Amendment AA1-ASA1-SB55

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.

SB55-ASA1-AA1,454,4 (10) (a) The department shall promulgate rules relating to prohibitions on fraud that are substantially similar to applicable provisions under s. 49.49 (1) (a).

SB55-ASA1-AA1,454,8 (b) A person who is convicted of violating a rule promulgated by the department under par. (a) in connection with that person's furnishing of prescription drugs under this section may be fined not more than $25,000, or imprisoned for not more than 7 years and 6 months, or both.

SB55-ASA1-AA1,454,11 (c) A person other than a person specified in par. (b) who is convicted of violating a rule promulgated by the department under par. (a) may be fined not more than $10,000, or imprisoned for not more than one year, or both.

SB55-ASA1-AA1,454,17 (11) If federal law is amended to provide coverage for prescription drugs for outpatient care as a benefit under medicare or to provide similar coverage under another program, the department shall submit to appropriate standing committees of the legislature under s. 13.172 (3) a report that contains an analysis of the differences between such a federal program and the program under this section and that provides recommendations concerning alignment, if any, of the differences.

SB55-ASA1-AA1,454,22 (12) After June 30, 2002, and before July 1, 2004, the department may not subject a manufacturer that enters into a rebate agreement under sub. (7) to prior authorization requirements for a prescription drug under this section that are an expansion of prior authorization requirements in effect under the medical assistance program on July 1, 2002.

SB55-ASA1-AA1,455,2 (13) Except as provided in subs. (9) to (12), and except for the department's rule-making requirements and authority, the department may enter into a contract with an entity to perform the duties and exercise the powers of the department under this section.".

SB55-ASA1-AA1,455,3 837. Page 647, line 14: delete lines 14 to 24.

SB55-ASA1-AA1,455,4 838. Page 648, line 1: delete lines 1 to 12 and substitute:

SB55-ASA1-AA1,455,5 " Section 1838vb. 49.85 (1) of the statutes is amended to read:

SB55-ASA1-AA1,455,13 49.85 (1) County department notification requirement. If a county department under s. 46.215, 46.22 or 46.23, a governing body of a federally recognized American Indian tribe or band or a Wisconsin works agency determines that the department of health and family services may recover an amount under s. 49.497 or 49.793 or that the department of workforce development may recover an amount under s. 49.125, 49.161 or 49.195 (3), the county department or, tribal governing body, or Wisconsin works agency shall notify the affected department of the determination.".

SB55-ASA1-AA1,455,14 839. Page 648, line 12: after that line insert:

SB55-ASA1-AA1,455,15 " Section 1838w. 49.85 (2) (a) of the statutes is amended to read:

SB55-ASA1-AA1,455,23 49.85 (2) (a) At least annually, the department of health and family services shall certify to the department of revenue the amounts that, based on the notifications received under sub. (1) and on other information received by the department of health and family services, the department of health and family services has determined that it may recover under s. 49.45 (2) (a) 10. or 49.497, except that the department of health and family services may not certify an amount under this subsection unless it has met the notice requirements under sub. (3) and unless its determination has either not been appealed or is no longer under appeal.".

SB55-ASA1-AA1,455,24 840. Page 648, line 21: after that line insert:

SB55-ASA1-AA1,456,1 " Section 1840e. 49.85 (3) (a) 1. of the statutes is amended to read:

SB55-ASA1-AA1,456,5 49.85 (3) (a) 1. Inform the person that the department of health and family services intends to certify to the department of revenue an amount that the department of health and family services has determined to be due under s. 49.45 (2) (a) 10. or 49.497, for setoff from any state tax refund that may be due the person.".

SB55-ASA1-AA1,456,6 841. Page 653, line 10: after that line insert:

SB55-ASA1-AA1,456,7 " Section 1877p. 50.03 (13) (a) of the statutes is amended to read:

SB55-ASA1-AA1,456,20 50.03 (13) (a) New license. Whenever ownership of a facility is transferred from the person or persons named in the license to any other person or persons, the transferee must obtain a new license. The license may be a probationary license. Penalties under sub. (1) shall apply to violations of this subsection. The transferee shall notify the department of the transfer, file an application under sub. (3) (b), and apply for a new license at least 30 days prior to final transfer. Retention of any interest required to be disclosed under sub. (3) (b) after transfer by any person who held such an interest prior to transfer may constitute grounds for denial of a license where violations of this subchapter for which notice had been given to the transferor are outstanding and uncorrected, if the department determines that effective control over operation of the facility has not been transferred. If the transferor was a provider under s. 49.43 (10), the transferee and transferor shall comply with s. 49.45 (21).".

SB55-ASA1-AA1,456,21 842. Page 653, line 10: after that line insert:

SB55-ASA1-AA1,456,22 " Section 1877g. 50.01 (1) (b) of the statutes is amended to read:

SB55-ASA1-AA1,457,3 50.01 (1) (b) A place where 3 or 4 adults who are not related to the operator reside and receive care, treatment or services that are above the level of room and board and that may include up to 7 hours per week of nursing care per resident. "Adult family home" does not include a place that is specified in sub. (1g) (a) to (d), (f) or (g) or a respite facility, as defined in s. 50.85 (1) (b).

SB55-ASA1-AA1, s. 1877h Section 1877h. 50.01 (1) (h) of the statutes is created to read:

SB55-ASA1-AA1,457,5 50.01 (1) (h) A respite facility, as defined in s. 50.85 (1) (b).

SB55-ASA1-AA1, s. 1877i Section 1877i. 50.01 (3) (f) of the statutes is created to read:

SB55-ASA1-AA1,457,7 50.01 (3) (f) A respite facility, as defined in s. 50.85 (1) (b).".

SB55-ASA1-AA1,457,8 843. Page 654, line 6: after that line insert:

SB55-ASA1-AA1,457,9 " Section 1894r. 50.04 (2d) of the statutes is created to read:

SB55-ASA1-AA1,457,10 50.04 (2d) Pharmaceutical services. (a) In this subsection:

SB55-ASA1-AA1,457,12 1. "Drug product" means a specific drug or drugs in a specific dosage form and strength from a known source of manufacture.

SB55-ASA1-AA1,457,15 2. "Unit dose drug delivery system" means a system for the distribution to nursing home residents of drug products under which a single dose of a drug product is individually packaged and sealed.

SB55-ASA1-AA1,457,18 3. "Unit dose packaging" includes individually wrapped, single doses of a drug product that are contained on cards and that may be singly accessed by punching out a single wrapping on the card.

SB55-ASA1-AA1,457,22 (b) Under a unit dose drug delivery system, as ordered by a physician, a pharmacy may dispense to a nursing home up to a one-month's supply of the physician-directed dosage of drug products for an individual nursing home resident. The drug products may be supplied by use of unit dose packaging.".

SB55-ASA1-AA1,457,23 844. Page 654, line 6: after that line insert:

SB55-ASA1-AA1,457,24 " Section 1894r. 50.065 (1) (c) (intro.) of the statutes is amended to read:

SB55-ASA1-AA1,458,6 50.065 (1) (c) (intro.) "Entity" means a facility, organization or service that is licensed or certified by or registered with the department to provide direct care or treatment services to clients. "Entity" includes a hospital, a personal care worker agency, a supportive home care service agency, a temporary employment agency that provides caregivers to another entity, a respite facility, and the board on aging and long-term care. "Entity" does not include any of the following:

SB55-ASA1-AA1, s. 1897g Section 1897g. 50.50 (3) (a) 7. of the statutes is created to read:

SB55-ASA1-AA1,458,8 50.50 (3) (a) 7. A respite facility.

SB55-ASA1-AA1, s. 1900b Section 1900b. Subchapter IV (title) of chapter 50 [precedes 50.85] of the statutes is amended to read:

SB55-ASA1-AA1,458,11 CHAPTER 50

SB55-ASA1-AA1,458,12 SUBCHAPTER IV

SB55-ASA1-AA1,458,13 respite facilities and HOSPICES

SB55-ASA1-AA1, s. 1900c Section 1900c. 50.85 of the statutes is created to read:

SB55-ASA1-AA1,458,16 50.85 Respite facilities for persons with like or similar disabilities. (1) Definitions. In this section:

SB55-ASA1-AA1,458,17 (a) "Disability" has the meaning given in rules promulgated under sub. (8) (e).

SB55-ASA1-AA1,458,19 (b) "Like or similar disabilities" has the meaning given in rules promulgated under sub. (8) (f).

SB55-ASA1-AA1,458,21 (c) "Respite care" means care provided to a person with a disability in order to provide temporary relief to the primary caregiver.

SB55-ASA1-AA1,458,25 (d) "Respite facility" means a facility in which overnight respite care is provided to up to 10 persons with like or similar disabilities who are at least 2 years of age and in which day respite care may be provided to up to 10 additional persons with like or similar disabilities who are at least 2 years of age.

SB55-ASA1-AA1,459,3 (2) Departmental powers and duties. The department shall provide uniform, statewide licensure, inspection, and regulation of respite facilities as specified in this section.

SB55-ASA1-AA1,459,6 (3) Licensure requirements. (a) No person may conduct, maintain, operate, or otherwise participate in conducting, maintaining, or operating a respite facility unless the respite facility is licensed by the department.

SB55-ASA1-AA1,459,9 (b) The department shall issue a license if the department finds that the applicant is fit and qualified and that the respite facility meets the requirements of this section and the rules promulgated under this section.

SB55-ASA1-AA1,459,14 (c) The department or the department's designated representative shall inspect or investigate a respite facility prior to issuance of a license for the respite facility and may inspect or investigate a respite facility as the department deems necessary, including a review of patient health care records of any individuals served by the respite facility, to determine if any person is in violation of this section.

SB55-ASA1-AA1,459,22 (d) The past record of violations of applicable federal laws or regulations or of state statutes or rules of this or any other state, in the operation of any health-related organization, by an operator, managing employee, or direct or indirect owner of a respite facility or of an interest of a respite facility is relevant to the issue of the fitness of an applicant for a license. The department or the department's designated representative shall inspect and investigate as necessary to determine the conditions existing in each case under this paragraph and shall prepare and maintain a written report concerning the investigation and inspection.

SB55-ASA1-AA1,460,2 (4) Use of name or advertising prohibited. No entity that is not a respite facility licensed under this section or an applicant for a license under this section may designate itself as a "respite facility" or use the word "respite facility" to represent or tend to represent the entity as a respite facility or services provided by the entity as services provided by a respite facility.

SB55-ASA1-AA1,460,3 (5) Licensing procedure. (a) The application for a license shall:

SB55-ASA1-AA1,460,4 1. Be in writing on a form provided by the department.

SB55-ASA1-AA1,460,5 2. Contain such information as the department requires.

SB55-ASA1-AA1,460,6 3. Include licensing fee payment, as specified in sub. (6).