Wisconsin Legislature: 10,99

40.51 (7) Any employer, other than the state, may offer to all of its employees a health care coverage plan through a program offered by the group insurance board. Notwithstanding sub. (2) and ss. 40.05 (4) and 40.52 (1), the department may by rule establish different eligibility standards or contribution requirements for such employees and employers and may by rule limit the categories of employers, other than the state, which may be included as participating employers under this subchapter. Beginning on January 1, 2012, except as otherwise provided in a collective bargaining agreement under subch. IV of ch. 111, an employer may not offer a health care coverage plan to its employees under this subsection if the employer pays more than 88 percent of the average premium cost of plans offered in any tier with the lowest employee premium cost under this subsection.

10,89 Section 89. 40.52 (3) of the statutes is amended to read:

40.52 (3) The group insurance board, after consulting with the board of regents of the University of Wisconsin System, shall establish the terms of a health insurance plan for graduate assistants, for teaching assistants, and for employees-in-training designated by the board of regents, who are employed on at least a one-third full-time basis and for teachers who are employed on at least a one-third full-time basis by the University of Wisconsin System with an expected duration of employment of at least 6 months but less than one year. Annually, the director of the office of state employment relations shall establish the amount that the employer is required to pay in premium costs under this subsection.

10,90 Section 90. 40.62 (2) of the statutes is amended to read:

40.62 (2) Sick leave accumulation shall be determined in accordance with rules of the department, any collective bargaining agreement under subch. I, V , or VI of ch. 111, and ss. 13.121 (4), 36.30, 49.825 (4) (d), 49.826 (4) (d), 230.35 (2), 233.10, 757.02 (5) and 978.12 (3).

10,91 Section 91. 40.80 (3) of the statutes is amended to read:

40.80 (3) Any action taken under this section shall apply to employees covered by a collective bargaining agreement under subch. V or VI of ch. 111.

10,92 Section 92. 40.81 (3) of the statutes is amended to read:

40.81 (3) Any action taken under this section shall apply to employees covered by a collective bargaining agreement under subch. IV, or V, or VI of ch. 111.

10,93 Section 93. 40.95 (1) (a) 2. of the statutes is amended to read:

40.95 (1) (a) 2. The employee has his or her compensation established in a collective bargaining agreement under subch. V or VI of ch. 111.

10,94 Section 94. 46.284 (4) (m) of the statutes is repealed.

10,95 Section 95. 46.2895 (8) (a) 1. of the statutes is amended to read:

46.2895 (8) (a) 1. If the long-term care district offers employment to any individual who was previously employed by a county, which participated in creating the district and at the time of the offer had not withdrawn or been removed from the district under sub. (14), and who while employed by the county performed duties relating to the same or a substantially similar function for which the individual is offered employment by the district and whose wages, hours and conditions of employment were established in a collective bargaining agreement with the county under subch. IV of ch. 111 that is in effect on the date that the individual commences employment with the district, with respect to that individual, abide by the terms of the collective bargaining agreement concerning the individual's wages and, if applicable, vacation allowance, sick leave accumulation, sick leave bank, holiday allowance, funeral leave allowance, personal day allowance, or paid time off allowance until the time of the expiration of that collective bargaining agreement or adoption of a collective bargaining agreement with the district under subch. IV of ch. 111 covering the individual as an employee of the district, whichever occurs first.

10,96 Section 96. 46.2898 of the statutes is repealed.

10,97 Section 97. 46.48 (9m) of the statutes is repealed.

10,98 Section 98. 49.175 (1) (zh) of the statutes is amended to read:

49.175 (1) (zh) Earned income tax credit supplement. For the transfer of moneys from the appropriation account under s. 20.437 (2) (md) to the appropriation account under s. 20.835 (2) (kf) for the earned income tax credit, $6,664,200 in fiscal year 2009-10 and $6,664,200 $43,664,200 in fiscal year 2010-2011.

10,99 Section 99. 49.45 (2m) of the statutes is created to read:

49.45 (2m) Authorization for modifications to programs; study. (a) In this subsection, "Medical Assistance program" includes any program operated under this subchapter, demonstration program operated under 42 USC 1315, and program operated under a waiver of federal law relating to medical assistance that is granted by the federal department of health and human services.

(b) The department shall study potential changes to the Medical Assistance state plan and to waivers of federal law relating to medical assistance obtained from the federal department of health and human services for all of the following purposes:

1. Increasing the cost effectiveness and efficiency of care and the care delivery system for Medical Assistance programs.

2. Limiting switching from private health insurance to Medical Assistance programs.

3. Ensuring the long-term viability and sustainability of Medical Assistance programs.

4. Advancing the accuracy and reliability of eligibility for Medical Assistance programs and claims determinations and payments.

5. Improving the health status of individuals who receive benefits under a Medical Assistance program.

6. Aligning Medical Assistance program benefit recipient and service provider incentives with health care outcomes.

7. Supporting responsibility and choice of medical assistance recipients.

(c) If the department determines, as a result of the study under par. (b), that revision of existing statutes or rules would be necessary to advance a purpose described in par. (b) 1. to 7., the department may promulgate rules that do any of the following related to Medical Assistance programs:

1. Require cost sharing from program benefit recipients up to the maximum allowed by federal law or a waiver of federal law.

2. Authorize providers to deny care or services if a program benefit recipient is unable to share costs, to the extent allowed by federal law or waiver.

3. Modify existing benefits or establish various benefit packages and offer different packages to different groups of recipients.

4. Revise provider reimbursement models for particular services.

5. Mandate that program benefit recipients enroll in managed care.

6. Restrict or eliminate presumptive eligibility.

7. To the extent permitted by federal law, impose restrictions on providing benefits to individuals who are not citizens of the United States.

8. Set standards for establishing and verifying eligibility requirements.

9. Develop standards and methodologies to assure accurate eligibility determinations and redetermine continuing eligibility.

10. Reduce income levels for purposes of determining eligibility to the extent allowed by federal law or waiver and subject to the limitations under par. (e) 2.

(e) 1. The department shall submit an amendment to the state Medical Assistance plan or request a waiver of federal laws related to medical assistance, if necessary, to the extent necessary to implement any rule promulgated under par. (c). If the federal department of health and human services does not allow the amendment or does not grant the waiver, the department may not put the rule into effect or implement the action described in the rule.

2. The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to have in effect eligibility standards, methodologies, and procedures under the state Medical Assistance plan or waivers of federal laws related to medical assistance that are more restrictive than those in place on March 23, 2010. If the waiver request does not receive federal approval before December 31, 2011, the department shall reduce income levels on July 1, 2012, for the purposes of determining eligibility to 133 percent of the federal poverty line for adults who are not pregnant and not disabled, to the extent permitted under 42 USC 1396a (gg), if the department follows the procedures under 42 USC 1396a (gg) (3).

10,100 Section 100. 49.45 (2m) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.

10,101 Section 101. 49.45 (3) (n) of the statutes is created to read:

49.45 (3) (n) This subsection does not apply if the department promulgates a rule under sub. (2m) (c) 4., to the extent that the rule conflicts with this subsection.

10,102 Section 102. 49.45 (3) (n) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.

10,103 Section 103. 49.45 (6m) (n) of the statutes is created to read:

49.45 (6m) (n) This subsection does not apply if the department promulgates a rule under sub. (2m) (c) 4., to the extent that the rule conflicts with this subsection.

10,104 Section 104. 49.45 (6m) (n) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.

10,105 Section 105. 49.45 (8) (b) of the statutes is amended to read:

49.45 (8) (b) Reimbursement Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), reimbursement under s. 20.435 (4) (b), (o), and (w) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under par. (c).

10,106 Section 106. 49.45 (8) (b) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

49.45 (8) (b) Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), reimbursement Reimbursement under s. 20.435 (4) (b), (o), and (w) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under par. (c).

10,107 Section 107. 49.45 (8) (c) of the statutes is amended to read:

49.45 (8) (c) The department shall establish a maximum statewide allowable fee per patient care visit, for each type of visit with respect to provider, that may be no greater than the cost per patient care visit, as determined by the department from cost reports of home health agencies, adjusted for costs related to case management, care coordination, travel, record keeping and supervision, unless otherwise provided by the department by rule promulgated under sub. (2m) (c).

10,108 Section 108. 49.45 (8) (c) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

10,109 Section 109. 49.45 (8r) of the statutes is amended to read:

49.45 (8r) Payment for certain obstetric and gynecological care. The Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), the rate of payment for obstetric and gynecological care provided in primary care shortage areas, as defined in s. 36.60 (1) (cm), or provided to recipients of medical assistance who reside in primary care shortage areas, that is equal to 125% of the rates paid under this section to primary care physicians in primary care shortage areas, shall be paid to all certified primary care providers who provide obstetric or gynecological care to those recipients.

10,110 Section 110. 49.45 (8r) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

49.45 (8r) Payment for certain obstetric and gynecological care. Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), the The rate of payment for obstetric and gynecological care provided in primary care shortage areas, as defined in s. 36.60 (1) (cm), or provided to recipients of medical assistance who reside in primary care shortage areas, that is equal to 125% of the rates paid under this section to primary care physicians in primary care shortage areas, shall be paid to all certified primary care providers who provide obstetric or gynecological care to those recipients.

