Amendment SSA1-SB55

SB55-SSA1,631,14 49.45 (46) (b) This subsection does not apply after July 1 June 30, 2003.

SB55-SSA1, s. 1792 Section 1792. 49.45 (48) of the statutes is created to read:

SB55-SSA1,631,20 49.45 (48) Payment of medicare part B outpatient hospital services coinsurances. The department shall include in the state plan for medical assistance a methodology for payment of the medicare part B outpatient hospital services coinsurance amounts that are authorized under ss. 49.46 (2) (c) 2., 4., and 5m., 49.468 (1) (b), and 49.47 (6) (a) 6. b., d., and f.

SB55-SSA1, s. 1797 Section 1797. 49.46 (1) (a) 1. of the statutes is amended to read:

SB55-SSA1,631,25 49.46 (1) (a) 1. Any person included in the Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources, would qualify for a grant of aid to families with dependent children and any person who does under s. 49.19.

SB55-SSA1,632,4 1g. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources, would qualify for a grant of aid to families with dependent children but who would not receive such the aid solely because of the application of s. 49.19 (11) (a) 7.

SB55-SSA1, s. 1797g Section 1797g. 49.46 (1) (a) 1. of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-SSA1,632,10 49.46 (1) (a) 1. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources or income, would qualify for a grant of aid to families with dependent children under s. 49.19 and whose income does not exceed the income limit under par. (ar).

SB55-SSA1, s. 1797j Section 1797j. 49.46 (1) (a) 1g. of the statutes, as created by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-SSA1,632,17 49.46 (1) (a) 1g. Notwithstanding s. 49.19 (20), any individual who, without regard to the individual's resources or income, would qualify for a grant of aid to families with dependent children but who would not receive the aid solely because of the application of s. 49.19 (11) (a) 7. and whose income does not exceed the income limit under par. (ar).

SB55-SSA1, s. 1798 Section 1798. 49.46 (1) (a) 1m. of the statutes is amended to read:

SB55-SSA1,632,22 49.46 (1) (a) 1m. Any pregnant woman who meets the resource and whose income limits does not exceed the standard of need under s. 49.19 (4) (bm) and (es) (11) 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.

SB55-SSA1, s. 1798g Section 1798g. 49.46 (1) (a) 1m. of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-SSA1,633,4 49.46 (1) (a) 1m. Any pregnant woman whose income does not exceed the standard of need under s. 49.19 (11) income limit under par. (ar) 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.

SB55-SSA1, s. 1800 Section 1800. 49.46 (1) (a) 6. of the statutes is amended to read:

SB55-SSA1,633,9 49.46 (1) (a) 6. Any person not described in pars. (c) to (e) who is, without regard to the individual's resources, would be considered, under federal law, to be receiving aid to families with dependent children for the purpose of determining eligibility for medical assistance.

SB55-SSA1, s. 1800m Section 1800m. 49.46 (1) (a) 6. of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-SSA1,633,16 49.46 (1) (a) 6. Any person not described in pars. (c) to (e) who, without regard to the individual's resources or income, would be considered, under federal law, to be receiving aid to families with dependent children for the purpose of determining eligibility for medical assistance and whose income does not exceed the income limit under par. (ar).

SB55-SSA1, s. 1801 Section 1801. 49.46 (1) (a) 9. of the statutes is amended to read:

SB55-SSA1,633,20 49.46 (1) (a) 9. Any pregnant woman not described under subd. 1., 1g., or 1m. whose family income does not exceed 133% of the poverty line for a family the size of the woman's family.

SB55-SSA1, s. 1802 Section 1802. 49.46 (1) (a) 10. of the statutes is amended to read:

SB55-SSA1,633,24 49.46 (1) (a) 10. Any child not described under subd. 1. or 1g. who is under 6 years of age and whose family income does not exceed 133% of the poverty line for a family the size of the child's family.

SB55-SSA1, s. 1803 Section 1803. 49.46 (1) (a) 11. of the statutes is amended to read:

SB55-SSA1,634,8 49.46 (1) (a) 11. If a waiver under s. 49.665 is granted and in effect, any child not described under subd. 1. or 1g. who has attained the age of 6 but has not attained the age of 19 and whose family income does not exceed 100% of the poverty line for a family the size of the child's family. If a waiver under s. 49.665 is not granted or in effect, any child not described in subd. 1. or 1g. who was born after September 30,1983, who has attained the age of 6 but has not attained the age of 19 and whose family income does not exceed 100% of the poverty line for a family the size of the child's family.

SB55-SSA1, s. 1804 Section 1804. 49.46 (1) (a) 12. of the statutes is amended to read:

SB55-SSA1,634,12 49.46 (1) (a) 12. Any child not described under subd. 1. or 1g. who is under 19 years of age and who meets the resource and whose income limits does not exceed the standard of need under s. 49.19 (4) (11).

SB55-SSA1, s. 1804g Section 1804g. 49.46 (1) (a) 12. of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-SSA1,634,17 49.46 (1) (a) 12. Any child not described under subd. 1. or 1g. who is under 19 years of age and whose income does not exceed the standard of need under s. 49.19 (11) income limit under par. (ar).

SB55-SSA1, s. 1804m Section 1804m. 49.46 (1) (ar) of the statutes is created to read:

SB55-SSA1,634,24 49.46 (1) (ar) An individual is eligible to receive medical assistance under par. (a) 1., 1g., 1m., 6., and 12. if the individual's total income does not exceed the standard of need under s. 49.19 (11) (a) 1. a. increased by the same percentage as the percentage increase in the consumer price index, as defined in s. 49.455 (1) (b), between September 2001 and September of the year immediately before the year in which the individual's income is being determined.

SB55-SSA1, s. 1805 Section 1805. 49.46 (1) (e) of the statutes is amended to read:

SB55-SSA1,635,7 49.46 (1) (e) If an application under s. 49.47 (3) shows that the person has individual meets the income and resources within the limitations of limits under s. 49.19, or meets the income and resource requirements under federal Title XVI or s. 49.77, or that the person individual is an essential person, an accommodated person, or a patient in a public medical institution, the person individual shall be granted the benefits enumerated under sub. (2) whether or not the person individual requests or receives a grant of any of such aids.

SB55-SSA1, s. 1805d Section 1805d. 49.46 (1) (e) of the statutes, as affected by 2001 Wisconsin Act .... (this act), is amended to read:

SB55-SSA1,635,15 49.46 (1) (e) If an application under s. 49.47 (3) shows that the individual meets the income limits under s. 49.19 par. (ar) or meets the income and resource requirements under federal Title XVI or s. 49.77, or that the individual is an essential person, an accommodated person, or a patient in a public medical institution, the individual shall be granted the benefits enumerated under sub. (2) whether or not the individual requests or receives a grant of any of such aids.

SB55-SSA1, s. 1806 Section 1806. 49.46 (2) (b) 18. of the statutes is amended to read:

SB55-SSA1,635,19 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 June 30, 2003.

SB55-SSA1, s. 1807 Section 1807. 49.46 (2) (c) 2. of the statutes is amended to read:

SB55-SSA1,636,8 49.46 (2) (c) 2. For an individual who is entitled to coverage under part A of medicare, entitled to coverage under part B of medicare, meets the eligibility criteria under sub. (1) and meets the limitation on income under subd. 6., medical assistance shall include payment of the deductible and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to 1395zz, including those medicare services that are not included in the approved state plan for services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under part A of medicare. Payment of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-SSA1, s. 1808 Section 1808. 49.46 (2) (c) 4. of the statutes is amended to read:

SB55-SSA1,636,20 49.46 (2) (c) 4. For an individual who is entitled to coverage under part A of medicare, entitled to coverage under part B of medicare and meets the eligibility criteria for medical assistance under sub. (1), but does not meet the limitation on income under subd. 6., medical assistance shall include payment of the deductible and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to 1395zz, including those medicare services that are not included in the approved state plan for services under 42 USC 1396. Payment of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-SSA1, s. 1809 Section 1809. 49.46 (2) (c) 5m. of the statutes is amended to read:

SB55-SSA1,637,5 49.46 (2) (c) 5m. For an individual who is only entitled to coverage under part B of medicare and meets the eligibility criteria under sub. (1), but does not meet the limitation on income under subd. 6., medical assistance shall include payment of the deductible and coinsurance portions of medicare services under 42 USC 1395j to 1395w, including those medicare services that are not included in the approved state plan for services under 42 USC 1396. Payment of coinsurance for a service under part B of medicare, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-SSA1, s. 1810 Section 1810. 49.468 (1) (b) of the statutes is amended to read:

SB55-SSA1,637,20 49.468 (1) (b) For an elderly or disabled individual who is entitled to coverage under part A of medicare, entitled to coverage under part B of medicare and who does not meet the eligibility criteria for medical assistance under s. 49.46 (1), 49.465 or 49.47 (4) but meets the limitations on income and resources under par. (d), medical assistance shall pay the deductible and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to 1395zz, including those medicare services that are not included in the approved state plan for services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under part A of medicare. Payment of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-SSA1, s. 1811 Section 1811. 49.47 (4) (a) 1. of the statutes is amended to read:

SB55-SSA1,637,24 49.47 (4) (a) 1. Under 18 21 years of age or, if the person and resides in an intermediate care facility, skilled nursing facility, or inpatient psychiatric hospital, under 21 years of age.

SB55-SSA1, s. 1812 Section 1812. 49.47 (4) (a) 2. of the statutes is renumbered 49.47 (4) (ag) 2.

SB55-SSA1, s. 1813 Section 1813 . 49.47 (4) (ag) (intro.) of the statutes is created to read:

SB55-SSA1,638,4 49.47 (4) (ag) (intro.) Any individual whose income does not exceed the limits under par. (c) and who complies with par. (cm) is eligible for medical assistance under this section if the individual is one of the following:

SB55-SSA1, s. 1814 Section 1814 . 49.47 (4) (ag) 1. of the statutes is created to read:

SB55-SSA1,638,6 49.47 (4) (ag) 1. Under the age of 18.

SB55-SSA1, s. 1815 Section 1815. 49.47 (4) (b) 2m. a. of the statutes is amended to read:

SB55-SSA1,638,13 49.47 (4) (b) 2m. a. For persons who are eligible under par. (a) 1. or 2., one vehicle is exempt from consideration as an asset. A 2nd vehicle is exempt from consideration as an asset only if the department determines that it is necessary for the purpose of employment or to obtain medical care. The equity value of any nonexempt vehicles owned by the applicant is an asset for the purposes of determining eligibility for medical assistance under this section.

SB55-SSA1, s. 1815g Section 1815g. 49.47 (4) (c) 1. of the statutes is renumbered 49.47 (4) (c) 1. (intro.) and amended to read:

SB55-SSA1,638,17 49.47 (4) (c) 1. (intro.) Except as provided in par. (am) and as limited by subd. 3., eligibility exists if income does not exceed 133 1/3% of the greater of the following:

SB55-SSA1,638,23 a. An amount equal to the maximum aid to families with dependent children payment under s. 49.19 (11) (a) 1. a. for the applicant's family size or increased by the same percentage as the percentage increase in the consumer price index, as defined in s. 49.455 (1) (b), between September 2001 and September of the year immediately before the year in which the individual's income is being determined and multiplied by 133 1/3%.

SB55-SSA1,639,7 b. An amount equal to 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-SSA1, s. 1815j Section 1815j. 49.47 (4) (c) 1m. of the statutes is created to read:

SB55-SSA1,639,16 49.47 (4) (c) 1m. For purposes of determining whether an individual's income meets the income requirements under subd. 1., "income" includes all of the individual's 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, and "income" does not include earned or unearned income that 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-SSA1, s. 1816 Section 1816. 49.47 (6) (a) 6. b. of the statutes is amended to read:

SB55-SSA1,640,4 49.47 (6) (a) 6. b. An individual who is entitled to coverage under part A of medicare, entitled to coverage under part B of medicare, meets the eligibility criteria under sub. (4) (a) and meets the income limitation, the deductible and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to 1395zz, including those medicare services that are not included in the approved state plan for services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums under part A of medicare. Payment of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-SSA1, s. 1817 Section 1817. 49.47 (6) (a) 6. d. of the statutes is amended to read:

SB55-SSA1,640,15 49.47 (6) (a) 6. d. An individual who is entitled to coverage under part A of medicare, entitled to coverage under part B of medicare and meets the eligibility criteria for medical assistance under sub. (4) (a) but does not meet the income limitation, the deductible and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which are not paid under 42 USC 1395 to 1395zz, including those medicare services that are not included in the approved state plan for services under 42 USC 1396. Payment of coinsurance for a service under part B of medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-SSA1, s. 1818 Section 1818. 49.47 (6) (a) 6. f. of the statutes is amended to read:

SB55-SSA1,640,25 49.47 (6) (a) 6. f. For an individual who is only entitled to coverage under part B of medicare and meets the eligibility criteria under sub. (4), but does not meet the income limitation, medical assistance shall include payment of the deductible and coinsurance portions of medicare services under 42 USC 1395j to 1395w, including those medicare services that are not included in the approved state plan for services under 42 USC 1396. Payment of coinsurance for a service under part B of medicare, other than payment of coinsurance for outpatient hospital services, may not exceed the allowable charge for the service under medical assistance minus the medicare payment.

SB55-SSA1, s. 1819 Section 1819. 49.47 (6) (a) 7. of the statutes is amended to read:

SB55-SSA1,641,5 49.47 (6) (a) 7. Beneficiaries eligible under sub. (4) (a) 2. (ag) 2. or (am) 1., for services under s. 49.46 (2) (a) and (b) that are related to pregnancy, including postpartum services and family planning services, as defined in s. 253.07 (1) (b), or related to other conditions which may complicate pregnancy.

SB55-SSA1, s. 1820 Section 1820. 49.472 (6) (a) of the statutes is amended to read:

SB55-SSA1,641,12 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation under s. 20.435 (4) (b) or (w), 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.

SB55-SSA1, s. 1821 Section 1821. 49.472 (6) (b) of the statutes is amended to read:

SB55-SSA1,641,17 49.472 (6) (b) If federal financial participation is available, from the appropriation under s. 20.435 (4) (b) or (w), 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).

SB55-SSA1, s. 1822 Section 1822. 49.473 of the statutes is created to read:

SB55-SSA1,641,20 49.473 Medical assistance; women diagnosed with breast or cervical cancer. (1) In this section:

SB55-SSA1,641,22 (a) "County department" means a county department under s. 46.215, 46.22, or 46.23.

SB55-SSA1,641,23 (b) "Qualified entity" has the meaning given in 42 USC 1396r-1b (b) (2).

SB55-SSA1,642,3 (2) A woman is eligible for medical assistance as provided under sub. (5) if, after applying to the department or a county department, the department or a county department determines that she meets all of the following requirements:

SB55-SSA1,642,6 (a) The woman is not eligible for medical assistance under ss. 49.46 (1) and (1m), 49.465, 49.468, 49.47, and 49.472, and is not eligible for health care coverage under s. 49.665.

SB55-SSA1,642,7 (b) The woman is under 65 years of age.

SB55-SSA1,642,9 (c) The woman is not eligible for health care coverage that qualifies as creditable coverage in 42 USC 300gg (c).

SB55-SSA1,642,12 (d) The woman has been screened for breast or cervical cancer under a breast and cervical cancer early detection program that is authorized under a grant received under 42 USC 300k.

SB55-SSA1,642,13 (e) The woman requires treatment for breast or cervical cancer.

SB55-SSA1,642,18 (3) Prior to applying to the department or a county department for medical assistance, a woman is eligible for medical assistance as provided under sub. (5) beginning on the date on which a qualified entity determines, on the basis of preliminary information, that the women meets the requirements specified in sub. (2) and ending on one of the following dates:

SB55-SSA1,642,22 (a) If the woman applies to the department or a county department for medical assistance within the time limit required under sub. (4), the day on which the department or county department determines whether the woman meets the requirements under sub. (2).

SB55-SSA1,643,2 (b) If the woman does not apply to the department or county department for medical assistance within the time limit required under sub. (4), the last day of the month following the month in which the qualified entity determines that the woman is eligible for medical assistance.

SB55-SSA1,643,6 (4) A woman who a qualified entity determines under sub. (3) is eligible for medical assistance shall apply to the department or county department no later than the last day of the month following the month in which the qualified entity determines that the woman is eligible for medical assistance.

SB55-SSA1,643,10 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b) and (o), allowable charges to a provider who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who meets the requirements under sub. (2) for all benefits and services specified under s. 49.46 (2).

SB55-SSA1,643,12 (6) A qualified entity that determines under sub. (3) that a woman is eligible for medical assistance as provided under sub. (5) shall do all of the following:

SB55-SSA1,643,14 (a) Notify the department of the determination no later than 5 days after the date on which the determination is made.

SB55-SSA1,643,18 (b) Inform the woman at the of time the determination that she is required to apply to the department or a county department for medical assistance no later than the last day of the month following the month in which the qualified entity determines that the woman is eligible for medical assistance.