under
25supplemental security income under 42 USC 1381 to 1383c and state supplemental

1aid under s. 49.77 whichever is higher. In this subdivision "income" includes earned
2or unearned income that would be included in determining eligibility for the
3individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled under
442 USC 1381 to 1385. "Income" does not include earned or unearned income which
5would be excluded in determining eligibility for the individual or family under s.
649.19 or 49.77, or for the aged, blind or disabled individual under 42 USC 1381 to
71385
.
SB55-SSA1, s. 1815j 8Section 1815j. 49.47 (4) (c) 1m. of the statutes is created to read:
SB55-SSA1,639,169 49.47 (4) (c) 1m. For purposes of determining whether an individual's income
10meets the income requirements under subd. 1., "income" includes all of the
11individual's earned or unearned income that would be included in determining
12eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind,
13or disabled under 42 USC 1381 to 1385, and "income" does not include earned or
14unearned income that would be excluded in determining eligibility for the individual
15or family under s. 49.19 or 49.77, or for the aged, blind, or disabled individual under
1642 USC 1381 to 1385.
SB55-SSA1, s. 1816 17Section 1816. 49.47 (6) (a) 6. b. of the statutes is amended to read:
SB55-SSA1,640,418 49.47 (6) (a) 6. b. An individual who is entitled to coverage under part A of
19medicare, entitled to coverage under part B of medicare, meets the eligibility criteria
20under sub. (4) (a) and meets the income limitation, the deductible and coinsurance
21portions of medicare services under 42 USC 1395 to 1395zz which are not paid under
2242 USC 1395 to 1395zz, including those medicare services that are not included in
23the approved state plan for services under 42 USC 1396; the monthly premiums
24payable under 42 USC 1395v; the monthly premiums, if applicable, under 42 USC
251395i-2
(d); and the late enrollment penalty, if applicable, for premiums under part

1A of medicare. Payment of coinsurance for a service under part B of medicare under
242 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital
3services,
may not exceed the allowable charge for the service under medical
4assistance minus the medicare payment.
SB55-SSA1, s. 1817 5Section 1817. 49.47 (6) (a) 6. d. of the statutes is amended to read:
SB55-SSA1,640,156 49.47 (6) (a) 6. d. An individual who is entitled to coverage under part A of
7medicare, entitled to coverage under part B of medicare and meets the eligibility
8criteria for medical assistance under sub. (4) (a) but does not meet the income
9limitation, the deductible and coinsurance portions of medicare services under 42
10USC 1395
to 1395zz which are not paid under 42 USC 1395 to 1395zz, including those
11medicare services that are not included in the approved state plan for services under
1242 USC 1396. Payment of coinsurance for a service under part B of medicare under
1342 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital
14services,
may not exceed the allowable charge for the service under medical
15assistance minus the medicare payment.
SB55-SSA1, s. 1818 16Section 1818. 49.47 (6) (a) 6. f. of the statutes is amended to read:
SB55-SSA1,640,2517 49.47 (6) (a) 6. f. For an individual who is only entitled to coverage under part
18B of medicare and meets the eligibility criteria under sub. (4), but does not meet the
19income limitation, medical assistance shall include payment of the deductible and
20coinsurance portions of medicare services under 42 USC 1395j to 1395w, including
21those medicare services that are not included in the approved state plan for services
22under 42 USC 1396. Payment of coinsurance for a service under part B of medicare,
23other than payment of coinsurance for outpatient hospital services,
may not exceed
24the allowable charge for the service under medical assistance minus the medicare
25payment.
SB55-SSA1, s. 1819
1Section 1819. 49.47 (6) (a) 7. of the statutes is amended to read:
SB55-SSA1,641,52 49.47 (6) (a) 7. Beneficiaries eligible under sub. (4) (a) 2. (ag) 2. or (am) 1., for
3services under s. 49.46 (2) (a) and (b) that are related to pregnancy, including
4postpartum services and family planning services, as defined in s. 253.07 (1) (b), or
5related to other conditions which may complicate pregnancy.
