49.45 (52) (a) 2. The department may require a county department or local health department to submit a certified cost report that meets the requirements of the federal department of health and human services for covered services described in subd. 1.
32,1447
Section
1447. 49.45 (52) (b) of the statutes is created to read:
49.45 (52) (b) If the department provides the notice under par. (c) selecting the payment procedure in this paragraph, all of the following apply:
1. Annually, a county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437 shall submit a certified cost report that meets the requirements of the federal department of health and human services for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating in the early intervention program under s. 51.44.
2. For services described under subd. 1., the department shall base the amount of a claim for federal medical assistance funds on certified cost reports submitted by county departments under subd. 1. to the extent the reports comply with federal requirements.
3. The department shall pay county departments a percentage of the federal funds claimed under subd. 2. for services described under subd. 1., which percentage is established in the most recent biennial budget.
4. The department may pay a local health department, as defined in s. 250.01 (4), that submits certified cost reports for services described under subd. 1. a percentage of the federal funds claimed for those services, which percentage is established in the most recent biennial budget.
32,1448
Section
1448. 49.45 (52) (c) of the statutes is created to read:
49.45 (52) (c) The department shall select a payment procedure under either par. (a) or (b) and may change which procedure under par. (a) or (b) is selected. The department shall notify each county department and local health department, as applicable, of the selected payment procedure before the date on which payment for services is made under that selected or newly selected procedure.
32,1449
Section
1449. 49.45 (53) of the statutes is amended to read:
49.45 (53) Payments for certain services. Beginning on January 1, 2003, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payments to providers for covered services under ss. 49.46 (2) (a) 4. d. and (b) 6. j. and m. and 49.471 (11) (f) that are provided before January 1, 2012.
49.46 (1) (n) If the department creates a policy under s. 49.45 (2m) (c) 8., 9., or 10., this subsection does not apply to the extent that it conflicts with the policy.
32,1453f
Section 1453f. 49.46 (1) (n) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.
49.46 (2) (a) (intro.) Except as provided in par. (be) and unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the department shall audit and pay allowable charges to certified providers for medical assistance on behalf of recipients for the following federally mandated benefits:
32,1453i
Section 1453i. 49.46 (2) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.46 (2) (a) (intro.) Except as provided in par. (be) and unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the department shall audit and pay allowable charges to certified providers for medical assistance on behalf of recipients for the following federally mandated benefits:
49.46 (2) (b) (intro.) Except as provided in pars. (be) and (dc) and unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the department shall audit and pay allowable charges to certified providers for medical assistance on behalf of recipients for the following services:
32,1453L
Section 1453L. 49.46 (2) (b) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.46 (2) (b) (intro.) Except as provided in pars. (be) and (dc) and unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the department shall audit and pay allowable charges to certified providers for medical assistance on behalf of recipients for the following services:
32,1453m
Section 1453m. 49.46 (2) (c) 2. of the statutes is amended to read:
49.46
(2) (c) 2. For an individual who is entitled to coverage under
part Part A of
medicare Medicare, entitled to coverage under
part Part B of
medicare Medicare, meets the eligibility criteria under sub. (1)
, and meets the limitation on income under subd. 6.,
medical assistance Medical Assistance shall include payment of the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395 to
1395zz which that are not paid under
42 USC 1395 to
1395zz, including those
medicare Medicare services that are not included in the approved state plan for services under
42 USC 1396; the monthly premiums payable under
42 USC 1395v; the monthly premiums, if applicable, under
42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under
part Part A of
medicare Medicare. Payment of coinsurance for a service under
part Part B of
medicare Medicare under
42 USC 1395j to
1395w, other than payment of coinsurance for outpatient hospital services, and payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under
medical assistance Medical Assistance minus the
medicare Medicare payment.
32,1453n
Section 1453n. 49.46 (2) (c) 3. of the statutes is amended to read:
49.46
(2) (c) 3. For an individual who is only entitled to coverage under
part Part A of
medicare Medicare, meets the eligibility criteria under sub. (1)
, and meets the limitation on income under subd. 6.,
medical assistance Medical Assistance shall include payment of the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395 to
1395i which that are not paid under
42 USC 1395 to
1395i, including those
medicare Medicare services that are not included in the approved state plan for services under
42 USC 1396; the monthly premiums, if applicable, under
42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under
part Part A of
medicare Medicare. Payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under Medical Assistance minus the Medicare payment.
32,1453o
Section 1453o. 49.46 (2) (c) 4. of the statutes is amended to read:
49.46
(2) (c) 4. For an individual who is entitled to coverage under
part Part A of
medicare Medicare, entitled to coverage under
part Part B of
medicare Medicare, and meets the eligibility criteria for
medical assistance Medical Assistance under sub. (1), but does not meet the limitation on income under subd. 6.,
medical assistance Medical Assistance shall include payment of the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395 to
1395zz which that are not paid under
42 USC 1395 to
1395zz, including those
medicare Medicare services that are not included in the approved state plan for services under
42 USC 1396. Payment of coinsurance for a service under
part Part B of
medicare Medicare under
42 USC 1395j to
1395w, other than payment of coinsurance for outpatient hospital services, and payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under
medical assistance Medical Assistance minus the
medicare Medicare payment.
32,1453p
Section 1453p. 49.46 (2) (c) 5. of the statutes is amended to read:
49.46
(2) (c) 5. For an individual who is only entitled to coverage under
part Part A of
medicare Medicare and meets the eligibility criteria for
medical assistance
Medical Assistance under sub. (1), but does not meet the limitation on income under subd. 6.,
medical assistance
Medical Assistance shall include payment of the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395 to
1395i which that are not paid under
42 USC 1395 to
1395i, including those
medicare Medicare services that are not included in the approved state plan for services under
42 USC 1396.
Payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under Medical Assistance minus the Medicare payment.
32,1453q
Section 1453q. 49.46 (2) (c) 5m. of the statutes is amended to read:
49.46
(2) (c) 5m. For an individual who is only entitled to coverage under
part Part B of
medicare Medicare and meets the eligibility criteria under sub. (1), but does not meet the limitation on income under subd. 6.,
medical assistance Medical Assistance shall include payment of the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395j to
1395w, including those
medicare Medicare services that are not included in the approved state plan for services under
42 USC 1396. Payment of coinsurance for a service under
part Part B of
medicare, other than payment of coinsurance for outpatient hospital services, Medicare may not exceed the allowable charge for the service under
medical assistance Medical Assistance minus the
medicare Medicare payment.
49.465 (2) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), a pregnant woman is eligible for medical assistance benefits, as provided under sub. (3), 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 the highest level for eligibility for benefits under s. 49.46 (1) or 49.47 (4) (am) or (c) 1. and ending as follows:
32,1453s
Section 1453s. 49.465 (2) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.465 (2) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), a A pregnant woman is eligible for medical assistance benefits, as provided under sub. (3), 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 the highest level for eligibility for benefits under s. 49.46 (1) or 49.47 (4) (am) or (c) 1. and ending as follows:
32,1455
Section
1455. 49.468 (1) (b) of the statutes is amended to read:
49.468
(1) (b) For an elderly or disabled individual who is entitled to coverage under
part Part A of
medicare Medicare, entitled to coverage under
part Part B of
medicare Medicare, and who does not meet the eligibility criteria for
medical assistance Medical Assistance under s. 49.46 (1), 49.465, 49.47 (4), or 49.471 but meets the limitations on income and resources under par. (d),
medical assistance Medical Assistance shall pay the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395 to
1395zz which that are not paid under
42 USC 1395 to
1395zz, including those
medicare Medicare services that are not included in the approved state plan for services under
42 USC 1396; the monthly premiums payable under
42 USC 1395v; the monthly premiums, if applicable, under
42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under
part Part A of
medicare Medicare. Payment of coinsurance for a service under
part Part B of
medicare Medicare under
42 USC 1395j to
1395w, other than payment of coinsurance for outpatient hospital services, and payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under
medical assistance Medical Assistance minus the
medicare Medicare payment.
32,1456
Section
1456. 49.468 (1) (c) of the statutes is amended to read:
49.468
(1) (c) For an elderly or disabled individual who is only entitled to coverage under
part Part A of
medicare Medicare and who does not meet the eligibility criteria for
medical assistance Medical Assistance under s. 49.46 (1), 49.465, 49.47 (4), or 49.471 but meets the limitations on income and resources under par. (d),
medical assistance Medical Assistance shall pay the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395 to
1395i which that are not paid under
42 USC 1395 to
1395i, including those
medicare Medicare services that are not included in the approved state plan for services under
42 USC 1396; the monthly premiums, if applicable, under
42 USC 1395i-2 (d); and the late enrollment penalty for premiums under
part
Part A of
medicare Medicare, if applicable.
Payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under Medical Assistance minus the Medicare payment.
49.47 (4) (a) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), any individual who meets the limitations on income and resources under pars. (b) to (c) and who complies with pars. (cm) and (cr) shall be eligible for medical assistance under this section if such individual is:
32,1457q
Section 1457q. 49.47 (4) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.47 (4) (a) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), any Any individual who meets the limitations on income and resources under pars. (b) to (c) and who complies with pars. (cm) and (cr) shall be eligible for medical assistance under this section if such individual is:
32,1459
Section
1459. 49.47 (4) (i) 1. of the statutes is amended to read:
49.47 (4) (i) 1. The department shall request a waiver from the secretary of the federal department of health and human services to permit the application of subd. 2. The waiver shall request approval to implement the waiver on a statewide basis, unless the department of health services determines that statewide implementation of the waiver would present an obstacle to the approval of the waiver by the secretary of the federal department of health and human services, in which case the waiver shall request approval to implement the waiver in 48 pilot counties to be selected by the department of health services. Within 30 days after August 12, 1993, the department of regulation and licensing safety and professional services shall notify funeral directors licensed under ch. 445, cemetery associations, as defined in s. 157.061 (1r), and cemetery authorities, as defined in s. 157.061 (2), of the terms of the waiver required to be requested under this subdivision. If the waiver is approved by the secretary of the federal department of health and human services and if the waiver remains in effect, subd. 2. shall apply.
32,1459bn
Section 1459bn. 49.47 (4) (k) of the statutes is created to read:
49.47 (4) (k) Notwithstanding par. (b) 3. and s. 445.125 (1) (a), no later than 60 days after the effective date of this paragraph .... [LRB inserts date], the department shall seek approval from the federal Centers for Medicare and Medicaid Services to permit friends and family members of any individual receiving medical assistance under this section to contribute funds to an irrevocable burial trust for the individual, up to a total irrevocable trust amount of $4,500, without the individual losing eligibility for medical assistance under this section. If the federal Centers for Medicare and Medicaid Services approves the request, the department shall implement the change under this section within 60 days after receiving approval.
49.47 (5) Investigation by department. (intro.) The department may make additional investigation of eligibility at any of the following times:
49.47 (5) (a) When there is reasonable ground for belief that an applicant may not be eligible or that the beneficiary may have received benefits to which the beneficiary is not entitled.
49.47 (5) (c) Any time determined by the department by a policy created under s. 49.45 (2m) (c) to determine eligibility or to reevaluate continuing eligibility, except that if federal law allows a reevaluation of eligibility more frequently than every 12 months and if there is no conflicting provision of state law, the department is not required to create a policy to reevaluate eligibility under this section.
32,1459j
Section 1459j. 49.47 (5) (c) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.
49.47 (6) (a) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the department shall audit and pay charges to certified providers for medical assistance on behalf of the following:
32,1459o
Section 1459o. 49.47 (6) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.47 (6) (a) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the The department shall audit and pay charges to certified providers for medical assistance on behalf of the following:
32,1459p
Section 1459p. 49.47 (6) (a) 6. b. of the statutes is amended to read:
49.47
(6) (a) 6. b. An individual who is entitled to coverage under
part Part A of
medicare Medicare, entitled to coverage under
part Part B of
medicare Medicare, meets the eligibility criteria under sub. (4) (a)
, and meets the income limitation, the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395 to
1395zz which that are not paid under
42 USC 1395 to
1395zz, including those
medicare Medicare services that are not included in the approved state plan for services under
42 USC 1396; the monthly premiums payable under
42 USC 1395v; the monthly premiums, if applicable, under
42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under
part Part A of
medicare Medicare. Payment of coinsurance for a service under
part Part B of
medicare Medicare under
42 USC 1395j to
1395w, other than payment of coinsurance for outpatient hospital services, and payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under
medical assistance Medical Assistance minus the
medicare
Medicare payment.
32,1459q
Section 1459q. 49.47 (6) (a) 6. c. of the statutes is amended to read:
49.47
(6) (a) 6. c. An individual who is only entitled to coverage under
part Part A of
medicare Medicare, meets the eligibility criteria under sub. (4) (a)
, and meets the income limitation, the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395 to
1395i which that are not paid under
42 USC 1395 to
1395i, including those
medicare Medicare services that are not included in the approved state plan for services under
42 USC 1396; the monthly premiums, if applicable, under
42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under
part Part A of
medicare Medicare. Payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under Medical Assistance minus the Medicare payment.
32,1459r
Section 1459r. 49.47 (6) (a) 6. d. of the statutes is amended to read:
49.47
(6) (a) 6. d. An individual who is entitled to coverage under
part Part A of
medicare Medicare, entitled to coverage under
part Part B of
medicare Medicare, and meets the eligibility criteria for
medical assistance Medical Assistance under sub. (4) (a)
, but does not meet the income limitation, the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395 to
1395zz which that are not paid under
42 USC 1395 to
1395zz, including those
medicare Medicare services that are not included in the approved state plan for services under
42 USC 1396. Payment of coinsurance for a service under
part Part B of
medicare Medicare under
42 USC 1395j to
1395w, other than payment of coinsurance for outpatient hospital services, and payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under
medical assistance Medical Assistance minus the
medicare
Medicare payment.
32,1459s
Section 1459s. 49.47 (6) (a) 6. e. of the statutes is amended to read:
49.47
(6) (a) 6. e. An individual who is only entitled to coverage under
part Part A of
medicare Medicare and meets the eligibility criteria for
medical assistance
Medical Assistance under sub. (4) (a), but does not meet the income limitation, the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395 to
1395i, including those services that are not included in the approved state plan for services under
42 USC 1396.
Payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under Medical Assistance minus the Medicare payment.
32,1459t
Section 1459t. 49.47 (6) (a) 6. f. of the statutes is amended to read:
49.47
(6) (a) 6. f. For an individual who is only entitled to coverage under
part Part B of
medicare Medicare and meets the eligibility criteria under sub. (4), but does not meet the income limitation,
medical assistance Medical Assistance shall include payment of the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395j to
1395w, including those
medicare Medicare services that are not included in the approved state plan for services under
42 USC 1396. Payment of coinsurance for a service under
part Part B of
medicare, other than payment of coinsurance for outpatient hospital services, Medicare may not exceed the allowable charge for the service under
medical assistance Medical Assistance minus the
medicare
Medicare payment.
49.471 (13) Applicability. If the department creates a policy under s. 49.45 (2m) (c), subs. (4), (5), (6), (7), (8), (10), and (11) do not apply to the extent that those subsections conflict with the policy.
32,1461h
Section 1461h. 49.471 (13) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.
49.472 (3) Eligibility. (intro.) Except as provided in sub. (6) (a) and unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), an individual is eligible for and shall receive medical assistance under this section if all of the following conditions are met:
32,1461q
Section 1461q. 49.472 (3) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.472 (3) Eligibility. (intro.) Except as provided in sub. (6) (a) and unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), an individual is eligible for and shall receive medical assistance under this section if all of the following conditions are met:
49.472 (4) (b) (intro.) The department may waive monthly premiums that are calculated to be below $10 per month. Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the department may not assess a monthly premium for any individual whose income level, after adding the individual's earned income and unearned income, is below 150% of the poverty line.
32,1462h
Section 1462h. 49.472 (4) (b) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.472 (4) (b) (intro.) The department may waive monthly premiums that are calculated to be below $10 per month. Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the The department may not assess a monthly premium for any individual whose income level, after adding the individual's earned income and unearned income, is below 150% of the poverty line.
32,1463
Section
1463. 49.472 (6) (a) of the statutes is amended to read:
49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account accounts under s. 20.435 (4) (b), (gm), or (w), the department shall, on the part of an individual who is eligible for medical assistance under sub. (3), pay premiums for or purchase individual coverage offered by the individual's employer if the department determines that paying the premiums for or purchasing the coverage will not be more costly than providing medical assistance.
32,1464
Section
1464. 49.472 (6) (b) of the statutes is amended to read:
49.472 (6) (b) If federal financial participation is available, from the appropriation account accounts under s. 20.435 (4) (b), (gm), or (w), the department may pay medicare Part A and Part B premiums for individuals who are eligible for medicare and for medical assistance under sub. (3).
49.473 (2) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), a woman is eligible for medical assistance as provided under sub. (5) if, after applying to the department or a county department, the department or a county department determines that she meets all of the following requirements:
32,1465p
Section 1465p. 49.473 (2) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.473 (2) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), a A woman is eligible for medical assistance as provided under sub. (5) if, after applying to the department or a county department, the department or a county department determines that she meets all of the following requirements:
