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.
DHS 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.
DHS 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.
49.685(1)(d)
(d) "Home care" means the self-infusion of a clotting factor on an outpatient basis by the patient or the infusion of a clotting factor to a patient on an outpatient basis by a person trained in such procedures.
49.685(1)(e)
(e) "Maintenance program" means the individual's therapeutic and treatment regimen, including medical, dental, social and vocational rehabilitation including home health care.
49.685(1)(f)
(f) "Net worth" means the sum of the value of liquid assets, real property, after excluding the first $10,000 of the full value of the home derived by dividing the assessed value by the assessment ratio of the taxation district.
49.685(1)(g)
(g) "Physician director" means the medical director of the comprehensive hemophilia treatment center which is directly responsible for an individual's maintenance program.
49.685(2)
(2) Assistance program. From the appropriation accounts under
s. 20.435 (4) (e) and
(je), the department shall establish a program of financial assistance to persons suffering from hemophilia and other related congenital bleeding disorders. The program shall assist such persons to purchase the blood derivatives and supplies necessary for home care. The program shall be administered through the comprehensive hemophilia treatment centers.
49.685(4)
(4) Eligibility. Any permanent resident of this state who suffers from hemophilia or other related congenital bleeding disorder may participate in the program if that person meets the requirements of this section and
s. 49.687 and the standards set by rule under this section and
s. 49.687. The person shall enter into an agreement with the comprehensive hemophilia treatment center for a maintenance program to be followed by that person as a condition for continued eligibility. The physician director or a designee shall, at least once in each 6-month period, review the maintenance program and verify that the person is complying with the program.
49.685(5)
(5) Recovery from other sources. The department is responsible for payments for blood products and supplies used in home care by persons participating in the program. The department may enter into agreements with comprehensive hemophilia treatment centers under which the treatment center assumes the responsibility for recovery of the payments from a 3rd party, including any insurer.
49.685(6)(a)(a) The department shall, by rule, establish a reasonable cost for blood products and supplies used in home care as a basis of reimbursement under this section.
49.685(6)(b)
(b) Reimbursement shall not be made under this section for any blood products or supplies that are not purchased from or provided by a comprehensive hemophilia treatment center, or a source approved by the treatment center. Reimbursement shall not be made under this section for any portion of the costs of blood products or supplies that are payable under any other state, federal, or other health care coverage program under which the person is covered, including a health care coverage program specified by rule under
s. 49.687 (1m), or under any grant, contract, or other contractual arrangement.
49.685(6)(c)
(c) The reasonable cost, determined under
par. (a), of blood products and supplies used in home care for which reimbursement is not prohibited under
par. (b), shall be reimbursed under this section after deduction of the patient's liability, determined under
sub. (7).
49.685(7)(a)1.1. The percentage of the patient's liability for the reasonable costs for blood products and supplies which are determined to be eligible for reimbursement under
sub. (6) shall be based upon the income and the size of the person's family unit, according to standards to be established by the department under
s. 49.687.
49.685(7)(a)2.
2. In determining income, only the income of the patient and persons responsible for the patient's support under
s. 49.90 may be considered.
49.685(7)(a)4.
4. In determining family size, only persons who are related to the patient as parent, spouse, legal dependent or, if under the age of 18, as brother or sister may be considered.
49.685(7)(a)5.
5. In determining net worth, only the net worth of the patient and persons responsible for the patient's support under
s. 49.90 will be considered.
49.685(7)(b)
(b) Individual liability shall be determined at the time of initial treatment and shall be redetermined annually or upon the patient's notification to the department of a change in family size or financial condition.
49.685(8)
(8) Department's duties. The department shall:
49.685(8)(a)
(a) Extend financial assistance under this section to eligible persons suffering from hemophilia or other related congenital bleeding disorders.
49.685(8)(b)
(b) Employ administrative personnel to implement this section.
49.685(8)(c)
(c) Promulgate all rules necessary to implement this section.
49.685 Cross-reference
Cross-reference: See also ch.
DHS 153, Wis. adm. code.
49.686
49.686
AZT and pentamidine reimbursement program. 49.686(1)(a)
(a) "AIDS" means acquired immunodeficiency syndrome.
49.686(1)(b)
(b) "Gross income" means all income, from whatever source derived and in whatever form realized, whether in money, property or services.
49.686(1)(c)
(c) "HIV" means any strain of human immunodeficiency virus, which causes acquired immunodeficiency syndrome.
49.686(1)(d)
(d) "HIV infection" means the pathological state produced by a human body in response to the presence of HIV.
49.686(1)(f)
(f) "Residence" means the concurrence of physical presence with intent to remain in a place of fixed habitation. Physical presence is prima facie evidence of intent to remain.
49.686(2)
(2) Reimbursement. From the appropriation accounts under
s. 20.435 (1) (am),
(i), and
(ma), the department may reimburse or supplement the reimbursement of the cost of AZT, the drug pentamidine, and any drug approved for reimbursement under
sub. (4) (c) for an individual who is eligible under
sub. (3).
