49.47 (4) (k) Notwithstanding par. (b) 3. and s. 445.125 (1) (a), no later than 60 days after the effective date of this paragraph .... [LRB inserts date], the department shall seek approval from the federal Centers for Medicare and Medicaid Services to permit friends and family members of any individual receiving medical assistance under this section to contribute funds to an irrevocable burial trust for the individual, up to a total irrevocable trust amount of $4,500, without the individual losing eligibility for medical assistance under this section. If the federal Centers for Medicare and Medicaid Services approves the request, the department shall implement the change under this section within 60 days after receiving approval.
49.47 (5) Investigation by department. (intro.) The department may make additional investigation of eligibility at any of the following times:
49.47 (5) (a) When there is reasonable ground for belief that an applicant may not be eligible or that the beneficiary may have received benefits to which the beneficiary is not entitled.
49.47 (5) (c) Any time determined by the department by a policy created under s. 49.45 (2m) (c) to determine eligibility or to reevaluate continuing eligibility, except that if federal law allows a reevaluation of eligibility more frequently than every 12 months and if there is no conflicting provision of state law, the department is not required to create a policy to reevaluate eligibility under this section.
32,1459j
Section 1459j. 49.47 (5) (c) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.
49.47 (6) (a) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the department shall audit and pay charges to certified providers for medical assistance on behalf of the following:
32,1459o
Section 1459o. 49.47 (6) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.47 (6) (a) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the The department shall audit and pay charges to certified providers for medical assistance on behalf of the following:
32,1459p
Section 1459p. 49.47 (6) (a) 6. b. of the statutes is amended to read:
49.47
(6) (a) 6. b. 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. (4) (a)
, and meets the income limitation, 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.
32,1459q
Section 1459q. 49.47 (6) (a) 6. c. of the statutes is amended to read:
49.47
(6) (a) 6. c. An individual who is only entitled to coverage under
part Part A of
medicare Medicare, meets the eligibility criteria under sub. (4) (a)
, and meets the income limitation, 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.
32,1459r
Section 1459r. 49.47 (6) (a) 6. d. of the statutes is amended to read:
49.47
(6) (a) 6. d. An individual who is entitled to coverage under
part Part A of
medicare Medicare, entitled to coverage under
part Part B of
medicare Medicare, and meets the eligibility criteria for
medical assistance Medical Assistance under sub. (4) (a)
, but does not meet the income limitation, 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. 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.
32,1459s
Section 1459s. 49.47 (6) (a) 6. e. of the statutes is amended to read:
49.47
(6) (a) 6. e. An individual who is only entitled to coverage under
part Part A of
medicare Medicare and meets the eligibility criteria for
medical assistance
Medical Assistance under sub. (4) (a), but does not meet the income limitation, the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395 to
1395i, including those services that are not included in the approved state plan for services under
42 USC 1396.
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.
32,1459t
Section 1459t. 49.47 (6) (a) 6. f. of the statutes is amended to read:
49.47
(6) (a) 6. f. For an individual who is only entitled to coverage under
part Part B of
medicare Medicare and meets the eligibility criteria under sub. (4), but does not meet the income limitation,
medical assistance Medical Assistance shall include payment of the deductible and coinsurance portions of
medicare Medicare services under
42 USC 1395j to
1395w, including those
medicare Medicare services that are not included in the approved state plan for services under
42 USC 1396. Payment of coinsurance for a service under
part Part B of
medicare, other than payment of coinsurance for outpatient hospital services, Medicare may not exceed the allowable charge for the service under
medical assistance Medical Assistance minus the
medicare
Medicare payment.
49.471 (13) Applicability. If the department creates a policy under s. 49.45 (2m) (c), subs. (4), (5), (6), (7), (8), (10), and (11) do not apply to the extent that those subsections conflict with the policy.
32,1461h
Section 1461h. 49.471 (13) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.
49.472 (3) Eligibility. (intro.) Except as provided in sub. (6) (a) and unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), an individual is eligible for and shall receive medical assistance under this section if all of the following conditions are met:
32,1461q
Section 1461q. 49.472 (3) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.472 (3) Eligibility. (intro.) Except as provided in sub. (6) (a) and unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), an individual is eligible for and shall receive medical assistance under this section if all of the following conditions are met:
49.472 (4) (b) (intro.) The department may waive monthly premiums that are calculated to be below $10 per month. Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the department may not assess a monthly premium for any individual whose income level, after adding the individual's earned income and unearned income, is below 150% of the poverty line.
32,1462h
Section 1462h. 49.472 (4) (b) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.472 (4) (b) (intro.) The department may waive monthly premiums that are calculated to be below $10 per month. Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the The department may not assess a monthly premium for any individual whose income level, after adding the individual's earned income and unearned income, is below 150% of the poverty line.
32,1463
Section
1463. 49.472 (6) (a) of the statutes is amended to read:
49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account accounts under s. 20.435 (4) (b), (gm), 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.
32,1464
Section
1464. 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 accounts under s. 20.435 (4) (b), (gm), 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).
49.473 (2) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), a woman is eligible for medical assistance as provided under sub. (5) if, after applying to the department or a county department, the department or a county department determines that she meets all of the following requirements:
32,1465p
Section 1465p. 49.473 (2) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.473 (2) (intro.) Unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c), a A woman is eligible for medical assistance as provided under sub. (5) if, after applying to the department or a county department, the department or a county department determines that she meets all of the following requirements:
49.473 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b), (gm), 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), unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c).
32,1470b
Section 1470b. 49.473 (5) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:
49.473 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b), (gm), 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), unless otherwise provided by the department by a policy created under s. 49.45 (2m) (c).
32,1477r
Section 1477r. 49.67 (3) (am) 2. b. of the statutes is amended to read:
49.67 (3) (am) 2. b. If the applicant is under 27 26 years of age, notice that he or she may be eligible for coverage as a dependent under his or her parent's health care plan in accordance with s. 632.885, and that his or her parent's plan must include coverage for services that are not covered under the plan under this section.
32,1478
Section
1478. 49.68 (3) (b) of the statutes is amended to read:
49.68 (3) (b) From the appropriation accounts under ss. 20.435 (4) (e) and (je), the state shall pay the cost of, at a rate determined by the department under par. (e), for medical treatment that is required as a direct result of chronic renal disease of certified patients from the date of certification, including the cost of administering recombinant human erythropoietin to appropriate patients, whether the treatment is rendered in an approved facility in the state or in a dialysis or transplantation center which that is approved as such by a contiguous state, subject to the conditions specified under par. (d). Approved facilities may include a hospital in-center dialysis unit or a nonhospital dialysis center which that is closely affiliated with a home dialysis program supervised by an approved facility. Aid shall also be provided for all reasonable expenses incurred by a potential living-related donor, including evaluation, hospitalization, surgical costs, and postoperative follow-up to the extent that these costs are not reimbursable under the federal medicare program or other insurance. In addition, all expenses incurred in the procurement, transportation, and preservation of cadaveric donor kidneys shall be covered to the extent that these costs are not otherwise reimbursable. All donor-related costs are chargeable to the recipient and reimbursable under this subsection.
32,1479
Section
1479. 49.68 (3) (e) of the statutes is amended to read:
49.68 (3) (e) State aids Payment for services provided under this section shall be equal to at a rate determined by the department that does not exceed the allowable charges under the federal Medicare program. In no case shall state rates for individual service elements exceed the federally defined allowable costs. The rate of charges for services not covered by public and private insurance shall not exceed the reasonable charges as established by medicare Medicare fee determination procedures. A person that provides to a patient a service for which aid is provided under this section shall accept the amount paid under this section for the service as payment in full and may not bill the patient for any amount by which the charge for the service exceeds the amount paid for the service under this section. The state may not pay for the cost of travel, lodging, or meals for persons who must travel to receive inpatient and outpatient dialysis treatment for kidney disease. This paragraph shall not apply to donor related costs as defined in par. (b).
32,1486m
Section 1486m. 49.78 (1) (br) of the statutes is created to read:
49.78 (1) (br) "Multicounty consortium" means a group of counties that is approved by the department under sub. (1m) to administer income maintenance programs.
32,1487m
Section 1487m. 49.78 (1m) of the statutes is created to read:
49.78 (1m) Multicounty consortia. (a) Except as provided in par. (c), each county with a population of less than 750,000 shall participate in a multicounty consortium that is approved by the department under par. (b).
(b) By October 31, 2011, the department shall approve multicounty consortia. The department may not approve more than 10 multicounty consortia.
(c) If a county with a population of less than 750,000 does not participate in a multicounty consortium or the department determines that a multicounty consortium does not satisfy the department's performance requirements, the department shall assume responsibility for administering income maintenance programs in that county or in the geographical area of the multicounty consortium. The department may provide income maintenance program administration under this paragraph by contracting with another multicounty consortium or by providing the administrative services with state resources and employees.
(d) If the department assumes responsibility for administering income maintenance programs in a county or in the geographical area of the multicounty consortium under par. (c), any county for which the department administers income maintenance programs shall pay to the department the amount that the county expended for the administration of income maintenance programs in calendar year 2009. For the purposes of this paragraph, Kenosha County expended $673,000 for the administration of income maintenance programs in calendar year 2009.
32,1488m
Section 1488m. 49.78 (1r) of the statutes is created to read:
49.78 (1r) Single county consortia. The department shall administer income maintenance programs in a county with a population of 750,000 or more as a single-county consortium, including the administrative functions specified in sub. (2) (b) 1.
32,1489m
Section 1489m. 49.78 (2) (title) of the statutes is amended to read:
49.78 (2) (title) Contracts with multicounty consortia.
32,1490m
Section 1490m. 49.78 (2) of the statutes is renumbered 49.78 (2) (a) and amended to read:
49.78 (2) (a) Annually, for the income maintenance program functions, if any, that the department delegates to a county or tribal governing body beginning with contracts for 2012, the department and county department under s. 46.215, 46.22, or 46.23 shall enter into a contract, and the department and tribal governing body may enter into a contract, for reimbursement of the county department or tribal governing body for the reasonable cost of administering with each multicounty consortium to administer income maintenance programs in the multicounty consortium's geographical area.
32,1491m
Section 1491m. 49.78 (2) (b) of the statutes is created to read:
49.78 (2) (b) A contract under par. (a) shall provide all of the following:
1. That the multicounty consortia shall be responsible for all of the following administrative functions related to income maintenance programs:
a. Operating and maintaining a call center.
b. Conducting application processing and eligibility determinations.
c. Conducting ongoing case management.
d. Providing lobby services.
2. That the department and multicounty consortia shall cooperate to provide the following administrative functions related to the income maintenance programs:
a. Conducting subrogation and benefit recovery efforts.
b. Participating in fair hearings.
c. Conducting fraud prevention and identification activities.
3. That the department will reimburse a multicounty consortium for services provided under the contract on a risk-adjusted case load basis.
32,1492m
Section 1492m. 49.78 (2m) of the statutes is created to read:
49.78 (2m) Administration by a tribal governing body. (a) A tribal governing body may administer income maintenance programs by electing to have the department administer the tribe's income maintenance programs or by providing the required administrative services and entering into a contract with the department for reimbursement under par. (b).
(b) Annually, for the income maintenance administrative program functions, if any, that the department delegates to a tribal governing body, the department and tribal governing body may enter into a contract, for reimbursement of the tribal governing body for the reasonable cost of administering income maintenance programs.
(c) The amount of each reimbursement paid under a contract entered into par. (b) shall be calculated using a formula based on workload within the limits of state and federal funds. The department may adjust reimbursement amounts determined under the contract for workload changes and computer network activities performed by a tribal governing body.
32,1493m
Section 1493m. 49.78 (2r) of the statutes is created to read:
49.78 (2r) Departmental administrative functions. The department shall perform all of the following administrative functions related to income maintenance programs:
(a) Providing income maintenance worker training.
(b) Performing 2nd-party reviews.
(c) Administering the funeral expenses program under s. 49.785.
(d) Providing information technology and licenses for call centers that are operated by multicounty consortia.
(e) Maintaining the client assistance reemployment and economic support system.
(f) Contracting with multicounty consortia under sub. (2), including establishing performance requirements.
(g) Contracting with tribal governing bodies under sub. (2m), including establishing performance requirements.
