SB44, s. 1371
18Section
1371. 49.45 (7) (a) of the statutes is amended to read:
SB44,610,219
49.45
(7) (a) A recipient who is a patient in a public medical institution or an
20accommodated person and has a monthly income exceeding the payment rates
21established under
42 USC 1382 (e) may retain
$45
$30 unearned income or the
22amount of any pension paid under
38 USC 3203 (f) 38 USC 5503 (d), whichever is
23greater, per month for personal needs. Except as provided in s. 49.455 (4) (a), the
24recipient shall apply income in excess of
$45 $30 or the amount of any pension paid
25under
38 USC 3203 (f) 38 USC 5503 (d), whichever is greater, less any amount
1deducted under rules promulgated by the department, toward the cost of care in the
2facility.
SB44, s. 1372
3Section
1372. 49.45 (8) (b) of the statutes is amended to read:
SB44,610,84
49.45
(8) (b) Reimbursement under s. 20.435 (4) (b),
(gp), (o),
(r), and (w) for
5home health services provided by a certified home health agency or independent
6nurse shall be made at the home health agency's or nurse's usual and customary fee
7per patient care visit, subject to a maximum allowable fee per patient care visit that
8is established under par. (c).
SB44, s. 1373
9Section
1373. 49.45 (18) (intro.) of the statutes is renumbered 49.45 (18) (ac)
10and amended to read:
SB44,610,2211
49.45
(18) (ac) Except as provided in pars.
(a) (am) to (d),
and subject to par.
12(ag), any person eligible for medical assistance under s. 49.46, 49.468
, or 49.47 shall
13pay up to the maximum amounts allowable under
42 CFR 447.53 to
447.58 for
14purchases of services provided under s. 49.46 (2). The service provider shall collect
15the
specified or allowable copayment, coinsurance
, or deductible, unless the service
16provider determines that the cost of collecting the copayment, coinsurance
, or
17deductible exceeds the amount to be collected. The department shall reduce
18payments to each provider by the amount of the
specified or allowable copayment,
19coinsurance
, or deductible. No provider may deny care or services because the
20recipient is unable to share costs, but an inability to share costs specified in this
21subsection does not relieve the recipient of liability for these costs.
Liability under
22this subsection is limited by the following provisions:
SB44, s. 1374
23Section
1374. 49.45 (18) (a) of the statutes is renumbered 49.45 (18) (am).
SB44, s. 1375
24Section
1375. 49.45 (18) (ag) of the statutes is created to read:
SB44,611,2
149.45
(18) (ag) Except as provided in pars. (am), (b), and (c), and subject to par.
2(d), a recipient specified in par. (ac) shall pay all of the following:
SB44,611,43
1. A copayment of $1 for each prescription of a drug that bears only a generic
4name, as defined in s. 450.12 (1) (b).
SB44,611,65
2. A copayment of $3 for each prescription of a drug that bears a brand name,
6as defined in s. 450.12 (1) (a).
SB44, s. 1376
7Section
1376. 49.45 (18) (d) of the statutes is amended to read:
SB44,611,118
49.45
(18) (d) No person who designates a pharmacy or pharmacist as his or
9her sole provider of prescription drugs and who so uses that pharmacy or pharmacist
10is liable under this subsection for more than
$5
$12 per month for prescription drugs
11received.
SB44, s. 1377
12Section
1377. 49.45 (19) (bm) of the statutes is amended to read:
SB44,611,1513
49.45
(19) (bm) The
department or the county department under s. 46.215 or
1446.22 shall notify applicants of the requirements of this subsection at the time of
15application.
SB44, s. 1378
16Section
1378. 49.45 (24m) (intro.) of the statutes is amended to read:
SB44,611,2117
49.45
(24m) Home health care and personal care pilot program. (intro.)
