SB476,4,2523 49.47 (4) (b) 2w. For a person who is eligible under par. (a) 3. or 4. or (aq), life
24insurance with cash surrender values if the total face value of all life insurance
25policies is not more than $1,500.
SB476, s. 9
1Section 9. 49.47 (4) (b) 3. of the statutes is amended to read:
SB476,5,62 49.47 (4) (b) 3. For a person who is eligible under par. (a) 3. or 4. or (aq), funds
3set aside to meet the burial and related expenses of the person and his or her spouse
4in an amount not to exceed $1,500 each, minus the sum of the cash value of any life
5insurance excluded under subd. 2w. and the amount in any irrevocable burial trust
6under s. 445.125 (1) (a).
SB476, s. 10 7Section 10. 49.47 (4) (c) 1. of the statutes is amended to read:
SB476,5,188 49.47 (4) (c) 1. Except as provided in par. pars. (am) and (aq) and as limited by
9subd. 3., eligibility exists if income does not exceed 133 1/3% of the maximum aid to
10families with dependent children payment under s. 49.19 (11) for the applicant's
11family size or the combined benefit amount available under supplemental security
12income under 42 USC 1381 to 1383c and state supplemental aid under s. 49.77
13whichever is higher. In this subdivision "income" includes earned or unearned
14income that would be included in determining eligibility for the individual or family
15under s. 49.19 or 49.77, or for the aged, blind or disabled under 42 USC 1381 to 1385.
16"Income" does not include earned or unearned income which would be excluded in
17determining eligibility for the individual or family under s. 49.19 or 49.77, or for the
18aged, blind or disabled individual under 42 USC 1381 to 1385.
SB476, s. 11 19Section 11. 49.47 (4) (c) 3. of the statutes is amended to read:
SB476,5,2320 49.47 (4) (c) 3. Except as provided in par. pars. (am) and (aq), no person is
21eligible for medical assistance under this section if the person's income exceeds the
22maximum income levels that the U.S. department of health and human services sets
23for federal financial participation under 42 USC 1396b (f).
SB476, s. 12 24Section 12. 49.47 (4) (i) 2. (intro.) of the statutes is amended to read:
SB476,6,3
149.47 (4) (i) 2. (intro.) Notwithstanding par. (b) 2r. and 3., a person who is
2described in par. (a) 3. or 4. or (aq) is not eligible for benefits under this section if any
3of the following criteria is met:
SB476, s. 13 4Section 13. 49.688 of the statutes is created to read:
SB476,6,6 549.688 Prescription drug assistance for low-income elderly persons.
6(1)
In this section:
SB476,6,77 (a) "Generic name" has the meaning given in s. 450.12 (1) (b).
SB476,6,118 (b) "Prescription drug" means a prescription drug, as defined in s. 450.01 (20),
9that is included in the drugs specified under s. 49.46 (2) (b) 6. h. and that is
10manufactured by a manufacturer that enters into a rebate agreement in force under
11sub. (7).
SB476,6,1212 (c) "Prescription order" has the meaning given in s. 450.01 (21).
SB476,6,20 13(2) A person who is a resident, as defined in s. 27.01 (10) (a), of this state, who
14is at least 65 years of age, who is ineligible for medical assistance, whose income does
15not exceed 185% of the poverty line and who pays the program enrollment fee
16specified in sub. (3) (a) is eligible to purchase a prescription drug at the amounts
17specified in sub. (6) (b). The person may apply to the department, on a form provided
18by the department together with program enrollment fee payment, for a
19determination of eligibility and issuance of a prescription drug card for purchase of
20prescription drugs under this section.
SB476,6,21 21(3) Program participants shall pay all of the following:
SB476,6,2222 (a) Annually, a program enrollment fee of $25.
SB476,6,2323 (b) Annually, a deductible of $840.
SB476,6,2424 (c) After payment of the deductible under par. (b), all of the following:
SB476,7,2
11. A copayment of $10 for each prescription drug that bears only a generic
2name.
SB476,7,43 2. A copayment of $20 for each prescription drug that does not bear only a
4generic name.
SB476,7,8 5(4) The department shall devise and distribute a form for application for the
6program under sub. (2), shall determine eligibility of applicants and shall issue to
7eligible persons a prescription drug card for use in purchasing prescription drugs, as
8specified in sub. (5).
SB476,7,14 9(5) Beginning July 1, 2001, as a condition of participation by a pharmacy or
10pharmacist in the program under ss. 49.45, 49.46 or 49.47, the pharmacy or
11pharmacist may not charge a person who presents a valid prescription order and a
12card indicating that he or she meets eligibility requirements under sub. (2) an
13amount for a prescription drug under the order that exceeds the amounts specified
14in sub. (6) (b).
SB476,7,17 15(6) (a) The charge for a prescription drug shall be calculated at the average
16wholesale price minus 5% or the maximum allowable cost, as determined by the
17department, whichever is less.
SB476,7,1918 (b) The amounts that a pharmacy or pharmacist may charge a person specified
19in sub. (2) in a calendar year period for a prescription drug are the following:
SB476,7,2320 1. If applicable, a deductible, as specified in sub. (3) (b), for a prescription drug
21that is charged at the rate specified in par. (a), plus a dispensing fee that is equal to
22the dispensing fee permitted to be charged for prescription drugs for which coverage
23is provided under s. 49.46 (2) (b) 6. h.
SB476,7,2524 2. After the deductible under subd. 1. is charged, the copayment, as applicable,
25that is specified in sub. (3) (c) 1. or 2.
SB476,8,4
1(c) The department shall calculate and transmit to pharmacies and
2pharmacists that are certified providers of medical assistance amounts that may be
3used in calculating charges under par. (a). The department shall periodically update
4this information and transmit the updated amounts to pharmacies and pharmacists.
SB476,8,9 5(7) The department or an entity with which the department contracts may
6enter into a rebate agreement that is modeled on the rebate agreement specified
7under 42 USC 1396r-8 with a drug manufacturer that sells drugs for prescribed use
8in this state. The rebate agreement, if negotiated, shall include all of the following
9as requirements:
SB476,8,1310 (a) That the manufacturer shall make rebate payments for each prescription
11drug of the manufacturer that is prescribed for persons who are eligible under sub.
12(2), to the state treasurer to be credited to the appropriation under s. 20.435 (4) (j),
13each calendar quarter or according to a schedule established by the department.
SB476,8,1514 (b) That the amount of the rebate payment shall be determined by a method
15specified in 42 USC 1396r-8 (c).
SB476,8,24 16(8) From the appropriation accounts under s. 20.435 (4) (bv) and (j), beginning
17July 1, 2001, the department shall provide to pharmacies and pharmacists
18payments, under a schedule that is identical to that used by the department for
19payment of pharmacy provider claims under medical assistance, that correspond to
20the amounts charged by the pharmacies and pharmacists to persons who meet
21criteria for eligibility under sub. (2) for a prescription drug at the rate specified in
22sub. (6) (a), minus the amount of a copayment charged under sub. (6) (b) 2., plus a
23dispensing fee, as specified in sub. (6) (b) 1. The department shall devise and
24distribute a form for reports by pharmacies and pharmacists under this subsection.
SB476,9,6
1(9) The department shall monitor compliance by pharmacies and pharmacists
2that are certified providers of medical assistance with the requirements of sub. (5)
3and shall annually report to the legislature under s. 13.172 (2) concerning the
4compliance. The report shall include information on any pharmacies or pharmacists
5that discontinue participation as certified providers of medical assistance and the
6reasons given for the discontinuance.
SB476,9,10 7(10) If federal law is amended to provide coverage for prescription drugs for
8outpatient care as a benefit under medicare or to provide similar coverage under
9another program, the department shall submit a report concerning this fact to
10appropriate standing committees of the legislature under s. 13.172 (3).
SB476,9,14 11(11) After June 30, 2001, and before July 1, 2003, the department may not
12under sub. (4) subject a manufacturer that enters into a rebate agreement under sub.
13(7) to prior authorization requirements for a prescription drug for outpatient care for
14treatment of a chronic condition.
SB476,9,17 15(12) Except as provided in subs. (9) to (11), the department may enter into a
16contract with an entity to perform the duties and exercise the powers of the
17department under this section.
SB476, s. 14 18Section 14. Appropriation changes.
SB476,9,2419 (1) Prescription drug assistance for elderly; administration. In the schedule
20under section 20.005 (3) of the statutes for the appropriation to the joint committee
21on finance under section 20.865 (4) (a) of the statutes, as affected by the acts of 1999,
22the dollar amount is increased by $2,000,000 for fiscal year 2000-01 to increase
23funding for administration of the prescription drug assistance for elderly program
24under section 49.688 of the statutes, as created by this act.
SB476, s. 15 25Section 15. Initial applicability.
SB476,10,3
1(1) The treatment of section 49.47 (4) (aq), (b) 2m. b., 2r., 2w. and 3., (c) 1. and
23. and (i) (2) (intro.) of the statutes first applies to eligibility determinations made
3for medical assistance on July 1, 2001.
SB476, s. 16 4Section 16. Effective dates; health and family services. This act takes
5effect on the day after publication, except as follows:
SB476,10,76 (1) Prescription drug assistance for elderly. The treatment of section 20.435
7(4) (bv) of the statutes takes effect on July 1, 2001.
SB476,10,88 (End)
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