Amendment SSA1-SB21

SB21-SSA1,1797 Section 1797. 49.45 (23) (g) of the statutes is created to read:

SB21-SSA1,557,25 49.45 (23) (g) 1. Subject to subd. 3., the department shall submit to the secretary of the federal department of health and human services an amendment to the waiver requested under par. (a) that authorizes the department to do all of the following with respect to the childless adults demonstration project under this subsection:

SB21-SSA1,558,1 a. Impose monthly premiums as determined by the department.

SB21-SSA1,558,3 b. Impose higher premiums for enrollees who engage in behaviors that increase their health risks, as determined by the department.

SB21-SSA1,558,4 c. Require a health risk assessment for all enrollees.

SB21-SSA1,558,7 d. Limit an enrollee's eligibility under the demonstration project to no more than 48 months. The department shall specify the eligibility formula in the waiver amendment.

SB21-SSA1,558,10 e. Require, as a condition of eligibility, that an applicant or enrollee submit to a drug screening assessment and, if indicated, a drug test, as specified by the department in the waiver amendment.

SB21-SSA1,558,15 2. Subject to subd. 3., if the secretary of the federal department of health and human services approves the amendment to the waiver under par. (a), in whole or in part, the department shall implement the changes to the demonstration project under this subsection specified in subd. 1. a. to e. that are approved by the secretary, consistent with the approval.

SB21-SSA1,558,24 3. Prior to submitting to the secretary of the federal department of health and human services the amendment described in subd. 1., the department shall submit to the joint committee on finance a report that summarizes the provisions, and provides an estimate of the fiscal effect, of the proposed amendment to the waiver. If the secretary of the federal department of health and human services approves the amendment described in subd. 1., in whole or in part, before implementing the changes approved by the secretary, the department shall submit a report to the joint committee on finance that summarizes the provisions, and provides an estimate of the fiscal effect, of the amendment approved by the secretary.

SB21-SSA1,1798 Section 1798. 49.45 (24k) of the statutes is created to read:

SB21-SSA1,559,14 49.45 (24k) Dental reimbursement pilot project. (a) 1. Subject to approval of the federal department of health and human services under par. (b), the department, as a pilot project, shall distribute moneys in each fiscal year to increase the reimbursement rate under Medical Assistance for pediatric dental care and adult emergency dental services, as defined by the department, that are provided in Brown, Marathon, Polk, and Racine counties. The reimbursement rate for these services shall equal 80 percent of the median fee for each service as reported in the most recent fee survey for the east north central region conducted by the American Dental Association or shall equal the provider's usual and customary charge, whichever is less. If a median fee is not reported for a service, the department shall establish a fee for the service that approximates 80 percent of the median usual and customary charge for that service for dentists practicing in the state but the reimbursement received by a provider may not exceed the provider's usual and customary charge for that service.

SB21-SSA1,560,2 2. For dental services provided on a fee-for-service basis as of July 1, 2015, the reimbursement rate increase specified in subd. 1. shall be distributed on a fee-for-service basis. For dental services provided as of July 1, 2015, by a health maintenance organization that contracts with the department to provide Medical Assistance services at a capitated rate, the department shall distribute the reimbursement rate increase under subd. 1. to the health maintenance organization. The department shall include in a contract with a health maintenance organization that provides dental services described in subd. 1. in the counties specified in subd. 1. a requirement that the health maintenance organization reimburse providers of services in accordance with the reimbursement rate increase pilot project under subd. 1. The department may not distribute the reimbursement rate increase under subd. 1. to federally qualified health centers that receive a grant under 42 USC 254b.

SB21-SSA1,560,8 (b) The department shall request any waiver from and submit any amendments to the state Medical Assistance plan to the federal department of health and human services necessary for the reimbursement rate increase pilot project under par. (a). If any necessary waiver request or state plan amendment request is approved, the department shall implement par. (a) beginning on the effective date of the waiver or plan amendment.

SB21-SSA1,560,16 (c) If the reimbursement rate increase pilot project under par. (a) is implemented, before the first day of the 4th month beginning after the effective date of the waiver or plan amendment described in par. (b) and quarterly thereafter, the department shall collaborate with the Health Policy Institute of the American Dental Association to evaluate the pilot project under par. (a) and shall submit a report to the joint committee on finance that includes data on all of the following key outcomes of interest from the pilot counties specified in par. (a) and from counties that are not pilot counties:

SB21-SSA1,560,18 1. Dental care utilization among children and adults in dental clinics and in emergency rooms.

SB21-SSA1,560,19 2. Participation by dentists in the Medical Assistance program.

SB21-SSA1,560,21 3. The fiscal impact of the pilot project under par. (a), including costs and savings.

