AB11,45,1413 5. Improving the health status of individuals who receive benefits under a
14Medical Assistance program.
AB11,45,1615 6. Aligning Medical Assistance program benefit recipient and service provider
16incentives with health care outcomes.
AB11,45,1717 7. Supporting responsibility and choice of medical assistance recipients.
AB11,45,2118 (c) Subject to par. (d), if the department determines, as a result of the study
19under par. (b), that revision of existing statutes or rules would be necessary to
20advance a purpose described in par. (b) 1. to 7., the department may promulgate rules
21that do any of the following related to Medical Assistance programs:
AB11,45,2322 1. Require cost sharing from program benefit recipients up to the maximum
23allowed by federal law or a waiver of federal law.
AB11,45,2524 2. Authorize providers to deny care or services if a program benefit recipient
25is unable to share costs, to the extent allowed by federal law or waiver.
AB11,46,2
13. Modify existing benefits or establish various benefit packages and offer
2different packages to different groups of recipients.
AB11,46,33 4. Revise provider reimbursement models for particular services.
AB11,46,44 5. Mandate that program benefit recipients enroll in managed care.
AB11,46,55 6. Restrict or eliminate presumptive eligibility.
AB11,46,76 7. To the extent permitted by federal law, impose restrictions on providing
7benefits to individuals who are not citizens of the United States.
AB11,46,88 8. Set standards for establishing and verifying eligibility requirements.
AB11,46,109 9. Develop standards and methodologies to assure accurate eligibility
10determinations and redetermine continuing eligibility.
AB11,46,1211 10. Reduce income levels for purposes of determining eligibility to the extent
12allowed by federal law or waiver and subject to the limitations under par. (e) 2.
AB11,46,2413 (d) Before promulgating a rule under par. (c), the department shall submit to
14the joint committee on finance the proposed rule and any plan that the department
15develops as a result of the study under par. (b). If the cochairpersons of the committee
16do not notify the department within 14 working days after the date of the
17department's submittal that the committee has scheduled a meeting for the purpose
18of reviewing the proposed rule or plan, the proposed rule may be promulgated and
19any plan may be implemented as proposed by the department. If, within 14 working
20days after the date of the department's submittal, the cochairpersons of the
21committee notify the department that the committee has scheduled a meeting for the
22purpose of reviewing the proposed rule or plan, the proposed rule may be
23promulgated, and the plan may be implemented only upon approval of the
24committee.
AB11,47,6
1(e) 1. The department shall submit an amendment to the state Medical
2Assistance plan or request a waiver of federal laws related to medical assistance, if
3necessary, to the extent necessary to implement any rule promulgated under par. (c).
4If the federal department of health and human services does not allow the
5amendment or does not grant the waiver, the department may not put the rule into
6effect or implement the action described in the rule.
AB11,47,167 2. The department shall request a waiver from the secretary of the federal
8department of health and human services to permit the department to have in effect
9eligibility standards, methodologies, and procedures under the state Medical
10Assistance plan or waivers of federal laws related to medical assistance that are more
11restrictive than those in place on March 23, 2010. If the waiver request does not
12receive federal approval before December 31, 2011, the department shall reduce
13income levels on July 1, 2012, for the purposes of determining eligibility to 133
14percent of the federal poverty line for adults who are not pregnant and not disabled,
15to the extent permitted under 42 USC 1396a (gg), if the department follows the
16procedures under 42 USC 1396a (gg) (3).
AB11,47,2417 (f) Using the procedure under s. 227.24, the department may promulgate a rule
18under par. (c) as an emergency rule. Notwithstanding s. 227.24 (1) (a) and (3), the
19department is not required to provide evidence that promulgating a rule under par.
20(c) as an emergency rule is necessary for the preservation of the public peace, health,
21safety, or welfare and is not required to provide a finding of emergency for a rule
22promulgated under par. (c). Notwithstanding s. 227.24 (1) (c) and (2), an emergency
23rule promulgated under this paragraph remains in effect until whichever of the
24following occurs first:
AB11,47,2525 1. The effective date of the repeal of the emergency rule.
AB11,48,2
12. The date on which the permanent rule promulgated under par. (c) takes
2effect.
AB11, s. 113 3Section 113. 49.45 (3) (n) of the statutes is created to read:
AB11,48,54 49.45 (3) (n) This subsection does not apply if the department promulgates a
5rule under sub. (2m) (c) 4., to the extent that the rule conflicts with this subsection.
AB11, s. 114 6Section 114. 49.45 (6m) (n) of the statutes is created to read:
AB11,48,87 49.45 (6m) (n) This subsection does not apply if the department promulgates
8a rule under sub. (2m) (c) 4., to the extent that the rule conflicts with this subsection.
AB11, s. 115 9Section 115. 49.45 (8) (b) of the statutes is amended to read:
AB11,48,1510 49.45 (8) (b) Reimbursement Unless otherwise provided by the department by
11rule promulgated under sub. (2m) (c), reimbursement
under s. 20.435 (4) (b), (o), and
12(w) for home health services provided by a certified home health agency or
13independent nurse shall be made at the home health agency's or nurse's usual and
14customary fee per patient care visit, subject to a maximum allowable fee per patient
15care visit that is established under par. (c).
AB11, s. 116 16Section 116. 49.45 (8) (c) of the statutes is amended to read:
AB11,48,2217 49.45 (8) (c) The department shall establish a maximum statewide allowable
18fee per patient care visit, for each type of visit with respect to provider, that may be
19no greater than the cost per patient care visit, as determined by the department from
20cost reports of home health agencies, adjusted for costs related to case management,
21care coordination, travel, record keeping and supervision, unless otherwise provided
22by the department by rule promulgated under sub. (2m) (c)
.
AB11, s. 117 23Section 117. 49.45 (8r) of the statutes is amended to read:
AB11,49,624 49.45 (8r) Payment for certain obstetric and gynecological care. The Unless
25otherwise provided by the department by rule promulgated under sub. (2m) (c), the


1rate of payment for obstetric and gynecological care provided in primary care
2shortage areas, as defined in s. 36.60 (1) (cm), or provided to recipients of medical
3assistance who reside in primary care shortage areas, that is equal to 125% of the
4rates paid under this section to primary care physicians in primary care shortage
5areas, shall be paid to all certified primary care providers who provide obstetric or
6gynecological care to those recipients.
AB11, s. 118 7Section 118. 49.45 (8v) of the statutes is amended to read:
AB11,49,188 49.45 (8v) Incentive-based pharmacy payment system. The department shall
9establish a system of payment to pharmacies for legend and over-the-counter drugs
10provided to recipients of medical assistance that has financial incentives for
11pharmacists who perform services that result in savings to the medical assistance
12program. Under this system, the department shall establish a schedule of fees that
13is designed to ensure that any incentive payments made are equal to or less than the
14documented savings unless otherwise provided by the department by rule
15promulgated under sub. (2m) (c)
. The department may discontinue the system
16established under this subsection if the department determines, after performance
17of a study, that payments to pharmacists under the system exceed the documented
18savings under the system.
AB11, s. 119 19Section 119. 49.45 (18) (ac) of the statutes is amended to read:
AB11,50,720 49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag),
21any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the
22benefits under s. 49.46 (2) (a) and (b) under s. 49.471 shall pay up to the maximum
23amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided
24under s. 49.46 (2). The service provider shall collect the specified or allowable
25copayment, coinsurance, or deductible, unless the service provider determines that

1the cost of collecting the copayment, coinsurance, or deductible exceeds the amount
2to be collected. The department shall reduce payments to each provider by the
3amount of the specified or allowable copayment, coinsurance, or deductible. No
4Unless otherwise provided by the department by rule promulgated under sub. (2m)
5(c), no
provider may deny care or services because the recipient is unable to share
6costs, but an inability to share costs specified in this subsection does not relieve the
7recipient of liability for these costs.
AB11, s. 120 8Section 120. 49.45 (18) (ag) (intro.) of the statutes is amended to read:
AB11,50,119 49.45 (18) (ag) (intro.) Except as provided in pars. (am), (b), and (c), and subject
10to par. (d), a recipient specified in par. (ac) shall pay all of the following, unless
11otherwise provided by the department by rule promulgated under sub. (2m) (c)
:
AB11, s. 121 12Section 121. 49.45 (18) (b) (intro.) of the statutes is amended to read:
AB11,50,1513 49.45 (18) (b) (intro.) The Unless otherwise provided by the department by rule
14promulgated under sub. (2m) (c), the
following services are not subject to recipient
15cost sharing under this subsection:
AB11, s. 122 16Section 122. 49.45 (18) (d) of the statutes is amended to read:
AB11,50,2117 49.45 (18) (d) No person who designates a pharmacy or pharmacist as his or
18her sole provider of prescription drugs and who so uses that pharmacy or pharmacist
19is liable under this subsection for more than $12 per month for prescription drugs
20received, unless otherwise provided by the department by rule promulgated under
21sub. (2m) (c)
.
AB11, s. 123 22Section 123. 49.45 (23) (a) of the statutes is amended to read:
AB11,51,623 49.45 (23) (a) The department shall request a waiver from the secretary of the
24federal department of health and human services to permit the department to
25conduct a demonstration project to provide health care coverage for basic primary

1and preventive care to adults who are under the age of 65, who have family incomes
2not to exceed 200 percent of the poverty line, and who are not otherwise eligible for
3medical assistance under this subchapter, the Badger Care health care program
4under s. 49.665, or Medicare under 42 USC 1395 et seq. If the department
5promulgates a rule under sub. (2m) (c) 10., this paragraph does not apply to the
6extent that it conflicts with the rule.
AB11, s. 124 7Section 124. 49.45 (23) (b) of the statutes is amended to read:
AB11,51,178 49.45 (23) (b) If the waiver is granted and in effect, the department may
9promulgate rules defining the health care benefit plan, including more specific
10eligibility requirements and cost-sharing requirements. Cost Unless otherwise
11provided by the department by rule promulgated under sub. (2m) (c), cost
sharing
12may include an annual enrollment fee, which may not exceed $75 per year.
13Notwithstanding s. 227.24 (3), the plan details under this subsection may be
14promulgated as an emergency rule under s. 227.24 without a finding of emergency.
15If the waiver is granted and in effect, the demonstration project under this subsection
16shall begin on January 1, 2009, or on the effective date of the waiver, whichever is
17later.
AB11, s. 125 18Section 125. 49.45 (24g) (c) of the statutes is amended to read:
AB11,52,319 49.45 (24g) (c) The department's proposal under par. (a) shall specify increases
20in reimbursement rates for providers that satisfy the conditions under par. (a) 1. or
212., and shall provide for payment of a monthly per-patient care coordination fee to
22those providers. The department shall set the increases in reimbursement rates and
23the monthly per-patient care coordination fee so that together they provide
24sufficient incentive for providers to satisfy a condition under par. (a) 1. or 2. The
25proposal shall specify effective dates for the increases in reimbursement rates and

1the monthly per-patient care coordination fee that are no sooner than July 1, 2011.
2If the department promulgates a rule under sub. (2m) (c) 4., this paragraph does not
3apply to the extent that it conflicts with the rule.
AB11, s. 126 4Section 126. 49.45 (24r) (a) of the statutes is amended to read:
AB11,52,115 49.45 (24r) (a) The department shall implement any waiver granted by the
6secretary of the federal department of health and human services to permit the
7department to conduct a demonstration project to provide family planning, as
8defined in s. 253.07 (1) (a), under medical assistance to any woman between the ages
9of 15 and 44 whose family income does not exceed 200% of the poverty line for a family
10the size of the woman's family. If the department promulgates a rule under sub. (2m)
11(c) 10., this paragraph does not apply to the extent it conflicts with the rule.
AB11, s. 127 12Section 127. 49.45 (24r) (b) of the statutes is amended to read:
AB11,52,1913 49.45 (24r) (b) The department may request an amended waiver from the
14secretary to permit the department to conduct a demonstration project to provide
15family planning to any man between the ages of 15 and 44 whose family income does
16not exceed 200 percent of the poverty line for a family the size of the man's family.
17If the amended waiver is granted, the department may implement the waiver. If the
18department promulgates a rule under sub. (2m) (c) 10., this paragraph does not apply
19to the extent it conflicts with the rule.
AB11, s. 128 20Section 128. 49.45 (25g) (c) of the statutes is amended to read:
AB11,53,721 49.45 (25g) (c) The department's proposal under par. (b) shall specify increases
22in reimbursement rates for providers that satisfy the conditions under par. (b), and
23shall provide for payment of a monthly per-patient care coordination fee to those
24providers. The department shall set the increases in reimbursement rates and the
25monthly per-patient care coordination fee so that together they provide sufficient

1incentive for providers to satisfy a condition under par. (b) 1. or 2. The proposal shall
2specify effective dates for the increases in reimbursement rates and the monthly
3per-patient care coordination fee that are no sooner than January 1, 2011. The
4increases in reimbursement rates and monthly per-patient care coordination fees
5that are not provided by the federal government shall be paid from the appropriation
6under. s. 20.435 (1) (am). If the department promulgates a rule under sub. (2m) (c)
74., this paragraph does not apply to the extent it conflicts with the rule.
AB11, s. 129 8Section 129. 49.45 (27) of the statutes is amended to read:
AB11,53,139 49.45 (27) Eligibility of aliens. A person who is not a U.S. citizen or an alien
10lawfully admitted for permanent residence or otherwise permanently residing in the
11United States under color of law may not receive medical assistance benefits except
12as provided under 8 USC 1255a (h) (3) or 42 USC 1396b (v), unless otherwise
13provided by the department by rule promulgated under sub. (2m) (c)
.
AB11, s. 130 14Section 130. 49.45 (39) (b) 1. of the statutes is amended to read:
AB11,54,2415 49.45 (39) (b) 1. `Payment for school medical services.' If a school district or a
16cooperative educational service agency elects to provide school medical services and
17meets all requirements under par. (c), the department shall reimburse the school
18district or the cooperative educational service agency for 60% of the federal share of
19allowable charges for the school medical services that it provides , unless otherwise
20provided by the department by rule promulgated under sub. (2m) (c),
and, as
21specified in subd. 2., for allowable administrative costs. If the Wisconsin Center for
22the Blind and Visually Impaired or the Wisconsin Educational Services Program for
23the Deaf and Hard of Hearing elects to provide school medical services and meets all
24requirements under par. (c), the department shall reimburse the department of
25public instruction for 60% of the federal share of allowable charges for the school

1medical services that the Wisconsin Center for the Blind and Visually Impaired or
2the Wisconsin Educational Services Program for the Deaf and Hard of Hearing
3provides, unless otherwise provided by the department by rule promulgated under
4sub. (2m) (c),
and, as specified in subd. 2., for allowable administrative costs. A school
5district, cooperative educational service agency, the Wisconsin Center for the Blind
6and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
7and Hard of Hearing may submit, and the department shall allow, claims for common
8carrier transportation costs as a school medical service unless the department
9receives notice from the federal health care financing administration that, under a
10change in federal policy, the claims are not allowed. If the department receives the
11notice, a school district, cooperative educational service agency, the Wisconsin
12Center for the Blind and Visually Impaired, or the Wisconsin Educational Services
13Program for the Deaf and Hard of Hearing may submit, and the department shall
14allow, unreimbursed claims for common carrier transportation costs incurred before
15the date of the change in federal policy. The department shall promulgate rules
16establishing a methodology for making reimbursements under this paragraph. All
17other expenses for the school medical services provided by a school district or a
18cooperative educational service agency shall be paid for by the school district or the
19cooperative educational service agency with funds received from state or local taxes.
20The school district, the Wisconsin Center for the Blind and Visually Impaired, the
21Wisconsin Educational Services Program for the Deaf and Hard of Hearing, or the
22cooperative educational service agency shall comply with all requirements of the
23federal department of health and human services for receiving federal financial
24participation.
AB11, s. 131 25Section 131. 49.46 (1) (n) of the statutes is created to read:
AB11,55,2
149.46 (1) (n) If the department promulgates a rule under s. 49.45 (2m) (c) 8.,
29., or 10., this subsection does not apply to the extent that it conflicts with the rule.
AB11, s. 132 3Section 132. 49.46 (2) (a) (intro.) of the statutes is amended to read:
AB11,55,74 49.46 (2) (a) (intro.) Except as provided in par. (be) and unless otherwise
5provided by the department by rule promulgated under s. 49.45 (2m) (c)
, the
6department shall audit and pay allowable charges to certified providers for medical
7assistance on behalf of recipients for the following federally mandated benefits:
AB11, s. 133 8Section 133. 49.46 (2) (b) (intro.) of the statutes is amended to read:
AB11,55,129 49.46 (2) (b) (intro.) Except as provided in pars. (be) and (dc) and unless
10otherwise provided by the department by rule promulgated under s. 49.45 (2m) (c)
,
11the department shall audit and pay allowable charges to certified providers for
12medical assistance on behalf of recipients for the following services:
AB11, s. 134 13Section 134. 49.465 (2) (intro.) of the statutes is amended to read:
AB11,55,2014 49.465 (2) (intro.) A Unless otherwise provided by the department by rule
15promulgated under s. 49.45 (2m) (c), a
pregnant woman is eligible for medical
16assistance benefits, as provided under sub. (3), during the period beginning on the
17day on which a qualified provider determines, on the basis of preliminary
18information, that the woman's family income does not exceed the highest level for
19eligibility for benefits under s. 49.46 (1) or 49.47 (4) (am) or (c) 1. and ending as
20follows:
AB11, s. 135 21Section 135. 49.47 (4) (a) (intro.) of the statutes is amended to read:
AB11,55,2522 49.47 (4) (a) (intro.) Any Unless otherwise provided by the department by rule
23under s. 49.45 (2m) (c), any
individual who meets the limitations on income and
24resources under pars. (b) to (c) and who complies with pars. (cm) and (cr) shall be
25eligible for medical assistance under this section if such individual is:
AB11, s. 136
1Section 136. 49.47 (5) (intro.) of the statutes is amended to read:
AB11,56,32 49.47 (5) Investigation by department. (intro.) The department may make
3additional investigation of eligibility at any of the following times:
AB11, s. 137 4Section 137. 49.47 (5) (a) of the statutes is amended to read:
AB11,56,75 49.47 (5) (a) When there is reasonable ground for belief that an applicant may
6not be eligible or that the beneficiary may have received benefits to which the
7beneficiary is not entitled; or.
AB11, s. 138 8Section 138. 49.47 (5) (c) of the statutes is created to read:
AB11,56,139 49.47 (5) (c) Any time determined by the department by rule promulgated
10under s. 49.45 (2m) (c) to determine eligibility or to reevaluate continuing eligibility,
11except that if federal law allows a reevaluation of eligibility more frequently than
12every 12 months and if there is no conflicting provision of state law, the department
13is not required to promulgate a rule to reevaluate eligibility under this section.
AB11, s. 139 14Section 139. 49.47 (6) (a) (intro.) of the statutes is amended to read:
AB11,56,1715 49.47 (6) (a) (intro.) The Unless otherwise provided by the department by rule
16promulgated under s. 49.45 (2m) (c), the
department shall audit and pay charges to
17certified providers for medical assistance on behalf of the following:
AB11, s. 140 18Section 140. 49.471 (13) of the statutes is created to read:
AB11,56,2119 49.471 (13) Applicability. If the department promulgates a rule under s. 49.45
20(2m) (c), subs. (4), (5), (6), (7), (8), (10), and (11) do not apply to the extent that those
21subsections conflict with the rule.
AB11, s. 141 22Section 141. 49.472 (3) (intro.) of the statutes is amended to read:
AB11,57,223 49.472 (3) Eligibility. (intro.) Except as provided in sub. (6) (a) and unless
24otherwise provided by the department by rule promulgated under s. 49.45 (2m) (c)
,

1an individual is eligible for and shall receive medical assistance under this section
2if all of the following conditions are met:
AB11, s. 142 3Section 142. 49.472 (4) (b) (intro.) of the statutes is amended to read:
AB11,57,84 49.472 (4) (b) (intro.) The department may waive monthly premiums that are
5calculated to be below $10 per month. The Unless otherwise provided by the
6department by rule promulgated under s. 49.45 (2m) (c), the
department may not
7assess a monthly premium for any individual whose income level, after adding the
8individual's earned income and unearned income, is below 150% of the poverty line.
AB11, s. 143 9Section 143. 49.473 (2) (intro.) of the statutes is amended to read:
AB11,57,1410 49.473 (2) (intro.) A Unless otherwise provided by the department by rule
11promulgated under s. 49.45 (2m) (c), a
woman is eligible for medical assistance as
12provided under sub. (5) if, after applying to the department or a county department,
13the department or a county department determines that she meets all of the
14following requirements:
AB11, s. 144 15Section 144. 49.473 (5) of the statutes is amended to read:
AB11,57,2116 49.473 (5) The department shall audit and pay, from the appropriation
17accounts under s. 20.435 (4) (b) and (o), allowable charges to a provider who is
18certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who
19meets the requirements under sub. (2) for all benefits and services specified under
20s. 49.46 (2), unless otherwise provided by the department by rule promulgated under
21s. 49.45 (2m) (c)
.
AB11, s. 145 22Section 145. 49.825 (3) (b) 4. of the statutes is repealed.
AB11, s. 146 23Section 146. 49.826 (3) (b) 4. of the statutes is repealed.
AB11, s. 147 24Section 147. Chapter 52 of the statutes is repealed.
AB11, s. 148 25Section 148. 59.875 of the statutes is created to read:
AB11,58,3
159.875 Payment of contributions in an employee retirement system of
2populous counties.
(1) In this section, "county" means any county having a
3population of 500,000 or more.
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