SB232, s. 6 3Section 6. 49.45 (8r) of the statutes, as affected by 2011 Wisconsin Act 10 and
42011 Wisconsin Act 32, section 1436y, is amended to read:
SB232,4,125 49.45 (8r) Payment for certain obstetric and gynecological care. Unless
6otherwise provided by the department by a policy created under sub. (2m) (c), the
The
7rate of payment for obstetric and gynecological care provided in primary care
8shortage areas, as defined in s. 36.60 (1) (cm), or provided to recipients of medical
9assistance who reside in primary care shortage areas, that is equal to 125% of the
10rates paid under this section to primary care physicians in primary care shortage
11areas, shall be paid to all certified primary care providers who provide obstetric or
12gynecological care to those recipients.
SB232, s. 7 13Section 7. 49.45 (8v) of the statutes, as affected by 2011 Wisconsin Act 10 and
142011 Wisconsin Act 32, section 1437e, is amended to read:
SB232,4,2515 49.45 (8v) Incentive-based pharmacy payment system. The department shall
16establish a system of payment to pharmacies for legend and over-the-counter drugs
17provided to recipients of medical assistance that has financial incentives for
18pharmacists who perform services that result in savings to the medical assistance
19program. Under this system, the department shall establish a schedule of fees that
20is designed to ensure that any incentive payments made are equal to or less than the
21documented savings unless otherwise provided by the department by a policy
22created under sub. (2m) (c)
. The department may discontinue the system established
23under this subsection if the department determines, after performance of a study,
24that payments to pharmacists under the system exceed the documented savings
25under the system.
SB232, s. 8
1Section 8. 49.45 (18) (ac) of the statutes, as affected by 2011 Wisconsin Act 10
2and 2011 Wisconsin Act 32, section 1437j, is amended to read:
SB232,5,153 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.
SB232, s. 9 16Section 9. 49.45 (18) (ag) (intro.) of the statutes, as affected by 2011 Wisconsin
17Act 10
and 2011 Wisconsin Act 32, section 1437n, is amended to read:
SB232,5,2018 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)
:
SB232, s. 10 21Section 10. 49.45 (18) (b) (intro.) of the statutes, as affected by 2011 Wisconsin
22Act 10
and 2011 Wisconsin Act 32, section 1437q, is amended to read:
SB232,5,2523 49.45 (18) (b) (intro.) Unless otherwise provided by the department by a policy
24created under sub. (2m) (c), the
The following services are not subject to recipient cost
25sharing under this subsection:
SB232, s. 11
1Section 11. 49.45 (18) (d) of the statutes, as affected by 2011 Wisconsin Act 10
2and 2011 Wisconsin Act 32, section 1437t, is amended to read:
SB232,6,73 49.45 (18) (d) No person who designates a pharmacy or pharmacist as his or
4her sole provider of prescription drugs and who so uses that pharmacy or pharmacist
5is liable under this subsection for more than $12 per month for prescription drugs
6received, unless otherwise provided by the department by a policy created under sub.
7(2m) (c)
.
SB232, s. 12 8Section 12. 49.45 (23) (a) of the statutes, as affected by 2011 Wisconsin Act 10
9and 2011 Wisconsin Act 32, section 1438d, is amended to read:
SB232,6,1810 49.45 (23) (a) The department shall request a waiver from the secretary of the
11federal department of health and human services to permit the department to
12conduct a demonstration project to provide health care coverage for basic primary
13and preventive care to adults who are under the age of 65, who have family incomes
14not to exceed 200 percent of the poverty line, and who are not otherwise eligible for
15medical assistance under this subchapter, the Badger Care health care program
16under s. 49.665, or Medicare under 42 USC 1395 et seq. If the department creates
17a policy under sub. (2m) (c) 10., this paragraph does not apply to the extent that it
18conflicts with the policy.
SB232, s. 13 19Section 13. 49.45 (23) (b) of the statutes, as affected by 2011 Wisconsin Act 10
20and 2011 Wisconsin Act 32, section 1438h, is amended to read:
SB232,7,521 49.45 (23) (b) If the waiver is granted and in effect, the department may
22promulgate rules defining the health care benefit plan, including more specific
23eligibility requirements and cost-sharing requirements. Unless otherwise provided
24by the department by a policy created under sub. (2m) (c), cost
Cost sharing may
25include an annual enrollment fee, which may not exceed $75 per year.

1Notwithstanding s. 227.24 (3), the plan details under this subsection may be
2promulgated as an emergency rule under s. 227.24 without a finding of emergency.
3If the waiver is granted and in effect, the demonstration project under this subsection
4shall begin on January 1, 2009, or on the effective date of the waiver, whichever is
5later.
SB232, s. 14 6Section 14. 49.45 (24g) (c) of the statutes, as affected by 2011 Wisconsin Act
710
and 2011 Wisconsin Act 32, section 1438L, is amended to read:
SB232,7,178 49.45 (24g) (c) The department's proposal under par. (a) shall specify increases
9in reimbursement rates for providers that satisfy the conditions under par. (a) 1. or
102., and shall provide for payment of a monthly per-patient care coordination fee to
11those providers. The department shall set the increases in reimbursement rates and
12the monthly per-patient care coordination fee so that together they provide
13sufficient incentive for providers to satisfy a condition under par. (a) 1. or 2. The
14proposal shall specify effective dates for the increases in reimbursement rates and
15the monthly per-patient care coordination fee that are no sooner than July 1, 2011.
16If the department creates a policy under sub. (2m) (c) 4., this paragraph does not
17apply to the extent that it conflicts with the policy.
SB232, s. 15 18Section 15. 49.45 (24s) (a) of the statutes, as created by 2011 Wisconsin Act
1932
, section 1441b, is amended to read:
SB232,7,2420 49.45 (24s) (a) The department shall request a waiver from the secretary of the
21federal department of health and human services to permit the department to
22provide optional services for family planning, as defined in s. 253.07 (1) (a), under
23medical assistance, unless otherwise provided by the department by a policy created
24under sub. (2m) (c) 10
. The department shall implement any waiver granted.
SB232, s. 16
1Section 16. 49.45 (25g) (c) of the statutes, as affected by 2011 Wisconsin Act
210
and 2011 Wisconsin Act 32, section 1441c, is amended to read:
SB232,8,143 49.45 (25g) (c) The department's proposal under par. (b) shall specify increases
4in reimbursement rates for providers that satisfy the conditions under par. (b), and
5shall provide for payment of a monthly per-patient care coordination fee to those
6providers. The department shall set the increases in reimbursement rates and the
7monthly per-patient care coordination fee so that together they provide sufficient
8incentive for providers to satisfy a condition under par. (b) 1. or 2. The proposal shall
9specify effective dates for the increases in reimbursement rates and the monthly
10per-patient care coordination fee that are no sooner than January 1, 2011. The
11increases in reimbursement rates and monthly per-patient care coordination fees
12that are not provided by the federal government shall be paid from the appropriation
13under. s. 20.435 (1) (am). If the department creates a policy under sub. (2m) (c) 4.,
14this paragraph does not apply to the extent it conflicts with the policy.
SB232, s. 17 15Section 17. 49.45 (27) of the statutes, as affected by 2011 Wisconsin Act 10 and
162011 Wisconsin Act 32, section 1441f, is amended to read:
SB232,8,2117 49.45 (27) Eligibility of aliens. A person who is not a U.S. citizen or an alien
18lawfully admitted for permanent residence or otherwise permanently residing in the
19United States under color of law may not receive medical assistance benefits except
20as provided under 8 USC 1255a (h) (3) or 42 USC 1396b (v), unless otherwise
21provided by the department by a policy created under sub. (2m) (c)
.
SB232, s. 18 22Section 18. 49.45 (39) (b) 1. of the statutes, as affected by 2011 Wisconsin Act
2310
and 2011 Wisconsin Act 32, section 1442g, is amended to read:
SB232,9,2524 49.45 (39) (b) 1. `Payment for school medical services.' If a school district or a
25cooperative educational service agency elects to provide school medical services and

1meets all requirements under par. (c), the department shall reimburse the school
2district or the cooperative educational service agency for 60% of the federal share of
3allowable charges for the school medical services that it provides , unless otherwise
4provided by the department by a policy created under sub. (2m) (c),
and, as specified
5in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind
6and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
7and Hard of Hearing elects to provide school medical services and meets all
8requirements under par. (c), the department shall reimburse the department of
9public instruction for 60% of the federal share of allowable charges for the school
10medical services that the Wisconsin Center for the Blind and Visually Impaired or
11the Wisconsin Educational Services Program for the Deaf and Hard of Hearing
12provides, unless otherwise provided by the department by a policy created under sub.
13(2m) (c),
and, as specified in subd. 2., for allowable administrative costs. A school
14district, cooperative educational service agency, the Wisconsin Center for the Blind
15and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
16and Hard of Hearing may submit, and the department shall allow, claims for common
17carrier transportation costs as a school medical service unless the department
18receives notice from the federal health care financing administration that, under a
19change in federal policy, the claims are not allowed. If the department receives the
20notice, a school district, cooperative educational service agency, the Wisconsin
21Center for the Blind and Visually Impaired, or the Wisconsin Educational Services
22Program for the Deaf and Hard of Hearing may submit, and the department shall
23allow, unreimbursed claims for common carrier transportation costs incurred before
24the date of the change in federal policy. The department shall promulgate rules
25establishing a methodology for making reimbursements under this paragraph.

1Alleother expenses for the school medical services provided by a school district or a
2cooperative educational service agency shall be paid for by the school district or the
3cooperative educational service agency with funds received from state or local taxes.
4The school district, the Wisconsin Center for the Blind and Visually Impaired, the
5Wisconsin Educational Services Program for the Deaf and Hard of Hearing, or the
6cooperative educational service agency shall comply with all requirements of the
7federal department of health and human services for receiving federal financial
8participation.
SB232, s. 19 9Section 19. 49.46 (1) (n) of the statutes, as affected by 2011 Wisconsin Act 10
10and 2011 Wisconsin Act 32, section 1453e, is repealed.
SB232, s. 20 11Section 20. 49.46 (2) (a) (intro.) of the statutes, as affected by 2011 Wisconsin
12Act 10
and 2011 Wisconsin Act 32, section 1453h, is amended to read:
SB232,10,1613 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:
SB232, s. 21 17Section 21. 49.46 (2) (b) (intro.) of the statutes, as affected by 2011 Wisconsin
18Act 10
and 2011 Wisconsin Act 32, section 1453k, is amended to read:
SB232,10,2219 49.46 (2) (b) (intro.) Except as provided in pars. (be) and (dc) and unless
20otherwise provided 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 services:
SB232, s. 22 23Section 22. 49.465 (2) (intro.) of the statutes, as affected by 2011 Wisconsin
24Act 10
and 2011 Wisconsin Act 32, section 1453r, is amended to read:
SB232,11,6
149.465 (2) (intro.) Unless otherwise provided by the department by a policy
2created under s. 49.45 (2m) (c), a
A pregnant woman is eligible for medical assistance
3benefits, as provided under sub. (3), during the period beginning on the day on which
4a qualified provider determines, on the basis of preliminary information, that the
5woman's family income does not exceed the highest level for eligibility for benefits
6under s. 49.46 (1) or 49.47 (4) (am) or (c) 1. and ending as follows:
SB232, s. 23 7Section 23. 49.47 (4) (a) (intro.) of the statutes, as affected by 2011 Wisconsin
8Act 10
and 2011 Wisconsin Act 32, section 1457p, is amended to read:
SB232,11,129 49.47 (4) (a) (intro.) Unless otherwise provided by the department by a policy
10created under s. 49.45 (2m) (c), any
Any individual who meets the limitations on
11income and resources under pars. (b) to (c) and who complies with pars. (cm) and (cr)
12shall be eligible for medical assistance under this section if such individual is:
SB232, s. 24 13Section 24. 49.47 (5) (c) of the statutes, as affected by 2011 Wisconsin Act 10
14and 2011 Wisconsin Act 32, section 1459i, is repealed.
SB232, s. 25 15Section 25. 49.47 (6) (a) (intro.) of the statutes, as affected by 2011 Wisconsin
16Act 10
and 2011 Wisconsin Act 32, section 1459n, is amended to read:
SB232,11,1917 49.47 (6) (a) Unless otherwise provided by the department by a policy created
18under s. 49.45 (2m) (c), the
The department shall audit and pay charges to certified
19providers for medical assistance on behalf of the following:
SB232, s. 26 20Section 26. 49.471 (13) of the statutes, as affected by 2011 Wisconsin Act 10
21and 2011 Wisconsin Act 32, section 1461g, is repealed.
SB232, s. 27 22Section 27. 49.472 (3) (intro.) of the statutes, as affected by 2011 Wisconsin
23Act 10
and 2011 Wisconsin Act 32, section 1461p, is amended to read:
SB232,12,224 49.472 (3) Eligibility. (intro.) Except as provided in sub. (6) (a) and unless
25otherwise provided by the department by a policy created under s. 49.45 (2m) (c)
, an

1individual is eligible for and shall receive medical assistance under this section if all
2of the following conditions are met:
SB232, s. 28 3Section 28. 49.472 (4) (b) (intro.) of the statutes, as affected by 2011 Wisconsin
4Act 10
and 2011 Wisconsin Act 32, section 1462g, is amended to read:
SB232,12,95 49.472 (4) (b) (intro.) The department may waive monthly premiums that are
6calculated to be below $10 per month. Unless otherwise provided by the department
7by a policy created under s. 49.45 (2m) (c), the
The department may not assess a
8monthly premium for any individual whose income level, after adding the
9individual's earned income and unearned income, is below 150% of the poverty line.
SB232, s. 29 10Section 29. 49.473 (2) (intro.) of the statutes, as affected by 2011 Wisconsin
11Act 10
and 2011 Wisconsin Act 32, section 1465n, is amended to read:
SB232,12,1612 49.473 (2) (intro.) Unless otherwise provided by the department by a policy
13created under s. 49.45 (2m) (c), a
A woman is eligible for medical assistance as
14provided under sub. (5) if, after applying to the department or a county department,
15the department or a county department determines that she meets all of the
16following requirements:
SB232, s. 30 17Section 30. 49.473 (5) of the statutes, as affected by 2011 Wisconsin Act 10 and
182011 Wisconsin Act 32, section 1469y, is amended to read:
SB232,12,2419 49.473 (5) The department shall audit and pay, from the appropriation
20accounts under s. 20.435 (4) (b), (gm), and (o), allowable charges to a provider who
21is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who
22meets the requirements under sub. (2) for all benefits and services specified under
23s. 49.46 (2), unless otherwise provided by the department by a policy created under
24s. 49.45 (2m) (c)
.
SB232,12,2525 (End)
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