Amendment JR2 SA2-SSA1-AB1

AB1-SSA1-SA2,183,25 (a) The applicant or participant withdraws the petition in writing.

AB1-SSA1-SA2,184,3 (b) The sole issue in the petition concerns an automatic grant adjustment or change for a class of participants as required by state or federal law, unless the issue concerns an incorrect computation of the participant's benefit.

AB1-SSA1-SA2,184,7 (c) The applicant or participant abandons the petition. Abandonment occurs if the applicant or participant fails to appear in person or by a representative at a scheduled hearing without providing the department with good cause for that failure to appear.

AB1-SSA1-SA2,184,9 (4) Nonentitlement. This section does not create an entitlement to any services or benefits under Wisconsin works.".

AB1-SSA1-SA2,184,10 155. Page 37, line 25: after that line insert:

AB1-SSA1-SA2,184,12 " Section 119k. 49.175 (1) (z) of the statutes, as affected by 2001 Wisconsin Act 16, is amended to read:

AB1-SSA1-SA2,184,17 49.175 (1) (z) Community youth grant. For a competitive grant program administered by the department to fund programs that improve social, academic and employment skills of youth who are eligible to receive temporary assistance for needy families under 42 USC 601 et seq., $7,579,700 $7,829,700 in fiscal year 2001-02 and $50,000 $300,000 fiscal year 2002-03.".

AB1-SSA1-SA2,184,18 156. Page 38, line 6: after that line insert:

AB1-SSA1-SA2,184,20 " Section 119r. 49.195 (3) of the statutes, as affected by 2001 Wisconsin Act 16, is amended to read:

AB1-SSA1-SA2,185,8 49.195 (3) A county, tribal governing body, Wisconsin works agency or the department shall determine whether an overpayment has been made under s. 49.19, 49.148, 49.155 or 49.157 and, if so, the amount of the overpayment. The county, tribal governing body, Wisconsin works agency or department shall provide notice of the overpayment to the liable person. The department shall give that person an opportunity for a review following the procedure specified under s. 49.152 49.16, if the person received the overpayment under s. 49.141 to 49.161, and for a hearing under ch. 227. Notwithstanding s. 49.96, the department shall promptly recover all overpayments made under s. 49.19, 49.148, 49.155 or 49.157 that have not already been received under s. 49.161 or 49.19 (17) and shall promulgate rules establishing policies and procedures to administer this subsection. The rules shall include notification procedures similar to those established for child support collections.".

AB1-SSA1-SA2,185,9 157. Page 38, line 20: after that line insert:

AB1-SSA1-SA2,185,10 " Section 121k. 49.26 (1) (h) 1. as. of the statutes is amended to read:

AB1-SSA1-SA2,185,14 49.26 (1) (h) 1. as. The individual has failed to request a hearing or has failed to show good cause for not cooperating with case management efforts in a hearing. The hearing shall be requested and held under s. 49.152 49.16. The department shall determine by rule the criteria for good cause.".

AB1-SSA1-SA2,185,15 158. Page 38, line 20: after that line insert:

AB1-SSA1-SA2,185,16 " Section 121pb. 49.45 (2) (a) 9. of the statutes is amended to read:

AB1-SSA1-SA2,185,20 49.45 (2) (a) 9. Periodically set forth conditions of participation and reimbursement in a contract with provider for contracts with providers of service under this section. The department shall promulgate rules that specify criteria for and required procedures for submittal of appropriate claims for reimbursement.

AB1-SSA1-SA2, s. 121pc Section 121pc. 49.45 (2) (a) 10. a. of the statutes, as affected by 2001 Wisconsin Act 16, is renumbered 49.45 (2) (a) 10. and amended to read:

AB1-SSA1-SA2,186,5 49.45 (2) (a) 10. After reasonable notice and opportunity for a hearing conducted as a class 2 proceeding under ch. 227, recover money improperly or erroneously paid or overpayments to a provider by offsetting or adjusting amounts owed the provider under the program, crediting against a provider's future claims for reimbursement for other services or items furnished by the provider under the program, or requiring the provider to make direct payment to the department or its fiscal intermediary.

AB1-SSA1-SA2, s. 121pd Section 121pd. 49.45 (2) (a) 10. b. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pe Section 121pe. 49.45 (2) (a) 10. c. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pf Section 121pf. 49.45 (2) (a) 11. a. of the statutes, as affected by 2001 Wisconsin Act 16, is renumbered 49.45 (2) (a) 11. and amended to read:

AB1-SSA1-SA2,186,14 49.45 (2) (a) 11. Establish criteria for the certification of eligible providers of medical assistance and, except as provided in par. (b) 6m. and s. 49.48, and subject to par. (b) 7. and 8., certify providers who meet the criteria.

AB1-SSA1-SA2, s. 121pg Section 121pg. 49.45 (2) (a) 11. b. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121ph Section 121ph. 49.45 (2) (a) 12. a. of the statutes, as affected by 2001 Wisconsin Act 16, is renumbered 49.45 (2) (a) 12. and amended to read:

AB1-SSA1-SA2,187,7 49.45 (2) (a) 12. Decertify or suspend under this subdivision a provider from or restrict a provider's participation in the medical assistance program, if after giving reasonable notice and opportunity for hearing the department finds that the provider has violated a federal statute or regulation or a state statute or administrative rule and the violation is by statute, regulation, or rule grounds for decertification or restriction. The department shall suspend the provider pending the hearing under this subdivision if the department includes in its decertification notice findings that the provider's continued participation in the medical assistance program pending hearing is likely to lead to the irretrievable loss of public funds and is unnecessary to provide adequate access to services to medical assistance recipients. As soon as practicable after the hearing, the department shall issue a written decision suspension. No payment may be made under the medical assistance program with respect to any service or item furnished by the provider subsequent to decertification or during the period of suspension.

AB1-SSA1-SA2, s. 121pi Section 121pi. 49.45 (2) (a) 12. b. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pj Section 121pj. 49.45 (2) (a) 14. of the statutes is amended to read:

AB1-SSA1-SA2,187,13 49.45 (2) (a) 14. Assure due process in implementing subds. 12. and 13. by providing written notice, a fair hearing and a written decision and a hearing conducted as a class 2 proceeding under ch. 227.

AB1-SSA1-SA2, s. 121pk Section 121pk. 49.45 (2) (b) 6m. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pL Section 121pL. 49.45 (2) (b) 7. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pm Section 121pm. 49.45 (2) (b) 8. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pn Section 121pn. 49.45 (2) (b) 9. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pp Section 121pp. 49.45 (3) (g) 1. of the statutes, as affected by 2001 Wisconsin Act 16, is renumbered 49.45 (3) (g) and amended to read:

AB1-SSA1-SA2,188,18 49.45 (3) (g) The secretary may authorize personnel to audit or investigate and report to the department on any matter involving violations or complaints alleging violations of statutes, regulations, or rules applicable to the medical assistance program and to perform such investigations or audits as are required to verify the actual provision of services or items available under the medical assistance program and the appropriateness and accuracy of claims for reimbursement submitted by providers participating in the program. Department employees authorized by the secretary under this paragraph shall be issued, and shall possess at all times while they are performing their investigatory or audit functions under this section, identification, signed by the secretary, that specifically designates the bearer as possessing the authorization to conduct medical assistance investigations or audits. Under the request of a designated person and upon presentation of the person's authorization, providers and medical assistance recipients shall accord the person access to any provider personnel, records, books, or documents or other information needed. Under the written request of a designated person and upon presentation of the person's authorization, providers and recipients shall accord the person access to any needed patient health care records of a recipient. Authorized employees may hold hearings, administer oaths, take testimony, and perform all other duties necessary to bring the matter before the department for final adjudication and determination.

AB1-SSA1-SA2, s. 121pq Section 121pq. 49.45 (3) (g) 2. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pr Section 121pr. 49.45 (3) (h) 1. of the statutes is created to read:

AB1-SSA1-SA2,189,7 49.45 (3) (h) 1. For purposes of any audit, investigation, examination, analysis, review, or other function authorized by law with respect to the medical assistance program, the secretary shall have the power to sign and issue subpoenas to any person requiring the production of any pertinent books, records, patient health care records, or other information. Subpoenas so issued shall be served by anyone authorized by the secretary by delivering a copy to the person named in the subpoena, or by registered mail or certified mail addressed to the person at his or her last-known residence or principal place of business. A verified return by the person serving the subpoena setting forth the manner of service, or, in the event service is by registered or certified mail, the return post-office receipt signed by the person served constitutes proof of service.

AB1-SSA1-SA2, s. 121ps Section 121ps. 49.45 (3) (h) 1m. of the statutes, as affected by 2001 Wisconsin Act 16, is renumbered 49.45 (3) (h) 3. and amended to read:

AB1-SSA1-SA2,189,19 49.45 (3) (h) 3. The failure or refusal of a provider to accord department auditors or investigators access as required under par. (g) to any provider personnel, records, books, patient health care records of medical assistance recipients, or documents or other information requested constitutes person to purge himself or herself of contempt found under s. 885.12 and perform the act as required by law shall constitute grounds for decertification or suspension of the provider that person from participation in the medical assistance program. No payment may be made for services rendered by the provider that person following decertification, or during the period of suspension, or during any period of provider failure or refusal to accord access as required under par. (g).

AB1-SSA1-SA2, s. 121pt Section 121pt. 49.45 (3) (h) 1n. of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pu Section 121pu. 49.45 (3) (h) 2. of the statutes is created to read:

AB1-SSA1-SA2,190,2 49.45 (3) (h) 2. In the event of contumacy or refusal to obey a subpoena issued under this paragraph and duly served upon any person, any judge in a court of record in the county in which the person was served may enforce the subpoena in accordance with s. 885.12.

AB1-SSA1-SA2, s. 121pv Section 121pv. 49.45 (21) (title) of the statutes, as affected by 2001 Wisconsin Act 16, is amended to read:

AB1-SSA1-SA2,190,6 49.45 (21) (title) Taking over provider's operation Transfer of business, liability for; repayments required.

AB1-SSA1-SA2, s. 121pw Section 121pw. 49.45 (21) (ag) of the statutes, as created by 2001 Wisconsin Act 16, is repealed.

AB1-SSA1-SA2, s. 121pwj Section 121pwj. 49.45 (21) (ar) of the statutes, as affected by 2001 Wisconsin Act 16, is renumbered 49.45 (21) (a) and amended to read:

AB1-SSA1-SA2,190,19 49.45 (21) (a) Before a person may take over the operation of a provider that is If any provider liable for repayment of improper or erroneous payments or overpayments under ss. 49.43 to 49.497, full repayment shall be made. Upon request, the department shall notify the provider or the person that intends to take over the operation of the provider as to whether the provider sells or otherwise transfers ownership of his or her business or all or substantially all of the assets of the business, the transferor and transferee are each liable for the repayment. Prior to final transfer, the transferee is responsible for contacting the department and ascertaining if the transferor is liable under this paragraph.

AB1-SSA1-SA2, s. 121px Section 121px. 49.45 (21) (b) of the statutes, as affected by 2001 Wisconsin Act 16, is amended to read:

AB1-SSA1-SA2,191,6 49.45 (21) (b) If, notwithstanding the prohibition under par. (ar), a person takes over the operation of a provider If a transfer occurs and the applicable amount under par. (ar) (a) has not been repaid, the department may, in addition to withholding certification as authorized under sub. (2) (b) 8., proceed against the provider or the person either the transferor or the transferee. Within 30 days after the certified provider receives receiving notice from the department, the transferor or the transferee shall pay the amount shall be repaid in full. If the amount is not repaid in full Upon failure to comply, the department may bring an action to compel payment,. If a transferor fails to pay within 90 days after receiving notice from the department, the department may proceed under sub. (2) (a) 12., or may do both.

AB1-SSA1-SA2, s. 121py Section 121py. 49.45 (21) (e) of the statutes, as created by 2001 Wisconsin Act 16, is repealed.".

AB1-SSA1-SA2,191,10 159. Page 38, line 21: delete the material beginning with that line and ending with page 39, line 10, and substitute:

AB1-SSA1-SA2,191,11 " Section 122b. 49.45 (49) of the statutes is created to read:

AB1-SSA1-SA2,191,12 49.45 (49) Prescription drug prior authorization. (a) In this subsection:

AB1-SSA1-SA2,191,14 1. "Average manufacturer price" has the meaning given in 42 USC 1396r-8 (k) (1).

AB1-SSA1-SA2,191,15 2. "HIV infection" has the meaning given in s. 252.01 (2).

AB1-SSA1-SA2,191,16 3. "Institution for mental diseases" has the meaning given in s. 46.011 (1m).

AB1-SSA1-SA2,191,18 4. "Intermediate care facility for the mentally retarded" has the meaning given in s. 46.278 (1m) (am).

AB1-SSA1-SA2,191,19 5. "Nursing home" has the meaning given in s. 50.01 (3).

AB1-SSA1-SA2,191,20 6. "Pharmacist" has the meaning given in s. 450.01 (15).

AB1-SSA1-SA2,191,21 7. "Physician" has the meaning given in s. 448.01 (5).

AB1-SSA1-SA2,191,23 8. "Preferred prescription drug list" means a list of prescription drugs to which prior authorization does not apply.

AB1-SSA1-SA2,191,24 9. "Prescription drug" has the meaning given in s. 450.01 (20).

AB1-SSA1-SA2,192,3 (b) Except for all of the following, beginning July 1, 2003, the department shall subject all prescription drugs that are prescribed for medical assistance recipients to requirements of prior authorization:

AB1-SSA1-SA2,192,5 1. Prescription drugs that are used to treat mental illness, including anxiety, depression, or psychosis, or to treat HIV infection.

AB1-SSA1-SA2,192,8 2. Prescription drugs that are prescribed for residents of nursing homes, of institutions for mental diseases, and of intermediate care facilities for the mentally retarded.

AB1-SSA1-SA2,192,10 3. Prescription drugs that are included in a preferred prescription drug list of the department under par. (f).

AB1-SSA1-SA2,192,13 (c) The secretary shall exercise his or her authority under s. 15.04 (1) (c) to create a prescription drug prior authorization committee and shall appoint as members at least all of the following:

AB1-SSA1-SA2,192,14 1. Two physicians who are currently in practice.

AB1-SSA1-SA2,192,15 2. Two pharmacists.

AB1-SSA1-SA2,192,18 3. One advocate for recipients of medical assistance who has sufficient medical background, as determined by the department, to evaluate a prescription drug's clinical effectiveness.

AB1-SSA1-SA2,192,20 (d) The prescription drug prior authorization committee appointed under par. (c) shall do all of the following:

AB1-SSA1-SA2,192,25 1. Review the department's prior authorization policies and advise the department on issues related to prior authorization decisions made concerning prescription drugs on behalf of medical assistance recipients. In making its review under this subdivision, the committee shall accept information or commentary from representatives of the pharmaceutical manufacturing industry.

AB1-SSA1-SA2,193,4 2. Consider the clinical efficacy, safety, and cost effectiveness of prescription drugs and develop and provide to the department a recommended preferred prescription drug list. In initially developing and subsequently revising the preferred prescription drug list, the committee shall do all of the following:

AB1-SSA1-SA2,193,7 a. Ensure that the manufacturers of prescription drugs that agree to provide a supplemental rebate, as specified in par. (h), have an opportunity to present evidence supporting inclusion of a product on the list.

AB1-SSA1-SA2,193,9 b. At least every 12 months, review all prescription drug classes included in the department's list of preferred prescription drugs under par. (f).

AB1-SSA1-SA2,193,12 c. From the department's list of preferred prescription drugs under par. (f), recommend additions or deletions that permit cost-saving, medically appropriate drug therapies for medical assistance recipients.

AB1-SSA1-SA2,193,14 (e) The department shall do all of the following on behalf of the prescription drug prior authorization committee:

AB1-SSA1-SA2,193,18 1. If the department has received timely notice that a drug or any of its uses has received approval by the federal food and drug administration under a priority new drug application, ensure that the drug will be reviewed by the committee at the committee's earliest regularly scheduled meeting.

AB1-SSA1-SA2,193,21 2. If the department has received notice from a drug manufacturer of a new drug product, schedule, to the extent possible, a product review for the product by the committee at the committee's earliest regularly scheduled meeting.

AB1-SSA1-SA2,193,24 (f) 1. After considering all of the following, the department may, beginning July 1, 2002, adopt a preferred prescription drug list and shall disseminate the list to all appropriate providers of medical assistance:

AB1-SSA1-SA2,194,2 a. The recommendation of the prescription drug prior authorization committee under par. (d) 2.

AB1-SSA1-SA2,194,3 b. The clinical efficacy of a prescription drug.

AB1-SSA1-SA2,194,5 c. The price of competing products minus payment of any rebate made under 42 USC 1396r-8 and par. (h).

AB1-SSA1-SA2,194,6 d. If par. (h) 4. applies.

AB1-SSA1-SA2,194,10 2. The department shall periodically update the preferred prescription drug list, based on the department's consideration of recommendations of the prescription drug prior authorization committee and shall disseminate the changes to appropriate providers.

AB1-SSA1-SA2,194,12 3. The department shall make the preferred prescription drug list under subd. 1. and the updates under subd. 2. publicly available.

AB1-SSA1-SA2,194,18 (g) A medical assistance recipient may contest the decision of the department to deny prior authorization for a prescription drug that is excluded from the preferred prescription drug list under par. (f) by filing, within 45 days after denial of coverage for a prescription drug that is subject to prior authorization, a written request for a hearing under s. 227.44 to the division of hearings and appeals created under s. 15.103 (1).

AB1-SSA1-SA2,194,20 (h) 1. If a manufacturer of a prescription drug pays a rebate under 42 USC 1396r-8, one of the following applies:

AB1-SSA1-SA2,195,2 a. If the rebate is less than 15.1%, the department may enter into an arrangement with the manufacturer that requires the manufacturer to provide a supplemental rebate to the department in an amount that, together with the rebate paid under 42 USC 1396r-8, equals at least 15.1% of the average manufacturer price for the manufacturer's prescription drug products that are provided to medical assistance recipients, except that the department may determine that a specific prescription drug is competitive at a lower rebate percentage.