LRBa2933/1
PJK/DAK/MDK:kjf:ch
2003 - 2004 LEGISLATURE
ASSEMBLY AMENDMENT 1,
TO 2003 SENATE BILL 322
March 11, 2004 - Offered by Representative Wasserman.
SB322-AA1,1,11 At the locations indicated, amend the bill as follows:
SB322-AA1,2,14 21. Page 1, line 2: after "plan" insert "treating property taxes as a deduction to
3annual household income for purposes of determining eligibility and deductible
4amounts under the prescription drug assistance program for the elderly; exempting
5amounts claimed for depreciation for purposes of calculating farm and
6self-employment income under the Medical Assistance and Badger Care health care
7programs; requiring Medical Assistance incentive payments to hospitals that
8establish a physician order entry record system; prescriptions for antibiotic drugs for
9treatment of chlamydia, gonorrhea, or trichomonas; the requirements for
10examinations for nursing home administrator licenses and for reciprocal nursing
11home administrator licenses and creating an exemption from such requirements;
12provision of home and community-based services under a community integration
13program to persons relocated from facilities; discrimination in prescription drug

1prices; health care provider service rates and insurer health care services
2reimbursement rates; expanding the Volunteer Health Care Provider Program to
3include provision of services to students from 4-year-old kindergarten to grade 6 in
4public elementary schools, charter schools, and private schools that participate in
5the Milwaukee Parental Choice Program; allowing any provider to participate in a
6health care plan under the terms of the plan, requiring an annual period for
7providers to elect to participate in health care plans, and requiring notice to a
8provider of the reason for exclusion from a health care plan; treatment of prescription
9drug costs, diagnostic testing, and payments under mandated insurance coverage of
10treatment for nervous and mental disorders and alcoholism and other drug abuse
11problems; increasing the limits for insurance coverage of nervous or mental health
12disorders or alcoholism or other drug abuse problems; an exception to confidentiality
13requirements for treatment records; granting rule-making authority; and requiring
14the exercise of rule-making authority".
SB322-AA1,2,15 152. Page 2, line 1: before that line insert:
SB322-AA1,2,16 16" Section 1. 20.435 (4) (b) of the statutes is amended to read:
SB322-AA1,3,717 20.435 (4) (b) Medical assistance program benefits. Biennially, the amounts in
18the schedule to provide the state share of medical assistance program benefits
19administered under s. 49.45, to provide medical assistance program benefits
20administered under s. 49.45 that are not also provided under par. (o), to fund the pilot
21project under s. 46.27 (9) and (10), to provide the facility payments under 1999
22Wisconsin Act 9
, section 9123 (9m), to fund services provided by resource centers
23under s. 46.283 and for services under the family care benefit under s. 46.284 (5).
24Notwithstanding s. 20.002 (1), the department may transfer from this appropriation

1to the appropriation under sub. (7) (kb) funds in the amount of and for the purposes
2specified in s. 46.485. Notwithstanding ss. 20.001 (3) (b) and 20.002 (1), the
3department may credit or deposit into this appropriation and may transfer between
4fiscal years funds that it transfers from the appropriation under sub. (7) (kb) for the
5purposes specified in s. 46.485 (3r). Notwithstanding s. 20.002 (1), the department
6may transfer from this appropriation to the appropriation account under sub. (7) (bd)
7funds in the amount and for the purposes specified in s. 49.45 (6v) (6L).
SB322-AA1, s. 2 8Section 2. 20.435 (7) (bd) of the statutes is amended to read:
SB322-AA1,3,249 20.435 (7) (bd) Community options program; pilot projects; family care benefit.
10The amounts in the schedule for assessments, case planning, services,
11administration and risk reserve escrow accounts under s. 46.27, for pilot projects
12under s. 46.271 (1), to fund services provided by resource centers under s. 46.283 (5),
13for services under the family care benefit under s. 46.284 (5) and for the payment of
14premiums under s. 49.472 (5). If the department transfers funds to this
15appropriation from the appropriation account under sub. (4) (b), the amounts in the
16schedule for the fiscal year for which the transfer is made are increased by the
17amount of the transfer for the purposes specified in s. 49.45 (6v) (6L).
18Notwithstanding ss. 20.001 (3) (a) and 20.002 (1), the department may under this
19paragraph transfer moneys between fiscal years. Except for moneys authorized for
20transfer under this appropriation or under s. 46.27 (7) (fm) or (g), all moneys under
21this appropriation that are allocated under s. 46.27 and are not spent or encumbered
22by counties or by the department by December 31 of each year shall lapse to the
23general fund on the succeeding January 1 unless transferred to the next calendar
24year by the joint committee on finance.
SB322-AA1, s. 3 25Section 3. 46.03 (44) of the statutes is created to read:
SB322-AA1,4,9
146.03 (44) Sexually transmitted disease treatment information. Promulgate
2a rule specifying the information that a physician, physician assistant, or advanced
3practice nurse prescriber may provide, in writing, to a patient under s. 448.035 (3)
4and encourage physicians, physician assistants, and advanced practice nurse
5prescribers to provide such information to a patient under s. 448.035 (3). The
6information shall consist of information about sexually transmitted diseases and
7their treatment and about the risk of drug allergies. The information shall also
8include a statement advising a person with questions about the information to
9contact his or her physician or local health department, as defined in s. 250.01 (4).
SB322-AA1, s. 4 10Section 4. 46.277 (1) of the statutes is amended to read:
SB322-AA1,4,2211 46.277 (1) Legislative intent. The intent of the program under this section is
12to provide home or community-based care to serve in a noninstitutional community
13setting a person who meets eligibility requirements under 42 USC 1396n (c) and is
14relocated from an institution other than a state center for the developmentally
15disabled or meets the level of care requirements for medical assistance
16reimbursement in a skilled nursing facility or an intermediate care facility, except
17that the number of persons who receive home or community-based care under this
18section is not intended, other than under sub. (4) (c), to exceed the number of nursing
19home beds that are delicensed as part of a plan submitted by the facility and
20approved by the department. The intent of the program is also that counties use all
21existing services for providing care under this section, including those services
22currently provided by counties.
SB322-AA1, s. 5 23Section 5. 46.277 (1m) (a) of the statutes is renumbered 46.277 (1m) (ak).
SB322-AA1, s. 6 24Section 6. 46.277 (1m) (ag) of the statutes is created to read:
SB322-AA1,5,2
146.277 (1m) (ag) "Delicensed" means deducted from the number of beds stated
2on a facility's license, as specified under s. 50.03 (4) (e).
SB322-AA1, s. 7 3Section 7. 46.277 (2) (intro.) of the statutes is amended to read:
SB322-AA1,5,164 46.277 (2) Departmental powers and duties. (intro.) The department may
5request a waiver from the secretary of the federal department of health and human
6services, under 42 USC 1396n (c), authorizing the department to serve medical
7assistance recipients, who meet the level of care requirements for medical assistance
8reimbursement in a skilled nursing facility or an intermediate care facility, in their
9communities by providing home or community-based services as part of medical
10assistance. The Except under sub. (4) (c), the number of persons for whom the waiver
11is requested may not exceed the number of nursing home beds that are delicensed
12as part of a plan submitted by the facility and approved by the department. If the
13department requests a waiver, it shall include all assurances required under 42 USC
141396n
(c) (2) in its request. If the department receives this waiver, it may request
15one or more 3-year extensions of the waiver under 42 USC 1396n (c) and shall
16perform the following duties:
SB322-AA1, s. 8 17Section 8. 46.277 (3) (a) of the statutes is amended to read:
SB322-AA1,6,218 46.277 (3) (a) Sections 46.27 (3) (b) and 46.275 (3) (a) and (c) to (e) apply to
19county participation in this program, except that services provided in the program
20shall substitute for care provided a person in a skilled nursing facility or
21intermediate care facility who meets the level of care requirements for medical
22assistance reimbursement to that facility rather than for care provided at a state
23center for the developmentally disabled. The Except in sub. (4) (c), the number of
24persons who receive services provided by the program under this paragraph may not
25exceed the number of nursing home beds, other than beds specified in sub. (5g) (b),

1that are delicensed as part of a plan submitted by the facility and approved by the
2department.
SB322-AA1, s. 9 3Section 9. 46.277 (3) (b) 1. of the statutes is amended to read:
SB322-AA1,6,74 46.277 (3) (b) 1. If Except under sub. (4) (c), if the provision of services under
5this section results in a decrease in the statewide nursing home bed limit under s.
