SB40,748,136
2. The department may promulgate emergency rules under s. 227.24 for the
7administration of this section for the period before the effective date of any
8permanent rules promulgated under subd. 1., but not to exceed the period authorized
9under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) (a), (2) (b), and (3), the
10department is not required to provide evidence that promulgating a rule under this
11subdivision as an emergency rule is necessary for the preservation of the public
12peace, health, safety, or welfare and is not required to provide a finding of emergency
13for a rule promulgated under this subdivision.
SB40,748,1714
(b) If the amendments to the state plan submitted under sub. (2) are approved
15and a waiver that is consistent with all of the provisions of this section is granted and
16in effect, the department shall publish a notice in the Wisconsin Administrative
17Register that states the date on which BadgerCare Plus is implemented.
SB40, s. 1606
18Section
1606. 49.472 (6) (a) of the statutes is amended to read:
SB40,748,2419
49.472
(6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account
20under s. 20.435 (4) (b),
(gp), or (w)
, or (xd), the department shall, on the part of an
21individual who is eligible for medical assistance under sub. (3), pay premiums for or
22purchase individual coverage offered by the individual's employer if the department
23determines that paying the premiums for or purchasing the coverage will not be more
24costly than providing medical assistance.
SB40, s. 1607
25Section
1607. 49.472 (6) (b) of the statutes is amended to read:
SB40,749,4
149.472
(6) (b) If federal financial participation is available, from the
2appropriation account under s. 20.435 (4) (b),
(gp), or (w)
, or (xd), the department may
3pay medicare Part A and Part B premiums for individuals who are eligible for
4medicare and for medical assistance under sub. (3).
SB40, s. 1608
5Section
1608. 49.473 (2) (a) of the statutes is amended to read:
SB40,749,86
49.473
(2) (a) The woman is not eligible for medical assistance under ss. 49.46
7(1) and (1m), 49.465, 49.468, 49.47,
49.471, and 49.472, and is not eligible for health
8care coverage under s. 49.665.
SB40, s. 1609
9Section
1609. 49.473 (5) of the statutes is amended to read:
SB40,749,1410
49.473
(5) The department shall audit and pay, from the appropriation
11accounts under s. 20.435 (4) (b),
(gp), and (o)
, and (xd), allowable charges to a provider
12who is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman
13who meets the requirements under sub. (2) for all benefits and services specified
14under s. 49.46 (2).
SB40, s. 1610
15Section
1610. 49.475 (1) (a) of the statutes is renumbered 49.475 (1) (ar).
SB40, s. 1611
16Section
1611. 49.475 (1) (ag) of the statutes is created to read:
SB40,749,1817
49.475
(1) (ag) "Covered entity" means any of the following that is not an
18insurer:
SB40,749,1919
1. A nonprofit hospital, as defined in s. 46.21 (2) (m).
SB40,749,2320
2. An employer, as defined in s. 101.01 (4), labor union, or other group of persons
21organized in this state if the employer, labor union, or other group provides
22prescription drug coverage to covered individuals who reside or are employed in this
23state.
SB40,749,2524
3. A comprehensive or limited health care benefits program administered by
25the state that provides prescription drug coverage.
SB40, s. 1612
1Section
1612. 49.475 (1) (am) of the statutes is created to read:
SB40,750,52
49.475
(1) (am) "Covered individual" means an individual who is a member,
3participant, enrollee, policyholder, certificate holder, contract holder, or beneficiary
4of a covered entity, or a dependent of the individual, and who receives prescription
5drug coverage from or through the covered entity.
SB40, s. 1613
6Section
1613. 49.475 (1) (c) of the statutes is created to read:
SB40,750,117
49.475
(1) (c) "Pharmacy benefits management" means the procurement of
8prescription drugs at a negotiated rate for dispensation in this state to covered
9individuals; the administration or management of prescription drug benefits
10provided by a covered entity for the benefit of covered individuals; or any of the
11following services provided in the administration of pharmacy benefits:
SB40,750,1212
1. Dispensation of prescription drugs by mail.
SB40,750,1413
2. Claims processing, retail network management, and payment of claims to
14pharmacies for prescription drugs dispensed to covered individuals.
SB40,750,1515
3. Clinical formulary development and management services.
SB40,750,1616
4. Rebate contracting and administration.
SB40,750,1817
5. Conduct of patient compliance, therapeutic intervention, generic
18substitution, and disease management programs.
SB40, s. 1614
19Section
1614. 49.475 (1) (d) of the statutes is created to read:
SB40,750,2120
49.475
(1) (d) "Pharmacy benefits manager" means a person that performs
21pharmacy benefits management functions.
SB40, s. 1615
22Section
1615. 49.475 (1) (e) of the statutes is created to read:
SB40,750,2423
49.475
(1) (e) "Recipient" means an individual or his or her spouse or dependent
24who has been or is one of the following:
SB40,751,2
11. A recipient of medical assistance or of a program administered under medical
2assistance under a waiver of federal Medicaid laws.
SB40,751,33
2. An enrollee of family care.
SB40,751,44
3. A recipient of the Badger Care health care program.
SB40,751,55
4. An individual who receives benefits under s. 49.68, 49.683, or 49.685.
SB40,751,76
5. A participant in the program of prescription drug assistance for elderly
7persons under s. 49.688.
SB40,751,88
6. A woman who receives services that are reimbursed under s. 255.06.
SB40, s. 1616
9Section
1616. 49.475 (1) (f) of the statutes is created to read:
SB40,751,1210
49.475
(1) (f) "Third party" means an entity that by statute, rule, or contract
11is responsible for payment of a claim for a health care item or service. "Third party"
12includes all of the following:
SB40,751,1313
1. An insurer.
SB40,751,15142. An employee benefit plan described in
29 USC 1003 (a) that is not exempt
15under
29 USC 1003 (b) and is not a multiple employer welfare arrangement.
SB40,751,16163. A service benefit plan, as specified in
42 USC 1396a (25) (I).
SB40,751,1717
4. A pharmacy benefits manager.
SB40, s. 1617
18Section
1617. 49.475 (2) of the statutes is repealed and recreated to read:
SB40,751,2019
49.475
(2) Requirements of 3rd parties. As a condition of doing business in this
20state, a 3rd party shall do all of the following:
SB40,751,2321
(a) Upon the department's request and in the manner prescribed by the
22department, provide information to the department necessary for the department to
23ascertain all of the following with respect to a recipient:
SB40,751,2524
1. Whether the recipient is being or has been provided coverage or a benefit or
25service by a 3rd party.
SB40,752,3
12. If subd. 1. applies, the nature and period of time of any coverage, benefit, or
2service provided, including the name, address, and identifying number of any
3applicable coverage plan.
SB40,752,74
(b) Accept assignment to the department of a right of a recipient to receive
53rd-party payment for an item or service for which payment under medical
6assistance has been made and accept the department's right to recover any
73rd-party payment made for which assignment has not been accepted.
SB40,752,108
(c) Respond to an inquiry by the department concerning a claim for payment
9of a health care item or service if the department submits the inquiry less than 36
10months after the date on which the health care item or service was provided.
SB40,752,1411
(d) If all of the following apply, agree not to deny a claim submitted by the
12department under par. (b) solely because of the claim's submission date, the type or
13format of the claim form, or failure by a recipient to present proper documentation
14at the time of delivery of the service, benefit, or item that is the basis of the claim:
SB40,752,1615
1. The department submits the claim less than 36 months after the date on
16which the health care item or service was provided.
SB40,752,1917
2. Action by the department to enforce the department's rights under this
18section with respect to the claim is commenced less than 72 months after the
19department submits the claim.
SB40, s. 1618
20Section
1618. 49.475 (3) (intro.) of the statutes is amended to read:
SB40,752,2321
49.475
(3) Written agreement. (intro.) Upon requesting
an insurer a 3rd party 22to provide the information under sub. (2)
(a), the department
and the 3rd party shall
23enter into a written agreement
with the insurer that satisfies all of the following:
SB40, s. 1619
24Section
1619. 49.475 (3) (a) of the statutes is amended to read:
SB40,753,2
149.475
(3) (a) Identifies
in detail the detailed format of the information to be
2disclosed provided to the department.
SB40, s. 1620
3Section
1620. 49.475 (3) (c) of the statutes is amended to read:
SB40,753,54
49.475
(3) (c) Specifies how the
insurer's 3rd party's reimbursable costs under
5sub. (5) will be determined and specifies the manner of payment.
SB40, s. 1621
6Section
1621. 49.475 (4) (a) of the statutes is amended to read:
SB40,753,107
49.475
(4) (a)
An insurer A 3rd party shall provide the information requested
8under sub. (2)
(a) within 180 days after receiving the department's request if it is the
9first time that the department has requested the
insurer 3rd party to disclose
10information under this section.
SB40, s. 1622
11Section
1622. 49.475 (4) (b) of the statutes is amended to read:
SB40,753,1512
49.475
(4) (b)
An insurer A 3rd party shall provide the information requested
13under sub. (2)
(a) within 30 days after receiving the department's request if the
14department has previously requested the
insurer 3rd party to disclose information
15under this section.
SB40, s. 1623
16Section
1623. 49.475 (4) (d) of the statutes is created to read:
SB40,753,1817
49.475
(4) (d) If a 3rd party other than an insurer fails to comply with par. (a)
18or (b), the department may so notify the attorney general.
SB40, s. 1624
19Section
1624. 49.475 (5) of the statutes is amended to read:
SB40,753,2520
49.475
(5) From the appropriations under s. 20.435 (4) (bm) and (pa), the
21department shall reimburse
an insurer A 3rd party that provides information under
22this section sub. (2) (a) for the
insurer's 3rd party's reasonable costs incurred in
23providing the requested information, including its reasonable costs, if any, to develop
24and operate automated systems specifically for the disclosure of
the information
25under this section.
SB40, s. 1625
1Section
1625. 49.475 (6) of the statutes is created to read:
SB40,754,112
49.475
(6) Sharing information. The department of health and family services
3shall provide to the department of workforce development, for purposes of the
4medical support liability program under s. 49.22, any information that the
5department of health and family services receives under this section. The
6department of workforce development may allow a county child support agency
7under s. 59.53 (5) or a tribal child support agency access to the information, subject
8to the use and disclosure restrictions under s. 49.83, and shall consult with the
9department of health and family services regarding procedures and methods to
10adequately safeguard the confidentiality of the information provided under this
11subsection.
SB40, s. 1626
12Section
1626. 49.475 (6) of the statutes, as created by 2007 Wisconsin Act ....
13(this act), is amended to read:
SB40,754,2314
49.475
(6) Sharing information. The department of health and family services
15shall provide to the department of
workforce development children and families, for
16purposes of the medical support liability program under s. 49.22, any information
17that the department of health and family services receives under this section. The
18department of
workforce development children and families may allow a county child
19support agency under s. 59.53 (5) or a tribal child support agency access to the
20information, subject to the use and disclosure restrictions under s. 49.83, and shall
21consult with the department of health and family services regarding procedures and
22methods to adequately safeguard the confidentiality of the information provided
23under this subsection.
SB40, s. 1627
24Section
1627. 49.48 (1m) of the statutes is amended to read:
SB40,755,7
149.48
(1m) If an individual who applies for or to renew a certification under
2sub. (1) does not have a social security number, the individual, as a condition of
3obtaining the certification, shall submit a statement made or subscribed under oath
4or affirmation to the department that the applicant does not have a social security
5number. The form of the statement shall be prescribed by the department of
6workforce development children and families. A certification issued or renewed in
7reliance upon a false statement submitted under this subsection is invalid.
SB40, s. 1628
8Section
1628. 49.48 (2) of the statutes is amended to read:
SB40,755,129
49.48
(2) The department
of health and family services may not disclose any
10information received under sub. (1) to any person except to the department of
11workforce development children and families for the purpose of making
12certifications required under s. 49.857.
SB40, s. 1629
13Section
1629. 49.48 (3) of the statutes is amended to read:
SB40,755,2514
49.48
(3) The department
of health and family services shall deny an
15application for the issuance or renewal of a certification specified in sub. (1), shall
16suspend a certification specified in sub. (1) or may, under a memorandum of
17understanding under s. 49.857 (2), restrict a certification specified in sub. (1) if the
18department of
workforce development children and families certifies under s. 49.857
19that the applicant for or holder of the certificate is delinquent in the payment of
20court-ordered payments of child or family support, maintenance, birth expenses,
21medical expenses or other expenses related to the support of a child or former spouse
22or fails to comply, after appropriate notice, with a subpoena or warrant issued by the
23department of
workforce development children and families or a county child
24support agency under s. 59.53 (5) and related to paternity or child support
25proceedings.
SB40, s. 1630
1Section
1630. 49.49 (3m) (a) (intro.) of the statutes is amended to read:
SB40,756,52
49.49
(3m) (a) (intro.) No provider may knowingly impose upon a recipient
3charges in addition to payments received for services under ss. 49.45 to
49.47 49.471 4or knowingly impose direct charges upon a recipient in lieu of obtaining payment
5under ss. 49.45 to
49.47 49.471 except under the following conditions:
SB40, s. 1631
6Section
1631. 49.49 (3m) (a) 1. of the statutes is amended to read:
SB40,756,87
49.49
(3m) (a) 1. Benefits or services are not provided under s. 49.46 (2)
or
849.471 (11) and the recipient is advised of this fact prior to receiving the service.
SB40, s. 1632
9Section
1632. 49.49 (3m) (a) 2. of the statutes is amended to read:
SB40,756,2010
49.49
(3m) (a) 2. If an applicant is determined to be eligible retroactively under
11s. 49.46 (1) (b)
or 49.47 (4) (d) and a provider bills the applicant directly for services
12and benefits rendered during the retroactive period, the provider shall, upon
13notification of the applicant's retroactive eligibility, submit claims for
14reimbursement payment under s. 49.45 for covered services or benefits rendered
to
15the recipient during the retroactive period. Upon receipt of payment
under s. 49.45,
16the provider shall reimburse the
applicant recipient or other person who has made
17prior payment to the provider
. No provider may be required to reimburse the
18applicant or other person in excess of the amount reimbursed under s. 49.45 for
19services provided to the recipient during the retroactive eligibility period, by the
20amount of the prior payment made.
SB40, s. 1633
21Section
1633
. 49.49 (3m) (a) 2. of the statutes, as affected by 2007 Wisconsin
22Act .... (this act), is amended to read:
SB40,757,623
49.49
(3m) (a) 2. If an applicant is determined to be eligible retroactively under
24s. 49.46 (1) (b)
or, 49.47 (4) (d)
, or 49.471 and a provider bills the applicant directly
25for services and benefits rendered during the retroactive period, the provider shall,
1upon notification of the applicant's retroactive eligibility, submit claims for payment
2under s. 49.45 for covered services or benefits rendered to the recipient during the
3retroactive period. Upon receipt of payment under s. 49.45, the provider shall
4reimburse the recipient or other person who has made prior payment to the provider
5for services provided to the recipient during the retroactive eligibility period, by the
6amount of the prior payment made.
SB40, s. 1634
7Section
1634
. 49.49 (3m) (a) 3. of the statutes is amended to read:
SB40,757,118
49.49
(3m) (a) 3. Benefits or services for which recipient copayment,
9coinsurance
, or deductible is required under s. 49.45 (18), not to exceed maximum
10amounts allowable under
42 CFR 447.53 to
447.58, or for which recipient copayment
11or coinsurance is required under s. 49.471 (11).
SB40, s. 1635
12Section
1635. 49.497 (title) of the statutes is amended to read:
SB40,757,14
1349.497 (title)
Recovery of incorrect Medical Assistance or Badger Care
14payments and of unpaid employer penalties.