SB55-SSA1, s. 1820 6Section 1820. 49.472 (6) (a) of the statutes is amended to read:
SB55-SSA1,641,127 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation under s.
820.435 (4) (b) or (w), the department shall, on the part of an individual who is eligible
9for medical assistance under sub. (3), pay premiums for or purchase individual
10coverage offered by the individual's employer if the department determines that
11paying the premiums for or purchasing the coverage will not be more costly than
12providing medical assistance.
SB55-SSA1, s. 1821 13Section 1821. 49.472 (6) (b) of the statutes is amended to read:
SB55-SSA1,641,1714 49.472 (6) (b) If federal financial participation is available, from the
15appropriation under s. 20.435 (4) (b) or (w), the department may pay medicare Part
16A and Part B premiums for individuals who are eligible for medicare and for medical
17assistance under sub. (3).
SB55-SSA1, s. 1822 18Section 1822. 49.473 of the statutes is created to read:
SB55-SSA1,641,20 1949.473 Medical assistance; women diagnosed with breast or cervical
20cancer. (1)
In this section:
SB55-SSA1,641,2221 (a) "County department" means a county department under s. 46.215, 46.22,
22or 46.23.
SB55-SSA1,641,2323 (b) "Qualified entity" has the meaning given in 42 USC 1396r-1b (b) (2).
SB55-SSA1,642,3
1(2) A woman is eligible for medical assistance as provided under sub. (5) if, after
2applying to the department or a county department, the department or a county
3department determines that she meets all of the following requirements:
SB55-SSA1,642,64 (a) The woman is not eligible for medical assistance under ss. 49.46 (1) and
5(1m), 49.465, 49.468, 49.47, and 49.472, and is not eligible for health care coverage
6under s. 49.665.
SB55-SSA1,642,77 (b) The woman is under 65 years of age.
SB55-SSA1,642,98 (c) The woman is not eligible for health care coverage that qualifies as
9creditable coverage in 42 USC 300gg (c).
SB55-SSA1,642,1210 (d) The woman has been screened for breast or cervical cancer under a breast
11and cervical cancer early detection program that is authorized under a grant
12received under 42 USC 300k.
SB55-SSA1,642,1313 (e) The woman requires treatment for breast or cervical cancer.
SB55-SSA1,642,18 14(3) Prior to applying to the department or a county department for medical
15assistance, a woman is eligible for medical assistance as provided under sub. (5)
16beginning on the date on which a qualified entity determines, on the basis of
17preliminary information, that the women meets the requirements specified in sub.
18(2) and ending on one of the following dates:
SB55-SSA1,642,2219 (a) If the woman applies to the department or a county department for medical
20assistance within the time limit required under sub. (4), the day on which the
21department or county department determines whether the woman meets the
22requirements under sub. (2).
SB55-SSA1,643,223 (b) If the woman does not apply to the department or county department for
24medical assistance within the time limit required under sub. (4), the last day of the

1month following the month in which the qualified entity determines that the woman
2is eligible for medical assistance.
SB55-SSA1,643,6 3(4) A woman who a qualified entity determines under sub. (3) is eligible for
4medical assistance shall apply to the department or county department no later than
5the last day of the month following the month in which the qualified entity
6determines that the woman is eligible for medical assistance.
SB55-SSA1,643,10 7(5) The department shall audit and pay, from the appropriation accounts under
8s. 20.435 (4) (b) and (o), allowable charges to a provider who is certified under s. 49.45
9(2) (a) 11. for medical assistance on behalf of a woman who meets the requirements
10under sub. (2) for all benefits and services specified under s. 49.46 (2).
SB55-SSA1,643,12 11(6) A qualified entity that determines under sub. (3) that a woman is eligible
12for medical assistance as provided under sub. (5) shall do all of the following:
SB55-SSA1,643,1413 (a) Notify the department of the determination no later than 5 days after the
14date on which the determination is made.
SB55-SSA1,643,1815 (b) Inform the woman at the of time the determination that she is required to
16apply to the department or a county department for medical assistance no later than
17the last day of the month following the month in which the qualified entity
18determines that the woman is eligible for medical assistance.
SB55-SSA1,643,20 19(7) The department shall provide qualified entities with application forms for
20medical assistance and information on how to assist women in completing the form.
SB55-SSA1, s. 1835k 21Section 1835k. Subchapter V (title) of chapter 49 [precedes 49.66] of the
22statutes is amended to read:
SB55-SSA1,643,2323 CHAPTER 49
SB55-SSA1,644,3
1SUBCHAPTER V
2 OTHER MEDICALLY RELATED SERVICES
3AND SUPPORT and medical PROGRAMS
SB55-SSA1, s. 1836 4Section 1836. 49.665 (4) (at) 1. a. of the statutes is amended to read:
SB55-SSA1,644,95 49.665 (4) (at) 1. a. Except as provided in subd. 1. b., the department shall
6establish a lower maximum income level for the initial eligibility determination if
7funding under s. 20.435 (4) (bc), (jz) and, (p), and (x) is insufficient to accommodate
8the projected enrollment levels for the health care program under this section. The
9adjustment may not be greater than necessary to ensure sufficient funding.
SB55-SSA1, s. 1836g 10Section 1836g. 49.665 (4) (at) 1. b. of the statutes is amended to read:
SB55-SSA1,644,2111 49.665 (4) (at) 1. b. The department may not lower the maximum income level
12for initial eligibility unless the department first submits to the joint committee on
13finance its plans a plan for lowering the maximum income level and the committee
14approves the plan
. If, within 14 days after submitting the plan the date on which the
15plan is submitted
to the joint committee on finance, the cochairpersons of the
16committee do not notify the secretary that the committee has scheduled a meeting
17for the purpose of reviewing the plan, the department shall implement the plan is
18considered approved by the committee
as proposed. If within 14 days after the date
19on which the plan is submitted to the committee, the cochairpersons of the committee
20notify the secretary that the committee has scheduled a meeting to review the plan,
21the department may implement the plan only as approved by the committee
.
SB55-SSA1, s. 1836r 22Section 1836r. 49.665 (4) (at) 1. c. of the statutes is created to read:
SB55-SSA1,645,823 49.665 (4) (at) 1. c. Notwithstanding s. 20.001 (3) (b), if, after reviewing the plan
24submitted under subd. 1. b., the joint committee on finance determines that the
25amounts appropriated under s. 20.435 (4) (bc), (jz), (p), and (x) are insufficient to

1accommodate the projected enrollment levels, the committee may transfer
2appropriated moneys from the general purpose revenue appropriation account of any
3state agency, as defined in s. 20.001 (1), other than a sum sufficient appropriation
4account, to the appropriation account under s. 20.435 (4) (bc) to supplement the
5health care program under this section if the committee finds that the transfer will
6eliminate unnecessary duplication of functions, result in more efficient and effective
7methods for performing programs or more effectively carry out legislative intent, and
8that legislative intent will not be changed by the transfer.
SB55-SSA1, s. 1837 9Section 1837. 49.665 (4) (at) 2. of the statutes is amended to read:
SB55-SSA1,645,1410 49.665 (4) (at) 2. If, after the department has established a lower maximum
11income level under subd. 1., projections indicate that funding under s. 20.435 (4) (bc),
12(jz) and, (p), and (x) is sufficient to raise the level, the department shall, by state plan
13amendment, raise the maximum income level for initial eligibility, but not to exceed
14185% of the poverty line.
SB55-SSA1, s. 1837p 15Section 1837p. 49.68 (3) (b) of the statutes is amended to read:
SB55-SSA1,646,616 49.68 (3) (b) The From the appropriation accounts under ss. 20.435 (4) (e) and
17(je), the
state shall pay the cost of medical treatment required as a direct result of
18chronic renal disease of certified patients from the date of certification, including the
19cost of administering recombinant human erythropoietin to appropriate patients,
20whether the treatment is rendered in an approved facility in the state or in a dialysis
21or transplantation center which is approved as such by a contiguous state, subject
22to the conditions specified under par. (d). Approved facilities may include a hospital
23in-center dialysis unit or a nonhospital dialysis center which is closely affiliated with
24a home dialysis program supervised by an approved facility. Aid shall also be
25provided for all reasonable expenses incurred by a potential living-related donor,

1including evaluation, hospitalization, surgical costs and postoperative follow-up to
2the extent that these costs are not reimbursable under the federal medicare program
3or other insurance. In addition, all expenses incurred in the procurement,
4transportation and preservation of cadaveric donor kidneys shall be covered to the
5extent that these costs are not otherwise reimbursable. All donor-related costs are
6chargeable to the recipient and reimbursable under this subsection.
SB55-SSA1, s. 1837q 7Section 1837q. 49.683 (2) of the statutes is amended to read:
SB55-SSA1,646,98 49.683 (2) Approved costs for medical care under sub. (1) shall be paid from the
9appropriation accounts under s. 20.435 (4) (e) and (je).
SB55-SSA1, s. 1837r 10Section 1837r. 49.685 (2) of the statutes is amended to read:
SB55-SSA1,646,1611 49.685 (2) Assistance program. The From the appropriation accounts under
12s. 20.435 (4) (e) and (je), the
department shall establish a program of financial
13assistance to persons suffering from hemophilia and other related congenital
14bleeding disorders. The program shall assist such persons to purchase the blood
15derivatives and supplies necessary for home care. The program shall be
16administered through the comprehensive hemophilia treatment centers.
SB55-SSA1, s. 1837s 17Section 1837s. 49.687 (title) of the statutes is amended to read:
SB55-SSA1,646,19 1849.687 (title) Disease aids; patient financial and liability requirements;
19rebate agreements
.
SB55-SSA1, s. 1838 20Section 1838. 49.687 (2) of the statutes is amended to read:
SB55-SSA1,647,321 49.687 (2) The department shall develop and implement a sliding scale of
22patient liability for kidney disease aid under s. 49.68, cystic fibrosis aid under s.
2349.683 and hemophilia treatment under s. 49.685, based on the patient's ability to
24pay for treatment. To ensure that the needs for treatment of patients with lower
25incomes receive priority within the availability of funds under s. 20.435 (4) (e) and

1(je)
, the department shall revise the sliding scale for patient liability by January 1,
21994, and shall, every 3 years thereafter by January 1, review and, if necessary,
3revise the sliding scale.
SB55-SSA1, s. 1838c 4Section 1838c. 49.687 (3) of the statutes is created to read:
SB55-SSA1,647,105 49.687 (3) The department or an entity with which the department contracts
6shall provide to a drug manufacturer that sells drugs for prescribed use in this state
7documents designed for use by the manufacturer in entering into a rebate agreement
8with the department or entity that is modeled on the rebate agreement specified
9under 42 USC 1396r-8. The department or entity may enter into a rebate agreement
10under this subsection that shall include all of the following as requirements:
SB55-SSA1,647,1611 (a) That, as a condition of coverage for prescription drugs of a manufacturer
12under s. 49.68, 49.683, or 49.685, the manufacturer shall make rebate payments for
13each prescription drug of the manufacturer that is prescribed for and purchased by
14persons who meet eligibility criteria under s. 49.68, 49.683, or 49.685, to the state
15treasurer to be credited to the appropriation under s. 20.435 (4) (je), each calendar
16quarter or according to a schedule established by the department.
SB55-SSA1,647,2217 (b) That the amount of the rebate payment shall be determined by a method
18specified in 42 USC 1396r-8 (c), except that, if the average manufacturer price for
19a prescription drug exceeds the average manufacturer price of the drug as of
20December 31, 2000, or the first calendar quarter after the day on which the drug was
21first available, as adjusted for inflation, the rebate amount shall increase by the
22amount of the difference.
SB55-SSA1, s. 1838sb 23Section 1838sb. 49.79 (2) (b) of the statutes is created to read:
SB55-SSA1,648,3
149.79 (2) (b) An individual who fails to comply with the work requirements of
2the employment and training program under s. 49.13 (2) (a) is ineligible to
3participate in the food stamp program as specified under s. 49.13 (3).
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