Wisconsin Legislature: 33,1392s

33,1385 Section 1385. 49.45 (30m) (a) 2. of the statutes is created to read:

49.45 (30m) (a) 2. Services in an intermediate care facility for the mentally retarded, as defined in s. 46.278 (1m) (am), other than a state center for the developmentally disabled.

33,1386 Section 1386. 49.45 (30m) (a) 3. of the statutes is created to read:

49.45 (30m) (a) 3. Services for which payment is permitted under sub. (6c) (d) 2. that are provided in a nursing facility, as defined in s. 46.279 (1) (c).

33,1386d Section 1386d. 49.45 (30m) (am) of the statutes is created to read:

49.45 (30m) (am) The department shall provide the portion of the payment that is not provided by the federal government for any of the services specified in par. (a) 1. to 3. that are provided to an individual with developmental disability who is eligible for medical assistance, as determined under the contract under s. 46.279 (4m).

33,1387 Section 1387. 49.45 (30m) (b) of the statutes is created to read:

49.45 (30m) (b) No payment under this section may be made for services specified under par. (a) or (am) unless the individual who receives the services is protectively placed under s. 55.06 (9) (a) or is placed under an emergency placement under s. 55.06 (11) (a) or a temporary placement under s. 55.06 (11) (c).

33,1388 Section 1388. 49.45 (30m) (c) of the statutes is created to read:

49.45 (30m) (c) No payment under this section may be made for services specified under par. (a) 2. or 3. that are provided to an individual who was placed in or admitted to an intermediate facility, as defined in s. 46.279 (1) (b), or nursing facility, as defined in s. 46.279 (1) (c), unless one of the following applies:

1. Any placement or admission that is made after April 30, 2005, complied with the requirements of s. 46.279.

2. For an individual who was protectively placed under ch. 55 at any time, any annual review that is conducted under s. 55.06 (10) (a) 1. after April 30, 2005, complies with the requirements of s. 55.06 (10) (a) 2.

33,1389 Section 1389. 49.45 (36) of the statutes is amended to read:

49.45 (36) Homeless beneficiaries. A The department or a county department under s. 46.215, 46.22, or 46.23 may not place the word "homeless" on the medical assistance identification card of any person who is determined to be eligible for medical assistance benefits and who is homeless.

33,1390 Section 1390. 49.45 (39) (b) 1. of the statutes is amended to read:

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 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 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 Except as provided in subd. 1m., 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.

33,1391 Section 1391. 49.45 (39) (b) 1m. of the statutes is created to read:

49.45 (39) (b) 1m. `Supplementary payment for school medical services.' In addition to the reimbursement the department provides under subd. 1. to a school district or cooperative educational service agency for school medical services, the department may make supplementary payments from the appropriation accounts under s. 20.435 (4) (b) and (o). The total of the supplementary payments and allowable charges paid under subd. 1. may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

33,1392 Section 1392. 49.45 (39) (b) 2. of the statutes is amended to read:

49.45 (39) (b) 2. `Payment for school medical services administrative costs.' The department shall reimburse a school district or a cooperative educational service agency specified under subd. 1. subds. 1. and 1m. and shall reimburse the department of public instruction on behalf of the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing for 90% of the federal share of allowable administrative costs, using time studies, beginning in fiscal year 1999-2000. A school district or a cooperative educational service agency may submit, and the department of health and family services shall allow, claims for administrative costs incurred during the period that is up to 24 months before the date of the claim, if allowable under federal law.

33,1392p Section 1392p. 49.45 (49) (a) (intro.) of the statutes is renumbered 49.45 (49) (bm) and amended to read:

49.45 (49) (bm) The secretary shall exercise his or her authority under s. 15.04 (1) (c) to create a prescription drug prior authorization and therapeutics committee to advise the department on issues related to prior authorization decisions made concerning prescription drugs on behalf of medical assistance recipients. The secretary shall appoint as members at least all of the following: and to advise the department on the research, development, and approval of any preferred drug list for the Medical Assistance program or the program under s. 49.665 or 49.688.

33,1392q Section 1392q. 49.45 (49) (a) 1. of the statutes is repealed.

33,1392r Section 1392r. 49.45 (49) (a) 2. and 3. of the statutes are renumbered 49.45 (49) (c) 6. and 7.

33,1392rj Section 1392rj. 49.45 (49) (ag) of the statutes is created to read:

49.45 (49) (ag) In this subsection:

1. "Labeler" means a person who receives prescription drugs from a manufacturer or wholesaler and repackages those drugs for later retail sale, and has a labeler code issued by the federal food and drug administration under 21 CFR 207.20 (b).

2. "Manufacturer" means a person who is engaged in the production, preparation, propagation, compounding, conversion, or processing of prescription drugs.

3. "Physician" has the meaning given in s. 448.01 (5).

33,1392s Section 1392s. 49.45 (49) (b) of the statutes is renumbered 49.45 (49) (g) and amended to read:

49.45 (49) (g) The prescription drug prior authorization and therapeutics committee shall accept information or commentary from representatives of the pharmaceutical manufacturing industry in the committee's review of prior authorization policies.

33,1392t Section 1392t. 49.45 (49) (c), (d), (e), (f), (h) and (i) of the statutes are created to read:

49.45 (49) (c) The secretary shall appoint as members of the prescription drug prior authorization and therapeutics committee at least all of the following:

1. A physician who has expertise in family practice.

2. A physician who has expertise in pediatrics.

3. A physician who has expertise in geriatrics.

4. A physician who has expertise in psychiatry.

5. A physician who has expertise in internal medicine and specializes in the treatment of diabetes.

(d) A person who is employed by or under contract with a manufacturer, a labeler, or the state may not serve as a member of the prescription drug prior authorization and therapeutics committee, except that the following agreements do not bar a person from serving as a member of the committee:

1. An agreement with the department to comply with the requirements for provider certification under sub. (2) (a) 11.

2. An agreement between a physician or pharmacist and a manufacturer for the physician or pharmacist to conduct research in return for grant funding from a manufacturer.

(e) If a physician or pharmacist who is a member of the prescription drug prior authorization and therapeutics committee receives any grant funding from a manufacturer to conduct research, the physician or pharmacist must disclose the grant funding to the department. Any physician or pharmacist who is a candidate for membership on the committee and receives such grant funding must disclose the grant funding to the department before the secretary appoints the person as a member of the committee.

(f) During the first meeting of the prescription drug prior authorization and therapeutics committee in each calendar year, the committee shall elect a member to serve as the chairperson of the committee for a one-year term. The committee shall meet at least once annually and on the call of the chairperson. A majority of the committee constitutes a quorum to do business. Recommendations of the committee shall be determined by majority vote.

(h) The department shall consider all relevant recommendations of the prescription drug prior authorization and therapeutics committee before requiring prior authorization for a prescription drug under the Medical Assistance program or under s. 49.665 or 49.688.

(i) By January 1 annually, the department shall submit a report to the governor, the members of the joint committee on finance, and the appropriate standing committees of the legislature under s. 13.172 (3), on any changes that the department made in the previous 12 months to department policies related to prior authorization for prescription drugs under the Medical Assistance program or the program under s. 49.665 or 49.688, and shall include all of the following in the report:

1. The name and therapeutic class for each prescription drug for which the department changed prior authorization policies.

2. The criteria for approving a prior authorization request for any prescription drug identified under subd. 1.

3. Identification of any differences between the policies adopted by the department and relevant recommendations of the prescription drug prior authorization and therapeutics committee and, if applicable, the clinical and scientific reasons for diverging from the committee's recommendations.

33,1392u Section 1392u. 49.45 (49g) of the statutes is created to read:

49.45 (49g) Mental health medication review committee. The secretary shall exercise his or her authority under s. 15.04 (1) (c) to create a mental health medication review committee to advise the department on implementation of prior authorization requirements for selective serotonin reuptake inhibiters under s. 49.45 (49m) and on implementation of a process for reviewing utilization of drugs to treat mental illness under the Medical Assistance program. The secretary shall appoint at least one advocate for persons having a mental illness and at least one consumer of a drug used to treat a mental illness and advocates and consumers shall constitute a majority of the members of the committee.

33,1393 Section 1393. 49.45 (49m) of the statutes is created to read:

49.45 (49m) Prescription drug cost controls; purchasing agreements. (a) In this section:

1. "Brand name" has the meaning given in s. 450.12 (1) (a).

2. "Generic name" has the meaning given in s. 450.12 (1) (b).

3. "Prescription drug" has the meaning given in s. 450.01 (20).

(b) The department may enter into a multi-state purchasing agreement with another state or a purchasing agreement with a purchaser of prescription drugs if the other state or purchaser agrees to participate in one or more of the activities specified in par. (c) 1. to 4.

(c) The department may design and implement a program to reduce the cost of prescription drugs and to maintain high quality in prescription drug therapies, which shall include all of the following:

1. A list of the prescription drugs that are included as a benefit under s. 49.46 (2) (b) 6. h. that identifies preferred choices within therapeutic classes and includes prescription drugs that bear only generic names.

2. Establishing supplemental rebates under agreements with prescription drug manufacturers for prescription drugs provided to recipients under Medical Assistance and Badger Care and to eligible persons under s. 49.688 and, if it is possible to implement the program without adversely affecting supplemental rebates for Medical Assistance, Badger Care, and prescription drug assistance under s. 49.688, to beneficiaries of participants under par. (b).

3. Utilization management and fraud and abuse controls.

4. Any other activity to reduce the cost of or expenditures for prescription drugs and maintain high quality in prescription drug therapies.

(cg) The department shall consider all relevant recommendations of the prescription drug prior authorization and therapeutics committee before including a prescription drug on, or excluding a prescription drug from, a list under par. (c) 1.

(cr) 1. Except as provided in subd. 2., the department may not require prior authorization for a prescription drug under s. 49.46 (2) (b) 6. h. that is prescribed to treat a mental illness.

2. The department may require prior authorization for a selective serotonin reuptake inhibitor that is first prescribed for a person on or after March 15, 2004.

(d) The department may enter into a contract with an entity to perform any of the duties and exercise any of the powers of the department under this subsection.

33,1393c Section 1393c. 49.45 (51) of the statutes is created to read:

49.45 (51) Medical care transportation services. (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 under s. 20.435 (4) (b) 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.

(b) On the date that is the 3rd Monday in November, the department shall annually pay to specific local governmental units the estimated net amounts specified in par. (a).

33,1401 Section 1401. 49.46 (2) (a) 4. c. of the statutes is amended to read:

49.46 (2) (a) 4. c. Skilled nursing home services other than in an institution for mental diseases, except as limited under s. 49.45 (6c) and (30m) (b) and (c).

33,1402 Section 1402. 49.46 (2) (b) 6. a. of the statutes is amended to read:

49.46 (2) (b) 6. a. Intermediate care facility services other than in an institution for mental diseases, except as limited under s. 49.45 (30m) (b) and (c).

33,1403d Section 1403d. 49.46 (2) (b) 8. of the statutes is amended to read:

49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27 (11), 46.275, 46.277 or 46.278 or, under the family care benefit if a waiver is in effect under s. 46.281 (1) (c), or under a waiver requested under 2001 Wisconsin Act 16, section 9123 (16rs), or 2003 Wisconsin Act .... (this act), section 9124 (8c).

33,1404 Section 1404. 49.472 (6) (a) of the statutes is amended to read:

49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account under s. 20.435 (4) (b) , (gp), or (w), the department shall, on the part of an individual who is eligible for medical assistance under sub. (3), pay premiums for or purchase individual coverage offered by the individual's employer if the department determines that paying the premiums for or purchasing the coverage will not be more costly than providing medical assistance.

33,1405 Section 1405. 49.472 (6) (b) of the statutes is amended to read:

49.472 (6) (b) If federal financial participation is available, from the appropriation account under s. 20.435 (4) (b), (gp), or (w), the department may pay medicare Part A and Part B premiums for individuals who are eligible for medicare and for medical assistance under sub. (3).

33,1406 Section 1406. 49.473 (title) of the statutes is amended to read:

49.473 (title) Medical assistance; women diagnosed with breast or cervical cancer or precancerous conditions.

33,1407 Section 1407. 49.473 (2) (c) of the statutes is amended to read:

49.473 (2) (c) The woman is not eligible for health care coverage that qualifies as creditable coverage in 42 USC 300gg (c), excluding the coverage specified in 42 USC 300gg (c) (1) (F).

33,1408 Section 1408. 49.473 (2) (e) of the statutes is amended to read:

49.473 (2) (e) The woman requires treatment for breast or cervical cancer or for a precancerous condition of the breast or cervix.

33,1409 Section 1409. 49.473 (5) of the statutes is amended to read:

49.473 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b), (gp), and (o), allowable charges to a provider who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who meets the requirements under sub. (2) for all benefits and services specified under s. 49.46 (2).

33,1410 Section 1410. 49.473 (6) (b) of the statutes is amended to read:

49.473 (6) (b) Inform the woman at the of time of the determination that she is required to apply to the department or a county department for medical assistance no later than the last day of the month following the month in which the qualified entity determines that the woman is eligible for medical assistance.

33,1412 Section 1412. 49.496 (4) of the statutes is amended to read: