LRB-0895/2
RLR:kjf:jf
2007 - 2008 LEGISLATURE
February 27, 2007 - Introduced by Senators Hansen, Lehman, Wirch, Schultz,
Miller, Erpenbach, Breske, Plale, Lassa, Sullivan
and Coggs, cosponsored
by Representatives Soletski, Nelson, Shilling, Hubler, Grigsby, Sheridan,
Staskunas, Pocan, Musser, A. Ott, Mason, Vruwink, Cullen, Hraychuck,
Sinicki
and Seidel. Referred to Committee on Public Health, Senior Issues,
Long Term Care and Privacy.
SB76,1,5 1An Act to renumber and amend 49.688 (11); to amend 49.688 (4); and to
2create
49.688 (4) (b) 2., 49.688 (4) (b) 3. and 49.688 (11) (b) of the statutes;
3relating to: eligibility for and deductible amounts under the prescription drug
4assistance program for the elderly, providing an exemption from emergency
5rule procedures, and requiring the exercise of rule-making authority.
Analysis by the Legislative Reference Bureau
Under current law, elderly persons may purchase prescription drugs at reduced
amounts under a program commonly known as "Senior Care." A person is eligible
for Senior Care if he or she is a state resident, is at least 65 years of age, is not a
medical assistance (MA) recipient or does not receive prescription drug coverage as
an MA recipient, and his or her annual household income, as determined by the
Department of Health and Family Services (DHFS), does not exceed 240 percent of
the federal poverty line. A person must pay an annual $30 fee to enroll in Senior
Care. An enrollee pays the "program payment rate" for prescription drugs (105
percent of the MA prescription drug payment rate plus a dispensing fee) until the
enrollee has met an annual deductible, if applicable, and thereafter pays only a
copayment of $5 for generic prescription drugs and a copayment of $15 for nongeneric
prescription drugs. A person whose annual household income is 160 percent or less
of the federal poverty line pays no deductible; if the person's annual household
income is more than 160 percent but not more than 200 percent of the federal poverty
line, the deductible is $500; and if the person's annual household income exceeds 200
percent of the federal poverty line, the deductible is $850.

Other persons who meet all of the requirements except the income limitation
are also eligible to purchase prescription drugs for the $5 and $15 copayment
amounts for the time remaining in a 12-month period after spending the difference
between their annual household income and 240 percent of the federal poverty line
by paying for prescription drugs at the retail price and satisfying the $850 deductible
by purchasing prescription drugs at the program payment rate.
The U.S. Department of Health and Family Services granted DHFS a Medicaid
waiver that allows DHFS to use federal Medicaid dollars to partially fund Senior
Care.
This bill directs DHFS to seek an amendment to the federal Medicaid waiver
for Senior Care that would allow DHFS to deduct the amount of property taxes that
a person is assessed on his or her principal dwelling when calculating the person's
household income for purposes of determining eligibility for and the deductible
amount under Senior Care. The bill requires DHFS to implement the waiver
amendment if the U.S. Department of Health and Human Services approves it.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB76, s. 1 1Section 1. 49.688 (4) of the statutes is amended to read:
SB76,2,52 49.688 (4) (a) The department shall devise and distribute a form for application
3for the program under sub. (2), shall determine eligibility for each 12-month benefit
4period of applicants and shall issue to eligible persons a prescription drug card for
5use in purchasing prescription drugs, as specified in sub. (5).
SB76,2,7 6(b) 1. The department shall promulgate rules that specify the criteria to be used
7to determine household income under sub. (2) (a) 4. and (b) and (3) (b) 1. and 2.
SB76, s. 2 8Section 2. 49.688 (4) (b) 2. of the statutes is created to read:
SB76,2,139 49.688 (4) (b) 2. The rules under subd. 1. shall require that when determining
10a person's household income the department deduct any amount that the person, or
11any member of his or her household, is assessed in property taxes on the person's
12principal dwelling for the calendar year in which the determination of household
13income is made.
SB76, s. 3
1Section 3. 49.688 (4) (b) 3. of the statutes is created to read:
SB76,3,42 49.688 (4) (b) 3. Subdivision 2. does not apply unless the waiver amendment
3requested by the department under sub. (11) (b) is approved by the U.S. secretary of
4health and human services.
SB76, s. 4 5Section 4. 49.688 (11) of the statutes is renumbered 49.688 (11) (a) and
6amended to read:
SB76,3,147 49.688 (11) (a) The department shall request from the federal U.S. secretary
8of health and human services a waiver, under 42 USC 1315 (a), of federal medicaid
9laws necessary to permit the department of health and family services to conduct a
10project, under all of the requirements of this section, to expand eligibility for medical
11assistance, for purposes of receipt of prescription drugs as a benefit, to include
12individuals who are eligible under sub. (2). The department may implement a waiver
13requested under this subsection only if the conditions of the waiver are consistent
14with the requirements of this section.
SB76,3,17 15(c) The Except as provided in sub. (4) (b) 3., the department shall implement
16the program under this section regardless of whether a waiver, as specified in this
17subsection, is received.
SB76, s. 5 18Section 5. 49.688 (11) (b) of the statutes is created to read:
SB76,3,2319 49.688 (11) (b) By the first day of the 4th month beginning after the effective
20date of this paragraph .... [revisor inserts date], the department of health and family
21services shall request from the U.S. secretary of health and human services an
22amendment to the waiver received under par. (a) that allows the department of
23health and family services to implement the requirement under sub. (4) (b) 2.
SB76, s. 6 24Section 6. Nonstatutory provisions.
SB76,4,13
1(1) Emergency rules. If the U.S. secretary of health and human services
2approves a request for a waiver amendment that is submitted under section 49.688
3(11) (b) of the statutes, as created by this act, the department of health and family
4services shall, using the procedure under section 227.24 of the statutes, promulgate
5the rule required under section 49.688 (4) (b) 2. of the statutes, as created by this act,
6for the period before the effective date of the permanent rule promulgated under
7section 49.688 (4) (b) 2. of the statutes, as created by this act, but not to exceed the
8period authorized under section 227.24 (1) (c) and (2) of the statutes.
9Notwithstanding section 227.24 (1) (a), (2) (b), and (3) of the statutes, the department
10is not required to provide evidence that promulgating a rule under this subsection
11as an emergency rule is necessary for the preservation of the public peace, health,
12safety, or welfare and is not required to provide a finding of emergency for a rule
13promulgated under this subsection.
SB76, s. 7 14Section 7. Initial applicability.
SB76,4,1915 (1) This act first applies to program eligibility determinations and
16determinations of deductible amounts that are made on the first day of the 4th month
17beginning after the secretary of the U.S. department of health and human services
18approves a request for a waiver amendment that is submitted under section 49.688
19(11) (b) of the statutes, as created by this act.
SB76,4,2020 (End)
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