Amendment JR1 SA1-SB11

SB11-SA1,5,12 " Section 112d. 49.45 (2m) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.".

SB11-SA1,5,13 13. Page 48, line 5: after that line insert:

SB11-SA1,5,15 " Section 113d. 49.45 (3) (n) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.".

SB11-SA1,5,16 14. Page 48, line 8: after that line insert:

SB11-SA1,5,18 " Section 114d. 49.45 (6m) (n) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.".

SB11-SA1,5,19 15. Page 48, line 15: after that line insert:

SB11-SA1,5,21 " Section 115d. 49.45 (8) (b) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,6,3 49.45 (8) (b) Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), reimbursement Reimbursement under s. 20.435 (4) (b), (o), and (w) for home health services provided by a certified home health agency or independent nurse shall be made at the home health agency's or nurse's usual and customary fee per patient care visit, subject to a maximum allowable fee per patient care visit that is established under par. (c).".

SB11-SA1,6,4 16. Page 48, line 22: after that line insert:

SB11-SA1,6,6 " Section 116d. 49.45 (8) (c) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,6,12 49.45 (8) (c) The department shall establish a maximum statewide allowable fee per patient care visit, for each type of visit with respect to provider, that may be no greater than the cost per patient care visit, as determined by the department from cost reports of home health agencies, adjusted for costs related to case management, care coordination, travel, record keeping and supervision, unless otherwise provided by the department by rule promulgated under sub. (2m) (c).".

SB11-SA1,6,13 17. Page 49, line 6: after that line insert:

SB11-SA1,6,15 " Section 117d. 49.45 (8r) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,6,23 49.45 (8r) Payment for certain obstetric and gynecological care. Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), the The rate of payment for obstetric and gynecological care provided in primary care shortage areas, as defined in s. 36.60 (1) (cm), or provided to recipients of medical assistance who reside in primary care shortage areas, that is equal to 125% of the rates paid under this section to primary care physicians in primary care shortage areas, shall be paid to all certified primary care providers who provide obstetric or gynecological care to those recipients.".

SB11-SA1,6,24 18. Page 49, line 18: after that line insert:

SB11-SA1,7,2 " Section 118d. 49.45 (8v) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,7,13 49.45 (8v) Incentive-based pharmacy payment system. The department shall establish a system of payment to pharmacies for legend and over-the-counter drugs provided to recipients of medical assistance that has financial incentives for pharmacists who perform services that result in savings to the medical assistance program. Under this system, the department shall establish a schedule of fees that is designed to ensure that any incentive payments made are equal to or less than the documented savings unless otherwise provided by the department by rule promulgated under sub. (2m) (c). The department may discontinue the system established under this subsection if the department determines, after performance of a study, that payments to pharmacists under the system exceed the documented savings under the system.".

SB11-SA1,7,14 19. Page 50, line 7: after that line insert:

SB11-SA1,7,16 " Section 119d. 49.45 (18) (ac) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,8,5 49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag), any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the benefits under s. 49.46 (2) (a) and (b) under s. 49.471 shall pay up to the maximum amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided under s. 49.46 (2). The service provider shall collect the specified or allowable copayment, coinsurance, or deductible, unless the service provider determines that the cost of collecting the copayment, coinsurance, or deductible exceeds the amount to be collected. The department shall reduce payments to each provider by the amount of the specified or allowable copayment, coinsurance, or deductible. Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), no No provider may deny care or services because the recipient is unable to share costs, but an inability to share costs specified in this subsection does not relieve the recipient of liability for these costs.".

SB11-SA1,8,6 20. Page 50, line 11: after that line insert:

SB11-SA1,8,8 " Section 120d. 49.45 (18) (ag) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,8,11 49.45 (18) (ag) (intro.) Except as provided in pars. (am), (b), and (c), and subject to par. (d), a recipient specified in par. (ac) shall pay all of the following, unless otherwise provided by the department by rule promulgated under sub. (2m) (c):".

