SB55-SSA1-SA2,222,2019 49.45 (6um) Supplemental grants to facilities in Milwaukee. (a) In this
20subsection:
SB55-SSA1-SA2,222,2121 1. "Medicare" has the meaning given in sub. (3) (L) 1. b.
SB55-SSA1-SA2,222,2222 2. "Minority group member" has the meaning given in s. 146.185 (1) (f).
SB55-SSA1-SA2,222,2423 3. "Nursing home" means a nursing home that is licensed under s. 50.03 and
24that is certified by the department as a provider of medical assistance.
SB55-SSA1-SA2,223,4
1(b) Notwithstanding sub. (6m), from the appropriations under s. 20.435 (4) (b)
2and (o), to ensure the availability of nursing home services in the city of Milwaukee,
3the department may award grants in each fiscal year to an applying nursing home
4that meets all of the following criteria:
SB55-SSA1-SA2,223,55 1. The nursing home is located in the city of Milwaukee.
SB55-SSA1-SA2,223,76 2. Patient occupancy of the nursing home is at least 80% of the nursing home's
7licensed bed capacity.
SB55-SSA1-SA2,223,108 3. More than 90% of the nursing home's residents are eligible for medical
9assistance, including those who have dual eligibility for medical assistance and
10medicare.
SB55-SSA1-SA2,223,1211 4. The nursing home is not affiliated with a religious organization from which
12the nursing home receives operating support.
SB55-SSA1-SA2,223,1313 5. The nursing home is certified as a medicare provider.
SB55-SSA1-SA2,223,1414 6. At least 75% of the nursing home's employees are minority group members.
SB55-SSA1-SA2,223,1815 (c) Funding for grants under par. (b) shall be based on the total cost of the
16nursing home's services per patient who is a recipient of medical assistance or $140
17per patient day for a patient who is a recipient of medical assistance, whichever is
18less, less any payment received under s. 49.45 (6m).".
SB55-SSA1-SA2,223,19 19861. Page 629, line 22: after that line insert:
SB55-SSA1-SA2,223,20 20" Section 1787r. 49.45 (24h) of the statutes is created to read:
SB55-SSA1-SA2,224,221 49.45 (24h) Dental services reimbursement rates. Rates of reimbursement
22for dental services for each year shall equal the fee at which 75% of dentists in the
23east north central region charge equal or lesser amounts, as specified in the most

1recently published annual Survey of Dental Fees of the American Dental
2Association.".
SB55-SSA1-SA2,224,3 3862. Page 630, line 7: after that line insert:
SB55-SSA1-SA2,224,5 4" Section 1789t. 49.45 (39) (b) 1. of the statutes is renumbered 49.45 (39) (b)
51. a. and amended to read:
SB55-SSA1-SA2,225,116 49.45 (39) (b) 1. a. If a school district or a cooperative educational service
7agency elects to provide school medical services and meets all requirements under
8par. (c), the department shall, except as provided in subd. 1. b., reimburse the school
9district or the cooperative educational service agency for 60% of the federal share of
10allowable charges for the school medical services that it provides and, as specified
11in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind
12and Visually Impaired or the Wisconsin School for the Deaf elects to provide school
13medical services and meets all requirements under par. (c), the department shall
14reimburse the department of public instruction for 60% of the federal share of
15allowable charges for the school medical services that the Wisconsin Center for the
16Blind and Visually Impaired or the Wisconsin School for the Deaf provides and, as
17specified in subd. 2., for allowable administrative costs. A school district, cooperative
18educational service agency, the Wisconsin Center for the Blind and Visually
19Impaired or the Wisconsin School for the Deaf may submit, and the department shall
20allow, claims for common carrier transportation costs as a school medical service
21unless the department receives notice from the federal health care financing
22administration that, under a change in federal policy, the claims are not allowed. If
23the department receives the notice, a school district, cooperative educational service
24agency, the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin

1School for the Deaf may submit, and the department shall allow, unreimbursed
2claims for common carrier transportation costs incurred before the date of the change
3in federal policy. The department shall promulgate rules establishing a methodology
4for making reimbursements under this paragraph. All other expenses for the school
5medical services provided by a school district or a cooperative educational service
6agency shall be paid for by the school district or the cooperative educational service
7agency with funds received from state or local taxes. The school district, the
8Wisconsin Center for the Blind and Visually Impaired, the Wisconsin School for the
9Deaf or the cooperative educational service agency shall comply with all
10requirements of the federal department of health and human services for receiving
11federal financial participation.
