SB40-SSA1,758,11
149.49
(3m) (a) 2. If an applicant is determined to be eligible retroactively under
2s. 49.46 (1) (b)
or 49.47 (4) (d) and a provider bills the applicant directly for services
3and benefits rendered during the retroactive period, the provider shall, upon
4notification of the applicant's retroactive eligibility, submit claims for
5reimbursement payment under s. 49.45 for covered services or benefits rendered
to
6the recipient during the retroactive period. Upon receipt of payment
under s. 49.45,
7the provider shall reimburse the
applicant recipient or other person who has made
8prior payment to the provider
. No provider may be required to reimburse the
9applicant or other person in excess of the amount reimbursed under s. 49.45 for
10services provided to the recipient during the retroactive eligibility period, by the
11amount of the prior payment made.
SB40-SSA1, s. 1633
12Section
1633
. 49.49 (3m) (a) 2. of the statutes, as affected by 2007 Wisconsin
13Act .... (this act), is amended to read:
SB40-SSA1,758,2214
49.49
(3m) (a) 2. If an applicant is determined to be eligible retroactively under
15s. 49.46 (1) (b)
or, 49.47 (4) (d)
, or 49.471 and a provider bills the applicant directly
16for services and benefits rendered during the retroactive period, the provider shall,
17upon notification of the applicant's retroactive eligibility, submit claims for payment
18under s. 49.45 for covered services or benefits rendered to the recipient during the
19retroactive period. Upon receipt of payment under s. 49.45, the provider shall
20reimburse the recipient or other person who has made prior payment to the provider
21for services provided to the recipient during the retroactive eligibility period, by the
22amount of the prior payment made.
SB40-SSA1,759,224
49.49
(3m) (a) 3. Benefits or services for which recipient copayment,
25coinsurance
, or deductible is required under s. 49.45 (18), not to exceed maximum
1amounts allowable under
42 CFR 447.53 to
447.58, or for which recipient copayment
2or coinsurance is required under s. 49.471 (11).
SB40-SSA1, s. 1634r
3Section 1634r. 49.496 (3) (a) (intro.) of the statutes is amended to read:
SB40-SSA1,759,74
49.496
(3) (a) (intro.) Except as provided in par. (b), the department shall file
5a claim against the estate of a recipient for all of the following
, subject to the exclusion
6of any amounts under the Long-Term Care Partnership Program established under
7s. 49.45 (31), unless already recovered by the department under this section:
SB40-SSA1,759,10
949.497 (title)
Recovery of incorrect Medical Assistance or Badger Care
10payments and of unpaid employer penalties.
SB40-SSA1,759,2212
49.497
(1r) (a) The department may recover any penalty assessment not paid
13under s. 49.471 (9) (c) from the employer against which the penalty was assessed.
14If, after notice that payment of a penalty is overdue, the employer who is liable fails
15to pay the penalty amount, or enter into or comply with an agreement for payment,
16the department may bring an action to enforce the liability or may issue an order to
17compel payment of the liability. Any person aggrieved by an order issued by the
18department under this paragraph may appeal the order as a contested case under
19ch. 227 by filing with the department a request for a hearing within 30 days after the
20date of the order. The only issue at the hearing shall be the determination by the
21department that the person has not paid the penalty or entered into, or complied
22with, an agreement for payment.
SB40-SSA1,760,723
(b) If any employer named in an order to compel payment issued under par. (a)
24fails to pay the department any amount due under the terms of the order and no
25contested case to review the order is pending and the time for filing for a contested
1case review has expired, the department may present a certified copy of the order to
2the circuit court for any county. The sworn statement of the secretary shall be
3evidence of the failure to pay the penalty. The circuit court shall, without notice,
4render judgment in accordance with the order. A judgment rendered under this
5paragraph shall have the same effect and shall be entered in the judgment and lien
6docket and may be enforced in the same manner as if the judgment had been
7rendered in an action tried and determined by the circuit court.
SB40-SSA1,760,98
(c) The recovery procedure under this subsection is in addition to any other
9recovery procedure authorized by law.
SB40-SSA1,760,1511
49.497
(4) The department may appear for the state in any and all collection
12matters under this section, and may commence suit in the name of the department
13to recover an incorrect payment from the recipient to whom or on whose behalf it was
14made
or to recover an unpaid penalty from the employer against which the penalty
15was assessed.
SB40-SSA1, s. 1639
17Section
1639. 49.665 (4) (at) 1. a. of the statutes is amended to read:
SB40-SSA1,760,2318
49.665
(4) (at) 1. a. Except as provided in subd. 1. b., the department shall
19establish a lower maximum income level for the initial eligibility determination if
20funding under s. 20.435 (4)
(bc), (jz), (p),
and (x)
, and (xd) is insufficient to
21accommodate the projected enrollment levels for the health care program under this
22section. The adjustment may not be greater than necessary to ensure sufficient
23funding.
SB40-SSA1, s. 1640
24Section
1640. 49.665 (4) (at) 1. cm. of the statutes is amended to read:
SB40-SSA1,761,11
149.665
(4) (at) 1. cm. Notwithstanding s. 20.001 (3) (b), if, after reviewing the
2plan submitted under subd. 1. b., the joint committee on finance determines that the
3amounts appropriated under s. 20.435 (4)
(bc), (jz), (p),
and (x)
, and (xd) are
4insufficient to accommodate the projected enrollment levels, the committee may
5transfer appropriated moneys from the general purpose revenue appropriation
6account of any state agency, as defined in s. 20.001 (1), other than a sum sufficient
7appropriation account, to the appropriation account under s. 20.435 (4)
(bc) (b) to
8supplement the health care program under this section if the committee finds that
9the transfer will eliminate unnecessary duplication of functions, result in more
10efficient and effective methods for performing programs, or more effectively carry out
11legislative intent, and that legislative intent will not be changed by the transfer.
SB40-SSA1,761,1713
49.665
(4) (at) 2. If, after the department has established a lower maximum
14income level under subd. 1., projections indicate that funding under s. 20.435 (4)
(bc), 15(jz), (p),
and (x)
, and (xd) is sufficient to raise the level, the department shall, by state
16plan amendment, raise the maximum income level for initial eligibility, but not to
17exceed 185% of the poverty line.
SB40-SSA1,761,2519
49.665
(4g) Disease management program. Based on the health conditions
20identified by the physical health risk assessments, if performed under sub. (4m), the
21department shall develop and implement, for individuals who are eligible under sub.
22(4), disease management programs that are similar to that developed and followed
23by the Marshfield Clinic in this state under the Physician Group Practice
24Demonstration Program authorized under
42 USC 1315 (e) and (f). These programs
25shall have at least the following characteristics:
SB40-SSA1,762,3
1(a) The use of information science to improve health care delivery by
2summarizing a patient's health status and providing reminders for preventive
3measures.
SB40-SSA1,762,54
(b) Educating health care providers on health care process improvement by
5developing best practice models.
SB40-SSA1,762,86
(c) The improvement and expansion of care management programs to assist in
7standardization of best practices, patient education, support systems, and
8information gathering.
SB40-SSA1,762,109
(d)
Establishment of a system of provider compensation that is aligned with
10clinical quality, practice management, and cost of care.
SB40-SSA1,762,1211
(e) Focus on patient care interventions for certain chronic conditions, to reduce
12hospital admissions.
SB40-SSA1,762,1814
49.665
(4m) Physical health risk assessment. The department shall
15encourage each individual who is determined on or after the effective date of this
16subsection .... [revisor inserts date], to be eligible under sub. (4) to receive a physical
17health risk assessment as part of the first physical examination the individual
18receives under Badger Care.
SB40-SSA1, s. 1642
19Section
1642. 49.665 (5m) of the statutes is repealed and recreated to read:
SB40-SSA1,762,2220
49.665
(5m) Information about Badger Care recipients. The department
21shall obtain and share information about Badger Care health care program
22recipients as provided in s. 49.475.
SB40-SSA1,763,224
49.665
(7) (a) 1. Notwithstanding sub. (4) (a) 3m.
and (ap) 2., the department
25shall mail information verification forms to the employers of the individuals required
1to provide the verifications under sub. (4) (a) 3m.
and (ap) 2. to obtain the information
2specified.
SB40-SSA1,763,94
49.686
(6) Health Insurance Risk-Sharing Plan pilot program. (a) Subject
5to par. (b), the department shall conduct a 3-year pilot program, to begin on October
61, 2007, under which the department may pay premiums for coverage under the
7Health Insurance Risk-Sharing Plan under subch. II of ch. 149, and pay copayments
8under that plan for prescription drugs for which reimbursement may be provided
9under sub. (2), for individuals who satisfy all of the following:
SB40-SSA1,763,1010
1. The individuals are eligible for reimbursement under this section.
SB40-SSA1,763,1111
2. The individuals are currently taking antiretroviral drugs.
SB40-SSA1,763,1212
3. The individuals do not have health insurance coverage.
SB40-SSA1,763,1613
4. The individuals are not eligible for premium subsidies under s. 252.16 or
14252.17 because they are not on unpaid medical leave, are not unable to continue
15employment, and have not had to reduce their employment hours because of an
16illness or medical condition arising from or related to HIV.
