AB40-ASA1,591,73 49.45 (27) Eligibility of aliens. A person who is not a U.S. citizen or an alien
4lawfully admitted for permanent residence or otherwise permanently residing in the
5United States under color of law may not receive medical assistance benefits except
6as provided under 8 USC 1255a (h) (3) or 42 USC 1396b (v), unless otherwise
7provided by the department by a policy created under sub. (2m) (c).
AB40-ASA1, s. 1441g 8Section 1441g. 49.45 (27) of the statutes, as affected by 2011 Wisconsin Act
9.... (this act), is amended to read:
AB40-ASA1,591,1410 49.45 (27) Eligibility of aliens. A person who is not a U.S. citizen or an alien
11lawfully admitted for permanent residence or otherwise permanently residing in the
12United States under color of law may not receive medical assistance benefits except
13as provided under 8 USC 1255a (h) (3) or 42 USC 1396b (v), unless otherwise
14provided by the department by a policy created under sub. (2m) (c)
.
AB40-ASA1, s. 1442g 15Section 1442g. 49.45 (39) (b) 1. of the statutes, as affected by 2011 Wisconsin
16Act 10
, is repealed and recreated to read:
AB40-ASA1,593,217 49.45 (39) (b) 1. `Payment for school medical services.' If a school district or a
18cooperative educational service agency elects to provide school medical services and
19meets all requirements under par. (c), the department shall reimburse the school
20district or the cooperative educational service agency for 60% of the federal share of
21allowable charges for the school medical services that it provides, unless otherwise
22provided by the department by a policy created under sub. (2m) (c), and, as specified
23in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind
24and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
25and Hard of Hearing elects to provide school medical services and meets all

1requirements under par. (c), the department shall reimburse the department of
2public instruction for 60% of the federal share of allowable charges for the school
3medical services that the Wisconsin Center for the Blind and Visually Impaired or
4the Wisconsin Educational Services Program for the Deaf and Hard of Hearing
5provides, unless otherwise provided by the department by a policy created under sub.
6(2m) (c), and, as specified in subd. 2., for allowable administrative costs. A school
7district, cooperative educational service agency, the Wisconsin Center for the Blind
8and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
9and Hard of Hearing may submit, and the department shall allow, claims for common
10carrier transportation costs as a school medical service unless the department
11receives notice from the federal health care financing administration that, under a
12change in federal policy, the claims are not allowed. If the department receives the
13notice, a school district, cooperative educational service agency, the Wisconsin
14Center for the Blind and Visually Impaired, or the Wisconsin Educational Services
15Program for the Deaf and Hard of Hearing may submit, and the department shall
16allow, unreimbursed claims for common carrier transportation costs incurred before
17the date of the change in federal policy. The department shall promulgate rules
18establishing a methodology for making reimbursements under this paragraph. All
19other expenses for the school medical services provided by a school district or a
20cooperative educational service agency shall be paid for by the school district or the
21cooperative educational service agency with funds received from state or local taxes.
22The school district, the Wisconsin Center for the Blind and Visually Impaired, the
23Wisconsin Educational Services Program for the Deaf and Hard of Hearing, or the
24cooperative educational service agency shall comply with all requirements of the

1federal department of health and human services for receiving federal financial
2participation.
AB40-ASA1, s. 1442h 3Section 1442h. 49.45 (39) (b) 1. of the statutes, as affected by 2011 Wisconsin
4Act .... (this act), is amended to read:
AB40-ASA1,594,145 49.45 (39) (b) 1. `Payment for school medical services.' If a school district or a
6cooperative educational service agency elects to provide school medical services and
7meets all requirements under par. (c), the department shall reimburse the school
8district or the cooperative educational service agency for 60% of the federal share of
9allowable charges for the school medical services that it provides , unless otherwise
10provided by the department by a policy created under sub. (2m) (c),
and, as specified
11in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind
12and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
13and Hard of Hearing elects to provide school medical services and meets all
14requirements under par. (c), the department shall reimburse the department of
15public instruction for 60% of the federal share of allowable charges for the school
16medical services that the Wisconsin Center for the Blind and Visually Impaired or
17the Wisconsin Educational Services Program for the Deaf and Hard of Hearing
18provides, unless otherwise provided by the department by a policy created under sub.
19(2m) (c),
and, as specified in subd. 2., for allowable administrative costs. A school
20district, cooperative educational service agency, the Wisconsin Center for the Blind
21and Visually Impaired or the Wisconsin Educational Services Program for the Deaf
22and Hard of Hearing may submit, and the department shall allow, claims for common
23carrier transportation costs as a school medical service unless the department
24receives notice from the federal health care financing administration that, under a
25change in federal policy, the claims are not allowed. If the department receives the

1notice, a school district, cooperative educational service agency, the Wisconsin
2Center for the Blind and Visually Impaired, or the Wisconsin Educational Services
3Program for the Deaf and Hard of Hearing may submit, and the department shall
4allow, unreimbursed claims for common carrier transportation costs incurred before
5the date of the change in federal policy. The department shall promulgate rules
6establishing a methodology for making reimbursements under this paragraph. All
7other expenses for the school medical services provided by a school district or a
8cooperative educational service agency shall be paid for by the school district or the
9cooperative educational service agency with funds received from state or local taxes.
10The school district, the Wisconsin Center for the Blind and Visually Impaired, the
11Wisconsin Educational Services Program for the Deaf and Hard of Hearing, or the
12cooperative educational service agency shall comply with all requirements of the
13federal department of health and human services for receiving federal financial
14participation.
AB40-ASA1, s. 1443 15Section 1443. 49.45 (51) (a) of the statutes is amended to read:
AB40-ASA1,594,2316 49.45 (51) (a) By November 1 annually, the department shall provide to the
17department of revenue information concerning the estimated amounts of
18supplements payable from the appropriation accounts under s. 20.435 (4) (b) and
19(gm)
to specific local governmental units for the provision of transportation for
20medical care, as specified under s. 49.46 (2) (b) 3., during the fiscal year. Beginning
21November 1, 2004, the information that the department provides under this
22paragraph shall include any adjustments necessary to reflect actual claims
23submitted by service providers in the previous fiscal year.
AB40-ASA1, s. 1444 24Section 1444. 49.45 (52) (title) of the statutes is amended to read:
AB40-ASA1,594,2525 49.45 (52) (title) Payment adjustments ; federal funding for certain services.
AB40-ASA1, s. 1445
1Section 1445. 49.45 (52) of the statutes is renumbered 49.45 (52) (a) 1. and
2amended to read:
AB40-ASA1,595,163 49.45 (52) (a) 1. Beginning on January 1, 2003 If the department provides the
4notice under par. (c) selecting the payment procedure in this paragraph
, the
5department may, from the appropriation account under s. 20.435 (7) (b), make
6Medical Assistance payment adjustments to county departments under s. 46.215,
746.22, 46.23, or 51.42, or 51.437 or to local health departments, as defined in s. 250.01
8(4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and
9(b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16., except for
10services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating
11in the early intervention program under s. 51.44. Payment adjustments under this
12subsection paragraph shall include the state share of the payments. The total of any
13payment adjustments under this subsection paragraph and Medical Assistance
14payments made from appropriation accounts under s. 20.435 (4) (b), (gm), (o), and
15(w), may not exceed applicable limitations on payments under 42 USC 1396a (a) (30)
16(A).
AB40-ASA1, s. 1446 17Section 1446. 49.45 (52) (a) 2. of the statutes is created to read:
AB40-ASA1,595,2118 49.45 (52) (a) 2. The department may require a county department or local
19health department to submit a certified cost report that meets the requirements of
20the federal department of health and human services for covered services described
21in subd. 1.
AB40-ASA1, s. 1447 22Section 1447. 49.45 (52) (b) of the statutes is created to read:
AB40-ASA1,595,2423 49.45 (52) (b) If the department provides the notice under par. (c) selecting the
24payment procedure in this paragraph, all of the following apply:
AB40-ASA1,596,6
11. Annually, a county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437
2shall submit a certified cost report that meets the requirements of the federal
3department of health and human services for covered services under s. 49.46 (2) (a)
42. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13.,
515., and 16., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided
6to children participating in the early intervention program under s. 51.44.
AB40-ASA1,596,107 2. For services described under subd. 1., the department shall base the amount
8of a claim for federal medical assistance funds on certified cost reports submitted by
9county departments under subd. 1. to the extent the reports comply with federal
10requirements.
AB40-ASA1,596,1311 3. The department shall pay county departments a percentage of the federal
12funds claimed under subd. 2. for services described under subd. 1., which percentage
13is established in the most recent biennial budget.
AB40-ASA1,596,1714 4. The department may pay a local health department, as defined in s. 250.01
15(4), that submits certified cost reports for services described under subd. 1. a
16percentage of the federal funds claimed for those services, which percentage is
17established in the most recent biennial budget.
AB40-ASA1, s. 1448 18Section 1448. 49.45 (52) (c) of the statutes is created to read:
AB40-ASA1,596,2319 49.45 (52) (c) The department shall select a payment procedure under either
20par. (a) or (b) and may change which procedure under par. (a) or (b) is selected. The
21department shall notify each county department and local health department, as
22applicable, of the selected payment procedure before the date on which payment for
23services is made under that selected or newly selected procedure.
AB40-ASA1, s. 1449 24Section 1449. 49.45 (53) of the statutes is amended to read:
AB40-ASA1,597,4
149.45 (53) Payments for certain services. Beginning on January 1, 2003, the
2department may, from the appropriation account under s. 20.435 (7) (b), make
3Medical Assistance payments to providers for covered services under ss. 49.46 (2) (a)
44. d. and (b) 6. j. and m. and 49.471 (11) (f) that are provided before January 1, 2012.
AB40-ASA1, s. 1453e 5Section 1453e. 49.46 (1) (n) of the statutes, as created by 2011 Wisconsin Act
610
, is repealed and recreated to read:
AB40-ASA1,597,87 49.46 (1) (n) If the department creates a policy under s. 49.45 (2m) (c) 8., 9., or
810., this subsection does not apply to the extent that it conflicts with the policy.
AB40-ASA1, s. 1453f 9Section 1453f. 49.46 (1) (n) of the statutes, as created by 2011 Wisconsin Act
10.... (this act), is repealed.
AB40-ASA1, s. 1453h 11Section 1453h. 49.46 (2) (a) (intro.) of the statutes, as affected by 2011
12Wisconsin Act 10
, is repealed and recreated to read:
AB40-ASA1,597,1613 49.46 (2) (a) (intro.) Except as provided in par. (be) and unless otherwise
14provided by the department by a policy created under s. 49.45 (2m) (c), the
15department shall audit and pay allowable charges to certified providers for medical
16assistance on behalf of recipients for the following federally mandated benefits:
AB40-ASA1, s. 1453i 17Section 1453i. 49.46 (2) (a) (intro.) of the statutes, as affected by 2011
18Wisconsin Act .... (this act), is amended to read:
AB40-ASA1,597,2219 49.46 (2) (a) (intro.) Except as provided in par. (be) and unless otherwise
20provided by the department by a policy created under s. 49.45 (2m) (c)
, the
21department shall audit and pay allowable charges to certified providers for medical
22assistance on behalf of recipients for the following federally mandated benefits:
AB40-ASA1, s. 1453k 23Section 1453k. 49.46 (2) (b) (intro.) of the statutes, as affected by 2011
24Wisconsin Act 10
, is repealed and recreated to read:
AB40-ASA1,598,4
149.46 (2) (b) (intro.) Except as provided in pars. (be) and (dc) and unless
2otherwise provided by the department by a policy created under s. 49.45 (2m) (c), the
3department shall audit and pay allowable charges to certified providers for medical
4assistance on behalf of recipients for the following services:
AB40-ASA1, s. 1453L 5Section 1453L. 49.46 (2) (b) (intro.) of the statutes, as affected by 2011
6Wisconsin Act .... (this act), is amended to read:
AB40-ASA1,598,107 49.46 (2) (b) (intro.) Except as provided in pars. (be) and (dc) and unless
8otherwise provided by the department by a policy created under s. 49.45 (2m) (c)
, the
9department shall audit and pay allowable charges to certified providers for medical
10assistance on behalf of recipients for the following services:
AB40-ASA1, s. 1453m 11Section 1453m. 49.46 (2) (c) 2. of the statutes is amended to read:
AB40-ASA1,599,212 49.46 (2) (c) 2. For an individual who is entitled to coverage under part Part
13A of medicare Medicare, entitled to coverage under part Part B of medicare Medicare,
14meets the eligibility criteria under sub. (1), and meets the limitation on income under
15subd. 6., medical assistance Medical Assistance shall include payment of the
16deductible and coinsurance portions of medicare Medicare services under 42 USC
171395
to 1395zz which that are not paid under 42 USC 1395 to 1395zz, including those
18medicare Medicare services that are not included in the approved state plan for
19services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v;
20the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late
21enrollment penalty, if applicable, for premiums under part Part A of medicare
22Medicare. Payment of coinsurance for a service under part Part B of medicare
23Medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for
24outpatient hospital services,
and payment of deductibles and coinsurance for
25inpatient hospital services under Part A of Medicare
may not exceed the allowable

1charge for the service under medical assistance Medical Assistance minus the
2medicare Medicare payment.
AB40-ASA1, s. 1453n 3Section 1453n. 49.46 (2) (c) 3. of the statutes is amended to read:
AB40-ASA1,599,154 49.46 (2) (c) 3. For an individual who is only entitled to coverage under part
5Part A of medicare Medicare, meets the eligibility criteria under sub. (1), and meets
6the limitation on income under subd. 6., medical assistance Medical Assistance shall
7include payment of the deductible and coinsurance portions of medicare Medicare
8services under 42 USC 1395 to 1395i which that are not paid under 42 USC 1395 to
91395i, including those medicare Medicare services that are not included in the
10approved state plan for services under 42 USC 1396; the monthly premiums, if
11applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable,
12for premiums under part Part A of medicare Medicare. Payment of deductibles and
13coinsurance for inpatient hospital services under Part A of Medicare may not exceed
14the allowable charge for the service under Medical Assistance minus the Medicare
15payment
.
AB40-ASA1, s. 1453o 16Section 1453o. 49.46 (2) (c) 4. of the statutes is amended to read:
AB40-ASA1,600,517 49.46 (2) (c) 4. For an individual who is entitled to coverage under part Part
18A of medicare Medicare, entitled to coverage under part Part B of medicare Medicare,
19and meets the eligibility criteria for medical assistance Medical Assistance under
20sub. (1), but does not meet the limitation on income under subd. 6., medical
21assistance
Medical Assistance shall include payment of the deductible and
22coinsurance portions of medicare Medicare services under 42 USC 1395 to 1395zz
23which that are not paid under 42 USC 1395 to 1395zz, including those medicare
24Medicare services that are not included in the approved state plan for services under
2542 USC 1396. Payment of coinsurance for a service under part Part B of medicare

1Medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for
2outpatient hospital services,
and payment of deductibles and coinsurance for
3inpatient hospital services under Part A of Medicare
may not exceed the allowable
4charge for the service under medical assistance Medical Assistance minus the
5medicare Medicare payment.
AB40-ASA1, s. 1453p 6Section 1453p. 49.46 (2) (c) 5. of the statutes is amended to read:
AB40-ASA1,600,167 49.46 (2) (c) 5. For an individual who is only entitled to coverage under part
8Part A of medicare Medicare and meets the eligibility criteria for medical assistance
9Medical Assistance under sub. (1), but does not meet the limitation on income under
10subd. 6., medical assistance Medical Assistance shall include payment of the
11deductible and coinsurance portions of medicare Medicare services under 42 USC
121395
to 1395i which that are not paid under 42 USC 1395 to 1395i, including those
13medicare Medicare services that are not included in the approved state plan for
14services under 42 USC 1396. Payment of deductibles and coinsurance for inpatient
15hospital services under Part A of Medicare may not exceed the allowable charge for
16the service under Medical Assistance minus the Medicare payment.
AB40-ASA1, s. 1453q 17Section 1453q. 49.46 (2) (c) 5m. of the statutes is amended to read:
AB40-ASA1,601,218 49.46 (2) (c) 5m. For an individual who is only entitled to coverage under part
19Part B of medicare Medicare and meets the eligibility criteria under sub. (1), but does
20not meet the limitation on income under subd. 6., medical assistance Medical
21Assistance
shall include payment of the deductible and coinsurance portions of
22medicare Medicare services under 42 USC 1395j to 1395w, including those medicare
23Medicare services that are not included in the approved state plan for services under
2442 USC 1396. Payment of coinsurance for a service under part Part B of medicare,
25other than payment of coinsurance for outpatient hospital services,
Medicare may

1not exceed the allowable charge for the service under medical assistance Medical
2Assistance
minus the medicare Medicare payment.
AB40-ASA1, s. 1453r 3Section 1453r. 49.465 (2) (intro.) of the statutes, as affected by 2011 Wisconsin
4Act 10
, is repealed and recreated to read:
AB40-ASA1,601,105 49.465 (2) (intro.) Unless otherwise provided by the department by a policy
6created under s. 49.45 (2m) (c), a pregnant woman is eligible for medical assistance
7benefits, as provided under sub. (3), during the period beginning on the day on which
8a qualified provider determines, on the basis of preliminary information, that the
9woman's family income does not exceed the highest level for eligibility for benefits
10under s. 49.46 (1) or 49.47 (4) (am) or (c) 1. and ending as follows:
AB40-ASA1, s. 1453s 11Section 1453s. 49.465 (2) (intro.) of the statutes, as affected by 2011 Wisconsin
12Act .... (this act), is amended to read:
AB40-ASA1,601,1813 49.465 (2) (intro.) Unless otherwise provided by the department by a policy
14created under s. 49.45 (2m) (c), a
A pregnant woman is eligible for medical assistance
15benefits, as provided under sub. (3), during the period beginning on the day on which
16a qualified provider determines, on the basis of preliminary information, that the
17woman's family income does not exceed the highest level for eligibility for benefits
18under s. 49.46 (1) or 49.47 (4) (am) or (c) 1. and ending as follows:
AB40-ASA1, s. 1455 19Section 1455. 49.468 (1) (b) of the statutes is amended to read:
AB40-ASA1,602,1120 49.468 (1) (b) For an elderly or disabled individual who is entitled to coverage
21under part Part A of medicare Medicare, entitled to coverage under part Part B of
22medicare Medicare, and who does not meet the eligibility criteria for medical
23assistance
Medical Assistance under s. 49.46 (1), 49.465, 49.47 (4), or 49.471 but
24meets the limitations on income and resources under par. (d), medical assistance
25Medical Assistance shall pay the deductible and coinsurance portions of medicare

1Medicare services under 42 USC 1395 to 1395zz which that are not paid under 42
2USC 1395
to 1395zz, including those medicare Medicare services that are not
3included in the approved state plan for services under 42 USC 1396; the monthly
4premiums payable under 42 USC 1395v; the monthly premiums, if applicable, under
542 USC 1395i-2 (d); and the late enrollment penalty, if applicable, for premiums
6under part Part A of medicare Medicare. Payment of coinsurance for a service under
7part Part B of medicare Medicare under 42 USC 1395j to 1395w, other than payment
8of coinsurance for outpatient hospital services,
and payment of deductibles and
9coinsurance for inpatient hospital services under Part A of Medicare
may not exceed
10the allowable charge for the service under medical assistance Medical Assistance
11minus the medicare Medicare payment.
AB40-ASA1, s. 1456 12Section 1456. 49.468 (1) (c) of the statutes is amended to read:
AB40-ASA1,602,2513 49.468 (1) (c) For an elderly or disabled individual who is only entitled to
14coverage under part Part A of medicare Medicare and who does not meet the
15eligibility criteria for medical assistance Medical Assistance under s. 49.46 (1),
1649.465, 49.47 (4), or 49.471 but meets the limitations on income and resources under
17par. (d), medical assistance Medical Assistance shall pay the deductible and
18coinsurance portions of medicare Medicare services under 42 USC 1395 to 1395i
19which that are not paid under 42 USC 1395 to 1395i, including those medicare
20Medicare services that are not included in the approved state plan for services under
2142 USC 1396; the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and
22the late enrollment penalty for premiums under part Part A of medicare Medicare,
23if applicable. Payment of deductibles and coinsurance for inpatient hospital services
24under Part A of Medicare may not exceed the allowable charge for the service under
25Medical Assistance minus the Medicare payment.
AB40-ASA1, s. 1457p
1Section 1457p. 49.47 (4) (a) (intro.) of the statutes, as affected by 2011
2Wisconsin Act 10
, is repealed and recreated to read:
AB40-ASA1,603,63 49.47 (4) (a) (intro.) Unless otherwise provided by the department by a policy
4created under s. 49.45 (2m) (c), any individual who meets the limitations on income
5and resources under pars. (b) to (c) and who complies with pars. (cm) and (cr) shall
6be eligible for medical assistance under this section if such individual is:
AB40-ASA1, s. 1457q 7Section 1457q. 49.47 (4) (a) (intro.) of the statutes, as affected by 2011
8Wisconsin Act .... (this act), is amended to read:
AB40-ASA1,603,129 49.47 (4) (a) (intro.) Unless otherwise provided by the department by a policy
10created under s. 49.45 (2m) (c), any
Any individual who meets the limitations on
11income and resources under pars. (b) to (c) and who complies with pars. (cm) and (cr)
12shall be eligible for medical assistance under this section if such individual is:
AB40-ASA1, s. 1459 13Section 1459. 49.47 (4) (i) 1. of the statutes is amended to read:
AB40-ASA1,604,214 49.47 (4) (i) 1. The department shall request a waiver from the secretary of the
15federal department of health and human services to permit the application of subd.
162. The waiver shall request approval to implement the waiver on a statewide basis,
17unless the department of health services determines that statewide implementation
18of the waiver would present an obstacle to the approval of the waiver by the secretary
19of the federal department of health and human services, in which case the waiver
20shall request approval to implement the waiver in 48 pilot counties to be selected by
21the department of health services. Within 30 days after August 12, 1993, the
22department of regulation and licensing safety and professional services shall notify
23funeral directors licensed under ch. 445, cemetery associations, as defined in s.
24157.061 (1r), and cemetery authorities, as defined in s. 157.061 (2), of the terms of
25the waiver required to be requested under this subdivision. If the waiver is approved

1by the secretary of the federal department of health and human services and if the
2waiver remains in effect, subd. 2. shall apply.
AB40-ASA1, s. 1459bn 3Section 1459bn. 49.47 (4) (k) of the statutes is created to read:
AB40-ASA1,604,124 49.47 (4) (k) Notwithstanding par. (b) 3. and s. 445.125 (1) (a), no later than 60
5days after the effective date of this paragraph .... [LRB inserts date], the department
6shall seek approval from the federal Centers for Medicare and Medicaid Services to
7permit friends and family members of any individual receiving medical assistance
8under this section to contribute funds to an irrevocable burial trust for the
9individual, up to a total irrevocable trust amount of $4,500, without the individual
10losing eligibility for medical assistance under this section. If the federal Centers for
11Medicare and Medicaid Services approves the request, the department shall
12implement the change under this section within 60 days after receiving approval.
AB40-ASA1, s. 1459e 13Section 1459e. 49.47 (5) (intro.) of the statutes, as affected by 2011 Wisconsin
14Act 10
, is repealed and recreated to read:
AB40-ASA1,604,1615 49.47 (5) Investigation by department. (intro.) The department may make
16additional investigation of eligibility at any of the following times:
AB40-ASA1, s. 1459g 17Section 1459g. 49.47 (5) (a) of the statutes, as affected by 2011 Wisconsin Act
1810
, is repealed and recreated to read:
AB40-ASA1,604,2119 49.47 (5) (a) When there is reasonable ground for belief that an applicant may
20not be eligible or that the beneficiary may have received benefits to which the
21beneficiary is not entitled.
AB40-ASA1, s. 1459i 22Section 1459i. 49.47 (5) (c) of the statutes, as affected by 2011 Wisconsin Act
2310
, is repealed and recreated to read:
AB40-ASA1,605,324 49.47 (5) (c) Any time determined by the department by a policy created under
25s. 49.45 (2m) (c) to determine eligibility or to reevaluate continuing eligibility, except

1that if federal law allows a reevaluation of eligibility more frequently than every 12
2months and if there is no conflicting provision of state law, the department is not
3required to create a policy to reevaluate eligibility under this section.
AB40-ASA1, s. 1459j 4Section 1459j. 49.47 (5) (c) of the statutes, as created by 2011 Wisconsin Act
5.... (this act), is repealed.
AB40-ASA1, s. 1459n 6Section 1459n. 49.47 (6) (a) (intro.) of the statutes, as affected by 2011
7Wisconsin Act 10
, is repealed and recreated to read:
AB40-ASA1,605,108 49.47 (6) (a) (intro.) Unless otherwise provided by the department by a policy
9created under s. 49.45 (2m) (c), the department shall audit and pay charges to
10certified providers for medical assistance on behalf of the following:
AB40-ASA1, s. 1459o 11Section 1459o. 49.47 (6) (a) (intro.) of the statutes, as affected by 2011
12Wisconsin Act .... (this act), is amended to read:
AB40-ASA1,605,1513 49.47 (6) (a) (intro.) Unless otherwise provided by the department by a policy
14created under s. 49.45 (2m) (c), the
The department shall audit and pay charges to
15certified providers for medical assistance on behalf of the following:
AB40-ASA1, s. 1459p 16Section 1459p. 49.47 (6) (a) 6. b. of the statutes is amended to read:
AB40-ASA1,606,617 49.47 (6) (a) 6. b. An individual who is entitled to coverage under part Part A
18of medicare Medicare, entitled to coverage under part Part B of medicare Medicare,
19meets the eligibility criteria under sub. (4) (a), and meets the income limitation, the
20deductible and coinsurance portions of medicare Medicare services under 42 USC
211395
to 1395zz which that are not paid under 42 USC 1395 to 1395zz, including those
22medicare Medicare services that are not included in the approved state plan for
23services under 42 USC 1396; the monthly premiums payable under 42 USC 1395v;
24the monthly premiums, if applicable, under 42 USC 1395i-2 (d); and the late
25enrollment penalty, if applicable, for premiums under part Part A of medicare

1Medicare. Payment of coinsurance for a service under part Part B of medicare
2Medicare under 42 USC 1395j to 1395w, other than payment of coinsurance for
3outpatient hospital services,
and payment of deductibles and coinsurance for
4inpatient hospital services under Part A of Medicare
may not exceed the allowable
5charge for the service under medical assistance Medical Assistance minus the
6medicare Medicare payment.
AB40-ASA1, s. 1459q 7Section 1459q. 49.47 (6) (a) 6. c. of the statutes is amended to read:
AB40-ASA1,606,188 49.47 (6) (a) 6. c. An individual who is only entitled to coverage under part Part
9A of medicare Medicare, meets the eligibility criteria under sub. (4) (a), and meets
10the income limitation, the deductible and coinsurance portions of medicare Medicare
11services under 42 USC 1395 to 1395i which that are not paid under 42 USC 1395 to
121395i, including those medicare Medicare services that are not included in the
13approved state plan for services under 42 USC 1396; the monthly premiums, if
14applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable,
15for premiums under part Part A of medicare Medicare. Payment of deductibles and
16coinsurance for inpatient hospital services under Part A of Medicare may not exceed
17the allowable charge for the service under Medical Assistance minus the Medicare
18payment
.
AB40-ASA1, s. 1459r 19Section 1459r. 49.47 (6) (a) 6. d. of the statutes is amended to read:
AB40-ASA1,607,620 49.47 (6) (a) 6. d. An individual who is entitled to coverage under part Part A
21of medicare Medicare, entitled to coverage under part Part B of medicare Medicare,
22and meets the eligibility criteria for medical assistance Medical Assistance under
23sub. (4) (a), but does not meet the income limitation, the deductible and coinsurance
24portions of medicare Medicare services under 42 USC 1395 to 1395zz which that are
25not paid under 42 USC 1395 to 1395zz, including those medicare Medicare services

1that are not included in the approved state plan for services under 42 USC 1396.
2Payment of coinsurance for a service under part Part B of medicare Medicare under
342 USC 1395j to 1395w, other than payment of coinsurance for outpatient hospital
4services,
and payment of deductibles and coinsurance for inpatient hospital services
5under Part A of Medicare
may not exceed the allowable charge for the service under
6medical assistance Medical Assistance minus the medicare Medicare payment.
AB40-ASA1, s. 1459s 7Section 1459s. 49.47 (6) (a) 6. e. of the statutes is amended to read:
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:
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