SB38: Bill Text

SB38,1 Section 1. 20.435 (4) (h) of the statutes is repealed.

SB38,2 Section 2. 20.435 (4) (hm) of the statutes is amended to read:

SB38,3,6 20.435 (4) (hm) BadgerCare Plus Basic Plan; benefits and administration. All moneys received from premiums under s. 49.67 (4), 2011 stats., to pay for the provision of services under the BadgerCare Plus Basic Plan under s. 49.67, 2011 stats., and for administration of the plan.

SB38,3 Section 3. 20.435 (4) (jw) of the statutes is amended to read:

SB38,4,4 20.435 (4) (jw) BadgerCare Plus, hospital assessment, and pharmacy benefits purchasing pool administrative costs. All moneys received from payment of enrollment fees under the program under s. 49.45 (23), 2011 stats., all moneys transferred under s. 50.38 (9), all moneys transferred from the appropriation account under par. (jz), and 10 percent of all moneys received from penalty assessments under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), 2011 stats., to provide a portion of the state share of administrative costs for the BadgerCare Plus Medical Assistance program under s. 49.471, for administration of the hospital assessment under s. 50.38, and to administer a contract with an entity to operate the pharmacy benefits purchasing pool under s. 146.45.

SB38,4 Section 4. 25.77 (2) of the statutes is amended to read:

SB38,4,9 25.77 (2) All public funds that are related to payments under s. 49.45 and that are transferred or certified under 42 CFR 433.51 (b) and used as the nonfederal and federal share of Medical Assistance funding, except funds that are deposited into the appropriation accounts under s. 20.435 (4) (h), (kx) , or (ky).

SB38,5 Section 5. 49.45 (23) of the statutes is repealed.

SB38,6 Section 6. 49.45 (59) (b) of the statutes is amended to read:

SB38,4,24 49.45 (59) (b) Health maintenance organizations shall pay all of the moneys they receive under par. (a) to eligible hospitals, as defined in s. 50.38 (1), within 15 days after receiving the moneys. The department shall specify in contracts with health maintenance organizations to provide medical assistance a method that health maintenance organizations shall use to allocate the amounts received under par. (a) among eligible hospitals based on the number of discharges from inpatient stays and the number of outpatient visits for which the health maintenance organization paid such a hospital in the previous month for enrollees who are recipients of medical assistance, except enrollees who receive medical assistance under s. 49.45 (23). Payments under this paragraph shall be in addition to any amount that a health maintenance organization is required by agreement between the health maintenance organization and a hospital to pay the hospital for providing services to the health maintenance organization's enrollees.

SB38,7 Section 7. 49.471 (1) (cr) of the statutes is created to read:

SB38,5,2 49.471 (1) (cr) "Enhanced federal medical assistance percentage" means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

SB38,8 Section 8. 49.471 (4) (b) 5. of the statutes is created to read:

SB38,5,8 49.471 (4) (b) 5. Subject to sub. (4m), an adult who is under 65 years of age; who is not pregnant; who is not otherwise eligible for Medical Assistance under par. (a) or (b) 1. to 4. or s. 49.46 (1); and whose income, as determined under the method described in 42 USC 1396a (e) (14), does not exceed 133 percent of the poverty line for a family the size of the individual's family.

SB38,9 Section 9. 49.471 (4m) of the statutes is created to read:

SB38,5,17 49.471 (4m) Medicaid expansion. For services provided to individuals described under sub. (4) (b) 5., the department shall comply with all federal requirements to qualify for the highest available enhanced federal medical assistance percentage. The department shall submit any amendment to the state medical assistance plan, request for a waiver of federal Medicaid law, or other approval required by the federal government to provide services to the individuals described under sub. (4) (b) 5. and qualify for the highest available enhanced federal medical assistance percentage.

SB38,10 Section 10. 49.471 (11) (intro.) of the statutes is amended to read:

SB38,5,22 49.471 (11) Benchmark plan benefits and copayments. (intro.) Recipients Subject to sub. (11g), recipients who are not eligible for the benefits described in s. 49.46 (2) (a) and (b) shall have coverage of the following benefits and pay the following copayments:

SB38,11 Section 11 . 49.471 (11g) of the statutes is created to read:

SB38,6,4 49.471 (11g) Medicaid expansion benchmark coverage. (a) If, to obtain an enhanced federal medical assistance percentage, the federal department of health and human services prohibits charging of a copayment or premium to an individual described under sub (4) (b) 5., the department may not charge the copayments described under sub. (11) or a premium that would disqualify the department from obtaining an enhanced federal medical assistance percentage.

SB38,6,11 (b) If the federal department of health and human services determines that the benefits provided under sub. (11) are not sufficient to qualify the department to obtain an enhanced federal medical assistance percentage for benefits provided to individuals described under sub. (4) (b) 5., the department shall provide any benchmark coverage or benchmark equivalent coverage that complies with 42 USC 1396u-7 to qualify to obtain the highest available enhanced federal medical assistance percentage.

SB38,6,15 (c) Notwithstanding sub. (13), the department may not create a policy under s. 49.45 (2m) (c) that affects the eligibility or benefits of the individuals described under sub. (4) (b) 5. such that the department fails to obtain an enhanced federal medical assistance percentage.

SB38,12 Section 12 . 49.471 (11g) (c) of the statutes, as created by 2013 Wisconsin Act .... (this act), is repealed.

SB38,13 Section 13. 49.67 of the statutes is repealed.

SB38,14 Section 14. 49.686 (3) (d) of the statutes is amended to read:

SB38,6,25 49.686 (3) (d) Has applied for coverage under and has been denied eligibility for medical assistance within 12 months prior to application for reimbursement under sub. (2). This paragraph does not apply to an individual who is eligible for benefits under the demonstration project for childless adults under s. 49.45 (23) or to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471 (11).

SB38,15 Section 15. 149.12 (2) (f) 2. g. of the statutes is repealed.

SB38,16 Section 16. 227.01 (13) (ur) of the statutes is repealed.

SB38,17 Section 17. 227.42 (7) of the statutes is repealed.

SB38,18 Section 18. Effective dates. This act takes effect on January 1, 2014, except as follows:

SB38,7,7 (1) The repeal of section 49.471 (11g) (c) of the statutes takes effect on January 1, 2015.

SB38,7,8 (End)