SB40-SSA1,763,1817
(b) The pilot program shall be open to a minimum of 100 participants, with
18more participants if the department determines that it is cost-effective.
SB40-SSA1,763,2119
(c) The department may promulgate rules for the administration of the pilot
20program. Notwithstanding s. 227.24 (3), rules under this paragraph may be
21promulgated as emergency rules under s. 227.24 without a finding of emergency.
SB40-SSA1,763,2523
49.687
(6) The department shall obtain and share information about
24individuals who receive benefits under s. 49.68, 49.683, or 49.685 as provided in s.
2549.475.
SB40-SSA1, s. 1651
1Section
1651. 49.688 (5) (a) (intro.) of the statutes is amended to read:
SB40-SSA1,764,72
49.688
(5) (a) (intro.) Beginning on September 1, 2002, except as provided in
3sub. (7) (b), as a condition of participation by a pharmacy or pharmacist in the
4program under s. 49.45, 49.46,
or 49.47
, or 49.471, the pharmacy or pharmacist may
5not charge a person who presents a valid prescription order and a card indicating
6that he or she meets eligibility requirements under sub. (2) an amount for a
7prescription drug under the order that exceeds the following:
SB40-SSA1,764,259
49.688
(7) (a) Except as provided in par. (b), from the appropriation accounts
10under s. 20.435 (4) (bv), (j),
and (pg)
, and (xh), beginning on September 1, 2002, the
11department shall, under a schedule that is identical to that used by the department
12for payment of pharmacy provider claims under medical assistance, provide to
13pharmacies and pharmacists payments for prescription drugs sold by the
14pharmacies or pharmacists to persons eligible under sub. (2) who have paid the
15deductible specified under sub. (3) (b) 1. or 2. or who, under sub. (3) (b) 1., are not
16required to pay a deductible. The payment for each prescription drug under this
17paragraph shall be at the program payment rate, minus any copayment paid by the
18person under sub. (5) (a) 2. or 4., and plus, if applicable, incentive payments that are
19similar to those provided under s. 49.45 (8v). The department shall devise and
20distribute a claim form for use by pharmacies and pharmacists under this paragraph
21and may limit payment under this paragraph to those prescription drugs for which
22payment claims are submitted by pharmacists or pharmacies directly to the
23department. The department may apply to the program under this section the same
24utilization and cost control procedures that apply under rules promulgated by the
25department to medical assistance under subch. IV of ch. 49.
SB40-SSA1,765,92
49.688
(7) (b) During any period in which funding under s. 20.435 (4) (bv)
and, 3(pg)
, and (xh) is completely expended for the payments specified in par. (a), the
4requirements of par. (a) and subs. (3) (c), (5), and (6) (a) and (b) do not apply to drugs
5purchased during that period, but the department shall continue to accept
6applications and determine eligibility under sub. (4) and shall indicate to applicants
7that the eligibility of program participants to purchase prescription drugs as
8specified in sub. (3), under the requirements of sub. (5), is conditioned on the
9availability of funding under s. 20.435 (4) (bv)
and, (pg)
, and (xh).
SB40-SSA1, s. 1655
10Section
1655. 49.688 (8m) of the statutes is repealed and recreated to read:
SB40-SSA1,765,1211
49.688
(8m) The department shall obtain and share information about
12participants in the program under this section as provided in s. 49.475.
SB40-SSA1,765,2214
49.775
(2) (bm) The custodial parent assigns to the state any right of the
15custodial parent or of the dependent child to support from any other person. No
16amount of support that begins to accrue after the individual ceases to receive
17payments under this section may be considered assigned to the state. Any money
18that is received by the department of
workforce development children and families 19under an assignment to the state under this paragraph and that is not the federal
20share of support shall be paid to the custodial parent. The department of
workforce
21development children and families shall pay the federal share of support assigned
22under this paragraph as required under federal law or waiver.
SB40-SSA1,766,524
49.78
(4) Rules; merit system. The department of
workforce development 25children and families shall promulgate rules for the efficient administration of aid
1to families with dependent children in agreement with the requirement for federal
2aid, including the establishment and maintenance of personnel standards on a merit
3basis. The provisions of this section relating to personnel standards on a merit basis
4supersede any inconsistent provisions of any law relating to county personnel. This
5subsection shall not be construed to invalidate the provisions of s. 46.22 (1) (d).
SB40-SSA1,766,147
49.78
(5) Personnel examinations. Statewide examinations to ascertain
8qualifications of applicants in any county department administering aid to families
9with dependent children shall be given by the administrator of the division of merit
10recruitment and selection in the office of state employment relations. The office of
11state employment relations shall be reimbursed for actual expenditures incurred in
12the performance of its functions under this section from the appropriations available
13to the department of
health and family services children and families for
14administrative expenditures.
SB40-SSA1,766,2116
49.78
(7) County personnel systems. Pursuant to rules promulgated under
17sub. (4), the department of
workforce development
children and families where
18requested by the county shall delegate to that county, without restriction because of
19enumeration, any or all of the
authority of the department of
workforce
20development's authority children and families under sub. (4) to establish and
21maintain personnel standards including salary levels.
SB40-SSA1, s. 1660
22Section
1660. 49.785 (1) (intro.) of the statutes is amended to read:
SB40-SSA1,767,523
49.785
(1) (intro.) Except as provided in sub. (1m), if any recipient
of benefits
24under s. 49.148, 49.46 or 49.77, or under 42 USC 1381 to 1385 in effect on
25May 8, 1980, specified in sub. (1c) dies and the estate of the deceased recipient is
1insufficient to pay the funeral, burial
, and cemetery expenses of the deceased
2recipient, the county or applicable tribal governing body or organization responsible
3for burial of the recipient shall pay, to the person designated by the county
4department under s. 46.215, 46.22
, or 46.23 or applicable tribal governing body or
5organization responsible for the burial of the recipient, all of the following:
SB40-SSA1,767,77
49.785
(1c) All of the following are eligible recipients under this section:
SB40-SSA1,767,98(a) A recipient of benefits under s. 49.148, 49.46, or 49.77, or under
42 USC 1381 9to
1385 in effect on May 8, 1980.
SB40-SSA1,767,1010
(b) A recipient of benefits under s. 49.471 who is any of the following:
SB40-SSA1,767,1211
1. A pregnant woman or a child under 6 years of age with a family income not
12exceeding 185 percent of the poverty line at the time of death.
SB40-SSA1,767,1413
2. A child at least 6 years of age but less than 19 years of age with a family
14income not exceeding 100 percent of the poverty line at the time of death.
SB40-SSA1,767,1615
3. A parent or caretaker relative with a family income not exceeding 50 percent
16of the poverty line at the time of death.
SB40-SSA1,767,2221
49.79
(1) (g) "Wisconsin Works employment position" has the meaning given
22in s. 49.141 (1) (r).
SB40-SSA1,768,4
149.79
(8m) Applicants from correctional institutions. (a) The department
2shall allow a prisoner who is applying for the food stamp program from a correctional
3institution in anticipation of being released from the institution to use the address
4of the correctional institution as his or her address on the application.
SB40-SSA1,768,85
(b) The department shall allow an employee of a correctional institution who
6has been authorized by a prisoner of the institution to act on his or her behalf in
7matters related to the food stamp program to receive and conduct telephone calls on
8behalf of the prisoner in matters related to the food stamp program.
SB40-SSA1, s. 1668
9Section
1668. 49.79 (9) (a) 2. of the statutes, as affected by 2007 Wisconsin Act
10.... (this act), is amended to read:
SB40-SSA1,768,1411
49.79
(9) (a) 2. The department may not require an individual who is a recipient
12under the food stamp program and who is the caretaker of a child under the age of
1312 26 weeks to participate in any employment and training program under this
14subsection.
SB40-SSA1,768,21
1749.81 Public assistance recipients' bill of rights. (intro.) The department
18of health and family services, the department of
workforce development children and
19families, and all public assistance and relief-granting agencies shall respect rights
20for recipients of public assistance. The rights shall include all rights guaranteed by
21the U.S. constitution and the constitution of this state, and in addition shall include:
SB40-SSA1,769,223
49.81
(4) The right to a speedy determination of the recipient's status or
24eligibility for public assistance, to notice of any proposed change in such status or
1eligibility, and, in the case of assistance granted under s. 49.19, 49.46, 49.468
or, 249.47
, or 49.471, to a speedy appeals process for resolving contested determinations.
SB40-SSA1,769,134
49.82
(1) Departments to advise counties. The department of health and
5family services and the department of
workforce development children and families 6shall advise all county officers charged with the administration of requirements
7relating to public assistance programs under this chapter and shall render all
8possible assistance in securing compliance therewith, including the preparation of
9necessary forms and reports. The department of health and family services and the
10department of
workforce development children and families shall also publish any
11information that those departments consider advisable to acquaint persons entitled
12to public assistance, and the public generally, with the laws governing public
13assistance under this chapter.