SECTION 7. 48.975 (4m) of the statutes is created to read:
48.975 (4m) RECOVERY OF INCORRECT PAYMENTS. The department may recover an overpayment of adoption assistance from an adoptive parent who continues to receive adoption assistance for maintenance by reducing the amount of the adoptive parent's monthly payment of adoption assistance for maintenance. The department may by rule specify other methods for recovering overpayments of adoption assistance.
SECTION 8. 49.197 (1m) of the statutes is amended to read:
49.197 (1m) FRAUD INVESTIGATION. From the appropriations under s. 20.445 (3) (dz), (kx), (L), (md), (n), and (nL), the department shall establish a program to investigate suspected fraudulent activity on the part of recipients of aid to families with dependent children under s. 49.19, on the part of participants in the Wisconsin works Works program under ss. 49.141 to 49.161, and, if the department of health and family services contracts with the department under sub. (5), on the part of recipients of medical assistance under subch. IV and, food stamp benefits under the food stamp program under 7 USC 2011 to 2036, supplemental security income payments under s. 49.77, payments for the support of children of supplemental security income recipients under s. 49.775, and health care benefits under the Badger Care health care program under s. 49.665. The department's activities under this subsection may include, but are not limited to, comparisons of information provided to the department by an applicant and information provided by the applicant to other federal, state, and local agencies, development of an advisory welfare investigation prosecution standard, and provision of funds to county departments under ss. 46.215, 46.22, and 46.23 and to Wisconsin works Works agencies to encourage activities to detect fraud. The department shall cooperate with district attorneys regarding fraud prosecutions.
SECTION 9. 49.197 (3) of the statutes is amended to read:
49.197 (3) STATE ERROR REDUCTION ACTIVITIES. The department shall conduct activities to reduce payment errors in Wisconsin works Works under ss. 49.141 to 49.161 and, if the department of health and family services contracts with the department under sub. (5), the medical assistance Medical Assistance program under subch. IV and, the food stamp program under 7 USC 2011 to 2036, the supplemental security income payments program under s. 49.77, the program providing payments for the support of children of supplemental security income recipients under s. 49.775, and the Badger Care health care program under s. 49.665.
SECTION 10. 49.197 (4) of the statutes is amended to read:
49.197 (4) COUNTY AND TRIBAL ERROR REDUCTION. If the department of health and family services contracts with the department under sub. (5), the department shall provide funds from the appropriation under s. 20.445 (3) (kx) to counties and governing bodies of federally recognized American Indian tribes administering medical assistance Medical Assistance under subch. IV or, the food stamp program under 7 USC 2011 to 2036, the supplemental security income payments program under s. 49.77, the program providing payments for the support of children of supplemental security income recipients under s. 49.775, and the Badger Care health care program under s. 49.665 to offset administrative costs of reducing payment errors in those programs.
SECTION 11. 49.197 (5) of the statutes is amended to read:
49.197 (5) CONTRACTS FOR MEDICAL ASSISTANCE AND, FOOD STAMPS, SUPPLEMENTAL SECURITY INCOME, AND CARETAKER SUPPLEMENT. The Notwithstanding s. 49.845 (1) and (2), the department of health and family services may contract with the department to investigate suspected fraudulent activity on the part of recipients of medical assistance under subch. IV or recipients of, food stamp benefits under the food stamp program under 7 USC 2011 to 2036, supplemental security income payments under s. 49.77, payments for the support of children of supplemental security income recipients under s. 49.775, and health care benefits under the Badger Care health care program under s. 49.665 and to conduct activities to reduce payment errors in the Medical Assistance program under subch. IV, the food stamp program under 7 USC 2011 to 2036, the supplemental security income payments program under s. 49.77, the program providing payments for the support of children of supplemental security income recipients under s. 49.775, and the Badger Care health care program under s. 49.665, as provided in this section.
SECTION 12. 49.45 (2) (a) 3m. of the statutes is repealed.
SECTION 13. 49.77 (6) of the statutes is created to read:
49.77 (6) AUTHORITY TO ADMINISTER; RULES. The department shall administer this section and s. 49.775, and may promulgate rules to guide the administration of eligibility determinations and benefits payments.
SECTION 14. 49.78 (8) (a) of the statutes is amended to read:
49.78 (8) (a) From the appropriation accounts under s. 20.435 (4) (bn) and (nn) and subject to par. (b), the department shall reimburse each county and tribal governing body that contracts with the department under sub. (2) for reasonable costs of administering the income maintenance programs. The amount of each reimbursement paid under this paragraph shall be calculated using a formula based on workload within the limits of available state and federal funds under s. 20.435 (4) (bn) and (nn) by contract under sub. (2). The amount of reimbursement calculated under this paragraph and par. (b) is in addition to any reimbursement provided to a county or tribal governing body for fraud and error reduction under s. 49.197 (1m) and (4) or 49.845.