SB55-SSA1-SA2, s. 1789u 12Section 1789u. 49.45 (39) (b) 1. b. of the statutes is created to read:
SB55-SSA1-SA2,225,2113 49.45 (39) (b) 1. b. Beginning on July 1, 2003, the department shall, under this
14section, annually reimburse a school district and a cooperative educational service
15agency and shall reimburse the department of public instruction for the Wisconsin
16Center for the Blind and Visually Impaired and the Wisconsin School for the Deaf
17for 90% of the federal share of allowable charges received for school medical services
18in excess of $16,100,000. The reimbursement shall be based on the proportion of total
19school medical services for the school year that was provided by each school district,
20cooperative educational service agency, the Wisconsin Center for the Blind and
21Visually Impaired, and the Wisconsin School for the Deaf.".
SB55-SSA1-SA2,225,22 22863. Page 630, line 14: after that line insert:
SB55-SSA1-SA2,225,23 23" Section 1791h. 49.45 (47) (c) of the statutes is amended to read:
SB55-SSA1-SA2,226,5
149.45 (47) (c) The biennial fee for the certification required under par. (b) of an
2adult day care center is $89, plus a biennial fee of $17.80 per client, based on the
3number of clients that the adult day care center is certified to serve
$100. Fees
4collected under this paragraph shall be credited to the appropriation account under
5s. 20.435 (6) (jm).
SB55-SSA1-SA2, s. 1791i 6Section 1791i. 49.45 (47) (d) of the statutes is repealed.".
SB55-SSA1-SA2,226,7 7864. Page 632, line 4: after that line insert:
SB55-SSA1-SA2,226,8 8" Section 1799f. 49.46 (1) (a) 5m. of the statutes is created to read:
SB55-SSA1-SA2,226,119 49.46 (1) (a) 5m. Any individual who is at least 18 years of age but under 20
10years of age and who, on his or her 18th birthday, was in foster care, or treatment
11foster care placement under ch. 48 or 938, as determined by the department.".
SB55-SSA1-SA2,226,12 12865. Page 634, line 15: after that line insert:
SB55-SSA1-SA2,226,13 13" Section 1805f. 49.46 (2) (b) 1m. of the statutes is created to read:
SB55-SSA1-SA2,226,1614 49.46 (2) (b) 1m. Dental hygienists' services, limited to services that are
15payable under subd. 1. and that are within the scope of practice of a dental
16hygienist.".
SB55-SSA1-SA2,226,17 17866. Page 642, line 20: after that line insert:
SB55-SSA1-SA2,226,18 18" Section 1833k. 49.496 (3) (a) (intro.) of the statutes is amended to read:
SB55-SSA1-SA2,226,2319 49.496 (3) (a) (intro.) Except as provided in par. (b), the The department may
20not recover from the estate of a recipient any amount of medical assistance paid on
21behalf of the recipient, except that the department
shall file a claim against the
22estate of a recipient for all of the following unless already recovered by the
23department under this section:
SB55-SSA1-SA2, s. 1834g 24Section 1834g. 49.496 (3) (a) 2. d. of the statutes is repealed.
SB55-SSA1-SA2, s. 1834j
1Section 1834j. 49.496 (3) (a) 3. of the statutes is created to read:
SB55-SSA1-SA2,227,32 49.496 (3) (a) 3. Any medical assistance services that are required to be
3recovered under 42 USC 1396p.
SB55-SSA1-SA2, s. 1834k 4Section 1834k. 49.496 (3) (b) of the statutes is amended to read:
SB55-SSA1-SA2,227,75 49.496 (3) (b) A Notwithstanding par. (a), a claim under par. (a) is not
6allowable if the decedent has a surviving child who is under age 21 or disabled or a
7surviving spouse.".
SB55-SSA1-SA2,227,8 8867. Page 646, line 22: after that line insert:
SB55-SSA1-SA2,227,9 9" Section 1838gb. 49.688 of the statutes is created to read:
SB55-SSA1-SA2,227,11 1049.688 Prescription drug assistance for elderly persons. (1) In this
11section:
SB55-SSA1-SA2,227,1212 (a) "Generic name" has the meaning given in s. 450.12 (1) (b).
SB55-SSA1-SA2,227,1413 (b) "Poverty line" means the nonfarm federal poverty line for the continental
14United States, as defined by the federal department of labor under 42 USC 9902 (2).
SB55-SSA1-SA2,227,1815 (c) "Prescription drug" means a prescription drug, as defined in s. 450.01 (20),
16that is included in the drugs specified under s. 49.46 (2) (b) 6. h. and that is
17manufactured by a drug manufacturer that enters into a rebate agreement in force
18under sub. (6).
SB55-SSA1-SA2,227,1919 (d) "Prescription order" has the meaning given in s. 450.01 (21).
SB55-SSA1-SA2,227,2320 (e) "Program payment rate" means the rate of payment made for the identical
21drug specified under s. 49.46 (2) (b) 6. h., plus 5%, plus a dispensing fee that is equal
22to the dispensing fee permitted to be charged for prescription drugs for which
23coverage is provided under s. 49.46 (2) (b) 6. h.
SB55-SSA1-SA2,228,2
1(2) (a) A person to whom all of the following applies is eligible to purchase a
2prescription drug for the amounts specified in sub. (5) (a) 1. and 2.:
SB55-SSA1-SA2,228,33 1. The person is a resident, as defined in s. 27.01 (10) (a), of this state.
SB55-SSA1-SA2,228,44 2. The person is at least 65 years of age.
SB55-SSA1-SA2,228,55 3. The person is not a recipient of medical assistance.
SB55-SSA1-SA2,228,86 4. The person's annual household income, as determined by the department,
7does not exceed 300% of the federal poverty line for a family the size of the person's
8eligible family.
SB55-SSA1-SA2,228,99 5. The person pays the program enrollment fee specified in sub. (3) (a).
SB55-SSA1-SA2,228,1610 (b) A person to whom par. (a) 1. to 3. and 5. applies, but whose annual household
11income, as determined by the department, exceeds 300% of the federal poverty line
12for a family the size of the persons' eligible family, is eligible to purchase a
13prescription drug at the amounts specified in sub. (5) (a) 4. only during the remaining
14amount of any 12-month period in which the person has first paid the annual
15deductible specified in sub. (3) (b) 2. a. in purchasing prescription drugs at the retail
16price and has then paid the annual deductible specified in sub. (3) (b) 2. b.
SB55-SSA1-SA2,228,17 17(3) Program participants shall pay all of the following:
SB55-SSA1-SA2,228,1818 (a) For each 12-month benefit period, a program enrollment fee of $20.
SB55-SSA1-SA2,228,2219 (b) 1. For each 12-month benefit period, for a person specified in sub. (2) (a),
20a deductible for prescription drugs of $500, except that a person whose annual
21household income, as determined by the department, is 175% or less of the federal
22poverty line for a family the size of the person's eligible family pays no deductible.
SB55-SSA1-SA2,228,2423 2. For each 12-month benefit period, for a person specified in sub. (2) (b), a
24deductible for prescription drugs that equals all of the following:
SB55-SSA1-SA2,229,2
1a. The difference between the person's annual household income and 300% of
2the federal poverty line for a family the size of the person's eligible family.
SB55-SSA1-SA2,229,33 b. Five hundred dollars.
SB55-SSA1-SA2,229,54 (c) After payment of any applicable deductible under par. (b), all of the
5following:
SB55-SSA1-SA2,229,66 1. A copayment of $5 for each prescription drug that bears only a generic name.
SB55-SSA1-SA2,229,87 2. A copayment of $10 for each prescription drug that does not bear only a
8generic name.
SB55-SSA1-SA2,229,129 (d) Notwithstanding s. 49.002, if a person who is eligible under this section has
10other available coverage for payment of a prescription drug, this section applies only
11to costs for prescription drugs for the persons that are not covered under the person's
12other available coverage.
SB55-SSA1-SA2,229,18 13(4) The department shall devise and distribute a form for application for the
14program under sub. (2), shall determine eligibility for each 12-month benefit period
15of applicants and shall issue to eligible persons a prescription drug card for use in
16purchasing prescription drugs, as specified in sub. (5). The department shall
17promulgate rules that specify the criteria to be used to determine household income
18under sub. (2) (a) 4. and (b) and (3) (b) 1.
SB55-SSA1-SA2,229,23 19(5) (a) Beginning September 1, 2002, as a condition of participation by a
20pharmacy or pharmacist in the program under s. 49.45, 49.46, or 49.47, the
21pharmacy or pharmacist may not charge a person who presents a valid prescription
22order and a card indicating that he or she meets eligibility requirements under sub.
23(2) an amount for a prescription drug under the order that exceeds the following:
SB55-SSA1-SA2,229,2524 1. For a deductible, as specified in sub. (3) (b) 1. and 2. b., the program payment
25rate.
SB55-SSA1-SA2,230,3
12. After any applicable deductible under subd. 1. is charged, the copayment, as
2applicable, that is specified in sub. (3) (c) 1. or 2. No dispensing fee may be charged
3to a person under this subdivision.
SB55-SSA1-SA2,230,44 3. For a deductible, as specified in sub. (3) (b) 2. a., the retail price.
SB55-SSA1-SA2,230,75 4. After the deductible under subd. 3. is charged, the copayment, as applicable,
6that is specified in sub. (3) (c) 1. or 2. No dispensing fee may be charged to a person
7under this subdivision.
SB55-SSA1-SA2,230,118 (b) The department shall calculate and transmit to pharmacies and
9pharmacists that are certified providers of medical assistance amounts that may be
10used in calculating charges under par. (a). The department shall periodically update
11this information and transmit the updated amounts to pharmacies and pharmacists.
SB55-SSA1-SA2,230,17 12(6) The department, or an entity with which the department contracts, shall
13provide to a drug manufacturer that sells drugs for prescribed use in this state
14documents designed for use by the manufacturer in entering into a rebate agreement
15with the department or entity that is modeled on the rebate agreement specified
16under 42 USC 1396r-8. A rebate agreement under this subsection shall include all
17of the following as requirements:
SB55-SSA1-SA2,230,2318 (a) That the manufacturer shall make rebate payments for each prescription
19drug of the manufacturer that is prescribed for and purchased by persons who meet
20criteria under sub. (2) (a) and persons who meet criteria under sub. (2) (b) and have
21paid the deductible under sub. (3) (b) 2. a., to the state treasurer to be credited to the
22appropriation account under s. 20.435 (4) (j), each calendar quarter or according to
23a schedule established by the department.
SB55-SSA1-SA2,230,2524 (b) That the amount of the rebate payment shall be determined by a method
25specified in 42 USC 1396r-8 (c).
SB55-SSA1-SA2,231,16
1(7) From the appropriation accounts under s. 20.435 (4) (bv) and (j), beginning
2September 1, 2002, the department shall, under a schedule that is identical to that
3used by the department for payment of pharmacy provider claims under medical
4assistance, provide to pharmacies and pharmacists payments for prescription drugs
5sold by the pharmacies or pharmacists to persons eligible under sub. (2) who have
6paid the deductible specified under sub. (3) (b) 1. or 2. or who, under sub. (3) (b) 1.,
7are not required to pay a deductible. The payment for each prescription drug under
8this subsection shall be at the program payment rate, minus any copayment paid by
9the person under sub. (5) (a) 2. or 4., and plus, if applicable, incentive payments that
10are similar to those provided under s. 49.45 (8v). The department shall devise and
11distribute a claim form for use by pharmacies and pharmacists under this subsection
12and may limit payment under this subsection to those prescription drugs for which
13payment claims are submitted by pharmacists or pharmacies directly to the
14department. The department may apply to the program under this section the same
15utilization and cost control procedures that apply under rules promulgated by the
16department to medical assistance under subch. IV of ch. 49.
SB55-SSA1-SA2,231,23 17(8) The department shall, under methods promulgated by the department by
18rule, monitor compliance by pharmacies and pharmacists that are certified providers
19of medical assistance with the requirements of sub. (5) and shall annually report to
20the legislature under s. 13.172 (2) concerning the compliance. The report shall
21include information on any pharmacies or pharmacists that discontinue
22participation as certified providers of medical assistance and the reasons given for
23the discontinuance.
SB55-SSA1-SA2,231,25 24(9) (a) The department shall promulgate rules relating to prohibitions on fraud
25that are substantially similar to applicable provisions under s. 49.49 (1) (a).
SB55-SSA1-SA2,232,4
1(b) A person who is convicted of violating a rule promulgated by the department
2under par. (a) in connection with that person's furnishing of prescription drugs under
3this section may be fined not more than $25,000, or imprisoned for not more than 7
4years and 6 months, or both.
SB55-SSA1-SA2,232,75 (c) A person other than a person specified in par. (b) who is convicted of violating
6a rule promulgated by the department under par. (a) may be fined not more than
7$10,000, or imprisoned for not more than one year, or both.
SB55-SSA1-SA2,232,13 8(10) If federal law is amended to provide coverage for prescription drugs for
9outpatient care as a benefit under medicare or to provide similar coverage under
10another program, the department shall submit to appropriate standing committees
11of the legislature under s. 13.172 (3) a report that contains an analysis of the
12differences between such a federal program and the program under this section and
13that provides recommendations concerning alignment, if any, of the differences.
SB55-SSA1-SA2,232,17 14(11) Except as provided in subs. (8) to (10) and except for the department's
15rule-making requirements and authority, the department may enter into a contract
16with an entity to perform the duties and exercise the powers of the department under
17this section.".
SB55-SSA1-SA2,232,18 18868. Page 656, line 10: after that line insert:
SB55-SSA1-SA2,232,19 19" Section 1966v. 51.30 (4) (b) 10m. of the statutes is amended to read:
SB55-SSA1-SA2,232,2420 51.30 (4) (b) 10m. To the department of justice or a district attorney under s.
21980.015 (3) (b), if the treatment records are maintained by an agency with
22jurisdiction, as defined in s. 980.015 (1) 980.01 (1d), that has control or custody over
23a person who may meet the criteria for commitment as a sexually violent person
24under ch. 980.".
SB55-SSA1-SA2,233,1
1869. Page 656, line 11: delete lines 11 to 22 and substitute:
SB55-SSA1-SA2,233,2 2" Section 1968d. 51.42 (3) (ar) 4m. of the statutes is amended to read:
SB55-SSA1-SA2,233,93 51.42 (3) (ar) 4m. If state, federal, and county funding for alcohol and other
4drug abuse treatment services provided under subd. 4. are insufficient to meet the
5needs of all eligible individuals, ensure that first priority for services is given to
6pregnant women who suffer from alcoholism or alcohol abuse or are drug dependent
7and that second priority be given to individuals who are 20 years of age were eligible
8for the medical assistance program under s. 49.46 (1) (a) 5m. but became ineligible
9for the program solely because they attained the age of 20
.
SB55-SSA1-SA2, s. 1968dh 10Section 1968dh. 51.42 (3) (ar) 4p. of the statutes is created to read:
SB55-SSA1-SA2,233,1511 51.42 (3) (ar) 4p. If state, federal, and county funding for mental health services
12provided under subd. 4. are insufficient to meet the needs of all eligible individuals,
13ensure that first priority for services is given to individuals who are 20 years of age
14and were eligible for the medical assistance program under s. 49.46 (1) (a) 5m. but
15became ineligible for the program solely because they attained the age of 20.".
SB55-SSA1-SA2,233,16 16870. Page 665, line 20: after that line insert:
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