Amendment AA2-ASA1-AB56

AB56-ASA1-AA2,19,1 70. Page 356, line 5: after that line insert:

AB56-ASA1-AA2,19,2 “ Section 691d. 49.46 (2) (b) 21. of the statutes is created to read:

AB56-ASA1-AA2,19,4 49.46 (2) (b) 21. Subject to par. (bv), nonmedical services that contribute to the determinants of health.

AB56-ASA1-AA2,691g Section 691g. 49.46 (2) (bv) of the statutes is created to read:

AB56-ASA1-AA2,19,12 49.46 (2) (bv) The department shall determine those services under par. (b) 21. that contribute to the determinants of health. The department shall seek any necessary state plan amendment or request any waiver of federal Medicaid law to implement this paragraph. The department is not required to provided the services under this paragraph as a benefit under the Medical Assistance program if the federal department of health and human services does not provide federal financial participation for the services under this paragraph.”.

AB56-ASA1-AA2,19,13 71. Page 356, line 5: after that line insert:

AB56-ASA1-AA2,19,14 “ Section 695b. 49.47 (4) (ag) 2. of the statutes is amended to read:

AB56-ASA1-AA2,19,17 49.47 (4) (ag) 2. Pregnant and the woman's pregnancy is medically verified Eligibility continues to the last day of the month in which the 60th day or, if approved by the federal government, the 365th day after the last day of the pregnancy falls.”.

AB56-ASA1-AA2,19,18 72. Page 356, line 23: after that line insert:

AB56-ASA1-AA2,19,19 “ Section 699c. 49.471 (1) (cr) of the statutes is created to read:

AB56-ASA1-AA2,19,21 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

AB56-ASA1-AA2,700c Section 700c. 49.471 (4) (a) 4. b. of the statutes is amended to read:

AB56-ASA1-AA2,20,3 49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133 percent of the poverty line before application of the 5 percent income disregard under 42 CFR 435.603 (d).

AB56-ASA1-AA2,701c Section 701c. 49.471 (4) (a) 8. of the statutes is created to read:

AB56-ASA1-AA2,20,5 49.471 (4) (a) 8. An individual who meets all of the following criteria:

AB56-ASA1-AA2,20,6 a. The individual is an adult under the age of 65.

AB56-ASA1-AA2,20,8 b. The adult has a family income that does not exceed 133 percent of the poverty line, except as provided in sub. (4g).

AB56-ASA1-AA2,20,10 c. The adult is not otherwise eligible for the Medical Assistance program under this subchapter or the Medicare program under 42 USC 1395 et seq.

AB56-ASA1-AA2,702c Section 702c. 49.471 (4g) of the statutes is created to read:

AB56-ASA1-AA2,20,19 49.471 (4g) Medicaid expansion; federal medical assistance percentage. For services provided to individuals described under sub. (4) (a) 8., the department shall comply with all federal requirements to qualify for the highest available enhanced federal medical assistance percentage. The department shall submit any amendment to the state medical assistance plan, request for a waiver of federal Medicaid law, or other approval request required by the federal government to provide services to the individuals described under sub. (4) (a) 8. and qualify for the highest available enhanced federal medical assistance percentage.”.

AB56-ASA1-AA2,20,20 73. Page 356, line 23: after that line insert:

AB56-ASA1-AA2,20,21 “ Section 703b. 49.471 (6) (b) of the statutes is amended to read:

AB56-ASA1-AA2,21,2 49.471 (6) (b) A pregnant woman who is determined to be eligible for benefits under sub. (4) remains eligible for benefits under sub. (4) for the balance of the pregnancy and to the last day of the month in which the 60th day or, if approved by the federal government, the 365th day after the last day of the pregnancy falls without regard to any change in the woman's family income.

AB56-ASA1-AA2,704b Section 704b. 49.471 (6) (L) of the statutes is created to read:

AB56-ASA1-AA2,21,9 49.471 (6) (L) The department shall request from the federal department of health and human services approval of a state plan amendment, a waiver of federal Medicaid law, or approval of a demonstration project to maintain eligibility for post-partum women to the last day of the month in which the 365th day after the last day of the pregnancy falls under ss. 49.46 (1) (a) 1m. and 9. and (j), 49.47 (4) (ag) 2., and 49.471 (4) (a) 1g. and 1m., (6) (b), and (7) (b) 1.

AB56-ASA1-AA2,705b Section 705b. 49.471 (7) (b) 1. of the statutes is amended to read:

AB56-ASA1-AA2,21,21 49.471 (7) (b) 1. A pregnant woman whose family income exceeds 300 percent of the poverty line may become eligible for coverage under this section if the difference between the pregnant woman's family income and the applicable income limit under sub. (4) (a) is obligated or expended for any member of the pregnant woman's family for medical care or any other type of remedial care recognized under state law or for personal health insurance premiums or for both. Eligibility obtained under this subdivision continues without regard to any change in family income for the balance of the pregnancy and to the last day of the month in which the 60th day or, if approved by the federal government, the 365th day after the last day of the woman's pregnancy falls. Eligibility obtained by a pregnant woman under this subdivision extends to all pregnant women in the pregnant woman's family.”.

AB56-ASA1-AA2,21,22 74. Page 357, line 18: after that line insert:

AB56-ASA1-AA2,21,23 “ Section 711c. 49.686 (3) (d) of the statutes is amended to read:

AB56-ASA1-AA2,22,6 49.686 (3) (d) Has applied for coverage under and has been denied eligibility for medical assistance within 12 months prior to application for reimbursement under sub. (2). This paragraph does not apply to an individual who is eligible for benefits under the demonstration project for childless adults under s. 49.45 (23) BadgerCare Plus under s. 49.471 (4) (a) 8. or to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471 (11).”.

AB56-ASA1-AA2,22,7 75. Page 363, line 8: after that line insert:

AB56-ASA1-AA2,22,8 “ Section 746t. 51.03 (7) of the statutes is created to read:

AB56-ASA1-AA2,22,12 51.03 (7) From the appropriation under s. 20.435 (5) (dg), the department shall award grants to regional crisis stabilization facilities for adults. The department shall establish criteria for a regional crisis stabilization facility to receive a grant under this subsection.”.

AB56-ASA1-AA2,22,14 76. Page 364, line 14: delete the material beginning with that line and ending with page 365, line 8, and substitute:

AB56-ASA1-AA2,22,15 “ Section 750b. 51.422 (1) of the statutes is amended to read:

AB56-ASA1-AA2,22,23 51.422 (1) Program creation. The department shall create 2 or 3 new, regional comprehensive opioid treatment programs, and in the 2017-19 fiscal biennium, shall create 2 or 3 additional regional comprehensive opioid and methamphetamine treatment programs, to provide treatment for opioid and opiate addiction and methamphetamine addiction in underserved, high-need areas. The department shall obtain and review proposals for opioid and methamphetamine treatment programs in accordance with its request-for-proposal procedures. A program under this section may not offer methadone treatment.

AB56-ASA1-AA2,751b Section 751b. 51.422 (2) of the statutes is amended to read:

AB56-ASA1-AA2,23,10 51.422 (2) Program components. An opioid or methamphetamine treatment program created under this section shall offer an assessment to individuals in need of service to determine what type of treatment is needed. The program shall transition individuals to a certified residential program, if that level of treatment is necessary. The program shall provide counseling, medication-assisted treatment, including both long-acting opioid antagonist and partial agonist medications that have been approved by the federal food and drug administration if for treating opioid addiction, and abstinence-based treatment. The program shall transition individuals who have completed treatment to county-based or private post-treatment care.”.

AB56-ASA1-AA2,23,11 77. Page 365, line 9: delete lines 9 to 16 and substitute:

AB56-ASA1-AA2,23,12 “ Section 752b. 51.441 of the statutes is created to read:

AB56-ASA1-AA2,23,19 51.441 Comprehensive mental health consultation program. The department shall convene a statewide group of interested persons, including at least one representative of the Medical College of Wisconsin, to develop a concept paper, business plan, and standards for a comprehensive mental health consultation program that incorporates general psychiatry, geriatric psychiatry, addiction medicine and psychiatry, a perinatal psychiatry consultation program, and the child psychiatry consultation program under s. 51.442.”.

AB56-ASA1-AA2,23,20 78. Page 433, line 4: after that line insert:

AB56-ASA1-AA2,23,21 “ Section 1891b. 250.048 of the statutes is created to read:

AB56-ASA1-AA2,24,3 250.048 Prescription drug importation program. (1) Importation program requirements. The department, in consultation with persons interested in the sale and pricing of prescription drugs and appropriate officials and agencies of the federal government, shall design and implement a prescription drug importation program for the benefit of residents of this state, that generates savings for residents, and that satisfies all of the following:

AB56-ASA1-AA2,24,6 (a) The department shall designate a state agency to become a licensed wholesale distributor or to contract with a licensed wholesale distributor and shall seek federal certification and approval to import prescription drugs.

AB56-ASA1-AA2,24,9 (b) The prescription drug importation program under this section shall comply with relevant requirements of 21 USC 384, including safety and cost savings requirements.

AB56-ASA1-AA2,24,12 (c) The prescription drug importation program under this section shall import prescription drugs from Canadian suppliers regulated under any appropriate Canadian or provincial laws.

AB56-ASA1-AA2,24,15 (d) The prescription drug importation program under this section shall have a process to sample the purity, chemical composition, and potency of imported prescription drugs.

AB56-ASA1-AA2,24,19 (e) The prescription drug importation program under this section shall import only those prescription drugs for which importation creates substantial savings for residents of the state and only those prescription drugs that are not brand-name drugs and that have fewer than 4 competitor prescription drugs in the United States.

AB56-ASA1-AA2,24,22 (f) The department shall ensure that prescription drugs imported under the program under this section are not distributed, dispensed, or sold outside of the state.

AB56-ASA1-AA2,24,24 (g) The prescription drug importation program under this section shall ensure all of the following:

AB56-ASA1-AA2,25,2 1. Participation by any pharmacy or health care provider in the program is voluntary.

AB56-ASA1-AA2,25,4 2. Any pharmacy or health care provider participating in the program has the appropriate license or other credential in this state.

AB56-ASA1-AA2,25,7 3. Any pharmacy or health care provider participating in the program charges a consumer or health plan the actual acquisition cost of the imported prescription drug that is dispensed.

AB56-ASA1-AA2,25,11 (h) The prescription drug importation program under this section shall ensure that a payment by a health plan or health insurance policy for a prescription drug imported under the program reimburses no more than the actual acquisition cost of the imported prescription drug that is dispensed.

AB56-ASA1-AA2,25,14 (i) The prescription drug importation program under this section shall ensure that any health plan or health insurance policy participating in the program does all of the following:

AB56-ASA1-AA2,25,16 1. Maintains a formulary and claims payment system with current information on prescription drugs imported under the program.

AB56-ASA1-AA2,25,19 2. Bases cost-sharing amounts for participants or insureds under the plan or policy on no more than the actual acquisition cost of the prescription drug imported under the program that is dispensed to the participant or insured.

AB56-ASA1-AA2,25,22 3. Demonstrates to the department or a state agency designated by the department how premiums under the policy or plan are affected by savings on prescription drugs imported under the program.

AB56-ASA1-AA2,25,25 (j) Any wholesale distributor importing prescription drugs under the program under this section shall limit its profit margin to the amount established by the department or a state agency designated by the department.

AB56-ASA1-AA2,26,3 (k) The prescription drug importation program under this section may not import any generic prescription drug that would violate federal patent laws on branded products in this country.

AB56-ASA1-AA2,26,8 (L) The prescription drug importation program under this section shall comply to the extent practical and feasible before the prescription drug to be imported comes into possession of the state's wholesale distributor and fully after the prescription drug to be imported is in possession of the state's wholesale distributor with tracking and tracing requirements of 21 USC 360eee to 360eee-1.

AB56-ASA1-AA2,26,11 (m) The prescription drug importation program under this section shall establish a fee or other approach to finance the program that does not jeopardize significant savings to residents of the state.

AB56-ASA1-AA2,26,13 (n) The prescription drug importation program under this section shall have an audit function that ensures all of the following:

AB56-ASA1-AA2,26,16 1. The department has a sound methodology to determine the most cost-effective prescription drugs to include in the importation program under this section.

AB56-ASA1-AA2,26,18 2. The department has a process in place to select Canadian suppliers that are high quality, high performing, and in full compliance with Canadian laws.

AB56-ASA1-AA2,26,20 3. Prescription drugs imported under the program are pure, unadulterated, potent, and safe.

AB56-ASA1-AA2,26,22 4. The prescription drug importation program is complying with the requirements of this subsection.

AB56-ASA1-AA2,26,25 5. The prescription drug importation program under this section is adequately financed to support administrative functions of the program while generating significant cost savings to residents of the state.

AB56-ASA1-AA2,27,2 6. The prescription drug importation program under this section does not put residents of the state at a higher risk than if the program did not exist.

AB56-ASA1-AA2,27,4 7. The prescription drug importation program under this section provides and is projected to continue to provide substantial cost savings to residents of the state.

AB56-ASA1-AA2,27,7 (2) Anticompetitive behavior. The department, in consultation with the attorney general, shall identify the potential for and monitor anticompetitive behavior in industries affected by a prescription drug importation program.

AB56-ASA1-AA2,27,18 (3) Approval of program design; certification. No later than the first day of the 7th month beginning after the effective date of this subsection .... [LRB inserts date], the department shall submit to the joint committee on finance a report that includes the design of the prescription drug importation program in accordance with this section. The department may not submit the proposed prescription drug importation program to the federal department of health and human services unless the joint committee on finance approves the proposed prescription drug implementation program. Within 14 days of the date of approval by the joint committee on finance of the proposed prescription drug importation program, the department shall submit to the federal department of health and human services a request for certification of the approved prescription drug importation program.

AB56-ASA1-AA2,28,2 (4) Implementation of certified program. After the federal department of health and human services certifies the prescription drug importation program submitted under sub. (3), the department shall begin implementation of the program and the program shall be fully operational by 180 days after the date of certification by the federal department of health and human services. The department shall do all of the following to implement the prescription drug importation program to the extent the action is in accordance with other state laws and the certification by the federal department of health and human services:

AB56-ASA1-AA2,28,5 (a) Become a licensed wholesale distributor, designate another state agency to become a licensed wholesale distributor, or contract with a licensed wholesale distributor.

AB56-ASA1-AA2,28,7 (b) Contract with one or more Canadian suppliers that meet the criteria in sub. (1) (c).

AB56-ASA1-AA2,28,11 (c) Create an outreach and marketing plan to communicate with and provide information to health plans and health insurance policies, employers, pharmacies, health care providers, and residents of the state on participating in the prescription drug importation program.

AB56-ASA1-AA2,28,14 (d) Develop and implement a registration process for health plans and health insurance policies, pharmacies, and health care providers interested in participating in the prescription drug importation program.

AB56-ASA1-AA2,28,16 (e) Create a publicly accessible source for listing prices of prescription drugs imported under the program.

AB56-ASA1-AA2,28,19 (f) Create, publicize, and implement a method of communication to promptly answer questions from and address the needs of persons affected by the implementation of the program before the program is fully operational.

AB56-ASA1-AA2,28,21 (g) Establish the audit functions under sub. (1) (n) with a timeline to complete each audit function every 2 years.

AB56-ASA1-AA2,28,24 (h) Conduct any other activities determined by the department to be important to successful implementation of the prescription drug importation program under this section.

AB56-ASA1-AA2,29,2 (5) Report. By January 1 and July 1 of each year, the department shall submit to the joint committee on finance a report including all of the following:

AB56-ASA1-AA2,29,4 (a) A list of prescription drugs included in the importation program under this section.

AB56-ASA1-AA2,29,7 (b) The number of pharmacies, health care providers, and health plans and health insurance policies participating in the prescription drug importation program under this section.

AB56-ASA1-AA2,29,12 (c) The estimated amount of savings to residents of the state, health plans and health insurance policies, and employers resulting from the implementation of the prescription drug importation program under this section reported from the date of the previous report under this subsection and from the date the program was fully operational.

AB56-ASA1-AA2,29,14 (d) Findings of any audit functions under sub. (1) (n) completed since the date of the previous report under this subsection.”.

AB56-ASA1-AA2,29,15 79. Page 433, line 5: delete lines 5 to 11 and substitute:

AB56-ASA1-AA2,29,16 “ Section 1892b. 250.10 (1m) (b) of the statutes is amended to read: