Amendment SA2-SSA1-SB55

SB55-SSA1-SA2,217,9 2. "Nursing facility" means a nursing home, as defined in s. 50.01 (3), or a community-based residential facility that is licensed under s. 50.03 and that is certified by the department of health and family services to provide medical assistance services equivalent to those provided by a nursing home.

SB55-SSA1-SA2,217,17 (b) No nursing facility that has received money that is appropriated under s. 20.435 (4) (b), (o), or (w) may use any of that money to influence the decision of any individual to support or oppose a labor organization that represents or seeks to represent the individual or to become a member of a labor organization. This paragraph does not prohibit a person, if otherwise permitted by law, to negotiate or administer a collective bargaining agreement or to perform any action that is required by law or the terms of a collective bargaining agreement. This paragraph does not apply to any money received before January 1, 2002.

SB55-SSA1-SA2,217,23 (c) 1. The department shall accept complaints from any individual who alleges that a nursing facility is violating par. (b). The department shall notify the nursing facility that is the subject of the complaint within 7 days after receiving it and shall direct the nursing facility to provide the department, within 10 days after the department notifies it of the complaint, records showing that it did not violate par. (b).

SB55-SSA1-SA2,217,25 2. Notwithstanding subd. 1., the department may not require a nursing facility to maintain records relating to this subsection in any particular form.

SB55-SSA1-SA2,218,8 (d) The attorney general may bring an action to enforce par. (b). If the court determines that a nursing facility has violated par. (b), the court shall order the nursing facility to repay to the state an amount equal to the amount that the nursing facility received under s. 20.435 (4) (b), (o), or (w) and spent in connection with the nursing facility's violation. The nursing facility shall also forfeit an amount equal to twice the total amount that the nursing facility spent in connection with the nursing facility's violation. The court may also order injunctive relief and any other equitable relief that is appropriate.

SB55-SSA1-SA2,218,10 (e) 1. Any person other than the attorney general may bring an action to enforce par. (b), but only if all of the following apply:

SB55-SSA1-SA2,218,12 a. The person filed with the department a written complaint under par. (c) alleging a violation of par. (b).

SB55-SSA1-SA2,218,16 b. No earlier than 20 days after filing the complaint under par. (c) the person filed with the attorney general a copy of that complaint, a written description of the disposition of the complaint, and a written notice that the person intended to bring an enforcement action under this paragraph.

SB55-SSA1-SA2,218,17 c. At least 60 days have elapsed since the person complied with subd. 1. b.

SB55-SSA1-SA2,218,20 d. The attorney general did not bring an action to enforce par. (b) against the subject of the complaint filed under subd. 1. a. before the expiration of the time period specified in subd. 1. c.

SB55-SSA1-SA2,218,22 e. The complaint that the person files in his or her action is substantially based on the complaint that the person filed under subd. 1. a.

SB55-SSA1-SA2,219,2 2. If, in an action brought under this paragraph, the court determines that a nursing facility violated par. (b), the court shall impose any penalty that would have been required and may order any relief that would have been permitted if the action had been brought under par. (d). Any forfeiture ordered under this subdivision shall be paid to the state.

SB55-SSA1-SA2,219,4 (f) Notwithstanding s. 803.09 (1), any person may intervene in an action brought under par. (d) or (e).

SB55-SSA1-SA2,219,12 (g) If the court determines that a nursing facility violated par. (b) in a case brought under par. (d) or (e), the court shall order the nursing facility to pay the plaintiff's reasonable litigation costs, including a reasonable attorney fee, notwithstanding s. 814.04 (1). If a person has intervened in a case under par. (f), the court shall order the nursing facility or to pay the intervenor's reasonable litigation costs, including a reasonable attorney fee, notwithstanding s. 814.04 (1), if the court determines that the intervenor made a substantial contribution to the plaintiffs in prosecuting the action.

SB55-SSA1-SA2,219,23 (h) 1. If an operator or owner of a nursing facility discharges, demotes, threatens, or otherwise discriminates against an individual regarding compensation or terms, conditions, or privileges of employment because the individual or anyone acting at the request of the individual provided or attempted to provide information to the department or the attorney general regarding possible violations of par. (b), the individual may bring a civil action for any damages resulting from that discharge, demotion, threat, or discrimination. The action shall be commenced within 3 years after the discharge, demotion, threat, or discrimination or be barred. If the plaintiff proves by a preponderance of the evidence that the discharge, demotion, threat, or discrimination occurred, the court may grant any appropriate relief, including the following:

SB55-SSA1-SA2,219,24 a. Reinstatement of the individual to his or her former position.

SB55-SSA1-SA2,219,25 b. Compensatory damages.

SB55-SSA1-SA2,220,1 c. Costs, and not withstanding s. 814.04 (1), reasonable attorney fees.

SB55-SSA1-SA2,220,2 d. Other relief to remedy past discrimination.

SB55-SSA1-SA2,220,4 (2) An individual may not bring an action under subd. 1. if he or she did any of the following:

SB55-SSA1-SA2,220,5 a. Deliberately caused or participated in the violation of par. (b).

SB55-SSA1-SA2,220,7 b. Knowingly or recklessly provided substantially false information to the department regarding a violation of par. (b).

SB55-SSA1-SA2,220,10 (i) Any individual who knowingly authorizes the use of money received under s. 20.435 (4) (b), (o), or (w) in conjunction with a violation of par. (b) shall forfeit all of the following:

SB55-SSA1-SA2,220,11 1. $1,000 for each violation.

SB55-SSA1-SA2,220,13 2. The amount of money that the person authorized to be used under sub. (1) (intro.).".

SB55-SSA1-SA2,220,14 859. Page 627, line 2: after that line insert:

SB55-SSA1-SA2,220,15 " Section 10778d. 49.45 (6v) (b) of the statutes is amended to read:

SB55-SSA1-SA2,220,23 49.45 (6v) (b) The Beginning on September 1, 2002, 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-SA2, s. 1778h Section 1778h. 49.45 (6v) (c) of the statutes is amended to read:

SB55-SSA1-SA2,221,20 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-SA2, s. 1778p Section 1778p. 49.45 (6v) (d) of the statutes is created to read:

SB55-SSA1-SA2,222,12 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-SA2, s. 1778r Section 1778r. 49.45 (6v) (e) of the statutes is created to read:

SB55-SSA1-SA2,222,16 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-SA2,222,17 860. Page 627, line 2: after that line insert:

SB55-SSA1-SA2,222,18 " Section 1778g. 49.45 (6um) of the statutes is created to read:

SB55-SSA1-SA2,222,20 49.45 (6um) Supplemental grants to facilities in Milwaukee. (a) In this subsection:

SB55-SSA1-SA2,222,21 1. "Medicare" has the meaning given in sub. (3) (L) 1. b.

SB55-SSA1-SA2,222,22 2. "Minority group member" has the meaning given in s. 146.185 (1) (f).

SB55-SSA1-SA2,222,24 3. "Nursing home" means a nursing home that is licensed under s. 50.03 and that is certified by the department as a provider of medical assistance.

SB55-SSA1-SA2,223,4 (b) Notwithstanding sub. (6m), from the appropriations under s. 20.435 (4) (b) and (o), to ensure the availability of nursing home services in the city of Milwaukee, the department may award grants in each fiscal year to an applying nursing home that meets all of the following criteria:

SB55-SSA1-SA2,223,5 1. The nursing home is located in the city of Milwaukee.

SB55-SSA1-SA2,223,7 2. Patient occupancy of the nursing home is at least 80% of the nursing home's licensed bed capacity.

SB55-SSA1-SA2,223,10 3. More than 90% of the nursing home's residents are eligible for medical assistance, including those who have dual eligibility for medical assistance and medicare.

SB55-SSA1-SA2,223,12 4. The nursing home is not affiliated with a religious organization from which the nursing home receives operating support.

SB55-SSA1-SA2,223,13 5. The nursing home is certified as a medicare provider.

SB55-SSA1-SA2,223,14 6. At least 75% of the nursing home's employees are minority group members.

SB55-SSA1-SA2,223,18 (c) Funding for grants under par. (b) shall be based on the total cost of the nursing home's services per patient who is a recipient of medical assistance or $140 per patient day for a patient who is a recipient of medical assistance, whichever is less, less any payment received under s. 49.45 (6m).".

SB55-SSA1-SA2,223,19 861. Page 629, line 22: after that line insert:

SB55-SSA1-SA2,223,20 " Section 1787r. 49.45 (24h) of the statutes is created to read:

SB55-SSA1-SA2,224,2 49.45 (24h) Dental services reimbursement rates. Rates of reimbursement for dental services for each year shall equal the fee at which 75% of dentists in the east north central region charge equal or lesser amounts, as specified in the most recently published annual Survey of Dental Fees of the American Dental Association.".

SB55-SSA1-SA2,224,3 862. Page 630, line 7: after that line insert:

SB55-SSA1-SA2,224,5 " Section 1789t. 49.45 (39) (b) 1. of the statutes is renumbered 49.45 (39) (b) 1. a. and amended to read:

SB55-SSA1-SA2,225,11 49.45 (39) (b) 1. a. 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, except as provided in subd. 1. b., 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 for the Deaf 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 for the Deaf 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 for the Deaf 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 for the Deaf 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 for the Deaf 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-SA2, s. 1789u Section 1789u. 49.45 (39) (b) 1. b. of the statutes is created to read:

SB55-SSA1-SA2,225,21 49.45 (39) (b) 1. b. Beginning on July 1, 2003, the department shall, under this section, annually reimburse a school district and a cooperative educational service agency and shall reimburse the department of public instruction for the Wisconsin Center for the Blind and Visually Impaired and the Wisconsin School for the Deaf for 90% of the federal share of allowable charges received for school medical services in excess of $16,100,000. The reimbursement shall be based on the proportion of total school medical services for the school year that was provided by each school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired, and the Wisconsin School for the Deaf.".

SB55-SSA1-SA2,225,22 863. Page 630, line 14: after that line insert:

SB55-SSA1-SA2,225,23 " Section 1791h. 49.45 (47) (c) of the statutes is amended to read:

SB55-SSA1-SA2,226,5 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-SA2, s. 1791i Section 1791i. 49.45 (47) (d) of the statutes is repealed.".

SB55-SSA1-SA2,226,7 864. Page 632, line 4: after that line insert:

SB55-SSA1-SA2,226,8 " Section 1799f. 49.46 (1) (a) 5m. of the statutes is created to read:

SB55-SSA1-SA2,226,11 49.46 (1) (a) 5m. Any individual who is at least 18 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-SA2,226,12 865. Page 634, line 15: after that line insert:

SB55-SSA1-SA2,226,13 " Section 1805f. 49.46 (2) (b) 1m. of the statutes is created to read:

SB55-SSA1-SA2,226,16 49.46 (2) (b) 1m. Dental hygienists' services, limited to services that are payable under subd. 1. and that are within the scope of practice of a dental hygienist.".

SB55-SSA1-SA2,226,17 866. Page 642, line 20: after that line insert:

SB55-SSA1-SA2,226,18 " Section 1833k. 49.496 (3) (a) (intro.) of the statutes is amended to read:

SB55-SSA1-SA2,226,23 49.496 (3) (a) (intro.) Except as provided in par. (b), the The department may not recover from the estate of a recipient any amount of medical assistance paid on behalf of the recipient, except that the department shall file a claim against the estate of a recipient for all of the following unless already recovered by the department under this section:

SB55-SSA1-SA2, s. 1834g Section 1834g. 49.496 (3) (a) 2. d. of the statutes is repealed.

SB55-SSA1-SA2, s. 1834j Section 1834j. 49.496 (3) (a) 3. of the statutes is created to read:

SB55-SSA1-SA2,227,3 49.496 (3) (a) 3. Any medical assistance services that are required to be recovered under 42 USC 1396p.

SB55-SSA1-SA2, s. 1834k Section 1834k. 49.496 (3) (b) of the statutes is amended to read:

SB55-SSA1-SA2,227,7 49.496 (3) (b) A Notwithstanding par. (a), a claim under par. (a) is not allowable if the decedent has a surviving child who is under age 21 or disabled or a surviving spouse.".

SB55-SSA1-SA2,227,8 867. Page 646, line 22: after that line insert:

SB55-SSA1-SA2,227,9 " Section 1838gb. 49.688 of the statutes is created to read:

SB55-SSA1-SA2,227,11 49.688 Prescription drug assistance for elderly persons. (1) In this section:

SB55-SSA1-SA2,227,12 (a) "Generic name" has the meaning given in s. 450.12 (1) (b).

SB55-SSA1-SA2,227,14 (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-SA2,227,18 (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-SA2,227,19 (d) "Prescription order" has the meaning given in s. 450.01 (21).

SB55-SSA1-SA2,227,23 (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-SA2,228,2 (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-SA2,228,3 1. The person is a resident, as defined in s. 27.01 (10) (a), of this state.

SB55-SSA1-SA2,228,4 2. The person is at least 65 years of age.

SB55-SSA1-SA2,228,5 3. The person is not a recipient of medical assistance.

SB55-SSA1-SA2,228,8 4. The person's annual household income, as determined by the department, does not exceed 300% of the federal poverty line for a family the size of the person's eligible family.

SB55-SSA1-SA2,228,9 5. The person pays the program enrollment fee specified in sub. (3) (a).

SB55-SSA1-SA2,228,16 (b) A person to whom par. (a) 1. to 3. and 5. applies, but whose annual household income, as determined by the department, exceeds 300% 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.