Amendment SA2-SSA1-SB55

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.

SB55-SSA1-SA2,228,17 (3) Program participants shall pay all of the following:

SB55-SSA1-SA2,228,18 (a) For each 12-month benefit period, a program enrollment fee of $20.

SB55-SSA1-SA2,228,22 (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 175% or less of the federal poverty line for a family the size of the person's eligible family pays no deductible.

SB55-SSA1-SA2,228,24 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-SA2,229,2 a. The difference between the person's annual household income and 300% of the federal poverty line for a family the size of the person's eligible family.

SB55-SSA1-SA2,229,3 b. Five hundred dollars.

SB55-SSA1-SA2,229,5 (c) After payment of any applicable deductible under par. (b), all of the following:

SB55-SSA1-SA2,229,6 1. A copayment of $5 for each prescription drug that bears only a generic name.

SB55-SSA1-SA2,229,8 2. A copayment of $10 for each prescription drug that does not bear only a generic name.

SB55-SSA1-SA2,229,12 (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-SA2,229,18 (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-SA2,229,23 (5) (a) Beginning September 1, 2002, 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-SA2,229,25 1. For a deductible, as specified in sub. (3) (b) 1. and 2. b., the program payment rate.

SB55-SSA1-SA2,230,3 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-SA2,230,4 3. For a deductible, as specified in sub. (3) (b) 2. a., the retail price.

SB55-SSA1-SA2,230,7 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-SA2,230,11 (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-SA2,230,17 (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-SA2,230,23 (a) That 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-SA2,230,25 (b) That the amount of the rebate payment shall be determined by a method specified in 42 USC 1396r-8 (c).

SB55-SSA1-SA2,231,16 (7) From the appropriation accounts under s. 20.435 (4) (bv) and (j), beginning 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 subsection 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 subsection and may limit payment under this subsection 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-SA2,231,23 (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-SA2,231,25 (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-SA2,232,4 (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-SA2,232,7 (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-SA2,232,13 (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-SA2,232,17 (11) Except as provided in subs. (8) to (10) 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-SA2,232,18 868. Page 656, line 10: after that line insert:

SB55-SSA1-SA2,232,19 " Section 1966v. 51.30 (4) (b) 10m. of the statutes is amended to read:

SB55-SSA1-SA2,232,24 51.30 (4) (b) 10m. To the department of justice or a district attorney under s. 980.015 (3) (b), if the treatment records are maintained by an agency with jurisdiction, as defined in s. 980.015 (1) 980.01 (1d), that has control or custody over a person who may meet the criteria for commitment as a sexually violent person under ch. 980.".

SB55-SSA1-SA2,233,1 869. Page 656, line 11: delete lines 11 to 22 and substitute:

SB55-SSA1-SA2,233,2 " Section 1968d. 51.42 (3) (ar) 4m. of the statutes is amended to read:

SB55-SSA1-SA2,233,9 51.42 (3) (ar) 4m. If state, federal, and county funding for alcohol and other drug abuse treatment services provided under subd. 4. are insufficient to meet the needs of all eligible individuals, ensure that first priority for services is given to pregnant women who suffer from alcoholism or alcohol abuse or are drug dependent and that second priority be given to individuals who are 20 years of age were eligible for the medical assistance program under s. 49.46 (1) (a) 5m. but became ineligible for the program solely because they attained the age of 20.

SB55-SSA1-SA2, s. 1968dh Section 1968dh. 51.42 (3) (ar) 4p. of the statutes is created to read:

SB55-SSA1-SA2,233,15 51.42 (3) (ar) 4p. If state, federal, and county funding for mental health services provided under subd. 4. are insufficient to meet the needs of all eligible individuals, ensure that first priority for services is given to individuals who are 20 years of age and were eligible for the medical assistance program under s. 49.46 (1) (a) 5m. but became ineligible for the program solely because they attained the age of 20.".

SB55-SSA1-SA2,233,16 870. Page 665, line 20: after that line insert: