Amendment SSA1-AB133

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).

AB133-SSA1,726,21 b. Medical and remedial expenses and impairment-related work expenses.

AB133-SSA1,726,24 2m. If the disregards under subd. 2. exceed the unearned income against which they are applied, the department shall disregard the remainder in calculating the individual's earned income.

AB133-SSA1,727,2 3. The department may reduce the premium by 25% for an individual who is covered by private health insurance.

AB133-SSA1,727,6 (b) The department may waive monthly premiums that are calculated to be below $10 per month. 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.

AB133-SSA1,727,10 (5) Community options participants. From the appropriation under s. 20.435 (7) (bd), the department may pay all or a portion of the monthly premium calculated under sub. (4) (a) for an individual who is a participant in the community options program under s. 46.27 (11).

AB133-SSA1,727,16 (6) Insured persons. (a) Notwithstanding sub. (4) (a) 3., from the appropriation under s. 20.435 (4) (b), 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.

AB133-SSA1,727,19 (b) If federal financial participation is available, from the appropriation under s. 20.435 (4) (b), 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).

AB133-SSA1,727,20 (7) Department duties. The department shall do all of the following:

AB133-SSA1,727,23 (a) Determine eligibility, or contract with a county department, as defined in 49.45 (6c) (a) 3., or with a tribal governing body to determine eligibility, of individuals for the medical assistance purchase plan in accordance with sub. (3).

AB133-SSA1,728,2 (b) Ensure, to the extent practicable, continuity of care for a medical assistance recipient under this section who is engaged in paid employment, or is enrolled in a home-based or community-based waiver program under section 1915 (c) of the Social Security Act, and who becomes ineligible for medical assistance.

AB133-SSA1, s. 1441 Section 1441. 49.475 (5) of the statutes is amended to read:

AB133-SSA1,728,9 49.475 (5) Reimbursement of costs. From the appropriations under s. 20.435 (1) (4) (bm) and (p) (pa), the department shall reimburse an insurer that provides information under this section for the insurer's reasonable costs incurred in providing the requested information, including its reasonable costs, if any, to develop and operate automated systems specifically for the disclosure of information under this section.

AB133-SSA1, s. 1444 Section 1444. 49.496 (2) (title) of the statutes is amended to read:

AB133-SSA1,728,12 49.496 (2) (title) Liens on the homes of nursing home residents and inpatients at hospitals.

AB133-SSA1, s. 1445 Section 1445. 49.496 (2) (a) of the statutes is amended to read:

AB133-SSA1,728,20 49.496 (2) (a) Except as provided in par. (b), the department may obtain a lien on a recipient's home if the recipient resides in a nursing home, or if the recipient resides in a hospital and is required to contribute to the cost of care, and the recipient cannot reasonably be expected to be discharged from the nursing home or hospital and return home. The lien is for the amount of medical assistance paid on behalf of the recipient while the recipient resides in a nursing home that is recoverable under sub. (3) (a).

AB133-SSA1, s. 1446 Section 1446. 49.496 (2) (b) 3. of the statutes is amended to read:

AB133-SSA1,728,24 49.496 (2) (b) 3. The recipient's sibling who has an ownership interest in the home and who has lived in the home continuously beginning at least 12 months before the recipient was admitted to the nursing home or hospital.

AB133-SSA1, s. 1447 Section 1447. 49.496 (2) (c) 1. of the statutes is amended to read:

AB133-SSA1,729,4 49.496 (2) (c) 1. Notify the recipient in writing of its determination that the recipient cannot reasonably be expected to be discharged from the nursing home or hospital, its intent to impose a lien on the recipient's home and the recipient's right to a hearing on whether the requirements for the imposition of a lien are satisfied.

AB133-SSA1, s. 1448 Section 1448. 49.496 (2) (f) 3. of the statutes is amended to read:

AB133-SSA1,729,9 49.496 (2) (f) 3. A child of any age who resides in the home, if that child resided in the home for at least 24 months before the recipient was admitted to the nursing home or hospital and provided care to the recipient that delayed the recipient's admission to the nursing home or hospital.

AB133-SSA1, s. 1449 Section 1449. 49.496 (2) (f) 4. of the statutes is amended to read:

AB133-SSA1,729,13 49.496 (2) (f) 4. A sibling who resides in the home, if the sibling resided in the home for at least 12 months before the recipient was admitted to the nursing home or hospital.