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.
SB44, s. 1396 8Section 1396. 49.455 (5) (b) of the statutes is amended to read:
SB44,618,139 49.455 (5) (b) Notwithstanding ch. 766, in determining the resources of an
10institutionalized spouse at the time of application for medical assistance, the amount
11of resources considered to be available to the institutionalized spouse equals the
12value of all of the resources held by either or both spouses minus the greatest of the
13amounts determined under sub. (6) (b) 1. 1m. to 4.
SB44, s. 1397 14Section 1397. 49.455 (6) (a) of the statutes is amended to read:
SB44,618,2215 49.455 (6) (a) Notwithstanding s. 49.453 (2), an institutionalized spouse may
16transfer an amount of resources equal to not exceeding the community spouse
17resource allowance determined under par. (b) to, or for the sole benefit of, the
18community spouse without becoming ineligible for medical assistance for the period
19of ineligibility under s. 49.453 (3) as a result of the transfer. The institutionalized
20spouse shall make the transfer as soon as practicable after the initial determination
21of eligibility for medical assistance, taking into account the amount of time that is
22necessary to obtain a court order under par. (c).
SB44, s. 1398 23Section 1398. 49.455 (6) (b) (intro.) of the statutes is amended to read:
SB44,619,3
149.455 (6) (b) (intro.) The community spouse resource allowance equals the
2amount by which the amount of resources otherwise available to the community
3spouse is exceeded by the
greatest of the following:
SB44, s. 1399 4Section 1399. 49.455 (6) (b) 1. of the statutes is repealed.
SB44, s. 1400 5Section 1400. 49.455 (6) (b) 2. of the statutes is repealed.
SB44, s. 1401 6Section 1401. 49.46 (2) (a) 4. c. of the statutes is amended to read:
SB44,619,87 49.46 (2) (a) 4. c. Skilled nursing home services other than in an institution for
8mental diseases, except as limited under s. 49.45 (6c) and (30m) (b) and (c).
SB44, s. 1402 9Section 1402. 49.46 (2) (b) 6. a. of the statutes is amended to read:
SB44,619,1110 49.46 (2) (b) 6. a. Intermediate care facility services other than in an institution
11for mental diseases, except as limited under s. 49.45 (30m) (b) and (c).
SB44, s. 1403 12Section 1403. 49.46 (2) (b) 6. Lm. of the statutes is repealed.
SB44, s. 1404 13Section 1404. 49.472 (6) (a) of the statutes is amended to read:
SB44,619,1914 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account
15under s. 20.435 (4) (b), (gp), (r), or (w), the department shall, on the part of an
16individual who is eligible for medical assistance under sub. (3), pay premiums for or
17purchase individual coverage offered by the individual's employer if the department
18determines that paying the premiums for or purchasing the coverage will not be more
19costly than providing medical assistance.
SB44, s. 1405 20Section 1405. 49.472 (6) (b) of the statutes is amended to read:
SB44,619,2421 49.472 (6) (b) If federal financial participation is available, from the
22appropriation account under s. 20.435 (4) (b), (gp), (r), or (w), the department may
23pay medicare Part A and Part B premiums for individuals who are eligible for
24medicare and for medical assistance under sub. (3).
SB44, s. 1406 25Section 1406. 49.473 (title) of the statutes is amended to read:
SB44,620,2
149.473 (title) Medical assistance; women diagnosed with breast or
2cervical cancer
or precancerous conditions.
SB44, s. 1407 3Section 1407. 49.473 (2) (c) of the statutes is amended to read:
SB44,620,64 49.473 (2) (c) The woman is not eligible for health care coverage that qualifies
5as creditable coverage in 42 USC 300gg (c), excluding the coverage specified in 42
6USC 300gg
(c) (1) (F)
.
SB44, s. 1408 7Section 1408. 49.473 (2) (e) of the statutes is amended to read:
SB44,620,98 49.473 (2) (e) The woman requires treatment for breast or cervical cancer or
9for a precancerous condition of the breast or cervix
.
SB44, s. 1409 10Section 1409. 49.473 (5) of the statutes is amended to read:
SB44,620,1511 49.473 (5) The department shall audit and pay, from the appropriation
12accounts under s. 20.435 (4) (b), (gp), and (o), and (r), allowable charges to a provider
13who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman
14who meets the requirements under sub. (2) for all benefits and services specified
15under s. 49.46 (2).
SB44, s. 1410 16Section 1410. 49.473 (6) (b) of the statutes is amended to read:
SB44,620,2017 49.473 (6) (b) Inform the woman at the of time of the determination that she
18is required to apply to the department or a county department for medical assistance
19no later than the last day of the month following the month in which the qualified
20entity determines that the woman is eligible for medical assistance.
SB44, s. 1411 21Section 1411. 49.496 (3) (f) of the statutes is amended to read:
SB44,620,2322 49.496 (3) (f) The department may contract with or employ retain an attorney
23to probate estates to recover under this subsection the costs of care.
SB44, s. 1412 24Section 1412. 49.496 (4) of the statutes is amended to read:
SB44,621,15
149.496 (4) Administration. The department may require a county department
2under s. 46.215, 46.22, or 46.23 or the governing body of a federally recognized
3American Indian tribe administering medical assistance to gather and provide the
4department with information needed to recover medical assistance under this
5section. The department shall pay to a county department or tribal governing body
6an amount equal to 5% of the recovery collected by the department relating to a
7beneficiary for whom the county department or tribal governing body made the last
8determination of medical assistance eligibility. A county department or tribal
9governing body may use funds received under this subsection only to pay costs
10incurred under this subsection and, if any amount remains, to pay for improvements
11to functions required under s. 49.33 49.78 (2). The department may withhold
12payments under this subsection for failure to comply with the department's
13requirements under this subsection. The department shall treat payments made
14under this subsection as costs of administration of the medical assistance Medical
15Assistance
program.
SB44, s. 1413 16Section 1413. 49.498 (16) (g) of the statutes is amended to read:
SB44,621,2517 49.498 (16) (g) All forfeitures, penalty assessments , and interest, if any, shall
18be paid to the department within 10 days of receipt of notice of assessment or, if the
19forfeiture, penalty assessment, and interest, if any, are contested under par. (f),
20within 10 days of receipt of the final decision after exhaustion of administrative
21review, unless the final decision is appealed and the order is stayed by court order
22under sub. (19) (b). The department shall remit all forfeitures paid to the state
23treasurer
secretary of administration for deposit in the school fund. The department
24shall deposit all penalty assessments and interest in the appropriation under s.
2520.435 (6) (g).
SB44, s. 1414
1Section 1414. 49.665 (2) (title) of the statutes is amended to read:
SB44,622,22 49.665 (2) (title) Waiver Waivers.
SB44, s. 1415 3Section 1415. 49.665 (2) of the statutes is renumbered 49.665 (2) (a) and
4amended to read:
SB44,622,145 49.665 (2) (a) The department of health and family services shall request a
6waiver from the secretary of the federal department of health and human services
7to permit the department of health and family services to implement, beginning not
8later than July 1, 1998, or the effective date of the waiver, whichever is later, a health
9care program under this section. If a waiver that is consistent with all of the
10provisions of this section, excluding sub. (4) (a) 3m., is granted and in effect, the
11department of health and family services shall implement the program under this
12section. The department of health and family services may not implement the
13program under this section unless a waiver that is consistent with all of the
14provisions of this section, excluding sub. (4) (a) 3m., is granted and in effect.
SB44, s. 1416 15Section 1416. 49.665 (2) (b) of the statutes is created to read:
SB44,622,2516 49.665 (2) (b) If the department of health and family services determines that
17it needs a waiver to require the verification specified in sub. (4) (a) 3m., the
18department shall request a waiver from the secretary of the federal department of
19health and human services and may not implement the verification requirement
20under sub. (4) (a) 3m. unless the waiver is granted. If a waiver is required and is
21granted, the department of health and family services may implement the
22verification requirement under sub. (4) (a) 3m. as appropriate. If a waiver is not
23required, the department of health and family services may require the verification
24specified in sub. (4) (a) 3m. for eligibility determinations and annual review
25eligibility determinations made by the department, beginning on January 1, 2004.
SB44, s. 1417
1Section 1417. 49.665 (4) (am) 3m. of the statutes is created to read:
SB44,623,72 49.665 (4) (am) 3m. Each member of the child's household who is employed
3provides verification from his or her employer, in the manner specified by the
4department, of his or her earnings, of whether the employer provides health care
5coverage for which the child is eligible, and of the amount that the employer pays,
6if any, towards the cost of the health care coverage, excluding any deductibles or
7copayments required under the coverage.
SB44, s. 1418 8Section 1418. 49.665 (4m) of the statutes is created to read:
SB44,623,159 49.665 (4m) Supplemental payments to health maintenance organizations.
10From the appropriation under s. 20.435 (4) (wr), the department shall distribute
11funding in each fiscal year to a health maintenance organization, as defined under
12s. 609.01 (2), to supplement payment to the health maintenance organization under
13this section. The funding shall be to assist in meeting increasing costs, more intense
14use of services by Badger Care recipients, and other reimbursement needs that the
15department identifies.
SB44, s. 1419 16Section 1419. 49.665 (5) (a) of the statutes is renumbered 49.665 (5) (ag) and
17amended to read:
SB44,624,1318 49.665 (5) (ag) Except as provided in pars. (am), (b), and (bm), a family, or child
19who does not reside with his or her parent, who receives health care coverage under
20this section shall pay a percentage of the cost of that coverage in accordance with a
21schedule established by the department by rule. If the schedule established by the
22department requires a family, or child who does not reside with his or her parent, to
23contribute more than 3% of the family's or child's income towards the cost of the
24health care coverage provided under this section, the department shall submit the
25schedule to the joint committee on finance for review and approval of the schedule.

1If the cochairpersons of the joint committee on finance do not notify the department
2within 14 working days after the date of the department's submittal of the schedule
3that the committee has scheduled a meeting to review the schedule, the department
4may implement the schedule. If, within 14 days after the date of the department's
5submittal of the schedule, the cochairpersons of the committee notify the department
6that the committee has scheduled a meeting to review the schedule, the department
7may not require a family, or child who does not reside with his or her parent, to
8contribute more than 3% of the family's or child's income unless the joint committee
9on finance approves the schedule. The joint committee on finance may not approve
10and the department may not implement a schedule that requires a family or child
11to contribute, including the amounts required under par. (am), more than 3.5% of the
12family's or child's income towards the cost of the health care coverage provided under
13this section.
SB44, s. 1420 14Section 1420. 49.665 (5) (ac) of the statutes is created to read:
SB44,624,1715 49.665 (5) (ac) In this subsection, "cost" means total cost-sharing charges,
16including premiums, copayments, coinsurance, deductibles, enrollment fees, and
17any other cost-sharing charges.
SB44, s. 1421 18Section 1421. 49.665 (5) (ag) of the statutes, as affected by 2003 Wisconsin Act
19.... (this act), is amended to read:
SB44,625,1520 49.665 (5) (ag) Except as provided in pars. (am), (b), and (bm), a family, or child
21who does not reside with his or her parent, who receives health care coverage under
22this section shall pay a percentage of the cost of that coverage in accordance with a
23schedule established by the department by rule. If the schedule established by the
24department requires a family, or child who does not reside with his or her parent, to
25contribute more than 3% of the family's or child's income towards the cost of the

1health care coverage provided under this section, the department shall submit the
2schedule to the joint committee on finance for review and approval of the schedule.
3If the cochairpersons of the joint committee on finance do not notify the department
4within 14 working days after the date of the department's submittal of the schedule
5that the committee has scheduled a meeting to review the schedule, the department
6may implement the schedule. If, within 14 days after the date of the department's
7submittal of the schedule, the cochairpersons of the committee notify the department
8that the committee has scheduled a meeting to review the schedule, the department
9may not require a family, or child who does not reside with his or her parent, to
10contribute more than 3% of the family's or child's income unless the joint committee
11on finance approves the schedule. The joint committee on finance may not approve
12and the
The department may not establish or implement a schedule that requires a
13family or child to contribute, including the amounts required under par. (am), more
14than 3.5% 5% of the family's or child's income towards the cost of the health care
15coverage provided under this section.
SB44, s. 1422 16Section 1422. 49.665 (5) (am) of the statutes is created to read:
SB44,625,1917 49.665 (5) (am) Except as provided in pars. (b) and (bm), a child or family
18member who receives health care coverage under this section shall pay the following
19cost-sharing amounts:
SB44,625,2120 1. A copayment of $1 for each prescription of a drug that bears only a generic
21name, as defined in s. 450.12 (1) (b).
SB44,625,2322 2. A copayment of $3 for each prescription of a drug that bears a brand name,
23as defined in s. 450.12 (1) (a).
SB44, s. 1423 24Section 1423. 49.68 (3) (a) of the statutes is amended to read:
SB44,626,4
149.68 (3) (a) Any Subject to s. 49.687 (1m), any permanent resident of this state
2who suffers from chronic renal disease may be accepted into the dialysis treatment
3phase of the renal disease control program if the resident meets standards set by rule
4under sub. (2) and s. 49.687.
SB44, s. 1424 5Section 1424. 49.68 (3) (d) 1. of the statutes is amended to read:
SB44,626,196 49.68 (3) (d) 1. No aid may be granted under this subsection unless the recipient
7has no other form of aid available from the federal medicare program or, from private
8health, accident, sickness, medical, and hospital insurance coverage, or from other
9health care coverage specified by rule under s. 49.687 (1m) (b)
. If insufficient aid is
10available from other sources and if the recipient has paid an amount equal to the
11annual medicare deductible amount specified in subd. 2., the state shall pay the
12difference in cost to a qualified recipient. If at any time sufficient federal or private
13insurance aid or other health care coverage becomes available during the treatment
14period, state aid under this subsection shall be terminated or appropriately reduced.
15Any patient who is eligible for the federal medicare program shall register and pay
16the premium for medicare medical insurance coverage where permitted, and shall
17pay an amount equal to the annual medicare deductible amounts required under 42
18USC 1395e
and 1395L (b), prior to becoming eligible for state aid under this
19subsection
.
SB44, s. 1425 20Section 1425. 49.68 (3) (d) 3. of the statutes is created to read:
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