Caretaker of newborn infant program change and studies
Under current law, a person who meets the eligibility requirements for W-2 and
who is the custodial parent of a child who is 12 weeks old or younger may receive a
monthly grant of $673 and may not be required to participate in a W-2 employment
position. This bill increases the maximum age of the child so that the custodial
parent of a child who is six months old or younger may receive the monthly grant and
may not be required to participate in an employment position.
The bill directs DWD to conduct a study to determine the best ways to assist
low-income custodial parents and other at-risk low-income adults in getting and
keeping a job. DWD must submit a report with its findings and recommendations
to the governor and legislature. The bill also directs DWD to investigate ways in
which federal funding other than TANF block grants can be used to create a seamless
system of employment and education training services for low-income adults in
Wisconsin and to submit a report on its findings to DOA.
Under current law, DWD certifies to DOR any overpayment of food stamp
benefits or various benefits under W-2 for recovery as a setoff against any income
tax refund owed to the person who received the overpayment. Also under current
law, DWD makes job access loans to persons who are eligible for W-2 to enable them
to obtain or continue employment.
This bill authorizes DWD to certify delinquent job access loan repayments to
DOR for setoff against any income tax refund owed to the person who received the
loan. Delinquent repayment amounts collected by DOR and paid to DWD must be
used to make more job access loans.
Medical Assistance
Under current law, the MA trust fund (MATF) consists of all public funds for
MA nursing home payments that are transferred to the MATF as the nonfederal
share for the purpose of claiming federal moneys, and of all the matching moneys
received in return under the federal MA program (commonly known as Medicaid).
Counties that make these transfers to the MATF are reimbursed by DHFS from the
general fund.
This bill appropriates money from the MATF to reimburse counties for the
moneys the counties transferred to the state in support of MA payment for nursing
home services and that were used as the nonfederal share of MA payments.
Currently, under a waiver of federal Medicaid laws, DHFS administers a
community integration program (commonly known as CIP IA) under which MA
recipients who reside in state centers for the developmentally disabled are relocated
into their communities and provided home and community-based services. DHFS
administers another similar community integration program (commonly known as
"CIP IB"), under which persons with developmental disabilities who are relocated
from institutions other than state centers for the developmentally disabled or who
meet requirements for the care provided in intermediate care facilities for the
mentally retarded or brain injury rehabilitation facilities are relocated into their
communities.
This bill appropriates the moneys received from counties to provide
supplemental MA program benefits for CIP IA and CIP IB, emergency medical
transportation services, alcohol and other drug abuse and mental health treatment
and services, and school medical services, as part of a claim for federal Medicaid
matching moneys. The moneys counties must pay are related to the federal share
of rate increases for CIP IA and CIP IB beginning in 2001, the federal share of rate
increases for alcohol and other drug abuse and mental health treatment and services
beginning in 2003, and the moneys paid in support of the claim for federal Medicaid
matching moneys. If the amount received by DHFS exceeds payments for services,
the excess must be transferred to the MATF. The bill annually decreases the total
amount paid to school districts for special education by the amount of the
supplementary payment for MA school-based services received. In addition, the bill
expands the MATF to include moneys that are related to any MA service. Lastly, the
bill authorizes DHFS to award grants to counties from the MATF for mental health
community support programs and to distribute to counties and local health
departments from the MATF an amount equal to the amount that was distributed
in 2002 to reduce operating deficits.
Under current law, persons who apply for admission to nursing homes, state
centers for the developmentally disabled, or institutions for mental diseases,
including persons who are found by a court to be in need of protective services and
are protectively placed, must be screened to determine if they have a developmental
disability or mental illness and need facility care and active treatment. Residents
of these facilities who have a developmental disability or mental illness and
significant changes in their physical or mental conditions must also be screened to
determine if they need facility care or active treatment. Persons who are not in need
of facility care must be relocated. Currently, counties must provide the portion of the
MA program payment that is not provided by the federal government for services to
individuals in state centers for the developmentally disabled who are also mentally
ill and exhibit extremely aggressive and challenging behaviors. Under CIP IB, a
county that owns the institution from which a person is relocated into the community
must receive approval from DHFS of a plan for delicensing a bed of the institution
for the county to obtain reimbursement for the person's community care.
This bill restricts protective placements and admissions, after March 31, 2004,
of persons with developmental disabilities to intermediate facilities and nursing
facilities. Within 90 days after receiving written notice of the prospective placement
or admission of a person with developmental disabilities in an intermediate facility,
a county department of social services, human services, developmental disabilities
services, or community programs must develop a plan for providing home or
community-based care to the person in a noninstitutional setting. The person may
not be placed in or admitted to the intermediate facility unless a court finds that
placement in the community under such a plan is not in the person's best interests,
or the person or his or her guardian rejects the plan. Also, a person who has been
screened and found to require active treatment for developmental disability may not
be placed in or admitted to a nursing facility unless his or her need for care cannot
be met in an intermediate facility or under a plan for home or community care.
