AB133-SSA1,714,2319 49.45 (6w) (d) If the federal department of health and human services approves
20for state expenditure in a fiscal year amounts under s. 20.435 (5) (4) (o) that result
21in a lesser allocation amount than that allocated under this subsection or disallows
22use of the allocation of federal medicaid funds under par. (c), reduce allocations under
23this subsection and distribute on a prorated basis, as determined by the department.
AB133-SSA1, s. 1413 24Section 1413. 49.45 (6x) (a) of the statutes is amended to read:
AB133-SSA1,715,5
149.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
220.435 (5) (4) (b) and (o) the department shall distribute not more than $4,748,000
3in each fiscal year, to provide funds to an essential access city hospital, except that
4the department may not allocate funds to an essential access city hospital to the
5extent that the allocation would exceed any limitation under 42 USC 1396b (i) (3).
AB133-SSA1, s. 1414 6Section 1414. 49.45 (6x) (d) of the statutes is amended to read:
AB133-SSA1,715,117 49.45 (6x) (d) If the federal department of health and human services approves
8for state expenditure in any state fiscal year amounts under s. 20.435 (5) (4) (o) that
9result in a lesser distribution amount than that distributed under this subsection or
10disallows use of federal medicaid funds under par. (a), the department of health and
11family services shall reduce the distributions under this subsection.
AB133-SSA1, s. 1415 12Section 1415. 49.45 (6y) (a) of the statutes is amended to read:
AB133-SSA1,715,2213 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s.
1420.435 (5) (4) (b) and (o) the department shall distribute funding in each fiscal year
15to provide supplemental payment to hospitals that enter into a contract under s.
1649.02 (2) to provide health care services funded by a relief block grant, as determined
17by the department, for hospital services that are not in excess of the hospitals'
18customary charges for the services, as limited under 42 USC 1396b (i) (3). If no relief
19block grant is awarded under this chapter or if the allocation of funds to such
20hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department
21may distribute funds to hospitals that have not entered into a contract under s. 49.02
22(2).
AB133-SSA1, s. 1416 23Section 1416. 49.45 (6y) (am) of the statutes is created to read:
AB133-SSA1,716,524 49.45 (6y) (am) Notwithstanding sub. (3) (e), from the appropriations under s.
2520.435 (4) (b), (h) and (o) the department shall distribute funding in each fiscal year

1to provide supplemental payments to hospitals that enter into contracts under s.
249.02 (2) with a county having a population of 500,000 or more to provide health care
3services funded by a relief block grant, as determined by the department, for hospital
4services that are not in excess of the hospitals' customary charges for the services,
5as limited under 42 USC 1396b (i) (3).
AB133-SSA1, s. 1417 6Section 1417. 49.45 (6y) (b) of the statutes is amended to read:
AB133-SSA1,716,97 49.45 (6y) (b) The department need not promulgate as rules under ch. 227 the
8procedures, methods of distribution and criteria required for distribution under par.
9pars. (a) and (am).
AB133-SSA1, s. 1418 10Section 1418. 49.45 (6z) (a) (intro.) of the statutes is amended to read:
AB133-SSA1,716,2111 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations
12under s. 20.435 (5) (4) (b) and (o) the department shall distribute funding in each
13fiscal year to supplement payment for services to hospitals that enter into a contract
14under s. 49.02 (2) to provide health care services funded by a relief block grant under
15this chapter, if the department determines that the hospitals serve a
16disproportionate number of low-income patients with special needs. If no medical
17relief block grant under this chapter is awarded or if the allocation of funds to such
18hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department
19may distribute funds to hospitals that have not entered into a contract under s. 49.02
20(2). The department may not distribute funds under this subsection to the extent
21that the distribution would do any of the following:
AB133-SSA1, s. 1419 22Section 1419. 49.45 (8) (b) of the statutes is amended to read:
AB133-SSA1,717,223 49.45 (8) (b) Reimbursement under s. 20.435 (5) (4) (b) and (o) for home health
24services provided by a certified home health agency or independent nurse shall be
25made at the home health agency's or nurse's usual and customary fee per patient care

1visit, subject to a maximum allowable fee per patient care visit that is established
2under par. (c).
AB133-SSA1, s. 1424m 3Section 1424m. 49.45 (22) of the statutes is amended to read:
AB133-SSA1,717,154 49.45 (22) Medical assistance services provided by health maintenance
5organizations.
If the department contracts with health maintenance organizations
6for the provision of medical assistance it shall give special consideration to health
7maintenance organizations that provide or that contract to provide comprehensive,
8specialized health care services to pregnant teenagers. If the department contracts
9with health maintenance organizations for the provision of medical assistance, the
10department shall include in the contract a lead screening performance standard that
11requires the health maintenance organization to provide annually at least one lead
12blood test to at least 65% of the children ages 1 to 5 years who have been enrolled in
13the health maintenance organization for at least 6 months during the applicable
14year. The department shall specify in the contract financial penalties for failure to
15meet the lead screening performance standard.
AB133-SSA1, s. 1426 16Section 1426. 49.45 (24m) (intro.) of the statutes is amended to read:
AB133-SSA1,717,2117 49.45 (24m) Home health care and personal care pilot program. (intro.)
18From the appropriations under s. 20.435 (5) (4) (b) and (o), in order to test the
19feasibility of instituting a system of reimbursement for providers of home health care
20and personal care services for medical assistance recipients that is based on
21competitive bidding, the department shall:
AB133-SSA1, s. 1427g 22Section 1427g. 49.45 (39) (a) 1. of the statutes is amended to read:
AB133-SSA1,718,223 49.45 (39) (a) 1. "School" means a public school described under s. 115.01 (1)
24or, a charter school, as defined in s. 115.001 (1), the Wisconsin School for the Visually
25Handicapped or the Wisconsin School for the Deaf
. It includes school-operated early

1childhood programs for developmentally delayed and disabled 4-year-old and
25-year-old children.
AB133-SSA1, s. 1427h 3Section 1427h. 49.45 (39) (am) of the statutes is amended to read:
AB133-SSA1,718,154 49.45 (39) (am) Plan amendment. No later than September 30, 1995, the
5department shall submit to the federal department of health and human services an
6amendment to the state medical assistance plan to permit the application of pars. (b)
7to and (c). If the amendment to the state plan is approved, school districts and,
8cooperative educational service agencies and the department of public instruction on
9behalf of the Wisconsin School for the Visually Handicapped and the Wisconsin
10School for the Deaf
claim reimbursement under pars. (b) to and (c). Paragraphs (b)
11to and (c) do not apply unless the amendment to the state plan is approved and in
12effect. The department shall submit to the federal department of health and human
13services an amendment to the state plan if necessary to permit the application of
14pars. (b) and (c) to the Wisconsin School for the Visually Handicapped and the
15Wisconsin School for the Deaf.
AB133-SSA1, s. 1427i 16Section 1427i. 49.45 (39) (b) of the statutes is amended to read:
AB133-SSA1,719,1117 49.45 (39) (b) Payment for school medical services. If a school district or a
18cooperative educational service agency elects to provide school medical services and
19meets all requirements under par. (c), the department shall reimburse the school
20district or the cooperative educational service agency for 60% of the federal share of
21allowable charges for the school medical services that it provides and for allowable
22administrative costs. If the Wisconsin School for the Visually Handicapped or the
23Wisconsin School for the Deaf elects to provide school medical services and meets all
24requirements under par. (c), the department shall reimburse the department of
25public instruction for 60% of the federal share of allowable charges for the school

1medical services that the Wisconsin School for the Visually Handicapped or the
2Wisconsin School for the Deaf provides and for allowable administrative costs.
The
3department shall promulgate rules establishing a methodology for making
4reimbursements under this paragraph. All other expenses for the school medical
5services provided by a school district or a cooperative educational service agency
6shall be paid for by the school district or the cooperative educational service agency
7with funds received from state or local taxes. The school district , the Wisconsin
8School for the Visually Handicapped, the Wisconsin School for the Deaf
or the
9cooperative educational service agency shall comply with all requirements of the
10federal department of health and human services for receiving federal financial
11participation.
AB133-SSA1, s. 1428 12Section 1428. 49.45 (46) of the statutes is created to read:
AB133-SSA1,719,2513 49.45 (46) Alcohol and other drug abuse residential treatment services. (a)
14If a county, city, town or village elects to become certified as a provider of alcohol and
15other drug abuse residential treatment services or to contract with a certified
16provider to provide the services, the county, city, town or village may provide directly
17or under contract alcohol and other drug abuse residential treatment services in
18facilities with fewer than 16 beds under this subsection in the county, city, town or
19village to medical assistance recipients through the medical assistance program. A
20county, city, town or village that elects to provide or to contract for the services shall
21pay the amount of the allowable charges for the services under the medical
22assistance program that is not provided by the federal government. The department
23shall reimburse the county, city, town or village under this subsection only for the
24amount of the allowable charges for those services under the medical assistance
25program that is provided by the federal government.
AB133-SSA1,720,1
1(b) This subsection does not apply after July 1, 2003.
AB133-SSA1, s. 1429 2Section 1429. 49.45 (47) of the statutes is created to read:
AB133-SSA1,720,63 49.45 (47) Adult day care centers. (a) In this subsection, "adult day care
4center" means an entity that provides services for part of a day in a group setting to
5adults who need an enriched health-supportive or social experience and who may
6need assistance with activities of daily living, supervision or protection.
AB133-SSA1,720,97 (b) No person may receive reimbursement under s. 46.27 (11) for the provision
8of services to clients in an adult day care center unless the adult day care center is
9certified by the department under sub. (2) (a) 11. as a provider of medical assistance.
AB133-SSA1,720,1310 (c) The biennial fee for the certification required under par. (b) of an adult day
11care center is $89, plus a biennial fee of $17.80 per client, based on the number of
12clients that the adult day care center is certified to serve. Fees collected under this
13paragraph shall be credited to the appropriation account under s. 20.435 (6) (jm).
AB133-SSA1,720,1414 (d) The department, by rule, may increase any fee specified in par. (c).
AB133-SSA1, s. 1430 15Section 1430. 49.453 (4) (title) of the statutes is amended to read:
AB133-SSA1,720,1716 49.453 (4) (title) Irrevocable annuities , promissory notes and similar
17transfers
.
AB133-SSA1, s. 1431 18Section 1431. 49.453 (4) (a) of the statutes is renumbered 49.453 (4) (a) (intro.)
19and amended to read:
AB133-SSA1,721,220 49.453 (4) (a) (intro.) For the purposes of sub. (2), whenever a covered
21individual or his or her spouse, or another person acting on behalf of the covered
22individual or his or her spouse, transfers assets to an irrevocable annuity, or
23transfers assets by promissory note or similar instrument,
in an amount that exceeds
24the expected value of the benefit, the covered individual or his or her spouse transfers
25assets for less than fair market value. A transfer to an annuity, or a transfer by

1promissory note or similar instrument, is not in excess of the expected value only if
2all of the following are true:
AB133-SSA1, s. 1432 3Section 1432. 49.453 (4) (a) 1. and 2. of the statutes are created to read:
AB133-SSA1,721,64 49.453 (4) (a) 1. a. The periodic payments back to the transferor include
5principal and interest that, at the time that the transfer is made, is at least at one
6of the following:
AB133-SSA1,721,97 a. For an annuity, promissory note or similar instrument that is not specified
8under subd. 1. b. or par. (am), the applicable federal rate required under section 1274
9(d) of the Internal Revenue Code, as defined in s. 71.01 (6).
AB133-SSA1,721,1110 b. For an annuity with a guaranteed life payment, the appropriate average of
11the applicable federal rates based on the expected length of the annuity minus 1.5%.
AB133-SSA1,721,1512 2. The terms of the instrument provide for a payment schedule that includes
13equal periodic payments, except that payments may be unequal if the interest
14payments are tied to an interest rate and the inequality is caused exclusively by
15fluctuations in that rate.
AB133-SSA1, s. 1432g 16Section 1432g. 49.453 (4) (am) of the statutes is created to read:
AB133-SSA1,721,1917 49.453 (4) (am) Paragraph (a) 1. does not apply to a variable annuity that is
18tied to a mutual fund that is registered with the federal securities and exchange
19commission.
AB133-SSA1, s. 1433 20Section 1433. 49.453 (4) (c) of the statutes is amended to read:
AB133-SSA1,722,521 49.453 (4) (c) The department shall promulgate rules specifying the method to
22be used in calculating the expected value of the benefit, based on 26 CFR 1.72-1 to
231.72-18, and specifying the criteria for adjusting the expected value of the benefit
24based on a medical condition diagnosed by a physician before the assets were
25transferred to the annuity, or transferred by promissory note or similar instrument.

1In calculating the amount of the divestment when a transfer to an annuity, or a
2transfer by promissory note or similar instrument, is made, payments made to the
3transferor in any year subsequent to the year in which the transfer was made shall
4be discounted to the year in which the transfer was made by the applicable federal
5rate specified under par. (a) on the date of the transfer
.
AB133-SSA1, s. 1433t 6Section 1433t. 49.46 (1) (a) 1m. of the statutes is amended to read:
AB133-SSA1,722,107 49.46 (1) (a) 1m. Any pregnant woman who meets the resource and income
8limits under s. 49.19 (4) (bm) and (es) and whose pregnancy is medically verified.
9Eligibility continues to the last day of the month in which the 60th day after the last
10day of the pregnancy falls.
AB133-SSA1, s. 1433u 11Section 1433u. 49.46 (1) (a) 12. of the statutes is amended to read:
AB133-SSA1,722,1312 49.46 (1) (a) 12. Any child not described under subd. 1. who is under 19 years
13of age and who meets the resource and income limits under s. 49.19 (4) (es).
AB133-SSA1, s. 1433v 14Section 1433v. 49.46 (1) (a) 14m. of the statutes is created to read:
AB133-SSA1,722,2015 49.46 (1) (a) 14m. Any person who would meet the financial and other eligibility
16requirements for home or community-based services under the family care benefit
17but for the fact that the person engages in substantial gainful activity under 42 USC
181382c
(a) (3), if a waiver under s. 46.281 (1) (c) is in effect or federal law permits
19federal financial participation for medical assistance coverage of the person and if
20funding is available for the person under the family care benefit.
AB133-SSA1, s. 1434 21Section 1434. 49.46 (1p) of the statutes is created to read:
AB133-SSA1,723,322 49.46 (1p) Demonstration project for persons with HIV. The department
23shall request a waiver from the secretary of the federal department of health and
24human services to allow the department to provide under this section coverage of
25services specified under sub. (2) (b) 17. for persons who have HIV infection, as defined

1in s. 252.01 (2). If a waiver is granted and in effect, the department shall provide
2coverage for the services specified under sub. (2) (b) 17. for persons who qualify under
3the terms of the waiver.
AB133-SSA1, s. 1434t 4Section 1434t. 49.46 (2) (b) 1. (intro.) of the statutes is amended to read:
AB133-SSA1,723,85 49.46 (2) (b) 1. (intro.) Dentists' services, which, except as provided in s. 49.45
6(24g), and except for dentists' services provided pursuant to a federal waiver to
7individuals who have attained the age of 65, shall be provided on a fee-for-service
8basis and
limited to basic services within each of the following categories:
AB133-SSA1, s. 1435 9Section 1435. 49.46 (2) (b) 8. of the statutes is amended to read:
AB133-SSA1,723,1210 49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27
11(11), 46.275, 46.277 or 46.278 or under the family care benefit if a waiver is in effect
12under s. 46.281 (1) (c)
.
AB133-SSA1, s. 1436 13Section 1436. 49.46 (2) (b) 17. of the statutes is created to read:
AB133-SSA1,723,1614 49.46 (2) (b) 17. If a waiver under sub. (1p) is granted and in effect, clinical
15evaluation services, as defined by the department, for persons who qualify for
16coverage under sub. (1p).
AB133-SSA1, s. 1437 17Section 1437. 49.46 (2) (b) 18. of the statutes is created to read:
AB133-SSA1,723,2018 49.46 (2) (b) 18. Alcohol or other drug abuse residential treatment services of
19no more than 45 days per treatment episode, under s. 49.45 (46). This subdivision
20does not apply after July 1, 2003.
AB133-SSA1, s. 1438 21Section 1438. 49.47 (4) (as) 1. of the statutes is amended to read:
AB133-SSA1,724,222 49.47 (4) (as) 1. The person would meet the financial and other eligibility
23requirements for home or community-based services under s. 46.27 (11) or 46.277
24or under the family care benefit if a waiver is in effect under s. 46.281 (1) (c) but for

1the fact that the person engages in substantial gainful activity under 42 USC 1382c
2(a) (3).
AB133-SSA1, s. 1439 3Section 1439. 49.47 (4) (as) 3. of the statutes is amended to read:
AB133-SSA1,724,54 49.47 (4) (as) 3. Funding is available for the person under s. 46.27 (11) or 46.277
5or under the family care benefit if a waiver is in effect under s. 46.281 (1) (c).
AB133-SSA1, s. 1440 6Section 1440. 49.472 of the statutes is created to read:
AB133-SSA1,724,7 749.472 Medical assistance purchase plan. (1) Definitions. In this section:
AB133-SSA1,724,88 (a) "Earned income" has the meaning given in 42 USC 1382a (a) (1).
AB133-SSA1,724,109 (am) "Family" means an individual, the individual's spouse and any dependent
10child, as defined in s. 49.141 (1) (c), of the individual.
AB133-SSA1,724,1411 (b) "Health insurance" means surgical, medical, hospital, major medical or
12other health service coverage, including a self-insured health plan, but does not
13include hospital indemnity policies or ancillary coverages such as income
14continuation, loss of time or accident benefits.
AB133-SSA1,724,1815 (c) "Independence account" means an account approved by the department that
16consists solely of savings, and dividends or other gains derived from those savings,
17from income earned from paid employment after the initial date that an individual
18began receiving medical assistance under this section.
AB133-SSA1,724,2019 (d) "Medical assistance purchase plan" means medical assistance, eligibility for
20which is determined under this section.
AB133-SSA1,724,2121 (e) "Unearned income" has the meaning given in 42 USC 1382a (a) (2).
AB133-SSA1,725,5 22(2) Waivers and amendments. The department shall submit to the federal
23department of health and human services an amendment to the state medical
24assistance plan, and shall request any necessary waivers from the secretary of the
25federal department of health and human services, to permit the department to

1expand medical assistance eligibility as provided in this section. If the state plan
2amendment and all necessary waivers are approved and in effect, the department
3shall implement the medical assistance eligibility expansion under this section not
4later than January 1, 2000, or 3 months after full federal approval, whichever is
5later.
AB133-SSA1,725,8 6(3) Eligibility. Except as provided in sub. (6) (a), an individual is eligible for
7and shall receive medical assistance under this section if all of the following
8conditions are met:
AB133-SSA1,725,119 (a) The individual's family's net income is less than 250% of the poverty line for
10a family the size of the individual's family. In calculating the net income, the
11department shall apply all of the exclusions specified under 42 USC 1382a (b).
AB133-SSA1,725,1612 (b) The individual's assets do not exceed $15,000. In determining assets, the
13department may not include assets that are excluded from the resource calculation
14under 42 USC 1382b (a) or assets accumulated in an independence account. The
15department may exclude, in whole or in part, the value of a vehicle used by the
16individual for transportation to paid employment.
AB133-SSA1,725,2017 (c) The individual would be eligible for supplemental security income for
18purposes of receiving medical assistance but for evidence of work, attainment of the
19substantial gainful activity level, earned income and unearned income in excess of
20the limit established under 42 USC 1396d (q) (2) (B) and (D).
AB133-SSA1,725,2221 (e) The individual is legally able to work in all employment settings without
22a permit under s. 103.70.
AB133-SSA1,725,2523 (f) The individual maintains premium payments calculated by the department
24in accordance with sub. (4), unless the individual is exempted from premium
25payments under sub. (4) (b) or (5).
AB133-SSA1,726,3
1(g) The individual is engaged in gainful employment or is participating in a
2program that is certified by the department to provide health and employment
3services that are aimed at helping the individual achieve employment goals.
AB133-SSA1,726,54 (h) The individual meets all other requirements established by the department
5by rule.
AB133-SSA1,726,9 6(4) Premiums. (a) Except as provided in par. (b) and sub. (5), an individual who
7is eligible for medical assistance under sub. (3) and receives medical assistance shall
8pay a monthly premium to the department. The department shall establish the
9monthly premiums by rule in accordance with the following guidelines:
AB133-SSA1,726,1010 1. The premium for any individual may not exceed the sum of the following:
AB133-SSA1,726,1211 a. Three and one-half percent of the individual's earned income after the
12disregards specified in subd. 2m.
AB133-SSA1,726,1413 b. One hundred percent of the individual's unearned income after the
14deductions specified in subd. 2.
AB133-SSA1,726,1615 2. In determining an individual's unearned income under subd. 1., the
16department shall disregard all of the following:
AB133-SSA1,726,2017 a. A maintenance allowance established by the department by rule. The
18maintenance allowance may not be less than the sum of $20, the federal
19supplemental security income payment level determined under 42 USC 1382 (b) and
20the state supplemental payment determined under s. 49.77 (2m).
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