Amendment AA1-ASA1-SB55

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).

SB55-ASA1-AA1,460,7 (b) 1. A respite facility license is valid until suspended or revoked.

SB55-ASA1-AA1,460,9 2. Each license shall be issued only for the applicant named in the application and may not be transferred or assigned.

SB55-ASA1-AA1,460,11 3. Any license granted under special limitations prescribed by the department shall state the limitations.

SB55-ASA1-AA1,460,13 (6) Licensure fee. The annual fee for a licensed respite facility is $18 per bed, based on the number of licensed beds of the respite facility.

SB55-ASA1-AA1,460,19 (7) Suspension and revocation. (a) The department, after notice to the applicant or licensee, may suspend or revoke a license in any case in which the department finds that there has been a substantial failure to comply with the requirements of this section or the rules promulgated under this section. No state or federal funds passing through the state treasury may be paid to a respite facility that does not have a valid license issued under this section.

SB55-ASA1-AA1,460,22 (b) Notice under this subsection shall include a clear and concise statement of the violations on which the revocation is based, the statute or rule violated and notice of the opportunity for an evidentiary hearing under par. (c).

SB55-ASA1-AA1,460,25 (c) If a respite facility desires to contest the revocation of a license, the respite facility shall, within 10 days after receipt of notice under par. (b), notify the department in writing of its request for a hearing under s. 227.44.

SB55-ASA1-AA1,461,4 (d) 1. Subject to s. 227.51 (3), revocation shall become effective on the date set by the department in the notice of revocation, or upon final action after a hearing under ch. 227, or after court action if a stay is granted under ch. 227, whichever is later.

SB55-ASA1-AA1,461,7 3. The department may extend the effective date of license revocation in any case in order to permit orderly removal and relocation of individuals served by the respite facility.

SB55-ASA1-AA1,461,9 (8) Rule-making authority. The department shall promulgate all of the following rules:

SB55-ASA1-AA1,461,18 (a) Standards for the care, treatment, health, safety, rights, and welfare of persons with like or similar disabilities who receive respite care care from a respite facility and the maintenance, general hygiene and operation of a respite facility, which will permit the use of advancing knowledge to promote safe and adequate care and treatment for these individuals. These standards shall permit persons with like or similar disabilities who receive day care from a respite facility to share dining facilities and day trips with persons with with like or similar disabilities who receive overnight care from a respite facility. The standards shall also allow provision of fire safety training by a local fire inspector or a fire department.

SB55-ASA1-AA1,461,21 (b) Inspection or investigation procedures that the department or the department's designated representative may use to assure the provision of care and treatment that is commensurate with the standards established under par. (a).

SB55-ASA1-AA1,461,22 (c) Criteria for determining that the applicant for licensure is fit and qualified.

SB55-ASA1-AA1,461,25 (d) A procedure for waiver of and variance from standards under par. (a) or criteria under par. (c). The department may limit the duration of the waiver or variance.

SB55-ASA1-AA1,462,1 (e) A definition of "disability" for the purposes of this section.

SB55-ASA1-AA1,462,2 (f) A definition of "like or similar disabilities" for the purposes of this section.

SB55-ASA1-AA1,462,10 (9) Right of injunction. The department may, upon the advice of the attorney general, who shall represent the department in all proceedings under this section, institute an action in the name of the state in the circuit court for Dane County for injunctive relief or other process against any licensee, owner, operator, administrator or representative of any owner of a respite facility for the violation of any of the provisions of this section or rules promulgated under this section if the violation affects the health, safety, or welfare of persons with like or similar disabilities.

SB55-ASA1-AA1,462,16 (10) Forfeitures. (a) Any person who violates this subchapter or rules promulgated under this subchapter may be required to forfeit not more than $100 for the first violation and may be required to forfeit not more than $200 for the 2nd or any subsequent violation within a year. The period shall be measured using the dates of issuance of citations of the violations. Each day of violation constitutes a separate violation.

SB55-ASA1-AA1,462,19 (b) In determining whether a forfeiture is to be imposed and in fixing the amount of the forfeiture to be imposed, if any, for a violation, the following factors shall be considered:

SB55-ASA1-AA1,462,23 1. The gravity of the violation, including the probability that death or serious physical or psychological harm to a person receiving respite care from a respite facility will result or has resulted; the severity of the actual or potential harm; and the extent to which the provisions of the applicable statutes or rules were violated.