6150.31 (3), the facility affected by the decrease shall submit a plan for delicensing all
7or part of the facility that is approved by the department.
SB322-AA1, s. 10 8Section 10. 46.277 (3) (b) 2. of the statutes is amended to read:
SB322-AA1,6,149 46.277 (3) (b) 2. Each county department participating in the program shall
10provide home or community-based care to persons eligible under this section, except
11that the number of persons who receive home or community-based care under this
12section may not exceed, other than under sub. (4) (c), the number of nursing home
13beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan
14submitted by the facility and approved by the department.
SB322-AA1, s. 11 15Section 11. 46.277 (4) (a) of the statutes is amended to read:
SB322-AA1,6,2416 46.277 (4) (a) Any medical assistance recipient who meets the level of care
17requirements for medical assistance reimbursement in a skilled nursing facility or
18intermediate care facility is eligible to participate in the program, except that the
19number of participants may not exceed, other than under par. (c), the number of
20nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as
21part of a plan submitted by the facility and approved by the department. Such a
22recipient may apply, or any person may apply on behalf of such a recipient, for
23participation in the program. Section 46.275 (4) (b) applies to participation in the
24program.
SB322-AA1, s. 12 25Section 12. 46.277 (4) (b) of the statutes is amended to read:
SB322-AA1,7,8
146.277 (4) (b) To the extent authorized under 42 USC 1396n and except under
2par. (c)
, if a person discontinues participation in the program, a medical assistance
3recipient may participate in the program in place of the participant who discontinues
4if that recipient meets the level of care requirements for medical assistance
5reimbursement in a skilled nursing facility or intermediate care facility, except that
6the number of participants may not exceed the number of nursing home beds, other
7than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted
8by the facility and approved by the department.
SB322-AA1, s. 13 9Section 13. 46.277 (4) (c) of the statutes is created to read:
SB322-AA1,7,2010 46.277 (4) (c) The department may, under this paragraph, provide funding
11under this section for services for a medical assistance recipient who relocates from
12a facility to the community, beginning on the date of the relocation and ending on the
13date that the individual discontinues participation in the program or no longer meets
14the level of care requirements for medical assistance reimbursement in a skilled
15nursing facility or an intermediate care facility. Funding for medical assistance costs
16for individuals relocated under this paragraph may not exceed, in the aggregate,
17total medical assistance costs for the individuals if served in facilities. The total
18number of individuals who may participate in the program under this paragraph is
19not restricted by any otherwise applicable limitation on the number of individuals
20who may participate in the program under this section.
SB322-AA1, s. 14 21Section 14. 46.277 (5) (g) of the statutes, as created by 2003 Wisconsin Act 33,
22is amended to read:
SB322-AA1,8,323 46.277 (5) (g) The department may provide enhanced reimbursement for
24services provided under this section to an individual who is relocated to the
25community from a nursing home by a county department on or after July 26, 2003,

1if the nursing home bed that was used by the individual is delicensed upon relocation
2of the individual or if the individual is relocated under sub. (4) (c). The department
3shall develop and utilize a formula to determine the enhanced reimbursement rate.
SB322-AA1, s. 15 4Section 15. 46.277 (5g) (a) of the statutes is amended to read:
SB322-AA1,8,85 46.277 (5g) (a) The Except under sub. (4) (c), the number of persons served
6under this section may not exceed the number of nursing home beds that are
7delicensed as part of a plan submitted by the facility and approved by the
8department.
SB322-AA1, s. 16 9Section 16. 49.45 (6ur) of the statutes is created to read:
SB322-AA1,8,1610 49.45 (6ur) Physician order entry record system; incentive payments. From
11the appropriation accounts under s. 20.435 (4) (b) and (o), the department shall
12annually make an incentive payment to each hospital that establishes, by January
131, 2007, and thereafter continues to maintain a physician order entry record system
14for provided medical services that, at a minimum, include pharmacy, laboratory,
15ultrasonography, and radiology services. The incentive payment shall equal 1% of
16the Medical Assistance reimbursement to the hospital for the previous fiscal year.
SB322-AA1, s. 17 17Section 17. 49.45 (6v) of the statutes is renumbered 49.45 (6L).
SB322-AA1, s. 18 18Section 18. 49.45 (53) of the statutes is created to read:
SB322-AA1,8,2119 49.45 (53) Fiscal intermediary; dental forms. The department's fiscal
20intermediary shall maintain a separate unit for the processing of claims for dental
21services received under this section.
SB322-AA1, s. 19 22Section 19. 49.46 (1) (a) 1. of the statutes is amended to read:
SB322-AA1,8,2523 49.46 (1) (a) 1. Notwithstanding s. 49.19 (20), any individual who, without
24regard to the individual's resources and subject to par. (ar), would qualify for a grant
25of aid to families with dependent children under s. 49.19.
SB322-AA1, s. 20
1Section 20. 49.46 (1) (a) 1g. of the statutes is amended to read:
SB322-AA1,9,52 49.46 (1) (a) 1g. Notwithstanding s. 49.19 (20), any individual who, without
3regard to the individual's resources and subject to par. (ar), would qualify for a grant
4of aid to families with dependent children but who would not receive the aid solely
5because of the application of s. 49.19 (11) (a) 7.
SB322-AA1, s. 21 6Section 21. 49.46 (1) (a) 1m. of the statutes is amended to read:
SB322-AA1,9,107 49.46 (1) (a) 1m. Any pregnant woman whose income, determined in
8accordance with par. (ar),
does not exceed the standard of need under s. 49.19 (11)
9and whose pregnancy is medically verified. Eligibility continues to the last day of
10the month in which the 60th day after the last day of the pregnancy falls.
SB322-AA1, s. 22 11Section 22. 49.46 (1) (a) 6. of the statutes is amended to read:
SB322-AA1,9,1512 49.46 (1) (a) 6. Any person not described in pars. (c) to (e) who, without regard
13to the individual's resources and subject to par. (ar), would be considered, under
14federal law, to be receiving aid to families with dependent children for the purpose
15of determining eligibility for medical assistance.
SB322-AA1, s. 23 16Section 23. 49.46 (1) (a) 9. of the statutes is amended to read:
SB322-AA1,9,1917 49.46 (1) (a) 9. Any pregnant woman not described under subd. 1., 1g., or 1m.
18whose family income, determined in accordance with par. (ar), does not exceed 133%
19of the poverty line for a family the size of the woman's family.
SB322-AA1, s. 24 20Section 24. 49.46 (1) (a) 10. of the statutes is amended to read:
SB322-AA1,9,2321 49.46 (1) (a) 10. Any child not described under subd. 1. or 1g. who is under 6
22years of age and whose family income, determined in accordance with par. (ar), does
23not exceed 133% of the poverty line for a family the size of the child's family.
SB322-AA1, s. 25 24Section 25. 49.46 (1) (a) 11. of the statutes is amended to read:
SB322-AA1,10,9
149.46 (1) (a) 11. If a waiver under s. 49.665 is granted and in effect, any child
2not described under subd. 1. or 1g. who has attained the age of 6 but has not attained
3the age of 19 and whose family income, determined in accordance with par. (ar), does
4not exceed 100% of the poverty line for a family the size of the child's family. If a
5waiver under s. 49.665 is not granted or in effect, any child not described in subd. 1.
6or 1g. who was born after September 30,1983, who has attained the age of 6 but has
7not attained the age of 19 and whose family income, determined in accordance with
8par. (ar),
does not exceed 100% of the poverty line for a family the size of the child's
9family.
SB322-AA1, s. 26 10Section 26. 49.46 (1) (a) 12. of the statutes is amended to read:
SB322-AA1,10,1311 49.46 (1) (a) 12. Any child not described under subd. 1. or 1g. who is under 19
12years of age and whose income, determined in accordance with par. (ar), does not
13exceed the standard of need under s. 49.19 (11).
SB322-AA1, s. 27 14Section 27 . 49.46 (1) (ar) of the statutes is created to read:
SB322-AA1,10,2415 49.46 (1) (ar) 1. Except as provided in subd. 2. and except to the extent that the
16determination is inconsistent with 42 USC 1396a (a) (17), for purposes of
17determining under par. (a) 1., 1g., or 6. whether an individual would qualify for a
18grant of aid to families with dependent children under s. 49.19 or would be
19considered, under federal law, to be receiving aid to families with dependent
20children, or of determining whether an individual meets the income limits under par.
21(a) 1m., 9., 10., 11., or 12., "income" includes income that would be included in
22determining eligibility for aid to families with dependent children under s. 49.19 and
23excludes income that would be excluded in determining eligibility for aid to families
24with dependent children under s. 49.19.
SB322-AA1,11,7
12. Notwithstanding s. 49.19 (5), for purposes of determining under par. (a) 1.,
21g., or 6. whether an individual would qualify for a grant of aid to families with
3dependent children under s. 49.19 or would be considered, under federal law, to be
4receiving aid to families with dependent children, or of determining whether an
5individual meets the income limits under par. (a) 1m., 9., 10., 11., or 12., (am), or (e),
6the department shall exclude from the calculation of farm or self-employment
7income any amounts claimed for depreciation for income tax purposes.
SB322-AA1, s. 28 8Section 28. 49.46 (1) (e) of the statutes is amended to read:
SB322-AA1,11,159 49.46 (1) (e) If an application under s. 49.47 (3) shows that the individual
10individual's income, determined in accordance with par. (ar), meets the income limits
11under s. 49.19, or that the individual meets the income and resource requirements
12under federal Title XVI or s. 49.77, or that the individual is an essential person, an
13accommodated person, or a patient in a public medical institution, the individual
14shall be granted the benefits enumerated under sub. (2) whether or not the
15individual requests or receives a grant of any of such aids.
SB322-AA1, s. 29 16Section 29. 49.46 (1) (L) of the statutes is repealed.
SB322-AA1, s. 30 17Section 30. 49.47 (4) (am) 1. of the statutes is amended to read:
SB322-AA1,11,2318 49.47 (4) (am) 1. A pregnant woman whose family income , determined in
19accordance with par. (cg),
does not exceed 155% of the poverty line for a family the
20size of the woman's family, except that, if a waiver under par. (j) or a change in the
21approved state plan under s. 49.46 (1) (am) 2. is in effect, the income limit is 185%
22of the poverty line for a family the size of the woman's family in each state fiscal year
23after the 1994-95 state fiscal year.
SB322-AA1, s. 31 24Section 31. 49.47 (4) (am) 2. of the statutes is amended to read:
SB322-AA1,12,6
149.47 (4) (am) 2. A child who is under 6 years of age and whose family income,
2determined in accordance with par. (cg),
does not exceed 155% of the poverty line for
3a family the size of the child's family, except that, if a waiver under par. (j) or a change
4in the approved state plan under s. 49.46 (1) (am) 2. is in effect, the income limit is
5185% of the poverty line for a family the size of the child's family in each state fiscal
6year after the 1994-95 state fiscal year.
SB322-AA1, s. 32 7Section 32. 49.47 (4) (c) 1. of the statutes is amended to read:
SB322-AA1,12,138 49.47 (4) (c) 1. Except as provided in par. (am) and as limited by subd. 3.,
9eligibility exists if income, determined in accordance with par. (cg), does not exceed
10133 1/3% of the maximum aid to families with dependent children payment under
11s. 49.19 (11) for the applicant's family size or the combined benefit amount available
12under supplemental security income under 42 USC 1381 to 1383c and state
13supplemental aid under s. 49.77, whichever is higher. In this subdivision
SB322-AA1,12,21 14(cg) 1. Except as provided in subd. 3., for purposes of determining whether an
15individual's income meets the income requirements under par. (c),
"income" includes
16earned or unearned income that would be included in determining eligibility for the
17individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled under
1842 USC 1381 to 1385. "Income" does not include and excludes earned or unearned
19income which that would be excluded in determining eligibility for the individual or
20family under s. 49.19 or 49.77, or for the aged, blind or disabled individual under 42
21USC 1381
to 1385.
SB322-AA1, s. 33 22Section 33. 49.47 (4) (c) 3. of the statutes is amended to read:
SB322-AA1,13,223 49.47 (4) (c) 3. Except as provided in par. (am), no person is eligible for medical
24assistance under this section if the person's income, determined in accordance with

1par. (cg),
exceeds the maximum income levels that the U.S. department of health and
2human services sets for federal financial participation under 42 USC 1396b (f).
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