SB11-SA1,8,12 21. Page 50, line 15: after that line insert:

SB11-SA1,8,14 " Section 121d. 49.45 (18) (b) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,8,17 49.45 (18) (b) (intro.) Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), the The following services are not subject to recipient cost sharing under this subsection:".

SB11-SA1,8,18 22. Page 50, line 21: after that line insert:

SB11-SA1,8,20 " Section 122d. 49.45 (18) (d) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,9,2 49.45 (18) (d) No person who designates a pharmacy or pharmacist as his or her sole provider of prescription drugs and who so uses that pharmacy or pharmacist is liable under this subsection for more than $12 per month for prescription drugs received, unless otherwise provided by the department by rule promulgated under sub. (2m) (c).".

SB11-SA1,9,3 23. Page 51, line 6: after that line insert:

SB11-SA1,9,5 " Section 123d. 49.45 (23) (a) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,9,14 49.45 (23) (a) The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to conduct a demonstration project to provide health care coverage for basic primary and preventive care to adults who are under the age of 65, who have family incomes not to exceed 200 percent of the poverty line, and who are not otherwise eligible for medical assistance under this subchapter, the Badger Care health care program under s. 49.665, or Medicare under 42 USC 1395 et seq. If the department promulgates a rule under sub. (2m) (c) 10., this paragraph does not apply to the extent that it conflicts with the rule.".

SB11-SA1,9,15 24. Page 51, line 17: after that line insert:

SB11-SA1,9,17 " Section 124d. 49.45 (23) (b) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,9,24 49.45 (23) (b) If the waiver is granted and in effect, the department may promulgate rules defining the health care benefit plan, including more specific eligibility requirements and cost-sharing requirements. Unless otherwise provided by the department by rule promulgated under sub. (2m) (c), cost Cost sharing may include an annual enrollment fee, which may not exceed $75 per year. Notwithstanding s. 227.24 (3), the plan details under this subsection may be promulgated as an emergency rule under s. 227.24 without a finding of emergency. If the waiver is granted and in effect, the demonstration project under this subsection shall begin on January 1, 2009, or on the effective date of the waiver, whichever is later.".

SB11-SA1,10,4 25. Page 52, line 3: after that line insert:

SB11-SA1,10,6 " Section 125d. 49.45 (24g) (c) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,10,16 49.45 (24g) (c) The department's proposal under par. (a) shall specify increases in reimbursement rates for providers that satisfy the conditions under par. (a) 1. or 2., and shall provide for payment of a monthly per-patient care coordination fee to those providers. The department shall set the increases in reimbursement rates and the monthly per-patient care coordination fee so that together they provide sufficient incentive for providers to satisfy a condition under par. (a) 1. or 2. The proposal shall specify effective dates for the increases in reimbursement rates and the monthly per-patient care coordination fee that are no sooner than July 1, 2011. If the department promulgates a rule under sub. (2m) (c) 4., this paragraph does not apply to the extent that it conflicts with the rule.".

SB11-SA1,10,17 26. Page 52, line 11: after that line insert:

SB11-SA1,10,19 " Section 126d. 49.45 (24r) (a) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,11,2 49.45 (24r) (a) The department shall implement any waiver granted by the secretary of the federal department of health and human services to permit the department to conduct a demonstration project to provide family planning, as defined in s. 253.07 (1) (a), under medical assistance to any woman between the ages of 15 and 44 whose family income does not exceed 200% of the poverty line for a family the size of the woman's family. If the department promulgates a rule under sub. (2m) (c) 10., this paragraph does not apply to the extent it conflicts with the rule.".

SB11-SA1,11,3 27. Page 52, line 19: after that line insert:

SB11-SA1,11,5 " Section 127d. 49.45 (24r) (b) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,11,12 49.45 (24r) (b) The department may request an amended waiver from the secretary to permit the department to conduct a demonstration project to provide family planning to any man between the ages of 15 and 44 whose family income does not exceed 200 percent of the poverty line for a family the size of the man's family. If the amended waiver is granted, the department may implement the waiver. If the department promulgates a rule under sub. (2m) (c) 10., this paragraph does not apply to the extent it conflicts with the rule.".

SB11-SA1,11,13 28. Page 53, line 7: after that line insert:

SB11-SA1,11,15 " Section 128d. 49.45 (25g) (c) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,12,3 49.45 (25g) (c) The department's proposal under par. (b) shall specify increases in reimbursement rates for providers that satisfy the conditions under par. (b), and shall provide for payment of a monthly per-patient care coordination fee to those providers. The department shall set the increases in reimbursement rates and the monthly per-patient care coordination fee so that together they provide sufficient incentive for providers to satisfy a condition under par. (b) 1. or 2. The proposal shall specify effective dates for the increases in reimbursement rates and the monthly per-patient care coordination fee that are no sooner than January 1, 2011. The increases in reimbursement rates and monthly per-patient care coordination fees that are not provided by the federal government shall be paid from the appropriation under. s. 20.435 (1) (am). If the department promulgates a rule under sub. (2m) (c) 4., this paragraph does not apply to the extent it conflicts with the rule.".

SB11-SA1,12,4 29. Page 53, line 13: after that line insert:

SB11-SA1,12,6 " Section 129d. 49.45 (27) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,12,11 49.45 (27) Eligibility of aliens. A person who is not a U.S. citizen or an alien lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law may not receive medical assistance benefits except as provided under 8 USC 1255a (h) (3) or 42 USC 1396b (v), unless otherwise provided by the department by rule promulgated under sub. (2m) (c).".

SB11-SA1,12,12 30. Page 54, line 24: after that line insert:

SB11-SA1,12,14 " Section 130d. 49.45 (39) (b) 1. of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,13,25 49.45 (39) (b) 1. `Payment for school medical services.' If a school district or a cooperative educational service agency elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the school district or the cooperative educational service agency for 60% of the federal share of allowable charges for the school medical services that it provides , unless otherwise provided by the department by rule promulgated under sub. (2m) (c), and, as specified in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the department of public instruction for 60% of the federal share of allowable charges for the school medical services that the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing provides, unless otherwise provided by the department by rule promulgated under sub. (2m) (c), and, as specified in subd. 2., for allowable administrative costs. A school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, claims for common carrier transportation costs as a school medical service unless the department receives notice from the federal health care financing administration that, under a change in federal policy, the claims are not allowed. If the department receives the notice, a school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired, or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, unreimbursed claims for common carrier transportation costs incurred before the date of the change in federal policy. The department shall promulgate rules establishing a methodology for making reimbursements under this paragraph. All other expenses for the school medical services provided by a school district or a cooperative educational service agency shall be paid for by the school district or the cooperative educational service agency with funds received from state or local taxes. The school district, the Wisconsin Center for the Blind and Visually Impaired, the Wisconsin Educational Services Program for the Deaf and Hard of Hearing, or the cooperative educational service agency shall comply with all requirements of the federal department of health and human services for receiving federal financial participation.".

SB11-SA1,14,1 31. Page 55, line 2: after that line insert:

SB11-SA1,14,3 " Section 131d. 49.46 (1) (n) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.".

SB11-SA1,14,4 32. Page 55, line 7: after that line insert:

SB11-SA1,14,6 " Section 132d. 49.46 (2) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,14,10 49.46 (2) (a) (intro.) Except as provided in par. (be) and unless otherwise provided by the department by rule promulgated under s. 49.45 (2m) (c), the department shall audit and pay allowable charges to certified providers for medical assistance on behalf of recipients for the following federally mandated benefits:".

SB11-SA1,14,11 33. Page 55, line 12: after that line insert:

SB11-SA1,14,13 " Section 133d. 49.46 (2) (b) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,14,17 49.46 (2) (b) (intro.) Except as provided in pars. (be) and (dc) and unless otherwise provided by the department by rule promulgated under s. 49.45 (2m) (c), the department shall audit and pay allowable charges to certified providers for medical assistance on behalf of recipients for the following services:".

SB11-SA1,14,18 34. Page 55, line 20: after that line insert:

SB11-SA1,14,20 " Section 134d. 49.465 (2) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,15,3 49.465 (2) (intro.) Unless otherwise provided by the department by rule promulgated under s. 49.45 (2m) (c), a A pregnant woman is eligible for medical assistance benefits, as provided under sub. (3), 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 the highest level for eligibility for benefits under s. 49.46 (1) or 49.47 (4) (am) or (c) 1. and ending as follows:".

SB11-SA1,15,4 35. Page 55, line 25: after that line insert:

SB11-SA1,15,6 " Section 135d. 49.47 (4) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,15,10 49.47 (4) (a) (intro.) Unless otherwise provided by the department by rule under s. 49.45 (2m) (c), any Any individual who meets the limitations on income and resources under pars. (b) to (c) and who complies with pars. (cm) and (cr) shall be eligible for medical assistance under this section if such individual is:".

SB11-SA1,15,11 36. Page 56, line 13: after that line insert:

SB11-SA1,15,13 " Section 138d. 49.47 (5) (c) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.".

SB11-SA1,15,14 37. Page 56, line 17: after that line insert:

SB11-SA1,15,16 " Section 139d. 49.47 (6) (a) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,15,19 49.47 (6) (a) (intro.) Unless otherwise provided by the department by rule promulgated under s. 49.45 (2m) (c), the The department shall audit and pay charges to certified providers for medical assistance on behalf of the following:".

SB11-SA1,15,20 38. Page 56, line 21: after that line insert:

SB11-SA1,15,22 " Section 140d. 49.471 (13) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.".

SB11-SA1,15,23 39. Page 57, line 2: after that line insert:

SB11-SA1,16,2 " Section 141d. 49.472 (3) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,16,6 49.472 (3) Eligibility. (intro.) Except as provided in sub. (6) (a) and unless otherwise provided by the department by rule promulgated under s. 49.45 (2m) (c), an individual is eligible for and shall receive medical assistance under this section if all of the following conditions are met:".

SB11-SA1,16,7 40. Page 57, line 8: after that line insert:

SB11-SA1,16,9 " Section 142d. 49.472 (4) (b) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,16,14 49.472 (4) (b) (intro.) The department may waive monthly premiums that are calculated to be below $10 per month. Unless otherwise provided by the department by rule promulgated under s. 49.45 (2m) (c), the The department may not assess a monthly premium for any individual whose income level, after adding the individual's earned income and unearned income, is below 150% of the poverty line.".

SB11-SA1,16,15 41. Page 57, line 14: after that line insert:

SB11-SA1,16,17 " Section 143d. 49.473 (2) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,16,22 49.473 (2) (intro.) Unless otherwise provided by the department by rule promulgated under s. 49.45 (2m) (c), a A woman is eligible for medical assistance as provided under sub. (5) if, after applying to the department or a county department, the department or a county department determines that she meets all of the following requirements:".

SB11-SA1,16,23 42. Page 57, line 21: after that line insert:

SB11-SA1,17,2 " Section 144d. 49.473 (5) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB11-SA1,17,8 49.473 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b) and (o), allowable charges to a provider who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who meets the requirements under sub. (2) for all benefits and services specified under s. 49.46 (2), unless otherwise provided by the department by rule promulgated under s. 49.45 (2m) (c).".

SB11-SA1,17,10 43. Page 58, line 15: delete "half of all actuarially required" and substitute "all employee required".

SB11-SA1,17,11 44. Page 58, line 17: delete "actuarially".

SB11-SA1,17,12 45. Page 60, line 5: after that line insert: