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 of the statutes is repealed.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:
49.496 (4) Administration. The department may require a county department under s. 46.215, 46.22, or 46.23 or the governing body of a federally recognized American Indian tribe administering medical assistance to gather and provide the department with information needed to recover medical assistance under this section. The department shall pay to a county department or tribal governing body an amount equal to 5% of the recovery collected by the department relating to a beneficiary for whom the county department or tribal governing body made the last determination of medical assistance eligibility. A county department or tribal governing body may use funds received under this subsection only to pay costs incurred under this subsection and, if any amount remains, to pay for improvements to functions required under s. 49.33 49.78 (2). The department may withhold payments under this subsection for failure to comply with the department's requirements under this subsection. The department shall treat payments made under this subsection as costs of administration of the medical assistance Medical Assistance program.
33,1413
Section
1413. 49.498 (16) (g) of the statutes is amended to read:
49.498 (16) (g) All forfeitures, penalty assessments
, and interest, if any, shall be paid to the department within 10 days of receipt of notice of assessment or, if the forfeiture, penalty assessment, and interest, if any, are contested under par. (f), within 10 days of receipt of the final decision after exhaustion of administrative review, unless the final decision is appealed and the order is stayed by court order under sub. (19) (b). The department shall remit all forfeitures paid to the state treasurer secretary of administration for deposit in the school fund. The department shall deposit all penalty assessments and interest in the appropriation under s. 20.435 (6) (g).
33,1414
Section
1414. 49.665 (2) (title) of the statutes is amended to read:
49.665 (2) (title) Waiver
Waivers.
33,1415
Section
1415. 49.665 (2) of the statutes is renumbered 49.665 (2) (a) and amended to read:
49.665 (2) (a) The department of health and family services shall request a waiver from the secretary of the federal department of health and human services to permit the department of health and family services to implement, beginning not later than July 1, 1998, or the effective date of the waiver, whichever is later, a health care program under this section. If a waiver that is consistent with all of the provisions of this section, excluding sub. (4) (a) 3m., is granted and in effect, the department of health and family services shall implement the program under this section. The department of health and family services may not implement the program under this section unless a waiver that is consistent with all of the provisions of this section, excluding sub. (4) (a) 3m., is granted and in effect.
33,1416
Section
1416. 49.665 (2) (b) of the statutes is created to read:
49.665 (2) (b) If the department of health and family services determines that it needs a waiver to require the verification specified in sub. (4) (a) 3m., the department shall request a waiver from the secretary of the federal department of health and human services and may not implement the verification requirement under sub. (4) (a) 3m. unless the waiver is granted. If a waiver is required and is granted, the department of health and family services may implement the verification requirement under sub. (4) (a) 3m. as appropriate. If a waiver is not required, the department of health and family services may require the verification specified in sub. (4) (a) 3m. for eligibility determinations and annual review eligibility determinations made by the department, beginning on January 1, 2004.
33,1417
Section
1417. 49.665 (4) (a) 3m. of the statutes is created to read:
49.665 (4) (a) 3m. Each member of the family who is employed provides verification from his or her employer, in the manner specified by the department, of his or her earnings, of whether the employer provides health care coverage for which the family is eligible, and of the amount that the employer pays, if any, towards the cost of the health care coverage, excluding any deductibles or copayments required under the coverage.
33,1419
Section
1419. 49.665 (5) (a) of the statutes is renumbered 49.665 (5) (ag) and amended to read:
49.665 (5) (ag) Except as provided in pars. (am), (b), and (bm), a family, or child who does not reside with his or her parent, who receives health care coverage under this section shall pay a percentage of the cost of that coverage in accordance with a schedule established by the department by rule. If the schedule established by the department requires a family, or child who does not reside with his or her parent, to contribute more than 3% of the family's or child's income towards the cost of the health care coverage provided under this section, the department shall submit the schedule to the joint committee on finance for review and approval of the schedule. If the cochairpersons of the joint committee on finance do not notify the department within 14 working days after the date of the department's submittal of the schedule that the committee has scheduled a meeting to review the schedule, the department may implement the schedule. If, within 14 days after the date of the department's submittal of the schedule, the cochairpersons of the committee notify the department that the committee has scheduled a meeting to review the schedule, the department may not require a family, or child who does not reside with his or her parent, to contribute more than 3% of the family's or child's income unless the joint committee on finance approves the schedule. The joint committee on finance may not approve and the department may not implement a schedule that requires a family or child to contribute, including the amounts required under par. (am), more than 3.5% of the family's or child's income towards the cost of the health care coverage provided under this section.
33,1420
Section
1420. 49.665 (5) (ac) of the statutes is created to read:
49.665 (5) (ac) In this subsection, "cost" means total cost-sharing charges, including premiums, copayments, coinsurance, deductibles, enrollment fees, and any other cost-sharing charges.
33,1421
Section
1421. 49.665 (5) (ag) of the statutes, as affected by 2003 Wisconsin Act .... (this act), is amended to read:
49.665 (5) (ag) Except as provided in pars. (am), (b), and (bm), a family, or child who does not reside with his or her parent, who receives health care coverage under this section shall pay a percentage of the cost of that coverage in accordance with a schedule established by the department by rule. If the schedule established by the department requires a family, or child who does not reside with his or her parent, to contribute more than 3% of the family's or child's income towards the cost of the health care coverage provided under this section, the department shall submit the schedule to the joint committee on finance for review and approval of the schedule. If the cochairpersons of the joint committee on finance do not notify the department within 14 working days after the date of the department's submittal of the schedule that the committee has scheduled a meeting to review the schedule, the department may implement the schedule. If, within 14 days after the date of the department's submittal of the schedule, the cochairpersons of the committee notify the department that the committee has scheduled a meeting to review the schedule, the department may not require a family, or child who does not reside with his or her parent, to contribute more than 3% of the family's or child's income unless the joint committee on finance approves the schedule. The joint committee on finance may not approve and the The department may not establish or implement a schedule that requires a family or child to contribute, including the amounts required under par. (am), more than 3.5% 5% of the family's or child's income towards the cost of the health care coverage provided under this section.
33,1422
Section
1422. 49.665 (5) (am) of the statutes is created to read:
49.665 (5) (am) Except as provided in pars. (b) and (bm), a child or family member who receives health care coverage under this section shall pay the following cost-sharing amounts:
