Amendment SSA1-AB75

AB75-SSA1, s. 1322 Section 1322. 49.46 (2) (b) 6. e. of the statutes is amended to read:

AB75-SSA1,622,15 49.46 (2) (b) 6. e. Inpatient Subject to the limitation under s. 49.45 (30r), inpatient hospital, skilled nursing facility and intermediate care facility services for patients of any institution for mental diseases who are under 21 years of age, are under 22 years of age and who were receiving these services immediately prior to reaching age 21, or are 65 years of age or older.

AB75-SSA1, s. 1323 Section 1323. 49.46 (2) (b) 6. Lo. of the statutes is created to read:

AB75-SSA1,622,18 49.46 (2) (b) 6. Lo. Subject to the limitations under s. 49.45 (30g), community recovery services.

AB75-SSA1, s. 1323c Section 1323c. 49.46 (2) (b) 6. Lr. of the statutes is created to read:

AB75-SSA1,622,21 49.46 (2) (b) 6. Lr. Psychotherapy and alcohol and other drug abuse services, as specified under s. 49.45 (30f).

AB75-SSA1, s. 1324 Section 1324. 49.46 (2) (b) 8. of the statutes is amended to read:

AB75-SSA1,623,2 49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27 (11), 46.275, 46.277, 46.278, or 46.2785, 46.99, or under the family care benefit if a waiver is in effect under s. 46.281 (1d), or under the disabled children's long-term support program, as defined in s. 46.011 (1g).

AB75-SSA1, s. 1325 Section 1325. 49.46 (2) (b) 17. of the statutes is created to read:

AB75-SSA1,623,5 49.46 (2) (b) 17. Services under s. 49.45 (54) (b) for children participating in the early intervention program under s. 51.44, that are provided by a special educator.

AB75-SSA1, s. 1326 Section 1326. 49.46 (2) (d) of the statutes is amended to read:

AB75-SSA1,623,12 49.46 (2) (d) Benefits authorized under this subsection may not include payment for that part of any service payable through 3rd-party liability or any federal, state, county, municipal, or private benefit system to which the beneficiary is entitled. "Benefit system" does not include any public assistance program such as, but not limited to, Hill-Burton benefits under 42 USC 291c (e), in effect on April 30, 1980, or relief funded by a relief block grant.

AB75-SSA1, s. 1327 Section 1327. 49.47 (4) (b) (intro.) of the statutes is amended to read:

AB75-SSA1,623,21 49.47 (4) (b) (intro.) Eligibility exists if the applicant's property, subject to the exclusion of any amounts under the Long-Term Care Partnership Program established under s. 49.45 (31), any amounts in an independence account, as defined in s. 49.472 (1) (c), or any retirement assets that accrued from employment while the applicant was eligible for the community options program under s. 46.27 (11), or any other Medical Assistance program, including deferred compensation or the value of retirement accounts in the Wisconsin Retirement System or under the federal Social Security Act, does not exceed the following:

AB75-SSA1, s. 1328 Section 1328. 49.471 (2) of the statutes is amended to read:

AB75-SSA1,624,15 49.471 (2) Waiver and state plan amendments. The department shall request a waiver from, and submit amendments to the state Medical Assistance plan to, the secretary of the federal department of health and human services to implement BadgerCare Plus. If the state plan amendments are approved and a waiver that is substantially consistent with the provisions of this section, excluding sub. (2m), is granted and in effect, the department shall implement BadgerCare Plus beginning on January 1, 2008, the effective date of the state plan amendments, or the effective date of the waiver, whichever is latest. If the state plan amendments are approved but the terms of approval do not allow for federal funding of the cost of benefits for all or any part of one or more of the eligibility categories under sub. (4) (b), the department may at its discretion pay for the cost of benefits for all or any part of any group for which federal funding was denied exclusively with moneys from the appropriation under s. 20.435 (4) (b). If the state plan amendments are not approved or if a waiver that is substantially consistent with the provisions of this section, excluding sub. (2m), is not granted, BadgerCare Plus may not be implemented. If the state plan amendments are approved but approval is not continued or if a waiver that is substantially consistent with the provisions of this section, excluding sub. (2m), is granted but not continued in effect, BadgerCare Plus shall be discontinued.