The bill requires that residents of state centers for the developmentally
disabled who have been determined to need facility care and active treatment for
developmental disability be further screened to determine whether the level of care
that they require could be provided safely in an intermediate facility or under a plan
for home or community care.
The bill prohibits payment of the federal portion of MA for services for a
resident in a state center for the developmentally disabled who is also mentally ill
and exhibits extremely aggressive and challenging behaviors unless the person
receiving the services has been protectively or temporarily placed in the state center
or is placed there for emergency purposes. The bill requires that counties pay the
portion of MA that is not provided by the federal government for services to persons
with developmental disabilities in an intermediate care facility for the mentally
retarded and, if they have been determined to need facility care, for services in a
nursing facility; however, no payment of the federal portion of MA for services to
these persons may be made unless they were placed in or admitted to the facility after
the placing board considered a plan for home or community care and rejected the plan
or found it would not meet their needs. The requirements and limitations first apply
to services provided and payment made on April 1, 2004.
The bill changes laws relating to protective placement of persons who are found
incompetent. Under the bill, the court must notify the appropriate county
department to develop a plan for home or community care for a person about to be
protectively placed and the person must be placed in a noninstitutional community
setting under the plan unless the court finds that placement for home or community
care would not be in the person's best interests.
Under current law, a community integration program (commonly known as CIP
II) provides home or community-based care to persons who are relocated from
institutions other than the state centers for the developmentally disabled and to
persons who meet MA level-of-care requirements in nursing homes.
Beginning on June 1, 2004, this bill requires a county department of human
services, developmental disabilities services, or community programs of a county
that participates in CIP II or CIP IB to perform a needs and costs-based assessment
for nursing home residents who are eligible for but not receiving services under the
program; who have received MA coverage for their nursing home care for at least 30
days; and who prefer services in the community, rather than in the nursing home.
After completing the assessment, the county department must contact DHFS; if
DHFS determines that costs for services for the nursing home resident are below the
limit under a formula specified in the bill, or if DHFS determines that additional
funding is available for above-limit costs, the county department must offer the
home or community-based services to the nursing home resident. The county
department must initiate the assessment before the person has resided in the
nursing home for 90 days or before the cost of the resident's nursing home care has
been paid for under MA for 30 days, whichever is longer, and must complete the
assessment within 90 days. A county department that fails to meet these
requirements and to offer home or community-based care to the resident must pay
the nonfederal share of the resident's MA nursing home care unless the resident
refused to participate or the assessment determined that relocation was not feasible.
Beginning on January 1, 2004, DHFS is authorized to provide funding to counties
from the MA trust fund to conduct these relocation activities and to provide increased
funding for services to the nursing home residents who are relocated to communities.
This bill authorizes DHFS to assess each health maintenance organization
(HMO) 1% of its annual gross revenue, based on a statement that it must file with
OCI annually by March 1. The assessments are deposited into the MA trust fund.
In addition, the bill requires DHFS to distribute moneys in each fiscal year from the
MA trust fund to supplement MA payments to HMOs that provide services to MA
recipients; to supplement payments to HMOs that provide services to recipients of
Badger Care (a program of health care coverage for certain low-income children who
do not reside with a parent and for certain low-income families); to assist in meeting
increasing costs and more intense use of services by recipients; and to meet other
reimbursement needs that DHFS identifies.
Currently, DHFS must distribute in each fiscal year not more than $2,256,000
in supplemental payments to rural hospitals with high use of inpatient services by
patients whose care is paid for by the state or federal government, and to rural
hospitals that meet certain federal MA requirements. This bill eliminates MA
supplemental payments by DHFS to rural hospitals with high MA recipient use and
eliminates the statutory limit on the amount of supplemental payments that DHFS
must make to critical access hospitals.
Under current law, payments to nursing homes for services to recipients under
the MA program are calculated using a formula that considers certain costs of
individual nursing homes, including direct care, support services, fuel and utilities,
net property tax or municipal services, administrative and general costs, interest
expenses, and necessary capital payments. For direct care costs, DHFS must use
standards that sample nursing homes in the state, as adjusted for regional labor cost
variations. For nursing homes in Douglas, Pierce, and St. Croix counties, DHFS uses
a federal Medicare program hospital wage index.
This bill requires DHFS to make a flat-rate payment for MA nursing home
costs, as determined by DHFS, for personal comfort supplies and allowable support
service costs. Beginning July 1, 2004, the bill requires an MA flat-rate payment for
support services (dietary services, environmental services, fuel and utilities,
administrative and general costs) and direct care costs (personal comfort supplies,
medical supplies, over-the-counter drugs and nonbillable services for ancillary
nursing home personnel). Under the bill, cost-based payment will continue to be
made for nonbillable direct care costs for registered nurses, licensed practical nurses,
and nurse's assistants; property tax or municipal services; interest expenses; and
necessary capital payments. The bill eliminates the use of a federal Medicare
Program hospital wage index in calculating MA direct care costs for nursing homes
in Douglas, Pierce, and St. Croix counties and requires, instead, that direct care costs
for nursing homes in those counties be calculated as are direct care costs for nursing
homes in other counties. The bill clarifies that "costs for property taxes and
municipal services" refer to paid, rather than incurred, costs.
Under current law, counties may transfer moneys to the state as the nonfederal
share of public moneys to serve as the basis for claims for federal Medicaid matching
moneys. These federal matching moneys reduce the operating deficits of county, city,
village, or town nursing homes. Currently, if federal matching moneys that are
related to the transfers are not received in a fiscal year, DHFS may distribute up to
$37,100,000 to these facilities or a lesser amount if other federal Medicaid matching
moneys are reduced. If federal matching moneys that are related to the transfers are
received in a fiscal year, DHFS may distribute up to $77,100,000 to these facilities
and to care management organizations that contract with the facilities for services.
This bill eliminates the distinction between receipt and nonreceipt of federal
matching moneys that are related to the transfers with respect to distributing
moneys to reduce the operating deficits of county, city, village, or town nursing homes
and, instead, authorizes DHFS to distribute up to a total of $37,100,000 to these
facilities and to care management organizations.
Under current law, DHFS provides health care services to eligible individuals
under the MA program. Current law requires certain MA recipients to share the cost
of medical services provided under MA by paying up to the maximum amount
allowable under federal law. Current law also limits to $5 per month the total
amount that an MA recipient may be required to pay for prescription drugs if the
recipient designates a pharmacy or pharmacist as his or her sole provider of
prescription drugs.
Under this bill, MA recipients who must pay a portion of their medical services
must pay a copayment of $1 for each prescription for a generic drug and a copayment
of $3 for each prescription for a brand name drug. The bill also raises to $12 per
month the maximum amount an MA recipient may be required to pay for
prescription drugs if the MA recipient designates a pharmacy or pharmacist as his
or her sole provider of prescription drugs.
Under current law, a child or family with health care coverage under
BadgerCare and with an income that is equal to or greater than 150% of the federal
poverty level must contribute a percentage of income to the cost of the health care
according to a schedule established by DHFS. Current law requires DHFS to submit
the schedule to JCF for review and approval if the schedule requires a child or family
to contribute more than 3% of the child's or family's income to the cost of health care,
and JCF may not approve a schedule that requires a child or family to contribute
more than 3.5% of the child's or family's income.
Under this bill, each child or member of a family with health care coverage
under BadgerCare and with an income that is equal to or greater than 150% of the
federal poverty level must pay a copayment of $1 for each prescription for a generic
drug and a copayment of $3 for each prescription for a brand name drug. The bill
eliminates the requirement that DHFS submit the cost-sharing schedule to JCF and
prohibits DHFS from establishing or implementing a cost-sharing schedule that
requires a child or family to contribute more than 5% of income to the cost of health
care.
This bill authorizes DHFS to design and implement a program to reduce the
cost of prescription drugs and to maintain high quality in prescription drug
therapies. The program must include supplemental rebates under agreements with
prescription drug manufacturers for prescription drugs provided to MA and Badger
Care recipients and to persons eligible under a program of prescription drug
assistance to elderly persons (commonly known as Senior Care). The bill also
authorizes DHFS to enter into prescription drug multi-state purchasing agreements
and other agreements with prescription drug purchasers if the other state or
purchaser agrees to participate in any of the activities under the program.
Under current law, if a person who is eligible for BadgerCare or the purchase
plan portion of the MA program is also eligible for health care coverage that is offered
by an employer, DHFS may purchase the employer-offered health care coverage on
behalf of the person if DHFS determines that purchasing the coverage will not cost
more than providing the coverage under BadgerCare or MA.
Also under current law, if an employer offers health care coverage to its
employees, in some cases the insurer that provides the coverage must allow an
employee, or an employee's dependent, to enroll in the health care coverage plan
outside the usual enrollment periods. For example, if an employee refused coverage
under the employer's health care coverage plan during a previous enrollment period
because the employee had other health care coverage, the employee may enroll in the
employer's plan within 30 days after the other health care coverage terminates or is
exhausted. Likewise, if an employee gets married or adopts a child, the employee's
spouse or child may enroll in the employer's health care coverage plan during a
special enrollment period that lasts for 30 days from the date of the marriage or
adoption.
