SB40-SSA1,746,16 b. A child who is eligible under sub. (4) (a) 2. or (b) 2.

SB40-SSA1,746,17 c. A child whose family income does not exceed 200 percent of the poverty line.

SB40-SSA1,746,19 d. A pregnant woman whose family income does not exceed 200 percent of the poverty line.

SB40-SSA1,746,20 e. A child who obtains eligibility under sub. (7) (b) 2.

SB40-SSA1,746,21 f. An individual who is eligible under sub. (4) (a) 5.

SB40-SSA1,746,25 5. If a recipient who is required to pay a premium under this paragraph or under sub. (2m) or (4) (c) does not pay a premium when due, the recipient's coverage terminates and the recipient is not eligible for BadgerCare Plus for 6 calendar months following the date on which the recipient's coverage terminated.

SB40-SSA1,747,3 (11) Benchmark plan benefits and copayments. 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:

SB40-SSA1,747,6 (a) Subject to sub. (6) (k), prescription drugs bearing only a generic name, as defined in s. 450.12 (1) (b), with a copayment of no more than $5 per prescription, and subject to the Badger Rx Gold program discounts.

SB40-SSA1,747,8 (b) Physicians' services, including one annual routine physical examination, with a copayment of no more than $15 per visit.

SB40-SSA1,747,12 (c) Inpatient hospital services as medically necessary, subject to coinsurance payment per inpatient stay of no more than 10 percent of the allowable payment rates under s. 49.46 (2) for the services provided and a copayment of no more than $50 per admission for psychiatric services.

SB40-SSA1,747,17 (d) Outpatient hospital services, subject to coinsurance payment of no more than 10 percent of the allowable payment rates under s. 49.46 (2) for the services provided, except that use of emergency room services for treatment of a condition that is not an emergency medical condition, as defined in s. 632.85 (1) (a), shall require a copayment of no more than $75.

SB40-SSA1,747,18 (e) Laboratory and X-ray services, including mammography.

SB40-SSA1,747,19 (f) Home health services, limited to 60 visits per year.

SB40-SSA1,747,22 (g) Skilled nursing home services, limited to 30 days per year, and subject to coinsurance payment of no more than 10 percent of the allowable payment rates under s. 49.46 (2) for the services provided.

SB40-SSA1,747,25 (h) Inpatient rehabilitation services, limited to 60 days per year, and subject to coinsurance payment of no more than 10 percent of the allowable payment rates under s. 49.46 (2) for the services provided.

SB40-SSA1,748,3 (i) Physical, occupational, speech, and pulmonary therapy, limited to 20 visits per year for each type of therapy, and subject to coinsurance payment of no more than 10 percent of the allowable payment rates under s. 49.46 (2) for the services provided.

SB40-SSA1,748,6 (j) Cardiac rehabilitation, limited to 36 visits per year and subject to coinsurance payment of no more than 10 percent of the allowable payment rates under s. 49.46 (2) for the services provided.

SB40-SSA1,748,10 (k) Inpatient, outpatient, and transitional treatment for nervous or mental disorders and alcoholism and other drug abuse problems, with a copayment of no more than $15 per visit and coverage limits that are the same as those under the state employee health plan under s. 40.51 (6).

SB40-SSA1,748,13 (L) Durable medical equipment, limited to $2,500 per year, and subject to coinsurance payment of no more than 10 percent of the allowable payment rates under s. 49.46 (2) for the articles provided.

SB40-SSA1,748,16 (m) Transportation to obtain emergency medical care only, as medically necessary, and subject to coinsurance payment of no more than 10 percent of the allowable payment rates under s. 49.46 (2) for the services provided.

SB40-SSA1,748,18 (n) One refractive eye examination every 2 years, with a copayment of no more than $15 per visit.

SB40-SSA1,748,23 (o) Fifty percent of allowable charges for preventive and basic dental services, including services for accidental injury and for the diagnosis and treatment of temporomandibular disorders. The coverage under this paragraph is limited to $750 per year, applies only to pregnant women and children under 19 years of age, and requires an annual deductible of $200 and a copayment of no more than $15 per visit.

SB40-SSA1,748,24 (p) Early childhood developmental services, for children under 6 years of age.

SB40-SSA1,748,25 (q) Smoking cessation treatment, for pregnant women only.

SB40-SSA1,749,1 (r) Prenatal care coordination, for pregnant women at high risk only.

SB40-SSA1,749,11 (11m) Provider payments and requirements. The provider of a service or equipment under sub. (11) shall collect the specified or allowable copayment or coinsurance, unless the provider determines that the cost of collecting the copayment or coinsurance exceeds the amount to be collected. The department shall reduce payments for services or equipment under sub. (11) by the amount of the specified or allowable copayment or coinsurance. A provider may deny care or services or equipment under sub. (11) if the recipient does not pay the specified or allowable copayment or coinsurance. If a provider provides care or services or equipment under sub. (11) to a recipient who is unable to share costs as specified in sub. (11), the recipient is not relieved of liability for those costs.

SB40-SSA1,749,14 (12) Rules; notice of effective date. (a) 1. The department may promulgate any rules necessary for and consistent with its administrative responsibilities under this section, including additional eligibility criteria.

SB40-SSA1,749,22 2. The department may promulgate emergency rules under s. 227.24 for the administration of this section for the period before the effective date of any permanent rules promulgated under subd. 1., but not to exceed the period authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) (a), (2) (b), and (3), the department is not required to provide evidence that promulgating a rule under this subdivision as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this subdivision.

SB40-SSA1,750,2 (b) If the amendments to the state plan submitted under sub. (2) are approved and a waiver that is consistent with all of the provisions of this section is granted and in effect, the department shall publish a notice in the Wisconsin Administrative Register that states the date on which BadgerCare Plus is implemented.