AB75-SSA1,630,2317
49.471
(10) (b) 5. If a recipient who is required to pay a premium under this
18paragraph or under sub. (2m) or (4) (c)
either does not pay a premium when due
or
19requests that his or her coverage under this section be terminated, the recipient's
20coverage terminates and the recipient is not eligible for BadgerCare Plus for 6
21consecutive calendar months following the date on which the recipient's coverage
22terminated
, except for any month during that 6-month period when the recipient's
23family income does not exceed 150 percent of the poverty line.
AB75-SSA1,631,5
149.471
(12) (b) If the amendments to the state plan submitted under sub. (2)
2are approved and a waiver that is
substantially consistent with
all of the provisions
3of this section is granted and in effect, the department shall publish a notice in the
4Wisconsin Administrative Register that states the date on which BadgerCare Plus
5is implemented.
AB75-SSA1,631,87
49.493
(1) (b) "Medical benefits or assistance" means medical benefits under
8s.
49.02 or 253.05 or medical assistance.
AB75-SSA1,631,1511
49.686
(2) Reimbursement. From the
appropriations appropriation accounts 12under s. 20.435
(5) (1) (am), (i), and (ma), the department may reimburse or
13supplement the reimbursement of the cost of AZT, the drug pentamidine, and any
14drug approved for reimbursement under sub. (4) (c) for an individual who is eligible
15under sub. (3).
AB75-SSA1,631,2217
49.686
(3) (d) Has applied for coverage under and has been denied eligibility
18for medical assistance within 12 months prior to application for reimbursement
19under sub. (2).
This paragraph does not apply to an individual who is eligible for
20benefits under the demonstration project for childless adults under s. 49.45 (23) or
21to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471
22(11).
AB75-SSA1,632,224
49.686
(3) (f) Is an individual whose annual gross household income is at or
25below 200% of the poverty line and, if funding is available under s. 20.435 (1)
(i) or
1(m)
or (5) (i), is an individual whose annual gross household income is above 200%
2and at or below 300% of the poverty line.
AB75-SSA1,632,54
49.686
(6) (title)
Health Insurance Risk-Sharing Plan pilot program
5coverage.
AB75-SSA1, s. 1361
6Section
1361. 49.686 (6) (a) (intro.) of the statutes is amended to read:
AB75-SSA1,632,127
49.686
(6) (a) (intro.) Subject to par. (b), the department shall conduct a
3-year
8pilot program
, to begin on January 1, 2008, under which the department may pay
9premiums for coverage under the Health Insurance Risk-Sharing Plan under subch.
10II of ch. 149, and pay copayments under that plan for prescription drugs for which
11reimbursement may be provided under sub. (2), for individuals who satisfy all of the
12following:
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49.686
(6) (b) The
pilot program shall be open to a minimum of 100 participants
15at any given time, with more participants if the department determines that it is
16cost-effective.
AB75-SSA1,632,2018
49.686
(6) (c) The department may promulgate rules for the administration of
19the
pilot program. Notwithstanding s. 227.24 (3), rules under this paragraph may
20be promulgated as emergency rules under s. 227.24 without a finding of emergency.
AB75-SSA1,632,2522
49.688
(1) (e) "Program payment rate" means the rate of payment made for the
23identical drug specified under s. 49.46 (2) (b) 6. h.
, plus 5%, plus a dispensing fee that
24is equal to the dispensing fee permitted to be charged for prescription drugs for which
25coverage is provided under s. 49.46 (2) (b) 6. h.
AB75-SSA1,633,52
49.688
(3) (d)
Notwithstanding s. 49.002, if If a person who is eligible under this
3section has other available coverage for payment of a prescription drug, this section
4applies only to costs for prescription drugs for the person that are not covered under
5the person's other available coverage.
AB75-SSA1,633,118
49.688
(12) Except as provided in subs.
(8) (8m) to (11) and except for the
9department's rule-making requirements and authority, the department may enter
10into a contract with an entity to perform the duties and exercise the powers of the
11department under this section.