SB27-SSA1,634,124
49.47
(4) (k) Notwithstanding par. (b) 3. and s. 445.125 (1) (a), no later than 60
5days after the effective date of this paragraph .... [LRB inserts date], the department
6shall seek approval from the federal Centers for Medicare and Medicaid Services to
7permit friends and family members of any individual receiving medical assistance
8under this section to contribute funds to an irrevocable burial trust for the
9individual, up to a total irrevocable trust amount of $4,500, without the individual
10losing eligibility for medical assistance under this section. If the federal Centers for
11Medicare and Medicaid Services approves the request, the department shall
12implement the change under this section within 60 days after receiving approval.
SB27-SSA1,634,1615
49.47
(5) Investigation by department. (intro.) The department may make
16additional investigation of eligibility at any of the following times:
SB27-SSA1,634,2119
49.47
(5) (a) When there is reasonable ground for belief that an applicant may
20not be eligible or that the beneficiary may have received benefits to which the
21beneficiary is not entitled.
SB27-SSA1,635,324
49.47
(5) (c) Any time determined by the department by a policy created under
25s. 49.45 (2m) (c) to determine eligibility or to reevaluate continuing eligibility, except
1that if federal law allows a reevaluation of eligibility more frequently than every 12
2months and if there is no conflicting provision of state law, the department is not
3required to create a policy to reevaluate eligibility under this section.
SB27-SSA1, s. 1459j
4Section 1459j. 49.47 (5) (c) of the statutes, as created by 2011 Wisconsin Act
5.... (this act), is repealed.
SB27-SSA1,635,108
49.47
(6) (a) (intro.) Unless otherwise provided by the department by a policy
9created under s. 49.45 (2m) (c), the department shall audit and pay charges to
10certified providers for medical assistance on behalf of the following:
SB27-SSA1, s. 1459o
11Section 1459o. 49.47 (6) (a) (intro.) of the statutes, as affected by 2011
12Wisconsin Act .... (this act), is amended to read:
SB27-SSA1,635,1513
49.47
(6) (a) (intro.)
Unless otherwise provided by the department by a policy
14created under s. 49.45 (2m) (c), the The department shall audit and pay charges to
15certified providers for medical assistance on behalf of the following:
SB27-SSA1,636,617
49.47
(6) (a) 6. b. An individual who is entitled to coverage under
part Part A
18of
medicare Medicare, entitled to coverage under
part Part B of
medicare Medicare,
19meets the eligibility criteria under sub. (4) (a)
, and meets the income limitation, the
20deductible and coinsurance portions of
medicare Medicare services under
42 USC
211395 to
1395zz which that are not paid under
42 USC 1395 to
1395zz, including those
22medicare Medicare services that are not included in the approved state plan for
23services under
42 USC 1396; the monthly premiums payable under
42 USC 1395v;
24the monthly premiums, if applicable, under
42 USC 1395i-2 (d); and the late
25enrollment penalty, if applicable, for premiums under
part Part A of
medicare
1Medicare. Payment of coinsurance for a service under
part Part B of
medicare 2Medicare under
42 USC 1395j to
1395w, other than payment of coinsurance for
3outpatient hospital services, and payment of deductibles and coinsurance for
4inpatient hospital services under Part A of Medicare may not exceed the allowable
5charge for the service under
medical assistance Medical Assistance minus the
6medicare Medicare payment.
SB27-SSA1,636,188
49.47
(6) (a) 6. c. An individual who is only entitled to coverage under
part Part 9A of
medicare Medicare, meets the eligibility criteria under sub. (4) (a)
, and meets
10the income limitation, the deductible and coinsurance portions of
medicare Medicare 11services under
42 USC 1395 to
1395i which that are not paid under
42 USC 1395 to
121395i, including those
medicare Medicare services that are not included in the
13approved state plan for services under
42 USC 1396; the monthly premiums, if
14applicable, under
42 USC 1395i-2 (d); and the late enrollment penalty, if applicable,
15for premiums under
part Part A of
medicare Medicare. Payment of deductibles and
16coinsurance for inpatient hospital services under Part A of Medicare may not exceed
17the allowable charge for the service under Medical Assistance minus the Medicare
18payment.
SB27-SSA1,637,620
49.47
(6) (a) 6. d. An individual who is entitled to coverage under
part Part A
21of
medicare Medicare, entitled to coverage under
part Part B of
medicare Medicare, 22and meets the eligibility criteria for
medical assistance Medical Assistance under
23sub. (4) (a)
, but does not meet the income limitation, the deductible and coinsurance
24portions of
medicare Medicare services under
42 USC 1395 to
1395zz which that are
25not paid under
42 USC 1395 to
1395zz, including those
medicare Medicare services
1that are not included in the approved state plan for services under
42 USC 1396.
2Payment of coinsurance for a service under
part Part B of
medicare Medicare under
342 USC 1395j to
1395w, other than payment of coinsurance for outpatient hospital
4services, and payment of deductibles and coinsurance for inpatient hospital services
5under Part A of Medicare may not exceed the allowable charge for the service under
6medical assistance Medical Assistance minus the
medicare Medicare payment.
SB27-SSA1,637,158
49.47
(6) (a) 6. e. An individual who is only entitled to coverage under
part Part 9A of
medicare Medicare and meets the eligibility criteria for
medical assistance 10Medical Assistance under sub. (4) (a), but does not meet the income limitation, the
11deductible and coinsurance portions of
medicare Medicare services under
42 USC
121395 to
1395i, including those services that are not included in the approved state
13plan for services under
42 USC 1396.
Payment of deductibles and coinsurance for
14inpatient hospital services under Part A of Medicare may not exceed the allowable
15charge for the service under Medical Assistance minus the Medicare payment.
SB27-SSA1,638,217
49.47
(6) (a) 6. f. For an individual who is only entitled to coverage under
part 18Part B of
medicare Medicare and meets the eligibility criteria under sub. (4), but does
19not meet the income limitation,
medical assistance
Medical Assistance shall include
20payment of the deductible and coinsurance portions of
medicare Medicare services
21under
42 USC 1395j to
1395w, including those
medicare
Medicare services that are
22not included in the approved state plan for services under
42 USC 1396. Payment
23of coinsurance for a service under
part Part B of
medicare, other than payment of
24coinsurance for outpatient hospital services, Medicare may not exceed the allowable
1charge for the service under
medical assistance Medical Assistance minus the
2medicare Medicare payment.
SB27-SSA1,638,75
49.471
(13) Applicability. If the department creates a policy under s. 49.45
6(2m) (c), subs. (4), (5), (6), (7), (8), (10), and (11) do not apply to the extent that those
7subsections conflict with the policy.
SB27-SSA1, s. 1461h
8Section 1461h. 49.471 (13) of the statutes, as created by 2011 Wisconsin Act
9.... (this act), is repealed.
SB27-SSA1,638,1512
49.472
(3) Eligibility. (intro.) Except as provided in sub. (6) (a) and unless
13otherwise provided by the department by a policy created under s. 49.45 (2m) (c), an
14individual is eligible for and shall receive medical assistance under this section if all
15of the following conditions are met:
SB27-SSA1, s. 1461q
16Section 1461q. 49.472 (3) (intro.) of the statutes, as affected by 2011 Wisconsin
17Act .... (this act), is amended to read:
SB27-SSA1,638,2118
49.472
(3) Eligibility. (intro.) Except as provided in sub. (6) (a)
and unless
19otherwise provided by the department by a policy created under s. 49.45 (2m) (c), an
20individual is eligible for and shall receive medical assistance under this section if all
21of the following conditions are met:
SB27-SSA1,639,324
49.472
(4) (b) (intro.) The department may waive monthly premiums that are
25calculated to be below $10 per month. Unless otherwise provided by the department
1by a policy created under s. 49.45 (2m) (c), the department may not assess a monthly
2premium for any individual whose income level, after adding the individual's earned
3income and unearned income, is below 150% of the poverty line.
SB27-SSA1, s. 1462h
4Section 1462h. 49.472 (4) (b) (intro.) of the statutes, as affected by 2011
5Wisconsin Act .... (this act), is amended to read:
SB27-SSA1,639,106
49.472
(4) (b) (intro.) The department may waive monthly premiums that are
7calculated to be below $10 per month.
Unless otherwise provided by the department
8by a policy created under s. 49.45 (2m) (c), the The department may not assess a
9monthly premium for any individual whose income level, after adding the
10individual's earned income and unearned income, is below 150% of the poverty line.
SB27-SSA1,639,1712
49.472
(6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation
account 13accounts under s. 20.435 (4) (b)
, (gm), or (w), the department shall, on the part of an
14individual who is eligible for medical assistance under sub. (3), pay premiums for or
15purchase individual coverage offered by the individual's employer if the department
16determines that paying the premiums for or purchasing the coverage will not be more
17costly than providing medical assistance.
SB27-SSA1,639,2219
49.472
(6) (b) If federal financial participation is available, from the
20appropriation
account accounts under s. 20.435 (4) (b)
, (gm), or (w), the department
21may pay medicare Part A and Part B premiums for individuals who are eligible for
22medicare and for medical assistance under sub. (3).
SB27-SSA1,640,5
149.473
(2) (intro.) Unless otherwise provided by the department by a policy
2created under s. 49.45 (2m) (c), a woman is eligible for medical assistance as provided
3under sub. (5) if, after applying to the department or a county department, the
4department or a county department determines that she meets all of the following
5requirements:
SB27-SSA1, s. 1465p
6Section 1465p. 49.473 (2) (intro.) of the statutes, as affected by 2011
7Wisconsin Act .... (this act), is amended to read:
SB27-SSA1,640,128
49.473
(2) (intro.)
Unless otherwise provided by the department by a policy
9created under s. 49.45 (2m) (c), a A woman is eligible for medical assistance as
10provided under sub. (5) if, after applying to the department or a county department,
11the department or a county department determines that she meets all of the
12following requirements:
SB27-SSA1,640,2015
49.473
(5) The department shall audit and pay, from the appropriation
16accounts under s. 20.435 (4) (b), (gm), and (o), allowable charges to a provider who
17is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who
18meets the requirements under sub. (2) for all benefits and services specified under
19s. 49.46 (2), unless otherwise provided by the department by a policy created under
20s. 49.45 (2m) (c).
SB27-SSA1, s. 1470b
21Section 1470b. 49.473 (5) of the statutes, as affected by 2011 Wisconsin Act
22.... (this act), is amended to read:
SB27-SSA1,641,323
49.473
(5) The department shall audit and pay, from the appropriation
24accounts under s. 20.435 (4) (b), (gm), and (o), allowable charges to a provider who
25is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who
1meets the requirements under sub. (2) for all benefits and services specified under
2s. 49.46 (2)
, unless otherwise provided by the department by a policy created under
3s. 49.45 (2m) (c).
SB27-SSA1,641,85
49.67
(3) (am) 2. b. If the applicant is under
27 26 years of age, notice that he
6or she may be eligible for coverage as a dependent under his or her parent's health
7care plan in accordance with s. 632.885, and that his or her parent's plan must
8include coverage for services that are not covered under the plan under this section.
SB27-SSA1,642,210
49.68
(3) (b) From the appropriation accounts under ss. 20.435 (4) (e) and (je),
11the state shall pay
the cost of, at a rate determined by the department under par. (e),
12for medical treatment
that is required as a direct result of chronic renal disease of
13certified patients from the date of certification, including
the cost of administering
14recombinant human erythropoietin to appropriate patients, whether the treatment
15is rendered in an approved facility in the state or in a dialysis or transplantation
16center
which that is approved as such by a contiguous state, subject to the conditions
17specified under par. (d). Approved facilities may include a hospital in-center dialysis
18unit or a nonhospital dialysis center
which that is closely affiliated with a home
19dialysis program supervised by an approved facility. Aid shall also be provided for
20all reasonable expenses incurred by a potential living-related donor, including
21evaluation, hospitalization, surgical costs
, and postoperative follow-up to the extent
22that these costs are not reimbursable under the federal medicare program or other
23insurance. In addition, all expenses incurred in the procurement, transportation
, 24and preservation of cadaveric donor kidneys shall be covered to the extent that these
1costs are not otherwise reimbursable. All donor-related costs are chargeable to the
2recipient and reimbursable under this subsection.
SB27-SSA1,642,164
49.68
(3) (e)
State aids Payment for services provided under this section shall
5be
equal to at a rate determined by the department that does not exceed the allowable
6charges under the federal Medicare program. In no case shall state rates for
7individual service elements exceed the federally defined allowable costs. The rate
8of charges for services not covered by public and private insurance shall not exceed
9the reasonable charges as established by
medicare
Medicare fee determination
10procedures. A person that provides to a patient a service for which aid is provided
11under this section shall accept the amount paid under this section for the service as
12payment in full and may not bill the patient for any amount by which the charge for
13the service exceeds the amount paid for the service under this section. The state may
14not pay for the cost of travel, lodging, or meals for persons who must travel to receive
15inpatient and outpatient dialysis treatment for kidney disease. This paragraph shall
16not apply to donor related costs as defined in par. (b).
SB27-SSA1,642,2018
49.78 (1) (br) "Multicounty consortium" means a group of counties that is
19approved by the department under sub. (1m) to administer income maintenance
20programs.
SB27-SSA1,642,2422
49.78
(1m) Multicounty consortia. (a) Except as provided in par. (c), each
23county with a population of less than 750,000 shall participate in a multicounty
24consortium that is approved by the department under par. (b).
SB27-SSA1,643,2
1(b) By October 31, 2011, the department shall approve multicounty consortia.
2The department may not approve more than 10 multicounty consortia.
SB27-SSA1,643,103
(c) If a county with a population of less than 750,000 does not participate in a
4multicounty consortium or the department determines that a multicounty
5consortium does not satisfy the department's performance requirements, the
6department shall assume responsibility for administering income maintenance
7programs in that county or in the geographical area of the multicounty consortium.
8The department may provide income maintenance program administration under
9this paragraph by contracting with another multicounty consortium or by providing
10the administrative services with state resources and employees.
SB27-SSA1,643,1711
(d) If the department assumes responsibility for administering income
12maintenance programs in a county or in the geographical area of the multicounty
13consortium under par. (c), any county for which the department administers income
14maintenance programs shall pay to the department the amount that the county
15expended for the administration of income maintenance programs in calendar year
162009. For the purposes of this paragraph, Kenosha County expended $673,000 for
17the administration of income maintenance programs in calendar year 2009.
SB27-SSA1,643,2219
49.78
(1r) Single county consortia. The department shall administer income
20maintenance programs in a county with a population of 750,000 or more as a
21single-county consortium, including the administrative functions specified in sub.
22(2) (b) 1.
SB27-SSA1,643,2424
49.78
(2) (title)
Contracts with multicounty consortia.
SB27-SSA1, s. 1490m
1Section 1490m. 49.78 (2) of the statutes is renumbered 49.78 (2) (a) and
2amended to read:
SB27-SSA1,644,103
49.78
(2) (a) Annually,
for the income maintenance program functions, if any, 4that the department delegates to a county or tribal governing body beginning with
5contracts for 2012, the department
and county department under s. 46.215, 46.22,
6or 46.23 shall enter into a contract
, and the department and tribal governing body
7may enter into a contract, for reimbursement of the county department or tribal
8governing body for the reasonable cost of administering with each multicounty
9consortium to administer income maintenance programs
in the multicounty
10consortium's geographical area.
SB27-SSA1,644,1212
49.78
(2) (b) A contract under par. (a) shall provide all of the following:
SB27-SSA1,644,1413
1. That the multicounty consortia shall be responsible for all of the following
14administrative functions related to income maintenance programs:
SB27-SSA1,644,1515
a. Operating and maintaining a call center.
SB27-SSA1,644,1616
b. Conducting application processing and eligibility determinations.
SB27-SSA1,644,1717
c. Conducting ongoing case management.
SB27-SSA1,644,1818
d. Providing lobby services.
SB27-SSA1,644,2019
2. That the department and multicounty consortia shall cooperate to provide
20the following administrative functions related to the income maintenance programs:
SB27-SSA1,644,2121
a. Conducting subrogation and benefit recovery efforts.
SB27-SSA1,644,2222
b. Participating in fair hearings.
SB27-SSA1,644,2323
c. Conducting fraud prevention and identification activities.
SB27-SSA1,644,2524
3. That the department will reimburse a multicounty consortium for services
25provided under the contract on a risk-adjusted case load basis.
SB27-SSA1,645,62
49.78
(2m) Administration by a tribal governing body. (a) A tribal governing
3body may administer income maintenance programs by electing to have the
4department administer the tribe's income maintenance programs or by providing the
5required administrative services and entering into a contract with the department
6for reimbursement under par. (b).
SB27-SSA1,645,117
(b) Annually, for the income maintenance administrative program functions,
8if any, that the department delegates to a tribal governing body, the department and
9tribal governing body may enter into a contract, for reimbursement of the tribal
10governing body for the reasonable cost of administering income maintenance
11programs.
SB27-SSA1,645,1612
(c) The amount of each reimbursement paid under a contract entered into par.
13(b) shall be calculated using a formula based on workload within the limits of state
14and federal funds. The department may adjust reimbursement amounts determined
15under the contract for workload changes and computer network activities performed
16by a tribal governing body.
SB27-SSA1,645,2018
49.78
(2r) Departmental administrative functions. The department shall
19perform all of the following administrative functions related to income maintenance
20programs:
SB27-SSA1,645,2121
(a) Providing income maintenance worker training.
SB27-SSA1,645,2222
(b) Performing 2nd-party reviews.
SB27-SSA1,645,2323
(c) Administering the funeral expenses program under s. 49.785.
SB27-SSA1,645,2524
(d) Providing information technology and licenses for call centers that are
25operated by multicounty consortia.
SB27-SSA1,646,2
1(e) Maintaining the client assistance reemployment and economic support
2system.
SB27-SSA1,646,43
(f) Contracting with multicounty consortia under sub. (2), including
4establishing performance requirements.
SB27-SSA1,646,65
(g) Contracting with tribal governing bodies under sub. (2m), including
6establishing performance requirements.