SB11-SA1,5,12 11" Section 112d. 49.45 (2m) of the statutes, as created by 2011 Wisconsin Act
12.... (this act), is repealed.".
SB11-SA1,5,13 1313. Page 48, line 5: after that line insert:
SB11-SA1,5,15 14" Section 113d. 49.45 (3) (n) of the statutes, as created by 2011 Wisconsin Act
15.... (this act), is repealed.".
SB11-SA1,5,16 1614. Page 48, line 8: after that line insert:
SB11-SA1,5,18 17" Section 114d. 49.45 (6m) (n) of the statutes, as created by 2011 Wisconsin Act
18.... (this act), is repealed.".
SB11-SA1,5,19 1915. Page 48, line 15: after that line insert:
SB11-SA1,5,21 20" Section 115d. 49.45 (8) (b) of the statutes, as affected by 2011 Wisconsin Act
21.... (this act), is amended to read:
SB11-SA1,6,322 49.45 (8) (b) Unless otherwise provided by the department by rule promulgated
23under sub. (2m) (c), reimbursement
Reimbursement under s. 20.435 (4) (b), (o), and
24(w) for home health services provided by a certified home health agency or

1independent nurse shall be made at the home health agency's or nurse's usual and
2customary fee per patient care visit, subject to a maximum allowable fee per patient
3care visit that is established under par. (c).".
SB11-SA1,6,4 416. Page 48, line 22: after that line insert:
SB11-SA1,6,6 5" Section 116d. 49.45 (8) (c) of the statutes, as affected by 2011 Wisconsin Act
6.... (this act), is amended to read:
SB11-SA1,6,127 49.45 (8) (c) The department shall establish a maximum statewide allowable
8fee per patient care visit, for each type of visit with respect to provider, that may be
9no greater than the cost per patient care visit, as determined by the department from
10cost reports of home health agencies, adjusted for costs related to case management,
11care coordination, travel, record keeping and supervision, unless otherwise provided
12by the department by rule promulgated under sub. (2m) (c)
.".
SB11-SA1,6,13 1317. Page 49, line 6: after that line insert:
SB11-SA1,6,15 14" Section 117d. 49.45 (8r) of the statutes, as affected by 2011 Wisconsin Act ....
15(this act), is amended to read:
SB11-SA1,6,2316 49.45 (8r) Payment for certain obstetric and gynecological care. Unless
17otherwise provided by the department by rule promulgated under sub. (2m) (c), the

18The rate of payment for obstetric and gynecological care provided in primary care
19shortage areas, as defined in s. 36.60 (1) (cm), or provided to recipients of medical
20assistance who reside in primary care shortage areas, that is equal to 125% of the
21rates paid under this section to primary care physicians in primary care shortage
22areas, shall be paid to all certified primary care providers who provide obstetric or
23gynecological care to those recipients.".
SB11-SA1,6,24 2418. Page 49, line 18: after that line insert:
SB11-SA1,7,2
1" Section 118d. 49.45 (8v) of the statutes, as affected by 2011 Wisconsin Act ....
2(this act), is amended to read:
SB11-SA1,7,133 49.45 (8v) Incentive-based pharmacy payment system. The department shall
4establish a system of payment to pharmacies for legend and over-the-counter drugs
5provided to recipients of medical assistance that has financial incentives for
6pharmacists who perform services that result in savings to the medical assistance
7program. Under this system, the department shall establish a schedule of fees that
8is designed to ensure that any incentive payments made are equal to or less than the
9documented savings unless otherwise provided by the department by rule
10promulgated under sub. (2m) (c)
. The department may discontinue the system
11established under this subsection if the department determines, after performance
12of a study, that payments to pharmacists under the system exceed the documented
13savings under the system.".
SB11-SA1,7,14 1419. Page 50, line 7: after that line insert:
SB11-SA1,7,16 15" Section 119d. 49.45 (18) (ac) of the statutes, as affected by 2011 Wisconsin
16Act .... (this act), is amended to read:
SB11-SA1,8,517 49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag),
18any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the
19benefits under s. 49.46 (2) (a) and (b) under s. 49.471 shall pay up to the maximum
20amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided
21under s. 49.46 (2). The service provider shall collect the specified or allowable
22copayment, coinsurance, or deductible, unless the service provider determines that
23the cost of collecting the copayment, coinsurance, or deductible exceeds the amount
24to be collected. The department shall reduce payments to each provider by the

1amount of the specified or allowable copayment, coinsurance, or deductible. Unless
2otherwise provided by the department by rule promulgated under sub. (2m) (c), no

3No provider may deny care or services because the recipient is unable to share costs,
4but an inability to share costs specified in this subsection does not relieve the
5recipient of liability for these costs.".
SB11-SA1,8,6 620. Page 50, line 11: after that line insert:
SB11-SA1,8,8 7" Section 120d. 49.45 (18) (ag) (intro.) of the statutes, as affected by 2011
8Wisconsin Act .... (this act), is amended to read:
SB11-SA1,8,119 49.45 (18) (ag) (intro.) Except as provided in pars. (am), (b), and (c), and subject
10to par. (d), a recipient specified in par. (ac) shall pay all of the following, unless
11otherwise provided by the department by rule promulgated under sub. (2m) (c)
:".
SB11-SA1,8,12 1221. Page 50, line 15: after that line insert:
SB11-SA1,8,14 13" Section 121d. 49.45 (18) (b) (intro.) of the statutes, as affected by 2011
14Wisconsin Act .... (this act), is amended to read:
SB11-SA1,8,1715 49.45 (18) (b) (intro.) Unless otherwise provided by the department by rule
16promulgated under sub. (2m) (c), the
The following services are not subject to
17recipient cost sharing under this subsection:".
SB11-SA1,8,18 1822. Page 50, line 21: after that line insert:
SB11-SA1,8,20 19" Section 122d. 49.45 (18) (d) of the statutes, as affected by 2011 Wisconsin Act
20.... (this act), is amended to read:
SB11-SA1,9,221 49.45 (18) (d) No person who designates a pharmacy or pharmacist as his or
22her sole provider of prescription drugs and who so uses that pharmacy or pharmacist
23is liable under this subsection for more than $12 per month for prescription drugs

1received, unless otherwise provided by the department by rule promulgated under
2sub. (2m) (c)
.".
SB11-SA1,9,3 323. Page 51, line 6: after that line insert:
SB11-SA1,9,5 4" Section 123d. 49.45 (23) (a) of the statutes, as affected by 2011 Wisconsin Act
5.... (this act), is amended to read:
SB11-SA1,9,146 49.45 (23) (a) The department shall request a waiver from the secretary of the
7federal department of health and human services to permit the department to
8conduct a demonstration project to provide health care coverage for basic primary
9and preventive care to adults who are under the age of 65, who have family incomes
10not to exceed 200 percent of the poverty line, and who are not otherwise eligible for
11medical assistance under this subchapter, the Badger Care health care program
12under s. 49.665, or Medicare under 42 USC 1395 et seq. If the department
13promulgates a rule under sub. (2m) (c) 10., this paragraph does not apply to the
14extent that it conflicts with the rule.
".
SB11-SA1,9,15 1524. Page 51, line 17: after that line insert:
SB11-SA1,9,17 16" Section 124d. 49.45 (23) (b) of the statutes, as affected by 2011 Wisconsin Act
17.... (this act), is amended to read:
SB11-SA1,9,2418 49.45 (23) (b) If the waiver is granted and in effect, the department may
19promulgate rules defining the health care benefit plan, including more specific
20eligibility requirements and cost-sharing requirements. Unless otherwise provided
21by the department by rule promulgated under sub. (2m) (c), cost
Cost sharing may
22include an annual enrollment fee, which may not exceed $75 per year.
23Notwithstanding s. 227.24 (3), the plan details under this subsection may be
24promulgated as an emergency rule under s. 227.24 without a finding of emergency.

1If the waiver is granted and in effect, the demonstration project under this subsection
2shall begin on January 1, 2009, or on the effective date of the waiver, whichever is
3later.".
SB11-SA1,10,4 425. Page 52, line 3: after that line insert:
SB11-SA1,10,6 5" Section 125d. 49.45 (24g) (c) of the statutes, as affected by 2011 Wisconsin
6Act .... (this act), is amended to read:
SB11-SA1,10,167 49.45 (24g) (c) The department's proposal under par. (a) shall specify increases
8in reimbursement rates for providers that satisfy the conditions under par. (a) 1. or
92., and shall provide for payment of a monthly per-patient care coordination fee to
10those providers. The department shall set the increases in reimbursement rates and
11the monthly per-patient care coordination fee so that together they provide
12sufficient incentive for providers to satisfy a condition under par. (a) 1. or 2. The
13proposal shall specify effective dates for the increases in reimbursement rates and
14the monthly per-patient care coordination fee that are no sooner than July 1, 2011.
15If the department promulgates a rule under sub. (2m) (c) 4., this paragraph does not
16apply to the extent that it conflicts with the rule.
".
SB11-SA1,10,17 1726. Page 52, line 11: after that line insert:
SB11-SA1,10,19 18" Section 126d. 49.45 (24r) (a) of the statutes, as affected by 2011 Wisconsin
19Act .... (this act), is amended to read:
SB11-SA1,11,220 49.45 (24r) (a) The department shall implement any waiver granted by the
21secretary of the federal department of health and human services to permit the
22department to conduct a demonstration project to provide family planning, as
23defined in s. 253.07 (1) (a), under medical assistance to any woman between the ages
24of 15 and 44 whose family income does not exceed 200% of the poverty line for a family

1the size of the woman's family. If the department promulgates a rule under sub. (2m)
2(c) 10., this paragraph does not apply to the extent it conflicts with the rule.
".
SB11-SA1,11,3 327. Page 52, line 19: after that line insert:
SB11-SA1,11,5 4" Section 127d. 49.45 (24r) (b) of the statutes, as affected by 2011 Wisconsin
5Act .... (this act), is amended to read:
SB11-SA1,11,126 49.45 (24r) (b) The department may request an amended waiver from the
7secretary to permit the department to conduct a demonstration project to provide
8family planning to any man between the ages of 15 and 44 whose family income does
9not exceed 200 percent of the poverty line for a family the size of the man's family.
10If the amended waiver is granted, the department may implement the waiver. If the
11department promulgates a rule under sub. (2m) (c) 10., this paragraph does not apply
12to the extent it conflicts with the rule.
".
SB11-SA1,11,13 1328. Page 53, line 7: after that line insert:
SB11-SA1,11,15 14" Section 128d. 49.45 (25g) (c) of the statutes, as affected by 2011 Wisconsin
15Act .... (this act), is amended to read:
SB11-SA1,12,316 49.45 (25g) (c) The department's proposal under par. (b) shall specify increases
17in reimbursement rates for providers that satisfy the conditions under par. (b), and
18shall provide for payment of a monthly per-patient care coordination fee to those
19providers. The department shall set the increases in reimbursement rates and the
20monthly per-patient care coordination fee so that together they provide sufficient
21incentive for providers to satisfy a condition under par. (b) 1. or 2. The proposal shall
22specify effective dates for the increases in reimbursement rates and the monthly
23per-patient care coordination fee that are no sooner than January 1, 2011. The
24increases in reimbursement rates and monthly per-patient care coordination fees

1that are not provided by the federal government shall be paid from the appropriation
2under. s. 20.435 (1) (am). If the department promulgates a rule under sub. (2m) (c)
34., this paragraph does not apply to the extent it conflicts with the rule.
".
SB11-SA1,12,4 429. Page 53, line 13: after that line insert:
SB11-SA1,12,6 5" Section 129d. 49.45 (27) of the statutes, as affected by 2011 Wisconsin Act
6.... (this act), is amended to read:
SB11-SA1,12,117 49.45 (27) Eligibility of aliens. A person who is not a U.S. citizen or an alien
8lawfully admitted for permanent residence or otherwise permanently residing in the
9United States under color of law may not receive medical assistance benefits except
10as provided under 8 USC 1255a (h) (3) or 42 USC 1396b (v), unless otherwise
11provided by the department by rule promulgated under sub. (2m) (c)
.".
SB11-SA1,12,12 1230. Page 54, line 24: after that line insert:
SB11-SA1,12,14 13" Section 130d. 49.45 (39) (b) 1. of the statutes, as affected by 2011 Wisconsin
14Act .... (this act), is amended to read:
SB11-SA1,13,2515 49.45 (39) (b) 1. `Payment for school medical services.' If a school district or a
16cooperative educational service agency elects to provide school medical services and
17meets all requirements under par. (c), the department shall reimburse the school
18district or the cooperative educational service agency for 60% of the federal share of
19allowable charges for the school medical services that it provides , unless otherwise
20provided by the department by rule promulgated under sub. (2m) (c),
and, as
21specified in subd. 2., for allowable administrative costs. If the Wisconsin Center for
22the Blind and Visually Impaired or the Wisconsin Educational Services Program for
23the Deaf and Hard of Hearing elects to provide school medical services and meets all
24requirements under par. (c), the department shall reimburse the department of

1public instruction for 60% of the federal share of allowable charges for the school
2medical services that the Wisconsin Center for the Blind and Visually Impaired or
3the Wisconsin Educational Services Program for the Deaf and Hard of Hearing
4provides, unless otherwise provided by the department by rule promulgated under
5sub. (2m) (c),
and, as specified in subd. 2., for allowable administrative costs. A school
6district, cooperative educational service agency, the Wisconsin Center for the Blind
7and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
8and Hard of Hearing may submit, and the department shall allow, claims for common
9carrier transportation costs as a school medical service unless the department
10receives notice from the federal health care financing administration that, under a
11change in federal policy, the claims are not allowed. If the department receives the
12notice, a school district, cooperative educational service agency, the Wisconsin
13Center for the Blind and Visually Impaired, or the Wisconsin Educational Services
14Program for the Deaf and Hard of Hearing may submit, and the department shall
15allow, unreimbursed claims for common carrier transportation costs incurred before
16the date of the change in federal policy. The department shall promulgate rules
17establishing a methodology for making reimbursements under this paragraph. All
18other expenses for the school medical services provided by a school district or a
19cooperative educational service agency shall be paid for by the school district or the
20cooperative educational service agency with funds received from state or local taxes.
21The school district, the Wisconsin Center for the Blind and Visually Impaired, the
22Wisconsin Educational Services Program for the Deaf and Hard of Hearing, or the
23cooperative educational service agency shall comply with all requirements of the
24federal department of health and human services for receiving federal financial
25participation.".
SB11-SA1,14,1
131. Page 55, line 2: after that line insert:
SB11-SA1,14,3 2" Section 131d. 49.46 (1) (n) of the statutes, as created by 2011 Wisconsin Act
3.... (this act), is repealed.".
SB11-SA1,14,4 432. Page 55, line 7: after that line insert:
SB11-SA1,14,6 5" Section 132d. 49.46 (2) (a) (intro.) of the statutes, as affected by 2011
6Wisconsin Act .... (this act), is amended to read:
SB11-SA1,14,107 49.46 (2) (a) (intro.) Except as provided in par. (be) and unless otherwise
8provided by the department by rule promulgated under s. 49.45 (2m) (c)
, the
9department shall audit and pay allowable charges to certified providers for medical
10assistance on behalf of recipients for the following federally mandated benefits:".
SB11-SA1,14,11 1133. Page 55, line 12: after that line insert:
SB11-SA1,14,13 12" Section 133d. 49.46 (2) (b) (intro.) of the statutes, as affected by 2011
13Wisconsin Act .... (this act), is amended to read:
SB11-SA1,14,1714 49.46 (2) (b) (intro.) Except as provided in pars. (be) and (dc) and unless
15otherwise provided by the department by rule promulgated under s. 49.45 (2m) (c)
,
16the department shall audit and pay allowable charges to certified providers for
17medical assistance on behalf of recipients for the following services:".
SB11-SA1,14,18 1834. Page 55, line 20: after that line insert:
SB11-SA1,14,20 19" Section 134d. 49.465 (2) (intro.) of the statutes, as affected by 2011 Wisconsin
20Act .... (this act), is amended to read:
SB11-SA1,15,321 49.465 (2) (intro.) Unless otherwise provided by the department by rule
22promulgated under s. 49.45 (2m) (c), a
A pregnant woman is eligible for medical
23assistance benefits, as provided under sub. (3), during the period beginning on the
24day on which a qualified provider determines, on the basis of preliminary

1information, that the woman's family income does not exceed the highest level for
2eligibility for benefits under s. 49.46 (1) or 49.47 (4) (am) or (c) 1. and ending as
3follows:".
SB11-SA1,15,4 435. Page 55, line 25: after that line insert:
SB11-SA1,15,6 5" Section 135d. 49.47 (4) (a) (intro.) of the statutes, as affected by 2011
6Wisconsin Act .... (this act), is amended to read:
SB11-SA1,15,107 49.47 (4) (a) (intro.) Unless otherwise provided by the department by rule
8under s. 49.45 (2m) (c), any
Any individual who meets the limitations on income and
9resources under pars. (b) to (c) and who complies with pars. (cm) and (cr) shall be
10eligible for medical assistance under this section if such individual is:".
SB11-SA1,15,11 1136. Page 56, line 13: after that line insert:
SB11-SA1,15,13 12" Section 138d. 49.47 (5) (c) of the statutes, as created by 2011 Wisconsin Act
13.... (this act), is repealed.".
SB11-SA1,15,14 1437. Page 56, line 17: after that line insert:
SB11-SA1,15,16 15" Section 139d. 49.47 (6) (a) (intro.) of the statutes, as affected by 2011
16Wisconsin Act .... (this act), is amended to read:
SB11-SA1,15,1917 49.47 (6) (a) (intro.) Unless otherwise provided by the department by rule
18promulgated under s. 49.45 (2m) (c), the
The department shall audit and pay charges
19to certified providers for medical assistance on behalf of the following:".
SB11-SA1,15,20 2038. Page 56, line 21: after that line insert:
SB11-SA1,15,22 21" Section 140d. 49.471 (13) of the statutes, as created by 2011 Wisconsin Act
22.... (this act), is repealed.".
SB11-SA1,15,23 2339. Page 57, line 2: after that line insert:
SB11-SA1,16,2
1" Section 141d. 49.472 (3) (intro.) of the statutes, as affected by 2011 Wisconsin
2Act .... (this act), is amended to read:
SB11-SA1,16,63 49.472 (3) Eligibility. (intro.) Except as provided in sub. (6) (a) and unless
4otherwise provided by the department by rule promulgated under s. 49.45 (2m) (c)
,
5an individual is eligible for and shall receive medical assistance under this section
6if all of the following conditions are met:".
SB11-SA1,16,7 740. Page 57, line 8: after that line insert:
SB11-SA1,16,9 8" Section 142d. 49.472 (4) (b) (intro.) of the statutes, as affected by 2011
9Wisconsin Act .... (this act), is amended to read:
SB11-SA1,16,1410 49.472 (4) (b) (intro.) The department may waive monthly premiums that are
11calculated to be below $10 per month. Unless otherwise provided by the department
12by rule promulgated under s. 49.45 (2m) (c), the
The department may not assess a
13monthly premium for any individual whose income level, after adding the
14individual's earned income and unearned income, is below 150% of the poverty line.".
SB11-SA1,16,15 1541. Page 57, line 14: after that line insert:
SB11-SA1,16,17 16" Section 143d. 49.473 (2) (intro.) of the statutes, as affected by 2011 Wisconsin
17Act .... (this act), is amended to read:
SB11-SA1,16,2218 49.473 (2) (intro.) Unless otherwise provided by the department by rule
19promulgated under s. 49.45 (2m) (c), a
A woman is eligible for medical assistance as
20provided under sub. (5) if, after applying to the department or a county department,
21the department or a county department determines that she meets all of the
22following requirements:".
SB11-SA1,16,23 2342. Page 57, line 21: after that line insert:
SB11-SA1,17,2
1" Section 144d. 49.473 (5) of the statutes, as affected by 2011 Wisconsin Act
2.... (this act), is amended to read:
SB11-SA1,17,83 49.473 (5) The department shall audit and pay, from the appropriation
4accounts under s. 20.435 (4) (b) and (o), allowable charges to a provider who is
5certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who
6meets the requirements under sub. (2) for all benefits and services specified under
7s. 49.46 (2), unless otherwise provided by the department by rule promulgated under
8s. 49.45 (2m) (c)
.".
SB11-SA1,17,10 943. Page 58, line 15: delete "half of all actuarially required" and substitute "all
10employee required".
SB11-SA1,17,11 1144. Page 58, line 17: delete "actuarially".
SB11-SA1,17,12 1245. Page 60, line 5: after that line insert:
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