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AB40-ASA1,607,158 49.47 (6) (a) 6. e. An individual who is only entitled to coverage under part Part
9A of medicare Medicare and meets the eligibility criteria for medical assistance
10Medical Assistance under sub. (4) (a), but does not meet the income limitation, the
11deductible and coinsurance portions of medicare Medicare services under 42 USC
121395
to 1395i, including those services that are not included in the approved state
13plan for services under 42 USC 1396. Payment of deductibles and coinsurance for
14inpatient hospital services under Part A of Medicare may not exceed the allowable
15charge for the service under Medical Assistance minus the Medicare payment.
AB40-ASA1, s. 1459t 16Section 1459t. 49.47 (6) (a) 6. f. of the statutes is amended to read:
AB40-ASA1,608,217 49.47 (6) (a) 6. f. For an individual who is only entitled to coverage under part
18Part B of medicare Medicare and meets the eligibility criteria under sub. (4), but does
19not meet the income limitation, medical assistance Medical Assistance shall include
20payment of the deductible and coinsurance portions of medicare Medicare services
21under 42 USC 1395j to 1395w, including those medicare Medicare services that are
22not included in the approved state plan for services under 42 USC 1396. Payment
23of coinsurance for a service under part Part B of medicare, other than payment of
24coinsurance for outpatient hospital services,
Medicare may not exceed the allowable

1charge for the service under medical assistance Medical Assistance minus the
2medicare Medicare payment.
AB40-ASA1, s. 1461g 3Section 1461g. 49.471 (13) of the statutes, as created by 2011 Wisconsin Act
410
, is repealed and recreated to read:
AB40-ASA1,608,75 49.471 (13) Applicability. If the department creates a policy under s. 49.45
6(2m) (c), subs. (4), (5), (6), (7), (8), (10), and (11) do not apply to the extent that those
7subsections conflict with the policy.
AB40-ASA1, s. 1461h 8Section 1461h. 49.471 (13) of the statutes, as created by 2011 Wisconsin Act
9.... (this act), is repealed.
AB40-ASA1, s. 1461p 10Section 1461p. 49.472 (3) (intro.) of the statutes, as affected by 2011
11Wisconsin Act 10
, is repealed and recreated to read:
AB40-ASA1,608,1512 49.472 (3) Eligibility. (intro.) Except as provided in sub. (6) (a) and unless
13otherwise provided by the department by a policy created under s. 49.45 (2m) (c), an
14individual is eligible for and shall receive medical assistance under this section if all
15of the following conditions are met:
AB40-ASA1, s. 1461q 16Section 1461q. 49.472 (3) (intro.) of the statutes, as affected by 2011 Wisconsin
17Act .... (this act), is amended to read:
AB40-ASA1,608,2118 49.472 (3) Eligibility. (intro.) Except as provided in sub. (6) (a) and unless
19otherwise provided by the department by a policy created under s. 49.45 (2m) (c)
, an
20individual is eligible for and shall receive medical assistance under this section if all
21of the following conditions are met:
AB40-ASA1, s. 1462g 22Section 1462g. 49.472 (4) (b) (intro.) of the statutes, as affected by 2011
23Wisconsin Act 10
, is repealed and recreated to read:
AB40-ASA1,609,324 49.472 (4) (b) (intro.) The department may waive monthly premiums that are
25calculated to be below $10 per month. Unless otherwise provided by the department

1by a policy created under s. 49.45 (2m) (c), the department may not assess a monthly
2premium for any individual whose income level, after adding the individual's earned
3income and unearned income, is below 150% of the poverty line.
AB40-ASA1, s. 1462h 4Section 1462h. 49.472 (4) (b) (intro.) of the statutes, as affected by 2011
5Wisconsin Act .... (this act), is amended to read:
AB40-ASA1,609,106 49.472 (4) (b) (intro.) The department may waive monthly premiums that are
7calculated to be below $10 per month. Unless otherwise provided by the department
8by a policy created under s. 49.45 (2m) (c), the
The department may not assess a
9monthly premium for any individual whose income level, after adding the
10individual's earned income and unearned income, is below 150% of the poverty line.
AB40-ASA1, s. 1463 11Section 1463. 49.472 (6) (a) of the statutes is amended to read:
AB40-ASA1,609,1712 49.472 (6) (a) Notwithstanding sub. (4) (a) 3., from the appropriation account
13accounts under s. 20.435 (4) (b), (gm), or (w), the department shall, on the part of an
14individual who is eligible for medical assistance under sub. (3), pay premiums for or
15purchase individual coverage offered by the individual's employer if the department
16determines that paying the premiums for or purchasing the coverage will not be more
17costly than providing medical assistance.
AB40-ASA1, s. 1464 18Section 1464. 49.472 (6) (b) of the statutes is amended to read:
AB40-ASA1,609,2219 49.472 (6) (b) If federal financial participation is available, from the
20appropriation account accounts under s. 20.435 (4) (b), (gm), or (w), the department
21may pay medicare Part A and Part B premiums for individuals who are eligible for
22medicare and for medical assistance under sub. (3).
AB40-ASA1, s. 1465n 23Section 1465n. 49.473 (2) (intro.) of the statutes, as affected by 2011
24Wisconsin Act 10
, is repealed and recreated to read:
AB40-ASA1,610,5
149.473 (2) (intro.) Unless otherwise provided by the department by a policy
2created under s. 49.45 (2m) (c), a woman is eligible for medical assistance as provided
3under sub. (5) if, after applying to the department or a county department, the
4department or a county department determines that she meets all of the following
5requirements:
AB40-ASA1, s. 1465p 6Section 1465p. 49.473 (2) (intro.) of the statutes, as affected by 2011
7Wisconsin Act .... (this act), is amended to read:
AB40-ASA1,610,128 49.473 (2) (intro.) Unless otherwise provided by the department by a policy
9created under s. 49.45 (2m) (c), a
A woman is eligible for medical assistance as
10provided under sub. (5) if, after applying to the department or a county department,
11the department or a county department determines that she meets all of the
12following requirements:
AB40-ASA1, s. 1469y 13Section 1469y. 49.473 (5) of the statutes, as affected by 2011 Wisconsin Act
1410
, is repealed and recreated to read:
AB40-ASA1,610,2015 49.473 (5) The department shall audit and pay, from the appropriation
16accounts under s. 20.435 (4) (b), (gm), and (o), allowable charges to a provider who
17is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who
18meets the requirements under sub. (2) for all benefits and services specified under
19s. 49.46 (2), unless otherwise provided by the department by a policy created under
20s. 49.45 (2m) (c).
AB40-ASA1, s. 1470b 21Section 1470b. 49.473 (5) of the statutes, as affected by 2011 Wisconsin Act
22.... (this act), is amended to read:
AB40-ASA1,611,323 49.473 (5) The department shall audit and pay, from the appropriation
24accounts under s. 20.435 (4) (b), (gm), and (o), allowable charges to a provider who
25is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who

1meets the requirements under sub. (2) for all benefits and services specified under
2s. 49.46 (2), unless otherwise provided by the department by a policy created under
3s. 49.45 (2m) (c)
.
AB40-ASA1, s. 1477r 4Section 1477r. 49.67 (3) (am) 2. b. of the statutes is amended to read:
AB40-ASA1,611,85 49.67 (3) (am) 2. b. If the applicant is under 27 26 years of age, notice that he
6or she may be eligible for coverage as a dependent under his or her parent's health
7care plan in accordance with s. 632.885, and that his or her parent's plan must
8include coverage for services that are not covered under the plan under this section.
AB40-ASA1, s. 1478 9Section 1478. 49.68 (3) (b) of the statutes is amended to read:
AB40-ASA1,612,210 49.68 (3) (b) From the appropriation accounts under ss. 20.435 (4) (e) and (je),
11the state shall pay the cost of, at a rate determined by the department under par. (e),
12for
medical treatment that is required as a direct result of chronic renal disease of
13certified patients from the date of certification, including the cost of administering
14recombinant human erythropoietin to appropriate patients, whether the treatment
15is rendered in an approved facility in the state or in a dialysis or transplantation
16center which that is approved as such by a contiguous state, subject to the conditions
17specified under par. (d). Approved facilities may include a hospital in-center dialysis
18unit or a nonhospital dialysis center which that is closely affiliated with a home
19dialysis program supervised by an approved facility. Aid shall also be provided for
20all reasonable expenses incurred by a potential living-related donor, including
21evaluation, hospitalization, surgical costs, and postoperative follow-up to the extent
22that these costs are not reimbursable under the federal medicare program or other
23insurance. In addition, all expenses incurred in the procurement, transportation,
24and preservation of cadaveric donor kidneys shall be covered to the extent that these

1costs are not otherwise reimbursable. All donor-related costs are chargeable to the
2recipient and reimbursable under this subsection.
AB40-ASA1, s. 1479 3Section 1479. 49.68 (3) (e) of the statutes is amended to read:
AB40-ASA1,612,164 49.68 (3) (e) State aids Payment for services provided under this section shall
5be equal to at a rate determined by the department that does not exceed the allowable
6charges under the federal Medicare program. In no case shall state rates for
7individual service elements exceed the federally defined allowable costs. The rate
8of charges for services not covered by public and private insurance shall not exceed
9the reasonable charges as established by medicare Medicare fee determination
10procedures. A person that provides to a patient a service for which aid is provided
11under this section shall accept the amount paid under this section for the service as
12payment in full and may not bill the patient for any amount by which the charge for
13the service exceeds the amount paid for the service under this section. The state may
14not pay for the cost of travel, lodging, or meals for persons who must travel to receive
15inpatient and outpatient dialysis treatment for kidney disease. This paragraph shall
16not apply to donor related costs as defined in par. (b).
AB40-ASA1, s. 1486m 17Section 1486m. 49.78 (1) (br) of the statutes is created to read:
AB40-ASA1,612,2018 49.78 (1) (br) "Multicounty consortium" means a group of counties that is
19approved by the department under sub. (1m) to administer income maintenance
20programs.
AB40-ASA1, s. 1487m 21Section 1487m. 49.78 (1m) of the statutes is created to read:
AB40-ASA1,612,2422 49.78 (1m) Multicounty consortia. (a) Except as provided in par. (c), each
23county with a population of less than 750,000 shall participate in a multicounty
24consortium that is approved by the department under par. (b).
AB40-ASA1,613,2
1(b) By October 31, 2011, the department shall approve multicounty consortia.
2The department may not approve more than 10 multicounty consortia.
AB40-ASA1,613,103 (c) If a county with a population of less than 750,000 does not participate in a
4multicounty consortium or the department determines that a multicounty
5consortium does not satisfy the department's performance requirements, the
6department shall assume responsibility for administering income maintenance
7programs in that county or in the geographical area of the multicounty consortium.
8The department may provide income maintenance program administration under
9this paragraph by contracting with another multicounty consortium or by providing
10the administrative services with state resources and employees.
AB40-ASA1,613,1711 (d) If the department assumes responsibility for administering income
12maintenance programs in a county or in the geographical area of the multicounty
13consortium under par. (c), any county for which the department administers income
14maintenance programs shall pay to the department the amount that the county
15expended for the administration of income maintenance programs in calendar year
162009. For the purposes of this paragraph, Kenosha County expended $673,000 for
17the administration of income maintenance programs in calendar year 2009.
AB40-ASA1, s. 1488m 18Section 1488m. 49.78 (1r) of the statutes is created to read:
AB40-ASA1,613,2219 49.78 (1r) Single county consortia. The department shall administer income
20maintenance programs in a county with a population of 750,000 or more as a
21single-county consortium, including the administrative functions specified in sub.
22(2) (b) 1.
AB40-ASA1, s. 1489m 23Section 1489m. 49.78 (2) (title) of the statutes is amended to read:
AB40-ASA1,613,2424 49.78 (2) (title) Contracts with multicounty consortia.
AB40-ASA1, s. 1490m
1Section 1490m. 49.78 (2) of the statutes is renumbered 49.78 (2) (a) and
2amended to read:
AB40-ASA1,614,103 49.78 (2) (a) Annually, for the income maintenance program functions, if any,
4that the department delegates to a county or tribal governing body beginning with
5contracts for 2012
, the department and county department under s. 46.215, 46.22,
6or 46.23
shall enter into a contract, and the department and tribal governing body
7may enter into a contract, for reimbursement of the county department or tribal
8governing body for the reasonable cost of administering
with each multicounty
9consortium to administer
income maintenance programs in the multicounty
10consortium's geographical area
.
AB40-ASA1, s. 1491m 11Section 1491m. 49.78 (2) (b) of the statutes is created to read:
AB40-ASA1,614,1212 49.78 (2) (b) A contract under par. (a) shall provide all of the following:
AB40-ASA1,614,1413 1. That the multicounty consortia shall be responsible for all of the following
14administrative functions related to income maintenance programs:
AB40-ASA1,614,1515 a. Operating and maintaining a call center.
AB40-ASA1,614,1616 b. Conducting application processing and eligibility determinations.
AB40-ASA1,614,1717 c. Conducting ongoing case management.
AB40-ASA1,614,1818 d. Providing lobby services.
AB40-ASA1,614,2019 2. That the department and multicounty consortia shall cooperate to provide
20the following administrative functions related to the income maintenance programs:
AB40-ASA1,614,2121 a. Conducting subrogation and benefit recovery efforts.
AB40-ASA1,614,2222 b. Participating in fair hearings.
AB40-ASA1,614,2323 c. Conducting fraud prevention and identification activities.
AB40-ASA1,614,2524 3. That the department will reimburse a multicounty consortium for services
25provided under the contract on a risk-adjusted case load basis.
AB40-ASA1, s. 1492m
1Section 1492m. 49.78 (2m) of the statutes is created to read:
AB40-ASA1,615,62 49.78 (2m) Administration by a tribal governing body. (a) A tribal governing
3body may administer income maintenance programs by electing to have the
4department administer the tribe's income maintenance programs or by providing the
5required administrative services and entering into a contract with the department
6for reimbursement under par. (b).
AB40-ASA1,615,117 (b) Annually, for the income maintenance administrative program functions,
8if any, that the department delegates to a tribal governing body, the department and
9tribal governing body may enter into a contract, for reimbursement of the tribal
10governing body for the reasonable cost of administering income maintenance
11programs.
AB40-ASA1,615,1612 (c) The amount of each reimbursement paid under a contract entered into par.
13(b) shall be calculated using a formula based on workload within the limits of state
14and federal funds. The department may adjust reimbursement amounts determined
15under the contract for workload changes and computer network activities performed
16by a tribal governing body.
AB40-ASA1, s. 1493m 17Section 1493m. 49.78 (2r) of the statutes is created to read:
AB40-ASA1,615,2018 49.78 (2r) Departmental administrative functions. The department shall
19perform all of the following administrative functions related to income maintenance
20programs:
AB40-ASA1,615,2121 (a) Providing income maintenance worker training.
AB40-ASA1,615,2222 (b) Performing 2nd-party reviews.
AB40-ASA1,615,2323 (c) Administering the funeral expenses program under s. 49.785.
AB40-ASA1,615,2524 (d) Providing information technology and licenses for call centers that are
25operated by multicounty consortia.
AB40-ASA1,616,2
1(e) Maintaining the client assistance reemployment and economic support
2system.
AB40-ASA1,616,43 (f) Contracting with multicounty consortia under sub. (2), including
4establishing performance requirements.
AB40-ASA1,616,65 (g) Contracting with tribal governing bodies under sub. (2m), including
6establishing performance requirements.
AB40-ASA1,616,97 (h) Monitoring contracts with multicounty consortia and tribal governing
8bodies, including compliance with performance standards and federal and other
9reporting requirements.
AB40-ASA1,616,1010 (i) Operating a centralized document processing unit.
AB40-ASA1, s. 1494m 11Section 1494m. 49.78 (8) (a) of the statutes is amended to read:
AB40-ASA1,616,2412 49.78 (8) (a) From the appropriation accounts appropriations under s. 20.435
13(4) (bn) and (nn) and subject to par. (b), the department shall provide funding to
14reimburse each county multicounty consortium that contracts with the department
15under sub. (2)
and each tribal governing body that contracts with the department
16under sub. (2) (2m) for reasonable the costs of administering the income maintenance
17programs, including conducting fraud prevention activities. The amount of each
18reimbursement paid under this paragraph shall be calculated using a formula based
19on workload within the limits of available state and federal funds under s. 20.435 (4)
20(bn) and (nn) by contract under sub. (2)
, in accordance with the terms of the
21applicable contract
. The amount of reimbursement calculated under this paragraph
22and par. (b) is in addition to any reimbursement provided to a county , multicounty
23consortium,
or tribal governing body for fraud and error reduction under s. 49.197
24or 49.845.
AB40-ASA1, s. 1495m 25Section 1495m. 49.78 (8) (b) of the statutes is amended to read:
AB40-ASA1,617,5
149.78 (8) (b) The department may adjust the amounts determined under par.
2(a) for workload changes and computer network activities performed by a county or
3tribal governing body and
may reduce the amount of any reimbursement if federal
4reimbursement is withheld due to audits, quality control samples, or program
5reviews.
AB40-ASA1, s. 1496m 6Section 1496m. 49.78 (10) (title) of the statutes is amended to read:
AB40-ASA1,617,77 49.78 (10) (title) County Reimbursement certification.
AB40-ASA1, s. 1497m 8Section 1497m. 49.78 (10) (a) of the statutes is amended to read:
AB40-ASA1,617,219 49.78 (10) (a) Each county treasurer and director of a county department under
10s. 46.215, 46.22, or 46.23
An authorized representative from each multicounty
11consortium
that contracts with the department under sub. (2) and each tribal
12governing body that contracts with the department under sub. (2) (2m) shall certify
13monthly under oath to the department in such manner as the department prescribes
14the claim of the county multicounty consortium or tribal governing body for state
15reimbursement under sub. (8) (a). The department shall review each claim of
16reimbursement and, if the department approves the claim, the department shall
17certify to the department of administration for reimbursement to the county
18multicounty consortium or tribal governing body for amounts due under sub. (8) (a)
19and payment claimed to be made to the counties multicounty consortia or tribal
20governing bodies monthly. The department may make advance payments prior to
21the beginning of each month equal to one-twelfth of the contracted amount.
AB40-ASA1, s. 1498m 22Section 1498m. 49.78 (10) (b) of the statutes is amended to read:
AB40-ASA1,618,623 49.78 (10) (b) To facilitate prompt reimbursement the certificate of the
24department may be based on the certified statements of the county officers
25authorized representatives of multicounty consortia or tribal governing body

1executives filed under par. (a). Funds recovered from audit adjustments from a prior
2fiscal year may be included in subsequent certifications only to pay counties or
3multicounty consortia
owed funds as a result of any audit adjustment. By September
430 annually, the department shall submit a report to the appropriate standing
5committees under s. 13.172 (3) on funds recovered and paid out during the previous
6calendar year as a result of audit adjustments.
AB40-ASA1, s. 1499m 7Section 1499m. 49.78 (11) (a) of the statutes is amended to read:
AB40-ASA1,618,208 49.78 (11) (a) 1. The department, a county department under s. 46.215, 46.22,
9or 46.23, a multicounty consortium, or a tribal governing body may request from any
10person in this state information it determines appropriate and necessary for
11determining or verifying eligibility or benefits for a recipient under any income
12maintenance program. Unless access to the information is prohibited or restricted
13by law, or unless the person has good cause, as determined by the department in
14accordance with federal law and regulations, for refusing to cooperate, the person
15shall make a good faith effort to provide the information within 7 days after receiving
16a request under this paragraph. The department, county department, multicounty
17consortium,
or tribal governing body, or employees of any of them, may not disclose
18information obtained under this subdivision for any purpose not connected with the
19administration of the income maintenance program for which the information was
20requested.
AB40-ASA1,618,2421 2. In conjunction with any request for information under subd. 1., including a
22request made by subpoena under par. (b), the department, county department,
23multicounty consortium, or tribal governing body shall advise the person of the time
24by which the information must be provided.
AB40-ASA1, s. 1500m 25Section 1500m. 49.78 (11) (b) of the statutes is amended to read:
AB40-ASA1,619,5
149.78 (11) (b) The department, a county department, a multicounty
2consortium,
or a tribal governing body may issue a subpoena, in substantially the
3form authorized under s. 885.02, to compel the production of financial information
4or other documentary evidence for determining or verifying eligibility or benefits for
5a recipient under any income maintenance program.
AB40-ASA1, s. 1501m 6Section 1501m. 49.78 (11) (c) 1. of the statutes is amended to read:
AB40-ASA1,619,97 49.78 (11) (c) 1. Allowing access to financial or other records by the department,
8a county department, a multicounty consortium, or a tribal governing body in
9response to a request under par. (a) or a subpoena described in par. (b).
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