Amendment SSA1-AB75

AB75-SSA1,618,9 b. A county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437.

AB75-SSA1,618,11 c. A federally recognized American Indian tribe or band certified to provide services to medical assistance beneficiaries.

AB75-SSA1,618,12 d. A home health agency licensed under s. 50.49.

AB75-SSA1,618,14 e. Any other entity certified under sub. (2) (a) 11. to provide personal care services under s. 49.46 (2) (b) 6. j.

AB75-SSA1, s. 1313k Section 1313k. 49.45 (44) of the statutes is amended to read:

AB75-SSA1,619,3 49.45 (44) Prenatal, postpartum and young child care coordination. Providers in Milwaukee County that are certified to provide care coordination services under s. 49.46 (2) (b) 12. may be certified to provide to medical assistance recipients prenatal and postpartum care coordination services and care coordination services for children who have not attained the age of 7. Providers in the city of Racine that are certified to provide care coordination services under s. 49.46 (2) (b) 12. and are participating in a program under s. 253.16 may be certified to provide to medical assistance recipients prenatal and postpartum care coordination services and care coordination services for children who have not attained the age of 2. A provider of those care coordination services shall provide to a person receiving those services the information relating to shaken baby syndrome and impacted babies required under s. 253.15 (6). The department shall provide reimbursement for those care coordination services only if at least one of the following conditions is met:

AB75-SSA1,619,7 (a) The recipient is a resident of Milwaukee County or the city of Racine and has received services under s. 49.46 (2) (b) 12. and is pregnant or has given birth within 8 weeks after the individual ceased to receive services under s. 49.46 (2) (b) 12.

AB75-SSA1,619,9 (b) The recipient is a resident of Milwaukee County or the city of Racine, is pregnant and has received a risk assessment approved by the department.

AB75-SSA1,619,12 (c) The recipient is a resident of Milwaukee County or the city of Racine, has given birth within the 8 weeks immediately preceding the request for services under s. 49.46 (2) (b) 12m. and has received a risk assessment approved by the department.

AB75-SSA1, s. 1314 Section 1314. 49.45 (47) (c) of the statutes is amended to read:

AB75-SSA1,619,16 49.45 (47) (c) The biennial fee for the certification required under par. (b) of an adult day care center is $100 $127. Fees collected under this paragraph shall be credited to the appropriation account under s. 20.435 (6) (jm).

AB75-SSA1, s. 1315 Section 1315. 49.45 (47) (e) of the statutes is created to read:

AB75-SSA1,619,22 49.45 (47) (e) If the department takes enforcement action against an adult day care center for violating a certification requirement established under s. 49.45 (2) (a) 11., and the department subsequently conducts an on-site inspection of the adult day care center to review the adult day care center's action to correct the violation, the department may impose a $200 inspection fee on the adult day care center.

AB75-SSA1, s. 1316 Section 1316. 49.45 (52) of the statutes, as affected by 2009 Wisconsin Act 2, is amended to read:

AB75-SSA1,620,12 49.45 (52) Payment adjustments. Beginning on January 1, 2003, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payment adjustments to county departments under s. 46.215, 46.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01 (4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16, except for services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating in the early intervention program under s. 51.44. Payment adjustments under this subsection shall include the state share of the payments. The total of any payment adjustments under this subsection and Medical Assistance payments made from appropriation accounts under s. 20.435 (4) (b), (o), and (w), may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

AB75-SSA1, s. 1317 Section 1317. 49.45 (54) of the statutes is created to read:

AB75-SSA1,620,25 49.45 (54) Therapy for children participating in the birth to 3 program. (a) Federal share for county expenditures. If a county certifies to the department that the amount the county expended to provide services specified under s. 49.46 (2) (b) 6. b. and c. to children participating in the early intervention program under s. 51.44 exceeds the amount the county received as reimbursement under this section, based on reimbursement rates established by the department for those services, and the federal government pays the state the federal share of Medical Assistance for the amount by which the county expenditures exceed the reimbursement, the department may disburse the federal share to the county. A county that receives moneys under this paragraph shall expend the moneys for early intervention services under s. 51.44 or for services under the disabled children's long-term support program, as defined in s. 46.011 (1g).

