(b) (intro.) The department may waive monthly premiums that are 7
calculated 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 9
monthly premium for any individual whose income level, after adding the 10
individual's earned income and unearned income, is below 150% of the poverty line.
(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 14
individual who is eligible for medical assistance under sub. (3), pay premiums for or 15
purchase individual coverage offered by the individual's employer if the department 16
determines that paying the premiums for or purchasing the coverage will not be more 17
costly than providing medical assistance.
(b) If federal financial participation is available, from the 20
appropriation account accounts
under s. 20.435 (4) (b), (gm),
or (w), the department 21
may pay medicare Part A and Part B premiums for individuals who are eligible for 22
medicare and for medical assistance under sub. (3).
(intro.) Unless otherwise provided by the department by a policy 2
created under s. 49.45 (2m) (c), a woman is eligible for medical assistance as provided 3
under sub. (5) if, after applying to the department or a county department, the 4
department or a county department determines that she meets all of the following 5
AB40-ASA1, s. 1465p
49.473 (2) (intro.) of the statutes, as affected by 2011 7
Wisconsin Act .... (this act), is amended to read:
(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 10
provided under sub. (5) if, after applying to the department or a county department, 11
the department or a county department determines that she meets all of the 12
The department shall audit and pay, from the appropriation 16
accounts under s. 20.435 (4) (b), (gm), and (o), allowable charges to a provider who 17
is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who 18
meets the requirements under sub. (2) for all benefits and services specified under 19
s. 49.46 (2), unless otherwise provided by the department by a policy created under 20
s. 49.45 (2m) (c).
AB40-ASA1, s. 1470b
49.473 (5) of the statutes, as affected by 2011 Wisconsin Act 22
.... (this act), is amended to read:
The department shall audit and pay, from the appropriation 24
accounts under s. 20.435 (4) (b), (gm), and (o), allowable charges to a provider who 25
is certified under s. 49.45 (2) (a) 11. for medical assistance on behalf of a woman who
meets the requirements under sub. (2) for all benefits and services specified under 2
s. 49.46 (2), unless otherwise provided by the department by a policy created under
3s. 49.45 (2m) (c)
(am) 2. b. If the applicant is under 27 26
years of age, notice that he 6
or she may be eligible for coverage as a dependent under his or her parent's health 7
care plan in accordance with s. 632.885, and that his or her parent's plan must 8
include coverage for services that are not covered under the plan under this section.
(b) From the appropriation accounts under ss. 20.435 (4) (e) and (je), 11
the state shall pay the cost of, at a rate determined by the department under par. (e),
medical treatment that is
required as a direct result of chronic renal disease of 13
certified patients from the date of certification, including the cost of
recombinant human erythropoietin to appropriate patients, whether the treatment 15
is rendered in an approved facility in the state or in a dialysis or transplantation 16
center which that
is approved as such by a contiguous state, subject to the conditions 17
specified under par. (d). Approved facilities may include a hospital in-center dialysis 18
unit or a nonhospital dialysis center which that
is closely affiliated with a home 19
dialysis program supervised by an approved facility. Aid shall also be provided for 20
all reasonable expenses incurred by a potential living-related donor, including 21
evaluation, hospitalization, surgical costs,
and postoperative follow-up to the extent 22
that these costs are not reimbursable under the federal medicare program or other 23
insurance. In addition, all expenses incurred in the procurement, transportation, 24
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 2
recipient and reimbursable under this subsection.
(e) State aids Payment
for services provided under this section shall 5
be equal to at a rate determined by the department that does not exceed
the allowable 6
charges under the federal Medicare program. In no case shall state rates for 7
individual service elements exceed the federally defined allowable costs. The rate 8
of charges for services not covered by public and private insurance shall not exceed 9
the reasonable charges as established by medicare
fee determination 10
procedures. A person that provides to a patient a service for which aid is provided 11
under this section shall accept the amount paid under this section for the service as 12
payment in full and may not bill the patient for any amount by which the charge for 13
the service exceeds the amount paid for the service under this section. The state may 14
not pay for the cost of travel, lodging, or meals for persons who must travel to receive 15
inpatient and outpatient dialysis treatment for kidney disease. This paragraph shall 16
not apply to donor related costs as defined in par. (b).
49.78 (1) (br) "Multicounty consortium" means a group of counties that is 19
approved by the department under sub. (1m) to administer income maintenance 20
49.78 (1m) Multicounty consortia.
(a) Except as provided in par. (c), each 23
county with a population of less than 750,000 shall participate in a multicounty 24
consortium that is approved by the department under par. (b).
(b) By October 31, 2011, the department shall approve multicounty consortia. 2
The department may not approve more than 10 multicounty consortia.
(c) If a county with a population of less than 750,000 does not participate in a 4
multicounty consortium or the department determines that a multicounty 5
consortium does not satisfy the department's performance requirements, the 6
department shall assume responsibility for administering income maintenance 7
programs in that county or in the geographical area of the multicounty consortium. 8
The department may provide income maintenance program administration under 9
this paragraph by contracting with another multicounty consortium or by providing 10
the administrative services with state resources and employees.
(d) If the department assumes responsibility for administering income 12
maintenance programs in a county or in the geographical area of the multicounty 13
consortium under par. (c), any county for which the department administers income 14
maintenance programs shall pay to the department the amount that the county 15
expended for the administration of income maintenance programs in calendar year 16
2009. For the purposes of this paragraph, Kenosha County expended $673,000 for 17
the administration of income maintenance programs in calendar year 2009.
49.78 (1r) Single county consortia.
The department shall administer income 20
maintenance programs in a county with a population of 750,000 or more as a 21
single-county consortium, including the administrative functions specified in sub. 22
(2) (b) 1.
(title) Contracts with multicounty consortia.
AB40-ASA1, s. 1490m
49.78 (2) of the statutes is renumbered 49.78 (2) (a) and 2
amended to read:
(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,
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
(b) A contract under par. (a) shall provide all of the following:
1. That the multicounty consortia shall be responsible for all of the following 14
administrative functions related to income maintenance programs:
a. Operating and maintaining a call center.
b. Conducting application processing and eligibility determinations.
c. Conducting ongoing case management.
d. Providing lobby services.
2. That the department and multicounty consortia shall cooperate to provide 20
the following administrative functions related to the income maintenance programs:
a. Conducting subrogation and benefit recovery efforts.
b. Participating in fair hearings.
c. Conducting fraud prevention and identification activities.
3. That the department will reimburse a multicounty consortium for services 25
provided under the contract on a risk-adjusted case load basis.
49.78 (2m) Administration by a tribal governing body.
(a) A tribal governing 3
body may administer income maintenance programs by electing to have the 4
department administer the tribe's income maintenance programs or by providing the 5
required administrative services and entering into a contract with the department 6
for reimbursement under par. (b).
(b) Annually, for the income maintenance administrative program functions, 8
if any, that the department delegates to a tribal governing body, the department and 9
tribal governing body may enter into a contract, for reimbursement of the tribal 10
governing body for the reasonable cost of administering income maintenance 11
(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 14
and federal funds. The department may adjust reimbursement amounts determined 15
under the contract for workload changes and computer network activities performed 16
by a tribal governing body.
49.78 (2r) Departmental administrative functions.
The department shall 19
perform all of the following administrative functions related to income maintenance 20
(a) Providing income maintenance worker training.
(b) Performing 2nd-party reviews.
(c) Administering the funeral expenses program under s. 49.785.
(d) Providing information technology and licenses for call centers that are 25
operated by multicounty consortia.
(e) Maintaining the client assistance reemployment and economic support 2
(f) Contracting with multicounty consortia under sub. (2), including 4
establishing performance requirements.
(g) Contracting with tribal governing bodies under sub. (2m), including 6
establishing performance requirements.
(h) Monitoring contracts with multicounty consortia and tribal governing 8
bodies, including compliance with performance standards and federal and other 9
(i) Operating a centralized document processing unit.
(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 14
reimburse each county multicounty consortium that contracts with the department
15under sub. (2)
tribal governing body that contracts with the department 16
under sub. (2) (2m)
for reasonable the
costs of administering the income maintenance 17
programs, 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
. The amount of reimbursement calculated under this paragraph 22
and par. (b) is in addition to any reimbursement provided to a county
or tribal governing body for fraud and error reduction under s. 49.197 24
(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 4
reimbursement is withheld due to audits, quality control samples, or program 5
(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
that contracts with the department under sub. (2) and each tribal 12
governing body that contracts with the department under sub. (2) (2m)
shall certify 13
monthly under oath to the department in such manner as the department prescribes 14
the claim of the county multicounty consortium
or tribal governing body for state 15
reimbursement under sub. (8) (a). The department shall review each claim of 16
reimbursement and, if the department approves the claim, the department shall 17
certify to the department of administration for reimbursement to the
county 18multicounty consortium
or tribal governing body for amounts due under sub. (8) (a) 19
and payment claimed to be made to the counties multicounty consortia
or tribal 20
governing bodies monthly. The department may make advance payments prior to 21
the beginning of each month equal to one-twelfth of the contracted amount.
(b) To facilitate prompt reimbursement the certificate of the 24
department may be based on the certified statements of the county officers 25authorized representatives of multicounty consortia
or tribal governing body
executives filed under par. (a). Funds recovered from audit adjustments from a prior
fiscal year may be included in subsequent certifications only to pay counties or
owed funds as a result of any audit adjustment. By September 4
30 annually, the department shall submit a report to the appropriate standing 5
committees under s. 13.172 (3) on funds recovered and paid out during the previous 6
calendar year as a result of audit adjustments.
(a) 1. The department, a county department under s. 46.215, 46.22, 9
or 46.23, a multicounty consortium
, or a tribal governing body may request from any 10
person in this state information it determines appropriate and necessary for 11
determining or verifying eligibility or benefits for a recipient under any income 12
maintenance program. Unless access to the information is prohibited or restricted 13
by law, or unless the person has good cause, as determined by the department in 14
accordance with federal law and regulations, for refusing to cooperate, the person 15
shall make a good faith effort to provide the information within 7 days after receiving 16
a request under this paragraph. The department, county department,
or tribal governing body, or employees of any of them, may not disclose 18
information obtained under this subdivision for any purpose not connected with the 19
administration of the income maintenance program for which the information was 20
2. In conjunction with any request for information under subd. 1., including a 22
request made by subpoena under par. (b), the department, county department, 23multicounty consortium,
or tribal governing body shall advise the person of the time 24
by which the information must be provided.
(b) The department, a county department, a multicounty
or a tribal governing body may issue a subpoena, in substantially the 3
form authorized under s. 885.02, to compel the production of financial information 4
or other documentary evidence for determining or verifying eligibility or benefits for 5
a recipient under any income maintenance program.
(c) 1. Allowing access to financial or other records by the department, 8
a county department, a multicounty consortium,
or a tribal governing body in 9
response to a request under par. (a) or a subpoena described in par. (b).
(c) 2. Disclosing information from financial or other records to the 12
department, a county department, a multicounty consortium,
or a tribal governing 13
body in response to a request under par. (a) or a subpoena described in par. (b).
(c) 3. Any other action taken in good faith to comply with this 16
subsection or a subpoena described in par. (b) or to comply with a request for 17
information or access to records from the department, a county department, a
or a tribal governing body for determining or verifying 19
eligibility or benefits for a recipient under any income maintenance program.
From the appropriation under s. 20.435 (4) (bn) (br)
, the department 22
shall reimburse a county or applicable tribal governing body or organization for any 23
amount that the county or applicable tribal governing body or organization is 24
required to pay under sub. (1) if the county or applicable tribal governing body or 25
organization complies with sub. (3). From the appropriation under s. 20.435 (4) (bn)
, the department shall reimburse a county or applicable tribal governing body or 2
organization for cemetery expenses or for funeral and burial expenses for a person 3
described under sub. (1) that the county or applicable tribal governing body or 4
organization is not required to pay under subs. (1) and (1m) only if the department 5
approves the reimbursement due to unusual circumstances and if the county or 6
applicable tribal governing body or organization complies with sub. (3).
49.79 (1) (e) "Multicounty consortium" has the meaning given in s. 49.78 (1) 9
49.79 (3) Liability for lost food coupons.
(a) A county, multicounty
or federally recognized American Indian tribe is liable for all food stamp 13
coupons lost, misappropriated, or destroyed while under the county's
, consortium's, 14
or tribe's direct control, except as provided in par. (b).
(b) A county, multicounty consortium,
or federally recognized American Indian 16
tribe is not liable for food stamp coupons lost in natural disasters if it provides 17
evidence acceptable to the department that the coupons were destroyed and not 18
(c) A county, multicounty consortium,
or federally recognized American Indian 20
tribe is liable for food stamp coupons mailed to residents of the county or counties
21that are in the multicounty consortium
or members of the tribe and lost in the mail 22
due to incorrect information submitted to the department by the county or tribe.