Wisconsin Legislature: 32,1439

3. The cost of the repair is a covered benefit under the program of which the individual is a recipient.

32,1437j Section 1437j. 49.45 (18) (ac) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag), any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the benefits under s. 49.46 (2) (a) and (b) under s. 49.471 shall pay up to the maximum amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided under s. 49.46 (2). The service provider shall collect the specified or allowable copayment, coinsurance, or deductible, unless the service provider determines that the cost of collecting the copayment, coinsurance, or deductible exceeds the amount to be collected. The department shall reduce payments to each provider by the amount of the specified or allowable copayment, coinsurance, or deductible. Unless otherwise provided by the department by a policy created under sub. (2m) (c), no provider may deny care or services because the recipient is unable to share costs, but an inability to share costs specified in this subsection does not relieve the recipient of liability for these costs.

32,1437k Section 1437k. 49.45 (18) (ac) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag), any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the benefits under s. 49.46 (2) (a) and (b) under s. 49.471 shall pay up to the maximum amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided under s. 49.46 (2). The service provider shall collect the specified or allowable copayment, coinsurance, or deductible, unless the service provider determines that the cost of collecting the copayment, coinsurance, or deductible exceeds the amount to be collected. The department shall reduce payments to each provider by the amount of the specified or allowable copayment, coinsurance, or deductible. Unless otherwise provided by the department by a policy created under sub. (2m) (c), no No provider may deny care or services because the recipient is unable to share costs, but an inability to share costs specified in this subsection does not relieve the recipient of liability for these costs.

32,1437n Section 1437n. 49.45 (18) (ag) (intro.) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

49.45 (18) (ag) (intro.) Except as provided in pars. (am), (b), and (c), and subject to par. (d), a recipient specified in par. (ac) shall pay all of the following, unless otherwise provided by the department by a policy created under sub. (2m) (c):

32,1437o Section 1437o. 49.45 (18) (ag) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

32,1437q Section 1437q. 49.45 (18) (b) (intro.) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

49.45 (18) (b) (intro.) Unless otherwise provided by the department by a policy created under sub. (2m) (c), the following services are not subject to recipient cost sharing under this subsection:

32,1437r Section 1437r. 49.45 (18) (b) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

49.45 (18) (b) (intro.) Unless otherwise provided by the department by a policy created under sub. (2m) (c), the The following services are not subject to recipient cost sharing under this subsection:

32,1437t Section 1437t. 49.45 (18) (d) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

49.45 (18) (d) No person who designates a pharmacy or pharmacist as his or her sole provider of prescription drugs and who so uses that pharmacy or pharmacist is liable under this subsection for more than $12 per month for prescription drugs received, unless otherwise provided by the department by a policy created under sub. (2m) (c).

32,1437u Section 1437u. 49.45 (18) (d) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

32,1438d Section 1438d. 49.45 (23) (a) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

49.45 (23) (a) The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to conduct a demonstration project to provide health care coverage for basic primary and preventive care to adults who are under the age of 65, who have family incomes not to exceed 200 percent of the poverty line, and who are not otherwise eligible for medical assistance under this subchapter, the Badger Care health care program under s. 49.665, or Medicare under 42 USC 1395 et seq. If the department creates a policy under sub. (2m) (c) 10., this paragraph does not apply to the extent that it conflicts with the policy.

32,1438e Section 1438e. 49.45 (23) (a) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

32,1438h Section 1438h. 49.45 (23) (b) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

49.45 (23) (b) If the waiver is granted and in effect, the department may promulgate rules defining the health care benefit plan, including more specific eligibility requirements and cost-sharing requirements. Unless otherwise provided by the department by a policy created under sub. (2m) (c), cost sharing may include an annual enrollment fee, which may not exceed $75 per year. Notwithstanding s. 227.24 (3), the plan details under this subsection may be promulgated as an emergency rule under s. 227.24 without a finding of emergency. If the waiver is granted and in effect, the demonstration project under this subsection shall begin on January 1, 2009, or on the effective date of the waiver, whichever is later.

32,1438i Section 1438i. 49.45 (23) (b) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

49.45 (23) (b) If the waiver is granted and in effect, the department may promulgate rules defining the health care benefit plan, including more specific eligibility requirements and cost-sharing requirements. Unless otherwise provided by the department by a policy created under sub. (2m) (c), cost Cost sharing may include an annual enrollment fee, which may not exceed $75 per year. Notwithstanding s. 227.24 (3), the plan details under this subsection may be promulgated as an emergency rule under s. 227.24 without a finding of emergency. If the waiver is granted and in effect, the demonstration project under this subsection shall begin on January 1, 2009, or on the effective date of the waiver, whichever is later.

32,1438L Section 1438L. 49.45 (24g) (c) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

49.45 (24g) (c) The department's proposal under par. (a) shall specify increases in reimbursement rates for providers that satisfy the conditions under par. (a) 1. or 2., and shall provide for payment of a monthly per-patient care coordination fee to those providers. The department shall set the increases in reimbursement rates and the monthly per-patient care coordination fee so that together they provide sufficient incentive for providers to satisfy a condition under par. (a) 1. or 2. The proposal shall specify effective dates for the increases in reimbursement rates and the monthly per-patient care coordination fee that are no sooner than July 1, 2011. If the department creates a policy under sub. (2m) (c) 4., this paragraph does not apply to the extent that it conflicts with the policy.

32,1438m Section 1438m. 49.45 (24g) (c) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

32,1439 Section 1439. 49.45 (24m) (intro.) of the statutes is amended to read:

49.45 (24m) (intro.) From the appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), in order to test the feasibility of instituting a system of reimbursement for providers of home health care and personal care services for medical assistance recipients that is based on competitive bidding, the department shall:

32,1439n Section 1439n. 49.45 (24r) of the statutes , as affected by 2011 Wisconsin Act .... (this act), is repealed.

32,1439w Section 1439w. 49.45 (24r) (a) of the statutes is amended to read:

49.45 (24r) (a) The department shall implement any waiver granted by the secretary of the federal department of health and human services to permit the department to conduct a demonstration project to provide family planning, as defined in s. 253.07 (1) (a), under medical assistance to any woman between the ages of 15 and 44 whose family income does not exceed 200% of the poverty line for a family the size of the woman's family. If the department creates a policy under sub. (2m) (c) 10., this paragraph does not apply to the extent that it conflicts with the policy.

32,1439x Section 1439x. 49.45 (24r) (b) of the statutes is amended to read:

49.45 (24r) (b) The department may request an amended waiver from the secretary to permit the department to conduct a demonstration project to provide family planning to any man between the ages of 15 and 44 whose family income does not exceed 200 percent of the poverty line for a family the size of the man's family. If the amended waiver is granted, the department may implement the waiver. If the department creates a policy under sub. (2m) (c) 10., this paragraph does not apply to the extent that it conflicts with the policy.

32,1441b Section 1441b. 49.45 (24s) of the statutes is created to read:

49.45 (24s) Family planning project. (a) The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to provide optional services for family planning, as defined in s. 253.07 (1) (a), under medical assistance to any female between the ages of 15 and 44 whose family income does not exceed 200 percent of the poverty line for a family the size of the female's family , unless otherwise provided by the department by a policy created under sub. (2m) (c) 10. The department shall implement any waiver granted.

(b) The department shall request a waiver, or an amendment to the waiver requested under par. (a), from the secretary of the federal department of health and human services to require all of the following:

1. As a condition of receiving services under par. (a), parental notification for family planning services for any female under 18 years of age.

2. The department to determine eligibility to receive family planning services under par. (a) for a female under 18 years of age using the family income of the female's parent or guardian instead of only the female's income.

32,1441bg Section 1441bg. 49.45 (24s) (a) of the statutes, as created by 2011 Wisconsin Act .... (this act), is amended to read:

49.45 (24s) (a) The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to provide optional services for family planning, as defined in s. 253.07 (1) (a), under medical assistance to any female between the ages of 15 and 44 whose family income does not exceed 200 percent of the poverty line for a family the size of the female's family, unless otherwise provided by the department by a policy created under sub. (2m) (c) 10. The department shall implement any waiver granted.

32,1441c Section 1441c. 49.45 (25g) (c) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

49.45 (25g) (c) The department's proposal under par. (b) shall specify increases in reimbursement rates for providers that satisfy the conditions under par. (b), and shall provide for payment of a monthly per-patient care coordination fee to those providers. The department shall set the increases in reimbursement rates and the monthly per-patient care coordination fee so that together they provide sufficient incentive for providers to satisfy a condition under par. (b) 1. or 2. The proposal shall specify effective dates for the increases in reimbursement rates and the monthly per-patient care coordination fee that are no sooner than January 1, 2011. The increases in reimbursement rates and monthly per-patient care coordination fees that are not provided by the federal government shall be paid from the appropriation under. s. 20.435 (1) (am). If the department creates a policy under sub. (2m) (c) 4., this paragraph does not apply to the extent it conflicts with the policy.

32,1441d Section 1441d. 49.45 (25g) (c) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

32,1441f Section 1441f. 49.45 (27) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

49.45 (27) Eligibility of aliens. A person who is not a U.S. citizen or an alien lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law may not receive medical assistance benefits except as provided under 8 USC 1255a (h) (3) or 42 USC 1396b (v), unless otherwise provided by the department by a policy created under sub. (2m) (c).

32,1441g Section 1441g. 49.45 (27) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

32,1442g Section 1442g. 49.45 (39) (b) 1. of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated 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, unless otherwise provided by the department by a policy created under sub. (2m) (c), 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, unless otherwise provided by the department by a policy created under sub. (2m) (c), 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 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.

32,1442h Section 1442h. 49.45 (39) (b) 1. of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

32,1443 Section 1443. 49.45 (51) (a) of the statutes is amended to read:

49.45 (51) (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 accounts under s. 20.435 (4) (b) and (gm) 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.

32,1444 Section 1444. 49.45 (52) (title) of the statutes is amended to read:

49.45 (52) (title) Payment adjustments ; federal funding for certain services.

32,1445 Section 1445. 49.45 (52) of the statutes is renumbered 49.45 (52) (a) 1. and amended to read:

49.45 (52) (a) 1. Beginning on January 1, 2003 If the department provides the notice under par. (c) selecting the payment procedure in this paragraph, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payment adjustments to county departments under s. 46.215, 46.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01 (4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating in the early intervention program under s. 51.44. Payment adjustments under this subsection paragraph shall include the state share of the payments. The total of any payment adjustments under this subsection paragraph and Medical Assistance payments made from appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

32,1446 Section 1446. 49.45 (52) (a) 2. of the statutes is created to read:

49.45 (52) (a) 2. The department may require a county department or local health department to submit a certified cost report that meets the requirements of the federal department of health and human services for covered services described in subd. 1.

32,1447 Section 1447. 49.45 (52) (b) of the statutes is created to read:

49.45 (52) (b) If the department provides the notice under par. (c) selecting the payment procedure in this paragraph, all of the following apply:

1. Annually, a county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437 shall submit a certified cost report that meets the requirements of the federal department of health and human services for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating in the early intervention program under s. 51.44.

2. For services described under subd. 1., the department shall base the amount of a claim for federal medical assistance funds on certified cost reports submitted by county departments under subd. 1. to the extent the reports comply with federal requirements.

3. The department shall pay county departments a percentage of the federal funds claimed under subd. 2. for services described under subd. 1., which percentage is established in the most recent biennial budget.

4. The department may pay a local health department, as defined in s. 250.01 (4), that submits certified cost reports for services described under subd. 1. a percentage of the federal funds claimed for those services, which percentage is established in the most recent biennial budget.

32,1448 Section 1448. 49.45 (52) (c) of the statutes is created to read:

49.45 (52) (c) The department shall select a payment procedure under either par. (a) or (b) and may change which procedure under par. (a) or (b) is selected. The department shall notify each county department and local health department, as applicable, of the selected payment procedure before the date on which payment for services is made under that selected or newly selected procedure.

32,1449 Section 1449. 49.45 (53) of the statutes is amended to read:

49.45 (53) Payments for certain services. Beginning on January 1, 2003, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payments to providers for covered services under ss. 49.46 (2) (a) 4. d. and (b) 6. j. and m. and 49.471 (11) (f) that are provided before January 1, 2012.

32,1453e Section 1453e. 49.46 (1) (n) of the statutes, as created by 2011 Wisconsin Act 10, is repealed and recreated to read:

49.46 (1) (n) If the department creates a policy under s. 49.45 (2m) (c) 8., 9., or 10., this subsection does not apply to the extent that it conflicts with the policy.

32,1453f Section 1453f. 49.46 (1) (n) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.

32,1453h Section 1453h. 49.46 (2) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

49.46 (2) (a) (intro.) Except as provided in par. (be) and unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the department shall audit and pay allowable charges to certified providers for medical assistance on behalf of recipients for the following federally mandated benefits:

32,1453i Section 1453i. 49.46 (2) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

32,1453k Section 1453k. 49.46 (2) (b) (intro.) of the statutes, as affected by 2011 Wisconsin Act 10, is repealed and recreated to read:

49.46 (2) (b) (intro.) Except as provided in pars. (be) and (dc) and unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the department shall audit and pay allowable charges to certified providers for medical assistance on behalf of recipients for the following services:

32,1453L Section 1453L. 49.46 (2) (b) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

32,1453m Section 1453m. 49.46 (2) (c) 2. of the statutes is amended to read:

49.46 (2) (c) 2. For an individual who is entitled to coverage under part Part A of medicare Medicare, entitled to coverage under part Part B of medicare Medicare, meets the eligibility criteria under sub. (1), and meets the limitation on income under subd. 6., medical assistance Medical Assistance shall include payment of the deductible and coinsurance portions of medicare Medicare services under 42 USC 1395 to 1395zz which that are not paid under 42 USC 1395 to 1395zz, including those medicare Medicare services that are not included in the approved state plan for services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under part Part A of medicare Medicare. Payment of coinsurance for a service under part Part B of medicare Medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, and payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under medical assistance Medical Assistance minus the medicare Medicare payment.

32,1453n Section 1453n. 49.46 (2) (c) 3. of the statutes is amended to read:

49.46 (2) (c) 3. For an individual who is only entitled to coverage under part Part A of medicare Medicare, meets the eligibility criteria under sub. (1), and meets the limitation on income under subd. 6., medical assistance Medical Assistance shall include payment of the deductible and coinsurance portions of medicare Medicare services under 42 USC 1395 to 1395i which that are not paid under 42 USC 1395 to 1395i, including those medicare Medicare services that are not included in the approved state plan for services under 42 USC 1396; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under part Part A of medicare Medicare. Payment of deductibles and coinsurance for inpatient hospital services under Part A of Medicare may not exceed the allowable charge for the service under Medical Assistance minus the Medicare payment.

32,1453o Section 1453o. 49.46 (2) (c) 4. of the statutes is amended to read: