SB44: Bill Text

SB44,611,15 49.45 (19) (bm) The department or the county department under s. 46.215 or 46.22 shall notify applicants of the requirements of this subsection at the time of application.

SB44, s. 1378 Section 1378. 49.45 (24m) (intro.) of the statutes is amended to read:

SB44,611,21 49.45 (24m) Home health care and personal care pilot program. (intro.) From the appropriations appropriation accounts under s. 20.435 (4) (b), (gp), (o), (r), and (w), in order to test the feasibility of instituting a system of reimbursement for providers of home health care and personal care services for medical assistance recipients that is based on competitive bidding, the department shall:

SB44, s. 1379 Section 1379. 49.45 (25) (am) (intro.) of the statutes is amended to read:

SB44,612,4 49.45 (25) (am) (intro.) Except as provided under pars. (be) and, (bg), and (bj) and sub. (24), case management services under s. 49.46 (2) (b) 9. and (bm) are reimbursable under medical assistance Medical Assistance only if provided to a medical assistance Medical Assistance beneficiary who receives case management services from or through a certified case management provider in a county, city, village, or town that elects, under par. (b), to make the services available and who meets at least one of the following conditions:

SB44, s. 1380 Section 1380. 49.45 (25) (bj) of the statutes is created to read:

SB44,612,13 49.45 (25) (bj) The department of corrections may elect to provide case management services under this subsection to persons who are under the supervision of that department under s. 938.183, 938.34 (4h), (4m), or (4n), or 938.357 (4), who are Medical Assistance beneficiaries, and who meet one or more of the conditions specified in par. (am). The amount of the allowable charges for those services under the Medical Assistance program that is not provided by the federal government shall be paid from the appropriation account under s. 20.410 (3) (hm), (ho), or (hr).

SB44, s. 1381 Section 1381. 49.45 (25) (c) of the statutes is amended to read:

SB44,612,19 49.45 (25) (c) Except as provided in pars. (b), (be) and, (bg), and (bj), the department shall reimburse a provider of case management services under this subsection only for the amount of the allowable charges for those services under the medical assistance Medical Assistance program that is provided by the federal government.

SB44, s. 1382 Section 1382. 49.45 (30e) of the statutes is repealed.

SB44, s. 1383 Section 1383. 49.45 (30m) of the statutes is renumbered 49.45 (30m) (a) (intro.) and amended to read:

SB44,613,2 49.45 (30m) (a) (intro.) A county shall provide the portion of the payment that is not provided by the federal government for all of the following services under s. 51.06 (1m) (d) to individuals with developmental disability who are eligible for medical assistance that is not provided by the federal government.:

SB44, s. 1384 Section 1384. 49.45 (30m) (a) 1. of the statutes is created to read:

SB44,613,4 49.45 (30m) (a) 1. Services under s. 51.06 (1m) (d).

SB44, s. 1385 Section 1385. 49.45 (30m) (a) 2. of the statutes is created to read:

SB44,613,8 49.45 (30m) (a) 2. Services in an intermediate care facility for the mentally retarded, as defined in s. 46.278 (1m) (am), other than a state center for the developmentally disabled.

SB44, s. 1386 Section 1386. 49.45 (30m) (a) 3. of the statutes is created to read:

SB44,613,11 49.45 (30m) (a) 3. Services for which payment is permitted under sub. (6c) (d) 2. that are provided in a nursing facility, as defined in s. 46.279 (1) (c).

SB44, s. 1387 Section 1387. 49.45 (30m) (b) of the statutes is created to read:

SB44,613,16 49.45 (30m) (b) No payment under this section may be made for services specified under par. (a) unless the individual who receives the services is protectively placed under s. 55.06 (9) (a) or is placed under an emergency placement under s. 55.06 (11) (a) or a temporary placement under s. 55.06 (11) (c).

SB44, s. 1388 Section 1388. 49.45 (30m) (c) of the statutes is created to read:

SB44,613,21 49.45 (30m) (c) No payment under this section may be made for services specified under par. (a) 2. or 3. that are provided to an individual who was placed in or admitted to an intermediate facility, as defined in s. 46.279 (1) (b), or nursing facility, as defined in s. 46.279 (1) (c), unless one of the following applies:

SB44,613,23 1. Any placement or admission that is made after March 31, 2004, complied with the requirements of s. 46.279.

SB44,614,3 2. For an individual who was protectively placed under ch. 55 at any time, any annual review that is conducted under s. 55.06 (10) (a) 1. after March 31, 2004, complies with the requirements of s. 55.06 (10) (a) 2.

SB44, s. 1389 Section 1389. 49.45 (36) of the statutes is amended to read:

SB44,614,8 49.45 (36) Homeless beneficiaries. A The department or a county department under s. 46.215, 46.22, or 46.23 may not place the word "homeless" on the medical assistance identification card of any person who is determined to be eligible for medical assistance benefits and who is homeless.

SB44, s. 1390 Section 1390. 49.45 (39) (b) 1. of the statutes is amended to read:

SB44,615,17 49.45 (39) (b) 1. `Payment for school medical services.' If a school district or a cooperative educational service agency elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the school district or the cooperative educational service agency for 60% of the federal share of allowable charges for the school medical services that it provides and, as specified in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the department of public instruction for 60% of the federal share of allowable charges for the school medical services that the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing provides and, as specified in subd. 2., for allowable administrative costs. A school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, claims for common carrier transportation costs as a school medical service unless the department receives notice from the federal health care financing administration that, under a change in federal policy, the claims are not allowed. If the department receives the notice, a school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired, or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, unreimbursed claims for common carrier transportation costs incurred before the date of the change in federal policy. The department shall promulgate rules establishing a methodology for making reimbursements under this paragraph. All Except as provided in subd. 1m., all other expenses for the school medical services provided by a school district or a cooperative educational service agency shall be paid for by the school district or the cooperative educational service agency with funds received from state or local taxes. The school district, the Wisconsin Center for the Blind and Visually Impaired, the Wisconsin Educational Services Program for the Deaf and Hard of Hearing, or the cooperative educational service agency shall comply with all requirements of the federal department of health and human services for receiving federal financial participation.

SB44, s. 1391 Section 1391. 49.45 (39) (b) 1m. of the statutes is created to read:

SB44,615,25 49.45 (39) (b) 1m. `Supplementary payment for school medical services.' In addition to the reimbursement the department provides under subd. 1. to a school district or cooperative educational service agency for school medical services, the department may make supplementary payments from the appropriation accounts under s. 20.435 (4) (b) and (o). The total of the supplementary payments and allowable charges paid under subd. 1. may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

SB44, s. 1392 Section 1392. 49.45 (39) (b) 2. of the statutes is amended to read:

SB44,616,11 49.45 (39) (b) 2. `Payment for school medical services administrative costs.' The department shall reimburse a school district or a cooperative educational service agency specified under subd. 1. subds. 1. and 1m. and shall reimburse the department of public instruction on behalf of the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing for 90% of the federal share of allowable administrative costs, using time studies, beginning in fiscal year 1999-2000. A school district or a cooperative educational service agency may submit, and the department of health and family services shall allow, claims for administrative costs incurred during the period that is up to 24 months before the date of the claim, if allowable under federal law.

SB44, s. 1393 Section 1393. 49.45 (49m) of the statutes is created to read:

SB44,616,14 49.45 (49m) Prescription drug cost controls; purchasing agreements. (a) In this section:

SB44,616,15 1. "Brand name" has the meaning given in s. 450.12 (1) (a).

SB44,616,16 2. "Generic name" has the meaning given in s. 450.12 (1) (b).

SB44,616,17 3. "Prescription drug" has the meaning given in s. 450.01 (20).

SB44,616,21 (b) The department may enter into a multi-state purchasing agreement with another state or a purchasing agreement with a purchaser of prescription drugs if the other state or purchaser agrees to participate in one or more of the activities specified in par. (c) 1. to 5.

SB44,616,24 (c) The department may design and implement a program to reduce the cost of prescription drugs and to maintain high quality in prescription drug therapies, which shall include all of the following:

SB44,617,3 1. A list of the prescription drugs that are included as a benefit under s. 49.46 (2) (b) 6. h. that identifies preferred choices within therapeutic classes and includes prescription drugs that bear only generic names.

SB44,617,9 2. Establishing supplemental rebates under agreements with prescription drug manufacturers for prescription drugs provided to recipients under Medical Assistance and Badger Care and to eligible persons under s. 49.688 and, if it is possible to implement the program without adversely affecting supplemental rebates for Medical Assistance, Badger Care, and prescription drug assistance under s. 49.688, to beneficiaries of participants under par. (b).

SB44,617,10 3. Utilization management and fraud and abuse controls.

SB44,617,12 4. Any other activity to reduce the cost of or expenditures for prescription drugs and maintain high quality in prescription drug therapies.

SB44,617,14 (d) The department may enter into a contract with an entity to perform any of the duties and exercise any of the powers of the department under this subsection.

SB44, s. 1394 Section 1394. 49.453 (1) (ak) of the statutes is created to read:

SB44,617,17 49.453 (1) (ak) "Consumer price index" has the meaning given in s. 49.455 (1) (b).

SB44, s. 1395 Section 1395. 49.453 (5) of the statutes is amended to read:

SB44,618,7 49.453 (5) Care or personal services. For the purposes of sub. (2), whenever a covered individual or his or her spouse, or another person acting on behalf of the covered individual or his or her spouse, transfers assets to a relative as payment for care or personal services that the relative provides to the covered individual, the covered individual or his or her spouse transfers assets for less than fair market value unless the care or services directly benefit the covered individual, the amount of the payment does not exceed reasonable compensation for the care or services that the relative performs and, if the amount of the payment in any year exceeds 10% of the community spouse resource allowance limit specified in s. 49.455 (6) (b) 1. $12,000 increased by the same percentage increase as the percentage increase in the consumer price index between September 1988 and September of the year before the calendar year in which the care or services for which the payment was made were performed, the agreement to pay the relative is specified in a notarized written agreement that exists at the time that the relative performs the care or services.

SB44, s. 1396 Section 1396. 49.455 (5) (b) of the statutes is amended to read:

SB44,618,13 49.455 (5) (b) Notwithstanding ch. 766, in determining the resources of an institutionalized spouse at the time of application for medical assistance, the amount of resources considered to be available to the institutionalized spouse equals the value of all of the resources held by either or both spouses minus the greatest of the amounts determined under sub. (6) (b) 1. 1m. to 4.

SB44, s. 1397 Section 1397. 49.455 (6) (a) of the statutes is amended to read:

SB44,618,22 49.455 (6) (a) Notwithstanding s. 49.453 (2), an institutionalized spouse may transfer an amount of resources equal to not exceeding the community spouse resource allowance determined under par. (b) to, or for the sole benefit of, the community spouse without becoming ineligible for medical assistance for the period of ineligibility under s. 49.453 (3) as a result of the transfer. The institutionalized spouse shall make the transfer as soon as practicable after the initial determination of eligibility for medical assistance, taking into account the amount of time that is necessary to obtain a court order under par. (c).

SB44, s. 1398 Section 1398. 49.455 (6) (b) (intro.) of the statutes is amended to read:

SB44,619,3 49.455 (6) (b) (intro.) The community spouse resource allowance equals the amount by which the amount of resources otherwise available to the community spouse is exceeded by the greatest of the following:

SB44, s. 1399 Section 1399. 49.455 (6) (b) 1. of the statutes is repealed.

SB44, s. 1400 Section 1400. 49.455 (6) (b) 2. of the statutes is repealed.

SB44, s. 1401 Section 1401. 49.46 (2) (a) 4. c. of the statutes is amended to read:

SB44,619,8 49.46 (2) (a) 4. c. Skilled nursing home services other than in an institution for mental diseases, except as limited under s. 49.45 (6c) and (30m) (b) and (c).

SB44, s. 1402 Section 1402. 49.46 (2) (b) 6. a. of the statutes is amended to read:

SB44,619,11 49.46 (2) (b) 6. a. Intermediate care facility services other than in an institution for mental diseases, except as limited under s. 49.45 (30m) (b) and (c).

SB44, s. 1403 Section 1403. 49.46 (2) (b) 6. Lm. of the statutes is repealed.

SB44, s. 1404 Section 1404. 49.472 (6) (a) of the statutes is amended to read:

SB44,619,19 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account under s. 20.435 (4) (b), (gp), (r), or (w), the department shall, on the part of an individual who is eligible for medical assistance under sub. (3), pay premiums for or purchase individual coverage offered by the individual's employer if the department determines that paying the premiums for or purchasing the coverage will not be more costly than providing medical assistance.

SB44, s. 1405 Section 1405. 49.472 (6) (b) of the statutes is amended to read:

SB44,619,24 49.472 (6) (b) If federal financial participation is available, from the appropriation account under s. 20.435 (4) (b), (gp), (r), or (w), the department may pay medicare Part A and Part B premiums for individuals who are eligible for medicare and for medical assistance under sub. (3).

SB44, s. 1406 Section 1406. 49.473 (title) of the statutes is amended to read:

SB44,620,2 49.473 (title) Medical assistance; women diagnosed with breast or cervical cancer or precancerous conditions.

SB44, s. 1407 Section 1407. 49.473 (2) (c) of the statutes is amended to read:

SB44,620,6 49.473 (2) (c) The woman is not eligible for health care coverage that qualifies as creditable coverage in 42 USC 300gg (c), excluding the coverage specified in 42 USC 300gg (c) (1) (F).

SB44, s. 1408 Section 1408. 49.473 (2) (e) of the statutes is amended to read:

SB44,620,9 49.473 (2) (e) The woman requires treatment for breast or cervical cancer or for a precancerous condition of the breast or cervix.

SB44, s. 1409 Section 1409. 49.473 (5) of the statutes is amended to read:

SB44,620,15 49.473 (5) The department shall audit and pay, from the appropriation accounts under s. 20.435 (4) (b), (gp), and (o), and (r), allowable charges to a provider who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who meets the requirements under sub. (2) for all benefits and services specified under s. 49.46 (2).

SB44, s. 1410 Section 1410. 49.473 (6) (b) of the statutes is amended to read:

SB44,620,20 49.473 (6) (b) Inform the woman at the of time of the determination that she is required to apply to the department or a county department for medical assistance no later than the last day of the month following the month in which the qualified entity determines that the woman is eligible for medical assistance.

SB44, s. 1411 Section 1411. 49.496 (3) (f) of the statutes is amended to read:

SB44,620,23 49.496 (3) (f) The department may contract with or employ retain an attorney to probate estates to recover under this subsection the costs of care.

SB44, s. 1412 Section 1412. 49.496 (4) of the statutes is amended to read:

SB44,621,15 49.496 (4) Administration. The department may require a county department under s. 46.215, 46.22, or 46.23 or the governing body of a federally recognized American Indian tribe administering medical assistance to gather and provide the department with information needed to recover medical assistance under this section. The department shall pay to a county department or tribal governing body an amount equal to 5% of the recovery collected by the department relating to a beneficiary for whom the county department or tribal governing body made the last determination of medical assistance eligibility. A county department or tribal governing body may use funds received under this subsection only to pay costs incurred under this subsection and, if any amount remains, to pay for improvements to functions required under s. 49.33 49.78 (2). The department may withhold payments under this subsection for failure to comply with the department's requirements under this subsection. The department shall treat payments made under this subsection as costs of administration of the medical assistance Medical Assistance program.

SB44, s. 1413 Section 1413. 49.498 (16) (g) of the statutes is amended to read:

SB44,621,25 49.498 (16) (g) All forfeitures, penalty assessments , and interest, if any, shall be paid to the department within 10 days of receipt of notice of assessment or, if the forfeiture, penalty assessment, and interest, if any, are contested under par. (f), within 10 days of receipt of the final decision after exhaustion of administrative review, unless the final decision is appealed and the order is stayed by court order under sub. (19) (b). The department shall remit all forfeitures paid to the state treasurer secretary of administration for deposit in the school fund. The department shall deposit all penalty assessments and interest in the appropriation under s. 20.435 (6) (g).

SB44, s. 1414 Section 1414. 49.665 (2) (title) of the statutes is amended to read:

SB44,622,2 49.665 (2) (title) Waiver Waivers.

SB44, s. 1415 Section 1415. 49.665 (2) of the statutes is renumbered 49.665 (2) (a) and amended to read:

SB44,622,14 49.665 (2) (a) The department of health and family services shall request a waiver from the secretary of the federal department of health and human services to permit the department of health and family services to implement, beginning not later than July 1, 1998, or the effective date of the waiver, whichever is later, a health care program under this section. If a waiver that is consistent with all of the provisions of this section, excluding sub. (4) (a) 3m., is granted and in effect, the department of health and family services shall implement the program under this section. The department of health and family services may not implement the program under this section unless a waiver that is consistent with all of the provisions of this section, excluding sub. (4) (a) 3m., is granted and in effect.