18From the
appropriations appropriation accounts under s. 20.435 (4) (b),
(gp), (o),
(r), 19and (w), in order to test the feasibility of instituting a system of reimbursement for
20providers of home health care and personal care services for medical assistance
21recipients that is based on competitive bidding, the department shall:
SB44, s. 1379
22Section
1379. 49.45 (25) (am) (intro.) of the statutes is amended to read:
SB44,612,423
49.45
(25) (am) (intro.) Except as provided under pars. (be)
and, (bg)
, and (bj) 24and sub. (24), case management services under s. 49.46 (2) (b) 9. and (bm) are
25reimbursable under
medical assistance Medical Assistance only if provided to a
1medical assistance Medical Assistance beneficiary who receives case management
2services from or through a certified case management provider in a county, city,
3village
, or town that elects, under par. (b), to make the services available and who
4meets at least one of the following conditions:
SB44, s. 1380
5Section
1380. 49.45 (25) (bj) of the statutes is created to read:
SB44,612,136
49.45
(25) (bj) The department of corrections may elect to provide case
7management services under this subsection to persons who are under the
8supervision of that department under s. 938.183, 938.34 (4h), (4m), or (4n), or
9938.357 (4), who are Medical Assistance beneficiaries, and who meet one or more of
10the conditions specified in par. (am). The amount of the allowable charges for those
11services under the Medical Assistance program that is not provided by the federal
12government shall be paid from the appropriation account under s. 20.410 (3) (hm),
13(ho), or (hr).
SB44, s. 1381
14Section
1381. 49.45 (25) (c) of the statutes is amended to read:
SB44,612,1915
49.45
(25) (c) Except as provided in pars. (b), (be)
and, (bg),
and (bj), the
16department shall reimburse a provider of case management services under this
17subsection only for the amount of the allowable charges for those services under the
18medical assistance Medical Assistance program that is provided by the federal
19government.
SB44, s. 1382
20Section
1382. 49.45 (30e) of the statutes is repealed.
SB44, s. 1383
21Section
1383. 49.45 (30m) of the statutes is renumbered 49.45 (30m) (a)
22(intro.) and amended to read:
SB44,613,223
49.45
(30m) (a) (intro.) A county shall provide the portion of
the payment that
24is not provided by the federal government for all of the following services
under s.
151.06 (1m) (d) to individuals
with developmental disability who are eligible for
2medical assistance
that is not provided by the federal government.:
SB44, s. 1384
3Section
1384. 49.45 (30m) (a) 1. of the statutes is created to read:
SB44,613,44
49.45
(30m) (a) 1. Services under s. 51.06 (1m) (d).
SB44, s. 1385
5Section
1385. 49.45 (30m) (a) 2. of the statutes is created to read:
SB44,613,86
49.45
(30m) (a) 2. Services in an intermediate care facility for the mentally
7retarded, as defined in s. 46.278 (1m) (am), other than a state center for the
8developmentally disabled.
SB44, s. 1386
9Section
1386. 49.45 (30m) (a) 3. of the statutes is created to read:
SB44,613,1110
49.45
(30m) (a) 3. Services for which payment is permitted under sub. (6c) (d)
112. that are provided in a nursing facility, as defined in s. 46.279 (1) (c).
SB44, s. 1387
12Section
1387. 49.45 (30m) (b) of the statutes is created to read:
SB44,613,1613
49.45
(30m) (b) No payment under this section may be made for services
14specified under par. (a) unless the individual who receives the services is protectively
15placed under s. 55.06 (9) (a) or is placed under an emergency placement under s.
1655.06 (11) (a) or a temporary placement under s. 55.06 (11) (c).
SB44, s. 1388
17Section
1388. 49.45 (30m) (c) of the statutes is created to read:
SB44,613,2118
49.45
(30m) (c) No payment under this section may be made for services
19specified under par. (a) 2. or 3. that are provided to an individual who was placed in
20or admitted to an intermediate facility, as defined in s. 46.279 (1) (b), or nursing
21facility, as defined in s. 46.279 (1) (c), unless one of the following applies:
SB44,613,2322
1. Any placement or admission that is made after March 31, 2004, complied
23with the requirements of s. 46.279.
SB44,614,3
12. For an individual who was protectively placed under ch. 55 at any time, any
2annual review that is conducted under s. 55.06 (10) (a) 1. after March 31, 2004,
3complies with the requirements of s. 55.06 (10) (a) 2.
SB44, s. 1389
4Section
1389. 49.45 (36) of the statutes is amended to read:
SB44,614,85
49.45
(36) Homeless beneficiaries. A The department or a county department
6under s. 46.215, 46.22
, or 46.23 may not place the word "homeless" on the medical
7assistance identification card of any person who is determined to be eligible for
8medical assistance benefits and who is homeless.
SB44, s. 1390
9Section
1390. 49.45 (39) (b) 1. of the statutes is amended to read:
SB44,615,1710
49.45
(39) (b) 1. `Payment for school medical services.' If a school district or a
11cooperative educational service agency elects to provide school medical services and
12meets all requirements under par. (c), the department shall reimburse the school
13district or the cooperative educational service agency for 60% of the federal share of
14allowable charges for the school medical services that it provides and, as specified
15in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind
16and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
17and Hard of Hearing elects to provide school medical services and meets all
18requirements under par. (c), the department shall reimburse the department of
19public instruction for 60% of the federal share of allowable charges for the school
20medical services that the Wisconsin Center for the Blind and Visually Impaired or
21the Wisconsin Educational Services Program for the Deaf and Hard of Hearing
22provides and, as specified in subd. 2., for allowable administrative costs. A school
23district, cooperative educational service agency, the Wisconsin Center for the Blind
24and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
25and Hard of Hearing may submit, and the department shall allow, claims for common
1carrier transportation costs as a school medical service unless the department
2receives notice from the federal health care financing administration that, under a
3change in federal policy, the claims are not allowed. If the department receives the
4notice, a school district, cooperative educational service agency, the Wisconsin
5Center for the Blind and Visually Impaired, or the Wisconsin Educational Services
6Program for the Deaf and Hard of Hearing may submit, and the department shall
7allow, unreimbursed claims for common carrier transportation costs incurred before
8the date of the change in federal policy. The department shall promulgate rules
9establishing a methodology for making reimbursements under this paragraph.
All 10Except as provided in subd. 1m., all other expenses for the school medical services
11provided by a school district or a cooperative educational service agency shall be paid
12for by the school district or the cooperative educational service agency with funds
13received from state or local taxes. The school district, the Wisconsin Center for the
14Blind and Visually Impaired, the Wisconsin Educational Services Program for the
15Deaf and Hard of Hearing, or the cooperative educational service agency shall
16comply with all requirements of the federal department of health and human
17services for receiving federal financial participation.
SB44, s. 1391
18Section
1391. 49.45 (39) (b) 1m. of the statutes is created to read:
SB44,615,2519
49.45
(39) (b) 1m. `Supplementary payment for school medical services.' In
20addition to the reimbursement the department provides under subd. 1. to a school
21district or cooperative educational service agency for school medical services, the
22department may make supplementary payments from the appropriation accounts
23under s. 20.435 (4) (b) and (o). The total of the supplementary payments and
24allowable charges paid under subd. 1. may not exceed applicable limitations on
25payments under
42 USC 1396a (a) (30) (A).
SB44, s. 1392
1Section
1392. 49.45 (39) (b) 2. of the statutes is amended to read:
SB44,616,112
49.45
(39) (b) 2. `Payment for school medical services administrative costs.' The
3department shall reimburse a school district or a cooperative educational service
4agency specified under
subd. 1. subds. 1. and 1m. and shall reimburse the
5department of public instruction on behalf of the Wisconsin Center for the Blind and
6Visually Impaired or the Wisconsin Educational Services Program for the Deaf and
7Hard of Hearing for 90% of the federal share of allowable administrative costs, using
8time studies, beginning in fiscal year 1999-2000. A school district or a cooperative
9educational service agency may submit, and the department of health and family
10services shall allow, claims for administrative costs incurred during the period that
11is up to 24 months before the date of the claim, if allowable under federal law.
SB44, s. 1393
12Section
1393. 49.45 (49m) of the statutes is created to read:
SB44,616,1413
49.45
(49m) Prescription drug cost controls; purchasing agreements. (a)
14In this section:
SB44,616,1515
1. "Brand name" has the meaning given in s. 450.12 (1) (a).
SB44,616,1616
2. "Generic name" has the meaning given in s. 450.12 (1) (b).
SB44,616,1717
3. "Prescription drug" has the meaning given in s. 450.01 (20).
SB44,616,2118
(b) The department may enter into a multi-state purchasing agreement with
19another state or a purchasing agreement with a purchaser of prescription drugs if
20the other state or purchaser agrees to participate in one or more of the activities
21specified in par. (c) 1. to 5.
SB44,616,2422
(c) The department may design and implement a program to reduce the cost
23of prescription drugs and to maintain high quality in prescription drug therapies,
24which shall include all of the following:
SB44,617,3
11. A list of the prescription drugs that are included as a benefit under s. 49.46
2(2) (b) 6. h. that identifies preferred choices within therapeutic classes and includes
3prescription drugs that bear only generic names.
SB44,617,94
2. Establishing supplemental rebates under agreements with prescription
5drug manufacturers for prescription drugs provided to recipients under Medical
6Assistance and Badger Care and to eligible persons under s. 49.688 and, if it is
7possible to implement the program without adversely affecting supplemental
8rebates for Medical Assistance, Badger Care, and prescription drug assistance under
9s. 49.688, to beneficiaries of participants under par. (b).
SB44,617,1010
3. Utilization management and fraud and abuse controls.
SB44,617,1211
4. Any other activity to reduce the cost of or expenditures for prescription drugs
12and maintain high quality in prescription drug therapies.
SB44,617,1413
(d) The department may enter into a contract with an entity to perform any of
14the duties and exercise any of the powers of the department under this subsection.
SB44, s. 1394
15Section
1394. 49.453 (1) (ak) of the statutes is created to read:
SB44,617,1716
49.453
(1) (ak) "Consumer price index" has the meaning given in s. 49.455 (1)
17(b).
SB44, s. 1395
18Section
1395. 49.453 (5) of the statutes is amended to read:
SB44,618,719
49.453
(5) Care or personal services. For the purposes of sub. (2), whenever
20a covered individual or his or her spouse, or another person acting on behalf of the
21covered individual or his or her spouse, transfers assets to a relative as payment for
22care or personal services that the relative provides to the covered individual, the
23covered individual or his or her spouse transfers assets for less than fair market
24value unless the care or services directly benefit the covered individual, the amount
25of the payment does not exceed reasonable compensation for the care or services that
1the relative performs and, if the amount of the payment
in any year exceeds 10% of
2the community spouse resource allowance limit specified in s. 49.455 (6) (b) 1. 3$12,000 increased by the same percentage increase as the percentage increase in the
4consumer price index between September 1988 and September of the year before the
5calendar year in which the care or services for which the payment was made were
6performed, the agreement to pay the relative is specified in a notarized written
7agreement that exists at the time that the relative performs the care or services.
SB44, s. 1396
8Section
1396. 49.455 (5) (b) of the statutes is amended to read:
SB44,618,139
49.455
(5) (b) Notwithstanding ch. 766, in determining the resources of an
10institutionalized spouse at the time of application for medical assistance, the amount
11of resources considered to be available to the institutionalized spouse equals the
12value of all of the resources held by either or both spouses minus the greatest of the
13amounts determined under sub. (6) (b)
1. 1m. to 4.
SB44, s. 1397
14Section
1397. 49.455 (6) (a) of the statutes is amended to read:
SB44,618,2215
49.455
(6) (a) Notwithstanding s. 49.453 (2), an institutionalized spouse may
16transfer an amount of resources
equal to not exceeding the community spouse
17resource allowance determined under par. (b) to, or for the sole benefit of, the
18community spouse without becoming ineligible for medical assistance for the period
19of ineligibility under s. 49.453 (3) as a result of the transfer. The institutionalized
20spouse shall make the transfer as soon as practicable after the initial determination
21of eligibility for medical assistance, taking into account the amount of time that is
22necessary to obtain a court order under par. (c).
SB44, s. 1398
23Section
1398. 49.455 (6) (b) (intro.) of the statutes is amended to read:
SB44,619,3
149.455
(6) (b) (intro.) The community spouse resource allowance equals the
2amount by which the amount of resources otherwise available to the community
3spouse is exceeded by the greatest of the following:
SB44, s. 1399
4Section
1399. 49.455 (6) (b) 1. of the statutes is repealed.
SB44, s. 1400
5Section
1400. 49.455 (6) (b) 2. of the statutes is repealed.
SB44, s. 1401
6Section
1401. 49.46 (2) (a) 4. c. of the statutes is amended to read:
SB44,619,87
49.46
(2) (a) 4. c. Skilled nursing home services other than in an institution for
8mental diseases, except as limited under s. 49.45 (6c)
and (30m) (b) and (c).
SB44, s. 1402
9Section
1402. 49.46 (2) (b) 6. a. of the statutes is amended to read:
SB44,619,1110
49.46
(2) (b) 6. a. Intermediate care facility services other than in an institution
11for mental diseases
, except as limited under s. 49.45 (30m) (b) and (c).
SB44, s. 1403
12Section
1403. 49.46 (2) (b) 6. Lm. of the statutes is repealed.
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.