SB44, s. 1361
15Section
1361. 49.45 (6t) (b) of the statutes is created to read:
SB44,606,1716
49.45
(6t) (b) If 2003 Wisconsin Act .... (this act), section 9124 (8) (a) applies,
17this subsection does not apply.
SB44, s. 1362
18Section
1362. 49.45 (6tt) of the statutes is created to read:
SB44,606,2419
49.45
(6tt) Distributions to county departments and local health
20departments. From the appropriation under s. 20.435 (4) (w), the department may
21in each fiscal year distribute moneys to county departments under s. 46.215, 46.22,
2246.23, or 51.42 or to local health departments, as defined in s. 250.01 (4), in amounts
23that are equal to the moneys received by these county departments or local health
24departments in calendar year 2002 under s. 49.45 (6t), 2001 stats.
SB44, s. 1363
25Section
1363. 49.45 (6u) (am) (intro.) of the statutes is amended to read:
SB44,607,12
149.45
(6u) (am) (intro.) Notwithstanding sub. (6m),
in state fiscal years in
2which less than $1 in federal financial participation relating to facilities is received
3under 42 CFR 433.51, from the appropriations under s. 20.435 (4) (o), (w), and (wm),
4for reduction of operating deficits, as defined under the methodology used by the
5department in December
, 2000, incurred by a facility that is established under s.
649.70 (1) or that is owned and operated by a city, village, or town,
and as payment
7to care management organizations, the department may not distribute to these
8facilities
and to care management organizations more than $37,100,000 in each
9fiscal year, as determined by the department. The total amount that a county
10certifies under this subsection may not exceed 100% of otherwise-unreimbursed
11care. In distributing funds under this subsection, the department shall perform all
12of the following:
SB44, s. 1364
13Section
1364. 49.45 (6u) (bm) of the statutes is repealed.
SB44, s. 1365
14Section
1365. 49.45 (6v) (b) of the statutes is amended to read:
SB44,607,2015
49.45
(6v) (b) The department shall, each year, submit to the joint committee
16on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that
17provides information on the utilization of beds by recipients of medical assistance in
18facilities and a discussion and detailed projection of the likely balances,
19expenditures, encumbrances and carry over of currently appropriated amounts in
20the appropriation accounts under s. 20.435 (4) (b)
and
, (gp), (o)
, and (r).
SB44, s. 1366
21Section
1366. 49.45 (6x) (a) of the statutes is amended to read:
SB44,608,222
49.45
(6x) (a) Notwithstanding sub. (3) (e), from the
appropriations 23appropriation accounts under s. 20.435 (4) (b),
(gp), (o),
(r), and (w), the department
24shall distribute not more than $4,748,000 in each fiscal year, to provide funds to an
25essential access city hospital, except that the department may not allocate funds to
1an essential access city hospital to the extent that the allocation would exceed any
2limitation under
42 USC 1396b (i) (3).
SB44, s. 1367
3Section
1367. 49.45 (6y) (a) of the statutes is amended to read:
SB44,608,134
49.45
(6y) (a) Notwithstanding sub. (3) (e), from the
appropriations 5appropriation accounts under s. 20.435 (4) (b),
(gp), (o),
(r), and (w), the department
6shall distribute funding in each fiscal year to provide supplemental payment to
7hospitals that enter into a contract under s. 49.02 (2) to provide health care services
8funded by a relief block grant, as determined by the department, for hospital services
9that are not in excess of the hospitals' customary charges for the services, as limited
10under
42 USC 1396b (i) (3). If no relief block grant is awarded under this chapter
11or if the allocation of funds to such hospitals would exceed any limitation under
42
12USC 1396b (i) (3), the department may distribute funds to hospitals that have not
13entered into a contract under s. 49.02 (2).
SB44, s. 1368
14Section
1368. 49.45 (6y) (am) of the statutes is amended to read:
SB44,608,2215
49.45
(6y) (am) Notwithstanding sub. (3) (e), from the
appropriations 16appropriation accounts under s. 20.435 (4) (b), (h),
(gp), (o),
(r), and (w), the
17department shall distribute funding in each fiscal year to provide supplemental
18payments to hospitals that enter into contracts under s. 49.02 (2) with a county
19having a population of 500,000 or more to provide health care services funded by a
20relief block grant, as determined by the department, for hospital services that are not
21in excess of the hospitals' customary charges for the services, as limited under
42
22USC 1396b (i) (3).