This bill requires an insurer that provides coverage under an employer's health
care coverage plan to permit an employee, or an employee's dependent, who is eligible
for but not enrolled in the employer's health care coverage plan to enroll in the
employer's plan during a special, 30-day enrollment period if: 1) the employee or
dependent is eligible for coverage under BadgerCare or MA; and 2) DHFS will
purchase the coverage on behalf of the employee or dependent because DHFS has
determined that it will not be more costly to pay the portion of the premium for which
the employee is responsible under the employer's plan than to provide coverage for
the employee or dependent under BadgerCare or MA. The 30-day enrollment period
begins on the date on which DHFS makes the determination about the cost of the
coverage.
Also under the bill, if DHFS determines that a waiver is required, DHFS must
request a waiver from the federal Department of Health and Human Services to
allow DHFS to require a family, as a condition of eligibility for BadgerCare, to provide
verification of an employed family member's earnings; whether the employer
provides health care coverage for which the family is eligible; and the amount that
the employer pays, if any, towards the cost of the health care coverage. Under current
law, a family with income below 185% of the poverty line is eligible for BadgerCare
if the family does not have access to employer-provided health care coverage for
which the employer pays at least 80% of the cost.
Under current law, a woman who has been screened for breast or cervical cancer
under a breast and cervical cancer early detection program authorized under a
federal grant, who requires treatment for breast or cervical cancer, who is under 65
years of age, and who is not eligible for health care coverage that qualifies under a
federal law as creditable coverage, (which generally includes any type of health care
coverage) is eligible for MA.
This bill expands the MA eligibility based on breast or cervical cancer in two
ways. First, in conformity with the interpretation of the Centers for Medicare and
Medicaid Services, the requirement that the woman is being treated for breast or
cervical cancer is expanded to include treatment for a precancerous condition of the
breast or cervix. Second, the requirement that a woman must be ineligible for
creditable coverage is changed, in conformity with a change in federal law, to exclude
from consideration eligibility for a medical care program of the federal Indian Health
Service or an American Indian tribal organization.
Under current law, a person who receives MA and who is in a public medical
institution, hospital, skilled nursing facility, or intermediate care facility generally
may retain $45 per month in unearned income for personal needs and must apply
any excess income toward the cost of his or her care in the institution or facility. This
bill changes the amount that may be retained for personal needs to $30 per month.
Under current law, to qualify for MA, an applicant must meet certain income
and asset limits. DHFS must exclude certain assets when determining whether an
applicant meets the asset limit, including up to $3,000 in an irrevocable burial trust.
This bill decreases the limit on an irrevocable burial trust to $1,500.
Under current law, mental health and psychological rehabilitative services
provided by a community support program to individuals with mental illness who
live in the community are a covered benefit under MA. The county pays all costs for
the services that are not paid by the federal government. Also covered, but only if
a county elects to offer the services as a benefit, are psychosocial services provided
by a community-based psychosocial service program to individuals with less severe
mental illness who live in the community. A county that elects to provide the services
as a benefit must pay all costs not paid by the federal government. This bill
eliminates psychosocial services provided by a community-based psychosocial
service program as a benefit under MA.
Under current law, county departments of social services, human services, and
developmental disabilities services, and local health departments that have
incurred costs in excess of reimbursement for providing certain services to MA
recipients may receive from DHFS a 60% federal Medicaid matching amount for
moneys the county departments and local health departments expend to reduce
operating deficits for those costs.
The bill makes these matching payments unavailable if the federal Center for
Medicare and Medicaid Services approves a revised payment methodology for MA
services provided by a local government. If this methodology is approved, a county
department or local health department that received a distribution from DHFS of
federal Medicaid matching moneys under the program for any year after 2002 must
return the moneys to DHFS.
Currently, DHFS must make incentive payments to counties for identifying MA
applicants and recipients who have other health insurance coverage and for
identifying providers of the other coverage. This bill eliminates this requirement.
Under current law, if a married person living in a medical institution or nursing
facility or receiving long-term care through a community-based program
(institutionalized spouse) is eligible for MA and his or her spouse is not also in a
medical institution or nursing facility or receiving long-term care through a
community-based program (community spouse), a certain amount of the couple's
assets need not be used to pay for the institutionalized spouse's care and may be
transferred to or retained by the community spouse. This asset amount is called the
"community spouse resource allowance," which under current law is the greatest of
a range of specified amounts.
To comply with a federal requirement that the community spouse resource
allowance be a single amount instead of a range, this bill changes the community
spouse resource allowance to $50,000 unless the amount established in a fair hearing
or by a court order is greater.
Currently, a person whose primary disabling condition is developmental
disability is eligible for the Family Care benefit (long-term care or referral) if he or
she is a resident of a county or a member of a federally recognized American Indian
tribe or band that operated a care management organization before July 1, 2003, is
at least 18 years old, and meets functional and financial eligibility criteria.
This bill eliminates the requirement that, to be eligible for the Family Care
benefit, an otherwise eligible person whose primary disabling condition is
developmental disability be a resident of a county or member of a tribe or band that
operated a care management organization before July 1, 2003. The bill also requires
the secretary of health and family services to assess the feasibility of expanding the
Family Care Program to include two additional counties and to report to the
secretary of administration and the governor by July 1, 2004, concerning the
feasibility and whether the expansion should be included as part of the biennial
budget bill for the 2005-07 fiscal biennium.
Current law authorizes DHFS to determine the date on which the functionality
criteria for Family Care eligibility first apply to applicants for the Family Care
benefit who are not MA recipients, but the date may not be later than January 1,
2004. This bill changes the date to be not later than January 1, 2006, but, before the
determined date, persons who are not eligible for MA may receive the Family Care
benefit if funding is available.
Children
Under current law, the state receives reimbursement under Title IV-E of the
federal Social Security Act (generally referred to as IV-E funds) for costs incurred
by the state and the counties relating to foster care and the adoption of children.
DHFS distributes IV-E funds as community aids to counties for providing social
services to children and families. If, at the end of any year, excess IV-E funds remain,
DHFS must carry forward to the next year those excess IV-E funds and distribute
not less than 50% of those excess IV-E funds to counties other than Milwaukee
County that are making a good faith effort to implement the statewide automated
child welfare information system for services and projects to assist children and
families. This bill requires DHFS to reduce by 50% the amount of excess IV-E funds
distributed to a county if, at the end of any year, the county is not using a centralized
unit contracted for by DHFS to determine if the cost of providing care for a child is
eligible for IV-E reimbursement.
Under current law, certain federal revenues are appropriated to DHFS for
distribution to counties for social, mental health, developmental disabilities, and
alcohol and other drug abuse services. This bill appropriates for distribution to
counties, as community aids, all federal MA moneys received in reimbursement of
the cost of preventing out-of-home placements of children.
Health
Under current law, DHFS inspects, licenses, and otherwise regulates nursing
homes and community-based residential facilities (C-BRFs). Revenues from
nursing home and C-BRF licensing fees are, in part, used for the costs of the
inspections and licensing. DHFS imposes and directly assesses forfeitures on
C-BRFs, ranging from $10 to $1,000, for each violation of regulatory statutes or
rules. DHFS also imposes and directly assesses forfeitures on nursing homes.
The bill increases from $1,000 to $10,000 the maximum amount of a forfeiture
that DHFS may impose on a violating C-BRF. The bill requires DHFS to impose on
a violating nursing home a forfeiture surcharge of 6% of each forfeiture amount.
Under current law, DHFS levies assessments on all occupied, licensed beds of
nursing homes and intermediate care facilities for the mentally retarded (ICFMRs)
that are not state-owned or state-operated or federally owned or federally operated,
except occupied, licensed beds for which payment is made under the federal Medicare
program. The assessments are $32 per month per bed of a nursing home and $100
per month per bed of an ICFMR.
This bill expands the assessments on occupied, licensed beds of nursing homes
and ICFMR to all licensed beds, including beds occupied by residents whose costs are
paid under the federal Medicare program, regardless of whether the nursing home
or ICFMR is privately owned or is owned or operated by the state or the federal
government. Under the bill, the amount of the assessment per licensed bed of a
nursing home is increased to up to $116 per month and the amount of the assessment
per licensed bed of an ICFMR is increased to up to $435 per month in fiscal year
2003-04 and up to $445 per month in fiscal year 2004-05. Of the amounts received
from the assessment, a portion is deposited into the general fund and the remainder
is deposited into the MA trust fund.
This bill requires, beginning on January 1, 2005, every governmental unit that
provides health insurance coverage for its employees to join a pharmacy benefits
purchasing pool that uses a preferred list of covered prescription drugs. The
governmental units must seek to develop the preferred list by identifying the relative
effectiveness of prescription drugs within therapeutic classes for particular diseases
and conditions and by identifying the least costly prescription drugs among those
found to be equally effective. After the purchasing pool is developed, the pool must
be available to an employer that is not a governmental unit and that provides health
insurance coverage to any of the employer's employees, if the governor requests the
employer to participate in the pool.
Under current law, elderly persons may purchase prescription drugs at reduced
prices under Senior Care. Persons eligible for Senior Care are state residents who
are at least 65 years old, who are not MA recipients or do not receive prescription
drug coverage as MA recipients, and whose annual household incomes do not exceed
240% of the federal poverty line for families the size of each person's eligible family.
Persons who meet these requirements must pay a 12-month program enrollment fee
of $20 and an annual $500 deductible for prescription drugs, at the "program
payment rate" (the MA prescription drug payment rate, plus 5%, plus a dispensing
fee), and then need pay only a copayment of $5 for generic prescription drugs and a
copayment of $15 for nongeneric prescription drugs. (Eligible persons with an
annual household income that does not exceed 160% of the federal poverty line for
families the size of the persons' eligible families are not required to pay the $500
deductible.) Other persons who meet all the requirements except the income
limitation are also eligible to purchase prescription drugs at reduced amounts under
Senior Care if, for each 12-month benefit period, they pay the program enrollment
fee and then first "spend down" their income by paying for prescription drugs, at the
program payment rate, a deductible of $500 plus, at the retail price, the difference
between their annual household income and 240% of the federal poverty line.
Payment is made to pharmacies and pharmacists, for prescription drugs sold to
Senior Care participants, by the state from the rebate payments and from general
purpose revenues, at the program payment rate.
This bill increases the deductible for each 12-month Senior Care benefit period
and the program enrollment fee for Senior Care participants based on the percentage
that a person's annual household income is of the federal poverty line for a family the
size of the person's eligible family. The bill also modifies the program enrollment fee
based on a person's income and reduces the program payment rate for payment to
pharmacies and pharmacists, to the MA prescription drug payment rate, plus a
dispensing fee.
Under current law, the Tobacco Control Board awards grants from the tobacco
control fund for activities related to smoking prevention and cessation. This bill
eliminates the Tobacco Control Board and transfers its responsibilities and
administration of the tobacco control fund to DHFS.
Annually on June 15 beginning in 2004, JCF must transfer from the permanent
endowment fund to the tobacco control fund the lesser of $25,000,000 or the proceeds
of, and investment earnings on, investments of the permanent endowment fund in
the prior year. Also on June 15 annually, beginning in 2004, a transfer must be made
from the general fund to the tobacco control fund of $25,000,000, less the amount that
must be transferred to the tobacco control fund from the permanent endowment
fund. This bill requires JCF to transfer annually, beginning on June 15, 2004, from
the permanent endowment fund to the tobacco control fund the lesser of $15,054,500
for fiscal year 2003-04, and the lesser of $15,062,000 for fiscal year 2004-05 and
every fiscal year thereafter, or the proceeds of, and investment earnings on,
investments of the permanent endowment fund in the prior calendar year. The bill
also makes a transfer from the general fund to the tobacco control fund annually,
beginning on June 15, 2004, of $15,054,500 for fiscal year 2003-04, and $15,062,000
for fiscal year 2004-05 and every fiscal year thereafter, less the amount transferred
by JCF to the tobacco control fund from the permanent endowment fund in that fiscal
year.
Under current law, DHFS evaluates grade A dairy operations to certify the
compliance rating of the operations to federal agencies, out-of-state markets,
DATCP, and local health departments. This bill transfers the certification of grade
A dairy operations, and incumbent employees performing the certification, from
DHFS to DATCP.
Under current law, the Adolescent Pregnancy Prevention and Pregnancy
Services (APPPS) Board is attached to DOA. The board must award not more than
$439,300 annually in grants to nonprofit corporations or public agencies to provide
adolescent pregnancy prevention programs or pregnancy services that include
health care, education, counseling, and vocational training. This bill eliminates the
APPPS Board and the grant program.
Under current law, DHFS annually assesses hospitals $1,500,000, in
proportion to each hospital's gross private-pay patient revenues during the
hospital's most recently concluded fiscal year. Of the assessments, 50% is used to
maintain a program, commonly known as Wisconcare, to provide primary health
care services to unemployed persons or persons employed fewer than 25 hours per
week who have no health care coverage, are unable to obtain health care coverage,
and have a family income that does not exceed 150% of the federal poverty line. The
remaining 50% is used to fund graduate medical education for the training of MA
program providers. This bill eliminates the assessments, eliminates the Wisconcare
program, and eliminates the funding of graduate medical education for the training
of MA providers.
Currently, DHFS provides funding to the Marquette University School of
Dentistry to provide dental services in underserved areas and to underserved
populations, to inmates of correctional centers in Milwaukee County, and in clinics
in the city of Milwaukee. DHFS also annually awards grants for fluoride
supplements, fluoride mouth rinses, and, in schools, dental sealants. This bill
eliminates this funding and these grants.
Under current law, DHFS must collect, analyze, and disseminate claims
information and other health care information from health care providers. This bill
eliminates this requirement.
Mental illness and developmental disabilities
Currently, DHFS maintains three state centers for persons with developmental
disabilities. This bill permits DHFS to maintain the Northern Center for the
Developmentally Disabled, but also authorizes DHFS to sell assets and real property
of the Northern Center for the Developmentally Disabled. If any of this property is
sold, DHFS must deposit the net proceeds into the budget stabilization fund.
Under current law, the state centers for the developmentally disabled may
provide intensive treatment services for up to 50 individuals with developmental
disabilities who are also diagnosed as mentally ill or who exhibit extremely
aggressive and challenging behaviors. This bill removes the limit on the number of
individuals who may be provided intensive treatment services at the state centers
for the developmentally disabled. However, the bill conditions receipt of those
services on a determination by DHFS that a licensed bed and necessary resources
are available and on an agreement between DHFS and the individual's county of
residence concerning a maximum discharge date for the individual. The bill also
authorizes DHFS to impose on counties that pay for these services a progressive
surcharge of an additional 10% of the amount paid under MA for the intensive
treatment services, for any part of the six-month period that an individual receives
the services beyond the discharge date agreed upon by DHFS and the individual's
county of residence. For each subsequent six-month period during any part of which
the individual receives the services, the surcharge is increased by an additional 10%.
From the moneys received under this surcharge, DHFS may pay to counties the costs
associated with relocating individuals into communities from state centers for the
developmentally disabled.
This bill provides funding in fiscal years 2003-04 and 2004-05 for mental
health and alcohol or other drug abuse managed care demonstration projects in up
to six counties.
Under current law, DHFS funds competency examinations of criminal
defendants in Milwaukee County. This bill limits DHFS funding for competency
examinations of criminal defendants to those outpatient competency examinations
that are for criminal defendants who are in jails or in locked units of facilities.
Other health and human services
Currently, the Health Insurance Risk-Sharing Plan (HIRSP) provides major
medical health insurance coverage for persons who are covered under Medicare
because they are disabled, persons who have tested positive for human
immunodeficiency virus, and persons who have been refused coverage, or coverage
at an affordable price, in the private health insurance market because of their mental
or physical health condition (collectively called eligible persons). Also eligible for
coverage are persons who do not currently have health insurance coverage, but who
were covered under certain types of health insurance coverage for at least 18 months
in the past (eligible individuals).
Under current law, the operating costs of HIRSP are first paid with general
purpose revenue and when those funds are exhausted the remainder of the operating
costs are paid 60% by premiums paid by persons covered under HIRSP and 40%
through insurer assessments and provider discounts, in equal amounts. Premiums
for eligible persons with annual household incomes below $25,000, and deductibles
for eligible persons with annual household incomes below $20,000, are partially
subsidized with more general purpose revenue and, if that is insufficient, with
further insurer assessments and provider discounts.
Under this bill, general purpose revenue is no longer used to pay operating costs
or premium and deductible subsidies. Operating costs are paid 58% by premiums
paid by covered persons, 21% through insurer assessments, and 21% through
provider discounts. Premium and deductible subsidies are paid by increasing
insurer assessments and by further reducing provider payment rates, in equal
amounts. In addition, the bill authorizes DHFS to provide subsidies for prescription
drug copayments paid by eligible persons with annual household incomes below
$25,000. These subsidies will also be paid equally by insurer assessments and
provider payment rate discounts.
HIRSP is administered by DHFS, in conjunction with a plan administrator and
a board of governors. Current law provides that the plan administrator is the same
fiscal agent with which DHFS contracts to administer MA. This bill eliminates the
requirement that the plan administrator be the fiscal agent for MA and provides that
the plan administrator may be selected by DHFS in a competitive bidding process.
Under current law, DHFS operates a Retired Senior Volunteers Program
(RSVP) to provide volunteer services in a community by persons aged 60 or older.
DHFS provides a state supplement to federally funded RSVP units that were in
operation on December 1, 1988, and provides an additional supplement to counties
and federally-recognized tribal governing bodies for federally and nonfederally
funded RSVPs. Persons who volunteer under a RSVP receive transportation
assistance and accident and liability insurance coverage during working hours.
This bill eliminates the RSVP.
Under current law, DHFS distributes community aids to counties to provide
social, mental health, developmental disabilities, and alcohol and other drug abuse
services. Community aids funds allocated to a county that are not spent or
encumbered by December 31 of each year lapse to the general fund, except that
DHFS, at the request of the county, must carry forward to the next year up to 3% of
the total amount of community aids allocated to the county for a year. Current law
also permits DHFS to carry forward 10% of any community aids funds that are not
spent or encumbered by a county by December 31 of each year and that are not
otherwise carried forward for emergencies, for services costs above planned levels,
and for increased costs due to population shifts.
This bill requires DHFS, at the request of a county, to carry forward to the next
year up to 5% of the community aids funds allocated to the county for family support
programs for the families of children with disabilities for a year. The bill also permits
DHFS to carry forward all other community aids funds allotted for those family
support programs that are not spent or encumbered by a county by December 31 of
each year and that are not otherwise carried forward for emergencies, for services
costs above planned levels, and for increased costs due to population shifts.
Under current law, DWD must distribute child support incentive payments to
counties according to a formula worked out between DWD and the counties. The
incentive payments come from federal incentive payments made to the state on the
basis of successful child support enforcement efforts of DWD and county child
support agencies and from certain child support collections assigned to the state by
public assistance recipients. The total incentive payments that are paid to all
counties in a year may not exceed $12,340,000.
This bill provides that, if the incentive payments received in a year from the
federal government exceed $12,340,000, the excess amount will be divided equally
between the counties and DWD. Each county's share of one-half of the excess will
be determined according to the existing formula. DWD may use its share of any
excess incentive payments for activities under its child support enforcement
program and for the costs of receiving and disbursing support and support-related
payments.
To be eligible for food stamps under current law, a custodial parent of a child
who has an absent parent must cooperate with efforts to establish or enforce a
support order, if appropriate. Current law also provides that in a number of
situations (when, for example, the state provides certain services or benefits on
behalf of a child, such as foster care aid or medical assistance) the state is a real party
in interest for purposes of establishing paternity or securing future support or
reimbursement of aid paid by the state. As a real party in interest, the state may
commence an action or join in an action that is already commenced. This bill adds
the receipt of food stamp benefits by a custodial parent of a child as another situation
in which the state, for the purpose of establishing paternity or securing future
support or reimbursement of aid paid, is a real party in interest in an action affecting
the family that involves the custodial parent.
This bill provides that, after a diligent effort has been made to ascertain the
location of the respondent, notice of an action to revise a child support order may be
given in the same manner as notice of an action to enforce a child support order, by
delivering written notice of the action to the most recent residential or employer
address that the respondent has provided to the county child support agency. Under
current law, such notice must be given by personal service.
Under current law, DHFS contracts for activities to augment the amount of
moneys received from the federal government under MA. Current law requires
DHFS to use the moneys received as a result of these income augmentation activities
to pay for the operational costs of those activities and permits DHFS to use the
moneys for other purposes if the secretary of administration and JCF, under a
14-day passive review process, approve a plan submitted by DHFS for the proposed
use of the moneys. This bill requires DHFS to distribute not less than 50% of the
federal MA moneys received as a result of income augmentation activities to counties
that are participating in the activities for social, mental health, developmental
disabilities, and alcohol and other drug abuse services.
Insurance
Under current law, certain health care providers are required to carry health
care liability insurance with specified liability limits. Damages awarded in a
medical malpractice action that exceed the policy limits of the health care liability
insurance of a health care provider subject to the health care liability insurance
requirements are paid by the patients compensation fund. Money for the fund comes
from annual assessments paid by the health care providers subject to the health care
liability insurance requirements.
This bill creates the health care provider availability and cost control fund,
transfers $200,000,000 from the patients compensation fund to the new fund, and
provides for the payment of any medical malpractice award that exceeds the moneys
remaining in the patients compensation fund with moneys from the general fund.
The new fund may be used to assist in the education and training of health care
providers, to ensure that health care providers serving recipients under the Medical
Assistance program or other health care programs established by the state receive
payment sufficient for their continued participation in these programs, and to defray
the cost of other health-related programs. This bill also appropriates money from
the new fund for benefits under the Medical Assistance program.
This bill eliminates the requirement that the Commissioner of Insurance and
each employee of OCI have a separate public officer's bond providing $100,000 of
coverage.
local government
Under current law, shared revenue payments in 2003 and county and
municipal aid payments in 2004 are paid entirely from the general fund. Under this
bill, of the total amount of shared revenue payments to be distributed in November
2003, $230,000,000 will be paid from the transportation fund, rather than from the
general fund. Of the total amount of county and municipal aid payments to be
distributed in November 2004, $170,000,000 will be paid from the transportation
fund, rather than from the general fund, and $20,000,000 will be paid from the utility
public benefits fund, rather than from the general fund.
In general the base for determining the amount of county and municipal aid
payments in 2004 is the amount of shared revenue that each county and municipality
received in 2003. After DOR determines the base amount for each county and
municipality, DOR reduces the payments to each county and municipality by
subtracting from the payments an amount based on the county's or municipality's
population, so that the total amount of all such payments is reduced by $40,000,000.
