Amendment ASA1-AB100

AB100-ASA1,499,14 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 subds. subd. 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.

AB100-ASA1, s. 1149f Section 1149f. 49.45 (42m) of the statutes is created to read:

AB100-ASA1,499,22 49.45 (42m) Physical and occupational therapy. (a) If, in authorizing the provision of physical or occupational therapy services under s. 49.46 (2) (b) 6. b., the department authorizes a reduced duration of services from the duration that the provider specifies in the authorization request, the department shall substantiate the reduction that the department made in the duration of the services if the provider of the services requests any additional authorizations for the provision of physical or occupational therapy services to the same individual.

AB100-ASA1,500,2 (b) The division of the department that is responsible for health care financing shall monitor compliance with the requirement under par. (a) in concert with representatives of the Wisconsin Physical Therapy Association and the Wisconsin Occupational Therapy Association.

AB100-ASA1, s. 1150 Section 1150. 49.46 (1) (a) 5. of the statutes is amended to read:

AB100-ASA1,500,6 49.46 (1) (a) 5. Any child in an adoption assistance, foster care, kinship care, long-term kinship care or, treatment foster care, or subsidized guardianship placement under ch. 48 or 938, as determined by the department.

AB100-ASA1, s. 1153 Section 1153. 49.46 (1) (a) 14. of the statutes is amended to read:

AB100-ASA1,500,13 49.46 (1) (a) 14. Any person who would meet the financial and other eligibility requirements for home or community-based services under s. 46.27 (11) or, 46.277, or 46.2785 but for the fact that the person engages in substantial gainful activity under 42 USC 1382c (a) (3), if a waiver under s. 49.45 (38) is in effect or federal law permits federal financial participation for medical assistance coverage of the person and if funding is available for the person under s. 46.27 (11) or, 46.277, or 46.2785.

AB100-ASA1, s. 1154 Section 1154. 49.46 (1) (a) 15. of the statutes is amended to read:

AB100-ASA1,500,17 49.46 (1) (a) 15. Any individual who is infected with tuberculosis and meets the income and resource eligibility requirements for the federal supplemental security Supplemental Security Income program under 42 USC 1381 to 1383d.

AB100-ASA1, s. 1157 Section 1157. 49.46 (2) (b) 8. of the statutes is amended to read:

AB100-ASA1,500,22 49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27 (11), 46.275, 46.277 or, 46.278, or 46.2785, under the family care benefit if a waiver is in effect under s. 46.281 (1) (c), or under a waiver requested under 2001 Wisconsin Act 16, section 9123 (16rs), or 2003 Wisconsin Act 33, section 9124 (8c).

AB100-ASA1, s. 1157j Section 1157j. 49.46 (2) (f) of the statutes is amended to read:

AB100-ASA1,501,3 49.46 (2) (f) Benefits under this subsection or s. 49.45 (27) may not include payment for gastric bypass surgery or gastric stapling surgery unless it is performed because of a medical emergency the procedure is required to be covered under federal medicaid law, as interpreted by the federal centers for medicare and medicaid services.

AB100-ASA1, s. 1158 Section 1158. 49.47 (4) (as) 1. of the statutes is amended to read:

AB100-ASA1,501,9 49.47 (4) (as) 1. The person would meet the financial and other eligibility requirements for home or community-based services under s. 46.27 (11) or, 46.277, or 46.2785 or under the family care benefit if a waiver is in effect under s. 46.281 (1) (c) but for the fact that the person engages in substantial gainful activity under 42 USC 1382c (a) (3).

AB100-ASA1, s. 1159 Section 1159. 49.47 (4) (as) 3. of the statutes is amended to read:

AB100-ASA1,501,13 49.47 (4) (as) 3. Funding is available for the person under s. 46.27 (11) or, 46.277, or 46.2785 or under the family care benefit if a waiver is in effect under s. 46.281 (1) (c).

AB100-ASA1, s. 1167 Section 1167. 49.497 (title) of the statutes is amended to read:

AB100-ASA1,501,16 49.497 (title) Recovery of incorrect medical assistance Medical Assistance or Badger Care payments.

AB100-ASA1, s. 1168 Section 1168. 49.497 (1) of the statutes is renumbered 49.497 (1) (a) (intro.) and amended to read:

AB100-ASA1,501,21 49.497 (1) (a) (intro.) The department may recover any payment made incorrectly for benefits specified under s. 49.46, 49.468 or 49.47 provided under this subchapter or s. 49.665 if the incorrect payment results from any of the following:

AB100-ASA1,501,23 1. A misstatement or omission of fact by a person supplying information in an application for benefits under s. 49.46, 49.468 or 49.47 this subchapter or s. 49.665.

AB100-ASA1,502,2 2. The department may also recover if a medical assistance failure of a Medical Assistance or Badger Care recipient or any other person responsible for giving information on the recipient's behalf fails to report the receipt of income or assets in an amount that would have affected the recipient's eligibility for benefits.

AB100-ASA1,502,9 (b) The department's right of recovery is against any medical assistance Medical Assistance or Badger Care recipient to whom or on whose behalf the incorrect payment was made. The extent of recovery is limited to the amount of the benefits incorrectly granted. The county department under s. 46.215 or 46.22 or the governing body of a federally recognized American Indian tribe administering medical assistance Medical Assistance or Badger Care shall begin recovery actions on behalf of the department according to rules promulgated by the department.

AB100-ASA1, s. 1169 Section 1169. 49.497 (1) (a) 3. of the statutes is created to read:

AB100-ASA1,502,15 49.497 (1) (a) 3. The failure of a Medical Assistance or Badger Care recipient or any other person responsible for giving information on the recipient's behalf to report any change in the recipient's financial or nonfinancial situation or eligibility characteristics that would have affected the recipient's eligibility for benefits or the recipient's cost-sharing requirements.

AB100-ASA1, s. 1170 Section 1170. 49.497 (1m) of the statutes is created to read:

AB100-ASA1,503,2 49.497 (1m) (a) If, after notice that an incorrect payment was made, a recipient, or parent of a minor recipient, who is liable for repayment of an incorrect payment fails to repay the incorrect payment or enter into, or comply with, an agreement for repayment, the department may bring an action to enforce the liability or may issue an order to compel payment of the liability. Any person aggrieved by an order issued by the department under this paragraph may appeal the order as a contested case under ch. 227 by filing with the department a request for a hearing within 30 days after the date of the order. The only issue at hearing shall be the determination by the department that the person has not repaid the incorrect payment or entered into, or complied with, an agreement for repayment.

AB100-ASA1,503,12 (b) If any recipient, or parent of a minor recipient, named in an order to compel payment issued under par. (a) fails to pay the department any amount due under the terms of the order and no contested case to review the order is pending and the time for filing for a contested case review has expired, the department may present a certified copy of the order to the circuit court for any county. The sworn statement of the secretary shall be evidence of the incorrect payment. The circuit court shall, without notice, render judgment in accordance with the order. A judgment rendered under this paragraph shall have the same effect and shall be entered in the judgment and lien docket and may be enforced in the same manner as if the judgment had been rendered in an action tried and determined by the circuit court.

AB100-ASA1,503,14 (c) The recovery procedure under this subsection is in addition to any other recovery procedure authorized by law.

AB100-ASA1, s. 1171 Section 1171. 49.497 (2) of the statutes is amended to read:

AB100-ASA1,503,19 49.497 (2) A county or governing body of a federally recognized American Indian tribe may retain 15% of benefits distributed under s. 49.46, 49.468 or 49.47 provided under this subchapter or s. 49.665 that are recovered under sub. (1) this section due to the efforts of an employee or officer of the county or tribe.

AB100-ASA1, s. 1172 Section 1172. 49.497 (4) of the statutes is created to read:

AB100-ASA1,503,24 49.497 (4) The department may appear for the state in any and all collection matters under this section, and may commence suit in the name of the department to recover an incorrect payment from the recipient to whom or on whose behalf it was made.

AB100-ASA1, s. 1173 Section 1173. 49.497 (5) of the statutes is created to read:

AB100-ASA1,504,3 49.497 (5) The department may make an agreement with a recipient, or parent of a minor recipient, who is liable under sub. (1), providing for repayment of an incorrect payment at a specified rate or amount.

AB100-ASA1, s. 1174 Section 1174. 49.665 (1) (b) of the statutes is amended to read:

AB100-ASA1,504,6 49.665 (1) (b) "Child" means a person who is born and who is under the age of 19.

AB100-ASA1, s. 1175 Section 1175. 49.665 (1) (g) of the statutes is created to read:

AB100-ASA1,504,9 49.665 (1) (g) "Unborn child" means a person from the time of conception until it is born alive.

AB100-ASA1, s. 1176 Section 1176. 49.665 (2) (a) of the statutes is renumbered 49.665 (2) (a) 1. and amended to read:

AB100-ASA1,504,22 49.665 (2) (a) 1. The department of health and family services shall request a waiver from the secretary of the federal department of health and human services to permit the department of health and family services to implement, beginning not later than July 1, 1998, or the effective date of the waiver, whichever is later, a health care program under this section. If a waiver that is consistent with all of the provisions of this section, excluding sub. (4) (a) 3m. and (ap) and provisions related to sub. (4) (ap), is granted and in effect, the department of health and family services shall implement the program under this section, subject to subd. 2. The department of health and family services may not implement the program under this section unless a waiver that is consistent with all of the provisions of this section, excluding sub. (4) (a) 3m. and (ap) and provisions related to sub. (4) (ap), is granted and in effect.

AB100-ASA1, s. 1177 Section 1177. 49.665 (2) (a) 2. of the statutes is created to read:

AB100-ASA1,505,2 49.665 (2) (a) 2. The department may not implement sub. (4) (ap) or provisions related to the coverage under sub. (4) (ap) unless a state plan amendment authorizing the coverage under sub. (4) (ap) is approved by the federal department of health and human services.

AB100-ASA1, s. 1178 Section 1178. 49.665 (3) of the statutes is amended to read:

AB100-ASA1,505,16 49.665 (3) Administration. The Subject to sub. (2) (a) 2., the department shall administer a program to provide the health services and benefits described in s. 49.46 (2) to persons that meet the eligibility requirements specified in sub. (4). The department shall promulgate rules setting forth the application procedures and appeal and grievance procedures. The department may promulgate rules limiting access to the program under this section to defined enrollment periods. The department may also promulgate rules establishing a method by which the department may purchase family coverage offered by the employer of a member of an eligible family or by of a member of a an eligible child's household , or family or individual coverage offered by the employer of an eligible unborn child's mother or her spouse, under circumstances in which the department determines that purchasing that coverage would not be more costly than providing the coverage under this section.

AB100-ASA1, s. 1179 Section 1179. 49.665 (4) (ap) of the statutes is created to read:

AB100-ASA1,505,22 49.665 (4) (ap) An unborn child whose mother is not eligible for health care coverage under par. (a) or (am) or for medical assistance under s. 49.46 or 49.47, except that she may be eligible for benefits under s. 49.45 (27), is eligible for health care coverage under this section, which shall be limited to coverage for prenatal care, if all of the following requirements are met:

AB100-ASA1,506,3 1. The income of the unborn child's mother, mother and her spouse, or mother and her family, whichever is applicable, does not exceed 185 percent of the poverty line, except as provided in par. (at) and except that, if an unborn child is already receiving health care coverage under this section, the applicable specified person or persons may have an income that does not exceed 200 percent of the poverty line. The department shall establish by rule the criteria to be used to determine income.

AB100-ASA1,506,6 2. Each of the following applicable persons who is employed provides verification from his or her employer, in the manner specified by the department, of his or her earnings:

AB100-ASA1,506,7 a. The unborn child's mother.

AB100-ASA1,506,8 b. The spouse of the unborn child's mother.

AB100-ASA1,506,9 c. Members of the unborn child's mother's family.

AB100-ASA1,506,11 3. The unborn child's mother provides medical verification of her pregnancy, in the manner specified by the department.

AB100-ASA1,506,13 4. The unborn child and the mother of the unborn child meet all other requirements established by the department by rule except for any of the following:

AB100-ASA1,506,15 a. The mother is not a U.S. citizen or an alien qualifying for medicaid under 8 USC 1612.

AB100-ASA1,506,16 b. The mother is an inmate of a public institution.

AB100-ASA1,506,18 c. The mother does not provide a social security number, but only if subd. 4. a. applies.

AB100-ASA1, s. 1180 Section 1180. 49.665 (4) (at) 3. of the statutes is amended to read:

AB100-ASA1,506,23 49.665 (4) (at) 3. The department may not adjust the maximum income level of 200% of the poverty line for persons already receiving health care coverage under this section or for applicable persons specified in par. (ap) 1. with respect to an unborn child already receiving health care coverage under this section.

AB100-ASA1, s. 1181 Section 1181. 49.665 (4) (c) of the statutes is amended to read:

AB100-ASA1,507,3 49.665 (4) (c) No person may be denied health care coverage under this section solely because of a health condition of that person or , of any family member of that person, or of the mother of an unborn child.

AB100-ASA1, s. 1182 Section 1182. 49.665 (4) (d) of the statutes is created to read:

AB100-ASA1,507,7 49.665 (4) (d) An unborn child's eligibility for coverage under par. (ap) shall not begin before the first day of the month in which the unborn child's mother provides the medical verification required under par. (ap) 3.

AB100-ASA1, s. 1183 Section 1183. 49.665 (5) (ag) of the statutes is amended to read:

AB100-ASA1,507,17 49.665 (5) (ag) Except as provided in pars. (am), (b), and (bm), a family, or a child who does not reside with his or her parent, or the mother of an unborn child, who receives health care coverage under this section shall pay a percentage of the cost of that coverage in accordance with a schedule established by the department by rule. The department may not establish or implement a schedule that requires a family or child to contribute contribution, including the amounts required under par. (am), of more than 5% of the family's or child's income of the family, child, or applicable persons specified in sub. (4) (ap) 1. towards the cost of the health care coverage provided under this section.

AB100-ASA1, s. 1184 Section 1184. 49.665 (5) (am) (intro.) of the statutes is amended to read:

AB100-ASA1,507,21 49.665 (5) (am) (intro.) Except as provided in pars. (b) and (bm), a child or, a family member, or the mother of an unborn child, who receives health care coverage under this section shall pay the following cost-sharing amounts:

AB100-ASA1, s. 1184c Section 1184c. 49.665 (5) (am) 1. of the statutes is amended to read:

AB100-ASA1,507,24 49.665 (5) (am) 1. A copayment of $1 $3 for each prescription of a drug that bears only a generic name, as defined in s. 450.12 (1) (b).

AB100-ASA1, s. 1185 Section 1185. 49.665 (5) (b) of the statutes is amended to read:

AB100-ASA1,508,4 49.665 (5) (b) The department may not require a family, or child who does not reside with his or her parent, or applicable persons specified in sub. (4) (ap) 1., with an income below 150% of the poverty line, to contribute to the cost of health care coverage provided under this section.

AB100-ASA1, s. 1186 Section 1186. 49.665 (5) (c) of the statutes is amended to read:

AB100-ASA1,508,8 49.665 (5) (c) The department may establish by rule requirements for wage withholding as a means of collecting the a family's or an unborn child's mother's share of the cost of the health care coverage under this section.

AB100-ASA1, s. 1186bc Section 1186bc. 49.665 (7) of the statutes is created to read:

AB100-ASA1,508,13 49.665 (7) Employer verification forms; forfeiture and penalty assessment. (a) 1. Notwithstanding sub. (4) (a) 3m., the department shall mail information verification forms to the employers of the individuals required to provide the verifications under sub. (4) (a) 3m. to obtain the information specified.

AB100-ASA1,508,17 2. An employer that receives a verification form shall complete the form and return it to the department, by mail, with a postmark that is not more than 30 working days after the date on which the department mailed the form to the employer.

AB100-ASA1,508,23 3. As an alternative to the method under subd. 2., an employer may, within 30 working days after the date on which the department mailed the form to the employer, return the completed form to the department by any electronic means approved by the department. The department must be able to determine, or the employer must be able to verify, the date on which the form was sent to the department electronically.

AB100-ASA1,509,3 (b) 1. Subject to subd. 3., an employer that does not comply with the requirements under par. (a) 2. or 3. shall be required to pay a forfeiture of $50 for each verification form not returned in compliance with par. (a) 2. or 3.

AB100-ASA1,509,5 2. Subject to subd. 3., whenever the department imposes a forfeiture under subd. 1., the department shall also levy a penalty assessment of $50.

AB100-ASA1,509,10 3. An employer with fewer than 250 employees may not be required to pay more than $1,000 in forfeitures and penalty assessments under this paragraph in any 6-month period. An employer with 250 or more employees may not be required to pay more than $15,000 in forfeitures and penalty assessments under this paragraph in any 6-month period.

AB100-ASA1,509,13 4. All penalty assessments collected under subd. 2. shall be credited to the appropriation account under s. 20.435 (4) (jz) and all forfeitures collected under subd. 1. shall be credited to the common school fund.

AB100-ASA1,509,17 (c) An employer may contest an assessment of forfeiture or penalty assessment under par. (b) by sending a written request for hearing to the division of hearings and appeals in the department of administration. Proceedings before the division are governed by ch. 227.

AB100-ASA1, s. 1186c Section 1186c. 49.665 (7) (a) 1. of the statutes, as created by 2005 Wisconsin Act .... (this act), is amended to read:

AB100-ASA1,509,23 49.665 (7) (a) 1. Notwithstanding sub. (4) (a) 3m. and (ap) 2., the department shall mail information verification forms to the employers of the individuals required to provide the verifications under sub. (4) (a) 3m. and (ap) 2. to obtain the information specified.

AB100-ASA1, s. 1188 Section 1188. 49.77 (6) of the statutes is created to read:

AB100-ASA1,510,3 49.77 (6) Authority to administer; rules. The department shall administer this section and s. 49.775, and may promulgate rules to guide the administration of eligibility determinations and benefits payments.

AB100-ASA1, s. 1188d Section 1188d. 49.77 (7) of the statutes is created to read: