SB44-SSA1,542,323 (f) During the first meeting of the prescription drug prior authorization and
24therapeutics committee in each calendar year, the committee shall elect a member
25to serve as the chairperson of the committee for a one-year term. The committee

1shall meet at least once annually and on the call of the chairperson. A majority of
2the committee constitutes a quorum to do business. Recommendations of the
3committee shall be determined by majority vote.
SB44-SSA1,542,74 (h) The department shall consider all relevant recommendations of the
5prescription drug prior authorization and therapeutics committee before requiring
6prior authorization for a prescription drug under the Medical Assistance program or
7under s. 49.665 or 49.668.
SB44-SSA1,542,138 (i) By January 1 annually, the department shall submit a report to the governor,
9the members of the joint committee on finance, and the appropriate standing
10committees of the legislature under s. 13.172 (3), on any changes that the
11department made in the previous 12 months to department policies related to prior
12authorization for prescription drugs under the Medical Assistance program or the
13program under s. 49.665 or 49.668, and shall include all of the following in the report:
SB44-SSA1,542,1514 1. The name and therapeutic class for each prescription drug for which the
15department changed prior authorization policies.
SB44-SSA1,542,1716 2. The criteria for approving a prior authorization request for any prescription
17drug identified under subd. 1.
SB44-SSA1,542,2118 3. Identification of any differences between the policies adopted by the
19department and relevant recommendations of the prescription drug prior
20authorization and therapeutics committee and, if applicable, the clinical and
21scientific reasons for diverging from the committee's recommendations.
SB44-SSA1, s. 1393 22Section 1393. 49.45 (49m) of the statutes is created to read:
SB44-SSA1,542,2423 49.45 (49m) Prescription drug cost controls; purchasing agreements. (a)
24In this section:
SB44-SSA1,542,2525 1. "Brand name" has the meaning given in s. 450.12 (1) (a).
SB44-SSA1,543,1
12. "Generic name" has the meaning given in s. 450.12 (1) (b).
SB44-SSA1,543,22 3. "Prescription drug" has the meaning given in s. 450.01 (20).
SB44-SSA1,543,63 (b) The department may enter into a multi-state purchasing agreement with
4another state or a purchasing agreement with a purchaser of prescription drugs if
5the other state or purchaser agrees to participate in one or more of the activities
6specified in par. (c) 1. to 4.
SB44-SSA1,543,97 (c) The department may design and implement a program to reduce the cost
8of prescription drugs and to maintain high quality in prescription drug therapies,
9which shall include all of the following:
SB44-SSA1,543,1210 1. A list of the prescription drugs that are included as a benefit under s. 49.46
11(2) (b) 6. h. that identifies preferred choices within therapeutic classes and includes
12prescription drugs that bear only generic names.
SB44-SSA1,543,1813 2. Establishing supplemental rebates under agreements with prescription
14drug manufacturers for prescription drugs provided to recipients under Medical
15Assistance and Badger Care and to eligible persons under s. 49.688 and, if it is
16possible to implement the program without adversely affecting supplemental
17rebates for Medical Assistance, Badger Care, and prescription drug assistance under
18s. 49.688, to beneficiaries of participants under par. (b).
SB44-SSA1,543,1919 3. Utilization management and fraud and abuse controls.
SB44-SSA1,543,2120 4. Any other activity to reduce the cost of or expenditures for prescription drugs
21and maintain high quality in prescription drug therapies.
SB44-SSA1,543,2422 (cg) The department shall consider all relevant recommendations of the
23prescription drug prior authorization and therapeutics committee before including
24a prescription drug on, or excluding a prescription drug from, a list under par. (c) 1.
SB44-SSA1,544,3
1(cr) 1. Except as provided in subd. 2., the department may not require prior
2authorization for a prescription drug under s. 49.46 (2) (b) 6. h. that is prescribed to
3treat a mental illness.
SB44-SSA1,544,54 2. The department may require prior authorization for a selective serotonin
5reuptake inhibitor that is first prescribed for a person on or after March 15, 2004.
SB44-SSA1,544,76 (d) The department may enter into a contract with an entity to perform any of
7the duties and exercise any of the powers of the department under this subsection.
SB44-SSA1, s. 1393c 8Section 1393c. 49.45 (51) of the statutes is created to read:
SB44-SSA1,544,169 49.45 (51) Medical care transportation services. (a) By November 1
10annually, the department shall provide to the department of revenue information
11concerning the estimated amounts of supplements payable from the appropriation
12under s. 20.435 (4) (b) to specific local governmental units for the provision of
13transportation for medical care, as specified under s. 49.46 (2) (b) 3., during the fiscal
14year. Beginning November 1, 2004, the information that the department provides
15under this paragraph shall include any adjustments necessary to reflect actual
16claims submitted by service providers in the previous fiscal year.
