SB44-SSA1,530,87
49.45
(6t) (b) If 2003 Wisconsin Act .... (this act), section 9124 (8) (a) applies,
8this subsection does not apply.
SB44-SSA1,530,1410
49.45
(6tt) Distributions to county departments and local health
11departments. From the appropriation under s. 20.435 (4) (w), the department may
12in each fiscal year distribute moneys to county departments under s. 46.215, 46.22,
1346.23, or 51.42 or to local health departments, as defined in s. 250.01 (4), under a plan
14developed by the department.
SB44-SSA1, s. 1363
15Section
1363. 49.45 (6u) (am) (intro.) of the statutes is amended to read:
SB44-SSA1,531,216
49.45
(6u) (am) (intro.) Notwithstanding sub. (6m),
in state fiscal years in
17which less than $1 in federal financial participation relating to facilities is received
18under 42 CFR 433.51, from the appropriations under s. 20.435 (4) (o), (w), and (wm),
19for reduction of operating deficits, as defined under the methodology used by the
20department in December
, 2000, incurred by a facility that is established under s.
2149.70 (1) or that is owned and operated by a city, village, or town,
and as payment
22to care management organizations, the department may not distribute to these
23facilities
and to care management organizations more than $37,100,000 in each
24fiscal year, as determined by the department. The total amount that a county
25certifies under this subsection may not exceed 100% of otherwise-unreimbursed
1care. In distributing funds under this subsection, the department shall perform all
2of the following:
SB44-SSA1,531,105
49.45
(6v) (b) The department shall, each year, submit to the joint committee
6on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that
7provides information on the utilization of beds by recipients of medical assistance in
8facilities and a discussion and detailed projection of the likely balances,
9expenditures, encumbrances and carry over of currently appropriated amounts in
10the appropriation accounts under s. 20.435 (4) (b)
, (gp), and (o).
SB44-SSA1,531,1712
49.45
(6x) (a) Notwithstanding sub. (3) (e), from the
appropriations 13appropriation accounts under s. 20.435 (4) (b),
(gp), (o), and (w), the department shall
14distribute not more than $4,748,000 in each fiscal year, to provide funds to an
15essential access city hospital, except that the department may not allocate funds to
16an essential access city hospital to the extent that the allocation would exceed any
17limitation under
42 USC 1396b (i) (3).
SB44-SSA1,532,319
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the
appropriations 20appropriation accounts under s. 20.435 (4) (b),
(gp), (o), and (w), the department shall
21distribute funding in each fiscal year to provide supplemental payment to hospitals
22that enter into a contract under s. 49.02 (2) to provide health care services funded
23by a relief block grant, as determined by the department, for hospital services that
24are not in excess of the hospitals' customary charges for the services, as limited under
2542 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the
1allocation of funds to such hospitals would exceed any limitation under
42 USC
21396b (i) (3), the department may distribute funds to hospitals that have not entered
3into a contract under s. 49.02 (2).
SB44-SSA1,532,125
49.45
(6y) (am) Notwithstanding sub. (3) (e), from the
appropriations 6appropriation accounts under s. 20.435 (4) (b), (h),
(gp), (o), and (w), the department
7shall distribute funding in each fiscal year to provide supplemental payments to
8hospitals that enter into contracts under s. 49.02 (2) with a county having a
9population of 500,000 or more to provide health care services funded by a relief block
10grant, as determined by the department, for hospital services that are not in excess
11of the hospitals' customary charges for the services, as limited under
42 USC 1396b 12(i) (3).
SB44-SSA1, s. 1369
13Section
1369. 49.45 (6z) (a) (intro.) of the statutes is amended to read:
SB44-SSA1,532,2414
49.45
(6z) (a) (intro.) Notwithstanding sub. (3) (e), from the
appropriations 15appropriation accounts under s. 20.435 (4) (b),
(gp), (o), and (w), the department shall
16distribute funding in each fiscal year to supplement payment for services to hospitals
17that enter into a contract under s. 49.02 (2) to provide health care services funded
18by a relief block grant under this chapter, if the department determines that the
19hospitals serve a disproportionate number of low-income patients with special
20needs. If no medical relief block grant under this chapter is awarded or if the
21allocation of funds to such hospitals would exceed any limitation under
42 USC
221396b (i) (3), the department may distribute funds to hospitals that have not entered
23into a contract under s. 49.02 (2). The department may not distribute funds under
24this subsection to the extent that the distribution would do any of the following:
SB44-SSA1,533,5
149.45
(8) (b) Reimbursement under s. 20.435 (4) (b),
(gp), (o), and (w) for home
2health services provided by a certified home health agency or independent nurse
3shall be made at the home health agency's or nurse's usual and customary fee per
4patient care visit, subject to a maximum allowable fee per patient care visit that is
5established under par. (c).