SECTION 15. 49.79 (9) of the statutes is repealed.
SECTION 16. 49.845 of the statutes is created to read:
49.845 Fraud investigation and error reduction. (1) FRAUD INVESTIGATION. From the appropriations under s. 20.435 (4) (bn), (kz), (L), and (nn), the department of health and family services shall establish a program to investigate suspected fraudulent activity on the part of recipients of medical assistance under subch. IV, food stamp benefits under the food stamp program under 7 USC 2011 to 2036, supplemental security income payments under s. 49.77, payments for the support of children of supplemental security income recipients under s. 49.775, and health care benefits under the Badger Care health care program under s. 49.665 and, if the department of workforce development contracts with the department of health and family services under sub. (4), on the part of recipients of aid to families with dependent children under s. 49.19 and participants in the Wisconsin Works program under ss. 49.141 to 49.161. The activities of the department of health and family services under this subsection may include comparisons of information provided to the department by an applicant and information provided by the applicant to other federal, state, and local agencies, development of an advisory welfare investigation prosecution standard, and provision of funds to county departments under ss. 46.215, 46.22, and 46.23 and to Wisconsin Works agencies to encourage activities to detect fraud. The department of health and family services shall cooperate with district attorneys regarding fraud prosecutions.
(2) STATE ERROR REDUCTION ACTIVITIES. The department of health and family services shall conduct activities to reduce payment errors in the Medical Assistance program under subch. IV, the food stamp program under 7 USC 2011 to 2036, the supplemental security income payments program under s. 49.77, the program providing payments for the support of children of supplemental security income recipients under s. 49.775, and the Badger Care health care program under s. 49.665 and, if the department of workforce development contracts with the department of health and family services under sub. (4), in Wisconsin Works under ss. 49.141 to 49.161.
(3) WISCONSIN WORKS AGENCY ERROR REDUCTION. If the department of workforce development contracts with the department of health and family services under sub. (4), the department of health and family services shall provide funds from the appropriation under s. 20.435 (4) (kz) to Wisconsin Works agencies to offset the administrative costs of reducing payment errors in Wisconsin Works under ss. 49.141 to 49.161.
(4) CONTRACT FOR WISCONSIN WORKS. Notwithstanding s. 49.197 (1m) and (3), the department of workforce development may contract with the department of health and family services to investigate suspected fraudulent activity on the part of recipients of aid to families with dependent children under s. 49.19 and participants in Wisconsin Works under ss. 49.141 to 49.161 and to conduct activities to reduce payment errors in Wisconsin Works under ss. 49.141 to 49.161, as provided in this section.
SECTION 17. 49.847 of the statutes is created to read:
49.847 Recovery of incorrect payments under certain public assistance programs. (1) Subject to ss. 49.497 (1) and 49.793 (1), the department of health and family services, or a county or elected governing body of a federally recognized American Indian tribe or band acting on behalf of the department, may recover benefits incorrectly paid under any of the programs administered by the department under this chapter.
(2) The department, county, or elected governing body may recover an overpayment from a family or individual who continues to receive benefits under any program administered by the department under this chapter by reducing the family's or individual's benefit amount. Subject to s. 49.793 (1), the department may by rule specify other methods for recovering incorrectly paid benefits.
(3) Subject to ss. 49.497 (2) and 49.793 (2), a county or elected governing body may retain a portion of an amount recovered under this section due to the efforts of an employee or officer of the county, tribe, or band, as provided by the department by rule.
SECTION 18. 49.85 (1) of the statutes is amended to read:
49.85 (1) DEPARTMENT NOTIFICATION REQUIREMENT. If a county department under s. 46.215, 46.22, or 46.23 or a governing body of a federally recognized American Indian tribe or band determines that the department of health and family services may recover an amount under s. 49.497, 49.793, or 49.847, or that the department of workforce development may recover an amount under s. 49.161, or 49.195 (3), or 49.793, or collect an amount under s. 49.147 (6) (cm), the county department or governing body shall notify the affected department of the determination. If a Wisconsin works Works agency determines that the department of workforce development may recover an amount under s. 49.161 or 49.195 (3), or collect an amount under s. 49.147 (6) (cm), the Wisconsin works Works agency shall notify the department of workforce development of the determination.
SECTION 19. 49.85 (2) (b) of the statutes is amended to read:
49.85 (2) (b) At least annually, the department of workforce development shall certify to the department of revenue the amounts that, based on the notifications received under sub. (1) and on other information received by the department of workforce development, the department of workforce development has determined that it may recover under ss. 49.161, and 49.195 (3), and 49.793, and collect under s. 49.147 (6) (cm), except that the department of workforce development may not certify an amount under this subsection unless it has met the notice requirements under sub. (3) and unless its determination has either not been appealed or is no longer under appeal.
SECTION 20. 49.85 (3) (a) 1. of the statutes is amended to read:
49.85 (3) (a) 1. Inform the person that the department of health and family services intends to certify to the department of revenue an amount that the department of health and family services has determined to be due under s. 49.45 (2) (a) 10. or, 49.497, 49.793, or 49.847, for setoff from any state tax refund that may be due the person.
SECTION 21. 49.85 (3) (b) 1. of the statutes is amended to read:
49.85 (3) (b) 1. Inform the person that the department of workforce development intends to certify to the department of revenue an amount that the department of workforce development has determined to be due under s. 49.161, or 49.195 (3), or 49.793, or to be delinquent under a repayment agreement for a loan under s. 49.147 (6), for setoff from any state tax refund that may be due the person.
SECTION 22. 71.93 (1) (a) 3. of the statutes is amended to read:
71.93 (1) (a) 3. An amount that the department of health and family services may recover under s. 49.45 (2) (a) 10. or, 49.497, 49.793, or 49.847, if the department of health and family services has certified the amount under s. 49.85.
SECTION 23. 71.93 (1) (a) 4. of the statutes is amended to read:
71.93 (1) (a) 4. An amount that the department of workforce development may recover under s. 49.161, or 49.195 (3), or 49.793, or may collect under s. 49.147 (6) (cm), if the department of workforce development has certified the amount under s. 49.85.
SECTION 24. 978.05 (4m) of the statutes is amended to read:
978.05 (4m) WELFARE FRAUD INVESTIGATIONS. Cooperate with the department departments of workforce development and health and family services regarding the fraud investigation program programs under s. ss. 49.197 (1m) and 49.845 (1).
(End)
LRB-0267LRB-0267/1
PJK:kjf:jf
2005 - 2006 LEGISLATURE
DOA:......Jablonsky, BB0037 - Eliminate double-counting of HIRSP deductible subsidy
For 2005-07 Budget -- Not Ready For Introduction
2005 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
Health and human services
Other health and human services
The Health Insurance Risk-Sharing Plan (HIRSP) under current law 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 (HIV), 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, as well as 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. DHFS and a board of governors administer HIRSP.
Sixty percent of the operating costs of HIRSP are paid by premiums paid by HIRSP enrollees and 40 percent of the operating costs are paid in equal amounts through insurer assessments and provider payment rate discounts. Premiums, deductibles, and prescription drug copayments for low-income HIRSP enrollees are subsidized by increasing insurer assessments and further reducing provider payment rates, in equal amounts.
In the statutory formula that DHFS uses for setting premiums, insurer assessments, and provider payment rates, the amounts received for premium, deductible, and prescription drug copayment subsidies are included in the premium amount that DHFS must set to equal 60 percent of HIRSP's operating costs. As a result, when their premiums are determined, HIRSP enrollees are given credit for the amounts paid by insurers and providers for premium, deductible, and prescription drug copayment subsidies. This bill removes the amounts paid by insurers and providers for deductible and prescription drug copayment subsidies from inclusion in the amount in the formula that equals 60 percent of HIRSP's operating costs. That formula amount, however, still includes the premium subsidies paid by insurers and providers.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 149.143 (1) (intro.) of the statutes is amended to read:
149.143 (1) (intro.) The department shall pay or recover the operating costs of the plan from the appropriation under s. 20.435 (4) (v) and administrative costs of the plan from the appropriation under s. 20.435 (4) (u). For purposes of determining premiums, insurer assessments and provider payment rate adjustments, the department shall apportion and prioritize responsibility for payment or recovery of plan costs, excluding deductible reductions under s. 149.14 (5) (a) and prescription drug copayment reductions under s. 149.14 (5) (e), from among the moneys constituting the fund as follows:
SECTION 2. 149.143 (1) (am) 1. of the statutes is amended to read:
149.143 (1) (am) 1. First, from premiums from eligible persons with coverage under s. 149.14 (2) (a) set at a rate that is 140% to 150% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan and from eligible persons with coverage under s. 149.14 (2) (b) set in accordance with s. 149.14 (5m), including amounts received for premium, deductible, and prescription drug copayment subsidies under s. 149.144, and from premiums collected from eligible persons with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b).
SECTION 3. 149.143 (1) (am) 3. of the statutes is amended to read:
149.143 (1) (am) 3. Third, by increasing premiums from eligible persons with coverage under s. 149.14 (2) (a) to more than the rate at which premiums were set under subd. 1. but not more than 200% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan and from eligible persons with coverage under s. 149.14 (2) (b) by a comparable amount in accordance with s. 149.14 (5m), including amounts received for premium, deductible, and prescription drug copayment subsidies under s. 149.144, and by increasing premiums from eligible persons with coverage under s. 149.146 in accordance with s. 149.146 (2) (b), to the extent that the amounts under subds. 1. and 2. are insufficient to pay 60% of plan costs.
SECTION 4. 149.143 (2) (a) (intro.) of the statutes is amended to read:
149.143 (2) (a) (intro.) Prior to each plan year, the department shall estimate the operating and administrative costs of the plan and the costs of the premium reductions under s. 149.165, the deductible reductions under s. 149.14 (5) (a), and any prescription drug copayment reductions under s. 149.14 (5) (e) for the new plan year and do all of the following:
SECTION 5. 149.143 (2) (a) 1. a. of the statutes is amended to read:
149.143 (2) (a) 1. a. Estimate the amount of enrollee premiums that would be received in the new plan year if the enrollee premiums were set at a level sufficient, when including amounts received for premium, deductible, and prescription drug copayment subsidies under s. 149.144 and from premiums collected from eligible persons with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b), to cover 60% of the estimated plan costs for the new plan year.
SECTION 6. 149.143 (2m) (a) 1. of the statutes is amended to read:
149.143 (2m) (a) 1. The amount of premiums received in a plan year from all eligible persons, including amounts received for premium, deductible, and prescription drug copayment subsidies.
SECTION 7. 149.143 (2m) (a) 2. of the statutes is amended to read:
149.143 (2m) (a) 2. The amount of premiums, including amounts received for premium, deductible, and prescription drug copayment subsidies, necessary to cover 60% of the plan costs for the plan year.
(End)
LRB-0269LRB-0269/1
PJK:jld:pg
2005 - 2006 LEGISLATURE
DOA:......Jablonsky, BB0039 - HIRSP Medicare deductible
For 2005-07 Budget -- Not Ready For Introduction
2005 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
Health and human services
Other health and human services
The Health Insurance Risk-Sharing Plan (HIRSP) under current law 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 (HIV), 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, as well as 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 (all called eligible persons). While an eligible person who is not covered under Medicare pays a deductible ranging from $500 to $2,500, generally depending on type of coverage and household income, an eligible person with Medicare coverage pays a deductible that is equal to the deductible under part A of Medicare.
The statutes provide that HIRSP will pay at least 80 percent of an eligible person's covered costs after those costs exceed the person's deductible, and will pay 100 percent of covered costs after the aggregate of covered costs not paid by HIRSP and the deductible exceeds $2,000 for an eligible person not covered under Medicare and $500 for an eligible person covered under Medicare. Currently, however, the deductible under part A of Medicare exceeds $500. Thus, under the statutes, HIRSP will begin paying 100 percent of covered costs incurred by an eligible person covered under Medicare before the person has paid the deductible. This bill corrects the inconsistency and provides that HIRSP will pay 100 percent of covered costs for an eligible person covered under Medicare after the covered costs exceed the lesser of $2,000 or the person's deductible, which is equal to the deductible under part A of Medicare.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 149.14 (5) (b) of the statutes is amended to read:
149.14 (5) (b) Except as provided in pars. (c) and (e), if the covered costs incurred in a calendar year by the an eligible person who is not eligible for Medicare exceed the deductible for major medical expense coverage in a calendar year, the plan shall pay at least 80% of any additional covered costs incurred by the person during the calendar year, and if the covered costs incurred in a calendar year by an eligible person who is eligible for Medicare exceed the deductible for major medical expense coverage or $2,000, whichever is less, the plan shall pay 100% of any additional covered costs incurred by the person during the calendar year.
SECTION 2. 149.14 (5) (c) of the statutes is amended to read:
149.14 (5) (c) Except as provided in par. (e), if the aggregate of the covered costs not paid by the plan under par. (b) and the deductible exceeds $500 for an eligible person receiving medicare, $2,000 for any other in a calendar year for an eligible person during a calendar year who is not eligible for Medicare, or $4,000 in a calendar year for all eligible persons in a family, the plan shall pay 100% of all covered costs incurred by the eligible person or the eligible persons in the family during the calendar year after the payment ceilings under this paragraph are exceeded.
SECTION 9421. Effective dates; health and family services.
(1) HEALTH INSURANCE RISK-SHARING PLAN DEDUCTIBLE. The treatment of section 149.14 (5) (b) and (c) of the statutes takes effect on January 1, 2006.
(End)
LRB-0270LRB-0270/1
PJK:jld:rs
2005 - 2006 LEGISLATURE
DOA:......Jablonsky, BB0040 - HIRSP eligibility
For 2005-07 Budget -- Not Ready For Introduction
2005 BILL
