Amendment CA1-SSA1-SB55

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.".

SB55-SSA1-CA1,318,3 964. Page 648, line 21: after that line insert:

SB55-SSA1-CA1,318,4 " Section 1840e. 49.85 (3) (a) 1. of the statutes is amended to read:

SB55-SSA1-CA1,318,8 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-SSA1-CA1,318,9 965. Page 653, line 10: after that line insert:

SB55-SSA1-CA1,318,10 " Section 1877g. 50.01 (1) (b) of the statutes is amended to read:

SB55-SSA1-CA1,318,15 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) (d).

SB55-SSA1-CA1, s. 1877h Section 1877h. 50.01 (1g) (h) of the statutes is created to read:

SB55-SSA1-CA1,318,17 50.01 (1g) (h) A respite facility, as defined in s. 50.85 (1) (d).

SB55-SSA1-CA1, s. 1877i Section 1877i. 50.01 (3) (f) of the statutes is created to read:

SB55-SSA1-CA1,318,19 50.01 (3) (f) A respite facility, as defined in s. 50.85 (1) (d).".

SB55-SSA1-CA1,318,20 966. Page 653, line 10: after that line insert:

SB55-SSA1-CA1,318,21 " Section 1877p. 50.03 (13) (a) of the statutes is amended to read:

SB55-SSA1-CA1,319,10 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-SSA1-CA1,319,11 967. Page 654, line 6: after that line insert:

SB55-SSA1-CA1,319,12 " Section 1894r. 50.065 (1) (c) (intro.) of the statutes is amended to read:

SB55-SSA1-CA1,319,18 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-SSA1-CA1, s. 1897g Section 1897g. 50.50 (3) (a) 7. of the statutes is created to read:

SB55-SSA1-CA1,319,20 50.50 (3) (a) 7. A respite facility.

SB55-SSA1-CA1, s. 1900b Section 1900b. Subchapter IV (title) of chapter 50 [precedes 50.85] of the statutes is amended to read:

SB55-SSA1-CA1,319,23 CHAPTER 50

SB55-SSA1-CA1,319,24 SUBCHAPTER IV

SB55-SSA1-CA1,320,1 respite facilities and HOSPICES

SB55-SSA1-CA1, s. 1900c Section 1900c. 50.85 of the statutes is created to read:

SB55-SSA1-CA1,320,4 50.85 Respite facilities for persons with like or similar disabilities. (1) Definitions. In this section:

SB55-SSA1-CA1,320,5 (a) "Disability" has the meaning given in rules promulgated under sub. (8) (e).

SB55-SSA1-CA1,320,7 (b) "Like or similar disabilities" has the meaning given in rules promulgated under sub. (8) (f).

SB55-SSA1-CA1,320,9 (c) "Respite care" means care provided to a person with a disability in order to provide temporary relief to the primary caregiver.

SB55-SSA1-CA1,320,13 (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-SSA1-CA1,320,16 (2) Departmental powers and duties. The department shall provide uniform, statewide licensure, inspection, and regulation of respite facilities as specified in this section.

SB55-SSA1-CA1,320,19 (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-SSA1-CA1,320,22 (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-SSA1-CA1,321,2 (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-SSA1-CA1,321,10 (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-SSA1-CA1,321,15 (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-SSA1-CA1,321,16 (5) Licensing procedure. (a) The application for a license shall:

SB55-SSA1-CA1,321,17 1. Be in writing on a form provided by the department.

SB55-SSA1-CA1,321,18 2. Contain such information as the department requires.

SB55-SSA1-CA1,321,19 3. Include licensing fee payment, as specified in sub. (6).

SB55-SSA1-CA1,321,20 (b) 1. A respite facility license is valid until suspended or revoked.

SB55-SSA1-CA1,321,22 2. Each license shall be issued only for the applicant named in the application and may not be transferred or assigned.