AB995: Bill Text

AB995, s. 6 Section 6. 46.277 (1m) (ag) of the statutes is created to read:

AB995,14,16 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).

AB995, s. 7 Section 7. 46.277 (2) (intro.) of the statutes is amended to read:

AB995,15,5 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:

AB995, s. 8 Section 8. 46.277 (3) (a) of the statutes is amended to read:

AB995,15,16 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.

AB995, s. 9 Section 9. 46.277 (3) (b) 1. of the statutes is amended to read:

AB995,15,21 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.

AB995, s. 10 Section 10. 46.277 (3) (b) 2. of the statutes is amended to read:

AB995,16,3 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.

AB995, s. 11 Section 11. 46.277 (4) (a) of the statutes is amended to read:

AB995,16,13 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.

AB995, s. 12 Section 12. 46.277 (4) (b) of the statutes is amended to read:

AB995,16,22 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.

AB995, s. 13 Section 13. 46.277 (4) (c) of the statutes is created to read:

AB995,17,9 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.

AB995, s. 14 Section 14. 46.277 (5) (g) of the statutes, as created by 2003 Wisconsin Act 33, is amended to read:

AB995,17,17 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.

AB995, s. 15 Section 15. 46.277 (5g) (a) of the statutes is amended to read:

AB995,17,22 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.

AB995, s. 16 Section 16. 49.45 (6ur) of the statutes is created to read:

AB995,18,5 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.

AB995, s. 17 Section 17. 49.45 (6v) of the statutes is renumbered 49.45 (6L).

AB995, s. 18 Section 18. 49.45 (53) of the statutes is created to read:

AB995,18,10 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.

AB995, s. 19 Section 19. 49.46 (1) (a) 1. of the statutes is amended to read:

AB995,18,14 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.

AB995, s. 20 Section 20. 49.46 (1) (a) 1g. of the statutes is amended to read:

AB995,18,19 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.

AB995, s. 21 Section 21. 49.46 (1) (a) 1m. of the statutes is amended to read:

AB995,18,24 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.

AB995, s. 22 Section 22. 49.46 (1) (a) 6. of the statutes is amended to read:

AB995,19,4 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.

AB995, s. 23 Section 23. 49.46 (1) (a) 9. of the statutes is amended to read:

AB995,19,8 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.

AB995, s. 24 Section 24. 49.46 (1) (a) 10. of the statutes is amended to read:

AB995,19,12 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.

AB995, s. 25 Section 25. 49.46 (1) (a) 11. of the statutes is amended to read:

AB995,19,22 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.

AB995, s. 26 Section 26. 49.46 (1) (a) 12. of the statutes is amended to read:

AB995,20,3 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).

AB995, s. 27 Section 27 . 49.46 (1) (ar) of the statutes is created to read:

AB995,20,14 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.

AB995,20,21 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.

AB995, s. 28 Section 28. 49.46 (1) (e) of the statutes is amended to read:

AB995,21,4 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.

AB995, s. 29 Section 29. 49.46 (1) (L) of the statutes is repealed.

AB995, s. 30 Section 30. 49.47 (4) (am) 1. of the statutes is amended to read:

AB995,21,12 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.

AB995, s. 31 Section 31. 49.47 (4) (am) 2. of the statutes is amended to read:

AB995,21,19 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.

AB995, s. 32 Section 32. 49.47 (4) (c) 1. of the statutes is amended to read:

AB995,22,2 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

AB995,22,10 (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.

AB995, s. 33 Section 33. 49.47 (4) (c) 3. of the statutes is amended to read:

AB995,22,15 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).

AB995, s. 34 Section 34 . 49.47 (4) (cg) 3. of the statutes is created to read:

AB995,22,20 49.47 (4) (cg) 3. Notwithstanding s. 49.19 (5), for purposes of determining whether an individual under par. (ag) or (am) is eligible for medical assistance, the department shall exclude from the calculation of farm or self-employment income any amounts claimed for depreciation for income tax purposes.

AB995, s. 35 Section 35. 49.47 (4) (h) of the statutes is renumbered 49.47 (4) (cg) 2. and amended to read:

AB995,23,3 49.47 (4) (cg) 2. For the Except as provided in subd. 3., for purposes of determining whether an individual meets the income limits under par. (am), "income" includes income that would be used 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.

AB995, s. 36 Section 36. 49.665 (4) (a) 1. of the statutes is amended to read:

AB995,23,9 49.665 (4) (a) 1. The family's income does not exceed 185% of the poverty line, except as provided in par. (at) and except that a family that is already receiving health care coverage under this section may have an income that does not exceed 200% of the poverty line. The Subject to par. (d), the department shall establish by rule the criteria to be used to determine income.

AB995, s. 37 Section 37. 49.665 (4) (d) of the statutes is created to read:

AB995,23,14 49.665 (4) (d) For purposes of determining a family's or child's income under this section, the department shall exclude from the calculation of farm or self-employment income any amounts claimed for depreciation for income tax purposes.