SB44-SSA1, s. 1373
6Section
1373. 49.45 (18) (intro.) of the statutes is renumbered 49.45 (18) (ac)
7and amended to read:
SB44-SSA1,533,198
49.45
(18) (ac) Except as provided in pars.
(a) (am) to (d),
and subject to par.
9(ag), any person eligible for medical assistance under s. 49.46, 49.468
, or 49.47 shall
10pay up to the maximum amounts allowable under
42 CFR 447.53 to
447.58 for
11purchases of services provided under s. 49.46 (2). The service provider shall collect
12the
specified or allowable copayment, coinsurance
, or deductible, unless the service
13provider determines that the cost of collecting the copayment, coinsurance
, or
14deductible exceeds the amount to be collected. The department shall reduce
15payments to each provider by the amount of the
specified or allowable copayment,
16coinsurance
, or deductible. No provider may deny care or services because the
17recipient is unable to share costs, but an inability to share costs specified in this
18subsection does not relieve the recipient of liability for these costs.
Liability under
19this subsection is limited by the following provisions:
SB44-SSA1, s. 1374
20Section
1374. 49.45 (18) (a) of the statutes is renumbered 49.45 (18) (am).
SB44-SSA1,533,2322
49.45
(18) (ag) Except as provided in pars. (am), (b), and (c), and subject to par.
23(d), a recipient specified in par. (ac) shall pay all of the following:
SB44-SSA1,533,2524
1. A copayment of $1 for each prescription of a drug that bears only a generic
25name, as defined in s. 450.12 (1) (b).
SB44-SSA1,534,2
12. A copayment of $3 for each prescription of a drug that bears a brand name,
2as defined in s. 450.12 (1) (a).
SB44-SSA1,534,74
49.45
(18) (d) No person who designates a pharmacy or pharmacist as his or
5her sole provider of prescription drugs and who so uses that pharmacy or pharmacist
6is liable under this subsection for more than
$5
$12 per month for prescription drugs
7received.
SB44-SSA1,534,119
49.45
(19) (bm) The
department or the county department under s. 46.215 or
1046.22 shall notify applicants of the requirements of this subsection at the time of
11application.
SB44-SSA1, s. 1378
12Section
1378. 49.45 (24m) (intro.) of the statutes is amended to read:
SB44-SSA1,534,1713
49.45
(24m) Home health care and personal care pilot program. (intro.)
14From the
appropriations appropriation accounts under s. 20.435 (4) (b),
(gp), (o), and
15(w), in order to test the feasibility of instituting a system of reimbursement for
16providers of home health care and personal care services for medical assistance
17recipients that is based on competitive bidding, the department shall:
SB44-SSA1, s. 1379
18Section
1379. 49.45 (25) (am) (intro.) of the statutes is amended to read:
SB44-SSA1,534,2519
49.45
(25) (am) (intro.) Except as provided under pars. (be)
and, (bg)
, and (bj) 20and sub. (24), case management services under s. 49.46 (2) (b) 9. and (bm) are
21reimbursable under
medical assistance Medical Assistance only if provided to a
22medical assistance Medical Assistance beneficiary who receives case management
23services from or through a certified case management provider in a county, city,
24village
, or town that elects, under par. (b), to make the services available and who
25meets at least one of the following conditions:
SB44-SSA1,535,92
49.45
(25) (bj) The department of corrections may elect to provide case
3management services under this subsection to persons who are under the
4supervision of that department under s. 938.183, 938.34 (4h), (4m), or (4n), or
5938.357 (4), who are Medical Assistance beneficiaries, and who meet one or more of
6the conditions specified in par. (am). The amount of the allowable charges for those
7services under the Medical Assistance program that is not provided by the federal
8government shall be paid from the appropriation account under s. 20.410 (3) (hm),
9(ho), or (hr).
SB44-SSA1,535,1511
49.45
(25) (c) Except as provided in pars. (b), (be)
and, (bg),
and (bj), the
12department shall reimburse a provider of case management services under this
13subsection only for the amount of the allowable charges for those services under the
14medical assistance Medical Assistance program that is provided by the federal
15government.
SB44-SSA1,535,1817
49.45
(30e) (a) 5. Any other condition required by rule under par. (b) 4. is
18satisfied.
SB44-SSA1,535,2120
49.45
(30e) (b) 4. Any other conditions for coverage of community-based
21psychosocial services under the Medical Assistance Program.
SB44-SSA1, s. 1383
22Section
1383. 49.45 (30m) of the statutes is renumbered 49.45 (30m) (a)
23(intro.) and amended to read:
SB44-SSA1,536,324
49.45
(30m) (a) (intro.)
Except as provided in par. (am), a county shall provide
25the portion of
the payment that is not provided by the federal government for all of
1the following services
under s. 51.06 (1m) (d) to individuals
with developmental
2disability who are eligible for medical assistance
that is not provided by the federal
3government.:
SB44-SSA1,536,55
49.45
(30m) (a) 1. Services under s. 51.06 (1m) (d).
SB44-SSA1,536,97
49.45
(30m) (a) 2. Services in an intermediate care facility for the mentally
8retarded, as defined in s. 46.278 (1m) (am), other than a state center for the
9developmentally disabled.
SB44-SSA1,536,1211
49.45
(30m) (a) 3. Services for which payment is permitted under sub. (6c) (d)
122. that are provided in a nursing facility, as defined in s. 46.279 (1) (c).
SB44-SSA1,536,1814
49.45
(30m) (am) The department shall provide the portion of the payment that
15is not provided by the federal government for any of the services specified in par. (a)
161. to 3. that are provided to an individual with developmental disability who is
17eligible for medical assistance, as determined under the contract under s. 46.279
18(4m).
SB44-SSA1,536,2320
49.45
(30m) (b) No payment under this section may be made for services
21specified under par. (a) or (am) unless the individual who receives the services is
22protectively placed under s. 55.06 (9) (a) or is placed under an emergency placement
23under s. 55.06 (11) (a) or a temporary placement under s. 55.06 (11) (c).
SB44-SSA1,537,4
149.45
(30m) (c) No payment under this section may be made for services
2specified under par. (a) 2. or 3. that are provided to an individual who was placed in
3or admitted to an intermediate facility, as defined in s. 46.279 (1) (b), or nursing
4facility, as defined in s. 46.279 (1) (c), unless one of the following applies:
SB44-SSA1,537,65
1. Any placement or admission that is made after April 30, 2005, complied with
6the requirements of s. 46.279.
SB44-SSA1,537,97
2. For an individual who was protectively placed under ch. 55 at any time, any
8annual review that is conducted under s. 55.06 (10) (a) 1. after April 30, 2005,
9complies with the requirements of s. 55.06 (10) (a) 2.
SB44-SSA1,537,1411
49.45
(36) Homeless beneficiaries. A The department or a county department
12under s. 46.215, 46.22
, or 46.23 may not place the word "homeless" on the medical
13assistance identification card of any person who is determined to be eligible for
14medical assistance benefits and who is homeless.
SB44-SSA1,538,2316
49.45
(39) (b) 1. `Payment for school medical services.' If a school district or a
17cooperative educational service agency elects to provide school medical services and
18meets all requirements under par. (c), the department shall reimburse the school
19district or the cooperative educational service agency for 60% of the federal share of
20allowable charges for the school medical services that it provides and, as specified
21in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind
22and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
23and Hard of Hearing elects to provide school medical services and meets all
24requirements under par. (c), the department shall reimburse the department of
25public instruction for 60% of the federal share of allowable charges for the school
1medical services that the Wisconsin Center for the Blind and Visually Impaired or
2the Wisconsin Educational Services Program for the Deaf and Hard of Hearing
3provides and, as specified in subd. 2., for allowable administrative costs. A school
4district, cooperative educational service agency, the Wisconsin Center for the Blind
5and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
6and Hard of Hearing may submit, and the department shall allow, claims for common
7carrier transportation costs as a school medical service unless the department
8receives notice from the federal health care financing administration that, under a
9change in federal policy, the claims are not allowed. If the department receives the
10notice, a school district, cooperative educational service agency, the Wisconsin
11Center for the Blind and Visually Impaired, or the Wisconsin Educational Services
12Program for the Deaf and Hard of Hearing may submit, and the department shall
13allow, unreimbursed claims for common carrier transportation costs incurred before
14the date of the change in federal policy. The department shall promulgate rules
15establishing a methodology for making reimbursements under this paragraph.