SB44-SSA1,544,1917 (b) On the date that is the 3rd Monday in November, the department shall
18annually pay to specific local governmental units the estimated net amounts
19specified in par. (a).
SB44-SSA1, s. 1401 20Section 1401. 49.46 (2) (a) 4. c. of the statutes is amended to read:
SB44-SSA1,544,2221 49.46 (2) (a) 4. c. Skilled nursing home services other than in an institution for
22mental diseases, except as limited under s. 49.45 (6c) and (30m) (b) and (c).
SB44-SSA1, s. 1402 23Section 1402. 49.46 (2) (b) 6. a. of the statutes is amended to read:
SB44-SSA1,544,2524 49.46 (2) (b) 6. a. Intermediate care facility services other than in an institution
25for mental diseases, except as limited under s. 49.45 (30m) (b) and (c).
SB44-SSA1, s. 1403d
1Section 1403d. 49.46 (2) (b) 8. of the statutes is amended to read:
SB44-SSA1,545,52 49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27
3(11), 46.275, 46.277 or 46.278 or, under the family care benefit if a waiver is in effect
4under s. 46.281 (1) (c), or under a waiver requested under 2001 Wisconsin Act 16,
5section 9123 (16rs), or 2003 Wisconsin Act .... (this act), section 9124 (8c)
.
SB44-SSA1, s. 1404 6Section 1404. 49.472 (6) (a) of the statutes is amended to read:
SB44-SSA1,545,127 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account
8under s. 20.435 (4) (b), (gp), or (w), the department shall, on the part of an individual
9who is eligible for medical assistance under sub. (3), pay premiums for or purchase
10individual coverage offered by the individual's employer if the department
11determines that paying the premiums for or purchasing the coverage will not be more
12costly than providing medical assistance.
SB44-SSA1, s. 1405 13Section 1405. 49.472 (6) (b) of the statutes is amended to read:
SB44-SSA1,545,1714 49.472 (6) (b) If federal financial participation is available, from the
15appropriation account under s. 20.435 (4) (b), (gp), or (w), the department may pay
16medicare Part A and Part B premiums for individuals who are eligible for medicare
17and for medical assistance under sub. (3).
SB44-SSA1, s. 1406 18Section 1406. 49.473 (title) of the statutes is amended to read:
SB44-SSA1,545,20 1949.473 (title) Medical assistance; women diagnosed with breast or
20cervical cancer
or precancerous conditions.
SB44-SSA1, s. 1407 21Section 1407. 49.473 (2) (c) of the statutes is amended to read:
SB44-SSA1,545,2422 49.473 (2) (c) The woman is not eligible for health care coverage that qualifies
23as creditable coverage in 42 USC 300gg (c), excluding the coverage specified in 42
24USC 300gg
(c) (1) (F)
.
SB44-SSA1, s. 1408 25Section 1408. 49.473 (2) (e) of the statutes is amended to read:
SB44-SSA1,546,2
149.473 (2) (e) The woman requires treatment for breast or cervical cancer or
2for a precancerous condition of the breast or cervix
.
SB44-SSA1, s. 1409 3Section 1409. 49.473 (5) of the statutes is amended to read:
SB44-SSA1,546,84 49.473 (5) The department shall audit and pay, from the appropriation
5accounts under s. 20.435 (4) (b), (gp), and (o), allowable charges to a provider who is
6certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who
7meets the requirements under sub. (2) for all benefits and services specified under
8s. 49.46 (2).
SB44-SSA1, s. 1410 9Section 1410. 49.473 (6) (b) of the statutes is amended to read:
SB44-SSA1,546,1310 49.473 (6) (b) Inform the woman at the of time of the determination that she
11is required to apply to the department or a county department for medical assistance
12no later than the last day of the month following the month in which the qualified
13entity determines that the woman is eligible for medical assistance.
SB44-SSA1, s. 1412 14Section 1412. 49.496 (4) of the statutes is amended to read:
SB44-SSA1,547,415 49.496 (4) Administration. The department may require a county department
16under s. 46.215, 46.22, or 46.23 or the governing body of a federally recognized
17American Indian tribe administering medical assistance to gather and provide the
18department with information needed to recover medical assistance under this
19section. The department shall pay to a county department or tribal governing body
20an amount equal to 5% of the recovery collected by the department relating to a
21beneficiary for whom the county department or tribal governing body made the last
22determination of medical assistance eligibility. A county department or tribal
23governing body may use funds received under this subsection only to pay costs
24incurred under this subsection and, if any amount remains, to pay for improvements
25to functions required under s. 49.33 49.78 (2). The department may withhold

1payments under this subsection for failure to comply with the department's
2requirements under this subsection. The department shall treat payments made
3under this subsection as costs of administration of the medical assistance Medical
4Assistance
program.
SB44-SSA1, s. 1413 5Section 1413. 49.498 (16) (g) of the statutes is amended to read:
SB44-SSA1,547,146 49.498 (16) (g) All forfeitures, penalty assessments , and interest, if any, shall
7be paid to the department within 10 days of receipt of notice of assessment or, if the
8forfeiture, penalty assessment, and interest, if any, are contested under par. (f),
9within 10 days of receipt of the final decision after exhaustion of administrative
10review, unless the final decision is appealed and the order is stayed by court order
11under sub. (19) (b). The department shall remit all forfeitures paid to the state
12treasurer
secretary of administration for deposit in the school fund. The department
13shall deposit all penalty assessments and interest in the appropriation under s.
1420.435 (6) (g).
SB44-SSA1, s. 1414 15Section 1414. 49.665 (2) (title) of the statutes is amended to read:
SB44-SSA1,547,1616 49.665 (2) (title) Waiver Waivers.
SB44-SSA1, s. 1415 17Section 1415. 49.665 (2) of the statutes is renumbered 49.665 (2) (a) and
18amended to read:
SB44-SSA1,548,319 49.665 (2) (a) The department of health and family services shall request a
20waiver from the secretary of the federal department of health and human services
21to permit the department of health and family services to implement, beginning not
22later than July 1, 1998, or the effective date of the waiver, whichever is later, a health
23care program under this section. If a waiver that is consistent with all of the
24provisions of this section, excluding sub. (4) (a) 3m., is granted and in effect, the
25department of health and family services shall implement the program under this

1section. The department of health and family services may not implement the
2program under this section unless a waiver that is consistent with all of the
3provisions of this section, excluding sub. (4) (a) 3m., is granted and in effect.
SB44-SSA1, s. 1416 4Section 1416. 49.665 (2) (b) of the statutes is created to read:
SB44-SSA1,548,145 49.665 (2) (b) If the department of health and family services determines that
6it needs a waiver to require the verification specified in sub. (4) (a) 3m., the
7department shall request a waiver from the secretary of the federal department of
8health and human services and may not implement the verification requirement
9under sub. (4) (a) 3m. unless the waiver is granted. If a waiver is required and is
10granted, the department of health and family services may implement the
11verification requirement under sub. (4) (a) 3m. as appropriate. If a waiver is not
12required, the department of health and family services may require the verification
13specified in sub. (4) (a) 3m. for eligibility determinations and annual review
14eligibility determinations made by the department, beginning on January 1, 2004.
SB44-SSA1, s. 1417 15Section 1417. 49.665 (4) (a) 3m. of the statutes is created to read:
SB44-SSA1,548,2116 49.665 (4) (a) 3m. Each member of the family who is employed provides
17verification from his or her employer, in the manner specified by the department, of
18his or her earnings, of whether the employer provides health care coverage for which
19the family is eligible, and of the amount that the employer pays, if any, towards the
20cost of the health care coverage, excluding any deductibles or copayments required
21under the coverage.
SB44-SSA1, s. 1419 22Section 1419. 49.665 (5) (a) of the statutes is renumbered 49.665 (5) (ag) and
23amended to read:
SB44-SSA1,549,1924 49.665 (5) (ag) Except as provided in pars. (am), (b), and (bm), a family, or child
25who does not reside with his or her parent, who receives health care coverage under

1this section shall pay a percentage of the cost of that coverage in accordance with a
2schedule established by the department by rule. If the schedule established by the
3department requires a family, or child who does not reside with his or her parent, to
4contribute more than 3% of the family's or child's income towards the cost of the
5health care coverage provided under this section, the department shall submit the
6schedule to the joint committee on finance for review and approval of the schedule.
7If the cochairpersons of the joint committee on finance do not notify the department
8within 14 working days after the date of the department's submittal of the schedule
9that the committee has scheduled a meeting to review the schedule, the department
10may implement the schedule. If, within 14 days after the date of the department's
11submittal of the schedule, the cochairpersons of the committee notify the department
12that the committee has scheduled a meeting to review the schedule, the department
13may not require a family, or child who does not reside with his or her parent, to
14contribute more than 3% of the family's or child's income unless the joint committee
15on finance approves the schedule. The joint committee on finance may not approve
16and the department may not implement a schedule that requires a family or child
17to contribute, including the amounts required under par. (am), more than 3.5% of the
18family's or child's income towards the cost of the health care coverage provided under
19this section.
SB44-SSA1, s. 1420 20Section 1420. 49.665 (5) (ac) of the statutes is created to read:
SB44-SSA1,549,2321 49.665 (5) (ac) In this subsection, "cost" means total cost-sharing charges,
22including premiums, copayments, coinsurance, deductibles, enrollment fees, and
23any other cost-sharing charges.
SB44-SSA1, s. 1421 24Section 1421. 49.665 (5) (ag) of the statutes, as affected by 2003 Wisconsin Act
25.... (this act), is amended to read:
SB44-SSA1,550,21
149.665 (5) (ag) Except as provided in pars. (am), (b), and (bm), a family, or child
2who does not reside with his or her parent, who receives health care coverage under
3this section shall pay a percentage of the cost of that coverage in accordance with a
4schedule established by the department by rule. If the schedule established by the
5department requires a family, or child who does not reside with his or her parent, to
6contribute more than 3% of the family's or child's income towards the cost of the
7health care coverage provided under this section, the department shall submit the
8schedule to the joint committee on finance for review and approval of the schedule.
9If the cochairpersons of the joint committee on finance do not notify the department
10within 14 working days after the date of the department's submittal of the schedule
11that the committee has scheduled a meeting to review the schedule, the department
12may implement the schedule. If, within 14 days after the date of the department's
13submittal of the schedule, the cochairpersons of the committee notify the department
14that the committee has scheduled a meeting to review the schedule, the department
15may not require a family, or child who does not reside with his or her parent, to
16contribute more than 3% of the family's or child's income unless the joint committee
17on finance approves the schedule. The joint committee on finance may not approve
18and the
The department may not establish or implement a schedule that requires a
19family or child to contribute, including the amounts required under par. (am), more
20than 3.5% 5% of the family's or child's income towards the cost of the health care
21coverage provided under this section.
SB44-SSA1, s. 1422 22Section 1422. 49.665 (5) (am) of the statutes is created to read:
SB44-SSA1,550,2523 49.665 (5) (am) Except as provided in pars. (b) and (bm), a child or family
24member who receives health care coverage under this section shall pay the following
25cost-sharing amounts:
SB44-SSA1,551,2
11. A copayment of $1 for each prescription of a drug that bears only a generic
2name, as defined in s. 450.12 (1) (b).
SB44-SSA1,551,43 2. A copayment of $3 for each prescription of a drug that bears a brand name,
4as defined in s. 450.12 (1) (a).
SB44-SSA1, s. 1423 5Section 1423. 49.68 (3) (a) of the statutes is amended to read:
SB44-SSA1,551,96 49.68 (3) (a) Any Subject to s. 49.687 (1m), any permanent resident of this state
7who suffers from chronic renal disease may be accepted into the dialysis treatment
8phase of the renal disease control program if the resident meets standards set by rule
9under sub. (2) and s. 49.687.
SB44-SSA1, s. 1424 10Section 1424. 49.68 (3) (d) 1. of the statutes is amended to read:
SB44-SSA1,551,2411 49.68 (3) (d) 1. No aid may be granted under this subsection unless the recipient
12has no other form of aid available from the federal medicare program or, from private
13health, accident, sickness, medical, and hospital insurance coverage, or from other
14health care coverage specified by rule under s. 49.687 (1m) (b)
. If insufficient aid is
15available from other sources and if the recipient has paid an amount equal to the
16annual medicare deductible amount specified in subd. 2., the state shall pay the
17difference in cost to a qualified recipient. If at any time sufficient federal or private
18insurance aid or other health care coverage becomes available during the treatment
19period, state aid under this subsection shall be terminated or appropriately reduced.
20Any patient who is eligible for the federal medicare program shall register and pay
21the premium for medicare medical insurance coverage where permitted, and shall
22pay an amount equal to the annual medicare deductible amounts required under 42
23USC 1395e
and 1395L (b), prior to becoming eligible for state aid under this
24subsection
.
SB44-SSA1, s. 1425 25Section 1425. 49.68 (3) (d) 3. of the statutes is created to read:
SB44-SSA1,552,5
149.68 (3) (d) 3. No payment shall be made under this subsection for any portion
2of medical treatment costs or other expenses that are payable under any state,
3federal, or other health care coverage program, including a health care coverage
4program specified by rule under s. 49.687 (1m) (b), or under any grant, contract, or
5other contractual arrangement.