SB44, s. 1369
23Section
1369. 49.45 (6z) (a) (intro.) of the statutes is amended to read:
SB44,609,924
49.45
(6z) (a) (intro.) Notwithstanding sub. (3) (e), from the
appropriations 25appropriation accounts under s. 20.435 (4) (b),
(gp), (o),
(r), and (w), the department
1shall distribute funding in each fiscal year to supplement payment for services to
2hospitals that enter into a contract under s. 49.02 (2) to provide health care services
3funded by a relief block grant under this chapter, if the department determines that
4the hospitals serve a disproportionate number of low-income patients with special
5needs. If no medical relief block grant under this chapter is awarded or if the
6allocation of funds to such hospitals would exceed any limitation under
42 USC
71396b (i) (3), the department may distribute funds to hospitals that have not entered
8into a contract under s. 49.02 (2). The department may not distribute funds under
9this subsection to the extent that the distribution would do any of the following:
SB44, s. 1370
10Section
1370. 49.45 (6zb) of the statutes is created to read:
SB44,609,1711
49.45
(6zb) Supplemental payments to health maintenance organizations. 12From the appropriation under s. 20.435 (4) (wr), the department shall distribute
13funding in each fiscal year to a health maintenance organization, as defined under
14s. 609.01 (2), to supplement payment to the health maintenance organization under
15this section. The funding shall be to assist in meeting increasing costs, more intense
16use of services by Medical Assistance recipients, and other reimbursement needs
17that the department identifies.
SB44, s. 1371
18Section
1371. 49.45 (7) (a) of the statutes is amended to read:
SB44,610,219
49.45
(7) (a) A recipient who is a patient in a public medical institution or an
20accommodated person and has a monthly income exceeding the payment rates
21established under
42 USC 1382 (e) may retain
$45
$30 unearned income or the
22amount of any pension paid under
38 USC 3203 (f) 38 USC 5503 (d), whichever is
23greater, per month for personal needs. Except as provided in s. 49.455 (4) (a), the
24recipient shall apply income in excess of
$45 $30 or the amount of any pension paid
25under
38 USC 3203 (f) 38 USC 5503 (d), whichever is greater, less any amount
1deducted under rules promulgated by the department, toward the cost of care in the
2facility.
SB44, s. 1372
3Section
1372. 49.45 (8) (b) of the statutes is amended to read:
SB44,610,84
49.45
(8) (b) Reimbursement under s. 20.435 (4) (b),
(gp), (o),
(r), and (w) for
5home health services provided by a certified home health agency or independent
6nurse shall be made at the home health agency's or nurse's usual and customary fee
7per patient care visit, subject to a maximum allowable fee per patient care visit that
8is established under par. (c).
SB44, s. 1373
9Section
1373. 49.45 (18) (intro.) of the statutes is renumbered 49.45 (18) (ac)
10and amended to read:
SB44,610,2211
49.45
(18) (ac) Except as provided in pars.
(a) (am) to (d),
and subject to par.
12(ag), any person eligible for medical assistance under s. 49.46, 49.468
, or 49.47 shall
13pay up to the maximum amounts allowable under
42 CFR 447.53 to
447.58 for
14purchases of services provided under s. 49.46 (2). The service provider shall collect
15the
specified or allowable copayment, coinsurance
, or deductible, unless the service
16provider determines that the cost of collecting the copayment, coinsurance
, or
17deductible exceeds the amount to be collected. The department shall reduce
18payments to each provider by the amount of the
specified or allowable copayment,
19coinsurance
, or deductible. No provider may deny care or services because the
20recipient is unable to share costs, but an inability to share costs specified in this
21subsection does not relieve the recipient of liability for these costs.
Liability under
22this subsection is limited by the following provisions:
SB44, s. 1374
23Section
1374. 49.45 (18) (a) of the statutes is renumbered 49.45 (18) (am).
SB44, s. 1375
24Section
1375. 49.45 (18) (ag) of the statutes is created to read:
SB44,611,2
149.45
(18) (ag) Except as provided in pars. (am), (b), and (c), and subject to par.