AB995, s. 38 Section 38. 49.688 (4r) of the statutes is created to read:

AB995,23,22 49.688 (4r) In determining a person's annual household income under sub. (2) (a) 4. and (b) for purposes of determining eligibility for prescription drug assistance and under sub. (3) (b) 1. and 2. a. for purposes of establishing the required deductible amount, the department shall deduct the amount of property taxes that the person or any member of his or her household paid on the person's primary residence in the 12-month period before the department makes an eligibility determination under sub. (4).

AB995, s. 39 Section 39. 51.30 (4) (b) 13. of the statutes is renumbered 51.30 (4) (cm) and amended to read:

AB995,24,14 51.30 (4) (cm) Required access to records. To the parents, children Notwithstanding par. (a), treatment records of an individual shall be released without informed written consent, except as restricted under par. (c), to the parent, child, sibling, or spouse of an individual who is or was a patient at an inpatient facility,; to a law enforcement officer who is seeking to determine whether an individual is on unauthorized absence from the facility, ; and to mental health professionals who are providing treatment to the individual at the time that the information is released to others. Information released under this subdivision paragraph is limited to notice as to whether or not an individual is a patient at the inpatient facility and, if the individual is no longer a patient at the inpatient facility, the facility or other place, if known, at which the individual is located. This paragraph does not apply to an individual's parent, child, sibling, or spouse from whom the individual has specifically requested that the information under this paragraph be withheld.

AB995, s. 40 Section 40. 100.31 (title) of the statutes is amended to read:

AB995,24,16 100.31 (title) Unfair discrimination in Prescription drug pricing.

AB995, s. 41 Section 41. 100.31 (1) (a) of the statutes is renumbered 100.31 (1) (bm) and amended to read:

AB995,24,20 100.31 (1) (bm) "Drug" "Prescription drug" means any substance subject to 21 USC 353 (b).

AB995, s. 42 Section 42. 100.31 (1) (ae) of the statutes is created to read:

AB995,24,23 100.31 (1) (ae) "Consumer" means a person for whom a prescription drug is prescribed.

AB995, s. 43 Section 43. 100.31 (1) (as) of the statutes is created to read:

AB995,25,4 100.31 (1) (as) "Federal drug list" means the "Approved Drug Products with Therapeutic Equivalence Evaluations" published by the federal food and drug administration, or other publication specified in rules promulgated by the department under sub. (2r).

AB995, s. 44 Section 44. 100.31 (1) (b) of the statutes is renumbered 100.31 (1) (am) and amended to read:

AB995,25,12 100.31 (1) (am) "Purchaser" " Dispenser" means any person who engages primarily in selling dispensing, as defined in s. 450.01 (7), prescription drugs directly to consumers for outpatient use. "Dispenser" includes a hospital that directly or indirectly bills patients for prescription drugs, or an insurer that issues a defined network plan, as defined in s. 609.01 (1b), and that provides prescription drugs or prescription drug coverage to the enrollees of the plan.

AB995, s. 45 Section 45. 100.31 (1) (c) of the statutes is amended to read:

AB995,25,15 100.31 (1) (c) "Seller" means any person who trades in prescription drugs for resale to purchasers dispensers in this state.

AB995, s. 46 Section 46. 100.31 (2) of the statutes is amended to read:

AB995,25,24 100.31 (2) Price discrimination prohibited. Every seller shall offer prescription drugs from the most current federal drug list of therapeutically equivalent drugs published by the federal food and drug administration to every purchaser dispenser in this state, with all rights and privileges offered or accorded by the seller to the most favored purchaser dispenser, including purchase prices for similar volume purchases, rebates, free merchandise, samples, and similar trade concessions. Nothing in this subsection prohibits the giving of a discount for volume purchases.

AB995, s. 47 Section 47. 100.31 (2r) of the statutes is created to read:

AB995,26,4 100.31 (2r) Rules. The department may promulgate rules that, for purposes of sub. (1) (as), specify a publication that identifies drug products approved on the basis of safety and effectiveness by the federal food and drug administration under the federal Food, Drug, and Cosmetic Act.

AB995, s. 48 Section 48. 100.31 (4) of the statutes is amended to read:

AB995,26,11 100.31 (4) Penalties. For any violation of this section, the department or a district attorney may commence an action on behalf of the state to recover a forfeiture of not less than $100 nor more than $10,000 for each offense. Each delivery of a prescription drug sold to a purchaser dispenser at a price in violation of this section and each separate day in violation of an injunction issued under this section is a separate offense.

AB995, s. 49 Section 49. 146.385 of the statutes is created to read:

AB995,26,14 146.385 Health care provider service rate charges; limitations. (1) In this section:

AB995,26,16 (a) "Health care provider" means any of the following that receives income from the provision of health care or mental health services, items, or supplies in this state: