(b) The department shall ensure that the total amount of moneys available to 8
pay hospitals described under this subsection is distributed in each fiscal year.
(c) The department shall limit the maximum payment to hospitals under this 10
subsection such that the amount of payment is in accordance with federal rules 11
concerning any hospital specific limit.
(d) The department shall seek any necessary approval from the federal 13
department of health and human services to implement the hospital payment 14
supplement described under par. (a). If approval is necessary and approval from the 15
federal department of health and human services is received, the department shall 16
implement the payment methodology described under par. (a). If approval is 17
necessary and the federal department of health and human services does not 18
approve, the department may not implement the hospital payment supplement 19
under par. (a).
49.45 (9r) of the statutes is created to read:
49.45 (9r) Complex rehabilitation technology.
(a) In this subsection:
1. “Complex needs patient" means an individual with a diagnosis or medical 23
condition that results in significant physical impairment or functional limitation.
2. “Complex rehabilitation technology" means items classified within Medicare 25
as durable medical equipment that are individually configured for individuals to
meet their specific and unique medical, physical, and functional needs and capacities 2
for basic activities of daily living and instrumental activities of daily living identified 3
as medically necessary.
3. “Individually configured" means having a combination of sizes, features, 5
adjustments, or modifications that a qualified complex rehabilitation technology 6
supplier can customize to the specific individual by measuring, fitting, 7
programming, adjusting, or adapting as appropriate so that the device operates in 8
accordance with an assessment or evaluation of the individual by a qualified health 9
care professional and is consistent with the individual's medical condition, physical 10
and functional needs and capacities, body size, period of need, and intended use.
4. “Medicare" means coverage under Part A or Part B of Title XVIII of the 12
federal Social Security Act, 42 USC 1395
5. “Qualified complex rehabilitation technology professional" means an 14
individual who is certified as an assistive technology professional by the 15
Rehabilitation Engineering and Assistive Technology Society of North America.
6. “Qualified complex rehabilitation technology supplier" means a company or 17
entity that meets all of the following criteria:
a. Is accredited by a recognized accrediting organization as a supplier of 19
complex rehabilitation technology.
b. Is an enrolled supplier for purposes of Medicare reimbursement that meets 21
the supplier and quality standards established for durable medical equipment 22
suppliers, including those for complex rehabilitation technology under Medicare.
c. Is an employer of at least one qualified complex rehabilitation technology 24
professional to analyze the needs and capacities of the complex needs patient in 25
consultation with qualified health care professionals, to participate in the selection
of appropriate complex rehabilitation technology for those needs and capacities of 2
the complex needs patient, and to provide training in the proper use of the complex 3
d. Requires a qualified complex rehabilitation technology professional to be 5
physically present for the evaluation and determination of appropriate complex 6
rehabilitation technology for a complex needs patient.
e. Has the capability to provide service and repair by qualified technicians for 8
all complex rehabilitation technology it sells.
f. Provides written information at the time of delivery of the complex 10
rehabilitation technology to the complex needs patient stating how the complex 11
needs patient may receive service and repair for the complex rehabilitation 12
7. “Qualified health care professional" means any of the following:
a. A physician or physician assistant licensed under subch. II of ch. 448.
b. A physical therapist licensed under subch. III of ch. 448.
c. An occupational therapist licensed under subch VII of ch. 448.
(b) The department shall promulgate rules and other policies for use of complex 18
rehabilitation technology by recipients of Medical Assistance. The department shall 19
include in the rules all of the following:
1. Designation of billing codes as complex rehabilitation technology including 21
creation of new billing codes or modification of existing billing codes. The 22
department shall include provisions allowing quarterly updates to the designations 23
under this subdivision.
2. Establishment of specific supplier standards for companies or entities that 2
provide complex rehabilitation technology and limiting reimbursement only to 3
suppliers that are qualified complex rehabilitation technology suppliers.
3. A requirement that Medical Assistance recipients who need a manual 5
wheelchair, power wheelchair, or other seating component to be evaluated by all of 6
a. A qualified health care professional who does not have a financial 8
relationship with a qualified complex rehabilitation technology supplier.
b. A qualified complex rehabilitation technology professional.
4. Establishment and maintenance of payment rates for complex rehabilitation 11
technology that are adequate to ensure complex needs patients have access to 12
complex rehabilitation technology, taking into account the significant resources, 13
infrastructure, and staff needed to appropriately provide complex rehabilitation 14
technology to meet the unique needs of complex needs patients.
5. A requirement for contracts with the department that managed care plans 16
providing services to Medical Assistance recipients comply with this subsection and 17
the rules promulgated under this subsection.
6. Protection of access to complex rehabilitation technology for complex needs 19
49.45 (23) (g) 1. f. of the statutes is created to read:
(g) 1. f. Provide employment and training services to childless adults 22
receiving Medical Assistance under this subsection.
49.45 (23) (g) 2. of the statutes is repealed.
49.45 (23) (g) 3. and 4. of the statutes are created to read:
(g) 3. If the secretary of the federal department of health and human 2
services approves any portion of the waiver amendment requested under subd. 1., 3
the department shall, no later than the first day of the 4th month beginning after 4
that approval, submit to the joint committee on finance a report that includes all of 5
a. A description of each component of the waiver amendment that is approved 7
and any pertinent information on the department's plan for implementation.
b. An estimate of the effect of implementation of the approved portions of the 9
waiver amendment on enrollment in and the budget of the Medical Assistance 10
program in the fiscal biennium in which approval occurs and in future fiscal 11
4. The department may not implement any approved portion of the waiver 13
amendment requested under subd. 1. unless the joint committee on finance meets 14
under s. 13.10 and approves the implementation of that portion of the waiver 15
amendment. In a meeting under s. 13.10 to review the report submitted under subd. 16
3., the joint committee on finance may approve or disapprove of the waiver 17
amendment portions that are approved by the federal department of health and 18
human services or may modify the waiver amendment only by removing one or more 19
components of the waiver amendment. The department may implement the waiver 20
amendment only as approved by the joint committee on finance, including any 21
modifications. The department shall, if necessary to implement the waiver 22
amendment as modified by the joint committee on finance, submit a subsequent 23
waiver amendment request to the federal department of health and human services 24
that is consistent with the committee's actions.
49.45 (24n) of the statutes is created to read:
49.45 (24n) Reimbursement for dental services by facilities serving
2individuals with disabilities.
(a) Subject to approval of the federal department of 3
health and human services under par. (b), the department shall distribute moneys 4
in each fiscal year to increase the Medical Assistance reimbursement rates for all 5
eligible dental services rendered by facilities that provide at least 90 percent of their 6
dental services to individuals with cognitive and physical disabilities, as determined 7
by the department. Under this subsection, the enhanced reimbursement rates for 8
dental services would equal 200 percent of the Medical Assistance reimbursement 9
rates that would otherwise be paid for these dental services.
(b) The department shall request any waiver from and submit any 11
amendments to the state Medical Assistance plan to the federal department of health 12
and human services necessary for the Medical Assistance reimbursement rate 13
increase under par. (a). If any necessary waiver request or state plan amendment 14
request is approved, the department shall implement par. (a) beginning on the 15
effective date of the waiver or plan amendment.
49.45 (26g) of the statutes is created to read:
49.45 (26g) Intensive care coordination program.
(a) Subject to par. (h), the 18
department shall create and implement a program to reimburse hospitals and health 19
care systems for intensive care coordination services provided to recipients of 20
Medical Assistance under this subchapter who are not enrolled in coverage under 21
Medicare, 42 USC 1395
(b) The department shall select hospitals and health care systems to receive 23
reimbursement under this subsection that submit to the department a description 24
of their intensive care coordination program that includes all of the following:
1. A statement that the hospital or health care system will use emergency 2
department utilization data to identify recipients of Medical Assistance to receive 3
intensive care coordination to reduce use of the emergency department by those 4
Medical Assistance recipients.
