SB44, s. 1404 13Section 1404. 49.472 (6) (a) of the statutes is amended to read:
SB44,619,1914 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account
15under s. 20.435 (4) (b), (gp), (r), or (w), the department shall, on the part of an
16individual who is eligible for medical assistance under sub. (3), pay premiums for or
17purchase individual coverage offered by the individual's employer if the department
18determines that paying the premiums for or purchasing the coverage will not be more
19costly than providing medical assistance.
SB44, s. 1405 20Section 1405. 49.472 (6) (b) of the statutes is amended to read:
SB44,619,2421 49.472 (6) (b) If federal financial participation is available, from the
22appropriation account under s. 20.435 (4) (b), (gp), (r), or (w), the department may
23pay medicare Part A and Part B premiums for individuals who are eligible for
24medicare and for medical assistance under sub. (3).
SB44, s. 1406 25Section 1406. 49.473 (title) of the statutes is amended to read:
SB44,620,2
149.473 (title) Medical assistance; women diagnosed with breast or
2cervical cancer
or precancerous conditions.
SB44, s. 1407 3Section 1407. 49.473 (2) (c) of the statutes is amended to read:
SB44,620,64 49.473 (2) (c) The woman is not eligible for health care coverage that qualifies
5as creditable coverage in 42 USC 300gg (c), excluding the coverage specified in 42
6USC 300gg
(c) (1) (F)
.
SB44, s. 1408 7Section 1408. 49.473 (2) (e) of the statutes is amended to read:
SB44,620,98 49.473 (2) (e) The woman requires treatment for breast or cervical cancer or
9for a precancerous condition of the breast or cervix
.
SB44, s. 1409 10Section 1409. 49.473 (5) of the statutes is amended to read:
SB44,620,1511 49.473 (5) The department shall audit and pay, from the appropriation
12accounts under s. 20.435 (4) (b), (gp), and (o), and (r), allowable charges to a provider
13who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman
14who meets the requirements under sub. (2) for all benefits and services specified
15under s. 49.46 (2).
SB44, s. 1410 16Section 1410. 49.473 (6) (b) of the statutes is amended to read:
SB44,620,2017 49.473 (6) (b) Inform the woman at the of time of the determination that she
18is required to apply to the department or a county department for medical assistance
19no later than the last day of the month following the month in which the qualified
20entity determines that the woman is eligible for medical assistance.
SB44, s. 1411 21Section 1411. 49.496 (3) (f) of the statutes is amended to read:
SB44,620,2322 49.496 (3) (f) The department may contract with or employ retain an attorney
23to probate estates to recover under this subsection the costs of care.
SB44, s. 1412 24Section 1412. 49.496 (4) of the statutes is amended to read:
SB44,621,15
149.496 (4) Administration. The department may require a county department
2under s. 46.215, 46.22, or 46.23 or the governing body of a federally recognized
3American Indian tribe administering medical assistance to gather and provide the
4department with information needed to recover medical assistance under this
5section. The department shall pay to a county department or tribal governing body
6an amount equal to 5% of the recovery collected by the department relating to a
7beneficiary for whom the county department or tribal governing body made the last
8determination of medical assistance eligibility. A county department or tribal
9governing body may use funds received under this subsection only to pay costs
10incurred under this subsection and, if any amount remains, to pay for improvements
11to functions required under s. 49.33 49.78 (2). The department may withhold
12payments under this subsection for failure to comply with the department's
13requirements under this subsection. The department shall treat payments made
14under this subsection as costs of administration of the medical assistance Medical
15Assistance
program.
SB44, s. 1413 16Section 1413. 49.498 (16) (g) of the statutes is amended to read:
SB44,621,2517 49.498 (16) (g) All forfeitures, penalty assessments , and interest, if any, shall
18be paid to the department within 10 days of receipt of notice of assessment or, if the
19forfeiture, penalty assessment, and interest, if any, are contested under par. (f),
20within 10 days of receipt of the final decision after exhaustion of administrative
21review, unless the final decision is appealed and the order is stayed by court order
22under sub. (19) (b). The department shall remit all forfeitures paid to the state
23treasurer
secretary of administration for deposit in the school fund. The department
24shall deposit all penalty assessments and interest in the appropriation under s.
2520.435 (6) (g).
SB44, s. 1414
1Section 1414. 49.665 (2) (title) of the statutes is amended to read:
SB44,622,22 49.665 (2) (title) Waiver Waivers.
SB44, s. 1415 3Section 1415. 49.665 (2) of the statutes is renumbered 49.665 (2) (a) and
4amended to read:
SB44,622,145 49.665 (2) (a) The department of health and family services shall request a
6waiver from the secretary of the federal department of health and human services
7to permit the department of health and family services to implement, beginning not
8later than July 1, 1998, or the effective date of the waiver, whichever is later, a health
9care program under this section. If a waiver that is consistent with all of the
10provisions of this section, excluding sub. (4) (a) 3m., is granted and in effect, the
11department of health and family services shall implement the program under this
12section. The department of health and family services may not implement the
13program under this section unless a waiver that is consistent with all of the
14provisions of this section, excluding sub. (4) (a) 3m., is granted and in effect.
SB44, s. 1416 15Section 1416. 49.665 (2) (b) of the statutes is created to read:
SB44,622,2516 49.665 (2) (b) If the department of health and family services determines that
17it needs a waiver to require the verification specified in sub. (4) (a) 3m., the
18department shall request a waiver from the secretary of the federal department of
19health and human services and may not implement the verification requirement
20under sub. (4) (a) 3m. unless the waiver is granted. If a waiver is required and is
21granted, the department of health and family services may implement the
22verification requirement under sub. (4) (a) 3m. as appropriate. If a waiver is not
23required, the department of health and family services may require the verification
24specified in sub. (4) (a) 3m. for eligibility determinations and annual review
25eligibility determinations made by the department, beginning on January 1, 2004.
SB44, s. 1417
1Section 1417. 49.665 (4) (am) 3m. of the statutes is created to read:
SB44,623,72 49.665 (4) (am) 3m. Each member of the child's household who is employed
3provides verification from his or her employer, in the manner specified by the
4department, of his or her earnings, of whether the employer provides health care
5coverage for which the child is eligible, and of the amount that the employer pays,
6if any, towards the cost of the health care coverage, excluding any deductibles or
7copayments required under the coverage.
SB44, s. 1418 8Section 1418. 49.665 (4m) of the statutes is created to read:
SB44,623,159 49.665 (4m) Supplemental payments to health maintenance organizations.
10From the appropriation under s. 20.435 (4) (wr), the department shall distribute
11funding in each fiscal year to a health maintenance organization, as defined under
12s. 609.01 (2), to supplement payment to the health maintenance organization under
13this section. The funding shall be to assist in meeting increasing costs, more intense
14use of services by Badger Care recipients, and other reimbursement needs that the
15department identifies.
SB44, s. 1419 16Section 1419. 49.665 (5) (a) of the statutes is renumbered 49.665 (5) (ag) and
17amended to read:
SB44,624,1318 49.665 (5) (ag) Except as provided in pars. (am), (b), and (bm), a family, or child
19who does not reside with his or her parent, who receives health care coverage under
20this section shall pay a percentage of the cost of that coverage in accordance with a
21schedule established by the department by rule. If the schedule established by the
22department requires a family, or child who does not reside with his or her parent, to
23contribute more than 3% of the family's or child's income towards the cost of the
24health care coverage provided under this section, the department shall submit the
25schedule to the joint committee on finance for review and approval of the schedule.

1If the cochairpersons of the joint committee on finance do not notify the department
2within 14 working days after the date of the department's submittal of the schedule
3that the committee has scheduled a meeting to review the schedule, the department
4may implement the schedule. If, within 14 days after the date of the department's
5submittal of the schedule, the cochairpersons of the committee notify the department
6that the committee has scheduled a meeting to review the schedule, the department
7may not require a family, or child who does not reside with his or her parent, to
8contribute more than 3% of the family's or child's income unless the joint committee
9on finance approves the schedule. The joint committee on finance may not approve
10and the department may not implement a schedule that requires a family or child
11to contribute, including the amounts required under par. (am), more than 3.5% of the
12family's or child's income towards the cost of the health care coverage provided under
13this section.
SB44, s. 1420 14Section 1420. 49.665 (5) (ac) of the statutes is created to read:
SB44,624,1715 49.665 (5) (ac) In this subsection, "cost" means total cost-sharing charges,
16including premiums, copayments, coinsurance, deductibles, enrollment fees, and
17any other cost-sharing charges.
SB44, s. 1421 18Section 1421. 49.665 (5) (ag) of the statutes, as affected by 2003 Wisconsin Act
19.... (this act), is amended to read:
SB44,625,1520 49.665 (5) (ag) Except as provided in pars. (am), (b), and (bm), a family, or child
21who does not reside with his or her parent, who receives health care coverage under
22this section shall pay a percentage of the cost of that coverage in accordance with a
23schedule established by the department by rule. If the schedule established by the
24department requires a family, or child who does not reside with his or her parent, to
25contribute more than 3% of the family's or child's income towards the cost of the

1health care coverage provided under this section, the department shall submit the
2schedule to the joint committee on finance for review and approval of the schedule.
3If the cochairpersons of the joint committee on finance do not notify the department
4within 14 working days after the date of the department's submittal of the schedule
5that the committee has scheduled a meeting to review the schedule, the department
6may implement the schedule. If, within 14 days after the date of the department's
7submittal of the schedule, the cochairpersons of the committee notify the department
8that the committee has scheduled a meeting to review the schedule, the department
9may not require a family, or child who does not reside with his or her parent, to
10contribute more than 3% of the family's or child's income unless the joint committee
11on finance approves the schedule. The joint committee on finance may not approve
12and the
The department may not establish or implement a schedule that requires a
13family or child to contribute, including the amounts required under par. (am), more
14than 3.5% 5% of the family's or child's income towards the cost of the health care
15coverage provided under this section.
SB44, s. 1422 16Section 1422. 49.665 (5) (am) of the statutes is created to read:
SB44,625,1917 49.665 (5) (am) Except as provided in pars. (b) and (bm), a child or family
18member who receives health care coverage under this section shall pay the following
19cost-sharing amounts:
SB44,625,2120 1. A copayment of $1 for each prescription of a drug that bears only a generic
21name, as defined in s. 450.12 (1) (b).
SB44,625,2322 2. A copayment of $3 for each prescription of a drug that bears a brand name,
23as defined in s. 450.12 (1) (a).
SB44, s. 1423 24Section 1423. 49.68 (3) (a) of the statutes is amended to read:
SB44,626,4
149.68 (3) (a) Any Subject to s. 49.687 (1m), any permanent resident of this state
2who suffers from chronic renal disease may be accepted into the dialysis treatment
3phase of the renal disease control program if the resident meets standards set by rule
4under sub. (2) and s. 49.687.
SB44, s. 1424 5Section 1424. 49.68 (3) (d) 1. of the statutes is amended to read:
SB44,626,196 49.68 (3) (d) 1. No aid may be granted under this subsection unless the recipient
7has no other form of aid available from the federal medicare program or, from private
8health, accident, sickness, medical, and hospital insurance coverage, or from other
9health care coverage specified by rule under s. 49.687 (1m) (b)
. If insufficient aid is
10available from other sources and if the recipient has paid an amount equal to the
11annual medicare deductible amount specified in subd. 2., the state shall pay the
12difference in cost to a qualified recipient. If at any time sufficient federal or private
13insurance aid or other health care coverage becomes available during the treatment
14period, state aid under this subsection shall be terminated or appropriately reduced.
15Any patient who is eligible for the federal medicare program shall register and pay
16the premium for medicare medical insurance coverage where permitted, and shall
17pay an amount equal to the annual medicare deductible amounts required under 42
18USC 1395e
and 1395L (b), prior to becoming eligible for state aid under this
19subsection
.
SB44, s. 1425 20Section 1425. 49.68 (3) (d) 3. of the statutes is created to read:
SB44,626,2521 49.68 (3) (d) 3. No payment shall be made under this subsection for any portion
22of medical treatment costs or other expenses that are payable under any state,
23federal, or other health care coverage program, including a health care coverage
24program specified by rule under s. 49.687 (1m) (b), or under any grant, contract, or
25other contractual arrangement.
SB44, s. 1426
1Section 1426. 49.68 (3) (e) of the statutes is amended to read:
SB44,627,132 49.68 (3) (e) State aids for services provided under this section shall be equal
3to
may not exceed the allowable charges under the federal medicare program. In no
4case shall state rates for individual service elements exceed the federally defined
5allowable costs. The rate of charges for services not covered by public and private
6insurance shall not exceed the reasonable charges as established by medicare fee
7determination procedures. A person that provides to a patient a service for which
8aid is provided under this section shall accept the amount paid under this section for
9the service as payment in full and may not bill the patient for any amount by which
10the charge for the service exceeds the amount paid for the service under this section.

11The state may not pay for the cost of travel, lodging, or meals for persons who must
12travel to receive inpatient and outpatient dialysis treatment for kidney disease. This
13paragraph shall not apply to donor related costs as defined in par. (b).
SB44, s. 1427 14Section 1427. 49.682 (6) of the statutes is amended to read:
SB44,627,1615 49.682 (6) The department may contract with or employ retain an attorney to
16probate estates to recover under this section the costs of care.
SB44, s. 1428 17Section 1428. 49.683 (1) of the statutes is amended to read:
SB44,627,2118 49.683 (1) The Subject to s. 49.687 (1m), the department may provide financial
19assistance for costs of medical care of persons over the age of 18 years with the
20diagnosis of cystic fibrosis who meet financial requirements established by the
21department by rule under s. 49.687 (1).
SB44, s. 1429 22Section 1429. 49.683 (3) of the statutes is created to read:
SB44,628,223 49.683 (3) No payment shall be made under this section for any portion of
24medical care costs that are payable under any state, federal, or other health care

1coverage program, including a health care coverage program specified by rule under
2s. 49.687 (1m) (b), or under any grant, contract, or other contractual arrangement.
SB44, s. 1430 3Section 1430. 49.685 (6) (b) of the statutes is amended to read:
SB44,628,114 49.685 (6) (b) Reimbursement shall not be made under this section for any
5blood products or supplies which that are not purchased from or provided by a
6comprehensive hemophilia treatment center, or a source approved by the treatment
7center. Reimbursement shall not be made under this section for any portion of the
8costs of blood products or supplies which that are payable under any other state or,
9federal program, or other health care coverage program, including a health care
10coverage program specified by rule under s. 49.687 (1m) (b),
or under any grant,
11contract and any, or other contractual arrangement.
SB44, s. 1431 12Section 1431. 49.687 (title) of the statutes is amended to read:
SB44,628,14 1349.687 (title) Disease aids; patient requirements; rebate agreements;
14cost containment
.
SB44, s. 1432 15Section 1432. 49.687 (1) of the statutes is amended to read:
SB44,629,316 49.687 (1) The department shall promulgate rules that require a person who
17is eligible for benefits under s. 49.68, 49.683, or 49.685 and whose current estimated
18total family
income exceeds specified limits for the current year is at or above 200%
19of the poverty line
to obligate or expend specified portions of the income for medical
20care for treatment of kidney disease, cystic fibrosis, or hemophilia before receiving
21benefits under s. 49.68, 49.683, or 49.685. The rules shall require a person to pay 1%
22of his or her total family income for the cost of medical treatment covered under s.
2349.68, 49.683, or 49.685 if that income is from 300% to 325% of the federal poverty
24line, 1.75% if that income is more than 325% but not more than 350% of the federal
25poverty line, 2.5% if that income is more than 350% but not more than 375% of the

1federal poverty line, 3.25% if that income is more than 375% but not more than 400%
2of the federal poverty line, and 4.25% if that income is more than 400% of the federal
3poverty line.
SB44, s. 1433 4Section 1433. 49.687 (1m) of the statutes is created to read:
SB44,629,95 49.687 (1m) (a) A person is not eligible to receive benefits under s. 49.68,
649.683, or 49.685 unless, before the person applies for benefits under s. 49.68, 49.683,
7or 49.685, the person first applies for benefits under all other health care coverage
8programs specified by the department by rule under par. (b) for which the person
9reasonably may be eligible.
SB44,629,1510 (b) The department shall promulgate rules that specify other health care
11coverage programs for which a person must apply before applying for benefits under
12s. 49.68, 49.683, or 49.685. The programs specified by rule must include the Medical
13Assistance program under subch. IV, the Badger Care health care program under s.
1449.665, and the prescription drug assistance for elderly persons program under s.
1549.688.
SB44,629,2316 (c) Using the procedure under s. 227.24, the department may promulgate rules
17under par. (b) for the period before the effective date of any permanent rules
18promulgated under par. (b), but not to exceed the period authorized under s. 227.24
19(1) (c) and (2). Notwithstanding s. 227.24 (1) (a), (2) (b), and (3), the department is
20not required to provide evidence that promulgating a rule under par. (b) as an
21emergency rule is necessary for the preservation of the public peace, health, safety,
22or welfare and is not required to make a finding of emergency for promulgating a rule
23under par. (b) as an emergency rule.
SB44, s. 1434 24Section 1434. 49.687 (2) of the statutes is amended to read:
SB44,630,10
149.687 (2) The department shall develop and implement a sliding scale of
2patient liability for kidney disease aid under s. 49.68, cystic fibrosis aid under s.
349.683, and hemophilia treatment under s. 49.685, based on the patient's ability to
4pay for treatment. To The department shall continuously review the sliding scale for
5patient liability and revise it as needed to
ensure that the needs for treatment of
6patients with lower incomes receive priority within the availability of funds
amounts
7budgeted
under s. 20.435 (4) (e) and (je), the department shall revise the sliding scale
8for patient liability by January 1, 1994, and shall, every 3 years thereafter by
9January 1, review and, if necessary, revise the sliding scale
are sufficient to cover
10treatment costs
.
SB44, s. 1435 11Section 1435. 49.687 (2m) of the statutes is created to read:
SB44,630,1612 49.687 (2m) If a pharmacy directly bills the department or an entity with
13which the department contracts for a drug supplied to a person receiving benefits
14under s. 49.68, 49.683, or 49.685 and prescribed for treatment covered under s. 49.68,
1549.683, or 49.685, the person shall pay a $5 copayment amount for each such generic
16drug and a $15 copayment amount for each such brand name drug.
SB44, s. 1436 17Section 1436. 49.687 (3) (a) of the statutes is amended to read:
SB44,630,2418 49.687 (3) (a) That, as a condition of coverage for prescription drugs of a
19manufacturer under s. 49.68, 49.683, or 49.685, the manufacturer shall make rebate
20payments for each prescription drug of the manufacturer that is prescribed for and
21purchased by persons who meet eligibility criteria under s. 49.68, 49.683, or 49.685,
22to the state treasurer secretary of administration to be credited to the appropriation
23under s. 20.435 (4) (je), each calendar quarter or according to a schedule established
24by the department.
SB44, s. 1437 25Section 1437. 49.687 (4) of the statutes is created to read:
SB44,631,2
149.687 (4) The department may adopt managed care methods of cost
2containment for the programs under ss. 49.68, 49.683, and 49.685.
SB44, s. 1438 3Section 1438. 49.688 (1) (e) of the statutes is amended to read:
SB44,631,74 49.688 (1) (e) "Program payment rate" means the rate of payment made for the
5identical drug specified under s. 49.46 (2) (b) 6. h., plus 5%, plus a dispensing fee that
6is equal to the dispensing fee permitted to be charged for prescription drugs for which
7coverage is provided under s. 49.46 (2) (b) 6. h.
SB44, s. 1439 8Section 1439. 49.688 (3) (a) of the statutes is renumbered 49.688 (3) (a) (intro.)
9and amended to read:
SB44,631,1310 49.688 (3) (a) (intro.) For each 12-month benefit period, a program enrollment
11fee of $20. that is based on the percentage that a person's annual household income,
12as determined by the department, is of the federal poverty line for a family the size
13of the person's eligible family, as follows:
SB44, s. 1440 14Section 1440. 49.688 (3) (a) 1. of the statutes is created to read:
SB44,631,1515 49.688 (3) (a) 1. Two hundred percent or less, $25.
SB44, s. 1441 16Section 1441. 49.688 (3) (a) 2. of the statutes is created to read:
SB44,631,1717 49.688 (3) (a) 2. More than 200%, $30.
SB44, s. 1442 18Section 1442. 49.688 (3) (b) 1. of the statutes is renumbered 49.688 (3) (b) 1.
19(intro.) and amended to read:
SB44,631,2420 49.688 (3) (b) 1. (intro.) For each 12-month benefit period, for a person specified
21in sub. (2) (a), a deductible for prescription drugs of $500, except that a person whose
22that is based on the percentage that a person's annual household income, as
23determined by the department, is 160% or less of the federal poverty line for a family
24the size of the person's eligible family pays no deductible., as follows:
SB44, s. 1443 25Section 1443. 49.688 (3) (b) 1. a. of the statutes is created to read:
SB44,632,1
149.688 (3) (b) 1. a. One hundred sixty percent or less, no deductible.
SB44, s. 1444 2Section 1444. 49.688 (3) (b) 1. b. of the statutes is created to read:
SB44,632,33 49.688 (3) (b) 1. b. More than 160%, but not more than 200%, $500.
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