AB75-SSA1, s. 1329 Section 1329. 49.471 (3) (a) 1. of the statutes is amended to read:

AB75-SSA1,624,24 49.471 (3) (a) 1. Notwithstanding ss. 49.46 (1), 49.465, 49.47 (4), and 49.665 (4), if the amendments to the state plan under sub. (2) are approved and a waiver under sub. (2) that is substantially consistent with all of the provisions of this section, excluding sub. (2m), is granted and in effect, an individual described in sub. (4) (a) or (b) or (5) is not eligible under s. 49.46, 49.465, 49.47, or 49.665 for Medical Assistance or BadgerCare health program benefits. The eligibility of an individual described in sub. (4) (a) or (b) or (5) for Medical Assistance benefits shall be determined under this section.

AB75-SSA1, s. 1330 Section 1330. 49.471 (3) (b) 1. (intro.) of the statutes is amended to read:

AB75-SSA1,625,7 49.471 (3) (b) 1. (intro.) If an individual over 18 years of age who is eligible for and receiving Medical Assistance benefits under s. 49.46, 49.47, or 49.665 in the month before BadgerCare Plus is implemented loses that eligibility solely due to the implementation of BadgerCare Plus and, because of his or her income, is not eligible for BadgerCare Plus, the individual shall continue receiving for 18 12 consecutive months the medical assistance he or she was receiving before the implementation of BadgerCare Plus if all of the following are satisfied:

AB75-SSA1, s. 1331 Section 1331. 49.471 (3) (b) 1. c. of the statutes is amended to read:

AB75-SSA1,625,11 49.471 (3) (b) 1. c. The individual continues to meet meets all nonfinancial eligibility requirements for the coverage that he or she had in the month before the implementation of BadgerCare Plus under this section.

AB75-SSA1, s. 1332 Section 1332. 49.471 (3) (b) 2. of the statutes is amended to read:

AB75-SSA1,625,16 49.471 (3) (b) 2. Notwithstanding subd. 1., if at any time during an individual's 18-month 12-month eligibility extension under subd. 1. any criterion under subd. 1. a. to d. is not satisfied, the individual's eligibility for the extended coverage is terminated and any time remaining in the eligibility period is lost.

AB75-SSA1, s. 1333 Section 1333. 49.471 (4) (a) 4. a. of the statutes is amended to read:

AB75-SSA1,625,23 49.471 (4) (a) 4. a. The individual is a parent or caretaker relative of a child who is living in the home with the parent or caretaker relative or who is temporarily absent from the home for not more than 6 months or, if the child has been removed from the home for more than 6 months, the parent or caretaker relative is working toward unifying the family by complying with a permanency plan under s. 48.38 or 938.38.

AB75-SSA1, s. 1334 Section 1334. 49.471 (4) (a) 5. of the statutes is amended to read:

AB75-SSA1,626,6 49.471 (4) (a) 5. An individual who, regardless of family income, was born on or after January 1, 1990, and who, on his or her 18th birthday, was in a foster care or treatment foster care placement under the responsibility of a state, as determined by the department. The coverage for an individual under this subdivision ends on the last day of the month in which the individual becomes 21 years of age, unless he or she otherwise loses eligibility sooner.

AB75-SSA1, s. 1335 Section 1335. 49.471 (4) (a) 7. of the statutes is created to read:

AB75-SSA1,626,10 49.471 (4) (a) 7. Individuals who qualify for a medical assistance eligibility extension under s. 49.46 (1) (c), (cg), or (co) when their income increases above the poverty line.

AB75-SSA1, s. 1336 Section 1336. 49.471 (4) (b) 1m. of the statutes is amended to read:

AB75-SSA1,626,13 49.471 (4) (b) 1m. A pregnant woman or unborn child who obtains eligibility under sub. (7) (b) 1.

AB75-SSA1, s. 1337 Section 1337. 49.471 (4) (b) 4. a. of the statutes is amended to read:

AB75-SSA1,626,20 49.471 (4) (b) 4. a. The individual is a parent or caretaker relative of a child who is living in the home with the parent or caretaker relative or who is temporarily absent from the home for not more than 6 months or, if the child has been removed from the home for more than 6 months, the parent or caretaker relative is working toward unifying the family by complying with a permanency plan under s. 48.38 or 938.38.

AB75-SSA1, s. 1338 Section 1338. 49.471 (5) (b) 1. of the statutes is amended to read:

AB75-SSA1,627,2 49.471 (5) (b) 1. Except as provided in sub. (6) (a) 1., a pregnant woman is eligible for the benefits specified in par. (c) during the period beginning on the day on which a qualified provider determines, on the basis of preliminary information, that the woman's family income does not exceed 300 percent of the poverty line and ending on the applicable day specified in subd. 3.

AB75-SSA1, s. 1339 Section 1339. 49.471 (5) (b) 2. of the statutes is amended to read:

AB75-SSA1,627,8 49.471 (5) (b) 2. Except as provided in sub. (6) (a) 2., a child who is not an unborn child is eligible for the benefits described in s. 49.46 (2) (a) and (b) during the period beginning on the day on which a qualified entity determines, on the basis of preliminary information, that the child's family income does not exceed 150 percent of the poverty line and ending on the applicable day specified in subd. 3.

AB75-SSA1, s. 1340 Section 1340. 49.471 (5) (c) of the statutes is renumbered 49.471 (5) (c) 2. and amended to read:

AB75-SSA1,627,14 49.471 (5) (c) 2. On behalf of a woman under par. (b) 1. whose family income exceeds 200 percent of the poverty line, the department shall audit and pay allowable charges to a provider certified under s. 49.45 (2) (a) 11. only for ambulatory prenatal care services under the benefits under sub. (11).

AB75-SSA1, s. 1341 Section 1341. 49.471 (5) (c) 1. of the statutes is created to read:

AB75-SSA1,627,19 49.471 (5) (c) 1. On behalf of a woman under par. (b) 1. whose family income does not exceed 200 percent of the poverty line, the department shall audit and pay allowable charges to a provider certified under s. 49.45 (2) (a) 11. only for ambulatory prenatal care services under the benefits described in s. 49.46 (2) (a) and (b).

AB75-SSA1, s. 1342 Section 1342. 49.471 (6) (a) of the statutes is renumbered 49.471 (6) (a) 2. and amended to read:

AB75-SSA1,628,3 49.471 (6) (a) 2. Any pregnant woman, including a pregnant woman under sub (5) (b) 1., child who is not an unborn child, including a child under sub. (5) (b) 2., parent, or caretaker relative whose family income is less than 150 percent of the poverty line is eligible for medical assistance under this section for any of the 3 months prior to the month of application if the individual met the eligibility criteria under this section and had a family income of less than 150 percent of the poverty line in that month.

AB75-SSA1, s. 1343 Section 1343. 49.471 (6) (a) 1. of the statutes is created to read:

AB75-SSA1,628,8 49.471 (6) (a) 1. Any pregnant woman, including a pregnant woman under sub. (5) (b) 1., is eligible for medical assistance under this section for any of the 3 months prior to the month of application if she met the eligibility criteria under this section in that month.

AB75-SSA1, s. 1344 Section 1344. 49.471 (6) (e) of the statutes is repealed.

AB75-SSA1, s. 1345 Section 1345. 49.471 (7) (b) 1. of the statutes is amended to read:

AB75-SSA1,628,22 49.471 (7) (b) 1. A pregnant woman, or an unborn child, whose family income exceeds 300 percent of the poverty line may become eligible for coverage under this section if the difference between the pregnant woman's or unborn child's family income and the applicable income limit under sub. (4) (b) is obligated or expended for any member of the pregnant woman's or unborn child's family for medical care or any other type of remedial care recognized under state law or for personal health insurance premiums or for both. Eligibility obtained under this subdivision continues without regard to any change in family income for the balance of the pregnancy and, for a pregnant woman but not for an unborn child, to the last day of the month in which the 60th day after the last day of the woman's pregnancy falls. Eligibility obtained by a pregnant woman under this subdivision extends to all pregnant women in the pregnant woman's family.

AB75-SSA1, s. 1346 Section 1346. 49.471 (7) (b) 2. of the statutes is amended to read:

AB75-SSA1,629,7 49.471 (7) (b) 2. A child who is not an unborn child and, whose family income exceeds 150 percent of the poverty line, and who is ineligible under this section solely because of sub. (8) (b) may obtain eligibility under this section if the difference between the child's family income and 150 percent of the poverty line is obligated or expended on behalf of the child or any member of the child's family for medical care or any other type of remedial care recognized under state law or for personal health insurance premiums or for both. Eligibility obtained under this subdivision during any 6-month period, as determined by the department, continues for the remainder of the 6-month period and extends to all children in the family.

AB75-SSA1, s. 1347 Section 1347. 49.471 (7) (b) 3. of the statutes is amended to read:

AB75-SSA1,629,17 49.471 (7) (b) 3. For a pregnant woman or an unborn child to obtain eligibility under subd. 1., the amount that must be obligated or expended in any 6-month period is equal to the sum of the differences in each of those 6 months between the pregnant woman's or unborn child's monthly family income and the monthly family income that is 300 percent of the poverty line. For a child to obtain eligibility under subd. 2., the amount that must be obligated or expended in any 6-month period is equal to the sum of the differences in each of those 6 months between the child's monthly family income and the monthly family income that is 150 percent of the poverty line.

AB75-SSA1, s. 1348 Section 1348. 49.471 (7) (c) 1. of the statutes is amended to read:

AB75-SSA1,629,21 49.471 (7) (c) 1. Deduct from family the individual's income, up to the amount of the individual's income, any payments made by amount the individual is obligated to pay for court-ordered child or family support or maintenance.

AB75-SSA1, s. 1349 Section 1349. 49.471 (8) (d) 1. f. of the statutes is created to read:

AB75-SSA1,629,23 49.471 (8) (d) 1. f. An individual described in sub. (4) (a) 7.

AB75-SSA1, s. 1350 Section 1350. 49.471 (8) (d) 2. c. of the statutes is amended to read:

AB75-SSA1,630,8 49.471 (8) (d) 2. c. One or more members of the individual's family were eligible for other health insurance coverage or Medical Assistance under s. 49.46 or 49.47 at the time the employee failed to enroll in the health insurance coverage under par. (b) 1. and no member of the family was eligible for coverage under this section at that time or, if one or more members of the individual's family were eligible for coverage under this section at that time, family income did not exceed 150 percent of the poverty line or the individual qualified for a medical assistance eligibility extension as provided in sub. (4) (a) 7.

AB75-SSA1, s. 1351 Section 1351. 49.471 (10) (a) of the statutes is amended to read:

AB75-SSA1,630,13 49.471 (10) (a) Copayments. Except as provided in s. 49.45 (18) (am) 2. and (b) 2., all cost-sharing provisions under s. 49.45 (18) apply to a recipient with coverage of the benefits described in s. 49.46 (2) (a) and (b) to the same extent as they apply to a person eligible for medical assistance under s. 49.46, 49.468, or 49.47.

AB75-SSA1, s. 1352 Section 1352. 49.471 (10) (b) 4. g. of the statutes is created to read:

AB75-SSA1,630,15 49.471 (10) (b) 4. g. An individual described in sub. (4) (a) 7.

AB75-SSA1, s. 1353 Section 1353. 49.471 (10) (b) 5. of the statutes is amended to read:

AB75-SSA1,630,23 49.471 (10) (b) 5. If a recipient who is required to pay a premium under this paragraph or under sub. (2m) or (4) (c) either does not pay a premium when due or requests that his or her coverage under this section be terminated, the recipient's coverage terminates and the recipient is not eligible for BadgerCare Plus for 6 consecutive calendar months following the date on which the recipient's coverage terminated, except for any month during that 6-month period when the recipient's family income does not exceed 150 percent of the poverty line.

AB75-SSA1, s. 1354 Section 1354. 49.471 (12) (b) of the statutes is amended to read:

AB75-SSA1,631,5 49.471 (12) (b) If the amendments to the state plan submitted under sub. (2) are approved and a waiver that is substantially consistent with all of the provisions of this section is granted and in effect, the department shall publish a notice in the Wisconsin Administrative Register that states the date on which BadgerCare Plus is implemented.

AB75-SSA1, s. 1355 Section 1355. 49.493 (1) (b) of the statutes is amended to read:

AB75-SSA1,631,8 49.493 (1) (b) "Medical benefits or assistance" means medical benefits under s. 49.02 or 253.05 or medical assistance.

AB75-SSA1, s. 1356 Section 1356. 49.665 (6) of the statutes is repealed.

AB75-SSA1, s. 1357 Section 1357. 49.686 (2) of the statutes is amended to read:

AB75-SSA1,631,15 49.686 (2) Reimbursement. From the appropriations appropriation accounts under s. 20.435 (5) (1) (am), (i), and (ma), the department may reimburse or supplement the reimbursement of the cost of AZT, the drug pentamidine, and any drug approved for reimbursement under sub. (4) (c) for an individual who is eligible under sub. (3).

AB75-SSA1, s. 1358 Section 1358. 49.686 (3) (d) of the statutes is amended to read:

AB75-SSA1,631,22 49.686 (3) (d) Has applied for coverage under and has been denied eligibility for medical assistance within 12 months prior to application for reimbursement under sub. (2). This paragraph does not apply to an individual who is eligible for benefits under the demonstration project for childless adults under s. 49.45 (23) or to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471 (11).

AB75-SSA1, s. 1359 Section 1359. 49.686 (3) (f) of the statutes is amended to read:

AB75-SSA1,632,2 49.686 (3) (f) Is an individual whose annual gross household income is at or below 200% of the poverty line and, if funding is available under s. 20.435 (1) (i) or (m) or (5) (i), is an individual whose annual gross household income is above 200% and at or below 300% of the poverty line.

AB75-SSA1, s. 1360 Section 1360. 49.686 (6) (title) of the statutes is amended to read:

AB75-SSA1,632,5 49.686 (6) (title) Health Insurance Risk-Sharing Plan pilot program coverage.

AB75-SSA1, s. 1361 Section 1361. 49.686 (6) (a) (intro.) of the statutes is amended to read:

AB75-SSA1,632,12 49.686 (6) (a) (intro.) Subject to par. (b), the department shall conduct a 3-year pilot program, to begin on January 1, 2008, under which the department may pay premiums for coverage under the Health Insurance Risk-Sharing Plan under subch. II of ch. 149, and pay copayments under that plan for prescription drugs for which reimbursement may be provided under sub. (2), for individuals who satisfy all of the following:

AB75-SSA1, s. 1362 Section 1362. 49.686 (6) (b) of the statutes is amended to read:

AB75-SSA1,632,16 49.686 (6) (b) The pilot program shall be open to a minimum of 100 participants at any given time, with more participants if the department determines that it is cost-effective.

AB75-SSA1, s. 1363 Section 1363. 49.686 (6) (c) of the statutes is amended to read:

AB75-SSA1,632,20 49.686 (6) (c) The department may promulgate rules for the administration of the pilot program. Notwithstanding s. 227.24 (3), rules under this paragraph may be promulgated as emergency rules under s. 227.24 without a finding of emergency.

AB75-SSA1, s. 1364 Section 1364. 49.688 (1) (e) of the statutes is amended to read:

AB75-SSA1,632,25 49.688 (1) (e) "Program payment rate" means the rate of payment made for the identical drug specified under s. 49.46 (2) (b) 6. h., plus 5%, plus a dispensing fee that is equal to the dispensing fee permitted to be charged for prescription drugs for which coverage is provided under s. 49.46 (2) (b) 6. h.

AB75-SSA1, s. 1365 Section 1365. 49.688 (3) (d) of the statutes is amended to read:

AB75-SSA1,633,5 49.688 (3) (d) Notwithstanding s. 49.002, if If a person who is eligible under this section has other available coverage for payment of a prescription drug, this section applies only to costs for prescription drugs for the person that are not covered under the person's other available coverage.

AB75-SSA1, s. 1366 Section 1366. 49.688 (8) of the statutes is repealed.