SB27-SSA1,613,153
49.45
(18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag),
4any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the
5benefits under s. 49.46 (2) (a) and (b) under s. 49.471 shall pay up to the maximum
6amounts allowable under
42 CFR 447.53 to
447.58 for purchases of services provided
7under s. 49.46 (2). The service provider shall collect the specified or allowable
8copayment, coinsurance, or deductible, unless the service provider determines that
9the cost of collecting the copayment, coinsurance, or deductible exceeds the amount
10to be collected. The department shall reduce payments to each provider by the
11amount of the specified or allowable copayment, coinsurance, or deductible.
Unless
12otherwise provided by the department by a policy created under sub. (2m) (c), no No 13provider may deny care or services because the recipient is unable to share costs, but
14an inability to share costs specified in this subsection does not relieve the recipient
15of liability for these costs.
SB27-SSA1,613,2018
49.45
(18) (ag) (intro.) Except as provided in pars. (am), (b), and (c), and subject
19to par. (d), a recipient specified in par. (ac) shall pay all of the following, unless
20otherwise provided by the department by a policy created under sub. (2m) (c):
SB27-SSA1, s. 1437o
21Section 1437o. 49.45 (18) (ag) (intro.) of the statutes, as affected by 2011
22Wisconsin Act .... (this act), is amended to read:
SB27-SSA1,613,2523
49.45
(18) (ag) (intro.) Except as provided in pars. (am), (b), and (c), and subject
24to par. (d), a recipient specified in par. (ac) shall pay all of the following
, unless
25otherwise provided by the department by a policy created under sub. (2m) (c):
SB27-SSA1,614,53
49.45
(18) (b) (intro.) Unless otherwise provided by the department by a policy
4created under sub. (2m) (c), the following services are not subject to recipient cost
5sharing under this subsection:
SB27-SSA1, s. 1437r
6Section 1437r. 49.45 (18) (b) (intro.) of the statutes, as affected by 2011
7Wisconsin Act .... (this act), is amended to read:
SB27-SSA1,614,108
49.45
(18) (b) (intro.)
Unless otherwise provided by the department by a policy
9created under sub. (2m) (c), the The following services are not subject to recipient cost
10sharing under this subsection:
SB27-SSA1,614,1713
49.45
(18) (d) No person who designates a pharmacy or pharmacist as his or
14her sole provider of prescription drugs and who so uses that pharmacy or pharmacist
15is liable under this subsection for more than $12 per month for prescription drugs
16received, unless otherwise provided by the department by a policy created under sub.
17(2m) (c).
SB27-SSA1, s. 1437u
18Section 1437u. 49.45 (18) (d) of the statutes, as affected by 2011 Wisconsin Act
19.... (this act), is amended to read:
SB27-SSA1,614,2420
49.45
(18) (d) No person who designates a pharmacy or pharmacist as his or
21her sole provider of prescription drugs and who so uses that pharmacy or pharmacist
22is liable under this subsection for more than $12 per month for prescription drugs
23received
, unless otherwise provided by the department by a policy created under sub.
24(2m) (c).
SB27-SSA1,615,113
49.45
(23) (a) The department shall request a waiver from the secretary of the
4federal department of health and human services to permit the department to
5conduct a demonstration project to provide health care coverage for basic primary
6and preventive care to adults who are under the age of 65, who have family incomes
7not to exceed 200 percent of the poverty line, and who are not otherwise eligible for
8medical assistance under this subchapter, the Badger Care health care program
9under s. 49.665, or Medicare under
42 USC 1395 et seq. If the department creates
10a policy under sub. (2m) (c) 10., this paragraph does not apply to the extent that it
11conflicts with the policy.
SB27-SSA1, s. 1438e
12Section 1438e. 49.45 (23) (a) of the statutes, as affected by 2011 Wisconsin Act
13.... (this act), is amended to read:
SB27-SSA1,615,2214
49.45
(23) (a) The department shall request a waiver from the secretary of the
15federal department of health and human services to permit the department to
16conduct a demonstration project to provide health care coverage for basic primary
17and preventive care to adults who are under the age of 65, who have family incomes
18not to exceed 200 percent of the poverty line, and who are not otherwise eligible for
19medical assistance under this subchapter, the Badger Care health care program
20under s. 49.665, or Medicare under
42 USC 1395 et seq.
If the department creates
21a policy under sub. (2m) (c) 10., this paragraph does not apply to the extent that it
22conflicts with the policy.
SB27-SSA1,616,9
149.45
(23) (b) If the waiver is granted and in effect, the department may
2promulgate rules defining the health care benefit plan, including more specific
3eligibility requirements and cost-sharing requirements. Unless otherwise provided
4by the department by a policy created under sub. (2m) (c), cost sharing may include
5an annual enrollment fee, which may not exceed $75 per year. Notwithstanding s.
6227.24 (3), the plan details under this subsection may be promulgated as an
7emergency rule under s. 227.24 without a finding of emergency. If the waiver is
8granted and in effect, the demonstration project under this subsection shall begin on
9January 1, 2009, or on the effective date of the waiver, whichever is later.
SB27-SSA1, s. 1438i
10Section 1438i. 49.45 (23) (b) of the statutes, as affected by 2011 Wisconsin Act
11.... (this act), is amended to read:
SB27-SSA1,616,2112
49.45
(23) (b) If the waiver is granted and in effect, the department may
13promulgate rules defining the health care benefit plan, including more specific
14eligibility requirements and cost-sharing requirements.
Unless otherwise provided
15by the department by a policy created under sub. (2m) (c), cost
Cost sharing may
16include an annual enrollment fee, which may not exceed $75 per year.
17Notwithstanding s. 227.24 (3), the plan details under this subsection may be
18promulgated as an emergency rule under s. 227.24 without a finding of emergency.
19If the waiver is granted and in effect, the demonstration project under this subsection
20shall begin on January 1, 2009, or on the effective date of the waiver, whichever is
21later.
SB27-SSA1,617,824
49.45
(24g) (c) The department's proposal under par. (a) shall specify increases
25in reimbursement rates for providers that satisfy the conditions under par. (a) 1. or
12., and shall provide for payment of a monthly per-patient care coordination fee to
2those providers. The department shall set the increases in reimbursement rates and
3the monthly per-patient care coordination fee so that together they provide
4sufficient incentive for providers to satisfy a condition under par. (a) 1. or 2. The
5proposal shall specify effective dates for the increases in reimbursement rates and
6the monthly per-patient care coordination fee that are no sooner than July 1, 2011.
7If the department creates a policy under sub. (2m) (c) 4., this paragraph does not
8apply to the extent that it conflicts with the policy.
SB27-SSA1, s. 1438m
9Section 1438m. 49.45 (24g) (c) of the statutes, as affected by 2011 Wisconsin
10Act .... (this act), is amended to read:
SB27-SSA1,617,2011
49.45
(24g) (c) The department's proposal under par. (a) shall specify increases
12in reimbursement rates for providers that satisfy the conditions under par. (a) 1. or
132., and shall provide for payment of a monthly per-patient care coordination fee to
14those providers. The department shall set the increases in reimbursement rates and
15the monthly per-patient care coordination fee so that together they provide
16sufficient incentive for providers to satisfy a condition under par. (a) 1. or 2. The
17proposal shall specify effective dates for the increases in reimbursement rates and
18the monthly per-patient care coordination fee that are no sooner than July 1, 2011.
19If the department creates a policy under sub. (2m) (c) 4., this paragraph does not
20apply to the extent that it conflicts with the policy.
SB27-SSA1, s. 844
21Section
844. 49.45 (24m) (intro.) of the statutes is amended to read:
SB27-SSA1,618,222
49.45
(24m) (intro.) From the appropriation accounts under s. 20.435 (4) (b),
23(gm), (o), and (w), in order to test the feasibility of instituting a system of
24reimbursement for providers of home health care and personal care services for
1medical assistance recipients that is based on competitive bidding, the department
2shall:
SB27-SSA1, s. 1439n
3Section 1439n. 49.45 (24r) of the statutes, as affected by 2011 Wisconsin Act
4.... (this act), is repealed.
SB27-SSA1,618,126
49.45
(24r) (a) The department shall implement any waiver granted by the
7secretary of the federal department of health and human services to permit the
8department to conduct a demonstration project to provide family planning, as
9defined in s. 253.07 (1) (a), under medical assistance to any woman between the ages
10of 15 and 44 whose family income does not exceed 200% of the poverty line for a family
11the size of the woman's family.
If the department creates a policy under sub. (2m)
12(c) 10., this paragraph does not apply to the extent that it conflicts with the policy.
SB27-SSA1,618,2014
49.45
(24r) (b) The department may request an amended waiver from the
15secretary to permit the department to conduct a demonstration project to provide
16family planning to any man between the ages of 15 and 44 whose family income does
17not exceed 200 percent of the poverty line for a family the size of the man's family.
18If the amended waiver is granted, the department may implement the waiver.
If the
19department creates a policy under sub. (2m) (c) 10., this paragraph does not apply
20to the extent that it conflicts with the policy.
SB27-SSA1,619,422
49.45
(24s) Family planning project. (a) The department shall request a
23waiver from the secretary of the federal department of health and human services
24to permit the department to provide optional services for family planning, as defined
25in s. 253.07 (1) (a), under medical assistance to any female between the ages of 15
1and 44 whose family income does not exceed 200 percent of the poverty line for a
2family the size of the female's family, unless otherwise provided by the department
3by a policy created under sub. (2m) (c) 10. The department shall implement any
4waiver granted.
SB27-SSA1,619,75
(b) The department shall request a waiver, or an amendment to the waiver
6requested under par. (a), from the secretary of the federal department of health and
7human services to require all of the following:
SB27-SSA1,619,98
1. As a condition of receiving services under par. (a), parental notification for
9family planning services for any female under 18 years of age.
SB27-SSA1,619,1210
2. The department to determine eligibility to receive family planning services
11under par. (a) for a female under 18 years of age using the family income of the
12female's parent or guardian instead of only the female's income.
SB27-SSA1, s. 1441bg
13Section 1441bg. 49.45 (24s) (a) of the statutes, as created by 2011 Wisconsin
14Act .... (this act), is amended to read:
SB27-SSA1,619,2115
49.45
(24s) (a) The department shall request a waiver from the secretary of the
16federal department of health and human services to permit the department to
17provide optional services for family planning, as defined in s. 253.07 (1) (a), under
18medical assistance to any female between the ages of 15 and 44 whose family income
19does not exceed 200 percent of the poverty line for a family the size of the female's
20family
, unless otherwise provided by the department by a policy created under sub.
21(2m) (c) 10. The department shall implement any waiver granted.
SB27-SSA1,620,1024
49.45
(25g) (c) The department's proposal under par. (b) shall specify increases
25in reimbursement rates for providers that satisfy the conditions under par. (b), and
1shall provide for payment of a monthly per-patient care coordination fee to those
2providers. The department shall set the increases in reimbursement rates and the
3monthly per-patient care coordination fee so that together they provide sufficient
4incentive for providers to satisfy a condition under par. (b) 1. or 2. The proposal shall
5specify effective dates for the increases in reimbursement rates and the monthly
6per-patient care coordination fee that are no sooner than January 1, 2011. The
7increases in reimbursement rates and monthly per-patient care coordination fees
8that are not provided by the federal government shall be paid from the appropriation
9under. s. 20.435 (1) (am). If the department creates a policy under sub. (2m) (c) 4.,
10this paragraph does not apply to the extent it conflicts with the policy.
SB27-SSA1, s. 1441d
11Section 1441d. 49.45 (25g) (c) of the statutes, as affected by 2011 Wisconsin
12Act .... (this act), is amended to read:
SB27-SSA1,620,2413
49.45
(25g) (c) The department's proposal under par. (b) shall specify increases
14in reimbursement rates for providers that satisfy the conditions under par. (b), and
15shall provide for payment of a monthly per-patient care coordination fee to those
16providers. The department shall set the increases in reimbursement rates and the
17monthly per-patient care coordination fee so that together they provide sufficient
18incentive for providers to satisfy a condition under par. (b) 1. or 2. The proposal shall
19specify effective dates for the increases in reimbursement rates and the monthly
20per-patient care coordination fee that are no sooner than January 1, 2011. The
21increases in reimbursement rates and monthly per-patient care coordination fees
22that are not provided by the federal government shall be paid from the appropriation
23under. s. 20.435 (1) (am).
If the department creates a policy under sub. (2m) (c) 4.,
24this paragraph does not apply to the extent it conflicts with the policy.
SB27-SSA1,621,73
49.45
(27) Eligibility of aliens. A person who is not a U.S. citizen or an alien
4lawfully admitted for permanent residence or otherwise permanently residing in the
5United States under color of law may not receive medical assistance benefits except
6as provided under
8 USC 1255a (h) (3) or
42 USC 1396b (v), unless otherwise
7provided by the department by a policy created under sub. (2m) (c).
SB27-SSA1, s. 1441g
8Section 1441g. 49.45 (27) of the statutes, as affected by 2011 Wisconsin Act
9.... (this act), is amended to read:
SB27-SSA1,621,1410
49.45
(27) Eligibility of aliens. A person who is not a U.S. citizen or an alien
11lawfully admitted for permanent residence or otherwise permanently residing in the
12United States under color of law may not receive medical assistance benefits except
13as provided under
8 USC 1255a (h) (3) or
42 USC 1396b (v)
, unless otherwise
14provided by the department by a policy created under sub. (2m) (c).
SB27-SSA1,623,217
49.45
(39) (b) 1. `Payment for school medical services.' If a school district or a
18cooperative educational service agency elects to provide school medical services and
19meets all requirements under par. (c), the department shall reimburse the school
20district or the cooperative educational service agency for 60% of the federal share of
21allowable charges for the school medical services that it provides, unless otherwise
22provided by the department by a policy created under sub. (2m) (c), and, as specified
23in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind
24and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
25and Hard of Hearing elects to provide school medical services and meets all
1requirements under par. (c), the department shall reimburse the department of
2public instruction for 60% of the federal share of allowable charges for the school
3medical services that the Wisconsin Center for the Blind and Visually Impaired or
4the Wisconsin Educational Services Program for the Deaf and Hard of Hearing
5provides, unless otherwise provided by the department by a policy created under sub.
6(2m) (c), and, as specified in subd. 2., for allowable administrative costs. A school
7district, cooperative educational service agency, the Wisconsin Center for the Blind
8and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
9and Hard of Hearing may submit, and the department shall allow, claims for common
10carrier transportation costs as a school medical service unless the department
11receives notice from the federal health care financing administration that, under a
12change in federal policy, the claims are not allowed. If the department receives the
13notice, a school district, cooperative educational service agency, the Wisconsin
14Center for the Blind and Visually Impaired, or the Wisconsin Educational Services
15Program for the Deaf and Hard of Hearing may submit, and the department shall
16allow, unreimbursed claims for common carrier transportation costs incurred before
17the date of the change in federal policy. The department shall promulgate rules
18establishing a methodology for making reimbursements under this paragraph. All
19other expenses for the school medical services provided by a school district or a
20cooperative educational service agency shall be paid for by the school district or the
21cooperative educational service agency with funds received from state or local taxes.
22The school district, the Wisconsin Center for the Blind and Visually Impaired, the
23Wisconsin Educational Services Program for the Deaf and Hard of Hearing, or the
24cooperative educational service agency shall comply with all requirements of the
1federal department of health and human services for receiving federal financial
2participation.
SB27-SSA1, s. 1442h
3Section 1442h. 49.45 (39) (b) 1. of the statutes, as affected by 2011 Wisconsin
4Act .... (this act), is amended to read:
SB27-SSA1,624,145
49.45
(39) (b) 1. `Payment for school medical services.' If a school district or a
6cooperative educational service agency elects to provide school medical services and
7meets all requirements under par. (c), the department shall reimburse the school
8district or the cooperative educational service agency for 60% of the federal share of
9allowable charges for the school medical services that it provides
, unless otherwise
10provided by the department by a policy created under sub. (2m) (c), and, as specified
11in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind
12and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
13and Hard of Hearing elects to provide school medical services and meets all
14requirements under par. (c), the department shall reimburse the department of
15public instruction for 60% of the federal share of allowable charges for the school
16medical services that the Wisconsin Center for the Blind and Visually Impaired or
17the Wisconsin Educational Services Program for the Deaf and Hard of Hearing
18provides
, unless otherwise provided by the department by a policy created under sub.
19(2m) (c), and, as specified in subd. 2., for allowable administrative costs. A school
20district, cooperative educational service agency, the Wisconsin Center for the Blind
21and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
22and Hard of Hearing may submit, and the department shall allow, claims for common
23carrier transportation costs as a school medical service unless the department
24receives notice from the federal health care financing administration that, under a
25change in federal policy, the claims are not allowed. If the department receives the
1notice, a school district, cooperative educational service agency, the Wisconsin
2Center for the Blind and Visually Impaired, or the Wisconsin Educational Services
3Program for the Deaf and Hard of Hearing may submit, and the department shall
4allow, unreimbursed claims for common carrier transportation costs incurred before
5the date of the change in federal policy. The department shall promulgate rules
6establishing a methodology for making reimbursements under this paragraph. All
7other expenses for the school medical services provided by a school district or a
8cooperative educational service agency shall be paid for by the school district or the
9cooperative educational service agency with funds received from state or local taxes.
10The school district, the Wisconsin Center for the Blind and Visually Impaired, the
11Wisconsin Educational Services Program for the Deaf and Hard of Hearing, or the
12cooperative educational service agency shall comply with all requirements of the
13federal department of health and human services for receiving federal financial
14participation.
SB27-SSA1,624,2316
49.45
(51) (a) By November 1 annually, the department shall provide to the
17department of revenue information concerning the estimated amounts of
18supplements payable from the appropriation
accounts under s. 20.435 (4) (b)
and
19(gm) to specific local governmental units for the provision of transportation for
20medical care, as specified under s. 49.46 (2) (b) 3., during the fiscal year. Beginning
21November 1, 2004, the information that the department provides under this
22paragraph shall include any adjustments necessary to reflect actual claims
23submitted by service providers in the previous fiscal year.
SB27-SSA1, s. 846
24Section
846. 49.45 (52) (title) of the statutes is amended to read:
SB27-SSA1,624,2525
49.45
(52) (title)
Payment adjustments
; federal funding for certain services.
SB27-SSA1, s. 847
1Section
847. 49.45 (52) of the statutes is renumbered 49.45 (52) (a) 1. and
2amended to read:
SB27-SSA1,625,163
49.45
(52) (a) 1.
Beginning on January 1, 2003 If the department provides the
4notice under par. (c) selecting the payment procedure in this paragraph, the
5department may, from the appropriation account under s. 20.435 (7) (b), make
6Medical Assistance payment adjustments to county departments under s. 46.215,
746.22, 46.23,
or 51.42, or 51.437 or to local health departments, as defined in s. 250.01
8(4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and
9(b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16., except for
10services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating
11in the early intervention program under s. 51.44. Payment adjustments under this
12subsection paragraph shall include the state share of the payments. The total of any
13payment adjustments under this
subsection paragraph and Medical Assistance
14payments made from appropriation accounts under s. 20.435 (4) (b),
(gm), (o), and
15(w), may not exceed applicable limitations on payments under
42 USC 1396a (a) (30)
16(A).
SB27-SSA1, s. 848
17Section
848. 49.45 (52) (a) 2. of the statutes is created to read:
SB27-SSA1,625,2118
49.45
(52) (a) 2. The department may require a county department or local
19health department to submit a certified cost report that meets the requirements of
20the federal department of health and human services for covered services described
21in subd. 1.
SB27-SSA1,625,2423
49.45
(52) (b) If the department provides the notice under par. (c) selecting the
24payment procedure in this paragraph, all of the following apply:
SB27-SSA1,626,6
11. Annually, a county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437
2shall submit a certified cost report that meets the requirements of the federal
3department of health and human services for covered services under s. 49.46 (2) (a)
42. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13.,
515., and 16., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided
6to children participating in the early intervention program under s. 51.44.
SB27-SSA1,626,107
2. For services described under subd. 1., the department shall base the amount
8of a claim for federal medical assistance funds on certified cost reports submitted by
9county departments under subd. 1. to the extent the reports comply with federal
10requirements.
SB27-SSA1,626,1311
3. The department shall pay county departments a percentage of the federal
12funds claimed under subd. 2. for services described under subd. 1., which percentage
13is established in the most recent biennial budget.
SB27-SSA1,626,1714
4. The department may pay a local health department, as defined in s. 250.01
15(4), that submits certified cost reports for services described under subd. 1. a
16percentage of the federal funds claimed for those services, which percentage is
17established in the most recent biennial budget.
SB27-SSA1,626,2319
49.45
(52) (c) The department shall select a payment procedure under either
20par. (a) or (b) and may change which procedure under par. (a) or (b) is selected. The
21department shall notify each county department and local health department, as
22applicable, of the selected payment procedure before the date on which payment for
23services is made under that selected or newly selected procedure.
SB27-SSA1,627,4
149.45
(53) Payments for certain services. Beginning on January 1, 2003, the
2department may, from the appropriation account under s. 20.435 (7) (b), make
3Medical Assistance payments to providers for covered services under ss. 49.46 (2) (a)
44. d. and (b) 6. j. and m. and 49.471 (11) (f)
that are provided before January 1, 2012.
SB27-SSA1,627,87
49.46
(1) (n) If the department creates a policy under s. 49.45 (2m) (c) 8., 9., or
810., this subsection does not apply to the extent that it conflicts with the policy.
SB27-SSA1, s. 1453f
9Section 1453f. 49.46 (1) (n) of the statutes, as created by 2011 Wisconsin Act
10.... (this act), is repealed.
SB27-SSA1,627,1613
49.46
(2) (a) (intro.) Except as provided in par. (be) and unless otherwise
14provided by the department by a policy created under s. 49.45 (2m) (c), the
15department shall audit and pay allowable charges to certified providers for medical
16assistance on behalf of recipients for the following federally mandated benefits:
SB27-SSA1, s. 1453i
17Section 1453i. 49.46 (2) (a) (intro.) of the statutes, as affected by 2011
18Wisconsin Act .... (this act), is amended to read:
SB27-SSA1,627,2219
49.46
(2) (a) (intro.) Except as provided in par. (be)
and unless otherwise
20provided by the department by a policy created under s. 49.45 (2m) (c), the
21department shall audit and pay allowable charges to certified providers for medical
22assistance on behalf of recipients for the following federally mandated benefits:
SB27-SSA1,628,4
149.46
(2) (b) (intro.) Except as provided in pars. (be) and (dc) and unless
2otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the
3department shall audit and pay allowable charges to certified providers for medical
4assistance on behalf of recipients for the following services:
SB27-SSA1, s. 1453L
5Section 1453L. 49.46 (2) (b) (intro.) of the statutes, as affected by 2011
6Wisconsin Act .... (this act), is amended to read:
SB27-SSA1,628,107
49.46
(2) (b) (intro.) Except as provided in pars. (be) and (dc)
and unless
8otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the
9department shall audit and pay allowable charges to certified providers for medical
10assistance on behalf of recipients for the following services:
SB27-SSA1,629,212
49.46
(2) (c) 2. For an individual who is entitled to coverage under
part Part 13A of
medicare Medicare, entitled to coverage under
part Part B of
medicare Medicare,
14meets the eligibility criteria under sub. (1)
, and meets the limitation on income under
15subd. 6.,
medical assistance Medical Assistance shall include payment of the
16deductible and coinsurance portions of
medicare Medicare services under
42 USC
171395 to
1395zz which that are not paid under
42 USC 1395 to
1395zz, including those
18medicare Medicare services that are not included in the approved state plan for
19services under
42 USC 1396; the monthly premiums payable under
42 USC 1395v;
20the monthly premiums, if applicable, under
42 USC 1395i-2 (d); and the late
21enrollment penalty, if applicable, for premiums under
part Part A of
medicare 22Medicare. Payment of coinsurance for a service under
part Part B of
medicare 23Medicare under
42 USC 1395j to
1395w, other than payment of coinsurance for
24outpatient hospital services, and payment of deductibles and coinsurance for
25inpatient hospital services under Part A of Medicare may not exceed the allowable
1charge for the service under
medical assistance Medical Assistance minus the
2medicare Medicare payment.
SB27-SSA1,629,154
49.46
(2) (c) 3. For an individual who is only entitled to coverage under
part 5Part A of
medicare Medicare, meets the eligibility criteria under sub. (1)
, and meets
6the limitation on income under subd. 6.,
medical assistance Medical Assistance shall
7include payment of the deductible and coinsurance portions of
medicare Medicare 8services under
42 USC 1395 to
1395i which that are not paid under
42 USC 1395 to
91395i, including those
medicare Medicare services that are not included in the
10approved state plan for services under
42 USC 1396; the monthly premiums, if
11applicable, under
42 USC 1395i-2 (d); and the late enrollment penalty, if applicable,
12for premiums under
part Part A of
medicare Medicare. Payment of deductibles and
13coinsurance for inpatient hospital services under Part A of Medicare may not exceed
14the allowable charge for the service under Medical Assistance minus the Medicare
15payment.
SB27-SSA1,630,517
49.46
(2) (c) 4. For an individual who is entitled to coverage under
part Part 18A of
medicare Medicare, entitled to coverage under
part Part B of
medicare Medicare, 19and meets the eligibility criteria for
medical assistance Medical Assistance under
20sub. (1), but does not meet the limitation on income under subd. 6.,
medical
21assistance Medical Assistance shall include payment of the deductible and
22coinsurance portions of
medicare Medicare services under
42 USC 1395 to
1395zz 23which that are not paid under
42 USC 1395 to
1395zz, including those
medicare 24Medicare services that are not included in the approved state plan for services under
2542 USC 1396. Payment of coinsurance for a service under
part Part B of
medicare
1Medicare under
42 USC 1395j to
1395w, other than payment of coinsurance for
2outpatient hospital services, and payment of deductibles and coinsurance for
3inpatient hospital services under Part A of Medicare may not exceed the allowable
4charge for the service under
medical assistance Medical Assistance minus the
5medicare Medicare payment.
SB27-SSA1,630,167
49.46
(2) (c) 5. For an individual who is only entitled to coverage under
part 8Part A of
medicare Medicare and meets the eligibility criteria for
medical assistance 9Medical Assistance under sub. (1), but does not meet the limitation on income under
10subd. 6.,
medical assistance Medical Assistance shall include payment of the
11deductible and coinsurance portions of
medicare Medicare services under
42 USC
121395 to
1395i which that are not paid under
42 USC 1395 to
1395i, including those
13medicare Medicare services that are not included in the approved state plan for
14services under
42 USC 1396.
Payment of deductibles and coinsurance for inpatient
15hospital services under Part A of Medicare may not exceed the allowable charge for
16the service under Medical Assistance minus the Medicare payment.