Amendment CA1-SSA1-SB55

SB55-SSA1-CA1,304,6 957. Page 627, line 2: after that line insert:

SB55-SSA1-CA1,304,7 " Section 1778d. 49.45 (6v) (b) of the statutes is amended to read:

SB55-SSA1-CA1,304,15 49.45 (6v) (b) The Beginning on October 1, 2003, and annually thereafter, the department shall, each year, submit to the joint committee on finance a report for the previous fiscal year, except for the 1997-98 fiscal year, that provides information on the utilization of beds by recipients of medical assistance in facilities and a discussion and detailed projection of the likely balances, expenditures, encumbrances and carry over of currently appropriated amounts in the appropriation accounts under s. 20.435 (4) (b) and (o) for the immediately prior 2 consecutive fiscal years.

SB55-SSA1-CA1, s. 1778h Section 1778h. 49.45 (6v) (c) of the statutes is amended to read:

SB55-SSA1-CA1,305,12 49.45 (6v) (c) If the report specified in par. (b) indicates that utilization of beds by recipients of medical assistance in facilities is less than estimates for that utilization reflected in the intentions of the joint committee on finance, legislature and governor, as expressed by them in the budget determinations, the department shall include a proposal to transfer moneys from the appropriation under s. 20.435 (4) (b) to the appropriation under s. 20.435 (7) (bd) for the purpose of increasing funding for the community options program under s. 46.27. The amount proposed for transfer may not reduce the balance in the appropriation account under s. 20.435 (4) (b) below an amount necessary to ensure that that appropriation account will end the current fiscal year or the current fiscal biennium with a positive balance. The secretary shall transfer the amount identified under the proposal decreased during the most recently completed fiscal year from the utilization of beds by recipients of medical assistance in facilities in the next most recently completed fiscal year, the department shall multiply the difference between the number of days of care provided to the recipients in the facilities in each of those prior 2 consecutive fiscal years by the average daily costs of care in the facilities for the most recently completed fiscal year. The average daily costs of care shall be calculated by dividing the total of medical assistance expenditures for care in facilities for the most recently completed fiscal year by the total number of days of care provided in facilities in that fiscal year.

SB55-SSA1-CA1, s. 1778p Section 1778p. 49.45 (6v) (d) of the statutes is created to read:

SB55-SSA1-CA1,306,4 49.45 (6v) (d) If par. (c) applies and if the amount calculated under par. (c) is positive, the department's report under par. (b) shall include a proposal to transfer an amount equal to the portion of the amount calculated under par. (c) that is the state share of medical assistance expenditures from the appropriation account under s. 20.435 (4) (b) to the appropriation account under s. 20.435 (7) (bd) for the purpose of increasing funding for the long-term support community options program under s. 46.27. If the cochairpersons of the joint committee on finance do not notify the secretary within 14 working days after the date on which the department submits the proposal that the committee has scheduled a meeting for the purpose of reviewing the proposal, the secretary shall transfer the amount identified under the proposal. If, within 14 working days after the date on which the department submits the proposal, the cochairpersons of the joint committee on finance notify the secretary that the committee has scheduled a meeting for the purpose of reviewing the proposal, the secretary may transfer moneys from the appropriation account under s. 20.435 (4) (b) to the appropriation account under s. 20.435 (7) (bd) only as approved by the committee.

SB55-SSA1-CA1, s. 1778r Section 1778r. 49.45 (6v) (e) of the statutes is created to read:

SB55-SSA1-CA1,306,8 49.45 (6v) (e) Of the amount required to be transferred by the secretary under par. (d), 40% shall be expended for services as specified under s. 46.27 (7) and 60% shall be expended for services as specified under s. 46.27 (11).".

SB55-SSA1-CA1,306,9 958. Page 628, line 21: after that line insert:

SB55-SSA1-CA1,306,10 " Section 1786g. 49.45 (21) (title) of the statutes is amended to read:

SB55-SSA1-CA1,306,12 49.45 (21) (title) Transfer of business, liability for Taking over provider's operation; repayments required.

SB55-SSA1-CA1, s. 1786h Section 1786h. 49.45 (21) (a) of the statutes is renumbered 49.45 (21) (ar) and amended to read:

SB55-SSA1-CA1,306,23 49.45 (21) (ar) If any provider Before a person may take over the operation of a provider that is liable for repayment of improper or erroneous payments or overpayments under ss. 49.43 to 49.497 sells or otherwise transfers ownership of his or her business or all or substantially all of the assets of the business, the transferor and transferee are each liable for the repayment. Prior to final transfer, the transferee is responsible for contacting the department and ascertaining if the transferor, full repayment shall be made. Upon request, the department shall notify the provider or the person that intends to take over the operation of the provider as to whether the provider is liable under this paragraph.

SB55-SSA1-CA1, s. 1786i Section 1786i. 49.45 (21) (ag) of the statutes is created to read:

SB55-SSA1-CA1,307,3 49.45 (21) (ag) In this subsection, "take over the operation" means obtain, with respect to an aspect of a provider's business for which the provider has filed claims for medical assistance reimbursement, any of the following:

SB55-SSA1-CA1,307,5 1. Ownership of the provider's business or all or substantially all of the assets of the business.

SB55-SSA1-CA1,307,6 2. Majority control over decisions.

SB55-SSA1-CA1,307,7 3. The right to any profits or income.

SB55-SSA1-CA1,307,9 4. The right to contact and offer services to patients, clients, or residents served by the provider.

SB55-SSA1-CA1,307,12 5. An agreement that the provider will not compete with the person at all or with respect to a patient, client, resident, service, geographical area, or other part of the provider's business.

SB55-SSA1-CA1,307,14 6. The right to perform services that are substantially similar to services performed by the provider at the same location as those performed by the provider.

SB55-SSA1-CA1,307,16 7. The right to use any distinctive name or symbol by which the provider is known in connection with services to be provided by the person.

SB55-SSA1-CA1, s. 1786j Section 1786j. 49.45 (21) (b) of the statutes is amended to read:

SB55-SSA1-CA1,308,2 49.45 (21) (b) If a transfer occurs If, notwithstanding the prohibition under par. (ar), a person takes over the operation of a provider and the applicable amount under par. (a) (ar) has not been repaid, the department may, in addition to withholding certification as authorized under sub. (2) (b) 8., proceed against either the transferor or the transferee the provider or the person. Within 30 days after receiving the certified provider receives notice from the department, the transferor or the transferee shall pay the amount shall be repaid in full. Upon failure to comply If the amount is not repaid in full, the department may bring an action to compel payment. If a transferor fails to pay within 90 days after receiving notice from the department, the department, may proceed under sub. (2) (a) 12. , or may do both.

SB55-SSA1-CA1, s. 1786k Section 1786k. 49.45 (21) (e) of the statutes is created to read:

SB55-SSA1-CA1,308,5 49.45 (21) (e) The department shall promulgate rules to implement this subsection.".

SB55-SSA1-CA1,308,6 959. Page 630, line 7: after that line insert:

SB55-SSA1-CA1,308,7 " Section 1789b. 49.45 (39) (a) 1. of the statutes is amended to read:

SB55-SSA1-CA1,308,12 49.45 (39) (a) 1. "School" means a public school described under s. 115.01 (1), a charter school, as defined in s. 115.001 (1), the Wisconsin Center for the Blind and Visually Impaired, or the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing. It includes school-operated early childhood programs for developmentally delayed and disabled 4-year-old and 5-year-old children.

SB55-SSA1-CA1, s. 1789c Section 1789c. 49.45 (39) (am) of the statutes is amended to read:

SB55-SSA1-CA1,309,2 49.45 (39) (am) Plan amendment. No later than September 30, 1995, the department shall submit to the federal department of health and human services an amendment to the state medical assistance plan to permit the application of pars. (b) and (c). If the amendment to the state plan is approved, school districts, cooperative educational service agencies, and the department of public instruction on behalf of the Wisconsin Center for the Blind and Visually Impaired and the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing claim reimbursement under pars. (b) and (c). Paragraphs (b) and (c) do not apply unless the amendment to the state plan is approved and in effect. The department shall submit to the federal department of health and human services an amendment to the state plan if necessary to permit the application of pars. (b) and (c) to the Wisconsin Center for the Blind and Visually Impaired and the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing.

SB55-SSA1-CA1, s. 1789d Section 1789d. 49.45 (39) (b) of the statutes is amended to read:

SB55-SSA1-CA1,310,12 49.45 (39) (b) School medical services. 1. `Payment for school medical services.' If a school district or a cooperative educational service agency elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the school district or the cooperative educational service agency for 60% of the federal share of allowable charges for the school medical services that it provides and, as specified in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the department of public instruction for 60% of the federal share of allowable charges for the school medical services that the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing provides and, as specified in subd. 2., for allowable administrative costs. A school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, claims for common carrier transportation costs as a school medical service unless the department receives notice from the federal health care financing administration that, under a change in federal policy, the claims are not allowed. If the department receives the notice, a school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired, or the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, unreimbursed claims for common carrier transportation costs incurred before the date of the change in federal policy. The department shall promulgate rules establishing a methodology for making reimbursements under this paragraph. All other expenses for the school medical services provided by a school district or a cooperative educational service agency shall be paid for by the school district or the cooperative educational service agency with funds received from state or local taxes. The school district, the Wisconsin Center for the Blind and Visually Impaired, the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing, or the cooperative educational service agency shall comply with all requirements of the federal department of health and human services for receiving federal financial participation.

SB55-SSA1-CA1,310,22 2. `Payment for school medical services administrative costs.' The department shall reimburse a school district or a cooperative educational service agency specified under subd. 1. and shall reimburse the department of public instruction on behalf of the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin School Educational Services Program for the Deaf and Hard of Hearing for 90% of the federal share of allowable administrative costs, using time studies, beginning in fiscal year 1999-2000. A school district or a cooperative education educational service agency may submit, and the department of health and family services shall allow, claims for administrative costs incurred during the period that is up to 24 months before the date of the claim, if allowable under federal law.".

SB55-SSA1-CA1,310,23 960. Page 630, line 14: after that line insert:

SB55-SSA1-CA1,310,24 " Section 1791h. 49.45 (47) (c) of the statutes is amended to read:

SB55-SSA1-CA1,311,5 49.45 (47) (c) The biennial fee for the certification required under par. (b) of an adult day care center is $89, plus a biennial fee of $17.80 per client, based on the number of clients that the adult day care center is certified to serve $100. Fees collected under this paragraph shall be credited to the appropriation account under s. 20.435 (6) (jm).

SB55-SSA1-CA1, s. 1791i Section 1791i. 49.45 (47) (d) of the statutes is repealed.".

SB55-SSA1-CA1,311,7 961. Page 632, line 4: after that line insert:

SB55-SSA1-CA1,311,8 " Section 1799f. 49.46 (1) (a) 5m. of the statutes is created to read:

SB55-SSA1-CA1,311,11 49.46 (1) (a) 5m. Any individual who is at least 19 years of age but under 20 years of age and who, on his or her 18th birthday, was in foster care, or treatment foster care placement under ch. 48 or 938, as determined by the department.".

SB55-SSA1-CA1,311,12 962. Page 646, line 22: after that line insert:

SB55-SSA1-CA1,311,13 " Section 1838gb. 49.688 of the statutes is created to read:

SB55-SSA1-CA1,311,15 49.688 Prescription drug assistance for elderly persons. (1) In this section:

SB55-SSA1-CA1,311,16 (a) "Generic name" has the meaning given in s. 450.12 (1) (b).

SB55-SSA1-CA1,311,18 (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-SSA1-CA1,311,22 (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 drug manufacturer that enters into a rebate agreement in force under sub. (6).

SB55-SSA1-CA1,311,23 (d) "Prescription order" has the meaning given in s. 450.01 (21).

SB55-SSA1-CA1,312,4 (e) "Program payment rate" means the rate of payment made for the identical drug specified under s. 49.46 (2) (b) 6. h., plus 5%, 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-SSA1-CA1,312,6 (2) (a) A person to whom all of the following applies is eligible to purchase a prescription drug for the amounts specified in sub. (5) (a) 1. and 2.:

SB55-SSA1-CA1,312,7 1. The person is a resident, as defined in s. 27.01 (10) (a), of this state.

SB55-SSA1-CA1,312,8 2. The person is at least 65 years of age.

SB55-SSA1-CA1,312,9 3. The person is not a recipient of medical assistance.

SB55-SSA1-CA1,312,12 4. The person's annual household income, as determined by the department, does not exceed 240% of the federal poverty line for a family the size of the person's eligible family.

SB55-SSA1-CA1,312,13 5. The person pays the program enrollment fee specified in sub. (3) (a).

SB55-SSA1-CA1,312,20 (b) A person to whom par. (a) 1. to 3. and 5. applies, but whose annual household income, as determined by the department, exceeds 240% of the federal poverty line for a family the size of the persons' eligible family, is eligible to purchase a prescription drug at the amounts specified in sub. (5) (a) 4. only during the remaining amount of any 12-month period in which the person has first paid the annual deductible specified in sub. (3) (b) 2. a. in purchasing prescription drugs at the retail price and has then paid the annual deductible specified in sub. (3) (b) 2. b.

SB55-SSA1-CA1,312,21 (3) Program participants shall pay all of the following:

SB55-SSA1-CA1,312,22 (a) For each 12-month benefit period, a program enrollment fee of $20.

SB55-SSA1-CA1,313,2 (b) 1. For each 12-month benefit period, for a person specified in sub. (2) (a), a deductible for prescription drugs of $500, except that a person whose annual household income, as determined by the department, is 160% or less of the federal poverty line for a family the size of the person's eligible family pays no deductible.

SB55-SSA1-CA1,313,4 2. For each 12-month benefit period, for a person specified in sub. (2) (b), a deductible for prescription drugs that equals all of the following:

SB55-SSA1-CA1,313,6 a. The difference between the person's annual household income and 240% of the federal poverty line for a family the size of the person's eligible family.

SB55-SSA1-CA1,313,7 b. Five hundred dollars.

SB55-SSA1-CA1,313,9 (c) After payment of any applicable deductible under par. (b), all of the following:

SB55-SSA1-CA1,313,10 1. A copayment of $5 for each prescription drug that bears only a generic name.

SB55-SSA1-CA1,313,12 2. A copayment of $15 for each prescription drug that does not bear only a generic name.

SB55-SSA1-CA1,313,16 (d) 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 persons that are not covered under the person's other available coverage.

SB55-SSA1-CA1,313,22 (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 household income under sub. (2) (a) 4. and (b) and (3) (b) 1.

SB55-SSA1-CA1,314,3 (5) (a) Beginning on September 1, 2002, except as provided in sub. (7) (b), 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 following:

SB55-SSA1-CA1,314,5 1. For a deductible, as specified in sub. (3) (b) 1. and 2. b., the program payment rate.

SB55-SSA1-CA1,314,8 2. After any applicable deductible under subd. 1. is charged, the copayment, as applicable, that is specified in sub. (3) (c) 1. or 2. No dispensing fee may be charged to a person under this subdivision.

SB55-SSA1-CA1,314,9 3. For a deductible, as specified in sub. (3) (b) 2. a., the retail price.

SB55-SSA1-CA1,314,12 4. After the deductible under subd. 3. is charged, the copayment, as applicable, that is specified in sub. (3) (c) 1. or 2. No dispensing fee may be charged to a person under this subdivision.

SB55-SSA1-CA1,314,16 (b) 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-SSA1-CA1,314,22 (6) The department, or an entity with which the department contracts, shall provide to a drug manufacturer that sells drugs for prescribed use in this state documents designed for use by the manufacturer in entering into a rebate agreement with the department or entity that is modeled on the rebate agreement specified under 42 USC 1396r-8. A rebate agreement under this subsection shall include all of the following as requirements:

SB55-SSA1-CA1,315,3 (a) That, except as provided in sub. (7) (b), the manufacturer shall make rebate payments for each prescription drug of the manufacturer that is prescribed for and purchased by persons who meet criteria under sub. (2) (a) and persons who meet criteria under sub. (2) (b) and have paid the deductible under sub. (3) (b) 2. a., to the state treasurer to be credited to the appropriation account under s. 20.435 (4) (j), each calendar quarter or according to a schedule established by the department.

SB55-SSA1-CA1,315,5 (b) That, except as provided in sub. (7) (b), the amount of the rebate payment shall be determined by a method specified in 42 USC 1396r-8 (c).

SB55-SSA1-CA1,315,22 (7) (a) Except as provided in par. (b), from the appropriation accounts under s. 20.435 (4) (bv) and (j), beginning on September 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) (b) 1. or 2. or who, under sub. (3) (b) 1., are not required to pay a deductible. The payment for each prescription drug under this paragraph shall be at the program payment rate, minus any copayment paid by the person under sub. (5) (a) 2. or 4., and plus, if applicable, incentive payments that are similar to those provided under s. 49.45 (8v). The department shall devise and distribute a claim form for use by pharmacies and pharmacists under this paragraph and may limit payment under this paragraph to those prescription drugs for which payment claims are submitted by pharmacists or pharmacies 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 of ch. 49.

SB55-SSA1-CA1,316,4 (b) During any period in which funding under s. 20.435 (4) (bv) is completely expended for the payments specified in par. (a), the requirements of par. (a) and subs. (3) (c), (5), and (6) (a) and (b) do not apply to drugs purchased during that period, but the department shall continue to accept applications and determine eligibility under sub. (4) and shall indicate to applicants that the eligibility of program participants to purchase prescription drugs as specified in sub. (3), under the requirements of sub. (5), is conditioned on the availability of funding under s. 20.435 (4) (bv).

SB55-SSA1-CA1,316,11 (8) 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-SSA1-CA1,316,13 (9) (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-SSA1-CA1,316,17 (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-SSA1-CA1,316,20 (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-SSA1-CA1,317,2 (10) 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-SSA1-CA1,317,12 (11) The department shall request from the federal secretary of health and human services a waiver, under 42 USC 1315 (a), of federal medicaid laws necessary to permit the department of health and family services to conduct a project, under all of the requirements of this section, to expand eligibility for medical assistance, for purposes of receipt of prescription drugs as a benefit, to include individuals who are eligible under sub. (2). The department may implement a waiver requested under this subsection only if the conditions of the waiver are consistent with the requirements of this section. The department shall implement the program under this section regardless of whether a waiver, as specified in this subsection, is received.

SB55-SSA1-CA1,317,16 (12) Except as provided in subs. (8) to (11) 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-SSA1-CA1,317,17 963. Page 648, line 12: after that line insert:

SB55-SSA1-CA1,317,18 " Section 1838w. 49.85 (2) (a) of the statutes is amended to read:

SB55-SSA1-CA1,318,2 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.".