SB44-SSA1, s. 1426 6Section 1426. 49.68 (3) (e) of the statutes is amended to read:
SB44-SSA1,552,197 49.68 (3) (e) State aids for services any service provided under this section shall
8be equal to the lower of the allowable charges charge under the Medical Assistance
9program under subch. IV or
the federal medicare program Medicare program. In no
10case shall state rates for individual service elements exceed the federally defined
11allowable costs. The rate of charges for services not covered by public and private
12insurance shall not exceed the reasonable charges as established by medicare fee
13determination procedures. A person that provides to a patient a service for which
14aid is provided under this section shall accept the amount paid under this section for
15the service as payment in full and may not bill the patient for any amount by which
16the charge for the service exceeds the amount paid for the service under this section.

17The state may not pay for the cost of travel, lodging, or meals for persons who must
18travel to receive inpatient and outpatient dialysis treatment for kidney disease. This
19paragraph shall not apply to donor related costs as defined in par. (b).
SB44-SSA1, s. 1428 20Section 1428. 49.683 (1) of the statutes is amended to read:
SB44-SSA1,552,2421 49.683 (1) The Subject to s. 49.687 (1m), the department may provide financial
22assistance for costs of medical care of persons over the age of 18 years with the
23diagnosis of cystic fibrosis who meet financial requirements established by the
24department by rule under s. 49.687 (1).
SB44-SSA1, s. 1429 25Section 1429. 49.683 (3) of the statutes is created to read:
SB44-SSA1,553,4
149.683 (3) No payment shall be made under this section for any portion of
2medical care costs that are payable under any state, federal, or other health care
3coverage program, including a health care coverage program specified by rule under
4s. 49.687 (1m) (b), or under any grant, contract, or other contractual arrangement.
SB44-SSA1, s. 1430 5Section 1430. 49.685 (6) (b) of the statutes is amended to read:
SB44-SSA1,553,136 49.685 (6) (b) Reimbursement shall not be made under this section for any
7blood products or supplies which that are not purchased from or provided by a
8comprehensive hemophilia treatment center, or a source approved by the treatment
9center. Reimbursement shall not be made under this section for any portion of the
10costs of blood products or supplies which that are payable under any other state or,
11federal program, or other health care coverage program, including a health care
12coverage program specified by rule under s. 49.687 (1m) (b),
or under any grant,
13contract and any, or other contractual arrangement.
SB44-SSA1, s. 1431 14Section 1431. 49.687 (title) of the statutes is amended to read:
SB44-SSA1,553,16 1549.687 (title) Disease aids; patient requirements; rebate agreements;
16cost containment
.
SB44-SSA1, s. 1432 17Section 1432. 49.687 (1) of the statutes is amended to read:
SB44-SSA1,554,818 49.687 (1) The department shall promulgate rules that require a person who
19is eligible for benefits under s. 49.68, 49.683, or 49.685 and whose current estimated
20total family
income exceeds specified limits for the current year is at or above 200%
21of the poverty line
to obligate or expend specified portions of the income for medical
22care for treatment of kidney disease, cystic fibrosis, or hemophilia before receiving
23benefits under s. 49.68, 49.683, or 49.685. The rules shall require a person to pay
240.50% of his or her total family income for the cost of medical treatment covered
25under s. 49.68, 49.683, or 49.685 if that income is from 200% to 250% of the federal

1poverty line, 0.75% if that income is more than 250% but not more than 275% of the
2federal poverty line, 1% if that income is more than 275% but not more than 300%
3of the federal poverty line, 1.25% if that income is more than 300% but not more than
4325% of the federal poverty line, 2% if that income is more than 325% but not more
5than 350% of the federal poverty line, 2.75% if that income is more than 350% but
6not more than 375% of the federal poverty line, 3.5% if that income is more than 375%
7but not more than 400% of the federal poverty line, and 4.5% if that income is more
8than 400% of the federal poverty line.
SB44-SSA1, s. 1433 9Section 1433. 49.687 (1m) of the statutes is created to read:
SB44-SSA1,554,1410 49.687 (1m) (a) A person is not eligible to receive benefits under s. 49.68 or
1149.683 unless before the person applies for benefits under s. 49.68 or 49.683, the
12person first applies for benefits under all other health care coverage programs
13specified by the department by rule under par. (b) for which the person reasonably
14may be eligible.
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