(End)
LRB-0029LRB-0029/2
PJK:cjs&wlj:pg
2003 - 2004 LEGISLATURE
DOA:......Blaine - BB0001 Make eligibility for HIPP a qualifying event for immediate health insurance enrollment
For 2003-05 Budget -- Not Ready For Introduction
2003 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
Health and human services
Medical Assistance
Under current law, DHFS administers both the Badger Care health care (BadgerCare) program and the Medical Assistance (MA) program. Generally, both programs provide health care benefits to low-income persons. If a person who is eligible for the BadgerCare program or the purchase plan portion of the MA program is also eligible for health care coverage that is offered by an employer, DHFS may purchase the employer-offered health care coverage on behalf of the person if DHFS determines that purchasing the coverage will not cost more than providing the coverage under the BadgerCare or MA program for which the person is eligible.
Also under current law, if an employer offers health care coverage to its employees, certain specified situations require the insurer that provides the coverage to allow an employee, or an employee's dependent, to enroll in the health care coverage plan at times outside of the usual enrollment periods. For example, if an employee refused coverage under the employer's health care coverage plan during a previous enrollment period because the employee had other health care coverage, the employee may enroll in the employer's plan within 30 days after the other health care coverage terminates or is exhausted. Likewise, if an employee gets married or adopts a child, the employee's spouse or child may enroll in the employer's health care coverage plan during a special enrollment period that lasts for 30 days from the date of the marriage or adoption.
This bill requires an insurer that provides coverage under an employer's health care coverage plan to permit an employee, or an employee's dependent, who is eligible for but not enrolled in the employer's health care coverage plan to enroll in the employer's plan during a special, 30-day enrollment period if: 1) the employee or dependent is eligible for coverage under the BadgerCare or MA program; and 2) DHFS will purchase the coverage on behalf of the employee or dependent because DHFS has determined that it will not be more costly to pay the portion of the premium for which the employee is responsible under the employer's plan than to provide coverage for the employee or dependent under the BadgerCare or MA program. The 30-day enrollment period begins on the date on which DHFS makes the determination about the cost of the coverage.
Also under the bill, if DHFS determines that a waiver is required, DHFS is required to request a waiver from the federal Department of Health and Human Services to allow DHFS to require a family, as a condition of eligibility for the BadgerCare program, to provide a verification from the employer of any family member who is employed. The employer verification would include the following information: 1) the family member's earnings; 2) whether the employer provides health care coverage for which the family is eligible; and 3) the amount that the employer pays, if any, towards the cost of the health care coverage. Under current law, a family with income below 185% of the poverty line is eligible for the BadgerCare program if the family does not have access to employer-provided health care coverage for which the employer pays at least 80% of the cost. DHFS may implement the employer verification requirement beginning on January 1, 2004, if no waiver is needed. If a waiver is needed, however, DHFS may implement the employer verification requirement only if the waiver is granted.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 49.665 (2) (title) of the statutes is amended to read:
49.665 (2) (title) WAIVER WAIVERS.
SECTION 2. 49.665 (2) of the statutes is renumbered 49.665 (2) (a) and amended to read:
49.665 (2) (a) The department of health and family services shall request a waiver from the secretary of the federal department of health and human services to permit the department of health and family services to implement, beginning not later than July 1, 1998, or the effective date of the waiver, whichever is later, a health care program under this section. If a waiver that is consistent with all of the provisions of this section, excluding sub. (4) (a) 3m., is granted and in effect, the department of health and family services shall implement the program under this section. The department of health and family services may not implement the program under this section unless a waiver that is consistent with all of the provisions of this section, excluding sub. (4) (a) 3m., is granted and in effect.
SECTION 3. 49.665 (2) (b) of the statutes is created to read:
49.665 (2) (b) If the department of health and family services determines that it needs a waiver to require the verification specified in sub. (4) (a) 3m., the department shall request a waiver from the secretary of the federal department of health and human services and may not implement the verification requirement under sub. (4) (a) 3m. unless the waiver is granted. If a waiver is required and is granted, the department of health and family services may implement the verification requirement under sub. (4) (a) 3m. as appropriate. If a waiver is not required, the department of health and family services may require the verification specified in sub. (4) (a) 3m. for eligibility determinations and annual review eligibility determinations made by the department, beginning on January 1, 2004.
SECTION 4. 49.665 (4) (am) 3m. of the statutes is created to read:
49.665 (4) (am) 3m. Each member of the child's household who is employed provides verification from his or her employer, in the manner specified by the department, of his or her earnings, of whether the employer provides health care coverage for which the child is eligible, and of the amount that the employer pays, if any, towards the cost of the health care coverage, excluding any deductibles or copayments required under the coverage.
SECTION 5. 632.746 (7m) of the statutes is created to read:
632.746 (7m) (a) In this subsection, "terms of the group health benefit plan" does not include any requirements under the group health benefit plan related to enrollment periods or waiting periods.
(b) An insurer offering a group health benefit plan shall permit, as provided in par. (c), an employee who is not enrolled but who is eligible for coverage under the terms of the group health benefit plan, or a participant's or employee's dependent who is not enrolled but who is eligible for coverage under the terms of the group health benefit plan, to enroll for coverage under the terms of the plan if all of the following apply:
1. The employee or dependent is eligible for benefits under the Medical Assistance program under s. 49.472 or for coverage under the Badger Care health care program under s. 49.665.
2. The department of health and family services will purchase coverage under the group health benefit plan on behalf of the employee or dependent because the department of health and family services has determined that paying the portion of the premium for which the employee is responsible will not be more costly than providing the medical assistance or the coverage under the Badger Care health care program, whichever is applicable.
(c) An insurer permitting an employee or dependent to enroll under this subsection shall provide for an enrollment period of not less than 30 days, beginning on the date on which the department of health and family services makes the determination under par. (b) 2.
SECTION 9324. Initial applicability; health and family services.
(1) SPECIAL ENROLLMENT PERIOD. The treatment of section 632.746 (7m) of the statutes first applies with respect to determinations of the department of health and family services to purchase coverage under employer-sponsored health care plans that are made on the effective date of this subsection.
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LRB-0030LRB-0030/1
PJK:kmg&jld:rs
2003 - 2004 LEGISLATURE
DOA:...... Blaine - BB0002 Eliminate comprehensive community services as an MA benefit
For 2003-05 Budget -- Not Ready For Introduction
2003 BILL
AN ACT ...; relating to: benefits under the medical assistance program.
Analysis by the Legislative Reference Bureau
Health and human services
Medical assistance
Under current law, DHFS administers the medical assistance (MA) program under which eligible individuals receive health care services. Mental health and psychological rehabilitative services provided by a community support program to individuals with mental illness who live in the community is a covered benefit under the MA program. The county pays all costs for the services that are not paid by the federal government. Also covered, but only if a county elects to offer the services as a benefit, are psychosocial services provided by a community-based psychosocial service program to individuals with less severe mental illness who live in the community. A county that elects to provide the services as a benefit must pay all costs not paid by the federal government.
This bill eliminates psychosocial services provided by a community-based psychosocial service program as a possible benefit under the MA program.
For further information see the local fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
****NOTE: This is reconciled s. 49.45 (6t) (intro.). It was removed and its treatment added to LRB-1611. This section is affected by LRB-0030 and LRB-1611.
****NOTE: This is reconciled s. 49.45 (6t) (a). It was removed and its treatment added to LRB-1611. This section is affected by LRB-0030 and LRB-1611.
SECTION 1. 49.45 (30e) of the statutes is repealed.
SECTION 2. 49.46 (2) (b) 6. Lm. of the statutes is repealed.
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LRB-0032LRB-0032/P2
PJK:kmg:jf
2003 - 2004 LEGISLATURE
DOA:......Jablonsky - BB0004 Various cost control provisions for chronic disease aids program
For 2003-05 Budget -- Not Ready For Introduction
2003 BILL
AN ACT ...; relating to: changes to the chronic disease aids program, granting rule-making authority, and providing an exemption from emergency rule procedures.
Analysis by the Legislative Reference Bureau
Health and human services
Public assistance
Under current law, DHFS provides financial assistance for the cost of medical care for the treatment of chronic kidney disease, cystic fibrosis, and hemophilia to persons with those conditions. This assistance is collectively referred to as the chronic disease aids program. This bill makes three changes to the chronic disease aids program for cost control purposes. The bill authorizes DHFS to use managed care methods of cost containment for the chronic disease aids program. The bill eliminates the requirement that the rates paid by DHFS for services provided for the treatment of chronic kidney disease be equal to the allowable charges under the federal Medicare program and prohibits a provider of a service for the treatment of chronic kidney disease from billing a patient for any difference between the amount the state pays under the chronic disease aids program and the provider's charge for the service. Finally, the bill provides that a person may not receive benefits under the chronic disease aids program unless, before applying for benefits under that program, the person applies for benefits under other health care coverage programs for which he or she reasonably may be eligible. DHFS must promulgate rules specifying other health care coverage programs for which a person must apply, including the Medical Assistance program, the Badger Care health care program, and the prescription drug assistance for elderly persons program.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 49.68 (3) (a) of the statutes is amended to read:
49.68 (3) (a) Any Subject to s. 49.687 (1m), any permanent resident of this state who suffers from chronic renal disease may be accepted into the dialysis treatment phase of the renal disease control program if the resident meets standards set by rule under sub. (2) and s. 49.687.
SECTION 2. 49.68 (3) (d) 1. of the statutes is amended to read:
49.68 (3) (d) 1. No aid may be granted under this subsection unless the recipient has no other form of aid available from the federal medicare program or, from private health, accident, sickness, medical, and hospital insurance coverage, or from other health care coverage specified by rule under s. 49.687 (1m) (b). If insufficient aid is available from other sources and if the recipient has paid an amount equal to the annual medicare deductible amount specified in subd. 2., the state shall pay the difference in cost to a qualified recipient. If at any time sufficient federal or private insurance aid or other health care coverage becomes available during the treatment period, state aid under this subsection shall be terminated or appropriately reduced. Any patient who is eligible for the federal medicare program shall register and pay the premium for medicare medical insurance coverage where permitted, and shall pay an amount equal to the annual medicare deductible amounts required under 42 USC 1395e and 1395L (b), prior to becoming eligible for state aid under this subsection.
SECTION 3. 49.68 (3) (d) 3. of the statutes is created to read:
49.68 (3) (d) 3. No payment shall be made under this subsection for any portion of medical treatment costs or other expenses that are payable under any state, federal, or other health care coverage program, including a health care coverage program specified by rule under s. 49.687 (1m) (b), or under any grant, contract, or other contractual arrangement.
SECTION 4. 49.68 (3) (e) of the statutes is amended to read:
49.68 (3) (e) State aids for services provided under this section shall be equal to may not exceed the allowable charges under the federal medicare program. In no case shall state rates for individual service elements exceed the federally defined allowable costs. The rate of charges for services not covered by public and private insurance shall not exceed the reasonable charges as established by medicare fee determination procedures. A person that provides to a patient a service for which aid is provided under this section shall accept the amount paid under this section for the service as payment in full and may not bill the patient for any amount by which the charge for the service exceeds the amount paid for the service under this section. The state may not pay for the cost of travel, lodging, or meals for persons who must travel to receive inpatient and outpatient dialysis treatment for kidney disease. This paragraph shall not apply to donor related costs as defined in par. (b).
SECTION 5. 49.683 (1) of the statutes is amended to read:
49.683 (1) The Subject to s. 49.687 (1m), the department may provide financial assistance for costs of medical care of persons over the age of 18 years with the diagnosis of cystic fibrosis who meet financial requirements established by the department by rule under s. 49.687 (1).
SECTION 6. 49.683 (3) of the statutes is created to read:
49.683 (3) No payment shall be made under this section for any portion of medical care costs that are payable under any state, federal, or other health care coverage program, including a health care coverage program specified by rule under s. 49.687 (1m) (b), or under any grant, contract, or other contractual arrangement.
SECTION 7. 49.685 (6) (b) of the statutes is amended to read:
49.685 (6) (b) Reimbursement shall not be made under this section for any blood products or supplies which that are not purchased from or provided by a comprehensive hemophilia treatment center, or a source approved by the treatment center. Reimbursement shall not be made under this section for any portion of the costs of blood products or supplies which that are payable under any other state or, federal program, or other health care coverage program, including a health care coverage program specified by rule under s. 49.687 (1m) (b), or under any grant, contract and any, or other contractual arrangement.
SECTION 8. 49.687 (title) of the statutes is amended to read:
49.687 (title) Disease aids; patient requirements; rebate agreements; cost containment.
SECTION 9. 49.687 (1m) of the statutes is created to read:
49.687 (1m) (a) A person is not eligible to receive benefits under s. 49.68, 49.683, or 49.685 unless, before the person applies for benefits under s. 49.68, 49.683, or 49.685, the person first applies for benefits under all other health care coverage programs specified by the department by rule under par. (b) for which the person reasonably may be eligible.
(b) The department shall promulgate rules that specify other health care coverage programs for which a person must apply before applying for benefits under s. 49.68, 49.683, or 49.685. The programs specified by rule must include the Medical Assistance program under subch. IV, the Badger Care health care program under s. 49.665, and the prescription drug assistance for elderly persons program under s. 49.688.
(c) Using the procedure under s. 227.24, the department may promulgate rules under par. (b) for the period before the effective date of any permanent rules promulgated under par. (b), but not to exceed the period authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) (a), (2) (b), and (3), the department is not required to provide evidence that promulgating a rule under par. (b) as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to make a finding of emergency for promulgating a rule under par. (b) as an emergency rule.
SECTION 10. 49.687 (4) of the statutes is created to read:
49.687 (4) The department may adopt managed care methods of cost containment for the programs under ss. 49.68, 49.683, and 49.685.
SECTION 9324. Initial applicability; health and family services.
(1) APPLYING FOR CHRONIC DISEASE AIDS PROGRAM. The treatment of sections 49.68 (3) (a) and (d) 1., 49.683 (1), and 49.687 (1m) of the statutes first applies to persons who apply for benefits under section 49.68, 49.683, or 49.685 of the statutes on the effective date of this subsection.
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LRB-0033LRB-0033/P2
PJK:kmg:jf
2003 - 2004 LEGISLATURE
DOA:...... Blaine - BB0005 MA eligibility
For 2003-05 Budget -- Not Ready For Introduction
2003 BILL
AN ACT ...; relating to: Medical Assistance eligibility for women diagnosed with certain precancerous conditions.
Analysis by the Legislative Reference Bureau
