Amendment AA1-SB322

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-AA1,1,1 At the locations indicated, amend the bill as follows:

SB322-AA1,2,14 1. Page 1, line 2: after "plan" insert "treating property taxes as a deduction to annual household income for purposes of determining eligibility and deductible amounts under the prescription drug assistance program for the elderly; exempting amounts claimed for depreciation for purposes of calculating farm and self-employment income under the Medical Assistance and Badger Care health care programs; requiring Medical Assistance incentive payments to hospitals that establish a physician order entry record system; prescriptions for antibiotic drugs for treatment of chlamydia, gonorrhea, or trichomonas; the requirements for examinations for nursing home administrator licenses and for reciprocal nursing home administrator licenses and creating an exemption from such requirements; provision of home and community-based services under a community integration program to persons relocated from facilities; discrimination in prescription drug prices; health care provider service rates and insurer health care services reimbursement rates; expanding the Volunteer Health Care Provider Program to include provision of services to students from 4-year-old kindergarten to grade 6 in public elementary schools, charter schools, and private schools that participate in the Milwaukee Parental Choice Program; allowing any provider to participate in a health care plan under the terms of the plan, requiring an annual period for providers to elect to participate in health care plans, and requiring notice to a provider of the reason for exclusion from a health care plan; treatment of prescription drug costs, diagnostic testing, and payments under mandated insurance coverage of treatment for nervous and mental disorders and alcoholism and other drug abuse problems; increasing the limits for insurance coverage of nervous or mental health disorders or alcoholism or other drug abuse problems; an exception to confidentiality requirements for treatment records; granting rule-making authority; and requiring the exercise of rule-making authority".

SB322-AA1,2,15 2. Page 2, line 1: before that line insert:

SB322-AA1,2,16 " Section 1. 20.435 (4) (b) of the statutes is amended to read:

SB322-AA1,3,7 20.435 (4) (b) Medical assistance program benefits. Biennially, the amounts in the schedule to provide the state share of medical assistance program benefits administered under s. 49.45, to provide medical assistance program benefits administered under s. 49.45 that are not also provided under par. (o), to fund the pilot project under s. 46.27 (9) and (10), to provide the facility payments under 1999 Wisconsin Act 9, section 9123 (9m), to fund services provided by resource centers under s. 46.283 and for services under the family care benefit under s. 46.284 (5). Notwithstanding s. 20.002 (1), the department may transfer from this appropriation to the appropriation under sub. (7) (kb) funds in the amount of and for the purposes specified in s. 46.485. Notwithstanding ss. 20.001 (3) (b) and 20.002 (1), the department may credit or deposit into this appropriation and may transfer between fiscal years funds that it transfers from the appropriation under sub. (7) (kb) for the purposes specified in s. 46.485 (3r). Notwithstanding s. 20.002 (1), the department may transfer from this appropriation to the appropriation account under sub. (7) (bd) funds in the amount and for the purposes specified in s. 49.45 (6v) (6L).

SB322-AA1, s. 2 Section 2. 20.435 (7) (bd) of the statutes is amended to read:

SB322-AA1,3,24 20.435 (7) (bd) Community options program; pilot projects; family care benefit. The amounts in the schedule for assessments, case planning, services, administration and risk reserve escrow accounts under s. 46.27, for pilot projects under s. 46.271 (1), to fund services provided by resource centers under s. 46.283 (5), for services under the family care benefit under s. 46.284 (5) and for the payment of premiums under s. 49.472 (5). If the department transfers funds to this appropriation from the appropriation account under sub. (4) (b), the amounts in the schedule for the fiscal year for which the transfer is made are increased by the amount of the transfer for the purposes specified in s. 49.45 (6v) (6L). Notwithstanding ss. 20.001 (3) (a) and 20.002 (1), the department may under this paragraph transfer moneys between fiscal years. Except for moneys authorized for transfer under this appropriation or under s. 46.27 (7) (fm) or (g), all moneys under this appropriation that are allocated under s. 46.27 and are not spent or encumbered by counties or by the department by December 31 of each year shall lapse to the general fund on the succeeding January 1 unless transferred to the next calendar year by the joint committee on finance.

SB322-AA1, s. 3 Section 3. 46.03 (44) of the statutes is created to read:

SB322-AA1,4,9 46.03 (44) Sexually transmitted disease treatment information. Promulgate a rule specifying the information that a physician, physician assistant, or advanced practice nurse prescriber may provide, in writing, to a patient under s. 448.035 (3) and encourage physicians, physician assistants, and advanced practice nurse prescribers to provide such information to a patient under s. 448.035 (3). The information shall consist of information about sexually transmitted diseases and their treatment and about the risk of drug allergies. The information shall also include a statement advising a person with questions about the information to contact his or her physician or local health department, as defined in s. 250.01 (4).

SB322-AA1, s. 4 Section 4. 46.277 (1) of the statutes is amended to read:

SB322-AA1,4,22 46.277 (1) Legislative intent. The intent of the program under this section is to provide home or community-based care to serve in a noninstitutional community setting a person who meets eligibility requirements under 42 USC 1396n (c) and is relocated from an institution other than a state center for the developmentally disabled or meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or an intermediate care facility, except that the number of persons who receive home or community-based care under this section is not intended, other than under sub. (4) (c), to exceed the number of nursing home beds that are delicensed as part of a plan submitted by the facility and approved by the department. The intent of the program is also that counties use all existing services for providing care under this section, including those services currently provided by counties.

SB322-AA1, s. 5 Section 5. 46.277 (1m) (a) of the statutes is renumbered 46.277 (1m) (ak).

SB322-AA1, s. 6 Section 6. 46.277 (1m) (ag) of the statutes is created to read:

SB322-AA1,5,2 46.277 (1m) (ag) "Delicensed" means deducted from the number of beds stated on a facility's license, as specified under s. 50.03 (4) (e).

SB322-AA1, s. 7 Section 7. 46.277 (2) (intro.) of the statutes is amended to read:

SB322-AA1,5,16 46.277 (2) Departmental powers and duties. (intro.) The department may request a waiver from the secretary of the federal department of health and human services, under 42 USC 1396n (c), authorizing the department to serve medical assistance recipients, who meet the level of care requirements for medical assistance reimbursement in a skilled nursing facility or an intermediate care facility, in their communities by providing home or community-based services as part of medical assistance. The Except under sub. (4) (c), the number of persons for whom the waiver is requested may not exceed the number of nursing home beds that are delicensed as part of a plan submitted by the facility and approved by the department. If the department requests a waiver, it shall include all assurances required under 42 USC 1396n (c) (2) in its request. If the department receives this waiver, it may request one or more 3-year extensions of the waiver under 42 USC 1396n (c) and shall perform the following duties:

SB322-AA1, s. 8 Section 8. 46.277 (3) (a) of the statutes is amended to read:

SB322-AA1,6,2 46.277 (3) (a) Sections 46.27 (3) (b) and 46.275 (3) (a) and (c) to (e) apply to county participation in this program, except that services provided in the program shall substitute for care provided a person in a skilled nursing facility or intermediate care facility who meets the level of care requirements for medical assistance reimbursement to that facility rather than for care provided at a state center for the developmentally disabled. The Except in sub. (4) (c), the number of persons who receive services provided by the program under this paragraph may not exceed the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.

SB322-AA1, s. 9 Section 9. 46.277 (3) (b) 1. of the statutes is amended to read:

SB322-AA1,6,7 46.277 (3) (b) 1. If Except under sub. (4) (c), if the provision of services under this section results in a decrease in the statewide nursing home bed limit under s. 150.31 (3), the facility affected by the decrease shall submit a plan for delicensing all or part of the facility that is approved by the department.

SB322-AA1, s. 10 Section 10. 46.277 (3) (b) 2. of the statutes is amended to read:

SB322-AA1,6,14 46.277 (3) (b) 2. Each county department participating in the program shall provide home or community-based care to persons eligible under this section, except that the number of persons who receive home or community-based care under this section may not exceed, other than under sub. (4) (c), the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.

SB322-AA1, s. 11 Section 11. 46.277 (4) (a) of the statutes is amended to read:

SB322-AA1,6,24 46.277 (4) (a) Any medical assistance recipient who meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or intermediate care facility is eligible to participate in the program, except that the number of participants may not exceed, other than under par. (c), the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department. Such a recipient may apply, or any person may apply on behalf of such a recipient, for participation in the program. Section 46.275 (4) (b) applies to participation in the program.

SB322-AA1, s. 12 Section 12. 46.277 (4) (b) of the statutes is amended to read:

SB322-AA1,7,8 46.277 (4) (b) To the extent authorized under 42 USC 1396n and except under par. (c), if a person discontinues participation in the program, a medical assistance recipient may participate in the program in place of the participant who discontinues if that recipient meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or intermediate care facility, except that the number of participants may not exceed the number of nursing home beds, other than beds specified in sub. (5g) (b), that are delicensed as part of a plan submitted by the facility and approved by the department.

SB322-AA1, s. 13 Section 13. 46.277 (4) (c) of the statutes is created to read:

SB322-AA1,7,20 46.277 (4) (c) The department may, under this paragraph, provide funding under this section for services for a medical assistance recipient who relocates from a facility to the community, beginning on the date of the relocation and ending on the date that the individual discontinues participation in the program or no longer meets the level of care requirements for medical assistance reimbursement in a skilled nursing facility or an intermediate care facility. Funding for medical assistance costs for individuals relocated under this paragraph may not exceed, in the aggregate, total medical assistance costs for the individuals if served in facilities. The total number of individuals who may participate in the program under this paragraph is not restricted by any otherwise applicable limitation on the number of individuals who may participate in the program under this section.

SB322-AA1, s. 14 Section 14. 46.277 (5) (g) of the statutes, as created by 2003 Wisconsin Act 33, is amended to read:

SB322-AA1,8,3 46.277 (5) (g) The department may provide enhanced reimbursement for services provided under this section to an individual who is relocated to the community from a nursing home by a county department on or after July 26, 2003, if the nursing home bed that was used by the individual is delicensed upon relocation of the individual or if the individual is relocated under sub. (4) (c). The department shall develop and utilize a formula to determine the enhanced reimbursement rate.

SB322-AA1, s. 15 Section 15. 46.277 (5g) (a) of the statutes is amended to read:

SB322-AA1,8,8 46.277 (5g) (a) The Except under sub. (4) (c), the number of persons served under this section may not exceed the number of nursing home beds that are delicensed as part of a plan submitted by the facility and approved by the department.

SB322-AA1, s. 16 Section 16. 49.45 (6ur) of the statutes is created to read:

SB322-AA1,8,16 49.45 (6ur) Physician order entry record system; incentive payments. From the appropriation accounts under s. 20.435 (4) (b) and (o), the department shall annually make an incentive payment to each hospital that establishes, by January 1, 2007, and thereafter continues to maintain a physician order entry record system for provided medical services that, at a minimum, include pharmacy, laboratory, ultrasonography, and radiology services. The incentive payment shall equal 1% of the Medical Assistance reimbursement to the hospital for the previous fiscal year.

SB322-AA1, s. 17 Section 17. 49.45 (6v) of the statutes is renumbered 49.45 (6L).

SB322-AA1, s. 18 Section 18. 49.45 (53) of the statutes is created to read:

SB322-AA1,8,21 49.45 (53) Fiscal intermediary; dental forms. The department's fiscal intermediary shall maintain a separate unit for the processing of claims for dental services received under this section.

SB322-AA1, s. 19 Section 19. 49.46 (1) (a) 1. of the statutes is amended to read:

SB322-AA1,8,25 49.46 (1) (a) 1. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources and subject to par. (ar), would qualify for a grant of aid to families with dependent children under s. 49.19.

SB322-AA1, s. 20 Section 20. 49.46 (1) (a) 1g. of the statutes is amended to read:

SB322-AA1,9,5 49.46 (1) (a) 1g. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources and subject to par. (ar), 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.

SB322-AA1, s. 21 Section 21. 49.46 (1) (a) 1m. of the statutes is amended to read:

SB322-AA1,9,10 49.46 (1) (a) 1m. Any pregnant woman whose income, determined in accordance with par. (ar), does not exceed the standard of need under s. 49.19 (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.

SB322-AA1, s. 22 Section 22. 49.46 (1) (a) 6. of the statutes is amended to read:

SB322-AA1,9,15 49.46 (1) (a) 6. Any person not described in pars. (c) to (e) who, without regard to the individual's resources and subject to par. (ar), would be considered, under federal law, to be receiving aid to families with dependent children for the purpose of determining eligibility for medical assistance.

SB322-AA1, s. 23 Section 23. 49.46 (1) (a) 9. of the statutes is amended to read:

SB322-AA1,9,19 49.46 (1) (a) 9. Any pregnant woman not described under subd. 1., 1g., or 1m. whose family income, determined in accordance with par. (ar), does not exceed 133% of the poverty line for a family the size of the woman's family.

SB322-AA1, s. 24 Section 24. 49.46 (1) (a) 10. of the statutes is amended to read:

SB322-AA1,9,23 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, determined in accordance with par. (ar), does not exceed 133% of the poverty line for a family the size of the child's family.

SB322-AA1, s. 25 Section 25. 49.46 (1) (a) 11. of the statutes is amended to read:

SB322-AA1,10,9 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, determined in accordance with par. (ar), 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, determined in accordance with par. (ar), does not exceed 100% of the poverty line for a family the size of the child's family.

SB322-AA1, s. 26 Section 26. 49.46 (1) (a) 12. of the statutes is amended to read:

SB322-AA1,10,13 49.46 (1) (a) 12. Any child not described under subd. 1. or 1g. who is under 19 years of age and whose income, determined in accordance with par. (ar), does not exceed the standard of need under s. 49.19 (11).

SB322-AA1, s. 27 Section 27 . 49.46 (1) (ar) of the statutes is created to read:

SB322-AA1,10,24 49.46 (1) (ar) 1. Except as provided in subd. 2. and except to the extent that the determination is inconsistent with 42 USC 1396a (a) (17), for purposes of determining under par. (a) 1., 1g., or 6. whether an individual would qualify for a grant of aid to families with dependent children under s. 49.19 or would be considered, under federal law, to be receiving aid to families with dependent children, or of determining whether an individual meets the income limits under par. (a) 1m., 9., 10., 11., or 12., "income" includes income that would be included in determining eligibility for aid to families with dependent children under s. 49.19 and excludes income that would be excluded in determining eligibility for aid to families with dependent children under s. 49.19.

SB322-AA1,11,7 2. Notwithstanding s. 49.19 (5), for purposes of determining under par. (a) 1., 1g., or 6. whether an individual would qualify for a grant of aid to families with dependent children under s. 49.19 or would be considered, under federal law, to be receiving aid to families with dependent children, or of determining whether an individual meets the income limits under par. (a) 1m., 9., 10., 11., or 12., (am), or (e), the department shall exclude from the calculation of farm or self-employment income any amounts claimed for depreciation for income tax purposes.

SB322-AA1, s. 28 Section 28. 49.46 (1) (e) of the statutes is amended to read:

SB322-AA1,11,15 49.46 (1) (e) If an application under s. 49.47 (3) shows that the individual individual's income, determined in accordance with par. (ar), meets the income limits under s. 49.19, or that the individual 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.

SB322-AA1, s. 29 Section 29. 49.46 (1) (L) of the statutes is repealed.

SB322-AA1, s. 30 Section 30. 49.47 (4) (am) 1. of the statutes is amended to read:

SB322-AA1,11,23 49.47 (4) (am) 1. A pregnant woman whose family income , determined in accordance with par. (cg), does not exceed 155% of the poverty line for a family the size of the woman's family, except that, if a waiver under par. (j) or a change in the approved state plan under s. 49.46 (1) (am) 2. is in effect, the income limit is 185% of the poverty line for a family the size of the woman's family in each state fiscal year after the 1994-95 state fiscal year.

SB322-AA1, s. 31 Section 31. 49.47 (4) (am) 2. of the statutes is amended to read:

SB322-AA1,12,6 49.47 (4) (am) 2. A child who is under 6 years of age and whose family income, determined in accordance with par. (cg), does not exceed 155% of the poverty line for a family the size of the child's family, except that, if a waiver under par. (j) or a change in the approved state plan under s. 49.46 (1) (am) 2. is in effect, the income limit is 185% of the poverty line for a family the size of the child's family in each state fiscal year after the 1994-95 state fiscal year.

SB322-AA1, s. 32 Section 32. 49.47 (4) (c) 1. of the statutes is amended to read:

SB322-AA1,12,13 49.47 (4) (c) 1. Except as provided in par. (am) and as limited by subd. 3., eligibility exists if income, determined in accordance with par. (cg), does not exceed 133 1/3% of the maximum aid to families with dependent children payment under s. 49.19 (11) for the applicant's family size or 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

SB322-AA1,12,21 (cg) 1. Except as provided in subd. 3., for purposes of determining whether an individual's income meets the income requirements under par. (c), "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 and excludes earned or unearned income which 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.

SB322-AA1, s. 33 Section 33. 49.47 (4) (c) 3. of the statutes is amended to read:

SB322-AA1,13,2 49.47 (4) (c) 3. Except as provided in par. (am), no person is eligible for medical assistance under this section if the person's income, determined in accordance with par. (cg), exceeds the maximum income levels that the U.S. department of health and human services sets for federal financial participation under 42 USC 1396b (f).