Amendment SSA1-SB44

SB44-SSA1, s. 1367 Section 1367. 49.45 (6y) (a) of the statutes is amended to read:

SB44-SSA1,532,3 49.45 (6y) (a) Notwithstanding sub. (3) (e), from the appropriations appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), the department shall distribute funding in each fiscal year to provide supplemental payment to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3). If no relief block grant is awarded under this chapter or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2).

SB44-SSA1, s. 1368 Section 1368. 49.45 (6y) (am) of the statutes is amended to read:

SB44-SSA1,532,12 49.45 (6y) (am) Notwithstanding sub. (3) (e), from the appropriations appropriation accounts under s. 20.435 (4) (b), (h), (gp), (o), and (w), the department shall distribute funding in each fiscal year to provide supplemental payments to hospitals that enter into contracts under s. 49.02 (2) with a county having a population of 500,000 or more to provide health care services funded by a relief block grant, as determined by the department, for hospital services that are not in excess of the hospitals' customary charges for the services, as limited under 42 USC 1396b (i) (3).

SB44-SSA1, s. 1369 Section 1369. 49.45 (6z) (a) (intro.) of the statutes is amended to read:

SB44-SSA1,532,24 49.45 (6z) (a) (intro.) Notwithstanding sub. (3) (e), from the appropriations appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), the department shall distribute funding in each fiscal year to supplement payment for services to hospitals that enter into a contract under s. 49.02 (2) to provide health care services funded by a relief block grant under this chapter, if the department determines that the hospitals serve a disproportionate number of low-income patients with special needs. If no medical relief block grant under this chapter is awarded or if the allocation of funds to such hospitals would exceed any limitation under 42 USC 1396b (i) (3), the department may distribute funds to hospitals that have not entered into a contract under s. 49.02 (2). The department may not distribute funds under this subsection to the extent that the distribution would do any of the following:

SB44-SSA1, s. 1372 Section 1372. 49.45 (8) (b) of the statutes is amended to read:

SB44-SSA1,533,5 49.45 (8) (b) Reimbursement under s. 20.435 (4) (b), (gp), (o), and (w) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under par. (c).

SB44-SSA1, s. 1373 Section 1373. 49.45 (18) (intro.) of the statutes is renumbered 49.45 (18) (ac) and amended to read:

SB44-SSA1,533,19 49.45 (18) (ac) Except as provided in pars. (a) (am) to (d), and subject to par. (ag), any person eligible for medical assistance under s. 49.46, 49.468, or 49.47 shall pay up to the maximum amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided under s. 49.46 (2). The service provider shall collect the specified or allowable copayment, coinsurance , or deductible, unless the service provider determines that the cost of collecting the copayment, coinsurance, or deductible exceeds the amount to be collected. The department shall reduce payments to each provider by the amount of the specified or allowable copayment, coinsurance, or deductible. No provider may deny care or services because the recipient is unable to share costs, but an inability to share costs specified in this subsection does not relieve the recipient of liability for these costs. Liability under this subsection is limited by the following provisions:

SB44-SSA1, s. 1374 Section 1374. 49.45 (18) (a) of the statutes is renumbered 49.45 (18) (am).

SB44-SSA1, s. 1375 Section 1375. 49.45 (18) (ag) of the statutes is created to read:

SB44-SSA1,533,23 49.45 (18) (ag) Except as provided in pars. (am), (b), and (c), and subject to par. (d), a recipient specified in par. (ac) shall pay all of the following:

SB44-SSA1,533,25 1. A copayment of $1 for each prescription of a drug that bears only a generic name, as defined in s. 450.12 (1) (b).

SB44-SSA1,534,2 2. A copayment of $3 for each prescription of a drug that bears a brand name, as defined in s. 450.12 (1) (a).

SB44-SSA1, s. 1376 Section 1376. 49.45 (18) (d) of the statutes is amended to read:

SB44-SSA1,534,7 49.45 (18) (d) No person who designates a pharmacy or pharmacist as his or her sole provider of prescription drugs and who so uses that pharmacy or pharmacist is liable under this subsection for more than $5 $12 per month for prescription drugs received.

SB44-SSA1, s. 1377 Section 1377. 49.45 (19) (bm) of the statutes is amended to read:

SB44-SSA1,534,11 49.45 (19) (bm) The department or the county department under s. 46.215 or 46.22 shall notify applicants of the requirements of this subsection at the time of application.

SB44-SSA1, s. 1378 Section 1378. 49.45 (24m) (intro.) of the statutes is amended to read:

SB44-SSA1,534,17 49.45 (24m) Home health care and personal care pilot program. (intro.) From the appropriations appropriation accounts under s. 20.435 (4) (b), (gp), (o), and (w), in order to test the feasibility of instituting a system of reimbursement for providers of home health care and personal care services for medical assistance recipients that is based on competitive bidding, the department shall:

SB44-SSA1, s. 1379 Section 1379. 49.45 (25) (am) (intro.) of the statutes is amended to read:

SB44-SSA1,534,25 49.45 (25) (am) (intro.) Except as provided under pars. (be) and, (bg), and (bj) and sub. (24), case management services under s. 49.46 (2) (b) 9. and (bm) are reimbursable under medical assistance Medical Assistance only if provided to a medical assistance Medical Assistance beneficiary who receives case management services from or through a certified case management provider in a county, city, village, or town that elects, under par. (b), to make the services available and who meets at least one of the following conditions:

SB44-SSA1, s. 1380 Section 1380. 49.45 (25) (bj) of the statutes is created to read:

SB44-SSA1,535,9 49.45 (25) (bj) The department of corrections may elect to provide case management services under this subsection to persons who are under the supervision of that department under s. 938.183, 938.34 (4h), (4m), or (4n), or 938.357 (4), who are Medical Assistance beneficiaries, and who meet one or more of the conditions specified in par. (am). The amount of the allowable charges for those services under the Medical Assistance program that is not provided by the federal government shall be paid from the appropriation account under s. 20.410 (3) (hm), (ho), or (hr).

SB44-SSA1, s. 1381 Section 1381. 49.45 (25) (c) of the statutes is amended to read:

SB44-SSA1,535,15 49.45 (25) (c) Except as provided in pars. (b), (be) and, (bg), and (bj), the department shall reimburse a provider of case management services under this subsection only for the amount of the allowable charges for those services under the medical assistance Medical Assistance program that is provided by the federal government.

SB44-SSA1, s. 1382c Section 1382c. 49.45 (30e) (a) 5. of the statutes is created to read:

SB44-SSA1,535,18 49.45 (30e) (a) 5. Any other condition required by rule under par. (b) 4. is satisfied.

SB44-SSA1, s. 1382e Section 1382e. 49.45 (30e) (b) 4. of the statutes is created to read:

SB44-SSA1,535,21 49.45 (30e) (b) 4. Any other conditions for coverage of community-based psychosocial services under the Medical Assistance Program.

SB44-SSA1, s. 1383 Section 1383. 49.45 (30m) of the statutes is renumbered 49.45 (30m) (a) (intro.) and amended to read:

SB44-SSA1,536,3 49.45 (30m) (a) (intro.) Except as provided in par. (am), a county shall provide the portion of the payment that is not provided by the federal government for all of the following services under s. 51.06 (1m) (d) to individuals with developmental disability who are eligible for medical assistance that is not provided by the federal government.:

SB44-SSA1, s. 1384 Section 1384. 49.45 (30m) (a) 1. of the statutes is created to read:

SB44-SSA1,536,5 49.45 (30m) (a) 1. Services under s. 51.06 (1m) (d).

SB44-SSA1, s. 1385 Section 1385. 49.45 (30m) (a) 2. of the statutes is created to read:

SB44-SSA1,536,9 49.45 (30m) (a) 2. Services in an intermediate care facility for the mentally retarded, as defined in s. 46.278 (1m) (am), other than a state center for the developmentally disabled.

SB44-SSA1, s. 1386 Section 1386. 49.45 (30m) (a) 3. of the statutes is created to read:

SB44-SSA1,536,12 49.45 (30m) (a) 3. Services for which payment is permitted under sub. (6c) (d) 2. that are provided in a nursing facility, as defined in s. 46.279 (1) (c).

SB44-SSA1, s. 1386d Section 1386d. 49.45 (30m) (am) of the statutes is created to read:

SB44-SSA1,536,18 49.45 (30m) (am) The department shall provide the portion of the payment that is not provided by the federal government for any of the services specified in par. (a) 1. to 3. that are provided to an individual with developmental disability who is eligible for medical assistance, as determined under the contract under s. 46.279 (4m).

SB44-SSA1, s. 1387 Section 1387. 49.45 (30m) (b) of the statutes is created to read:

SB44-SSA1,536,23 49.45 (30m) (b) No payment under this section may be made for services specified under par. (a) or (am) unless the individual who receives the services is protectively placed under s. 55.06 (9) (a) or is placed under an emergency placement under s. 55.06 (11) (a) or a temporary placement under s. 55.06 (11) (c).

SB44-SSA1, s. 1388 Section 1388. 49.45 (30m) (c) of the statutes is created to read:

SB44-SSA1,537,4 49.45 (30m) (c) No payment under this section may be made for services specified under par. (a) 2. or 3. that are provided to an individual who was placed in or admitted to an intermediate facility, as defined in s. 46.279 (1) (b), or nursing facility, as defined in s. 46.279 (1) (c), unless one of the following applies:

SB44-SSA1,537,6 1. Any placement or admission that is made after April 30, 2005, complied with the requirements of s. 46.279.

SB44-SSA1,537,9 2. For an individual who was protectively placed under ch. 55 at any time, any annual review that is conducted under s. 55.06 (10) (a) 1. after April 30, 2005, complies with the requirements of s. 55.06 (10) (a) 2.

SB44-SSA1, s. 1389 Section 1389. 49.45 (36) of the statutes is amended to read:

SB44-SSA1,537,14 49.45 (36) Homeless beneficiaries. A The department or a county department under s. 46.215, 46.22, or 46.23 may not place the word "homeless" on the medical assistance identification card of any person who is determined to be eligible for medical assistance benefits and who is homeless.

SB44-SSA1, s. 1390 Section 1390. 49.45 (39) (b) 1. of the statutes is amended to read:

SB44-SSA1,538,23 49.45 (39) (b) 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 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 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 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 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 Except as provided in subd. 1m., 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 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.

SB44-SSA1, s. 1391 Section 1391. 49.45 (39) (b) 1m. of the statutes is created to read:

SB44-SSA1,539,7 49.45 (39) (b) 1m. `Supplementary payment for school medical services.' In addition to the reimbursement the department provides under subd. 1. to a school district or cooperative educational service agency for school medical services, the department may make supplementary payments from the appropriation accounts under s. 20.435 (4) (b) and (o). The total of the supplementary payments and allowable charges paid under subd. 1. may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

SB44-SSA1, s. 1392 Section 1392. 49.45 (39) (b) 2. of the statutes is amended to read:

SB44-SSA1,539,18 49.45 (39) (b) 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. subds. 1. and 1m. and shall reimburse the department of public instruction on behalf of the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin 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 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.

SB44-SSA1, s. 1392p Section 1392p. 49.45 (49) (a) (intro.) of the statutes is renumbered 49.45 (49) (bm) and amended to read:

SB44-SSA1,540,2 49.45 (49) (bm) The secretary shall exercise his or her authority under s. 15.04 (1) (c) to create a prescription drug prior authorization and therapeutics committee to advise the department on issues related to prior authorization decisions made concerning prescription drugs on behalf of medical assistance recipients . The secretary shall appoint as members at least all of the following: and to advise the department on the research, development, and approval of any preferred drug list for the Medical Assistance program or the program under s. 49.665 or 49.668.

SB44-SSA1, s. 1392q Section 1392q. 49.45 (49) (a) 1. of the statutes is repealed.

SB44-SSA1, s. 1392r Section 1392r. 49.45 (49) (a) 2. and 3. of the statutes are renumbered 49.45 (49) (c) 6. and 7.

SB44-SSA1, s. 1392rj Section 1392rj. 49.45 (49) (ag) of the statutes is created to read:

SB44-SSA1,540,7 49.45 (49) (ag) In this subsection:

SB44-SSA1,540,11 1. "Labeler" means a person who receives prescription drugs from a manufacturer or wholesaler and repackages those drugs for later retail sale, and has a labeler code issued by the federal food and drug administration under 21 CFR 207.20 (b).

SB44-SSA1,540,14 2. "Manufacturer" means a person who is engaged in the production, preparation, propagation, compounding, conversion, or processing of prescription drugs.

SB44-SSA1,540,15 3. "Physician" has the meaning given in s. 448.01 (5).

SB44-SSA1, s. 1392s Section 1392s. 49.45 (49) (b) of the statutes is renumbered 49.45 (49) (g) and amended to read:

SB44-SSA1,540,21 49.45 (49) (g) The prescription drug prior authorization and therapeutics committee shall accept information or commentary from representatives of the pharmaceutical manufacturing industry in the committee's review of prior authorization policies.

SB44-SSA1, s. 1392t Section 1392t. 49.45 (49) (c), (d), (e), (f), (h) and (i) of the statutes are created to read:

SB44-SSA1,540,25 49.45 (49) (c) The secretary shall appoint as members of the prescription drug prior authorization and therapeutics committee at least all of the following:

SB44-SSA1,541,1 1. A physician who has expertise in family practice.

SB44-SSA1,541,2 2. A physician who has expertise in pediatrics.

SB44-SSA1,541,3 3. A physician who has expertise in geriatrics.

SB44-SSA1,541,4 4. A physician who has expertise in psychiatry.

SB44-SSA1,541,6 5. A physician who has expertise in internal medicine and specializes in the treatment of diabetes.

SB44-SSA1,541,10 (d) A person who is employed by or under contract with a manufacturer, a labeler, or the state may not serve as a member of the prescription drug prior authorization and therapeutics committee, except that the following agreements do not bar a person from serving as a member of the committee:

SB44-SSA1,541,12 1. An agreement with the department to comply with the requirements for provider certification under sub. (2) (a) 11.

SB44-SSA1,541,15 2. An agreement between a physician or pharmacist and a manufacturer for the physician or pharmacist to conduct research in return for grant funding from a manufacturer.

SB44-SSA1,541,22 (e) If a physician or pharmacist who is a member of the prescription drug prior authorization and therapeutics committee receives any grant funding from a manufacturer to conduct research, the physician or pharmacist must disclose the grant funding to the department. Any physician or pharmacist who is a candidate for membership on the committee and receives such grant funding must disclose the grant funding to the department before the secretary appoints the person as a member of the committee.

SB44-SSA1,542,3 (f) During the first meeting of the prescription drug prior authorization and therapeutics committee in each calendar year, the committee shall elect a member to serve as the chairperson of the committee for a one-year term. The committee shall meet at least once annually and on the call of the chairperson. A majority of the committee constitutes a quorum to do business. Recommendations of the committee shall be determined by majority vote.

SB44-SSA1,542,7 (h) The department shall consider all relevant recommendations of the prescription drug prior authorization and therapeutics committee before requiring prior authorization for a prescription drug under the Medical Assistance program or under s. 49.665 or 49.668.

SB44-SSA1,542,13 (i) By January 1 annually, the department shall submit a report to the governor, the members of the joint committee on finance, and the appropriate standing committees of the legislature under s. 13.172 (3), on any changes that the department made in the previous 12 months to department policies related to prior authorization for prescription drugs under the Medical Assistance program or the program under s. 49.665 or 49.668, and shall include all of the following in the report:

SB44-SSA1,542,15 1. The name and therapeutic class for each prescription drug for which the department changed prior authorization policies.

SB44-SSA1,542,17 2. The criteria for approving a prior authorization request for any prescription drug identified under subd. 1.

SB44-SSA1,542,21 3. Identification of any differences between the policies adopted by the department and relevant recommendations of the prescription drug prior authorization and therapeutics committee and, if applicable, the clinical and scientific reasons for diverging from the committee's recommendations.