49.665(4)(at)2.
2. If, after the department has established a lower maximum income level under
subd. 1., projections indicate that funding under
s. 20.435 (4) (bc),
(jz),
(p), and
(x) is sufficient to raise the level, the department shall, by state plan amendment, raise the maximum income level for initial eligibility, but not to exceed 185% of the poverty line.
49.665(4)(at)3.
3. The department may not adjust the maximum income level of 200% of the poverty line for persons already receiving health care coverage under this section.
49.665(4)(b)
(b) Notwithstanding fulfillment of the eligibility requirements under this subsection, no person is entitled to health care coverage under this section.
49.665(4)(c)
(c) No person may be denied health care coverage under this section solely because of a health condition of that person or of any family member of that person.
49.665(5)(ac)(ac) In this subsection, "cost" means total cost-sharing charges, including premiums, copayments, coinsurance, deductibles, enrollment fees, and any other cost-sharing charges.
49.665(5)(ag)
(ag) Except as provided in
pars. (am),
(b), and
(bm), a family, or child who does not reside with his or her parent, who receives health care coverage under this section shall pay a percentage of the cost of that coverage in accordance with a schedule established by the department by rule. The department may not establish or implement a schedule that requires a family or child to contribute, including the amounts required under
par. (am), more than 5% of the family's or child's income towards the cost of the health care coverage provided under this section.
49.665(5)(am)
(am) Except as provided in
pars. (b) and
(bm), a child or family member who receives health care coverage under this section shall pay the following cost-sharing amounts:
49.665(5)(b)
(b) The department may not require a family, or child who does not reside with his or her parent, with an income below 150% of the poverty line to contribute to the cost of health care coverage provided under this section.
49.665(5)(bm)
(bm) If the federal department of health and human services notifies the department of health and family services that Native Americans may not be required to contribute to the cost of the health care coverage provided under this section, the department of health and family services may not require Native Americans to contribute to the cost of health care coverage under this section.
49.665(5)(c)
(c) The department may establish by rule requirements for wage withholding as a means of collecting the family's share of the cost of the health care coverage under this section.
49.665(5m)
(5m) Information about badger care recipients. 49.665(5m)(b)
(b) An insurer that issues or delivers a disability insurance policy that provides coverage to a resident of this state shall provide to the department, upon the department's request, information contained in the insurer's records regarding all of the following:
49.665(5m)(b)1.
1. Information that the department needs to identify recipients of badger care who satisfy any of the following:
49.665(5m)(b)1.b.
b. Would be eligible for benefits under a disability insurance policy if the recipient were enrolled as a dependent of a person insured under the disability insurance policy.
49.665(5m)(b)2.
2. Information required for submittal of claims under the insurer's disability insurance policy.
49.665(5m)(b)3.
3. The types of benefits provided by the disability insurance policy.
49.665(5m)(c)
(c) Upon requesting an insurer to provide the information under
par. (b), the department shall enter into a written agreement with the insurer that satisfies all of the following:
49.665(5m)(c)2.
2. Includes provisions that adequately safeguard the confidentiality of the information to be disclosed.
49.665(5m)(d)1.1. An insurer shall provide the information requested under
par. (b) within 180 days after receiving the department's request if it is the first time that the department has requested the insurer to disclose information under this subsection.
49.665(5m)(d)2.
2. An insurer shall provide the information requested under
par. (b) within 30 days after receiving the department's request if the department has previously requested the insurer to disclose information under this subsection.
49.665(5m)(d)3.
3. If an insurer fails to comply with
subd. 1. or
2., the department may notify the commissioner of insurance, and the commissioner of insurance may initiate enforcement proceedings against the insurer under
s. 601.41 (4) (a).
49.665(6)
(6) Annual report. Not later than October 1 of each year, the department shall submit a report to the legislature under
s. 13.172 (2) that summarizes enrollment in and cost of the health care program under this section and any other information that the department determines is pertinent information regarding the program under this section.
49.68
49.68
Aid for treatment of kidney disease. 49.68(1)
(1)
Declaration of policy. The legislature finds that effective means of treating kidney failure are available, including dialysis or artificial kidney treatment or transplants. It further finds that kidney disease treatment is prohibitively expensive for the overwhelming portion of the state's citizens. It further finds that public and private insurance coverage is inadequate in many cases to cover the cost of adequate treatment at the proper time in modern facilities. The legislature finds, in addition, that the incidence of the disease in the state is not so great that public aid may not be provided to alleviate this serious problem for a relatively modest investment. Therefore, it is declared to be the policy of this state to assure that all persons are protected from the destructive cost of kidney disease treatment by one means or another.
49.68(1m)
(1m) In this section, "recombinant human erythropoietin" means a bioengineered glycoprotein that has the same biological effects in stimulating red blood cell production as does the glycoprotein erythropoietin that is produced by the human body.
49.68(2)
(2) Duties of department. The department shall:
49.68(2)(a)
(a) Promulgate rules setting standards for operation and certification of dialysis and renal transplantation centers and home dialysis equipment and suppliers.
49.68(2)(b)
(b) Promulgate rules setting standards for acceptance and certification of patients into the treatment phase of the program.
49.68(2)(c)
(c) Promulgate rules concerning reasonable cost and length of treatment programs.
49.68(2)(d)
(d) Aid in preparing educational programs and materials informing the public as to chronic renal disease and the prevention and treatment thereof.
49.68(3)
(3) Aid to kidney disease patients. 49.68(3)(a)(a) Subject to
s. 49.687 (1m), any permanent resident of this state who suffers from chronic renal disease may be accepted into the dialysis treatment phase of the renal disease control program if the resident meets standards set by rule under
sub. (2) and
s. 49.687.
49.68(3)(b)
(b) From the appropriation accounts under
ss. 20.435 (4) (e) and
(je), the state shall pay the cost of medical treatment required as a direct result of chronic renal disease of certified patients from the date of certification, including the cost of administering recombinant human erythropoietin to appropriate patients, whether the treatment is rendered in an approved facility in the state or in a dialysis or transplantation center which is approved as such by a contiguous state, subject to the conditions specified under
par. (d). Approved facilities may include a hospital in-center dialysis unit or a nonhospital dialysis center which is closely affiliated with a home dialysis program supervised by an approved facility. Aid shall also be provided for all reasonable expenses incurred by a potential living-related donor, including evaluation, hospitalization, surgical costs and postoperative follow-up to the extent that these costs are not reimbursable under the federal medicare program or other insurance. In addition, all expenses incurred in the procurement, transportation and preservation of cadaveric donor kidneys shall be covered to the extent that these costs are not otherwise reimbursable. All donor-related costs are chargeable to the recipient and reimbursable under this subsection.
49.68(3)(c)
(c) Disbursement and collection of all funds under this subsection shall be by the department or by a fiscal intermediary, in accordance with a contract with a fiscal intermediary. The costs of the fiscal intermediary under this paragraph shall be paid from the appropriation under
s. 20.435 (1) (a).
49.68(3)(d)1.1. No aid may be granted under this subsection unless the recipient has no other form of aid available from the federal medicare program, from private health, accident, sickness, medical, and hospital insurance coverage, or from other health care coverage specified by rule under
s. 49.687 (1m). If insufficient aid is available from other sources and if the recipient has paid an amount equal to the annual medicare deductible amount specified in
subd. 2., the state shall pay the difference in cost to a qualified recipient. If at any time sufficient federal or private insurance aid or other health care coverage becomes available during the treatment period, state aid under this subsection shall be terminated or appropriately reduced. Any patient who is eligible for the federal medicare program shall register and pay the premium for medicare medical insurance coverage where permitted, and shall pay an amount equal to the annual medicare deductible amounts required under
42 USC 1395e and
1395L (b), prior to becoming eligible for state aid under this subsection.
49.68(3)(d)2.
2. Aid under this subsection is only available after the patient pays an annual amount equal to the annual deductible amount required under the federal medicare program. This subdivision requires an inpatient who seeks aid first to pay an annual deductible amount equal to the annual medicare deductible amount specified under
42 USC 1395e and requires an outpatient who seeks aid first to pay an annual deductible amount equal to the annual medicare deductible amount specified under
42 USC 1395L (b).
49.68(3)(d)3.
3. No payment shall be made under this subsection for any portion of medical treatment costs or other expenses that are payable under any state, federal, or other health care coverage program, including a health care coverage program specified by rule under
s. 49.687 (1m), or under any grant, contract, or other contractual arrangement.
49.68(3)(e)
(e) State aids for services provided under this section shall be equal to the allowable charges under the federal Medicare program. In no case shall state rates for individual service elements exceed the federally defined allowable costs. The rate of charges for services not covered by public and private insurance shall not exceed the reasonable charges as established by medicare fee determination procedures. A person that provides to a patient a service for which aid is provided under this section shall accept the amount paid under this section for the service as payment in full and may not bill the patient for any amount by which the charge for the service exceeds the amount paid for the service under this section. The state may not pay for the cost of travel, lodging, or meals for persons who must travel to receive inpatient and outpatient dialysis treatment for kidney disease. This paragraph shall not apply to donor related costs as defined in
par. (b).
49.68 Cross-reference
Cross Reference: See also ch.
HFS 152, Wis. adm. code.
49.682
49.682
Recovery from estates. 49.682(1)(c)
(c) "Home" means property in which a person has an ownership interest consisting of the person's dwelling and the land used and operated in connection with the dwelling.
49.682(2)(a)(a) Except as provided in
par. (d), the department shall file a claim against the estate of a client or against the estate of the surviving spouse of a client for the amount of aid under
s. 49.68,
49.683 or
49.685 paid to or on behalf of the client.
49.682(2)(b)
(b) The affidavit of a person designated by the secretary to administer this subsection is evidence of the amount of the claim.
49.682(2)(c)
(c) The court shall reduce the amount of a claim under
par. (a) by up to the amount specified in
s. 861.33 (2) if necessary to allow the client's heirs or the beneficiaries of the client's will to retain the following personal property:
49.682(2)(c)1.
1. The decedent's wearing apparel and jewelry held for personal use.
49.682(2)(c)3.
3. Other tangible personal property not used in trade, agriculture or other business, not to exceed in value the amount specified in
s. 861.33 (1) (a) 4.
49.682(2)(d)
(d) A claim under
par. (a) is not allowable if the decedent has a surviving child who is under age 21 or disabled or a surviving spouse.
49.682(2)(e)1.1. If the department's claim is not allowable because of
par. (d) and the estate includes an interest in a home, the court exercising probate jurisdiction shall, in the final judgment or summary findings and order, assign the interest in the home subject to a lien in favor of the department for the amount described in
par. (a). The personal representative or petitioner for summary settlement or summary assignment of the estate shall record the final judgment as provided in
s. 863.29,
867.01 (3) (h) or
867.02 (2) (h).
49.682(2)(e)2.
2. If the department's claim is not allowable because of
par. (d), the estate includes an interest in a home and the personal representative closes the estate by sworn statement under
s. 865.16, the personal representative shall stipulate in the statement that the home is assigned subject to a lien in favor of the department for the amount described in
par. (a). The personal representative shall record the statement in the same manner as described in
s. 863.29, as if the statement were a final judgment.
49.682(2)(f)
(f) The department may not enforce the lien under
par. (e) as long as any of the following survive the decedent:
49.682(2)(g)
(g) The department may enforce a lien under
par. (e) by foreclosure in the same manner as a mortgage on real property.
49.682(3)
(3) The department shall administer the program under this section and may contract with an entity to administer all or a portion of the program, including gathering and providing the department with information needed to recover payment of aid provided under
s. 49.68,
49.683 or
49.685. All funds received under this subsection, net of any amount claimed under
s. 867.035 (3), shall be remitted for deposit in the general fund.
49.682(4)(a)(a) The department may recover amounts under this section for the provision of aid provided under
s. 49.68,
49.683 or
49.685 paid on and after September 1, 1995.
49.682(4)(b)
(b) The department may file a claim under
sub. (2) only with respect to a client who dies after September 1, 1995.
49.682(5)
(5) The department shall promulgate rules establishing standards for determining whether the application of this section would work an undue hardship in individual cases. If the department determines that the application of this section would work an undue hardship in a particular case, the department shall waive application of this section in that case.
49.682(6)
(6) The department may contract with or employ an attorney to probate estates to recover under this section the costs of care.
49.682 History
History: 1995 a. 27 ss.
3044b to
3044j; Stats. 1995 s. 49.682;
1995 a. 225 ss.
127,
128;
1999 a. 9.
49.683
49.683
Cystic fibrosis aids. 49.683(1)
(1) Subject to
s. 49.687 (1m), the department may provide financial assistance for costs of medical care of persons over the age of 18 years with the diagnosis of cystic fibrosis who meet financial requirements established by the department by rule under
s. 49.687 (1).
49.683(3)
(3) No payment shall be made under this section for any portion of medical care costs that are payable under any state, federal, or other health care coverage program, including a health care coverage program specified by rule under
s. 49.687 (1m), or under any grant, contract, or other contractual arrangement.
49.683 History
History: 1973 c. 300; Stats. 1973 s. 146.35;
1973 c. 336 s.
55; Stats. 1973 s. 146.36;
1975 c. 39;
1979 c. 34 s.
2102 (43) (a);
1983 a. 27 s.
1562; Stats. 1983 s. 49.483;
1993 a. 16,
449;
1995 a. 27 ss.
3045,
3046,
3047; Stats. 1995 s. 49.683;
1997 a. 27;
1999 a. 9;
2001 a. 16;
2003 a. 33.
49.683 Cross-reference
Cross Reference: See also ch.
HFS 154, Wis. adm. code.
49.685
49.685
Hemophilia treatment services. 49.685(1)(a)
(a) "Comprehensive hemophilia treatment center" means a center, and its satellite facilities, approved by the department, which provide services, including development of the maintenance program, to persons with hemophilia and other related congenital bleeding disorders.
49.685(1)(c)
(c) "Hemophilia" means a bleeding disorder resulting from a genetically determined clotting factor abnormality or deficiency.