10,111 Section 111. 49.45 (8v) of the statutes is amended to read:

49.45 (8v) Incentive-based pharmacy payment system. The department shall establish a system of payment to pharmacies for legend and over-the-counter drugs provided to recipients of medical assistance that has financial incentives for pharmacists who perform services that result in savings to the medical assistance program. Under this system, the department shall establish a schedule of fees that is designed to ensure that any incentive payments made are equal to or less than the documented savings unless otherwise provided by the department by rule promulgated under sub. (2m) (c). The department may discontinue the system established under this subsection if the department determines, after performance of a study, that payments to pharmacists under the system exceed the documented savings under the system.

10,112 Section 112. 49.45 (8v) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

10,113 Section 113. 49.45 (18) (ac) of the statutes is amended to read:

49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag), any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the benefits under s. 49.46 (2) (a) and (b) under s. 49.471 shall pay up to the maximum amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided under s. 49.46 (2). The service provider shall collect the specified or allowable copayment, coinsurance, or deductible, unless the service provider determines that the cost of collecting the copayment, coinsurance, or deductible exceeds the amount to be collected. The department shall reduce payments to each provider by the amount of the specified or allowable copayment, coinsurance, or deductible. No Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), no provider may deny care or services because the recipient is unable to share costs, but an inability to share costs specified in this subsection does not relieve the recipient of liability for these costs.

10,114 Section 114. 49.45 (18) (ac) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag), any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the benefits under s. 49.46 (2) (a) and (b) under s. 49.471 shall pay up to the maximum amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided under s. 49.46 (2). The service provider shall collect the specified or allowable copayment, coinsurance, or deductible, unless the service provider determines that the cost of collecting the copayment, coinsurance, or deductible exceeds the amount to be collected. The department shall reduce payments to each provider by the amount of the specified or allowable copayment, coinsurance, or deductible. Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), no No provider may deny care or services because the recipient is unable to share costs, but an inability to share costs specified in this subsection does not relieve the recipient of liability for these costs.

10,115 Section 115. 49.45 (18) (ag) (intro.) of the statutes is amended to read:

49.45 (18) (ag) (intro.) Except as provided in pars. (am), (b), and (c), and subject to par. (d), a recipient specified in par. (ac) shall pay all of the following, unless otherwise provided by the department by rule promulgated under sub. (2m) (c):

10,116 Section 116. 49.45 (18) (ag) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

10,117 Section 117. 49.45 (18) (b) (intro.) of the statutes is amended to read:

49.45 (18) (b) (intro.) The Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), the following services are not subject to recipient cost sharing under this subsection:

10,118 Section 118. 49.45 (18) (b) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

49.45 (18) (b) (intro.) Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), the The following services are not subject to recipient cost sharing under this subsection:

10,119 Section 119. 49.45 (18) (d) of the statutes is amended to read:

49.45 (18) (d) No person who designates a pharmacy or pharmacist as his or her sole provider of prescription drugs and who so uses that pharmacy or pharmacist is liable under this subsection for more than $12 per month for prescription drugs received, unless otherwise provided by the department by rule promulgated under sub. (2m) (c).

10,120 Section 120. 49.45 (18) (d) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

10,121 Section 121. 49.45 (23) (a) of the statutes is amended to read:

49.45 (23) (a) The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to conduct a demonstration project to provide health care coverage for basic primary and preventive care to adults who are under the age of 65, who have family incomes not to exceed 200 percent of the poverty line, and who are not otherwise eligible for medical assistance under this subchapter, the Badger Care health care program under s. 49.665, or Medicare under 42 USC 1395 et seq. If the department promulgates a rule under sub. (2m) (c) 10., this paragraph does not apply to the extent that it conflicts with the rule.

10,122 Section 122. 49.45 (23) (a) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

10,123 Section 123. 49.45 (23) (b) of the statutes is amended to read:

49.45 (23) (b) If the waiver is granted and in effect, the department may promulgate rules defining the health care benefit plan, including more specific eligibility requirements and cost-sharing requirements. Cost Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), cost sharing may include an annual enrollment fee, which may not exceed $75 per year. Notwithstanding s. 227.24 (3), the plan details under this subsection may be promulgated as an emergency rule under s. 227.24 without a finding of emergency. If the waiver is granted and in effect, the demonstration project under this subsection shall begin on January 1, 2009, or on the effective date of the waiver, whichever is later.

10,124 Section 124. 49.45 (23) (b) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

49.45 (23) (b) If the waiver is granted and in effect, the department may promulgate rules defining the health care benefit plan, including more specific eligibility requirements and cost-sharing requirements. Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), cost Cost sharing may include an annual enrollment fee, which may not exceed $75 per year. Notwithstanding s. 227.24 (3), the plan details under this subsection may be promulgated as an emergency rule under s. 227.24 without a finding of emergency. If the waiver is granted and in effect, the demonstration project under this subsection shall begin on January 1, 2009, or on the effective date of the waiver, whichever is later.

10,125 Section 125. 49.45 (24g) (c) of the statutes is amended to read: