AB995: Bill Text

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:

AB995,26,19 1. An individual who is licensed, registered, permitted, or certified by the department of health and family services or by the department of regulation and licensing to provide health care or mental health services, items, or supplies.

AB995,26,21 2. A partnership, corporation, or limited liability company of individuals specified in subd. 1.

AB995,26,23 3. A facility or agency that provides health care or mental health services, items, or supplies.

AB995,27,3 (b) "Insurer" means an insurer that is authorized to do business in this state, in one or more lines of insurance that includes health insurance, and that offers health care plans, as defined in s. 628.36 (2) (a) 1., covering individuals in this state.

AB995,27,7 (2) (a) By April 1 annually, the department shall make available on the department's website, in a form that is downloadable, and, upon request, by mail, the current Medical Assistance fee schedule for health care services of health care providers.

AB995,27,9 (b) The department may make available on the department's website, in a form that is downloadable, and, upon request, by mail, all of the following:

AB995,27,12 1. The current insurer rates of health care providers provided to the department under sub. (3) (a), including any rate increases about which the department is informed under sub. (3 (a).

AB995,27,15 2. The current rates of reimbursement for health care services of health care providers provided to the department under sub. (5), including any rate increases about which the department is informed under sub. (5).

AB995,27,18 (c) The department may contract for the receipt of information under sub. (3) (a) or (5) and for the posting of the information under par. (a) or (b), in accordance with the department's request-for-proposal procedures.

AB995,28,2 (3) (a) By April 15 annually, a health care provider shall provide to the department, on a form provided by the department, a statement of the provider's rates for health care services for the period from the following May 1 to April 30. If during this period the health care provider increases any of the rates from the amount stated, the health care provider shall so inform the department, on a form provided by the department. The rates shall be stated in a form determined by the department that may include statement as a percentage of the Medical Assistance fee schedule for services of providers, as specified by the department under sub. (2) (a).

AB995,28,5 (b) Beginning on May 1 annually, a health care provider shall, with respect to the provider's rates for the period from that date to April 30 of the following year, do all of the following:

AB995,28,7 1. If the health care provider has an Internet website, post the rates, including any rate increases, on the website, in a form that is downloadable.

AB995,28,11 2. Take reasonable steps to ensure that health care consumers of services of the health care provider are aware that information on the provider's rates for health care services is available and are informed about the means by which the rate information may be obtained.

AB995,28,15 (4) Any increase in a rate for the health care service of a health care provider is chargeable only after the health care provider has, under sub. (3) (a), informed the department of the increase and has, if applicable, posted the rate increase under sub. (3) (b) 1.

AB995,28,24 (5) By April 15 annually, an insurer shall provide to the department, on a form provided by the department, and to the insurer's insureds a statement of the insurer's rates of reimbursement for health care services of health care providers for the period from the following May 1 to April 30. If during this period the insurer increases any of the rates of reimbursement from the amount stated, the insurer shall so inform the department, on a form provided by the department. The rates of reimbursement shall be stated as a percentage of the Medical Assistance fee schedule for health care services of health care providers, as specified by the department under sub. (2) (a).

AB995, s. 50 Section 50. 146.89 (1) of the statutes is renumbered 146.89 (1) (intro.) and amended to read:

AB995,29,3 146.89 (1) (intro.) In this section, "volunteer:

AB995,29,10 (r) "Volunteer health care provider" means an individual who is licensed as a physician under ch. 448, dentist under ch. 447, registered nurse, practical nurse, or nurse-midwife under ch. 441, optometrist under ch. 449, or physician assistant under ch. 448 or certified as a dietitian under subch. V of ch. 448 and who receives no income from the practice of that health care profession or who receives no income from the practice of that health care profession when providing services at the nonprofit agency or school specified under sub. (3).

AB995, s. 51 Section 51. 146.89 (1) (d) of the statutes is created to read:

AB995,29,13 146.89 (1) (d) "Governing body" means the governing body of any of the following:

AB995,29,14 1. A charter school, as defined in s. 115.001 (1).