2. The method the hospital or health care system uses to identify for intensive 6
care coordination a Medical Assistance recipient who uses the emergency 7
department frequently. The hospital or health care system shall specify how it 8
defines frequent emergency department use and may use criteria such as whether 9
a recipient of Medical Assistance visits the emergency room 3 or more times within 10
30 days, 6 or more times within 90 days, or 7 or more times within 12 months.
3. A description of the hospital's or health care system's intensive care 12
coordination team consisting of health care providers other than solely physicians, 13
such as nurses; social workers, case managers, or care coordinators
health specialists; and schedulers.
4. That the hospital or health care system provides to a Medical Assistance 16
recipient enrolled in intensive care coordination through the hospital or health care 17
system all of the following, as appropriate to his or her care:
a. Discharge instructions and contacts for following up on care and treatment.
b. Referral information.
c. Appointment scheduling.
d. Medication instructions.
e. Intensive care coordination by a social worker, case manager, or care 23
coordinator to connect the Medical Assistance recipient to a primary care provider 24
or to a managed care organization.
f. Information about other health and social resources, such as transportation 2
5. The outcomes intended to result from intensive care coordination by the 4
hospital or health care system. Outcomes for a Medical Assistance recipient during 5
a 6-month or 12-month period may include successful connection to primary care 6
or the managed care organization as evidenced by 2 or 3 primary care appointments, 7
successful connection to behavioral health resources and alcohol and other drug 8
abuse resources, as needed, or a decrease in use of the emergency room.
(c) The department shall do all of the following:
1. Respond to the hospital or health care system indicating if additional 11
information is required to determine eligibility for the reimbursement program 12
under this subsection.
2. If the hospital or health care system is eligible for the reimbursement 14
program under this subsection, provide a description of the process for enrolling 15
Medical Assistance recipients in intensive care coordination for reimbursement.
(d) The department shall provide as reimbursement for intensive care 17
coordination to eligible hospitals and health care systems participating in the 18
program under this subsection $500 for each Medical Assistance recipient who is not 19
enrolled in coverage under Medicare, 42 USC 1395
et seq., the hospital or health care 20
system enrolls in intensive care coordination. The initial enrollment for each 21
recipient lasts for 6 months, and the health care provider may enroll the Medical 22
Assistance recipient in one additional 6-month period for an additional $500 23
reimbursement payment. The department shall pay no more than $1,500,000 24
cumulatively in each fiscal year from all funding sources for reimbursements under 25
(e) Annually, each hospital and health care system that is eligible for the 2
reimbursement program under this subsection shall submit a report to the 3
department containing all of the following:
1. The number of Medical Assistance recipients served by intensive care 5
2. For each Medical Assistance recipient who is not enrolled in coverage under 7
Medicare, 42 USC 1395
et seq., the number of emergency department visits for a 8
period before enrollment of that recipient in intensive care coordination and the 9
number of emergency department visits for the same recipient during the same 10
period after enrollment in intensive care coordination.
3. Any demonstrated outcomes, such as those described in par. (b) 5., for 12
Medical Assistance recipients.
(f) For each hospital or health care system eligible for the reimbursement 14
program under this subsection, the department shall calculate the costs saved to the 15
Medical Assistance program by avoiding emergency department visits by 16
subtracting the sum of reimbursements made under par. (d) to the hospital or health 17
care system from the sum of costs of visits to the emergency department as reported 18
under par. (e) 2. that were expected to occur without intensive care coordination. If 19
the result of the calculation is positive, the department shall distribute half of the 20
amount saved to the hospital or health care system subject to par. (h).
(g) No later than 24 months after the date on which the first hospital or health 22
care system is able to enroll individuals in the intensive care coordination program 23
under this subsection, the department shall submit a report to the joint committee 24
on finance summarizing the information reported under par. (e) including the costs 25
saved by avoiding emergency department visits as calculated under par. (f).
(h) The department shall seek any necessary approval from the federal 2
department of health and human services to implement the program under this 3
subsection. If the federal department of health and human services disapproves the 4
request for approval, the department may implement the reimbursement under par. 5
(d), the savings distribution under par. (f), or both or any part of the program under 6
49.45 (29y) of the statutes is created to read:
49.45 (29y) Mental health consultation reimbursement.
(a) In this 9
subsection, “clinical consultation" means, for a student up to age 21, communication 10
from a mental health professional or a qualified treatment trainee working under the 11
supervision of a mental health professional to another individual who is working 12
with the client to inform, inquire, and instruct regarding all of the following and to 13
direct and coordinate clinical service components:
1. The client's symptoms.
2. Strategies for effective engagement, care, and intervention for the client.
3. Treatment expectations for the client across service settings.
(b) The department shall, subject to any approval necessary from the federal 18
department of health and human services, reimburse clinical consultation from the 19
Medical Assistance program under this subchapter.
(c) By March 31, 2019, the department shall submit a report to the joint 21
committee on finance on the utilization of the clinical consultation services under 22
(d) The department may not provide the reimbursement for clinical 24
consultation that occurs after June 30, 2019.
49.45 (39) (bm) of the statutes is repealed.
49.45 (47m) of the statutes is created to read:
49.45 (47m) Family Care funding.
(a) In this subsection, “care management 3
organization” means a care management organization under contract with the 4
department of health services as described under s. 46.284.
(b) The department shall collaborate with care management organizations and 6
the federal centers for Medicare and Medicaid services to develop an allowable 7
payment mechanism to increase the direct care and services portion of the capitation 8
rates to address the direct caregiver workforce challenges in the state.
(c) By December 31, 2017, the department shall seek any federal approval 10
necessary from the federal centers for Medicare and Medicaid services to implement 11
the payment mechanism developed under par. (b).
(d) The department may not implement the plan developed under this 13
subsection unless the department receives federal approval under par. (c). The 14
department may submit one or more requests to the joint committee on finance under 15
s. 13.10 to supplement the appropriation under s. 20.435 (4) (b) from the 16
appropriation under s. 20.865 (4) (a) for implementation of the payment mechanism 17
under par. (b). The department may only use moneys for the payment mechanism 18
under par. (b) if the joint committee on finance approves the request under this 19
paragraph. Notwithstanding s. 13.101, the joint committee on finance is not 20
required to find that an emergency exists before making a supplementation under 21
49.45 (53m) of the statutes is created to read:
49.45 (53m) Coverage program for institutions for mental disease.
to any necessary waiver approval of the federal department of health and human 25
services, or as otherwise permitted under federal law, the department may, if federal
funding participation is available, provide Medical Assistance coverage of services 2
provided in an institution for mental disease to persons ages 21 to 64.
49.45 (54) (b) of the statutes is repealed.
49.45 (54) (c) of the statutes is created to read:
(c) Special services.
From the appropriations under s. 20.435 (4) (b) 6
and (o) and (7) (bt), the department may pay the costs of services provided under the 7
early intervention program under s. 51.44 that are included in program participant's 8
individualized family service plan and that were not authorized for payment under 9
the state Medicaid plan or a department policy before July 1, 2017, including any 10
services under the early intervention program under s. 51.44 that are delivered by 11
a type of provider that becomes certified to provide Medical Assistance service on 12
July 1, 2017, or after.
49.46 (1) (em) of the statutes is created to read:
(em) To the extent approved by the federal government, for the 15
purposes of determining financial eligibility and any cost-sharing requirements of 16
an individual under par. (a) 6m., 14., or 14m., (d) 2., or (e), the department or its 17
designee shall exclude any assets accumulated in a person's independence account, 18
as defined in s. 49.472 (1) (c), and any income or assets from retirement benefits 19
earned or accumulated from income or employer contributions while employed and 20
receiving state-funded benefits under s. 46.27 or medical assistance under s. 49.472.
49.46 (2) (b) 6. dm. of the statutes is created to read:
(b) 6. dm. Durable medical equipment that is considered complex 23
rehabilitation technology, subject to the requirements under s. 49.45 (9r).