SB1,746,1919 (f) Home health services, limited to 60 visits per year.
SB1,746,2220 (g) Skilled nursing home services, limited to 30 days per year, and subject to
21coinsurance payment of no more than 10 percent of the allowable payment rates
22under s. 49.46 (2) for the services provided.
SB1,746,2523 (h) Inpatient rehabilitation services, limited to 60 days per year, and subject
24to coinsurance payment of no more than 10 percent of the allowable payment rates
25under s. 49.46 (2) for the services provided.
SB1,747,3
1(i) Physical, occupational, speech, and pulmonary therapy, limited to 20 visits
2per year for each type of therapy, and subject to coinsurance payment of no more than
310 percent of the allowable payment rates under s. 49.46 (2) for the services provided.
SB1,747,64 (j) Cardiac rehabilitation, limited to 36 visits per year and subject to
5coinsurance payment of no more than 10 percent of the allowable payment rates
6under s. 49.46 (2) for the services provided.
SB1,747,107 (k) Inpatient, outpatient, and transitional treatment for nervous or mental
8disorders and alcoholism and other drug abuse problems, with a copayment of no
9more than $15 per visit and coverage limits that are the same as those under the state
10employee health plan under s. 40.51 (6).
SB1,747,1311 (L) Durable medical equipment, limited to $2,500 per year, and subject to
12coinsurance payment of no more than 10 percent of the allowable payment rates
13under s. 49.46 (2) for the articles provided.
SB1,747,1614 (m) Transportation to obtain emergency medical care only, as medically
15necessary, and subject to coinsurance payment of no more than 10 percent of the
16allowable payment rates under s. 49.46 (2) for the services provided.
SB1,747,1817 (n) One refractive eye examination every 2 years, with a copayment of no more
18than $15 per visit.
SB1,747,2319 (o) Fifty percent of allowable charges for preventive and basic dental services,
20including services for accidental injury and for the diagnosis and treatment of
21temporomandibular disorders. The coverage under this paragraph is limited to $750
22per year, applies only to pregnant women and children under 19 years of age, and
23requires an annual deductible of $200 and a copayment of no more than $15 per visit.
SB1,747,2424 (p) Early childhood developmental services, for children under 6 years of age.
SB1,747,2525 (q) Smoking cessation treatment, for pregnant women only.
SB1,748,1
1(r) Prenatal care coordination, for pregnant women at high risk only.
SB1,748,11 2(11m) Provider payments and requirements. The provider of a service or
3equipment under sub. (11) shall collect the specified or allowable copayment or
4coinsurance, unless the provider determines that the cost of collecting the copayment
5or coinsurance exceeds the amount to be collected. The department shall reduce
6payments for services or equipment under sub. (11) by the amount of the specified
7or allowable copayment or coinsurance. A provider may deny care or services or
8equipment under sub. (11) if the recipient does not pay the specified or allowable
9copayment or coinsurance. If a provider provides care or services or equipment
10under sub. (11) to a recipient who is unable to share costs as specified in sub. (11),
11the recipient is not relieved of liability for those costs.
SB1,748,14 12(12) Rules; notice of effective date. (a) 1. The department may promulgate
13any rules necessary for and consistent with its administrative responsibilities under
14this section, including additional eligibility criteria.
SB1,748,2215 2. The department may promulgate emergency rules under s. 227.24 for the
16administration of this section for the period before the effective date of any
17permanent rules promulgated under subd. 1., but not to exceed the period authorized
18under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) (a), (2) (b), and (3), the
19department is not required to provide evidence that promulgating a rule under this
20subdivision as an emergency rule is necessary for the preservation of the public
21peace, health, safety, or welfare and is not required to provide a finding of emergency
22for a rule promulgated under this subdivision.
SB1,749,223 (b) If the amendments to the state plan submitted under sub. (2) are approved
24and a waiver that is consistent with all of the provisions of this section is granted and

1in effect, the department shall publish a notice in the Wisconsin Administrative
2Register that states the date on which BadgerCare Plus is implemented.
SB1, s. 1606 3Section 1606. 49.472 (6) (a) of the statutes is amended to read:
SB1,749,94 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account
5under s. 20.435 (4) (b), (gp), or (w), or (xd), the department shall, on the part of an
6individual who is eligible for medical assistance under sub. (3), pay premiums for or
7purchase individual coverage offered by the individual's employer if the department
8determines that paying the premiums for or purchasing the coverage will not be more
9costly than providing medical assistance.
SB1, s. 1607 10Section 1607. 49.472 (6) (b) of the statutes is amended to read:
SB1,749,1411 49.472 (6) (b) If federal financial participation is available, from the
12appropriation account under s. 20.435 (4) (b), (gp), or (w), or (xd), the department may
13pay medicare Part A and Part B premiums for individuals who are eligible for
14medicare and for medical assistance under sub. (3).
SB1, s. 1608 15Section 1608. 49.473 (2) (a) of the statutes is amended to read:
SB1,749,1816 49.473 (2) (a) The woman is not eligible for medical assistance under ss. 49.46
17(1) and (1m), 49.465, 49.468, 49.47, 49.471, and 49.472, and is not eligible for health
18care coverage under s. 49.665.
SB1, s. 1609 19Section 1609. 49.473 (5) of the statutes is amended to read:
SB1,749,2420 49.473 (5) The department shall audit and pay, from the appropriation
21accounts under s. 20.435 (4) (b), (gp), and (o), and (xd), allowable charges to a provider
22who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman
23who meets the requirements under sub. (2) for all benefits and services specified
24under s. 49.46 (2).
SB1, s. 1610 25Section 1610. 49.475 (1) (a) of the statutes is renumbered 49.475 (1) (ar).
SB1, s. 1611
1Section 1611. 49.475 (1) (ag) of the statutes is created to read:
SB1,750,32 49.475 (1) (ag) "Covered entity" means any of the following that is not an
3insurer:
SB1,750,44 1. A nonprofit hospital, as defined in s. 46.21 (2) (m).
SB1,750,85 2. An employer, as defined in s. 101.01 (4), labor union, or other group of persons
6organized in this state if the employer, labor union, or other group provides
7prescription drug coverage to covered individuals who reside or are employed in this
8state.
SB1,750,109 3. A comprehensive or limited health care benefits program administered by
10the state that provides prescription drug coverage.
SB1, s. 1612 11Section 1612. 49.475 (1) (am) of the statutes is created to read:
SB1,750,1512 49.475 (1) (am) "Covered individual" means an individual who is a member,
13participant, enrollee, policyholder, certificate holder, contract holder, or beneficiary
14of a covered entity, or a dependent of the individual, and who receives prescription
15drug coverage from or through the covered entity.
SB1, s. 1613 16Section 1613. 49.475 (1) (c) of the statutes is created to read:
SB1,750,2117 49.475 (1) (c) "Pharmacy benefits management" means the procurement of
18prescription drugs at a negotiated rate for dispensation in this state to covered
19individuals; the administration or management of prescription drug benefits
20provided by a covered entity for the benefit of covered individuals; or any of the
21following services provided in the administration of pharmacy benefits:
SB1,750,2222 1. Dispensation of prescription drugs by mail.
SB1,750,2423 2. Claims processing, retail network management, and payment of claims to
24pharmacies for prescription drugs dispensed to covered individuals.
SB1,750,2525 3. Clinical formulary development and management services.
SB1,751,1
14. Rebate contracting and administration.
SB1,751,32 5. Conduct of patient compliance, therapeutic intervention, generic
3substitution, and disease management programs.
SB1, s. 1614 4Section 1614. 49.475 (1) (d) of the statutes is created to read:
SB1,751,65 49.475 (1) (d) "Pharmacy benefits manager" means a person that performs
6pharmacy benefits management functions.
SB1, s. 1615 7Section 1615. 49.475 (1) (e) of the statutes is created to read:
SB1,751,98 49.475 (1) (e) "Recipient" means an individual or his or her spouse or dependent
9who has been or is one of the following:
SB1,751,1110 1. A recipient of medical assistance or of a program administered under medical
11assistance under a waiver of federal Medicaid laws.
SB1,751,1212 2. An enrollee of family care.
SB1,751,1313 3. A recipient of the Badger Care health care program.
SB1,751,1414 4. An individual who receives benefits under s. 49.68, 49.683, or 49.685.
SB1,751,1615 5. A participant in the program of prescription drug assistance for elderly
16persons under s. 49.688.
SB1,751,1717 6. A woman who receives services that are reimbursed under s. 255.06.
SB1, s. 1616 18Section 1616. 49.475 (1) (f) of the statutes is created to read:
SB1,751,2119 49.475 (1) (f) "Third party" means an entity that by statute, rule, or contract
20is responsible for payment of a claim for a health care item or service. "Third party"
21includes all of the following:
SB1,751,2222 1. An insurer.
SB1,751,24232. An employee benefit plan described in 29 USC 1003 (a) that is not exempt
24under 29 USC 1003 (b) and is not a multiple employer welfare arrangement.
SB1,751,25253. A service benefit plan, as specified in 42 USC 1396a (25) (I).
SB1,752,1
14. A pharmacy benefits manager.
SB1, s. 1617 2Section 1617. 49.475 (2) of the statutes is repealed and recreated to read:
SB1,752,43 49.475 (2) Requirements of 3rd parties. As a condition of doing business in this
4state, a 3rd party shall do all of the following:
SB1,752,75 (a) Upon the department's request and in the manner prescribed by the
6department, provide information to the department necessary for the department to
7ascertain all of the following with respect to a recipient:
SB1,752,98 1. Whether the recipient is being or has been provided coverage or a benefit or
9service by a 3rd party.
SB1,752,1210 2. If subd. 1. applies, the nature and period of time of any coverage, benefit, or
11service provided, including the name, address, and identifying number of any
12applicable coverage plan.
SB1,752,1613 (b) Accept assignment to the department of a right of a recipient to receive
143rd-party payment for an item or service for which payment under medical
15assistance has been made and accept the department's right to recover any
163rd-party payment made for which assignment has not been accepted.
SB1,752,1917 (c) Respond to an inquiry by the department concerning a claim for payment
18of a health care item or service if the department submits the inquiry less than 36
19months after the date on which the health care item or service was provided.
SB1,752,2320 (d) If all of the following apply, agree not to deny a claim submitted by the
21department under par. (b) solely because of the claim's submission date, the type or
22format of the claim form, or failure by a recipient to present proper documentation
23at the time of delivery of the service, benefit, or item that is the basis of the claim:
SB1,752,2524 1. The department submits the claim less than 36 months after the date on
25which the health care item or service was provided.
SB1,753,3
12. Action by the department to enforce the department's rights under this
2section with respect to the claim is commenced less than 72 months after the
3department submits the claim.
SB1, s. 1618 4Section 1618. 49.475 (3) (intro.) of the statutes is amended to read:
SB1,753,75 49.475 (3) Written agreement. (intro.) Upon requesting an insurer a 3rd party
6to provide the information under sub. (2) (a), the department and the 3rd party shall
7enter into a written agreement with the insurer that satisfies all of the following:
SB1, s. 1619 8Section 1619. 49.475 (3) (a) of the statutes is amended to read:
SB1,753,109 49.475 (3) (a) Identifies in detail the detailed format of the information to be
10disclosed provided to the department.
SB1, s. 1620 11Section 1620. 49.475 (3) (c) of the statutes is amended to read:
SB1,753,1312 49.475 (3) (c) Specifies how the insurer's 3rd party's reimbursable costs under
13sub. (5) will be determined and specifies the manner of payment.
SB1, s. 1621 14Section 1621. 49.475 (4) (a) of the statutes is amended to read:
SB1,753,1815 49.475 (4) (a) An insurer A 3rd party shall provide the information requested
16under sub. (2) (a) within 180 days after receiving the department's request if it is the
17first time that the department has requested the insurer 3rd party to disclose
18information under this section.
SB1, s. 1622 19Section 1622. 49.475 (4) (b) of the statutes is amended to read:
SB1,753,2320 49.475 (4) (b) An insurer A 3rd party shall provide the information requested
21under sub. (2) (a) within 30 days after receiving the department's request if the
22department has previously requested the insurer 3rd party to disclose information
23under this section.
SB1, s. 1623 24Section 1623. 49.475 (4) (d) of the statutes is created to read:
SB1,754,2
149.475 (4) (d) If a 3rd party other than an insurer fails to comply with par. (a)
2or (b), the department may so notify the attorney general.
SB1, s. 1624 3Section 1624. 49.475 (5) of the statutes is amended to read:
SB1,754,94 49.475 (5) From the appropriations under s. 20.435 (4) (bm) and (pa), the
5department shall reimburse an insurer A 3rd party that provides information under
6this section sub. (2) (a) for the insurer's 3rd party's reasonable costs incurred in
7providing the requested information, including its reasonable costs, if any, to develop
8and operate automated systems specifically for the disclosure of the information
9under this section.
SB1, s. 1625 10Section 1625. 49.475 (6) of the statutes is created to read:
SB1,754,2011 49.475 (6) Sharing information. The department of health and family services
12shall provide to the department of workforce development, for purposes of the
13medical support liability program under s. 49.22, any information that the
14department of health and family services receives under this section. The
15department of workforce development may allow a county child support agency
16under s. 59.53 (5) or a tribal child support agency access to the information, subject
17to the use and disclosure restrictions under s. 49.83, and shall consult with the
18department of health and family services regarding procedures and methods to
19adequately safeguard the confidentiality of the information provided under this
20subsection.
SB1, s. 1626 21Section 1626. 49.475 (6) of the statutes, as created by 2007 Wisconsin Act ....
22(this act), is amended to read:
SB1,755,723 49.475 (6) Sharing information. The department of health and family services
24shall provide to the department of workforce development children and families, for
25purposes of the medical support liability program under s. 49.22, any information

1that the department of health and family services receives under this section. The
2department of workforce development children and families may allow a county child
3support agency under s. 59.53 (5) or a tribal child support agency access to the
4information, subject to the use and disclosure restrictions under s. 49.83, and shall
5consult with the department of health and family services regarding procedures and
6methods to adequately safeguard the confidentiality of the information provided
7under this subsection.
SB1, s. 1627 8Section 1627. 49.48 (1m) of the statutes is amended to read:
SB1,755,159 49.48 (1m) If an individual who applies for or to renew a certification under
10sub. (1) does not have a social security number, the individual, as a condition of
11obtaining the certification, shall submit a statement made or subscribed under oath
12or affirmation to the department that the applicant does not have a social security
13number. The form of the statement shall be prescribed by the department of
14workforce development children and families. A certification issued or renewed in
15reliance upon a false statement submitted under this subsection is invalid.
SB1, s. 1628 16Section 1628. 49.48 (2) of the statutes is amended to read:
SB1,755,2017 49.48 (2) The department of health and family services may not disclose any
18information received under sub. (1) to any person except to the department of
19workforce development children and families for the purpose of making
20certifications required under s. 49.857.
SB1, s. 1629 21Section 1629. 49.48 (3) of the statutes is amended to read:
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