All 16Except as provided in subd. 1m., all other expenses for the school medical services
17provided by a school district or a cooperative educational service agency shall be paid
18for by the school district or the cooperative educational service agency with funds
19received from state or local taxes. The school district, the Wisconsin Center for the
20Blind and Visually Impaired, the Wisconsin Educational Services Program for the
21Deaf and Hard of Hearing, or the cooperative educational service agency shall
22comply with all requirements of the federal department of health and human
23services for receiving federal financial participation.
SB44-SSA1,539,7
149.45
(39) (b) 1m. `Supplementary payment for school medical services.' In
2addition to the reimbursement the department provides under subd. 1. to a school
3district or cooperative educational service agency for school medical services, the
4department may make supplementary payments from the appropriation accounts
5under s. 20.435 (4) (b) and (o). The total of the supplementary payments and
6allowable charges paid under subd. 1. may not exceed applicable limitations on
7payments under
42 USC 1396a (a) (30) (A).
SB44-SSA1,539,189
49.45
(39) (b) 2. `Payment for school medical services administrative costs.' The
10department shall reimburse a school district or a cooperative educational service
11agency specified under
subd. 1. subds. 1. and 1m. and shall reimburse the
12department of public instruction on behalf of the Wisconsin Center for the Blind and
13Visually Impaired or the Wisconsin Educational Services Program for the Deaf and
14Hard of Hearing for 90% of the federal share of allowable administrative costs, using
15time studies, beginning in fiscal year 1999-2000. A school district or a cooperative
16educational service agency may submit, and the department of health and family
17services shall allow, claims for administrative costs incurred during the period that
18is up to 24 months before the date of the claim, if allowable under federal law.
SB44-SSA1, s. 1392p
19Section 1392p. 49.45 (49) (a) (intro.) of the statutes is renumbered 49.45 (49)
20(bm) and amended to read:
SB44-SSA1,540,221
49.45
(49) (bm) The secretary shall exercise his or her authority under s. 15.04
22(1) (c) to create a prescription drug prior authorization
and therapeutics committee
23to advise the department on issues related to prior authorization decisions made
24concerning prescription drugs on behalf of medical assistance recipients
. The
25secretary shall appoint as members at least all of the following:
and to advise the
1department on the research, development, and approval of any preferred drug list
2for the Medical Assistance program or the program under s. 49.665 or 49.668.
SB44-SSA1, s. 1392r
4Section 1392r. 49.45 (49) (a) 2. and 3. of the statutes are renumbered 49.45
5(49) (c) 6. and 7.
SB44-SSA1,540,77
49.45
(49) (ag) In this subsection:
SB44-SSA1,540,118
1. "Labeler" means a person who receives prescription drugs from a
9manufacturer or wholesaler and repackages those drugs for later retail sale, and has
10a labeler code issued by the federal food and drug administration under
21 CFR
11207.20 (b).
SB44-SSA1,540,1412
2. "Manufacturer" means a person who is engaged in the production,
13preparation, propagation, compounding, conversion, or processing of prescription
14drugs.
SB44-SSA1,540,1515
3. "Physician" has the meaning given in s. 448.01 (5).
SB44-SSA1, s. 1392s
16Section 1392s. 49.45 (49) (b) of the statutes is renumbered 49.45 (49) (g) and
17amended to read:
SB44-SSA1,540,2118
49.45
(49) (g) The prescription drug prior authorization
and therapeutics 19committee shall accept information or commentary from representatives of the
20pharmaceutical manufacturing industry in the committee's review of prior
21authorization policies.
SB44-SSA1, s. 1392t
22Section 1392t. 49.45 (49) (c), (d), (e), (f), (h) and (i) of the statutes are created
23to read:
SB44-SSA1,540,2524
49.45
(49) (c) The secretary shall appoint as members of the prescription drug
25prior authorization and therapeutics committee at least all of the following: