Amendment SSA1-AB133

AB133-SSA1,714,23 49.45 (6w) (d) If the federal department of health and human services approves for state expenditure in a fiscal year amounts under s. 20.435 (5) (4) (o) that result in a lesser allocation amount than that allocated under this subsection or disallows use of the allocation of federal medicaid funds under par. (c), reduce allocations under this subsection and distribute on a prorated basis, as determined by the department.

AB133-SSA1, s. 1413 Section 1413. 49.45 (6x) (a) of the statutes is amended to read:

AB133-SSA1,715,5 49.45 (6x) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (5) (4) (b) and (o) the department shall distribute not more than $4,748,000 in each fiscal year, to provide funds to an essential access city hospital, except that the department may not allocate funds to an essential access city hospital to the extent that the allocation would exceed any limitation under 42 USC 1396b (i) (3).

AB133-SSA1, s. 1414 Section 1414. 49.45 (6x) (d) of the statutes is amended to read:

AB133-SSA1,715,11 49.45 (6x) (d) If the federal department of health and human services approves for state expenditure in any state fiscal year amounts under s. 20.435 (5) (4) (o) that result in a lesser distribution amount than that distributed under this subsection or disallows use of federal medicaid funds under par. (a), the department of health and family services shall reduce the distributions under this subsection.

AB133-SSA1, s. 1415 Section 1415. 49.45 (6y) (a) of the statutes is amended to read:

AB133-SSA1,715,22 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (5) (4) (b) and (o) the department shall distribute funding in each fiscal year to provide supplemental payment to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2).

AB133-SSA1, s. 1416 Section 1416. 49.45 (6y) (am) of the statutes is created to read:

AB133-SSA1,716,5 49.45 (6y) (am) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b), (h) and (o) the department shall distribute funding in each fiscal year to provide supplemental payments to hospitals that enter into contracts under s. 49.02 (2) with a county having a population of 500,000 or more to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3).

AB133-SSA1, s. 1417 Section 1417. 49.45 (6y) (b) of the statutes is amended to read:

AB133-SSA1,716,9 49.45 (6y) (b) The department need not promulgate as rules under ch. 227 the procedures, methods of distribution and criteria required for distribution under par. pars. (a) and (am).

AB133-SSA1, s. 1418 Section 1418. 49.45 (6z) (a) (intro.) of the statutes is amended to read:

AB133-SSA1,716,21 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (5) (4) (b) and (o) the department shall distribute funding in each fiscal year to supplement payment for services to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant under this chapter, if the department determines that the hospitals serve a disproportionate number of low-income patients with special needs. If no medical relief block grant under this chapter is awarded or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2). The department may not distribute funds under this subsection to the extent that the distribution would do any of the following:

AB133-SSA1, s. 1419 Section 1419. 49.45 (8) (b) of the statutes is amended to read:

AB133-SSA1,717,2 49.45 (8) (b) Reimbursement under s. 20.435 (5) (4) (b) and (o) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under par. (c).

AB133-SSA1, s. 1424m Section 1424m. 49.45 (22) of the statutes is amended to read:

AB133-SSA1,717,15 49.45 (22) Medical assistance services provided by health maintenance organizations. If the department contracts with health maintenance organizations for the provision of medical assistance it shall give special consideration to health maintenance organizations that provide or that contract to provide comprehensive, specialized health care services to pregnant teenagers. If the department contracts with health maintenance organizations for the provision of medical assistance, the department shall include in the contract a lead screening performance standard that requires the health maintenance organization to provide annually at least one lead blood test to at least 65% of the children ages 1 to 5 years who have been enrolled in the health maintenance organization for at least 6 months during the applicable year. The department shall specify in the contract financial penalties for failure to meet the lead screening performance standard.

AB133-SSA1, s. 1426 Section 1426. 49.45 (24m) (intro.) of the statutes is amended to read:

AB133-SSA1,717,21 49.45 (24m) Home health care and personal care pilot program. (intro.) From the appropriations under s. 20.435 (5) (4) (b) and (o), 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:

AB133-SSA1, s. 1427g Section 1427g. 49.45 (39) (a) 1. of the statutes is amended to read:

AB133-SSA1,718,2 49.45 (39) (a) 1. "School" means a public school described under s. 115.01 (1) or, a charter school, as defined in s. 115.001 (1), the Wisconsin School for the Visually Handicapped or the Wisconsin School for the Deaf. It includes school-operated early childhood programs for developmentally delayed and disabled 4-year-old and 5-year-old children.

AB133-SSA1, s. 1427h Section 1427h. 49.45 (39) (am) of the statutes is amended to read:

AB133-SSA1,718,15 49.45 (39) (am) Plan amendment. No later than September 30, 1995, the department shall submit to the federal department of health and human services an amendment to the state medical assistance plan to permit the application of pars. (b) to and (c). If the amendment to the state plan is approved, school districts and, cooperative educational service agencies and the department of public instruction on behalf of the Wisconsin School for the Visually Handicapped and the Wisconsin School for the Deaf claim reimbursement under pars. (b) to and (c). Paragraphs (b) to and (c) do not apply unless the amendment to the state plan is approved and in effect. The department shall submit to the federal department of health and human services an amendment to the state plan if necessary to permit the application of pars. (b) and (c) to the Wisconsin School for the Visually Handicapped and the Wisconsin School for the Deaf.

AB133-SSA1, s. 1427i Section 1427i. 49.45 (39) (b) of the statutes is amended to read:

AB133-SSA1,719,11 49.45 (39) (b) 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 for allowable administrative costs. If the Wisconsin School for the Visually Handicapped or the Wisconsin School for the Deaf 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 School for the Visually Handicapped or the Wisconsin School for the Deaf provides and for allowable administrative costs. 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 School for the Visually Handicapped, the Wisconsin School for the Deaf 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.

AB133-SSA1, s. 1428 Section 1428. 49.45 (46) of the statutes is created to read:

AB133-SSA1,719,25 49.45 (46) Alcohol and other drug abuse residential treatment services. (a) If a county, city, town or village elects to become certified as a provider of alcohol and other drug abuse residential treatment services or to contract with a certified provider to provide the services, the county, city, town or village may provide directly or under contract alcohol and other drug abuse residential treatment services in facilities with fewer than 16 beds under this subsection in the county, city, town or village to medical assistance recipients through the medical assistance program. A county, city, town or village that elects to provide or to contract for the services shall pay the amount of the allowable charges for the services under the medical assistance program that is not provided by the federal government. The department shall reimburse the county, city, town or village under this subsection only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.

AB133-SSA1,720,1 (b) This subsection does not apply after July 1, 2003.

AB133-SSA1, s. 1429 Section 1429. 49.45 (47) of the statutes is created to read:

AB133-SSA1,720,6 49.45 (47) Adult day care centers. (a) In this subsection, "adult day care center" means an entity that provides services for part of a day in a group setting to adults who need an enriched health-supportive or social experience and who may need assistance with activities of daily living, supervision or protection.

AB133-SSA1,720,9 (b) No person may receive reimbursement under s. 46.27 (11) for the provision of services to clients in an adult day care center unless the adult day care center is certified by the department under sub. (2) (a) 11. as a provider of medical assistance.

AB133-SSA1,720,13 (c) The biennial fee for the certification required under par. (b) of an adult day care center is $89, plus a biennial fee of $17.80 per client, based on the number of clients that the adult day care center is certified to serve. Fees collected under this paragraph shall be credited to the appropriation account under s. 20.435 (6) (jm).

AB133-SSA1,720,14 (d) The department, by rule, may increase any fee specified in par. (c).

AB133-SSA1, s. 1430 Section 1430. 49.453 (4) (title) of the statutes is amended to read:

AB133-SSA1,720,17 49.453 (4) (title) Irrevocable annuities , promissory notes and similar transfers.

AB133-SSA1, s. 1431 Section 1431. 49.453 (4) (a) of the statutes is renumbered 49.453 (4) (a) (intro.) and amended to read:

AB133-SSA1,721,2 49.453 (4) (a) (intro.) For the purposes of sub. (2), whenever a covered individual or his or her spouse, or another person acting on behalf of the covered individual or his or her spouse, transfers assets to an irrevocable annuity, or transfers assets by promissory note or similar instrument, in an amount that exceeds the expected value of the benefit, the covered individual or his or her spouse transfers assets for less than fair market value. A transfer to an annuity, or a transfer by promissory note or similar instrument, is not in excess of the expected value only if all of the following are true:

AB133-SSA1, s. 1432 Section 1432. 49.453 (4) (a) 1. and 2. of the statutes are created to read:

AB133-SSA1,721,6 49.453 (4) (a) 1. a. The periodic payments back to the transferor include principal and interest that, at the time that the transfer is made, is at least at one of the following:

AB133-SSA1,721,9 a. For an annuity, promissory note or similar instrument that is not specified under subd. 1. b. or par. (am), the applicable federal rate required under section 1274 (d) of the Internal Revenue Code, as defined in s. 71.01 (6).

AB133-SSA1,721,11 b. For an annuity with a guaranteed life payment, the appropriate average of the applicable federal rates based on the expected length of the annuity minus 1.5%.

AB133-SSA1,721,15 2. The terms of the instrument provide for a payment schedule that includes equal periodic payments, except that payments may be unequal if the interest payments are tied to an interest rate and the inequality is caused exclusively by fluctuations in that rate.

AB133-SSA1, s. 1432g Section 1432g. 49.453 (4) (am) of the statutes is created to read:

AB133-SSA1,721,19 49.453 (4) (am) Paragraph (a) 1. does not apply to a variable annuity that is tied to a mutual fund that is registered with the federal securities and exchange commission.

AB133-SSA1, s. 1433 Section 1433. 49.453 (4) (c) of the statutes is amended to read:

AB133-SSA1,722,5 49.453 (4) (c) The department shall promulgate rules specifying the method to be used in calculating the expected value of the benefit, based on 26 CFR 1.72-1 to 1.72-18, and specifying the criteria for adjusting the expected value of the benefit based on a medical condition diagnosed by a physician before the assets were transferred to the annuity, or transferred by promissory note or similar instrument. In calculating the amount of the divestment when a transfer to an annuity, or a transfer by promissory note or similar instrument, is made, payments made to the transferor in any year subsequent to the year in which the transfer was made shall be discounted to the year in which the transfer was made by the applicable federal rate specified under par. (a) on the date of the transfer.

AB133-SSA1, s. 1433t Section 1433t. 49.46 (1) (a) 1m. of the statutes is amended to read:

AB133-SSA1,722,10 49.46 (1) (a) 1m. Any pregnant woman who meets the resource and income limits under s. 49.19 (4) (bm) and (es) and whose pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th day after the last day of the pregnancy falls.

AB133-SSA1, s. 1433u Section 1433u. 49.46 (1) (a) 12. of the statutes is amended to read:

AB133-SSA1,722,13 49.46 (1) (a) 12. Any child not described under subd. 1. who is under 19 years of age and who meets the resource and income limits under s. 49.19 (4) (es).

AB133-SSA1, s. 1433v Section 1433v. 49.46 (1) (a) 14m. of the statutes is created to read:

AB133-SSA1,722,20 49.46 (1) (a) 14m. Any person who would meet the financial and other eligibility requirements for home or community-based services under the family care benefit but for the fact that the person engages in substantial gainful activity under 42 USC 1382c (a) (3), if a waiver under s. 46.281 (1) (c) is in effect or federal law permits federal financial participation for medical assistance coverage of the person and if funding is available for the person under the family care benefit.

AB133-SSA1, s. 1434 Section 1434. 49.46 (1p) of the statutes is created to read:

AB133-SSA1,723,3 49.46 (1p) Demonstration project for persons with HIV. The department shall request a waiver from the secretary of the federal department of health and human services to allow the department to provide under this section coverage of services specified under sub. (2) (b) 17. for persons who have HIV infection, as defined in s. 252.01 (2). If a waiver is granted and in effect, the department shall provide coverage for the services specified under sub. (2) (b) 17. for persons who qualify under the terms of the waiver.

AB133-SSA1, s. 1434t Section 1434t. 49.46 (2) (b) 1. (intro.) of the statutes is amended to read:

AB133-SSA1,723,8 49.46 (2) (b) 1. (intro.) Dentists' services, which, except as provided in s. 49.45 (24g), and except for dentists' services provided pursuant to a federal waiver to individuals who have attained the age of 65, shall be provided on a fee-for-service basis and limited to basic services within each of the following categories:

AB133-SSA1, s. 1435 Section 1435. 49.46 (2) (b) 8. of the statutes is amended to read:

AB133-SSA1,723,12 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).

AB133-SSA1, s. 1436 Section 1436. 49.46 (2) (b) 17. of the statutes is created to read:

AB133-SSA1,723,16 49.46 (2) (b) 17. If a waiver under sub. (1p) is granted and in effect, clinical evaluation services, as defined by the department, for persons who qualify for coverage under sub. (1p).

AB133-SSA1, s. 1437 Section 1437. 49.46 (2) (b) 18. of the statutes is created to read:

AB133-SSA1,723,20 49.46 (2) (b) 18. Alcohol or other drug abuse residential treatment services of no more than 45 days per treatment episode, under s. 49.45 (46). This subdivision does not apply after July 1, 2003.

AB133-SSA1, s. 1438 Section 1438. 49.47 (4) (as) 1. of the statutes is amended to read:

AB133-SSA1,724,2 49.47 (4) (as) 1. The person would meet the financial and other eligibility requirements for home or community-based services under s. 46.27 (11) or 46.277 or under the family care benefit if a waiver is in effect under s. 46.281 (1) (c) but for the fact that the person engages in substantial gainful activity under 42 USC 1382c (a) (3).

AB133-SSA1, s. 1439 Section 1439. 49.47 (4) (as) 3. of the statutes is amended to read:

AB133-SSA1,724,5 49.47 (4) (as) 3. Funding is available for the person under s. 46.27 (11) or 46.277 or under the family care benefit if a waiver is in effect under s. 46.281 (1) (c).

AB133-SSA1, s. 1440 Section 1440. 49.472 of the statutes is created to read:

AB133-SSA1,724,7 49.472 Medical assistance purchase plan. (1) Definitions. In this section:

AB133-SSA1,724,8 (a) "Earned income" has the meaning given in 42 USC 1382a (a) (1).

AB133-SSA1,724,10 (am) "Family" means an individual, the individual's spouse and any dependent child, as defined in s. 49.141 (1) (c), of the individual.

AB133-SSA1,724,14 (b) "Health insurance" means surgical, medical, hospital, major medical or other health service coverage, including a self-insured health plan, but does not include hospital indemnity policies or ancillary coverages such as income continuation, loss of time or accident benefits.

AB133-SSA1,724,18 (c) "Independence account" means an account approved by the department that consists solely of savings, and dividends or other gains derived from those savings, from income earned from paid employment after the initial date that an individual began receiving medical assistance under this section.

AB133-SSA1,724,20 (d) "Medical assistance purchase plan" means medical assistance, eligibility for which is determined under this section.

AB133-SSA1,724,21 (e) "Unearned income" has the meaning given in 42 USC 1382a (a) (2).

AB133-SSA1,725,5 (2) Waivers and amendments. The department shall submit to the federal department of health and human services an amendment to the state medical assistance plan, and shall request any necessary waivers from the secretary of the federal department of health and human services, to permit the department to expand medical assistance eligibility as provided in this section. If the state plan amendment and all necessary waivers are approved and in effect, the department shall implement the medical assistance eligibility expansion under this section not later than January 1, 2000, or 3 months after full federal approval, whichever is later.

AB133-SSA1,725,8 (3) Eligibility. Except as provided in sub. (6) (a), an individual is eligible for and shall receive medical assistance under this section if all of the following conditions are met:

AB133-SSA1,725,11 (a) The individual's family's net income is less than 250% of the poverty line for a family the size of the individual's family. In calculating the net income, the department shall apply all of the exclusions specified under 42 USC 1382a (b).

AB133-SSA1,725,16 (b) The individual's assets do not exceed $15,000. In determining assets, the department may not include assets that are excluded from the resource calculation under 42 USC 1382b (a) or assets accumulated in an independence account. The department may exclude, in whole or in part, the value of a vehicle used by the individual for transportation to paid employment.

AB133-SSA1,725,20 (c) The individual would be eligible for supplemental security income for purposes of receiving medical assistance but for evidence of work, attainment of the substantial gainful activity level, earned income and unearned income in excess of the limit established under 42 USC 1396d (q) (2) (B) and (D).

AB133-SSA1,725,22 (e) The individual is legally able to work in all employment settings without a permit under s. 103.70.

AB133-SSA1,725,25 (f) The individual maintains premium payments calculated by the department in accordance with sub. (4), unless the individual is exempted from premium payments under sub. (4) (b) or (5).

AB133-SSA1,726,3 (g) The individual is engaged in gainful employment or is participating in a program that is certified by the department to provide health and employment services that are aimed at helping the individual achieve employment goals.

AB133-SSA1,726,5 (h) The individual meets all other requirements established by the department by rule.

AB133-SSA1,726,9 (4) Premiums. (a) Except as provided in par. (b) and sub. (5), an individual who is eligible for medical assistance under sub. (3) and receives medical assistance shall pay a monthly premium to the department. The department shall establish the monthly premiums by rule in accordance with the following guidelines:

AB133-SSA1,726,10 1. The premium for any individual may not exceed the sum of the following:

AB133-SSA1,726,12 a. Three and one-half percent of the individual's earned income after the disregards specified in subd. 2m.

AB133-SSA1,726,14 b. One hundred percent of the individual's unearned income after the deductions specified in subd. 2.

AB133-SSA1,726,16 2. In determining an individual's unearned income under subd. 1., the department shall disregard all of the following:

AB133-SSA1,726,20 a. A maintenance allowance established by the department by rule. The maintenance allowance may not be less than the sum of $20, the federal supplemental security income payment level determined under 42 USC 1382 (b) and the state supplemental payment determined under s. 49.77 (2m).