AB500: Bill Text

AB500,5,4 40.51 (8) Every Except as provided in sub. (17), every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.87 (3) to (5), 632.895 (5m) and (8) to (10) and 632.896.

AB500, s. 4 Section 4. 40.51 (9) of the statutes is amended to read:

AB500,5,8 40.51 (9) Every Except as provided in sub. (17), every health maintenance organization and preferred provider plan offered by the state under sub. (6) shall comply with s. 632.87 (2m).

AB500, s. 5 Section 5. 40.51 (15m) of the statutes is amended to read:

AB500,5,12 40.51 (15m) Every Except as provided in sub. (17), every health care plan, except a health maintenance organization or a preferred provider plan, offered by the state under sub. (6) shall comply with s. 632.86.

AB500, s. 6 Section 6. 40.51 (17) of the statutes is created to read:

AB500,5,17 40.51 (17) If one of the plans offered by the state under sub. (6) is the basic plan under ch. 637, that plan is required to comply with only those health insurance mandates, as defined in s. 601.423 (1), that the commissioner of insurance determines by rule under s. 637.05 (1) apply to the basic plan under ch. 637.

AB500, s. 7 Section 7. 46.27 (11) (e) of the statutes is created to read:

AB500,5,23 46.27 (11) (e) Beginning on the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), the department may not provide home and community-based services under this subsection to persons eligible for medical assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) or 49.47 (4) (a) 1. or 2.

AB500, s. 8 Section 8. 46.275 (6) of the statutes is amended to read:

AB500,6,10 46.275 (6) Effective period. This section takes effect on the date approved by the secretary of the U.S. federal department of health and human services as the beginning date of the period of waiver received under sub. (2). This section remains in effect for 3 years following that date and, if the secretary of the U.S. federal department of health and human services approves a waiver extension, shall continue an additional 3 years, except that, beginning on the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), the department may not provide services under this section to persons eligible for medical assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) or 49.47 (4) (a) 1. or 2.

AB500, s. 9 Section 9. 46.278 (8) of the statutes is amended to read:

AB500,6,21 46.278 (8) Effective period. Except as provided under sub. (2), this section takes effect on the date approved by the secretary of the federal department of health and human services as the beginning date of the period of waiver received under sub. (3). This section remains in effect for 3 years following that date and, if the secretary of the federal department of health and human services approves a waiver extension, shall continue an additional 3 years, except that, beginning on the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), the department may not provide services under this section to persons eligible for medical assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) or 49.47 (4) (a) 1. or 2.

AB500, s. 10 Section 10. 49.002 (2) of the statutes is renumbered 49.002 (2) (a) and amended to read:

AB500,7,7 49.002 (2) (a) It Before the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), it is the declared legislative policy that general relief is the payer of last resort in all cases, except those cases involving crime victim awards under s. 949.06, where a dispute may arise over payment for costs associated with maintaining the health and welfare of recipients of general relief, including disputes concerning health care costs with private or public payees of health care costs, other governmental welfare programs, rehabilitation programs and programs requiring institutionalization or long-term medical and psychiatric treatment.

AB500, s. 11 Section 11. 49.002 (2) (b) of the statutes is created to read:

AB500,7,14 49.002 (2) (b) Beginning on the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), it is the declared legislative policy that general relief is the payer of last resort in all cases, except those cases involving crime victim awards under s. 949.06, where a dispute may arise over payment for costs associated with maintaining the welfare of recipients of general relief.

AB500, s. 12 Section 12. 49.01 (5m) of the statutes is renumbered 49.01 (5m) (a) and amended to read:

AB500,8,4 49.01 (5m) (a) "General Before the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), "general relief" means such services, commodities or money moneys as are reasonable and necessary under the circumstances to provide food, housing, clothing, fuel, light, water, medicine, medical, dental, and surgical treatment (including hospital care), optometrical services, nursing, transportation, and funeral expenses, and include includes wages for work relief. The food furnished shall be of a kind and quantity sufficient to provide a nourishing diet. The housing provided shall be adequate for health and decency. Where there are children of school age the general relief furnished shall include necessities for which no other provision is made by law. The general relief furnished, whether by money or otherwise, shall be at such times and in such amounts, as will in the discretion of the general relief official or agency meet the needs of the recipient and protect the public.

AB500, s. 13 Section 13. 49.01 (5m) (b) of the statutes is created to read:

AB500,8,16 49.01 (5m) (b) Beginning on the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), "general relief" means such services, commodities or moneys as are reasonable and necessary under the circumstances to provide food, housing, clothing, fuel, light, water, transportation, and funeral expenses, and includes wages for work relief. The food furnished shall be of a kind and quantity sufficient to provide a nourishing diet. The housing provided shall be adequate for health and decency. Where there are children of school age the general relief furnished shall include necessities for which no other provision is made by law. The general relief furnished, whether by money or otherwise, shall be at such times and in such amounts, as will in the discretion of the general relief official or agency meet the needs of the recipient and protect the public.

AB500, s. 14 Section 14. 49.015 (3) of the statutes is amended to read:

AB500,8,25 49.015 (3) After December 31, 1986, a A general relief agency may waive the requirement under sub. (1) (b) or (2) (a) in a medical emergency or in case of unusual misfortune or hardship. Before the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), a general relief agency may also waive the requirement under sub. (1) (b) or (2) (a) in a medical emergency. Each waiver shall be reported to the department. The department may deny reimbursement under s. 49.035 for any case in which a waiver is inappropriately granted.

AB500, s. 15 Section 15. 49.02 (5m) of the statutes is created to read:

AB500,9,6 49.02 (5m) Beginning on the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), the general relief agency shall assist general relief recipients in applying for health care coverage under the basic plan under s. 637.05 and in applying for a premium subsidy under s. 637.27.

AB500, s. 16 Section 16. 49.02 (20) of the statutes is created to read:

AB500,9,10 49.02 (20) Subsections (5), (6c), (6g), (6r), (8), (9) and (10) do not apply beginning on the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5).

AB500, s. 17 Section 17. 49.032 (4r) of the statutes is amended to read:

AB500,9,16 49.032 (4r) If a general relief agency provides a monthly general relief benefit to an eligible dependent person which exceeds the monthly benefit amount required under sub. (1) (c), the department shall reimburse the general relief agency at the rate set forth under s. 49.035 (1) (d), from the appropriation under s. 20.435 (4) (eb), for the amount paid to the eligible dependent person.

AB500, s. 18 Section 18. 49.035 (1) (intro.) and (d) of the statutes are consolidated, renumbered 49.035 (1) and amended to read:

AB500,9,21 49.035 (1) As provided in sub. (4e), the department shall reimburse, except for medical costs: (d) A, a county for up to 37.5% of the eligible costs paid by the general relief agency for general relief provided under s. 49.02.

AB500, s. 19 Section 19. 49.035 (2) (b) 7. and 8. of the statutes are amended to read:

AB500,9,24 49.035 (2) (b) 7. Up to 40% of eligible medical costs that are incurred by the county before the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), that are incurred on behalf of an individual client and that are not more than $10,000 per claim period.

AB500,10,6 8. Up to 70% of eligible medical costs that are incurred by the county before the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), that are incurred on behalf of an individual client and that exceed $10,000 per claim period.

AB500, s. 20 Section 20. 49.035 (2) (cm) (intro.) of the statutes is amended to read:

AB500,10,12 49.035 (2) (cm) (intro.) A county for up to 60% of the eligible medical costs that are incurred before the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5) for individual clients who are enrolled in a prepaid health care system with a uniform fee per person, if the following requirements are met:

AB500, s. 21 Section 21. 49.035 (4e) (a) and (b) of the statutes are amended to read:

AB500,10,21 49.035 (4e) (a) If claims for reimbursement of eligible general relief costs at the maximum rates under subs. (1) and (2) do not exceed the total of the funds available under s. 20.435 (4) (eb) and the payments to county hospitals and county mental health complexes under par. (c) for that fiscal year, the department shall determine the amount of a county's reimbursement from the appropriation under s. 20.435 (4) (eb) by applying the maximum rates under subs. (1) and (2) to the county's eligible costs and subtracting the amount paid to county hospitals and county mental health complexes in the county under par. (c).

AB500,11,5 (b) If claims for reimbursement of eligible general relief costs at the maximum rates under subs. (1) and (2) do exceed the total of the funds available under s. 20.435 (4) (eb) and the payments to county hospitals and county mental health complexes under par. (c) for that fiscal year, the department shall prorate the funds available under s. 20.435 (4) (eb) among the counties. Under this paragraph, the department shall determine the amount of a county's reimbursement from the appropriation under s. 20.435 (4) (eb) by subtracting the amount paid to county hospitals and county mental health complexes in the county under par. (c) from its prorated share of the funds available under s. 20.435 (4) (eb).

AB500, s. 22 Section 22. 49.035 (4e) (d) of the statutes is created to read:

AB500,11,10 49.035 (4e) (d) This subsection does not apply with respect to claims for reimbursement of eligible general relief costs that were incurred on or after the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5).

AB500, s. 23 Section 23. 49.035 (6) (am) and (b) of the statutes are amended to read:

AB500,11,15 49.035 (6) (am) Requires Before the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), requires prior authorization or health care provider certification for a specified period of time by the general relief agency for all nonemergency medical care that is provided.

AB500,11,23 (b) Develops Before the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), develops and files with the department on or before October 1 of each year a medical cost containment plan for the subsequent calendar year. The plan shall include provisions limiting the inappropriate use of emergency room care and controlling payments to providers and may include provisions on supplying case management services. The department shall approve or disapprove the plan within a reasonable period of time after the plan is timely filed.

AB500, s. 24 Section 24. 49.043 of the statutes is renumbered 49.043 (1) and amended to read:

AB500,12,4 49.043 (1) Any Except as provided in sub. (2), any municipality or county may purchase health or dental insurance for unemployed persons residing in the municipality or county who are not eligible for medical assistance under s. 49.46, 49.468 or 49.47.

AB500, s. 25 Section 25. 49.043 (2) of the statutes is created to read:

AB500,12,8 49.043 (2) This section does not apply on or after the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5).

AB500, s. 26 Section 26. 49.046 (3) (b) 1. to 3. of the statutes are consolidated, renumbered 49.046 (3) (b) 1 and amended to read:

AB500,12,14 49.046 (3) (b) 1. Payments Except as provided in subd. 2., payments for medical care may be made for any benefit authorized under s. 49.46 (2). 2. Payments and shall be equal to the rates established under s. 49.45. 3. Recipients of aid for medical care are subject to the copayment provisions established under s. 49.45 (18).

AB500, s. 27 Section 27. 49.046 (3) (b) 2. of the statutes is created to read:

AB500,12,18 49.046 (3) (b) 2. This paragraph does not apply with respect to payments for medical care incurred on or after the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5).

AB500, s. 28 Section 28. 49.046 (4) (bm) of the statutes is created to read:

AB500,12,24 49.046 (4) (bm) Beginning on the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), the administering agency shall assist recipients of aid under this section in applying for health care coverage under the basic plan under s. 637.05 and in applying for a premium subsidy under s. 637.27.

AB500, s. 29 Section 29. 49.06 (3) of the statutes is renumbered 49.06 (3) (a) and amended to read:

AB500,13,7 49.06 (3) (a) A Except as provided in par. (b), a general relief agency may adopt written criteria to deny eligibility for general relief medical benefits to a person who, in contemplation of becoming eligible to receive general relief benefits, disposes of his or her assets for significantly less than full value during the 90 days immediately before the person applies for general relief medical benefits.

AB500, s. 30 Section 30. 49.06 (3) (b) of the statutes is created to read:

AB500,13,11 49.06 (3) (b) This subsection does not apply after the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5).

AB500, s. 31 Section 31. 49.43 (8) of the statutes is amended to read:

AB500,13,19 49.43 (8) "Medical assistance" means any services or items under ss. 49.45 to 49.47 and 49.49 to 49.497, or any payment or reimbursement made for such services or items, and, beginning on the first day of the 12th month beginning after the date on which the department makes a determination under s. 49.44 (5), coverage under the basic plan under s. 637.05 provided to persons eligible for medical assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) or 49.47 (4) (a) 1. or 2.

AB500, s. 32 Section 32. 49.43 (10) of the statutes is amended to read:

AB500,14,3 49.43 (10) "Provider" means a person, corporation, limited liability company, partnership, unincorporated business or professional association and any agent or employe thereof who provides medical assistance under ss. 49.45 to 49.47, 49.49 and 49.495, including, beginning on the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), any insurer providing coverage under the basic plan under s. 637.05 to persons eligible for medical assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) or 49.47 (4) (a) 1. or 2.

AB500, s. 33 Section 33. 49.44 of the statutes is created to read:

AB500,14,6 49.44 Basic health insurance plan waiver or legislation. (1) Definitions. In this section:

AB500,14,7 (a) "Basic plan" means the basic health care plan under s. 637.05.

AB500,14,8 (b) "Eligible person" means a person eligible to receive medical assistance.

AB500,14,14 (2) Federal waiver. Except as provided in sub. (3), the department shall request a waiver, developed in consultation with and approved by the commissioner of insurance, from the secretary of the federal department of health and human services to allow the state to receive federal funding to provide health care coverage under the basic plan to persons eligible for medical assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) or 49.47 (4) (a) 1. or 2.

AB500,14,20 (3) Federal legislation. If the waiver request is denied, the department shall seek the enactment of federal legislation, developed in consultation with and approved by the commissioner of insurance, providing federal funding to the state to provide health care coverage under the basic plan to persons eligible for medical assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) or 49.47 (4) (a) 1. or 2.

AB500,14,24 (5) Certification by department. If the department determines that a waiver under sub. (2) is approved or legislation under sub. (3) is enacted, the department shall certify its determination to the commissioner of insurance on the first day of the first month beginning after the waiver is approved or the waiver is enacted.

AB500,15,7 (6) Effect of certification. Beginning on the first day of the 12th month beginning after the date on which the department makes a certification under sub. (5), from the appropriations under s. 20.435 (1) (b) and (o), medical assistance shall pay, for persons eligible for medical assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) or 49.47 (4) (a) 1. or 2., the premiums under s. 637.25 for coverage under the basic plan under s. 637.05 or, as provided in ss. 49.46 (2) (c) and (cm), 49.468 and 49.47 (6) (ag), medicare premiums, coinsurance and deductibles.

AB500, s. 34 Section 34. 49.45 (8m) (intro.) of the statutes is amended to read:

AB500,15,14 49.45 (8m) Rates for respiratory care services. (intro.) Notwithstanding a determination by the department of a maximum rate under sub. (8), the rates under sub. (8) and rates charged by providers under s. 49.46 (2) (a) 4. d. that are not home health agencies, for reimbursement for respiratory care services for ventilator-dependent individuals under ss. 49.46 (2) (b) 6. m. and 49.47 (6) (a) 1., shall be as follows:

AB500, s. 35 Section 35. 49.45 (24m) (a) of the statutes is amended to read:

AB500,15,19 49.45 (24m) (a) By September 1, 1990, select a county in this state and solicit bids from providers of home health care and personal care services in that county for the provision, on a contractual basis, of home health and personal care services authorized under ss. 49.46 (2) (a) 4. d. and (b) 6. j. and 49.47 (6) (a) 1.

AB500, s. 36 Section 36. 49.45 (37) (intro.) of the statutes is amended to read:

AB500,16,6 49.45 (37) Plans of care. (intro.) The department may seek a waiver of the requirement under 42 USC 1396n (c) (1) that the department review and approve every written plan of care developed for each individual who receives, under 42 USC 1396n (c) (1), home or community-based services under ss. 49.46 (2) (b) 8. and 49.47 (6) (a) 1. The waiver of the requirement, if granted, shall apply to those county departments or private nonprofit agencies that administer the services and that the department finds and certifies have implemented effective quality assurance systems for service plan development and implementation. If the federal health care financing administration approves the department's request for waiver of the requirement, the department shall, in evaluating a quality assurance system for certification, consider all of the following:

AB500, s. 37 Section 37. 49.45 (50) of the statutes is created to read:

AB500,16,13 49.45 (50) Applicability. Beginning on the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), subs. (2) (a) 9. to 14. and (b), (3) (b) to (k), (6b) to (9s), (13) to (16), (18), (20) to (22), (24) to (26), (29) to (32) and (35) to (37) do not apply with respect to persons eligible for medical assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) or 49.47 (4) (a) 1. or 2.

AB500, s. 38 Section 38. 49.46 (2) (a) (intro.) of the statutes is amended to read:

AB500,16,17 49.46 (2) (a) (intro.) Except as provided in par. pars. (be) and (bm), the department shall audit and pay allowable charges to certified providers for medical assistance on behalf of recipients for the following federally mandated benefits:

AB500, s. 39 Section 39. 49.46 (2) (b) (intro.) of the statutes is amended to read:

AB500,16,21 49.46 (2) (b) (intro.) Except as provided in par. pars. (be) and (bm), the department shall audit and pay allowable charges to certified providers for medical assistance on behalf of recipients for the following services:

AB500, s. 40 Section 40. 49.46 (2) (bm) of the statutes is created to read:

AB500,17,3 49.46 (2) (bm) Beginning on the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5), benefits for an individual who is eligible for medical assistance under sub. (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) are limited to coverage under the basic plan under s. 637.05 or to the payment of medicare premiums, coinsurance and deductibles to the extent provided in pars. (c) and (cm).

AB500, s. 41 Section 41. 49.465 (10) of the statutes is created to read:

AB500,17,8 49.465 (10) This section does not apply on or after the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5) with respect to persons eligible for medical assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) or 49.47 (4) (a) 1. or 2.

AB500, s. 42 Section 42. 49.47 (6) (a) (intro.) of the statutes is renumbered 49.47 (6) (a) and amended to read:

AB500,17,14 49.47 (6) (a) The Except as provided in pars. (ag), (ar) and (as), the department shall audit and pay charges to certified providers for medical assistance services under s. 49.46 (2) (a) and (b) on behalf of the following: all medical assistance recipients eligible under sub. (4).

AB500, s. 43 Section 43. 49.47 (6) (a) 1. of the statutes is repealed.