AB75-SSA1,621,12 (b) Services provided by special educators. If a county provides services to assess and promote skill acquisition to children who are participating in the early intervention program under s. 51.44 and the services are provided by a special educator who is a certified provider of medical assistance, the department shall reimburse the county the federal share of medical assistance for the county's allowable charges for providing the services. The county shall pay the the remaining expenses for the services. The department shall promulgate rules establishing certification requirements for special educators who provide service under this paragraph, and requirements for county reporting of expenditures for services under this paragraph. A county that receives moneys under this paragraph shall expend the moneys for early intervention services under s. 51.44 or for services under the disabled children's long-term support program, as defined in s. 46.011 (1g).

AB75-SSA1, s. 1318 Section 1318. 49.46 (1) (a) 5. of the statutes is amended to read:

AB75-SSA1,621,16 49.46 (1) (a) 5. Any child in an adoption assistance, foster care, treatment foster care, or subsidized guardianship placement under ch. 48 or 938, as determined by the department.

AB75-SSA1, s. 1319 Section 1319. 49.46 (1) (a) 16. of the statutes is repealed.

AB75-SSA1, s. 1320 Section 1320. 49.46 (1) (d) 1. of the statutes is amended to read:

AB75-SSA1,621,24 49.46 (1) (d) 1. Children who are placed in licensed foster homes or licensed treatment foster homes by the department and who would be eligible for payment of aid to families with dependent children in foster homes or treatment foster homes except that their placement is not made by a county department under s. 46.215, 46.22, or 46.23 will be considered as recipients of aid to families with dependent children.

AB75-SSA1, s. 1321 Section 1321. 49.46 (2) (b) 3. of the statutes is amended to read:

AB75-SSA1,622,6 49.46 (2) (b) 3. Transportation by emergency medical vehicle to obtain emergency medical care, transportation by specialized medical vehicle to obtain medical care including the unloaded travel of the specialized medical vehicle necessary to provide that transportation, or, if authorized in advance by the county department under s. 46.215 or 46.22, transportation by common carrier or private motor vehicle to obtain medical care.

AB75-SSA1, s. 1321r Section 1321r. 49.46 (2) (b) 6. (intro.) of the statutes is amended to read:

AB75-SSA1,622,9 49.46 (2) (b) 6. (intro.) The following services if that, other than under subd. 6. f., fm., k., and Lr., are prescribed by a physician:

AB75-SSA1, s. 1322 Section 1322. 49.46 (2) (b) 6. e. of the statutes is amended to read:

AB75-SSA1,622,15 49.46 (2) (b) 6. e. Inpatient Subject to the limitation under s. 49.45 (30r), inpatient hospital, skilled nursing facility and intermediate care facility services for patients of any institution for mental diseases who are under 21 years of age, are under 22 years of age and who were receiving these services immediately prior to reaching age 21, or are 65 years of age or older.

AB75-SSA1, s. 1323 Section 1323. 49.46 (2) (b) 6. Lo. of the statutes is created to read:

AB75-SSA1,622,18 49.46 (2) (b) 6. Lo. Subject to the limitations under s. 49.45 (30g), community recovery services.

AB75-SSA1, s. 1323c Section 1323c. 49.46 (2) (b) 6. Lr. of the statutes is created to read:

AB75-SSA1,622,21 49.46 (2) (b) 6. Lr. Psychotherapy and alcohol and other drug abuse services, as specified under s. 49.45 (30f).

AB75-SSA1, s. 1324 Section 1324. 49.46 (2) (b) 8. of the statutes is amended to read:

AB75-SSA1,623,2 49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27 (11), 46.275, 46.277, 46.278, or 46.2785, 46.99, or under the family care benefit if a waiver is in effect under s. 46.281 (1d), or under the disabled children's long-term support program, as defined in s. 46.011 (1g).

AB75-SSA1, s. 1325 Section 1325. 49.46 (2) (b) 17. of the statutes is created to read:

AB75-SSA1,623,5 49.46 (2) (b) 17. Services under s. 49.45 (54) (b) for children participating in the early intervention program under s. 51.44, that are provided by a special educator.

AB75-SSA1, s. 1326 Section 1326. 49.46 (2) (d) of the statutes is amended to read:

AB75-SSA1,623,12 49.46 (2) (d) Benefits authorized under this subsection may not include payment for that part of any service payable through 3rd-party liability or any federal, state, county, municipal, or private benefit system to which the beneficiary is entitled. "Benefit system" does not include any public assistance program such as, but not limited to, Hill-Burton benefits under 42 USC 291c (e), in effect on April 30, 1980, or relief funded by a relief block grant.

AB75-SSA1, s. 1327 Section 1327. 49.47 (4) (b) (intro.) of the statutes is amended to read:

AB75-SSA1,623,21 49.47 (4) (b) (intro.) Eligibility exists if the applicant's property, subject to the exclusion of any amounts under the Long-Term Care Partnership Program established under s. 49.45 (31), any amounts in an independence account, as defined in s. 49.472 (1) (c), or any retirement assets that accrued from employment while the applicant was eligible for the community options program under s. 46.27 (11), or any other Medical Assistance program, including deferred compensation or the value of retirement accounts in the Wisconsin Retirement System or under the federal Social Security Act, does not exceed the following:

AB75-SSA1, s. 1328 Section 1328. 49.471 (2) of the statutes is amended to read:

AB75-SSA1,624,15 49.471 (2) Waiver and state plan amendments. The department shall request a waiver from, and submit amendments to the state Medical Assistance plan to, the secretary of the federal department of health and human services to implement BadgerCare Plus. If the state plan amendments are approved and a waiver that is substantially consistent with the provisions of this section, excluding sub. (2m), is granted and in effect, the department shall implement BadgerCare Plus beginning on January 1, 2008, the effective date of the state plan amendments, or the effective date of the waiver, whichever is latest. If the state plan amendments are approved but the terms of approval do not allow for federal funding of the cost of benefits for all or any part of one or more of the eligibility categories under sub. (4) (b), the department may at its discretion pay for the cost of benefits for all or any part of any group for which federal funding was denied exclusively with moneys from the appropriation under s. 20.435 (4) (b). If the state plan amendments are not approved or if a waiver that is substantially consistent with the provisions of this section, excluding sub. (2m), is not granted, BadgerCare Plus may not be implemented. If the state plan amendments are approved but approval is not continued or if a waiver that is substantially consistent with the provisions of this section, excluding sub. (2m), is granted but not continued in effect, BadgerCare Plus shall be discontinued.

AB75-SSA1, s. 1329 Section 1329. 49.471 (3) (a) 1. of the statutes is amended to read:

AB75-SSA1,624,24 49.471 (3) (a) 1. Notwithstanding ss. 49.46 (1), 49.465, 49.47 (4), and 49.665 (4), if the amendments to the state plan under sub. (2) are approved and a waiver under sub. (2) that is substantially consistent with all of the provisions of this section, excluding sub. (2m), is granted and in effect, an individual described in sub. (4) (a) or (b) or (5) is not eligible under s. 49.46, 49.465, 49.47, or 49.665 for Medical Assistance or BadgerCare health program benefits. The eligibility of an individual described in sub. (4) (a) or (b) or (5) for Medical Assistance benefits shall be determined under this section.

AB75-SSA1, s. 1330 Section 1330. 49.471 (3) (b) 1. (intro.) of the statutes is amended to read:

AB75-SSA1,625,7 49.471 (3) (b) 1. (intro.) If an individual over 18 years of age who is eligible for and receiving Medical Assistance benefits under s. 49.46, 49.47, or 49.665 in the month before BadgerCare Plus is implemented loses that eligibility solely due to the implementation of BadgerCare Plus and, because of his or her income, is not eligible for BadgerCare Plus, the individual shall continue receiving for 18 12 consecutive months the medical assistance he or she was receiving before the implementation of BadgerCare Plus if all of the following are satisfied:

AB75-SSA1, s. 1331 Section 1331. 49.471 (3) (b) 1. c. of the statutes is amended to read:

AB75-SSA1,625,11 49.471 (3) (b) 1. c. The individual continues to meet meets all nonfinancial eligibility requirements for the coverage that he or she had in the month before the implementation of BadgerCare Plus under this section.

AB75-SSA1, s. 1332 Section 1332. 49.471 (3) (b) 2. of the statutes is amended to read:

AB75-SSA1,625,16 49.471 (3) (b) 2. Notwithstanding subd. 1., if at any time during an individual's 18-month 12-month eligibility extension under subd. 1. any criterion under subd. 1. a. to d. is not satisfied, the individual's eligibility for the extended coverage is terminated and any time remaining in the eligibility period is lost.

AB75-SSA1, s. 1333 Section 1333. 49.471 (4) (a) 4. a. of the statutes is amended to read:

AB75-SSA1,625,23 49.471 (4) (a) 4. a. The individual is a parent or caretaker relative of a child who is living in the home with the parent or caretaker relative or who is temporarily absent from the home for not more than 6 months or, if the child has been removed from the home for more than 6 months, the parent or caretaker relative is working toward unifying the family by complying with a permanency plan under s. 48.38 or 938.38.

AB75-SSA1, s. 1334 Section 1334. 49.471 (4) (a) 5. of the statutes is amended to read:

AB75-SSA1,626,6 49.471 (4) (a) 5. An individual who, regardless of family income, was born on or after January 1, 1990, and who, on his or her 18th birthday, was in a foster care or treatment foster care placement under the responsibility of a state, as determined by the department. The coverage for an individual under this subdivision ends on the last day of the month in which the individual becomes 21 years of age, unless he or she otherwise loses eligibility sooner.

AB75-SSA1, s. 1335 Section 1335. 49.471 (4) (a) 7. of the statutes is created to read:

AB75-SSA1,626,10 49.471 (4) (a) 7. Individuals who qualify for a medical assistance eligibility extension under s. 49.46 (1) (c), (cg), or (co) when their income increases above the poverty line.

AB75-SSA1, s. 1336 Section 1336. 49.471 (4) (b) 1m. of the statutes is amended to read:

AB75-SSA1,626,13 49.471 (4) (b) 1m. A pregnant woman or unborn child who obtains eligibility under sub. (7) (b) 1.

AB75-SSA1, s. 1337 Section 1337. 49.471 (4) (b) 4. a. of the statutes is amended to read:

AB75-SSA1,626,20 49.471 (4) (b) 4. a. The individual is a parent or caretaker relative of a child who is living in the home with the parent or caretaker relative or who is temporarily absent from the home for not more than 6 months or, if the child has been removed from the home for more than 6 months, the parent or caretaker relative is working toward unifying the family by complying with a permanency plan under s. 48.38 or 938.38.

AB75-SSA1, s. 1338 Section 1338. 49.471 (5) (b) 1. of the statutes is amended to read:

AB75-SSA1,627,2 49.471 (5) (b) 1. Except as provided in sub. (6) (a) 1., a pregnant woman is eligible for the benefits specified in par. (c) during the period beginning on the day on which a qualified provider determines, on the basis of preliminary information, that the woman's family income does not exceed 300 percent of the poverty line and ending on the applicable day specified in subd. 3.

AB75-SSA1, s. 1339 Section 1339. 49.471 (5) (b) 2. of the statutes is amended to read:

AB75-SSA1,627,8 49.471 (5) (b) 2. Except as provided in sub. (6) (a) 2., a child who is not an unborn child is eligible for the benefits described in s. 49.46 (2) (a) and (b) during the period beginning on the day on which a qualified entity determines, on the basis of preliminary information, that the child's family income does not exceed 150 percent of the poverty line and ending on the applicable day specified in subd. 3.

AB75-SSA1, s. 1340 Section 1340. 49.471 (5) (c) of the statutes is renumbered 49.471 (5) (c) 2. and amended to read:

AB75-SSA1,627,14 49.471 (5) (c) 2. On behalf of a woman under par. (b) 1. whose family income exceeds 200 percent of the poverty line, the department shall audit and pay allowable charges to a provider certified under s. 49.45 (2) (a) 11. only for ambulatory prenatal care services under the benefits under sub. (11).

AB75-SSA1, s. 1341 Section 1341. 49.471 (5) (c) 1. of the statutes is created to read:

AB75-SSA1,627,19 49.471 (5) (c) 1. On behalf of a woman under par. (b) 1. whose family income does not exceed 200 percent of the poverty line, the department shall audit and pay allowable charges to a provider certified under s. 49.45 (2) (a) 11. only for ambulatory prenatal care services under the benefits described in s. 49.46 (2) (a) and (b).

AB75-SSA1, s. 1342 Section 1342. 49.471 (6) (a) of the statutes is renumbered 49.471 (6) (a) 2. and amended to read:

AB75-SSA1,628,3 49.471 (6) (a) 2. Any pregnant woman, including a pregnant woman under sub (5) (b) 1., child who is not an unborn child, including a child under sub. (5) (b) 2., parent, or caretaker relative whose family income is less than 150 percent of the poverty line is eligible for medical assistance under this section for any of the 3 months prior to the month of application if the individual met the eligibility criteria under this section and had a family income of less than 150 percent of the poverty line in that month.

AB75-SSA1, s. 1343 Section 1343. 49.471 (6) (a) 1. of the statutes is created to read:

AB75-SSA1,628,8 49.471 (6) (a) 1. Any pregnant woman, including a pregnant woman under sub. (5) (b) 1., is eligible for medical assistance under this section for any of the 3 months prior to the month of application if she met the eligibility criteria under this section in that month.

AB75-SSA1, s. 1344 Section 1344. 49.471 (6) (e) of the statutes is repealed.

AB75-SSA1, s. 1345 Section 1345. 49.471 (7) (b) 1. of the statutes is amended to read:

AB75-SSA1,628,22 49.471 (7) (b) 1. A pregnant woman, or an unborn child, whose family income exceeds 300 percent of the poverty line may become eligible for coverage under this section if the difference between the pregnant woman's or unborn child's family income and the applicable income limit under sub. (4) (b) is obligated or expended for any member of the pregnant woman's or unborn child's family for medical care or any other type of remedial care recognized under state law or for personal health insurance premiums or for both. Eligibility obtained under this subdivision continues without regard to any change in family income for the balance of the pregnancy and, for a pregnant woman but not for an unborn child, to the last day of the month in which the 60th day after the last day of the woman's pregnancy falls. Eligibility obtained by a pregnant woman under this subdivision extends to all pregnant women in the pregnant woman's family.

AB75-SSA1, s. 1346 Section 1346. 49.471 (7) (b) 2. of the statutes is amended to read:

AB75-SSA1,629,7 49.471 (7) (b) 2. A child who is not an unborn child and, whose family income exceeds 150 percent of the poverty line, and who is ineligible under this section solely because of sub. (8) (b) may obtain eligibility under this section if the difference between the child's family income and 150 percent of the poverty line is obligated or expended on behalf of the child or any member of the child's family for medical care or any other type of remedial care recognized under state law or for personal health insurance premiums or for both. Eligibility obtained under this subdivision during any 6-month period, as determined by the department, continues for the remainder of the 6-month period and extends to all children in the family.

AB75-SSA1, s. 1347 Section 1347. 49.471 (7) (b) 3. of the statutes is amended to read:

AB75-SSA1,629,17 49.471 (7) (b) 3. For a pregnant woman or an unborn child to obtain eligibility under subd. 1., the amount that must be obligated or expended in any 6-month period is equal to the sum of the differences in each of those 6 months between the pregnant woman's or unborn child's monthly family income and the monthly family income that is 300 percent of the poverty line. For a child to obtain eligibility under subd. 2., the amount that must be obligated or expended in any 6-month period is equal to the sum of the differences in each of those 6 months between the child's monthly family income and the monthly family income that is 150 percent of the poverty line.

AB75-SSA1, s. 1348 Section 1348. 49.471 (7) (c) 1. of the statutes is amended to read:

AB75-SSA1,629,21 49.471 (7) (c) 1. Deduct from family the individual's income, up to the amount of the individual's income, any payments made by amount the individual is obligated to pay for court-ordered child or family support or maintenance.

AB75-SSA1, s. 1349 Section 1349. 49.471 (8) (d) 1. f. of the statutes is created to read:

AB75-SSA1,629,23 49.471 (8) (d) 1. f. An individual described in sub. (4) (a) 7.

AB75-SSA1, s. 1350 Section 1350. 49.471 (8) (d) 2. c. of the statutes is amended to read:

AB75-SSA1,630,8 49.471 (8) (d) 2. c. One or more members of the individual's family were eligible for other health insurance coverage or Medical Assistance under s. 49.46 or 49.47 at the time the employee failed to enroll in the health insurance coverage under par. (b) 1. and no member of the family was eligible for coverage under this section at that time or, if one or more members of the individual's family were eligible for coverage under this section at that time, family income did not exceed 150 percent of the poverty line or the individual qualified for a medical assistance eligibility extension as provided in sub. (4) (a) 7.

AB75-SSA1, s. 1351 Section 1351. 49.471 (10) (a) of the statutes is amended to read:

AB75-SSA1,630,13 49.471 (10) (a) Copayments. Except as provided in s. 49.45 (18) (am) 2. and (b) 2., all cost-sharing provisions under s. 49.45 (18) apply to a recipient with coverage of the benefits described in s. 49.46 (2) (a) and (b) to the same extent as they apply to a person eligible for medical assistance under s. 49.46, 49.468, or 49.47.

AB75-SSA1, s. 1352 Section 1352. 49.471 (10) (b) 4. g. of the statutes is created to read: