Amendment ASA1-AB40

AB40-ASA1, s. 1441b Section 1441b. 49.45 (24s) of the statutes is created to read:

AB40-ASA1,589,4 49.45 (24s) Family planning project. (a) The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to provide optional services for family planning, as defined in s. 253.07 (1) (a), under medical assistance to any female between the ages of 15 and 44 whose family income does not exceed 200 percent of the poverty line for a family the size of the female's family, unless otherwise provided by the department by a policy created under sub. (2m) (c) 10. The department shall implement any waiver granted.

AB40-ASA1,589,7 (b) The department shall request a waiver, or an amendment to the waiver requested under par. (a), from the secretary of the federal department of health and human services to require all of the following:

AB40-ASA1,589,9 1. As a condition of receiving services under par. (a), parental notification for family planning services for any female under 18 years of age.

AB40-ASA1,589,12 2. The department to determine eligibility to receive family planning services under par. (a) for a female under 18 years of age using the family income of the female's parent or guardian instead of only the female's income.

AB40-ASA1, s. 1441bg Section 1441bg. 49.45 (24s) (a) of the statutes, as created by 2011 Wisconsin Act .... (this act), is amended to read:

AB40-ASA1,589,21 49.45 (24s) (a) The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to provide optional services for family planning, as defined in s. 253.07 (1) (a), under medical assistance to any female between the ages of 15 and 44 whose family income does not exceed 200 percent of the poverty line for a family the size of the female's family, unless otherwise provided by the department by a policy created under sub. (2m) (c) 10. The department shall implement any waiver granted.

AB40-ASA1, s. 1441c Section 1441c. 49.45 (25g) (c) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

AB40-ASA1,590,10 49.45 (25g) (c) The department's proposal under par. (b) shall specify increases in reimbursement rates for providers that satisfy the conditions under par. (b), and shall provide for payment of a monthly per-patient care coordination fee to those providers. The department shall set the increases in reimbursement rates and the monthly per-patient care coordination fee so that together they provide sufficient incentive for providers to satisfy a condition under par. (b) 1. or 2. The proposal shall specify effective dates for the increases in reimbursement rates and the monthly per-patient care coordination fee that are no sooner than January 1, 2011. The increases in reimbursement rates and monthly per-patient care coordination fees that are not provided by the federal government shall be paid from the appropriation under. s. 20.435 (1) (am). If the department creates a policy under sub. (2m) (c) 4., this paragraph does not apply to the extent it conflicts with the policy.

AB40-ASA1, s. 1441d Section 1441d. 49.45 (25g) (c) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB40-ASA1,590,24 49.45 (25g) (c) The department's proposal under par. (b) shall specify increases in reimbursement rates for providers that satisfy the conditions under par. (b), and shall provide for payment of a monthly per-patient care coordination fee to those providers. The department shall set the increases in reimbursement rates and the monthly per-patient care coordination fee so that together they provide sufficient incentive for providers to satisfy a condition under par. (b) 1. or 2. The proposal shall specify effective dates for the increases in reimbursement rates and the monthly per-patient care coordination fee that are no sooner than January 1, 2011. The increases in reimbursement rates and monthly per-patient care coordination fees that are not provided by the federal government shall be paid from the appropriation under. s. 20.435 (1) (am). If the department creates a policy under sub. (2m) (c) 4., this paragraph does not apply to the extent it conflicts with the policy.

AB40-ASA1, s. 1441f Section 1441f. 49.45 (27) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

AB40-ASA1,591,7 49.45 (27) Eligibility of aliens. A person who is not a U.S. citizen or an alien lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law may not receive medical assistance benefits except as provided under 8 USC 1255a (h) (3) or 42 USC 1396b (v), unless otherwise provided by the department by a policy created under sub. (2m) (c).

AB40-ASA1, s. 1441g Section 1441g. 49.45 (27) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB40-ASA1,591,14 49.45 (27) Eligibility of aliens. A person who is not a U.S. citizen or an alien lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law may not receive medical assistance benefits except as provided under 8 USC 1255a (h) (3) or 42 USC 1396b (v), unless otherwise provided by the department by a policy created under sub. (2m) (c).