2(d), a recipient specified in par. (ac) shall pay all of the following:
SB44,611,43
1. A copayment of $1 for each prescription of a drug that bears only a generic
4name, as defined in s. 450.12 (1) (b).
SB44,611,65
2. A copayment of $3 for each prescription of a drug that bears a brand name,
6as defined in s. 450.12 (1) (a).
SB44, s. 1376
7Section
1376. 49.45 (18) (d) of the statutes is amended to read:
SB44,611,118
49.45
(18) (d) No person who designates a pharmacy or pharmacist as his or
9her sole provider of prescription drugs and who so uses that pharmacy or pharmacist
10is liable under this subsection for more than
$5
$12 per month for prescription drugs
11received.
SB44, s. 1377
12Section
1377. 49.45 (19) (bm) of the statutes is amended to read:
SB44,611,1513
49.45
(19) (bm) The
department or the county department under s. 46.215 or
1446.22 shall notify applicants of the requirements of this subsection at the time of
15application.
SB44, s. 1378
16Section
1378. 49.45 (24m) (intro.) of the statutes is amended to read:
SB44,611,2117
49.45
(24m) Home health care and personal care pilot program. (intro.)
18From the
appropriations appropriation accounts under s. 20.435 (4) (b),
(gp), (o),
(r), 19and (w), in order to test the feasibility of instituting a system of reimbursement for
20providers of home health care and personal care services for medical assistance
21recipients that is based on competitive bidding, the department shall:
SB44, s. 1379
22Section
1379. 49.45 (25) (am) (intro.) of the statutes is amended to read:
SB44,612,423
49.45
(25) (am) (intro.) Except as provided under pars. (be)
and, (bg)
, and (bj) 24and sub. (24), case management services under s. 49.46 (2) (b) 9. and (bm) are
25reimbursable under
medical assistance Medical Assistance only if provided to a
1medical assistance Medical Assistance beneficiary who receives case management
2services from or through a certified case management provider in a county, city,
3village
, or town that elects, under par. (b), to make the services available and who
4meets at least one of the following conditions:
SB44, s. 1380
5Section
1380. 49.45 (25) (bj) of the statutes is created to read:
SB44,612,136
49.45
(25) (bj) The department of corrections may elect to provide case
7management services under this subsection to persons who are under the
8supervision of that department under s. 938.183, 938.34 (4h), (4m), or (4n), or
9938.357 (4), who are Medical Assistance beneficiaries, and who meet one or more of
10the conditions specified in par. (am). The amount of the allowable charges for those
11services under the Medical Assistance program that is not provided by the federal
12government shall be paid from the appropriation account under s. 20.410 (3) (hm),
13(ho), or (hr).
SB44, s. 1381
14Section
1381. 49.45 (25) (c) of the statutes is amended to read:
SB44,612,1915
49.45
(25) (c) Except as provided in pars. (b), (be)
and, (bg),
and (bj), the
16department shall reimburse a provider of case management services under this
17subsection only for the amount of the allowable charges for those services under the
18medical assistance Medical Assistance program that is provided by the federal
19government.
SB44, s. 1382
20Section
1382. 49.45 (30e) of the statutes is repealed.
SB44, s. 1383
21Section
1383. 49.45 (30m) of the statutes is renumbered 49.45 (30m) (a)
22(intro.) and amended to read:
SB44,613,223
49.45
(30m) (a) (intro.) A county shall provide the portion of
the payment that
24is not provided by the federal government for all of the following services
under s.
151.06 (1m) (d) to individuals
with developmental disability who are eligible for
2medical assistance
that is not provided by the federal government.:
SB44, s. 1384
3Section
1384. 49.45 (30m) (a) 1. of the statutes is created to read:
SB44,613,44
49.45
(30m) (a) 1. Services under s. 51.06 (1m) (d).
SB44, s. 1385
5Section
1385. 49.45 (30m) (a) 2. of the statutes is created to read:
SB44,613,86
49.45
(30m) (a) 2. Services in an intermediate care facility for the mentally
7retarded, as defined in s. 46.278 (1m) (am), other than a state center for the
8developmentally disabled.
SB44, s. 1386
9Section
1386. 49.45 (30m) (a) 3. of the statutes is created to read:
SB44,613,1110
49.45
(30m) (a) 3. Services for which payment is permitted under sub. (6c) (d)
112. that are provided in a nursing facility, as defined in s. 46.279 (1) (c).
SB44, s. 1387
12Section
1387. 49.45 (30m) (b) of the statutes is created to read:
SB44,613,1613
49.45
(30m) (b) No payment under this section may be made for services
14specified under par. (a) unless the individual who receives the services is protectively
15placed under s. 55.06 (9) (a) or is placed under an emergency placement under s.
1655.06 (11) (a) or a temporary placement under s. 55.06 (11) (c).
SB44, s. 1388
17Section
1388. 49.45 (30m) (c) of the statutes is created to read:
SB44,613,2118
49.45
(30m) (c) No payment under this section may be made for services
19specified under par. (a) 2. or 3. that are provided to an individual who was placed in
20or admitted to an intermediate facility, as defined in s. 46.279 (1) (b), or nursing
21facility, as defined in s. 46.279 (1) (c), unless one of the following applies:
SB44,613,2322
1. Any placement or admission that is made after March 31, 2004, complied
23with the requirements of s. 46.279.
SB44,614,3
12. For an individual who was protectively placed under ch. 55 at any time, any
2annual review that is conducted under s. 55.06 (10) (a) 1. after March 31, 2004,
3complies with the requirements of s. 55.06 (10) (a) 2.
SB44, s. 1389
4Section
1389. 49.45 (36) of the statutes is amended to read:
SB44,614,85
49.45
(36) Homeless beneficiaries. A The department or a county department
6under s. 46.215, 46.22
, or 46.23 may not place the word "homeless" on the medical
7assistance identification card of any person who is determined to be eligible for
8medical assistance benefits and who is homeless.
SB44, s. 1390
9Section
1390. 49.45 (39) (b) 1. of the statutes is amended to read:
SB44,615,1710
49.45
(39) (b) 1. `Payment for school medical services.' If a school district or a
11cooperative educational service agency elects to provide school medical services and
12meets all requirements under par. (c), the department shall reimburse the school
13district or the cooperative educational service agency for 60% of the federal share of
14allowable charges for the school medical services that it provides and, as specified
15in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind
16and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
17and Hard of Hearing elects to provide school medical services and meets all
18requirements under par. (c), the department shall reimburse the department of
19public instruction for 60% of the federal share of allowable charges for the school
20medical services that the Wisconsin Center for the Blind and Visually Impaired or
21the Wisconsin Educational Services Program for the Deaf and Hard of Hearing
22provides and, as specified in subd. 2., for allowable administrative costs. A school
23district, cooperative educational service agency, the Wisconsin Center for the Blind
24and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
25and Hard of Hearing may submit, and the department shall allow, claims for common
1carrier transportation costs as a school medical service unless the department
2receives notice from the federal health care financing administration that, under a
3change in federal policy, the claims are not allowed. If the department receives the
4notice, a school district, cooperative educational service agency, the Wisconsin
5Center for the Blind and Visually Impaired, or the Wisconsin Educational Services
6Program for the Deaf and Hard of Hearing may submit, and the department shall
7allow, unreimbursed claims for common carrier transportation costs incurred before
8the date of the change in federal policy. The department shall promulgate rules
9establishing a methodology for making reimbursements under this paragraph.
All 10Except as provided in subd. 1m., all other expenses for the school medical services
11provided by a school district or a cooperative educational service agency shall be paid
12for by the school district or the cooperative educational service agency with funds
13received from state or local taxes. The school district, the Wisconsin Center for the
14Blind and Visually Impaired, the Wisconsin Educational Services Program for the
15Deaf and Hard of Hearing, or the cooperative educational service agency shall
16comply with all requirements of the federal department of health and human
17services for receiving federal financial participation.
SB44, s. 1391
18Section
1391. 49.45 (39) (b) 1m. of the statutes is created to read:
SB44,615,2519
49.45
(39) (b) 1m. `Supplementary payment for school medical services.' In
20addition to the reimbursement the department provides under subd. 1. to a school
21district or cooperative educational service agency for school medical services, the
22department may make supplementary payments from the appropriation accounts
23under s. 20.435 (4) (b) and (o). The total of the supplementary payments and
24allowable charges paid under subd. 1. may not exceed applicable limitations on
25payments under
42 USC 1396a (a) (30) (A).
SB44, s. 1392
1Section
1392. 49.45 (39) (b) 2. of the statutes is amended to read:
SB44,616,112
49.45
(39) (b) 2. `Payment for school medical services administrative costs.' The
3department shall reimburse a school district or a cooperative educational service
4agency specified under
subd. 1. subds. 1. and 1m. and shall reimburse the
5department of public instruction on behalf of the Wisconsin Center for the Blind and
6Visually Impaired or the Wisconsin Educational Services Program for the Deaf and
7Hard of Hearing for 90% of the federal share of allowable administrative costs, using
8time studies, beginning in fiscal year 1999-2000. A school district or a cooperative
9educational service agency may submit, and the department of health and family
10services shall allow, claims for administrative costs incurred during the period that
11is up to 24 months before the date of the claim, if allowable under federal law.
SB44, s. 1393
12Section
1393. 49.45 (49m) of the statutes is created to read:
SB44,616,1413
49.45
(49m) Prescription drug cost controls; purchasing agreements. (a)
14In this section:
SB44,616,1515
1. "Brand name" has the meaning given in s. 450.12 (1) (a).
SB44,616,1616
2. "Generic name" has the meaning given in s. 450.12 (1) (b).
SB44,616,1717
3. "Prescription drug" has the meaning given in s. 450.01 (20).
SB44,616,2118
(b) The department may enter into a multi-state purchasing agreement with
19another state or a purchasing agreement with a purchaser of prescription drugs if
20the other state or purchaser agrees to participate in one or more of the activities
21specified in par. (c) 1. to 5.
SB44,616,2422
(c) The department may design and implement a program to reduce the cost
23of prescription drugs and to maintain high quality in prescription drug therapies,
24which shall include all of the following:
SB44,617,3
11. A list of the prescription drugs that are included as a benefit under s. 49.46
2(2) (b) 6. h. that identifies preferred choices within therapeutic classes and includes
3prescription drugs that bear only generic names.
SB44,617,94
2. Establishing supplemental rebates under agreements with prescription
5drug manufacturers for prescription drugs provided to recipients under Medical
6Assistance and Badger Care and to eligible persons under s. 49.688 and, if it is
7possible to implement the program without adversely affecting supplemental
8rebates for Medical Assistance, Badger Care, and prescription drug assistance under
9s. 49.688, to beneficiaries of participants under par. (b).
SB44,617,1010
3. Utilization management and fraud and abuse controls.
SB44,617,1211
4. Any other activity to reduce the cost of or expenditures for prescription drugs
12and maintain high quality in prescription drug therapies.
SB44,617,1413
(d) The department may enter into a contract with an entity to perform any of
14the duties and exercise any of the powers of the department under this subsection.
SB44, s. 1394
15Section
1394. 49.453 (1) (ak) of the statutes is created to read:
SB44,617,1716
49.453
(1) (ak) "Consumer price index" has the meaning given in s. 49.455 (1)
17(b).
SB44, s. 1395
18Section
1395. 49.453 (5) of the statutes is amended to read:
SB44,618,719
49.453
(5) Care or personal services. For the purposes of sub. (2), whenever
20a covered individual or his or her spouse, or another person acting on behalf of the
21covered individual or his or her spouse, transfers assets to a relative as payment for
22care or personal services that the relative provides to the covered individual, the
23covered individual or his or her spouse transfers assets for less than fair market
24value unless the care or services directly benefit the covered individual, the amount
25of the payment does not exceed reasonable compensation for the care or services that
1the relative performs and, if the amount of the payment
in any year exceeds 10% of
2the community spouse resource allowance limit specified in s. 49.455 (6) (b) 1. 3$12,000 increased by the same percentage increase as the percentage increase in the
4consumer price index between September 1988 and September of the year before the
5calendar year in which the care or services for which the payment was made were
6performed, the agreement to pay the relative is specified in a notarized written
7agreement that exists at the time that the relative performs the care or services.