SB1,696,323 49.45 (3) (L) 2. The department may not pay a provider for a designated health
24service that is authorized under this section or s. 49.46 or, 49.47, or 49.471, that is
25provided as the result of a referral made to the provider by a physician and that,

1under 42 USC 1396b (s), if made on behalf of a beneficiary of medicare under the
2requirements of 42 USC 1395nn, as amended to August 10, 1993, would result in the
3denial of payment for the service under 42 USC 1395nn.
SB1, s. 1524 4Section 1524. 49.45 (3) (m) of the statutes is amended to read:
SB1,696,215 49.45 (3) (m) To be certified under sub. (2) (a) 11. to provide transportation by
6specialized medical vehicle, a person must have at least one human service vehicle,
7as defined in s. 340.01 (23g), that satisfies the requirements imposed under s. 110.05
8for a vehicle that is used to transport a person in a wheelchair. If a certified provider
9uses 2 or more vehicles to provide transportation by specialized medical vehicle, at
10least 2 of the vehicles must be human service vehicles that satisfy the requirements
11imposed under s. 110.05 for a vehicle that is used to transport a person in a
12wheelchair, and any 3rd or additional vehicle must be a human service vehicle to
13which the equipment required under s. 110.05 for transporting a person in a
14wheelchair may be added. The department shall pay for transportation by
15specialized medical vehicle under s. 49.46 (2) (b) 3. or 49.471 (11) (m) that is provided
16in a human service vehicle that is not equipped to transport a person in a wheelchair
17if the person being transported does not use a wheelchair. The reimbursement rate
18for transportation by specialized medical vehicle provided in a vehicle that is not
19equipped to accommodate a wheelchair shall be the same as for transportation by
20specialized medical vehicle provided in a vehicle that is equipped to accommodate a
21wheelchair.
SB1, s. 1524y 22Section 1524y. 49.45 (5m) (title) of the statutes is amended to read:
SB1,696,2423 49.45 (5m) (title) Supplemental funding for rural and critical access
24hospitals.
SB1, s. 1525 25Section 1525. 49.45 (5m) (am) of the statutes is amended to read:
SB1,697,10
149.45 (5m) (am) Notwithstanding sub. (3) (e), from the appropriation accounts
2under s. 20.435 (4) (b), (gp), (o), and (w), and (xd), the department shall distribute not
3more than $2,256,000 in each fiscal year 2007-08 and not more than $5,256,000 in
4fiscal year 2008-09 and each fiscal year thereafter
, to provide supplemental funds
5to rural hospitals that, as determined by the department, have high utilization of
6inpatient services by patients whose care is provided from governmental sources,
7and to provide supplemental funds to critical access hospitals, except that the
8department may not distribute funds to a rural hospital or to a critical access hospital
9to the extent that the distribution would exceed any limitation under 42 USC 1396b
10(i) (3).
SB1, s. 1526 11Section 1526. 49.45 (6c) (d) 1. of the statutes is amended to read:
SB1,698,612 49.45 (6c) (d) 1. No payment may be made under sub. (6m) to a facility or to
13an institution for mental diseases for the care of an individual who is otherwise
14eligible for medical assistance under s. 49.46 or, 49.47, or 49.471, who has
15developmental disability or mental illness and for whom under par. (b) or (c) it is
16determined that he or she does not need facility care, unless it is determined that the
17individual requires active treatment for developmental disability or active
18treatment for mental illness and has continuously resided in a facility or institution
19for mental diseases for at least 30 months prior to the date of the determination. If
20that individual requires active treatment and has so continuously resided, he or she
21shall be offered the choice of receiving active treatment for developmental disability
22or active treatment for mental illness in the facility or institution for mental diseases
23or in an alternative setting. A facility resident who has developmental disability or
24mental illness, for whom under par. (c) it is determined that he or she does not need
25facility care and who has not continuously resided in a facility for at least 30 months

1prior to the date of the determination, may not continue to reside in the facility after
2December 31, 1993, and shall, if the department so determines, be relocated from the
3facility after March 31, 1990, and before December 31, 1993. The county department
4shall be responsible for securing alternative residence on behalf of an individual who
5is required to be relocated from a facility under this subdivision, and the facility shall
6cooperate with the county department in the relocation.
SB1, s. 1527 7Section 1527. 49.45 (6c) (d) 2. of the statutes is amended to read:
SB1,698,148 49.45 (6c) (d) 2. Payment may be made under sub. (6m) to a facility or
9institution for mental diseases for the care of an individual who is otherwise eligible
10for medical assistance under s. 49.46 or, 49.47, or 49.471 and who has developmental
11disability or mental illness and is determined under par. (b) or (c) to need facility care,
12regardless of whether it is determined under par. (b) or (c) that the individual does
13or does not require active treatment for developmental disability or active treatment
14for mental illness.
SB1, s. 1528 15Section 1528. 49.45 (6m) (ag) (intro.) of the statutes is amended to read:
SB1,698,2216 49.45 (6m) (ag) (intro.) Payment for care provided in a facility under this
17subsection made under s. 20.435 (4) (b), (gp), (o), (pa), or (w), or (xd) shall, except as
18provided in pars. (bg), (bm), and (br), be determined according to a prospective
19payment system updated annually by the department. The payment system shall
20implement standards that are necessary and proper for providing patient care and
21that meet quality and safety standards established under subch. II of ch. 50 and ch.
22150. The payment system shall reflect all of the following:
SB1, s. 1530h 23Section 1530h. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:
SB1,699,1224 49.45 (6m) (ar) 1. a. The department shall establish standards for payment of
25allowable direct care costs under par. (am) 1. bm., for facilities that do not primarily

1serve the developmentally disabled, that take into account direct care costs for a
2sample of all of those facilities in this state and separate standards for payment of
3allowable direct care costs, for facilities that primarily serve the developmentally
4disabled, that take into account direct care costs for a sample of all of those facilities
5in this state. The standards shall be adjusted by the department for regional labor
6cost variations. The department shall treat as a single labor region the counties of
7Dane, Iowa, Columbia, and Sauk, and Rock and shall adjust payment so that the
8direct care cost targets of facilities in Dane, Iowa, Columbia, and Sauk counties are
9not reduced as a result of including facilities in Rock County in this labor region
. For
10facilities in Douglas, Pierce, and St. Croix counties, the department shall perform the
11adjustment by use of the wage index that is used by the federal department of health
12and human services for hospital reimbursement under 42 USC 1395 to 1395ggg.
SB1, s. 1532 13Section 1532 . 49.45 (6m) (br) 1. of the statutes is amended to read:
SB1,699,2314 49.45 (6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435 (4) (bt) or (7) (b)
15or 20.445 (3) 20.437 (2) (dz), the department shall reduce allocations of funds to
16counties in the amount of the disallowance from the appropriation account under s.
1720.435 (4) (bt) or (7) (b), or the department shall direct the department of workforce
18development
children and families to reduce allocations of funds to counties or
19Wisconsin works Works agencies in the amount of the disallowance from the
20appropriation account under s. 20.445 (3) 20.437 (2) (dz) or direct the department of
21corrections to reduce allocations of funds to counties in the amount of the
22disallowance from the appropriation account under s. 20.410 (3) (cd), in accordance
23with s. 16.544 to the extent applicable.
SB1, s. 1533 24Section 1533. 49.45 (6m) (m) of the statutes is created to read:
SB1,700,4
149.45 (6m) (m) To hold a bed in a facility, the department may pay the full
2payment rate under this subsection for up to 30 days for services provided to a person
3during the pendency of an undue hardship determination, as provided in s. 49.453
4(8) (b) 3.
SB1, s. 1534 5Section 1534. 49.45 (6v) (b) of the statutes is amended to read:
SB1,700,116 49.45 (6v) (b) The department shall, each year, submit to the joint committee
7on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that
8provides information on the utilization of beds by recipients of medical assistance in
9facilities and a discussion and detailed projection of the likely balances,
10expenditures, encumbrances and carry over of currently appropriated amounts in
11the appropriation accounts under s. 20.435 (4) (b), (gp), and (o), and (xd).
SB1, s. 1535 12Section 1535. 49.45 (6x) (a) of the statutes is amended to read:
SB1,700,1813 49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriation accounts
14under s. 20.435 (4) (b), (gp), (o), and (w), and (xd), the department shall distribute not
15more than $4,748,000 in each fiscal year, to provide funds to an essential access city
16hospital, except that the department may not allocate funds to an essential access
17city hospital to the extent that the allocation would exceed any limitation under 42
18USC 1396b
(i) (3).
SB1, s. 1536 19Section 1536. 49.45 (6y) (a) of the statutes is amended to read:
SB1,701,420 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriation accounts
21under s. 20.435 (4) (b), (gp), (o), and (w), and (xd), the department shall may
22distribute funding in each fiscal year to provide supplemental payment to hospitals
23that enter into a contract under s. 49.02 (2) to provide health care services funded
24by a relief block grant, as determined by the department, for hospital services that
25are not in excess of the hospitals' customary charges for the services, as limited under

142 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the
2allocation of funds to such hospitals would exceed any limitation under 42 USC
31396b
(i) (3), the department may distribute funds to hospitals that have not entered
4into a contract under s. 49.02 (2).
SB1, s. 1537 5Section 1537. 49.45 (6y) (am) of the statutes is amended to read:
SB1,701,126 49.45 (6y) (am) Notwithstanding sub. (3) (e), from the appropriation accounts
7under s. 20.435 (4) (b), (h), (gp), (o), and (w), and (xd), the department shall distribute
8funding in each fiscal year to provide supplemental payments to hospitals that enter
9into contracts under s. 49.02 (2) with a county having a population of 500,000 or more
10to provide health care services funded by a relief block grant, as determined by the
11department, for hospital services that are not in excess of the hospitals' customary
12charges for the services, as limited under 42 USC 1396b (i) (3).
SB1, s. 1538 13Section 1538 . 49.45 (6z) (a) (intro.) of the statutes is amended to read:
SB1,702,214 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriation
15accounts under s. 20.435 (4) (b), (gp), (o), and (w), and (xd), the department shall may
16distribute funding in each fiscal year to supplement payment for services to hospitals
17that enter into a contract under s. 49.02 (2) to provide health care services funded
18by a relief block grant under this chapter
indigent care agreements, in accordance
19with the approved state plan for services under 42 USC 1396a, with relief agencies
20that administer the medical relief block grant under this chapter
, if the department
21determines that the hospitals serve a disproportionate number of low-income
22patients with special needs. If no medical relief block grant under this chapter is
23awarded or if the allocation of funds to such hospitals would exceed any limitation
24under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that
25have not entered into a contract under s. 49.02 (2) indigent care agreements. The

1department may not distribute funds under this subsection to the extent that the
2distribution would do any of the following:
SB1, s. 1539 3Section 1539. 49.45 (8) (a) 4. of the statutes is amended to read:
SB1,702,124 49.45 (8) (a) 4. "Patient care visit" means a personal contact with a patient in
5a patient's home that is made by a registered nurse, licensed practical nurse, home
6health aide, physical therapist, occupational therapist, or speech-language
7pathologist who is on the staff of or under contract or arrangement with a home
8health agency, or by a registered nurse or licensed practical nurse practicing
9independently, to provide a service that is covered under s. 49.46 or, 49.47, or 49.471.
10"Patient care visit" does not include time spent by a nurse, therapist, or home health
11aide on case management, care coordination, travel, record keeping , or supervision
12that is related to the patient care visit.
SB1, s. 1540 13Section 1540. 49.45 (8) (b) of the statutes is amended to read:
SB1,702,1814 49.45 (8) (b) Reimbursement under s. 20.435 (4) (b), (gp), (o), and (w), and (xd)
15for home health services provided by a certified home health agency or independent
16nurse shall be made at the home health agency's or nurse's usual and customary fee
17per patient care visit, subject to a maximum allowable fee per patient care visit that
18is established under par. (c).
SB1, s. 1541 19Section 1541. 49.45 (9) of the statutes is amended to read:
SB1,703,1920 49.45 (9) Free choice. Any person eligible for medical assistance under ss. s.
2149.46, 49.468 and, 49.47, or 49.471 may use the physician, chiropractor, dentist,
22pharmacist, hospital, skilled nursing home, health maintenance organization,
23limited service health organization, preferred provider plan or other licensed,
24registered or certified provider of health care of his or her choice, except that free
25choice of a provider may be limited by the department if the department's alternate

1arrangements are economical and the recipient has reasonable access to health care
2of adequate quality. The department may also require a recipient to designate, in any
3or all categories of health care providers, a primary health care provider of his or her
4choice. After such a designation is made, the recipient may not receive services from
5other health care providers in the same category as the primary health care provider
6unless such service is rendered in an emergency or through written referral by the
7primary health care provider. Alternate designations by the recipient may be made
8in accordance with guidelines established by the department. Nothing in this
9subsection shall vitiate the legal responsibility of the physician, chiropractor,
10dentist, pharmacist, skilled nursing home, hospital, health maintenance
11organization, limited service health organization, preferred provider plan or other
12licensed, registered or certified provider of health care to patients. All contract and
13tort relationships with patients shall remain, notwithstanding a written referral
14under this section, as though dealings are direct between the physician, chiropractor,
15dentist, pharmacist, skilled nursing home, hospital, health maintenance
16organization, limited service health organization, preferred provider plan or other
17licensed, registered or certified provider of health care and the patient. No physician,
18chiropractor, pharmacist or dentist may be required to practice exclusively in the
19medical assistance program.
SB1, s. 1542 20Section 1542. 49.45 (18) (ac) of the statutes is amended to read:
SB1,704,721 49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag),
22any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the
23benefits under s. 49.46 (2) (a) and (b) under s. 49.471
shall pay up to the maximum
24amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided
25under s. 49.46 (2). The service provider shall collect the specified or allowable

1copayment, coinsurance, or deductible, unless the service provider determines that
2the cost of collecting the copayment, coinsurance, or deductible exceeds the amount
3to be collected. The department shall reduce payments to each provider by the
4amount of the specified or allowable copayment, coinsurance, or deductible. No
5provider may deny care or services because the recipient is unable to share costs, but
6an inability to share costs specified in this subsection does not relieve the recipient
7of liability for these costs.
SB1, s. 1543 8Section 1543. 49.45 (18) (am) of the statutes is amended to read:
SB1,704,119 49.45 (18) (am) No person is liable under this subsection for services provided
10through prepayment contracts. This paragraph does not apply to a person who is
11eligible for the benefits under s. 49.46 (2) (a) and (b) under s. 49.471.
SB1, s. 1546 12Section 1546. 49.45 (23) of the statutes is created to read:
SB1,704,2313 49.45 (23) Assistance for childless adults demonstration project. (a) The
14department shall request a waiver from the secretary of the federal department of
15health and human services to permit the department to conduct a demonstration
16project to provide health care coverage for basic primary and preventive care to
17adults who are under the age of 65, who have family incomes not to exceed 200
18percent of the poverty line, and who are not otherwise eligible for medical assistance
19under this subchapter, the Badger Care health care program under s. 49.665, or
20Medicare under 42 USC 1395 et seq. Any individual who had coverage under the
21Health Insurance Risk-Sharing Plan under subch. II of ch. 149 within 6 months
22before applying for the project under this subsection is not eligible to participate in
23the project under this subsection.
SB1,705,524 (b) If the waiver is granted and in effect, the department may promulgate rules
25defining the health care benefit plan, including more specific eligibility