AB40-ASA1, s. 1442g Section 1442g. 49.45 (39) (b) 1. of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

AB40-ASA1,593,2 49.45 (39) (b) 1. `Payment for school medical services.' If a school district or a cooperative educational service agency elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the school district or the cooperative educational service agency for 60% of the federal share of allowable charges for the school medical services that it provides, unless otherwise provided by the department by a policy created under sub. (2m) (c), and, as specified in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the department of public instruction for 60% of the federal share of allowable charges for the school medical services that the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing provides, unless otherwise provided by the department by a policy created under sub. (2m) (c), and, as specified in subd. 2., for allowable administrative costs. A school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, claims for common carrier transportation costs as a school medical service unless the department receives notice from the federal health care financing administration that, under a change in federal policy, the claims are not allowed. If the department receives the notice, a school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired, or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, unreimbursed claims for common carrier transportation costs incurred before the date of the change in federal policy. The department shall promulgate rules establishing a methodology for making reimbursements under this paragraph. All other expenses for the school medical services provided by a school district or a cooperative educational service agency shall be paid for by the school district or the cooperative educational service agency with funds received from state or local taxes. The school district, the Wisconsin Center for the Blind and Visually Impaired, the Wisconsin Educational Services Program for the Deaf and Hard of Hearing, or the cooperative educational service agency shall comply with all requirements of the federal department of health and human services for receiving federal financial participation.

AB40-ASA1, s. 1442h Section 1442h. 49.45 (39) (b) 1. of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB40-ASA1,594,14 49.45 (39) (b) 1. `Payment for school medical services.' If a school district or a cooperative educational service agency elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the school district or the cooperative educational service agency for 60% of the federal share of allowable charges for the school medical services that it provides , unless otherwise provided by the department by a policy created under sub. (2m) (c), and, as specified in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the department of public instruction for 60% of the federal share of allowable charges for the school medical services that the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing provides, unless otherwise provided by the department by a policy created under sub. (2m) (c), and, as specified in subd. 2., for allowable administrative costs. A school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, claims for common carrier transportation costs as a school medical service unless the department receives notice from the federal health care financing administration that, under a change in federal policy, the claims are not allowed. If the department receives the notice, a school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired, or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, unreimbursed claims for common carrier transportation costs incurred before the date of the change in federal policy. The department shall promulgate rules establishing a methodology for making reimbursements under this paragraph. All other expenses for the school medical services provided by a school district or a cooperative educational service agency shall be paid for by the school district or the cooperative educational service agency with funds received from state or local taxes. The school district, the Wisconsin Center for the Blind and Visually Impaired, the Wisconsin Educational Services Program for the Deaf and Hard of Hearing, or the cooperative educational service agency shall comply with all requirements of the federal department of health and human services for receiving federal financial participation.

AB40-ASA1, s. 1443 Section 1443. 49.45 (51) (a) of the statutes is amended to read:

AB40-ASA1,594,23 49.45 (51) (a) By November 1 annually, the department shall provide to the department of revenue information concerning the estimated amounts of supplements payable from the appropriation accounts under s. 20.435 (4) (b) and (gm) to specific local governmental units for the provision of transportation for medical care, as specified under s. 49.46 (2) (b) 3., during the fiscal year. Beginning November 1, 2004, the information that the department provides under this paragraph shall include any adjustments necessary to reflect actual claims submitted by service providers in the previous fiscal year.

AB40-ASA1, s. 1444 Section 1444. 49.45 (52) (title) of the statutes is amended to read:

AB40-ASA1,594,25 49.45 (52) (title) Payment adjustments ; federal funding for certain services.

AB40-ASA1, s. 1445 Section 1445. 49.45 (52) of the statutes is renumbered 49.45 (52) (a) 1. and amended to read:

AB40-ASA1,595,16 49.45 (52) (a) 1. Beginning on January 1, 2003 If the department provides the notice under par. (c) selecting the payment procedure in this paragraph, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payment adjustments to county departments under s. 46.215, 46.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01 (4), as appropriate, 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. Payment adjustments under this subsection paragraph shall include the state share of the payments. The total of any payment adjustments under this subsection paragraph and Medical Assistance payments made from appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

AB40-ASA1, s. 1446 Section 1446. 49.45 (52) (a) 2. of the statutes is created to read:

AB40-ASA1,595,21 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.

AB40-ASA1, s. 1447 Section 1447. 49.45 (52) (b) of the statutes is created to read:

AB40-ASA1,595,24 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:

AB40-ASA1,596,6 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.

AB40-ASA1,596,10 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.

AB40-ASA1,596,13 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.

AB40-ASA1,596,17 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.

AB40-ASA1, s. 1448 Section 1448. 49.45 (52) (c) of the statutes is created to read:

AB40-ASA1,596,23 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.

AB40-ASA1, s. 1449 Section 1449. 49.45 (53) of the statutes is amended to read:

AB40-ASA1,597,4 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.

AB40-ASA1, s. 1453e Section 1453e. 49.46 (1) (n) of the statutes, as created by 2011 Wisconsin Act 10, is repealed and recreated to read:

AB40-ASA1,597,8 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.

AB40-ASA1, s. 1453f Section 1453f. 49.46 (1) (n) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.

AB40-ASA1, s. 1453h Section 1453h. 49.46 (2) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

AB40-ASA1,597,16 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:

AB40-ASA1, s. 1453i Section 1453i. 49.46 (2) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB40-ASA1,597,22 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:

AB40-ASA1, s. 1453k Section 1453k. 49.46 (2) (b) (intro.) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

AB40-ASA1,598,4 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:

AB40-ASA1, s. 1453L Section 1453L. 49.46 (2) (b) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB40-ASA1,598,10 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:

AB40-ASA1, s. 1453m Section 1453m. 49.46 (2) (c) 2. of the statutes is amended to read:

AB40-ASA1,599,2 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.

AB40-ASA1, s. 1453n Section 1453n. 49.46 (2) (c) 3. of the statutes is amended to read:

AB40-ASA1,599,15 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.

AB40-ASA1, s. 1453o Section 1453o. 49.46 (2) (c) 4. of the statutes is amended to read:

AB40-ASA1,600,5 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.

AB40-ASA1, s. 1453p Section 1453p. 49.46 (2) (c) 5. of the statutes is amended to read:

AB40-ASA1,600,16 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.

AB40-ASA1, s. 1453q Section 1453q. 49.46 (2) (c) 5m. of the statutes is amended to read:

AB40-ASA1,601,2 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.

AB40-ASA1, s. 1453r Section 1453r. 49.465 (2) (intro.) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

AB40-ASA1,601,10 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:

AB40-ASA1, s. 1453s Section 1453s. 49.465 (2) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB40-ASA1,601,18 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:

AB40-ASA1, s. 1455 Section 1455. 49.468 (1) (b) of the statutes is amended to read:

AB40-ASA1,602,11 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.

AB40-ASA1, s. 1456 Section 1456. 49.468 (1) (c) of the statutes is amended to read:

AB40-ASA1,602,25 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.

AB40-ASA1, s. 1457p Section 1457p. 49.47 (4) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

AB40-ASA1,603,6 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:

AB40-ASA1, s. 1457q Section 1457q. 49.47 (4) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB40-ASA1,603,12 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:

AB40-ASA1, s. 1459 Section 1459. 49.47 (4) (i) 1. of the statutes is amended to read:

AB40-ASA1,604,2 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.

AB40-ASA1, s. 1459bn Section 1459bn. 49.47 (4) (k) of the statutes is created to read:

AB40-ASA1,604,12 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.

AB40-ASA1, s. 1459e Section 1459e. 49.47 (5) (intro.) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

AB40-ASA1,604,16 49.47 (5) Investigation by department. (intro.) The department may make additional investigation of eligibility at any of the following times:

AB40-ASA1, s. 1459g Section 1459g. 49.47 (5) (a) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

AB40-ASA1,604,21 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.

AB40-ASA1, s. 1459i Section 1459i. 49.47 (5) (c) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

AB40-ASA1,605,3 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.

AB40-ASA1, s. 1459j Section 1459j. 49.47 (5) (c) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.

AB40-ASA1, s. 1459n Section 1459n. 49.47 (6) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

AB40-ASA1,605,10 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:

AB40-ASA1, s. 1459o Section 1459o. 49.47 (6) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB40-ASA1,605,15 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:

AB40-ASA1, s. 1459p Section 1459p. 49.47 (6) (a) 6. b. of the statutes is amended to read:

AB40-ASA1,606,6 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.

AB40-ASA1, s. 1459q Section 1459q. 49.47 (6) (a) 6. c. of the statutes is amended to read:

AB40-ASA1,606,18 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.