Amendment AA1-ASA1-SB55

SB55-ASA1-AA1, s. 1786h Section 1786h. 49.45 (21) (a) of the statutes is renumbered 49.45 (21) (ar) and amended to read:

SB55-ASA1-AA1,442,14 49.45 (21) (ar) If any provider Before a person may take over the operation of a provider that is liable for repayment of improper or erroneous payments or overpayments under ss. 49.43 to 49.497 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, 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 is liable under this paragraph.

SB55-ASA1-AA1, s. 1786i Section 1786i. 49.45 (21) (ag) of the statutes is created to read:

SB55-ASA1-AA1,442,18 49.45 (21) (ag) In this subsection, "take over the operation" means obtain, with respect to an aspect of a provider's business for which the provider has filed claims for medical assistance reimbursement, any of the following:

SB55-ASA1-AA1,442,20 1. Ownership of the provider's business or all or substantially all of the assets of the business.

SB55-ASA1-AA1,442,21 2. Majority control over decisions.

SB55-ASA1-AA1,442,22 3. The right to any profits or income.

SB55-ASA1-AA1,442,24 4. The right to contact and offer services to patients, clients, or residents served by the provider.

SB55-ASA1-AA1,443,3 5. An agreement that the provider will not compete with the person at all or with respect to a patient, client, resident, service, geographical area, or other part of the provider's business.

SB55-ASA1-AA1,443,5 6. The right to perform services that are substantially similar to services performed by the provider at the same location as those performed by the provider.

SB55-ASA1-AA1,443,7 7. The right to use any distinctive name or symbol by which the provider is known in connection with services to be provided by the person.

SB55-ASA1-AA1, s. 1786j Section 1786j. 49.45 (21) (b) of the statutes is amended to read:

SB55-ASA1-AA1,443,18 49.45 (21) (b) If a transfer occurs If, notwithstanding the prohibition under par. (ar), a person takes over the operation of a provider and the applicable amount under par. (a) (ar) has not been repaid, the department may, in addition to withholding certification as authorized under sub. (2) (b) 8., proceed against either the transferor or the transferee the provider or the person. Within 30 days after receiving the certified provider receives notice from the department, the transferor or the transferee shall pay the amount shall be repaid in full. Upon failure to comply If the amount is not repaid in full, 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.".

SB55-ASA1-AA1,443,19 821. Page 630, line 20: after that line insert:

SB55-ASA1-AA1,443,20 " Section 1792g. 49.45 (49) of the statutes is created to read:

SB55-ASA1-AA1,444,2 49.45 (49) Prior authorization for legend drugs. If, after June 30, 2002, and before July 1, 2004, a manufacturer has in force a rebate agreement under s. 49.688 (7), the department may not during that period expand the prior authorization requirements for prescription drugs manufactured by the manufacturer for which coverage is provided under s. 49.46 (2) (b) 6. h. beyond those prior authorization requirements that are in effect on July 1, 2002.".

SB55-ASA1-AA1,444,3 822. Page 630, line 20: after that line insert:

SB55-ASA1-AA1,444,4 " Section 1792r. 49.45 (53) of the statutes is created to read:

SB55-ASA1-AA1,444,15 49.45 (53) Refund of medical relief and general relief. (a) If a service provider receives reimbursement under this section for a claim submitted by or on behalf of the service provider under the circumstance specified under s. 49.45 (2) (a) 2m. b., the service provider shall, as a condition of certification under sub. (2) (a) 11., refund to the county that initially reimbursed the services as general relief or as medical relief, any medical relief under a relief block grant or any general relief paid to the service provider for the medical assistance-reimbursable services rendered. The county shall separately identify this refund and remit to the department for deposit in the appropriation account under s. 20.435 (4) (ib) an amount that represents the state's contribution toward the original medical relief or general relief paid.

SB55-ASA1-AA1,444,21 (b) If the federal department of health and human services disallows payment to the state of federal financial participation for a claim submitted by or on behalf of a service provider under the circumstance specified under sub. (2) (a) 2m. b., the county shall remit to the department for deposit in the appropriation account under s. 20.435 (4) (ib) an amount that is equal to the amount of federal financial participation paid by the department to the service provider under par. (a).

SB55-ASA1-AA1,444,22 (c) This subsection does not apply after June 30, 2005.".

SB55-ASA1-AA1,444,23 823. Page 631, line 5: delete lines 5 to 17.

SB55-ASA1-AA1,445,2 824. Page 631, line 23: delete the material beginning with that line and ending with page 632, line 4.

SB55-ASA1-AA1,445,3 825. Page 632, line 10: delete lines 10 to 16.

SB55-ASA1-AA1,445,4 826. Page 633, line 13: delete lines 13 to 24.

SB55-ASA1-AA1,445,5 827. Page 634, line 8: delete lines 8 to 15.

SB55-ASA1-AA1,445,6 828. Page 637, line 6: after that line insert:

SB55-ASA1-AA1,445,7 " Section 1814L. 49.47 (4) (aq) of the statutes is created to read:

SB55-ASA1-AA1,445,12 49.47 (4) (aq) 1. Subject to subd. 2., an individual who does not meet the limitation on income under par. (c) is eligible for medical assistance if the individual's income does not exceed 100% of the federal poverty level, and the individual is 65 years of age or older or is blind or totally and permanently disabled, as defined under federal Title XVI.

SB55-ASA1-AA1,445,16 2. If a federal waiver is necessary to provide medical assistance to individuals specified in subd. 1., the department shall request a waiver from the secretary of the federal department of health and human services before providing medical assistance under this paragraph.".

SB55-ASA1-AA1,445,17 829. Page 637, line 13: after that line insert:

SB55-ASA1-AA1,445,18 " Section 1815cb. 49.47 (4) (b) 2m. b. of the statutes is amended to read:

SB55-ASA1-AA1,445,21 49.47 (4) (b) 2m. b. For persons who are eligible under par. (a) 3. or 4. or (aq), motor vehicles are exempt from consideration as an asset to the same extent as provided under 42 USC 1381 to 1385.

SB55-ASA1-AA1, s. 1815cc Section 1815cc. 49.47 (4) (b) 2r. of the statutes is amended to read:

SB55-ASA1-AA1,446,2 49.47 (4) (b) 2r. For a person who is eligible under par. (a) 3. or 4. or (aq), the value of any burial space or agreement representing the purchase of a burial space held for the purpose of providing a place for the burial of the person or any member of his or her immediate family.

SB55-ASA1-AA1, s. 1815cd Section 1815cd. 49.47 (4) (b) 2w. of the statutes is amended to read:

SB55-ASA1-AA1,446,6 49.47 (4) (b) 2w. For a person who is eligible under par. (a) 3. or 4. or (aq), life insurance with cash surrender values if the total face value of all life insurance policies is not more than $1,500.

SB55-ASA1-AA1, s. 1815ce Section 1815ce. 49.47 (4) (b) 3. of the statutes is amended to read:

SB55-ASA1-AA1,446,12 49.47 (4) (b) 3. For a person who is eligible under par. (a) 3. or 4. or (aq), funds set aside to meet the burial and related expenses of the person and his or her spouse in an amount not to exceed $1,500 each, minus the sum of the cash value of any life insurance excluded under subd. 2w. and the amount in any irrevocable burial trust under s. 445.125 (1) (a).

SB55-ASA1-AA1, s. 1815cf Section 1815cf. 49.47 (4) (c) 1. of the statutes is amended to read:

SB55-ASA1-AA1,446,25 49.47 (4) (c) 1. Except as provided in par. pars. (am) and (aq) and as limited by subd. 3., eligibility exists if income does not exceed 133 1/3% 133.33% of the maximum aid to families with dependent children payment under s. 49.19 (11) for the applicant's family size or the combined benefit amount available under supplemental security income under 42 USC 1381 to 1383c and state supplemental aid under s. 49.77 whichever is higher. In this subdivision "income" includes earned or unearned income that would be included in determining eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled under 42 USC 1381 to 1385. "Income" does not include earned or unearned income which would be excluded in determining eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled individual under 42 USC 1381 to 1385.".

SB55-ASA1-AA1,447,2 830. Page 637, line 14: delete the material beginning with that line and ending with page 638, line 16.

SB55-ASA1-AA1,447,3 831. Page 638, line 16: after that line insert:

SB55-ASA1-AA1,447,4 " Section 1815L. 49.47 (4) (c) 3. of the statutes is amended to read:

SB55-ASA1-AA1,447,8 49.47 (4) (c) 3. Except as provided in par. pars. (am) and (aq), no person is eligible for medical assistance under this section if the person's income exceeds the maximum income levels that the U.S. department of health and human services sets for federal financial participation under 42 USC 1396b (f).

SB55-ASA1-AA1, s. 1815p Section 1815p. 49.47 (4) (i) 2. (intro.) of the statutes is amended to read:

SB55-ASA1-AA1,447,12 49.47 (4) (i) 2. (intro.) Notwithstanding par. (b) 2r. and 3., a person who is described in par. (a) 3. or 4. or (aq) is not eligible for benefits under this section if any of the following criteria is met:".

SB55-ASA1-AA1,447,13 832. Page 642, line 20: after that line insert:

SB55-ASA1-AA1,447,14 " Section 1823r. 49.4981 of the statutes is created to read:

SB55-ASA1-AA1,447,20 49.4981 Comprehensive quality assessment pilot project. (1) If the department receives a waiver of federal medical assistance laws, as requested under 2001 Wisconsin Act .... (this act), section 9123 (19g), the department shall conduct a pilot project in the counties of Brown, Grant, Polk, and Waukesha under which nursing facilities shall apply to the department, under requirements specified by the department, to participate in the pilot project.

SB55-ASA1-AA1,448,10 (2) If participation for a nursing facility is approved by the department under subsection (1), and if the nursing facility contracts to receive a comprehensive quality assessment, under standards and principles of comprehensive assessments of the quality of care provided to residents of nursing facilities, the nursing facility shall provide to the department a copy of a report by the assessment provider of each such assessment that is conducted. Each report shall include any findings of violations of state statutes or rules by the nursing facility that are discovered in the course of performance of the assessment. The nursing facility shall provide information that the department requests concerning any violations noted. The department may use the assessment report and information provided by the nursing facility as evidence to which s. 50.04 (4) applies or upon which an applicable forfeiture under s. 49.498 (16) or 50.04 (5) may be assessed. Upon receipt of the assessment report, the department may, but is not required to, waive the requirement under s. 49.498 (13) for an annual survey of the nursing facility.".

SB55-ASA1-AA1,448,11 833. Page 642, line 20: after that line insert:

SB55-ASA1-AA1,448,12 " Section 1835h. 49.496 (3) (f) of the statutes is amended to read:

SB55-ASA1-AA1,448,15 49.496 (3) (f) The department may contract with or employ an attorney to probate estates to recover under this subsection the costs of care. Any such contract is subject to the requirements of s. 20.930 (2) to (5).".

SB55-ASA1-AA1,448,16 834. Page 644, line 14: after that line insert:

SB55-ASA1-AA1,448,17 " Section 1837e. 49.665 (5) (a) of the statutes is amended to read:

SB55-ASA1-AA1,449,14 49.665 (5) (a) Except as provided in pars. (b) and (bm), a family, or child who does not reside with his or her parent, who receives health care coverage under this section shall pay a percentage of the cost of that coverage in accordance with a schedule established by the department by rule. If Except as provided in par. (am), if the schedule established by the department requires a family, or child who does not reside with his or her parent, to contribute more than 3% of the family's or child's income towards the cost of the health care coverage provided under this section, the department shall submit the schedule to the joint committee on finance for review and approval of the schedule. If the cochairpersons of the joint committee on finance do not notify the department within 14 working days after the date of the department's submittal of the schedule that the committee has scheduled a meeting to review the schedule, the department may implement the schedule. If, within 14 days after the date of the department's submittal of the schedule, the cochairpersons of the committee notify the department that the committee has scheduled a meeting to review the schedule, the department may not require a family, or child who does not reside with his or her parent, to contribute more than 3% of the family's or child's income unless the joint committee on finance approves the schedule. The joint committee on finance may not approve and the department may not implement a schedule that requires a family or child to contribute more than 3.5% of the family's or child's income towards the cost of the health care coverage provided under this section.

SB55-ASA1-AA1, s. 1837eg Section 1837eg. 49.665 (5) (am) of the statutes is created to read:

SB55-ASA1-AA1,449,23 49.665 (5) (am) No later than January 1, 2002, the department shall request a waiver from the federal secretary of health and human services to increase the maximum amount that a family, or child who does not reside with his or her parent, is required to pay under par. (a) to 5% of the family's or child's income. If the waiver is granted, the department shall increase the maximum amount that a family, or child who does not reside with his or her parent, is required to pay under par. (a) to 5% of the family's or child's income and is not required to receive approval from the joint committee on finance before increasing the maximum amount.".

SB55-ASA1-AA1,449,24 835. Page 645, line 6: after that line insert:

SB55-ASA1-AA1,450,1 " Section 1837pm. 49.682 (6) of the statutes is amended to read:

SB55-ASA1-AA1,450,4 49.682 (6) The department may contract with or employ an attorney to probate estates to recover under this section the costs of care. Any such contract is subject to the requirements of s. 20.930 (2) to (5).".

SB55-ASA1-AA1,450,5 836. Page 646, line 22: after that line insert:

SB55-ASA1-AA1,450,6 " Section 1838f. 49.688 of the statutes is created to read:

SB55-ASA1-AA1,450,8 49.688 Prescription drug assistance for low-income elderly persons. (1) In this section:

SB55-ASA1-AA1,450,9 (a) "Generic name" has the meaning given in s. 450.12 (1) (b).

SB55-ASA1-AA1,450,11 (b) "Poverty line" means the nonfarm federal poverty line for the continental United States, as defined by the federal department of labor under 42 USC 9902 (2).

SB55-ASA1-AA1,450,15 (c) "Prescription drug" means a prescription drug, as defined in s. 450.01 (20), that is included in the drugs specified under s. 49.46 (2) (b) 6. h. and that is manufactured by a manufacturer that enters into a rebate agreement in force under sub. (7).

SB55-ASA1-AA1,450,16 (d) "Prescription order" has the meaning given in s. 450.01 (21).

SB55-ASA1-AA1,451,2 (2) A person who is a resident, as defined in s. 27.01 (10) (a), of this state, who is at least 65 years of age, who is not a recipient of medical assistance, whose annual household income, as determined by the department, does not exceed 185% of the poverty line for a family the size of the person's eligible family, and who pays the program enrollment fee specified in sub. (3) (a) is eligible to purchase a prescription drug at the amounts specified in sub. (6) (b). The person may apply to the department, on a form provided by the department for a determination of eligibility and issuance of a prescription drug card for purchase of prescription drugs under this section.

SB55-ASA1-AA1,451,3 (3) (a) Program participants shall pay all of the following:

SB55-ASA1-AA1,451,4 1. For each 12-month benefit period, a program enrollment fee of $25.

SB55-ASA1-AA1,451,5 2. For each 12-month benefit period, a deductible for each person of $840.

SB55-ASA1-AA1,451,6 3. After payment of the deductible under subd. 2., all of the following:

SB55-ASA1-AA1,451,8 a. A copayment of $10 for each prescription drug that bears only a generic name.

SB55-ASA1-AA1,451,10 b. A copayment of $20 for each prescription drug that does not bear only a generic name.

SB55-ASA1-AA1,451,14 (b) Notwithstanding s. 49.002, if a person who is eligible under this section has other available coverage for payment of a prescription drug, this section applies only to costs for prescription drugs for the person that are not covered under the person's other available coverage.

SB55-ASA1-AA1,451,20 (4) The department shall devise and distribute a form for application for the program under sub. (2), shall determine eligibility for each 12-month benefit period of applicants, and shall issue to eligible persons a prescription drug card for use in purchasing prescription drugs, as specified in sub. (5). The department shall promulgate rules that specify the criteria to be used to determine annual household income under sub. (2).

SB55-ASA1-AA1,452,2 (5) Beginning July 1, 2002, as a condition of participation by a pharmacy or pharmacist in the program under s. 49.45, 49.46, or 49.47, the pharmacy or pharmacist may not charge a person who presents a valid prescription order and a card indicating that he or she meets eligibility requirements under sub. (2) an amount for a prescription drug under the order that exceeds the amounts specified in sub. (6) (b).

SB55-ASA1-AA1,452,5 (6) (a) The charge for a prescription drug shall be calculated at the average wholesale price minus 5% or the maximum allowable cost, as determined by the department, whichever is less.

SB55-ASA1-AA1,452,7 (b) The amounts that a pharmacy or pharmacist may charge a person specified in sub. (2) in a 12-month period for a prescription drug are the following:

SB55-ASA1-AA1,452,11 1. If applicable, a deductible, as specified in sub. (3) (a) 2., for a prescription drug that is charged at the rate specified in par. (a), plus a dispensing fee that is equal to the dispensing fee permitted to be charged for prescription drugs for which coverage is provided under s. 49.46 (2) (b) 6. h.

SB55-ASA1-AA1,452,13 2. After the deductible under subd. 1. is charged, the copayment, as applicable, that is specified in sub. (3) (a) 3. a. or b.

SB55-ASA1-AA1,452,17 (c) The department shall calculate and transmit to pharmacies and pharmacists that are certified providers of medical assistance amounts that may be used in calculating charges under par. (a). The department shall periodically update this information and transmit the updated amounts to pharmacies and pharmacists.

SB55-ASA1-AA1,452,22 (7) The department or an entity with which the department contracts may enter into a rebate agreement that is modeled on the rebate agreement specified under 42 USC 1396r-8 with a drug manufacturer that sells drugs for prescribed use in this state. The rebate agreement, if negotiated, shall include all of the following as requirements:

SB55-ASA1-AA1,453,2 (a) That the manufacturer shall make rebate payments for each prescription drug of the manufacturer that is prescribed for persons who are eligible under sub. (2), to the state treasurer to be credited to the appropriation under s. 20.435 (4) (j), each calendar quarter or according to a schedule established by the department.

SB55-ASA1-AA1,453,4 (b) That the amount of the rebate payment shall be determined by a method specified in 42 USC 1396r-8 (c).

SB55-ASA1-AA1,453,19 (8) From the appropriation accounts under s. 20.435 (4) (bv) and (j), beginning July 1, 2002, the department shall, under a schedule that is identical to that used by the department for payment of pharmacy provider claims under medical assistance, provide to pharmacies and pharmacists payments for prescription drugs sold by the pharmacies or pharmacists to persons eligible under sub. (2) who have paid the deductible specified under sub. (3) (a) 2. The payment for each prescription drug under this subsection shall be at the rate specified in sub. (6) (a), minus the amount of a copayment charged under sub. (6) (b) 2., plus a dispensing fee, as specified in sub. (6) (b) 1. The department shall devise and distribute a form for reports by pharmacies and pharmacists under this subsection and may limit payment under this subsection to those prescription drugs for which payment claims are submitted by pharmacies or pharmacists directly to the department. The department may apply to the program under this section the same utilization and cost control procedures that apply under rules promulgated by the department to medical assistance under subch. IV.

SB55-ASA1-AA1,454,2 (9) The department shall, under methods promulgated by the department by rule, monitor compliance by pharmacies and pharmacists that are certified providers of medical assistance with the requirements of sub. (5) and shall annually report to the legislature under s. 13.172 (2) concerning the compliance. The report shall include information on any pharmacies or pharmacists that discontinue participation as certified providers of medical assistance and the reasons given for the discontinuance.