1requirements and cost-sharing requirements. Notwithstanding s. 227.24 (3), the
2plan details under this subsection may be promulgated as an emergency rule under
3s. 227.24 without a finding of emergency. If the waiver is granted and in effect, the
4demonstration project under this subsection shall begin on January 1, 2009, or on
5the effective date of the waiver, whichever is later.
SB1, s. 1547 6Section 1547. 49.45 (24g) of the statutes is repealed.
SB1, s. 1548 7Section 1548. 49.45 (24m) (intro.) of the statutes is amended to read:
SB1,705,128 49.45 (24m) (intro.) From the appropriation accounts under s. 20.435 (4) (b),
9(gp), (o), and (w), and (xd), in order to test the feasibility of instituting a system of
10reimbursement for providers of home health care and personal care services for
11medical assistance recipients that is based on competitive bidding, the department
12shall:
SB1, s. 1549 13Section 1549. 49.45 (24r) of the statutes is amended to read:
SB1,705,2314 49.45 (24r) Family planning demonstration project. The department shall
15request a an amended waiver from the secretary of the federal department of health
16and human services to permit the department to conduct a demonstration project to
17provide family planning services, as defined in s. 253.07 (1) (b) (a), under medical
18assistance to any woman or man between the ages of 15 and 44 whose family income
19does not exceed 185% 200 percent of the poverty line for a family the size of the
20woman's or man's family. If The department shall implement any waiver granted
21and, if
the amendment to the waiver is granted and in effect, the department shall
22implement the amended waiver no later than July 1, 1998 January 1, 2008, or on the
23federally approved effective date of the amended waiver, whichever is later.
SB1, s. 1550 24Section 1550. 49.45 (29) of the statutes is amended to read:
SB1,706,3
149.45 (29) Hospice reimbursement. The department shall promulgate rules
2limiting aggregate payments made to a hospice under ss. 49.46 and, 49.47, and
349.471
.
SB1, s. 1551c 4Section 1551c. 49.45 (31) of the statutes is repealed and recreated to read:
SB1,706,135 49.45 (31) Long-Term Care Partnership Program. (a) The department shall
6submit to the federal department of health and human services, not later than 3
7months after the effective date of this paragraph .... [revisor inserts date], an
8amendment to the state medical assistance plan that establishes in this state a
9Long-Term Care Partnership Program, as described in this subsection, and shall
10implement the program if the amendment to the state plan is approved. Under the
11program, the department shall exclude an amount equal to the amount of benefits
12that an individual receives under a qualifying long-term care insurance policy, as
13described in par. (b), when determining any of the following:
SB1,706,1514 1. The individual's resources for purposes of determining the individual's
15eligibility for medical assistance.
SB1,706,1716 2. The amount to be recovered from the individual's estate if the individual
17receives medical assistance.
SB1,706,2018 (b) To be eligible for the program, an individual must have been a resident of
19this state when the long-term care insurance policy was issued, and the policy must
20satisfy all of the following criteria:
SB1,706,2321 1. The policy was not issued before the date specified in the amendment to the
22state plan, which may not be before the first day of the calendar quarter in which the
23amendment is submitted to the federal department of health and human services.
SB1,706,2524 2. The policy meets the definition of a qualified long-term care insurance policy
25under 26 USC 7702B (b).
SB1,707,4
13. The policy meets the long-term care insurance model regulations and the
2requirements of the long-term care insurance model act promulgated by the
3National Association of Insurance Commissioners that are specified in 42 USC
41396p
(b) (5).
SB1,707,654. The policy includes the applicable inflation protection specified in 42 USC
61396p
(b) (1) (C) (iii) (IV).
SB1,707,87 5. The commissioner of insurance certifies to the department that the policy
8meets the criteria under subds. 2. to 4.
SB1,707,149 (c) 1. The department and the office of the commissioner of insurance shall
10approve a training program for individuals who sell long-term care insurance
11policies in the state to ensure that those individuals understand the relation of
12long-term care insurance to the Medical Assistance program and are able to explain
13to consumers the protections offered by long-term care insurance and how this type
14of insurance relates to private and public financing of long-term care.
SB1,707,2015 2. The training program approved under this paragraph shall include initial
16training that is not less than 8 hours long and ongoing training sessions that are not
17less than 4 hours long per session. Individuals who sell long-term care insurance
18policies shall be required to attend an ongoing training session every 24 months after
19the initial training. The commissioner may approve the initial and ongoing training
20sessions for continuing education requirements under s. 628.04 (3).
SB1,707,2421 3. The training under this paragraph shall cover at a minimum long-term care
22insurance, long-term care services, qualified partnerships, and the relationship
23between qualified partnerships and other public and private coverage of long-term
24care costs.
SB1,708,6
1(d) An insurer that issues a long-term care insurance policy described in par.
2(b) shall be required to submit reports to the secretary of the federal department of
3health and human services, in accordance with regulations developed by the
4secretary, that include notice of when benefits are paid under the policy, the amount
5of the benefits, notice of the termination of the policy, and any other information
6required by the secretary.
SB1, s. 1552 7Section 1552. 49.45 (35) of the statutes is repealed.
SB1, s. 1553 8Section 1553. 49.45 (40) of the statutes is amended to read:
SB1,708,129 49.45 (40) Periodic record matches. If the department contracts with the
10department of workforce development children and families under s. 49.197 (5), the
11department shall cooperate with the department of workforce development children
12and families
in matching records of medical assistance recipients under s. 49.32 (7).
SB1, s. 1554 13Section 1554. 49.45 (42m) (a) of the statutes is amended to read:
SB1,708,2014 49.45 (42m) (a) If, in authorizing the provision of physical or occupational
15therapy services under s. 49.46 (2) (b) 6. b. or 49.471 (11) (i), the department
16authorizes a reduced duration of services from the duration that the provider
17specifies in the authorization request, the department shall substantiate the
18reduction that the department made in the duration of the services if the provider
19of the services requests any additional authorizations for the provision of physical
20or occupational therapy services to the same individual.
SB1, s. 1554m 21Section 1554m. 49.45 (44m) of the statutes is created to read:
SB1,709,422 49.45 (44m) Extension of parent eligibility when child dies. The department
23shall request a waiver from the secretary of the federal department of health and
24human services to permit the department to extend the eligibility of a parent, for up
25to 90 days, under the Medical Assistance program under this subchapter or the

1Badger Care health care program under s. 49.665 if the parent's child dies while both
2the parent and the child are covered under the Medical Assistance program or the
3Badger Care health care program and the parent would lose eligibility solely due to
4the death of the child. The department shall implement any waiver that is granted.
SB1, s. 1555 5Section 1555. 49.45 (48) of the statutes is amended to read:
SB1,709,106 49.45 (48) Payment of medicare part B outpatient hospital services
7coinsurances.
The department shall include in the state plan for medical assistance
8a methodology for payment of the medicare part B outpatient hospital services
9coinsurance amounts that are authorized under ss. 49.46 (2) (c) 2., 4., and 5m., 49.468
10(1) (b), and 49.47 (6) (a) 6. b., d., and f., and 49.471 (6) (j) 1.
SB1, s. 1556 11Section 1556. 49.45 (49m) (c) 1. of the statutes is amended to read:
SB1,709,1512 49.45 (49m) (c) 1. A list of the prescription drugs that are included as a benefit
13under s. ss. 49.46 (2) (b) 6. h. and 49.471 (11) (a) that identifies preferred choices
14within therapeutic classes and includes prescription drugs that bear only generic
15names.
SB1, s. 1557 16Section 1557. 49.45 (52) of the statutes is amended to read:
SB1,710,217 49.45 (52) Payment adjustments. Beginning on January 1, 2003, the
18department may, from the appropriation account under s. 20.435 (7) (b), make
19Medical Assistance payment adjustments to county departments under s. 46.215,
2046.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01
21(4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and
22(b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16. Payment
23adjustments under this subsection shall include the state share of the payments.
24The total of any payment adjustments under this subsection and Medical Assistance
25payments made from appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w),

1and (xd)
may not exceed applicable limitations on payments under 42 USC 1396a (a)
2(30) (A).
SB1, s. 1558 3Section 1558. 49.45 (53) of the statutes is amended to read:
SB1,710,74 49.45 (53) Payments for certain services. Beginning on January 1, 2003, the
5department may, from the appropriation account under s. 20.435 (7) (b), make
6Medical Assistance payments to providers for covered services under s. ss. 49.46 (2)
7(a) 4. d. and (b) 6. j. and m. and 49.471 (11) (f).
SB1, s. 1559e 8Section 1559e. 49.45 (55) of the statutes is created to read:
SB1,710,189 49.45 (55) Health Opportunity Accounts Demonstration Program. The
10department shall request from the federal Centers for Medicare and Medicaid
11Services approval to participate in a demonstration program under 42 USC 1396u-8,
12under which Badger Care recipients may voluntarily enroll to contribute to health
13opportunity accounts and receive certain alternative benefits under medical
14assistance. If the Centers for Medicare and Medicaid Services approve the
15department's request, the department shall submit a proposed plan for
16implementation of the demonstration program to the joint committee on finance.
17The department may not implement the plan until it is approved by the committee,
18as submitted or as modified.
SB1, s. 1559g 19Section 1559g. 49.45 (56) of the statutes is created to read:
SB1,711,220 49.45 (56) Disease management program. Based on the health conditions
21identified by the physical health risk assessments, if performed under sub. (57), the
22department shall develop and implement, for Medical Assistance recipients, disease
23management programs that are similar to that developed and followed by the
24Marshfield Clinic in this state under the Physician Group Practice Demonstration

1Program authorized under 42 USC 1315 (e) and (f). These programs shall have at
2least the following characteristics:
SB1,711,53 (a) The use of information science to improve health care delivery by
4summarizing a patient's health status and providing reminders for preventive
5measures.
SB1,711,76 (b) Educating health care providers on health care process improvement by
7developing best practice models.
SB1,711,108 (c) The improvement and expansion of care management programs to assist in
9standardization of best practices, patient education, support systems, and
10information gathering.
SB1,711,1211 (d) Establishment of a system of provider compensation that is aligned with
12clinical quality, practice management, and cost of care.
SB1,711,1413 (e) Focus on patient care interventions for certain chronic conditions, to reduce
14hospital admissions.
SB1, s. 1559h 15Section 1559h. 49.45 (57) of the statutes is created to read:
SB1,711,2016 49.45 (57) Physical health risk assessment. The department shall encourage
17each individual who is determined on or after the effective date of this subsection ....
18[revisor inserts date], to be eligible for Medical Assistance to receive a physical health
19risk assessment as part of the first physical examination the individual receives
20under Medical Assistance.
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