SB55-SSA1, s. 1815g
14Section 1815g. 49.47 (4) (c) 1. of the statutes is renumbered 49.47 (4) (c) 1.
15(intro.) and amended to read:
SB55-SSA1,638,1716
49.47
(4) (c) 1. (intro.) Except as provided in par. (am) and as limited by subd.
173., eligibility exists if income does not exceed
133 1/3% of the greater of the following:
SB55-SSA1,638,23
18a. An amount equal to the maximum aid to families with dependent children
19payment under s. 49.19 (11)
(a) 1. a. for the applicant's family size
or increased by the
20same percentage as the percentage increase in the consumer price index, as defined
21in s. 49.455 (1) (b), between September 2001 and September of the year immediately
22before the year in which the individual's income is being determined and multiplied
23by 133 1/3%.
SB55-SSA1,639,7
24b. An amount equal to the combined benefit amount available under
25supplemental security income under
42 USC 1381 to
1383c and state supplemental
1aid under s. 49.77
whichever is higher. In this subdivision "income" includes earned
2or unearned income that would be included in determining eligibility for the
3individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled under
442 USC 1381 to 1385. "Income" does not include earned or unearned income which
5would be excluded in determining eligibility for the individual or family under s.
649.19 or 49.77, or for the aged, blind or disabled individual under 42 USC 1381 to
71385.
SB55-SSA1,639,169
49.47
(4) (c) 1m. For purposes of determining whether an individual's income
10meets the income requirements under subd. 1., "income" includes all of the
11individual's earned or unearned income that would be included in determining
12eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind,
13or disabled under
42 USC 1381 to
1385, and "income" does not include earned or
14unearned income that would be excluded in determining eligibility for the individual
15or family under s. 49.19 or 49.77, or for the aged, blind, or disabled individual under
1642 USC 1381 to
1385.
SB55-SSA1, s. 1816
17Section
1816. 49.47 (6) (a) 6. b. of the statutes is amended to read:
SB55-SSA1,640,418
49.47
(6) (a) 6. b. An individual who is entitled to coverage under part A of
19medicare, entitled to coverage under part B of medicare, meets the eligibility criteria
20under sub. (4) (a) and meets the income limitation, the deductible and coinsurance
21portions of medicare services under
42 USC 1395 to
1395zz which are not paid under
2242 USC 1395 to
1395zz, including those medicare services that are not included in
23the approved state plan for services under
42 USC 1396; the monthly premiums
24payable under
42 USC 1395v; the monthly premiums, if applicable, under
42 USC
251395i-2 (d); and the late enrollment penalty, if applicable, for premiums under part
1A of medicare. Payment of coinsurance for a service under part B of medicare under
242 USC 1395j to
1395w, other than payment of coinsurance for outpatient hospital
3services, may not exceed the allowable charge for the service under medical
4assistance minus the medicare payment.
SB55-SSA1,640,156
49.47
(6) (a) 6. d. An individual who is entitled to coverage under part A of
7medicare, entitled to coverage under part B of medicare and meets the eligibility
8criteria for medical assistance under sub. (4) (a) but does not meet the income
9limitation, the deductible and coinsurance portions of medicare services under
42
10USC 1395 to
1395zz which are not paid under
42 USC 1395 to
1395zz, including those
11medicare services that are not included in the approved state plan for services under
1242 USC 1396. Payment of coinsurance for a service under part B of medicare under
1342 USC 1395j to
1395w, other than payment of coinsurance for outpatient hospital
14services, may not exceed the allowable charge for the service under medical
15assistance minus the medicare payment.
SB55-SSA1, s. 1818
16Section
1818. 49.47 (6) (a) 6. f. of the statutes is amended to read:
SB55-SSA1,640,2517
49.47
(6) (a) 6. f. For an individual who is only entitled to coverage under part
18B of medicare and meets the eligibility criteria under sub. (4), but does not meet the
19income limitation, medical assistance shall include payment of the deductible and
20coinsurance portions of medicare services under
42 USC 1395j to
1395w, including
21those medicare services that are not included in the approved state plan for services
22under
42 USC 1396. Payment of coinsurance for a service under part B of medicare
,
23other than payment of coinsurance for outpatient hospital services, may not exceed
24the allowable charge for the service under medical assistance minus the medicare
25payment.
SB55-SSA1,641,52
49.47
(6) (a) 7. Beneficiaries eligible under sub. (4)
(a) 2. (ag) 2. or (am) 1., for
3services under s. 49.46 (2) (a) and (b) that are related to pregnancy, including
4postpartum services and family planning services, as defined in s. 253.07 (1) (b), or
5related to other conditions which may complicate pregnancy.
SB55-SSA1,641,127
49.472
(6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation under s.
820.435 (4) (b)
or (w), the department shall, on the part of an individual who is eligible
9for medical assistance under sub. (3), pay premiums for or purchase individual
10coverage offered by the individual's employer if the department determines that
11paying the premiums for or purchasing the coverage will not be more costly than
12providing medical assistance.
SB55-SSA1,641,1714
49.472
(6) (b) If federal financial participation is available, from the
15appropriation under s. 20.435 (4) (b)
or (w), the department may pay medicare Part
16A and Part B premiums for individuals who are eligible for medicare and for medical
17assistance under sub. (3).
SB55-SSA1,641,20
1949.473 Medical assistance; women diagnosed with breast or cervical
20cancer. (1) In this section:
SB55-SSA1,641,2221
(a) "County department" means a county department under s. 46.215, 46.22,
22or 46.23.
SB55-SSA1,641,2323
(b) "Qualified entity" has the meaning given in
42 USC 1396r-1b (b) (2).
SB55-SSA1,642,3
1(2) A woman is eligible for medical assistance as provided under sub. (5) if, after
2applying to the department or a county department, the department or a county
3department determines that she meets all of the following requirements:
SB55-SSA1,642,64
(a) The woman is not eligible for medical assistance under ss. 49.46 (1) and
5(1m), 49.465, 49.468, 49.47, and 49.472, and is not eligible for health care coverage
6under s. 49.665.
SB55-SSA1,642,77
(b) The woman is under 65 years of age.
SB55-SSA1,642,98
(c) The woman is not eligible for health care coverage that qualifies as
9creditable coverage in
42 USC 300gg (c).
SB55-SSA1,642,1210
(d) The woman has been screened for breast or cervical cancer under a breast
11and cervical cancer early detection program that is authorized under a grant
12received under
42 USC 300k.
SB55-SSA1,642,1313
(e) The woman requires treatment for breast or cervical cancer.
SB55-SSA1,642,18
14(3) Prior to applying to the department or a county department for medical
15assistance, a woman is eligible for medical assistance as provided under sub. (5)
16beginning on the date on which a qualified entity determines, on the basis of
17preliminary information, that the women meets the requirements specified in sub.
18(2) and ending on one of the following dates:
SB55-SSA1,642,2219
(a) If the woman applies to the department or a county department for medical
20assistance within the time limit required under sub. (4), the day on which the
21department or county department determines whether the woman meets the
22requirements under sub. (2).
SB55-SSA1,643,223
(b) If the woman does not apply to the department or county department for
24medical assistance within the time limit required under sub. (4), the last day of the
1month following the month in which the qualified entity determines that the woman
2is eligible for medical assistance.
SB55-SSA1,643,6
3(4) A woman who a qualified entity determines under sub. (3) is eligible for
4medical assistance shall apply to the department or county department no later than
5the last day of the month following the month in which the qualified entity
6determines that the woman is eligible for medical assistance.
SB55-SSA1,643,10
7(5) The department shall audit and pay, from the appropriation accounts under
8s. 20.435 (4) (b) and (o), allowable charges to a provider who is certified under s. 49.45
9(2) (a) 11. for medical assistance on behalf of a woman who meets the requirements
10under sub. (2) for all benefits and services specified under s. 49.46 (2).
SB55-SSA1,643,12
11(6) A qualified entity that determines under sub. (3) that a woman is eligible
12for medical assistance as provided under sub. (5) shall do all of the following:
SB55-SSA1,643,1413
(a) Notify the department of the determination no later than 5 days after the
14date on which the determination is made.
SB55-SSA1,643,1815
(b) Inform the woman at the of time the determination that she is required to
16apply to the department or a county department for medical assistance no later than
17the last day of the month following the month in which the qualified entity
18determines that the woman is eligible for medical assistance.
SB55-SSA1,643,20
19(7) The department shall provide qualified entities with application forms for
20medical assistance and information on how to assist women in completing the form.
SB55-SSA1, s. 1835k
21Section 1835k. Subchapter V (title) of chapter 49 [precedes 49.66] of the
22statutes is amended to read:
SB55-SSA1,644,3
1SUBCHAPTER V
2
OTHER
MEDICALLY RELATED SERVICES
3AND SUPPORT
and medical PROGRAMS
SB55-SSA1, s. 1836
4Section
1836. 49.665 (4) (at) 1. a. of the statutes is amended to read:
SB55-SSA1,644,95
49.665
(4) (at) 1. a. Except as provided in subd. 1. b., the department shall
6establish a lower maximum income level for the initial eligibility determination if
7funding under s. 20.435 (4) (bc), (jz)
and, (p)
, and (x) is insufficient to accommodate
8the projected enrollment levels for the health care program under this section. The
9adjustment may not be greater than necessary to ensure sufficient funding.
SB55-SSA1,644,2111
49.665
(4) (at) 1. b. The department may not lower the maximum income level
12for initial eligibility unless the department first submits to the joint committee on
13finance
its plans a plan for lowering the maximum income level
and the committee
14approves the plan. If, within 14 days after
submitting the plan the date on which the
15plan is submitted to the joint committee on finance, the cochairpersons of the
16committee do not notify the secretary that the committee has scheduled a meeting
17for the purpose of reviewing the plan, the
department shall implement the plan
is
18considered approved by the committee as proposed. If within 14 days after the date
19on which the plan is submitted to the committee, the cochairpersons of the committee
20notify the secretary that the committee has scheduled a meeting to review the plan,
21the department may implement the plan only as approved by the committee.
SB55-SSA1,645,823
49.665
(4) (at) 1. c. Notwithstanding s. 20.001 (3) (b), if, after reviewing the plan
24submitted under subd. 1. b., the joint committee on finance determines that the
25amounts appropriated under s. 20.435 (4) (bc), (jz), (p), and (x) are insufficient to
1accommodate the projected enrollment levels, the committee may transfer
2appropriated moneys from the general purpose revenue appropriation account of any
3state agency, as defined in s. 20.001 (1), other than a sum sufficient appropriation
4account, to the appropriation account under s. 20.435 (4) (bc) to supplement the
5health care program under this section if the committee finds that the transfer will
6eliminate unnecessary duplication of functions, result in more efficient and effective
7methods for performing programs or more effectively carry out legislative intent, and
8that legislative intent will not be changed by the transfer.
SB55-SSA1,645,1410
49.665
(4) (at) 2. If, after the department has established a lower maximum
11income level under subd. 1., projections indicate that funding under s. 20.435 (4) (bc),
12(jz)
and, (p)
, and (x) is sufficient to raise the level, the department shall, by state plan
13amendment, raise the maximum income level for initial eligibility, but not to exceed
14185% of the poverty line.
SB55-SSA1,646,616
49.68
(3) (b)
The From the appropriation accounts under ss. 20.435 (4) (e) and
17(je), the state shall pay the cost of medical treatment required as a direct result of
18chronic renal disease of certified patients from the date of certification, including the
19cost of administering recombinant human erythropoietin to appropriate patients,
20whether the treatment is rendered in an approved facility in the state or in a dialysis
21or transplantation center which is approved as such by a contiguous state, subject
22to the conditions specified under par. (d). Approved facilities may include a hospital
23in-center dialysis unit or a nonhospital dialysis center which is closely affiliated with
24a home dialysis program supervised by an approved facility. Aid shall also be
25provided for all reasonable expenses incurred by a potential living-related donor,
1including evaluation, hospitalization, surgical costs and postoperative follow-up to
2the extent that these costs are not reimbursable under the federal medicare program
3or other insurance. In addition, all expenses incurred in the procurement,
4transportation and preservation of cadaveric donor kidneys shall be covered to the
5extent that these costs are not otherwise reimbursable. All donor-related costs are
6chargeable to the recipient and reimbursable under this subsection.
SB55-SSA1,646,98
49.683
(2) Approved costs for medical care under sub. (1) shall be paid from the
9appropriation
accounts under s. 20.435 (4) (e)
and (je).
SB55-SSA1,646,1611
49.685
(2) Assistance program. The From the appropriation accounts under
12s. 20.435 (4) (e) and (je), the department shall establish a program of financial
13assistance to persons suffering from hemophilia and other related congenital
14bleeding disorders. The program shall assist such persons to purchase the blood
15derivatives and supplies necessary for home care. The program shall be
16administered through the comprehensive hemophilia treatment centers.
SB55-SSA1,646,19
1849.687 (title)
Disease aids; patient financial and liability requirements;
19rebate agreements.
SB55-SSA1,647,321
49.687
(2) The department shall develop and implement a sliding scale of
22patient liability for kidney disease aid under s. 49.68, cystic fibrosis aid under s.
2349.683 and hemophilia treatment under s. 49.685, based on the patient's ability to
24pay for treatment. To ensure that the needs for treatment of patients with lower
25incomes receive priority within the availability of funds under s. 20.435 (4) (e)
and
1(je), the department shall revise the sliding scale for patient liability by January 1,
21994, and shall, every 3 years thereafter by January 1, review and, if necessary,
3revise the sliding scale.
SB55-SSA1,647,105
49.687
(3) The department or an entity with which the department contracts
6shall provide to a drug manufacturer that sells drugs for prescribed use in this state
7documents designed for use by the manufacturer in entering into a rebate agreement
8with the department or entity that is modeled on the rebate agreement specified
9under
42 USC 1396r-8. The department or entity may enter into a rebate agreement
10under this subsection that shall include all of the following as requirements:
SB55-SSA1,647,1611
(a) That, as a condition of coverage for prescription drugs of a manufacturer
12under s. 49.68, 49.683, or 49.685, the manufacturer shall make rebate payments for
13each prescription drug of the manufacturer that is prescribed for and purchased by
14persons who meet eligibility criteria under s. 49.68, 49.683, or 49.685, to the state
15treasurer to be credited to the appropriation under s. 20.435 (4) (je), each calendar
16quarter or according to a schedule established by the department.
SB55-SSA1,647,2217
(b) That the amount of the rebate payment shall be determined by a method
18specified in
42 USC 1396r-8 (c), except that, if the average manufacturer price for
19a prescription drug exceeds the average manufacturer price of the drug as of
20December 31, 2000, or the first calendar quarter after the day on which the drug was
21first available, as adjusted for inflation, the rebate amount shall increase by the
22amount of the difference.
SB55-SSA1,648,3
149.79
(2) (b) An individual who fails to comply with the work requirements of
2the employment and training program under s. 49.13 (2) (a) is ineligible to
3participate in the food stamp program as specified under s. 49.13 (3).
SB55-SSA1,648,95
49.79
(9) Fraud investigations and error reduction activities. If the
6department does not contract with the department of workforce development under
7s. 49.197 (5), the department shall establish and administer a program to investigate
8fraudulent activity on the part of recipients of food stamps and to reduce errors in
9the payments of benefits under the food stamp program.
SB55-SSA1,648,1311
49.79
(10) Contract for employment and training program. The department
12shall contract with the department of workforce development to administer the
13employment and training program under s. 49.13.
SB55-SSA1,648,2415
49.85
(1) County department
Department notification requirement. If a
16county department under s. 46.215, 46.22
, or 46.23
, or a governing body of a federally
17recognized American Indian tribe or band
or a Wisconsin works agency determines
18that the department of health and family services may recover an amount under s.
1949.497 or that the department of workforce development may recover an amount
20under s. 49.125, 49.161
, or 49.195 (3), the county department or governing body shall
21notify the affected department of the determination.
If a Wisconsin works agency
22determines that the department of workforce development may recover an amount
23under s. 49.161 or 49.195 (3), the Wisconsin works agency shall notify the
24department of workforce development of the determination.
SB55-SSA1, s. 1838v
1Section 1838v. 49.85 (1) of the statutes, as affected by 2001 Wisconsin Act ....
2(this act), is amended to read:
SB55-SSA1,649,123
49.85
(1) Department notification requirement. If a county department
4under s. 46.215, 46.22, or 46.23 or a governing body of a federally recognized
5American Indian tribe or band determines that the department of health and family
6services may recover an amount under s. 49.497 or that the department of workforce
7development may recover an amount under s.
49.125, 49.161,
or 49.195 (3)
, or 49.793,
8the county department or governing body shall notify the affected department of the
9determination.
If a Wisconsin works agency determines that the department of
10workforce development may recover an amount under s. 49.161 or 49.195 (3), the
11Wisconsin works agency shall notify the department of workforce development of the
12determination.
SB55-SSA1,649,2114
49.85
(2) (b) At least annually, the department of workforce development shall
15certify to the department of revenue the amounts that, based on the notifications
16received under sub. (1) and on other information received by the department of
17workforce development, the department of workforce development has determined
18that it may recover under ss.
49.125, 49.161
and, 49.195 (3)
, and 49.793, except that
19the department of workforce development may not certify an amount under this
20subsection unless it has met the notice requirements under sub. (3) and unless its
21determination has either not been appealed or is no longer under appeal.
SB55-SSA1,650,223
49.85
(3) (b) 1. Inform the person that the department of workforce
24development intends to certify to the department of revenue an amount that the
25department of workforce development has determined to be due under s.
49.125,
149.161
or, 49.195 (3)
, or 49.793, for setoff from any state tax refund that may be due
2the person.
SB55-SSA1,650,154
49.853
(2) Financial record matching program and agreements. The
5department shall operate a financial record matching program under this section.
6The department shall promulgate rules specifying procedures under which the
7department shall enter into agreements with financial institutions doing business
8in this state to operate the financial record matching program under this section.
9The agreement shall require the financial institution to participate in the financial
10record matching program under this section by electing either the financial
11institution matching option under sub. (3) or the state matching option under sub.
12(4). The
rules promulgated under this section shall provide for reimbursement of 13financial institutions in an amount not to exceed their actual costs of participation 14department shall reimburse a financial institution up to $125 per quarter for
15participating in the financial record matching program under this section.
SB55-SSA1,650,2517
49.855
(1) If a person obligated to
provide pay child support, family support
or
, 18maintenance
, or the receiving and disbursing fee under s. 767.29 (1) (d) is delinquent
19in making
court-ordered any of those payments, or owes an outstanding amount that
20has been ordered by the court for past support, medical expenses
, or birth expenses,
21upon application under s. 59.53 (5) the department of workforce development shall
22certify the delinquent payment or outstanding amount to the department of revenue
23and, at least annually, shall provide to the department of revenue any certifications
24of delinquencies or outstanding amounts that it receives from another state because
25the obligor resides in this state.
SB55-SSA1,651,232
49.855
(3) Receipt of a certification by the department of revenue shall
3constitute a lien, equal to the amount certified, on any state tax refunds or credits
4owed to the obligor. The lien shall be foreclosed by the department of revenue as a
5setoff under s. 71.93 (3), (6)
, and (7). When the department of revenue determines
6that the obligor is otherwise entitled to a state tax refund or credit, it shall notify the
7obligor that the state intends to reduce any state tax refund or credit due the obligor
8by the amount the obligor is delinquent under the support
or, maintenance
, or
9receiving and disbursing fee order
or obligation, by the outstanding amount for past
10support, medical expenses
, or birth expenses under the court order
, or by the amount
11due under s. 46.10 (4) or 301.12 (4). The notice shall provide that within 20 days the
12obligor may request a hearing before the circuit court rendering the order
under
13which the obligation arose. Within 10 days after receiving a request for hearing
14under this subsection, the court shall set the matter for hearing. Pending further
15order by the court or family court commissioner, the department of workforce
16development or its designee, whichever is appropriate, is prohibited from disbursing
17the obligor's state tax refund or credit. The family court commissioner may conduct
18the hearing. The sole issues at that hearing shall be whether the obligor owes the
19amount certified and, if not and it is a support or maintenance order, whether the
20money withheld from a tax refund or credit shall be paid to the obligor or held for
21future support or maintenance.
An obligor may, within 20 days of receiving notice
22that the amount certified shall be withheld from his or her federal tax refund or
23credit, request a hearing under this subsection.
SB55-SSA1, s. 1844b
24Section 1844b. 49.855 (4) of the statutes is renumbered 49.855 (4) (a) and
25amended to read:
SB55-SSA1,652,12
149.855
(4) (a) The department of revenue shall send
that the portion of any
2state
or federal tax refunds or credits withheld for delinquent child
or family support
3or maintenance or past support, medical expenses
, or birth expenses to the
4department of workforce development or its designee for
distribution to the obligee 5deposit in the support collections trust fund under s. 25.68 and shall send the portion
6of any state tax refunds or credits withheld for delinquent receiving and disbursing
7fees to the department of workforce development or its designee for deposit in the
8appropriation account under s. 20.445 (3) (ja). The department of workforce
9development shall make a settlement at least annually with the department of
10revenue. The settlement shall state the amounts certified, the amounts deducted
11from tax refunds and credits
, and the administrative costs incurred by the
12department of revenue.
SB55-SSA1,652,2214
49.855
(4) (b) The department of administration shall send the portion of any
15federal tax refunds or credits received from the internal revenue service that was
16withheld for delinquent child or family support or maintenance or past support,
17medical expenses, or birth expenses to the department of workforce development or
18its designee for deposit in the support collections trust fund under s. 25.68 and shall
19send the portion of any federal tax refunds or credits received from the internal
20revenue service that was withheld for delinquent receiving and disbursing fees to the
21department of workforce development or its designee for deposit in the appropriation
22account under s. 20.445 (3) (ja).
SB55-SSA1,653,2324
49.855
(4m) (b) The department of revenue may provide a certification that it
25receives under sub. (1), (2m)
, or (2p) to the department of administration. Upon
1receipt of the certification, the department of administration shall determine
2whether the obligor is a vendor or is receiving any other payments from this state,
3except for wages, retirement benefits
, or assistance under s. 45.352, 1971 stats., s.
445.351 (1), this chapter
, or ch. 46, 108
, or 301. If the department of administration
5determines that the obligor is a vendor or is receiving payments from this state,
6except for wages, retirement benefits
, or assistance under s. 45.352, 1971 stats., s.
745.351 (1), this chapter
, or ch. 46, 108
, or 301, it shall begin to withhold the amount
8certified from those payments and shall notify the obligor that the state intends to
9reduce any payments due the obligor by the amount the obligor is delinquent under
10the support
or, maintenance
, or receiving and disbursing fee order
or obligation, by
11the outstanding amount for past support, medical expenses
, or birth expenses under
12the court order
, or by the amount due under s. 46.10 (4) or 301.12 (4). The notice shall
13provide that within 20 days after receipt of the notice the obligor may request a
14hearing before the circuit court rendering the order
under which the obligation arose.
15An obligor may, within 20 days after receiving notice, request a hearing under this
16paragraph. Within 10 days after receiving a request for hearing under this
17paragraph, the court shall set the matter for hearing. The family court commissioner
18may conduct the hearing. Pending further order by the court or family court
19commissioner, the department of workforce development or its designee, whichever
20is appropriate, may not disburse the payments withheld from the obligor. The sole
21issues at the hearing are whether the obligor owes the amount certified and, if not
22and it is a support or maintenance order, whether the money withheld shall be paid
23to the obligor or held for future support or maintenance.