SB21-SSA1,560,23 4. If feasible, a comparison of the pilot project as administered under a fee-for-service system and under a health maintenance organization system.

SB21-SSA1,561,3 5. If feasible, the impact of the pilot project on oral health outcomes, such as Medical Assistance recipients' self-reported assessment of oral health and barriers to obtaining dental care.

SB21-SSA1,561,7 (d) The department may not distribute the reimbursement rate increases under par. (a) for pediatric dental care and adult emergency dental services provided after the first day of the 37th month beginning after the effective date of the waiver or plan amendment described in par. (b).

SB21-SSA1,1799 Section 1799. 49.45 (30x) of the statutes is created to read:

SB21-SSA1,561,13 49.45 (30x) Licensed midwife services. (a) Provider reimbursement. Beginning January 1, 2016, services under s. 49.46 (2) (b) 12t. provided to an individual are reimbursable under the Medical Assistance program if an amendment to the state medical assistance plan approved by the federal department of health and human services permits reimbursement under s. 49.46 (2) (b) 12t.

SB21-SSA1,561,18 (b) Plan amendment. The department shall submit to the federal department of health and human services an amendment to the state medical assistance plan to permit the application of par. (a). The department may not pay reimbursement under par. (a) unless the amendment to the state plan allowing reimbursement under s. 49.46 (2) (b) 12t. is approved and in effect.

SB21-SSA1,1800 Section 1800. 49.45 (39) (bm) of the statutes is created to read:

SB21-SSA1,561,23 49.45 (39) (bm) Excess state share. Any portion of the state share under this subsection in excess of $42,200,000 in fiscal year 2015-16 and in excess of $41,700,000 in fiscal year 2016-17 and each fiscal year thereafter shall be deposited in the Medical Assistance trust fund.

SB21-SSA1,1801 Section 1801. 49.45 (39m) of the statutes is created to read:

SB21-SSA1,562,10 49.45 (39m) State plan amendment for pharmacist reimbursement. The department shall submit to the federal department of health and human services an amendment to the state Medical Assistance plan to permit Medical Assistance reimbursement to pharmacists who meet the training requirements specified by the department to administer vaccines, as determined by the department, to a person 6 to 18 years of age. The department shall provide Medical Assistance reimbursement under this subsection if the federal department of health and human services approves the amendment to the state Medical Assistance plan. A pharmacist or pharmacy shall enroll in the federal Vaccines for Children Program under 42 USC 1396s to be eligible for Medical Assistance reimbursement under this subsection.

SB21-SSA1,1802 Section 1802. 49.45 (41) (b) of the statutes is amended to read:

SB21-SSA1,562,21 49.45 (41) (b) If a county elects to become certified as a provider of mental health crisis intervention services, the county may provide mental health crisis intervention services under this subsection in the county to medical assistance recipients through the medical assistance program. A county that elects to provide the services shall pay the amount of the allowable charges for the services under the medical assistance program that is not provided by the federal government. From the appropriation account under s. 20.435 (5) (bL), the The department shall reimburse the county under this subsection only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.

SB21-SSA1,1803 Section 1803. 49.452 of the statutes is created to read:

SB21-SSA1,563,2 49.452 Counting promissory notes as assets for certain Medical Assistance programs. (1) In this section, "promissory note" means a written, unconditional agreement, given in return for goods, money loaned, or services rendered, under which one party promises to pay another party a specified sum of money at a specified time or on demand.

SB21-SSA1,563,5 (2) If an individual's assets are counted when determining or redetermining the individual's financial eligibility for Medical Assistance, the department shall include a promissory note as a countable asset if all of the following apply:

SB21-SSA1,563,8 (a) The individual applying for or receiving benefits under Medical Assistance or his or her spouse provided the goods, money loaned, or services rendered for the promissory note.

SB21-SSA1,563,10 (b) The promissory note was entered into or purchased on or after the effective date of this paragraph .... [LRB inserts date].

SB21-SSA1,563,12 (c) The promissory note is negotiable, assignable, and enforceable and does not contain any terms making it unmarketable.

SB21-SSA1,563,18 (3) A promissory note is presumed to be negotiable and its asset value is the outstanding principal balance at the time the individual applies for Medical Assistance or at the time the individual's eligibility for Medical Assistance is redetermined, unless the individual shows by credible evidence from a knowledgeable source that the note is nonnegotiable or has a different current market value, which will then be considered the asset value.

SB21-SSA1,1804 Section 1804. 49.453 (4c) (am) of the statutes is created to read:

SB21-SSA1,563,23 49.453 (4c) (am) Notwithstanding par. (a), for purposes of sub. (2), the purchase of or entering into a promissory note by an individual or his or her spouse on or after the effective date of this paragraph .... [LRB inserts date], is a transfer of assets for less than fair market value unless all of the following apply:

SB21-SSA1,563,24 1. The promissory note satisfies the requirements under par. (a) 1. to 3.

SB21-SSA1,564,2 2. The promissory note is negotiable, assignable, and enforceable and does not contain any terms making it unmarketable.

SB21-SSA1,1805 Section 1805. 49.453 (4c) (b) of the statutes is renumbered 49.453 (4c) (b) 1. and amended to read:

SB21-SSA1,564,9 49.453 (4c) (b) 1. The value of a promissory note , purchased before the effective date of this subdivision .... [LRB inserts date], a loan, or a mortgage that does not satisfy the requirements under par. (a) 1. to 3. is the outstanding balance due on the date that the individual applies for medical assistance for nursing facility services or other long-term care services described in sub. (2).

SB21-SSA1,1806 Section 1806. 49.453 (4c) (b) 2. of the statutes is created to read:

SB21-SSA1,564,17 49.453 (4c) (b) 2. The value of a promissory note purchased or entered into on or after the effective date of this subdivision .... [LRB inserts date], that does not satisfy the requirements under par. (am) 1. and 2. is the outstanding balance due on the date that the individual applies for Medical Assistance for nursing facility services or other long-term care services described in sub. (2) or on the date that the individual's eligibility for Medical Assistance for nursing facility services or other long-term care services described in sub. (2) is redetermined.

SB21-SSA1,1807 Section 1807. 49.46 (2) (b) 12t. of the statutes is created to read:

SB21-SSA1,564,21 49.46 (2) (b) 12t. Subject to the limitations under s. 49.45 (30x), licensed midwife services provided by a certified professional midwife licensed under s. 440.982.

SB21-SSA1,1808 Section 1808. 49.46 (2) (b) 14m. of the statutes is created to read:

SB21-SSA1,564,25 49.46 (2) (b) 14m. Subject to par. (bt), substance abuse treatment services provided by a medically monitored treatment service or a transitional residential treatment service.

SB21-SSA1,1809 Section 1809. 49.46 (2) (bt) of the statutes is created to read:

SB21-SSA1,565,6 49.46 (2) (bt) 1. For the purposes of par. (b) 14m., a "medically monitored treatment service" is a 24-hour, community-based service providing observation, monitoring, and treatment by a multidisciplinary team under supervision of a physician, with a minimum of 12 hours of counseling provided per week for each patient.

SB21-SSA1,565,10 2. For the purposes of par. (b) 14m., a "transitional residential treatment service" is a clinically supervised, peer-supported, therapeutic environment with clinical involvement providing substance abuse treatment in the form of counseling for 3 to 11 hours provided per week for each patient.

SB21-SSA1,565,14 3. If approval by the federal department of health and human services of a state plan amendment or waiver request is necessary for federal reimbursement of the services under par. (b) 14m., the department is not required to pay for services described in par. (b) 14m. if the department does not receive the necessary approval.

SB21-SSA1,565,17 4. The department may not provide reimbursement for services under par. (b) 14m. that are provided before July 1, 2016, or before the date of approval of the state plan amendment or waiver request described under subd. 3., whichever is later.

SB21-SSA1,1810 Section 1810. 49.471 (8) (d) 1. a. of the statutes is amended to read:

SB21-SSA1,565,20 49.471 (8) (d) 1. a. A pregnant woman, except as provided in pars. par. (cr) 1. c. and (fm) 4.

SB21-SSA1,1811 Section 1811. 49.471 (8) (f) of the statutes is repealed.

SB21-SSA1,1812 Section 1812. 49.471 (8) (fm) of the statutes is repealed.

SB21-SSA1,1813 Section 1813. 49.471 (8) (g) of the statutes is repealed.

SB21-SSA1,1814 Section 1814. 49.472 (5) of the statutes is amended to read:

SB21-SSA1,566,4 49.472 (5) Community options participants. From the appropriation under s. 20.435 (7) (4) (bd), the department may pay all or a portion of the monthly premium calculated under sub. (4) (a) for an individual who is a participant in the community options program under s. 46.27 (11).

SB21-SSA1,1817 Section 1817. 49.682 (title) of the statutes is amended to read:

SB21-SSA1,566,6 49.682 (title) Recovery from estates ; disease aids and funeral expenses.

SB21-SSA1,1818 Section 1818. 49.682 (1) (a) of the statutes is amended to read:

SB21-SSA1,566,10 49.682 (1) (a) "Client" means a person who receives or received aid under s. 49.68, 49.683, or 49.685 or a person on whose behalf funeral, burial, or cemetery expenses aid was provided under s. 49.785.

SB21-SSA1,1819b Section 1819b. 49.682 (1) (d) of the statutes is renumbered 49.682 (1) (d) (intro.) and amended to read:

SB21-SSA1,566,13 49.682 (1) (d) (intro.) "Nonclient surviving spouse" means any of the following:

SB21-SSA1,566,16 1. A person who was married to a client while when the client was receiving or received services or aid for which the cost may be recovered under sub. (2) (a) and who survived the client.

SB21-SSA1,1819c Section 1819c. 49.682 (1) (d) 2. of the statutes is created to read:

SB21-SSA1,566,22 49.682 (1) (d) 2. A person who was married to a client on whose behalf funeral, burial, or cemetery expenses aid was provided under s. 49.785, who was married to the client at the client's death or when the client was receiving or received any of the benefits described in s. 49.785 (1c) that made the client an eligible recipient under s. 49.785, or at both times, and who survived the client.

SB21-SSA1,1820 Section 1820. 49.682 (2) (am) of the statutes is created to read:

SB21-SSA1,567,3 49.682 (2) (am) The department shall file a claim against the estate of a client, and against the estate of a nonclient surviving spouse, for the amount of aid under s. 49.785 paid to or on behalf of the client.

SB21-SSA1,1821 Section 1821. 49.682 (2) (bm) 1. of the statutes is amended to read:

SB21-SSA1,567,7 49.682 (2) (bm) 1. Property that is subject to the department's claim under par. (a) or (am) in the estate of a client or in the estate of a nonclient surviving spouse is all property of a decedent that is included in the estate.

SB21-SSA1,1822 Section 1822. 49.682 (2) (bm) 2. of the statutes is amended to read:

SB21-SSA1,567,13 49.682 (2) (bm) 2. There is a presumption, consistent with s. 766.31, which may be rebutted, that all property in the estate of the nonclient surviving spouse was marital property held with the client and that 100 percent of the property in the estate of the nonclient surviving spouse is subject to the department's claim under par. (a) or (am).

SB21-SSA1,1823 Section 1823. 49.682 (2) (c) (intro.) of the statutes is amended to read:

SB21-SSA1,567,18 49.682 (2) (c) (intro.) The court shall reduce the amount of a claim under par. (a) or (am) by up to the amount specified in s. 861.33 (2) if necessary to allow the decedent's heirs or the beneficiaries of the decedent's will to retain the following personal property:

SB21-SSA1,1824 Section 1824. 49.682 (3) of the statutes is amended to read:

SB21-SSA1,567,25 49.682 (3) The department shall administer the program under this section and may contract with an entity to administer all or a portion of the program, including gathering and providing the department with information needed to recover payment of aid provided under s. 49.68, 49.683, or 49.685, or 49.785. All funds received under this subsection, net of any amount claimed under s. 49.849 (5), shall be remitted for deposit in the general fund.

SB21-SSA1,1825 Section 1825. 49.682 (4) (a) of the statutes is amended to read:

SB21-SSA1,568,5 49.682 (4) (a) The department may recover amounts under this section for the provision of aid provided under s. 49.68, 49.683, or 49.685 paid on and after September 1, 1995, and for the provision of aid provided under s. 49.785 paid on or after the effective date of this paragraph .... [LRB inserts date].

SB21-SSA1,1826 Section 1826. 49.682 (4) (b) of the statutes is amended to read:

SB21-SSA1,568,10 49.682 (4) (b) The department may file a claim under sub. (2) (a) only with respect to a client who dies after September 1, 1995. The department may file a claim under sub. (2) (am) only with respect to a client who dies after the effective date of this paragraph .... [LRB inserts date].

SB21-SSA1,1827 Section 1827. 49.682 (5) of the statutes is amended to read:

SB21-SSA1,568,17 49.682 (5) The department shall promulgate rules establishing standards for determining whether the application of this section with respect to a claim under sub. (2) (a) would work an undue hardship in individual cases. If the department determines that the application of this section with respect to a claim under sub. (2) (a) would work an undue hardship in a particular case, the department shall waive application of this section in that case.

SB21-SSA1,1830 Section 1830. 49.78 (5) of the statutes is amended to read:

SB21-SSA1,569,2 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 director of the bureau of merit recruitment and selection in the office of state employment relations department of administration. The office of state employment relations department of administration shall be reimbursed for actual expenditures incurred in the performance of its functions under this section from the appropriations available to the department of children and families for administrative expenditures.

SB21-SSA1,1831 Section 1831. 49.785 (1m) (d) of the statutes is created to read:

SB21-SSA1,569,8 49.785 (1m) (d) If the recipient, or the recipient's spouse or another person, owns a life insurance policy insuring the recipient's life and the face value of the policy is more than $3,000, any amount that the department would be obligated to pay under sub. (1) shall be reduced by one dollar for every dollar by which the face value of the policy exceeds $3,000.