Amendment SSA1-SB40

SB40-SSA1,757,16 49.485 False claims. Whoever knowingly presents or causes to be presented to any officer, employee, or agent of this state a false claim for medical assistance shall forfeit not less than $5,000 nor more than $10,000, plus 3 times the amount of the damages that were sustained by the state or would have been sustained by the state, whichever is greater, as a result of the false claim. The attorney general may bring an action on behalf of the state to recover any forfeiture incurred under this section.

SB40-SSA1, s. 1630 Section 1630. 49.49 (3m) (a) (intro.) of the statutes is amended to read:

SB40-SSA1,757,21 49.49 (3m) (a) (intro.) No provider may knowingly impose upon a recipient charges in addition to payments received for services under ss. 49.45 to 49.47 49.471 or knowingly impose direct charges upon a recipient in lieu of obtaining payment under ss. 49.45 to 49.47 49.471 except under the following conditions:

SB40-SSA1, s. 1631 Section 1631. 49.49 (3m) (a) 1. of the statutes is amended to read:

SB40-SSA1,757,24 49.49 (3m) (a) 1. Benefits or services are not provided under s. 49.46 (2) or 49.471 (11) and the recipient is advised of this fact prior to receiving the service.

SB40-SSA1, s. 1632 Section 1632. 49.49 (3m) (a) 2. of the statutes is amended to read:

SB40-SSA1,758,11 49.49 (3m) (a) 2. If an applicant is determined to be eligible retroactively under s. 49.46 (1) (b) or 49.47 (4) (d) and a provider bills the applicant directly for services and benefits rendered during the retroactive period, the provider shall, upon notification of the applicant's retroactive eligibility, submit claims for reimbursement payment under s. 49.45 for covered services or benefits rendered to the recipient during the retroactive period. Upon receipt of payment under s. 49.45, the provider shall reimburse the applicant recipient or other person who has made prior payment to the provider. No provider may be required to reimburse the applicant or other person in excess of the amount reimbursed under s. 49.45 for services provided to the recipient during the retroactive eligibility period, by the amount of the prior payment made.

SB40-SSA1, s. 1633 Section 1633 . 49.49 (3m) (a) 2. of the statutes, as affected by 2007 Wisconsin Act .... (this act), is amended to read:

SB40-SSA1,758,22 49.49 (3m) (a) 2. If an applicant is determined to be eligible retroactively under s. 49.46 (1) (b) or, 49.47 (4) (d), or 49.471 and a provider bills the applicant directly for services and benefits rendered during the retroactive period, the provider shall, upon notification of the applicant's retroactive eligibility, submit claims for payment under s. 49.45 for covered services or benefits rendered to the recipient during the retroactive period. Upon receipt of payment under s. 49.45, the provider shall reimburse the recipient or other person who has made prior payment to the provider for services provided to the recipient during the retroactive eligibility period, by the amount of the prior payment made.

SB40-SSA1, s. 1634 Section 1634 . 49.49 (3m) (a) 3. of the statutes is amended to read:

SB40-SSA1,759,2 49.49 (3m) (a) 3. Benefits or services for which recipient copayment, coinsurance, or deductible is required under s. 49.45 (18), not to exceed maximum amounts allowable under 42 CFR 447.53 to 447.58, or for which recipient copayment or coinsurance is required under s. 49.471 (11).

SB40-SSA1, s. 1634r Section 1634r. 49.496 (3) (a) (intro.) of the statutes is amended to read:

SB40-SSA1,759,7 49.496 (3) (a) (intro.) Except as provided in par. (b), the department shall file a claim against the estate of a recipient for all of the following , subject to the exclusion of any amounts under the Long-Term Care Partnership Program established under s. 49.45 (31), unless already recovered by the department under this section:

SB40-SSA1, s. 1635 Section 1635. 49.497 (title) of the statutes is amended to read:

SB40-SSA1,759,10 49.497 (title) Recovery of incorrect Medical Assistance or Badger Care payments and of unpaid employer penalties.

SB40-SSA1, s. 1636 Section 1636. 49.497 (1r) of the statutes is created to read:

SB40-SSA1,759,22 49.497 (1r) (a) The department may recover any penalty assessment not paid under s. 49.471 (9) (c) from the employer against which the penalty was assessed. If, after notice that payment of a penalty is overdue, the employer who is liable fails to pay the penalty amount, or enter into or comply with an agreement for payment, 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 the hearing shall be the determination by the department that the person has not paid the penalty or entered into, or complied with, an agreement for payment.

SB40-SSA1,760,7 (b) If any employer 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 failure to pay the penalty. 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.

SB40-SSA1,760,9 (c) The recovery procedure under this subsection is in addition to any other recovery procedure authorized by law.

SB40-SSA1, s. 1637 Section 1637. 49.497 (4) of the statutes is amended to read:

SB40-SSA1,760,15 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 or to recover an unpaid penalty from the employer against which the penalty was assessed.

SB40-SSA1, s. 1638 Section 1638. 49.665 (4) (ap) 2. of the statutes is repealed.

SB40-SSA1, s. 1639 Section 1639. 49.665 (4) (at) 1. a. of the statutes is amended to read:

SB40-SSA1,760,23 49.665 (4) (at) 1. a. Except as provided in subd. 1. b., the department shall establish a lower maximum income level for the initial eligibility determination if funding under s. 20.435 (4) (bc), (jz), (p), and (x), and (xd) is insufficient to accommodate the projected enrollment levels for the health care program under this section. The adjustment may not be greater than necessary to ensure sufficient funding.

SB40-SSA1, s. 1640 Section 1640. 49.665 (4) (at) 1. cm. of the statutes is amended to read:

SB40-SSA1,761,11 49.665 (4) (at) 1. cm. Notwithstanding s. 20.001 (3) (b), if, after reviewing the plan submitted under subd. 1. b., the joint committee on finance determines that the amounts appropriated under s. 20.435 (4) (bc), (jz), (p), and (x), and (xd) are insufficient to accommodate the projected enrollment levels, the committee may transfer appropriated moneys from the general purpose revenue appropriation account of any state agency, as defined in s. 20.001 (1), other than a sum sufficient appropriation account, to the appropriation account under s. 20.435 (4) (bc) (b) to supplement the health care program under this section if the committee finds that the transfer will eliminate unnecessary duplication of functions, result in more efficient and effective methods for performing programs, or more effectively carry out legislative intent, and that legislative intent will not be changed by the transfer.

SB40-SSA1, s. 1641 Section 1641. 49.665 (4) (at) 2. of the statutes is amended to read:

SB40-SSA1,761,17 49.665 (4) (at) 2. If, after the department has established a lower maximum income level under subd. 1., projections indicate that funding under s. 20.435 (4) (bc), (jz), (p), and (x), and (xd) is sufficient to raise the level, the department shall, by state plan amendment, raise the maximum income level for initial eligibility, but not to exceed 185% of the poverty line.

SB40-SSA1, s. 1641d Section 1641d. 49.665 (4g) of the statutes is created to read:

SB40-SSA1,761,25 49.665 (4g) Disease management program. Based on the health conditions identified by the physical health risk assessments, if performed under sub. (4m), the department shall develop and implement, for individuals who are eligible under sub. (4), disease management programs that are similar to that developed and followed by the Marshfield Clinic in this state under the Physician Group Practice Demonstration Program authorized under 42 USC 1315 (e) and (f). These programs shall have at least the following characteristics:

SB40-SSA1,762,3 (a) The use of information science to improve health care delivery by summarizing a patient's health status and providing reminders for preventive measures.

SB40-SSA1,762,5 (b) Educating health care providers on health care process improvement by developing best practice models.

SB40-SSA1,762,8 (c) The improvement and expansion of care management programs to assist in standardization of best practices, patient education, support systems, and information gathering.

SB40-SSA1,762,10 (d) Establishment of a system of provider compensation that is aligned with clinical quality, practice management, and cost of care.

SB40-SSA1,762,12 (e) Focus on patient care interventions for certain chronic conditions, to reduce hospital admissions.

SB40-SSA1, s. 1641e Section 1641e. 49.665 (4m) of the statutes is created to read:

SB40-SSA1,762,18 49.665 (4m) Physical health risk assessment. The department shall encourage each individual who is determined on or after the effective date of this subsection .... [revisor inserts date], to be eligible under sub. (4) to receive a physical health risk assessment as part of the first physical examination the individual receives under Badger Care.

SB40-SSA1, s. 1642 Section 1642. 49.665 (5m) of the statutes is repealed and recreated to read:

SB40-SSA1,762,22 49.665 (5m) Information about Badger Care recipients. The department shall obtain and share information about Badger Care health care program recipients as provided in s. 49.475.

SB40-SSA1, s. 1644 Section 1644. 49.665 (7) (a) 1. of the statutes is amended to read:

SB40-SSA1,763,2 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.

SB40-SSA1, s. 1646 Section 1646. 49.686 (6) of the statutes is created to read:

SB40-SSA1,763,9 49.686 (6) Health Insurance Risk-Sharing Plan pilot program. (a) Subject to par. (b), the department shall conduct a 3-year pilot program, to begin on October 1, 2007, under which the department may pay premiums for coverage under the Health Insurance Risk-Sharing Plan under subch. II of ch. 149, and pay copayments under that plan for prescription drugs for which reimbursement may be provided under sub. (2), for individuals who satisfy all of the following:

SB40-SSA1,763,10 1. The individuals are eligible for reimbursement under this section.

SB40-SSA1,763,11 2. The individuals are currently taking antiretroviral drugs.

SB40-SSA1,763,12 3. The individuals do not have health insurance coverage.

SB40-SSA1,763,16 4. The individuals are not eligible for premium subsidies under s. 252.16 or 252.17 because they are not on unpaid medical leave, are not unable to continue employment, and have not had to reduce their employment hours because of an illness or medical condition arising from or related to HIV.

SB40-SSA1,763,18 (b) The pilot program shall be open to a minimum of 100 participants, with more participants if the department determines that it is cost-effective.

SB40-SSA1,763,21 (c) The department may promulgate rules for the administration of the pilot program. Notwithstanding s. 227.24 (3), rules under this paragraph may be promulgated as emergency rules under s. 227.24 without a finding of emergency.

SB40-SSA1, s. 1650 Section 1650. 49.687 (6) of the statutes is created to read:

SB40-SSA1,763,25 49.687 (6) The department shall obtain and share information about individuals who receive benefits under s. 49.68, 49.683, or 49.685 as provided in s. 49.475.

SB40-SSA1, s. 1651 Section 1651. 49.688 (5) (a) (intro.) of the statutes is amended to read:

SB40-SSA1,764,7 49.688 (5) (a) (intro.) Beginning on September 1, 2002, except as provided in sub. (7) (b), as a condition of participation by a pharmacy or pharmacist in the program under s. 49.45, 49.46, or 49.47, or 49.471, 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:

SB40-SSA1, s. 1652 Section 1652. 49.688 (7) (a) of the statutes is amended to read:

SB40-SSA1,764,25 49.688 (7) (a) Except as provided in par. (b), from the appropriation accounts under s. 20.435 (4) (bv), (j), and (pg), and (xh), beginning on 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 paragraph 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 paragraph and may limit payment under this paragraph 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.

SB40-SSA1, s. 1653 Section 1653. 49.688 (7) (b) of the statutes is amended to read:

SB40-SSA1,765,9 49.688 (7) (b) During any period in which funding under s. 20.435 (4) (bv) and, (pg), and (xh) is completely expended for the payments specified in par. (a), the requirements of par. (a) and subs. (3) (c), (5), and (6) (a) and (b) do not apply to drugs purchased during that period, but the department shall continue to accept applications and determine eligibility under sub. (4) and shall indicate to applicants that the eligibility of program participants to purchase prescription drugs as specified in sub. (3), under the requirements of sub. (5), is conditioned on the availability of funding under s. 20.435 (4) (bv) and, (pg), and (xh).

SB40-SSA1, s. 1655 Section 1655. 49.688 (8m) of the statutes is repealed and recreated to read:

SB40-SSA1,765,12 49.688 (8m) The department shall obtain and share information about participants in the program under this section as provided in s. 49.475.

SB40-SSA1, s. 1656 Section 1656. 49.775 (2) (bm) of the statutes is amended to read:

SB40-SSA1,765,22 49.775 (2) (bm) The custodial parent assigns to the state any right of the custodial parent or of the dependent child to support from any other person. No amount of support that begins to accrue after the individual ceases to receive payments under this section may be considered assigned to the state. Any money that is received by the department of workforce development children and families under an assignment to the state under this paragraph and that is not the federal share of support shall be paid to the custodial parent. The department of workforce development children and families shall pay the federal share of support assigned under this paragraph as required under federal law or waiver.

SB40-SSA1, s. 1657 Section 1657. 49.78 (4) of the statutes is amended to read:

SB40-SSA1,766,5 49.78 (4) Rules; merit system. The department of workforce development children and families shall promulgate rules for the efficient administration of aid to families with dependent children in agreement with the requirement for federal aid, including the establishment and maintenance of personnel standards on a merit basis. The provisions of this section relating to personnel standards on a merit basis supersede any inconsistent provisions of any law relating to county personnel. This subsection shall not be construed to invalidate the provisions of s. 46.22 (1) (d).

SB40-SSA1, s. 1658 Section 1658. 49.78 (5) of the statutes is amended to read:

SB40-SSA1,766,14 49.78 (5) Personnel examinations. Statewide examinations to ascertain qualifications of applicants in any county department administering aid to families with dependent children shall be given by the administrator of the division of merit recruitment and selection in the office of state employment relations. The office of state employment relations shall be reimbursed for actual expenditures incurred in the performance of its functions under this section from the appropriations available to the department of health and family services children and families for administrative expenditures.

SB40-SSA1, s. 1659 Section 1659. 49.78 (7) of the statutes is amended to read:

SB40-SSA1,766,21 49.78 (7) County personnel systems. Pursuant to rules promulgated under sub. (4), the department of workforce development children and families where requested by the county shall delegate to that county, without restriction because of enumeration, any or all of the authority of the department of workforce development's authority children and families under sub. (4) to establish and maintain personnel standards including salary levels.

SB40-SSA1, s. 1660 Section 1660. 49.785 (1) (intro.) of the statutes is amended to read:

SB40-SSA1,767,5 49.785 (1) (intro.) Except as provided in sub. (1m), if any recipient of benefits under s. 49.148, 49.46 or 49.77, or under 42 USC 1381 to 1385 in effect on May 8, 1980, specified in sub. (1c) dies and the estate of the deceased recipient is insufficient to pay the funeral, burial, and cemetery expenses of the deceased recipient, the county or applicable tribal governing body or organization responsible for burial of the recipient shall pay, to the person designated by the county department under s. 46.215, 46.22, or 46.23 or applicable tribal governing body or organization responsible for the burial of the recipient, all of the following:

SB40-SSA1, s. 1661 Section 1661. 49.785 (1c) of the statutes is created to read:

SB40-SSA1,767,7 49.785 (1c) All of the following are eligible recipients under this section:

SB40-SSA1,767,9 (a) A recipient of benefits under s. 49.148, 49.46, or 49.77, or under 42 USC 1381 to 1385 in effect on May 8, 1980.

SB40-SSA1,767,10 (b) A recipient of benefits under s. 49.471 who is any of the following:

SB40-SSA1,767,12 1. A pregnant woman or a child under 6 years of age with a family income not exceeding 185 percent of the poverty line at the time of death.

SB40-SSA1,767,14 2. A child at least 6 years of age but less than 19 years of age with a family income not exceeding 100 percent of the poverty line at the time of death.

SB40-SSA1,767,16 3. A parent or caretaker relative with a family income not exceeding 50 percent of the poverty line at the time of death.

SB40-SSA1, s. 1662 Section 1662. 49.79 (1) (b) of the statutes is repealed.

SB40-SSA1, s. 1663 Section 1663. 49.79 (1) (d) of the statutes is repealed.

SB40-SSA1, s. 1664 Section 1664. 49.79 (1) (e) of the statutes is repealed.

SB40-SSA1, s. 1665 Section 1665. 49.79 (1) (g) of the statutes is created to read:

SB40-SSA1,767,22 49.79 (1) (g) "Wisconsin Works employment position" has the meaning given in s. 49.141 (1) (r).

SB40-SSA1, s. 1666 Section 1666. 49.79 (2) (a) of the statutes is repealed.

SB40-SSA1, s. 1667 Section 1667. 49.79 (2) (b) of the statutes is renumbered 49.79 (2).

SB40-SSA1, s. 1667f Section 1667f. 49.79 (8m) of the statutes is created to read:

SB40-SSA1,768,4 49.79 (8m) Applicants from correctional institutions. (a) The department shall allow a prisoner who is applying for the food stamp program from a correctional institution in anticipation of being released from the institution to use the address of the correctional institution as his or her address on the application.

SB40-SSA1,768,8 (b) The department shall allow an employee of a correctional institution who has been authorized by a prisoner of the institution to act on his or her behalf in matters related to the food stamp program to receive and conduct telephone calls on behalf of the prisoner in matters related to the food stamp program.

SB40-SSA1, s. 1668 Section 1668. 49.79 (9) (a) 2. of the statutes, as affected by 2007 Wisconsin Act .... (this act), is amended to read:

SB40-SSA1,768,14 49.79 (9) (a) 2. The department may not require an individual who is a recipient under the food stamp program and who is the caretaker of a child under the age of 12 26 weeks to participate in any employment and training program under this subsection.

SB40-SSA1, s. 1669 Section 1669. 49.79 (10) of the statutes is repealed.