2019 Wisconsin Act 9

49.155 (6) (c) The department shall set maximum payment rates for Level II certified family child care providers for services provided to eligible individuals under this section. The maximum rates set under this paragraph may not exceed 50 90 percent of the rates established under par. (a).

9,635 Section 635. 49.155 (7) (a) 1. of the statutes is amended to read:

49.155 (7) (a) 1. If a child care provider is convicted of a serious crime, as defined in s. 48.686 (1) (c), or if a caregiver specified in s. 48.686 (1) (ag) 1. a. or a nonclient resident, as defined in s. 48.686 (1) (bm), of the person subject to a background check under s. 48.686 (2) who operates, works at, or resides at a child care provider is convicted or adjudicated delinquent for committing a serious crime on or after his or her 10th birthday , as defined in s. 48.686 (1) (c), or if the department provides written notice under s. 48.686 (4p) that the child care provider, caregiver, or nonclient resident person is ineligible for certification, employment, or residence to operate, work at, or reside at the child care provider, the department or the county department under s. 46.215, 46.22, or 46.23 shall refuse to allow payment to the child care provider for any child care provided under this section beginning on the date of the conviction or delinquency adjudication.

9,636 Section 636. 49.155 (7) (a) 2. of the statutes is amended to read:

49.155 (7) (a) 2. If a child care provider is the subject of a pending criminal charge alleging that the person has committed a serious crime, as defined in s. 48.686 (1) (c), or if a caregiver specified in s. 48.686 (1) (ag) 1. or a nonclient resident, as defined in s. 48.686 (1) (bm), of the person subject to a background check under s. 48.686 (2) who operates, works at, or resides at a child care provider is the subject of a pending criminal charge or delinquency petition alleging that the person has committed a serious crime on or after his or her 10th birthday, as defined in s. 48.686 (1) (c), the department or the county department under s. 46.215, 46.22, or 46.23 shall immediately suspend refuse to allow payment to the child care provider for any child care provided under this section until the department obtains information regarding the final disposition of the charge or delinquency petition indicating that the person is not ineligible to receive such a payment operate, work at, or reside at the child care provider.

9,637 Section 637. 49.155 (7) (b) of the statutes is repealed and recreated to read:

49.155 (7) (b) 1. If a person subject to a background check under s. 48.686 (2) who operates, works at, or resides at a child care provider has been convicted or adjudicated delinquent for committing an offense that is not a serious crime, as defined in s. 48.686 (1) (c), but the department determines under s. 48.686 (5m) that the offense substantially relates to the care of children or the department determines that the offense substantially relates to the operation of a business, the department or the county department under s. 46.215, 46.22, or 46.23 may refuse to allow payment to the child care provider for child care provided under this section.

2. If a person subject to a background check under s. 48.686 (2) who operates, works at, or resides at a child care provider is the subject of a pending criminal charge or delinquency petition for committing an offense that is not a serious crime, as defined in s. 48.686 (1) (c), but the department determines under s. 48.686 (5m) that the offense substantially relates to the care of children or the department determines that the offense substantially relates to the operation of a business, the department or the county department under s. 46.215, 46.22, or 46.23 may refuse to allow payment to the child care provider for child care provided under this section.

9,640m Section 640m. 49.163 (2) (am) 2. of the statutes is amended to read:

49.163 (2) (am) 2. If over 24 25 years of age, be a biological or adoptive parent of a child under 18 years of age whose parental rights to the child have not been terminated or be a relative and primary caregiver of a child under 18 years of age.

9,643 Section 643. 49.175 (1) (intro.) of the statutes is amended to read:

49.175 (1) Allocation of funds. (intro.) Except as provided in subs. sub. (2) and (3), within the limits of the appropriations under s. 20.437 (2) (a), (cm), (dz), (k), (kx), (L), (mc), (md), (me), and (s) and (3) (kp), the department shall allocate the following amounts for the following purposes:

9,644 Section 644. 49.175 (1) (a), (b), (c), (g), (i), (k), (n), (o), (p), (q), (qm), (r), (s), (t), (u), (v), (y) and (z) of the statutes are amended to read:

49.175 (1) (a) Wisconsin Works benefits. For Wisconsin Works benefits, $42,500,000 $31,110,000 in fiscal year 2017-18 2019-20 and $44,625,000 $31,732,200 in fiscal year 2018-19 2020-21.

(b) Wisconsin Works agency contracts; job access loans. For contracts with Wisconsin Works agencies under s. 49.143 and for job access loans under s. 49.147 (6), $52,000,000 $50,000,000 in fiscal year 2017-18 2019-20 and $54,600,000 $50,000,000 in fiscal year 2018-19 2020-21.

(c) Case management incentive payments. For supplement payments to individuals under s. 49.255, $2,700,000 in fiscal year 2017-18 2019-20 and $2,700,000 in fiscal year 2018-19 2020-21.

(g) State administration of public assistance programs and overpayment collections. For state administration of public assistance programs and the collection of public assistance overpayments, $15,987,000 $16,671,200 in fiscal year 2017-18 2019-20 and $15,902,900 $17,268,300 in fiscal year 2018-19 2020-21.

(i) Emergency assistance. For emergency assistance under s. 49.138 and for transfer to the department of administration for low-income energy or weatherization assistance programs, $7,000,000 $6,000,000 in each fiscal year.

(k) Transform Milwaukee and Transitional Jobs programs. For contract costs under the Transform Milwaukee Jobs program and the Transitional Jobs program under s. 49.163, $7,000,000 $8,500,000 in fiscal year 2017-18 2019-20 and $8,000,000 $9,500,000 in fiscal year 2018-19 2020-21.

(n) Fostering futures: connections count. For funding community connectors to interact with vulnerable families with young children and to connect families with formal and informal community support, $360,300 in fiscal year 2017-18 and $560,300 in fiscal year 2018-19 $560,300 in each fiscal year.

(o) Evidence-based substance abuse prevention grants. For grants awarded under s. 48.545 (2) (c), $500,000 in each fiscal year 2018-19.

(p) Direct child care services. For direct child care services under s. 49.155, $289,215,200 or 49.257, $357,097,500 in fiscal year 2017-18 2019-20 and $318,369,200 $365,700,400 in fiscal year 2018-19 2020-21.

(q) Child care state administration and licensing activities. For state administration of child care programs under s. 49.155 and for child care licensing activities, $36,189,400 $40,152,100 in fiscal year 2017-18 2019-20 and $36,030,000 $41,555,200 in fiscal year 2018-19 2020-21.

(qm) Quality care for quality kids. For the child care quality improvement activities specified in s. ss. 49.155 (1g), $15,652,700 and 49.257, $16,532,900 in each fiscal year 2019-20 and $16,683,700 in fiscal year 2020-21.

(r) Children of recipients of supplemental security income. For payments made under s. 49.775 for the support of the dependent children of recipients of supplemental security income, $26,938,000 $25,013,300 in each fiscal year.

(s) Kinship care and long-term kinship care assistance. For kinship care and long-term kinship care payments under s. 48.57 (3m) (am) and (3n) (am), for assessments to determine eligibility for those payments, and for agreements under s. 48.57 (3t) with the governing bodies of Indian tribes for the administration of the kinship care and long-term kinship care programs within the boundaries of the reservations of those tribes, $22,012,100 $26,640,000 in fiscal year 2017-18 2019-20 and $22,741,200 $28,159,200 in fiscal year 2018-19 2020-21.

(t) Safety and out-of-home placement services. For services provided to ensure the safety of children who the department or a county determines may remain at home if appropriate services are provided, and for services provided to families with children placed in out-of-home care, $6,282,500 $8,314,300 in fiscal year 2017-18 2019-20 and $7,314,300 $9,314,300 in fiscal year 2018-19 2020-21. To receive funding under this paragraph, a county shall match a percentage of the amount received that is equal to the percentage the county is required to match for a distribution under s. 48.563 (2) as specified by the schedule established by the department under s. 48.569 (1) (d).

(u) Prevention services. For services to prevent child abuse or neglect, $5,289,600 in each fiscal year $5,789,600 in fiscal year 2019-20 and $6,789,600 in fiscal year 2020-21.

(v) General education development. For general education development testing and preparation for individuals who are eligible for temporary assistance for needy families under 42 USC 601 et seq., $115,000 $175,000 in each fiscal year.

(y) Offender reentry demonstration project. For the offender reentry demonstration project under s. 49.37 (1), $187,500 in fiscal year 2017-18 and $250,000 in fiscal year 2018-19 $250,000 in each fiscal year.

(z) Grants to the Boys and Girls Clubs of America. For grants to the Wisconsin Chapter of the Boys and Girls Clubs of America to fund programs that improve social, academic, and employment skills of youth who are eligible to receive temporary assistance for needy families under 42 USC 601 et seq., focusing on study habits, intensive tutoring in math and English, and exposure to career options and role models, $1,275,000 $2,675,000 in each fiscal year. Grants provided under this paragraph may not be used by the grant recipient to replace funding for programs that are being funded, when the grant proceeds are received, with moneys other than those from the appropriations specified in sub. (1) (intro.). The total amount of the grants includes funds for the Green Bay Boys and Girls Clubs for the BE GREAT: Graduate program in the amount of matching funds that the program provides, up to $75,000 $1,400,000 in each fiscal year, to be used only for activities for which federal Temporary Assistance for Needy Families block grant moneys may be used. The total amount of the grants also includes funds to be equally distributed among the Milwaukee, Oshkosh, and Appleton Boys and Girls Clubs for the BE GREAT: Graduate program in the amount of matching funds that the program provides, up to $100,000 in each fiscal year, to be used only for activities for which federal Temporary Assistance for Needy Families block grant moneys may be used.

9,644c Section 644c. 49.175 (1) (fa) of the statutes is created to read:

49.175 (1) (fa) Homeless case management services grants; additional funding. For grants to shelter facilities under s. 16.3085, $500,000 in fiscal year 2019-20 and $500,000 in fiscal year 2020-21. All moneys allocated under this paragraph shall be credited to the appropriation account under s. 20.865 (4) (g) for the purpose of supplementing the appropriation under s. 20.505 (7) (kg).

9,648 Section 648. 49.257 of the statutes is created to read:

49.257 Milwaukee child care grant program. (1) In this section, “child care provider” has the meaning given in s. 49.155 (1) (ag).

(2) From the allocation under s. 49.175 (1) (p), the department may award grants to child care providers to support access to high-quality child care for families that reside in a geographic area with high-poverty levels, as identified by the department, in the city of Milwaukee. A grant under this section may be used for start-up costs, ongoing operational costs, including subsidy payments for eligible families, and quality improvement activities. A child care provider that is awarded a grant under this subsection shall contribute matching funds equal to 25 percent of the amount awarded. The matching contribution may be in the form of money or in-kind goods or services.

(3) From the allocation under s. 49.175 (1) (qm), the department may award grants to any of the following to improve overall child care quality in the geographic area identified under sub. (2):

(a) Child care providers and employees of child care providers.

(b) Educational institutions for the purpose of educating employees of child care providers.

9,650m Section 650m. 49.36 (7) of the statutes is amended to read:

49.36 (7) The department shall pay a county, tribal governing body, or Wisconsin works agency not more than $400 $800 for each person who participates in the program under this section in the region in which the county, tribal governing body, or Wisconsin works agency administers the program under this section. The county, tribal governing body, or Wisconsin works agency shall pay any additional costs of the program.

9,651 Section 651. 49.45 (2) (a) 23. of the statutes is amended to read:

49.45 (2) (a) 23. Promulgate rules that define “supportive services", “personal services" and “nursing services" provided in a certified residential care apartment complex, as defined under s. 50.01 (6d), for purposes of reimbursement under ss. 46.27 (11) (c) 7. and s. 46.277 (5) (e).

9,654 Section 654. 49.45 (3) (a) of the statutes is amended to read:

49.45 (3) (a) Reimbursement shall be made to each county department under ss. 46.215, 46.22, and 46.23 for any administrative services performed in the Medical Assistance program on the basis of s. 49.78 (8). For purposes of reimbursement under this paragraph, assessments completed under s. 46.27 (6) (a) are administrative services performed in the Medical Assistance program.

9,659 Section 659. 49.45 (3p) (a) of the statutes is amended to read:

49.45 (3p) (a) Subject to par. (c) and notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b) and (o), in each fiscal year, the department shall pay to hospitals that would are not eligible for payments under sub. (3m) but that meet the criteria under sub. (3m) (a) except that the hospitals do not provide obstetric services 1. and 2. and that, in the most recent year for which information is available, charged at least 6 percent of overall charges for services to the Medical Assistance program for services provided to Medical Assistance recipients an amount equal to the sum of $250,000 $2,250,000, as the state share of payments, and the matching federal share of payments. The department may make a payment to a hospital under this subsection under a calculation method determined by the department that provides a fee-for-service supplemental payment that increases as the hospital's percentage of inpatient days for Medical Assistance recipients at the hospital the total amount of the hospital's overall charges for services that are charges to the Medical Assistance program increases.

9,660 Section 660. 49.45 (5) (a) of the statutes is amended to read:

49.45 (5) (a) Any person whose application for medical assistance is denied or is not acted upon promptly or who believes that the payments made in the person's behalf have not been properly determined or that his or her eligibility has not been properly determined may file an appeal with the department pursuant to par. (b). Review is unavailable if the decision or failure to act arose more than 45 days before submission of the petition for a hearing, except as provided in par. (ag) or (ar).

9,661 Section 661. 49.45 (5) (ag) of the statutes is created to read:

49.45 (5) (ag) A person shall request a hearing within 90 days of the date of receipt of a notice from a care management organization or managed care organization upholding its adverse benefit determination relating to any of the following or within 90 days of the date the care management organization or managed care organization failed to act on the contested matter within the time specified by the department:

1. Denial or limited authorization of a requested services, including a determination based on the type or level of service, requirement for medical necessity, appropriateness, setting, or effectiveness of a covered benefit.

2. Reduction, suspension, or termination of a previously authorized service, unless the service was only authorized for a limited amount or duration and that amount or duration has been completed.

3. Denial, in whole or in part, of payment for a service.

4. Failure to provide services in a timely manner.

5. Failure of a care management organization or managed care organization to act within the time frames provided in 42 CFR 438.408 (b) (1) and (2) regarding the standard resolution of grievances and appeals.

6. Denial of an enrollee's request to dispute financial liability, including copayments, premiums, deductibles, coinsurance, other cost sharing, and other member financial liabilities.

7. Denial of an enrollee, who is a resident of a rural area with only one care management organization or managed care organization, to obtain services outside the organization's network of contracted providers.

9,662 Section 662. 49.45 (5) (ar) of the statutes is created to read:

49.45 (5) (ar) If a federal regulation specifies a different time limit to request a hearing than par. (a) or (ag), the time limit in the federal regulation shall apply.

9,663 Section 663. 49.45 (5) (b) 1. (intro.) of the statutes is amended to read:

49.45 (5) (b) 1. (intro.) Upon receipt of a timely petition under par. (a) the department shall give the applicant or recipient reasonable notice and opportunity for a fair hearing. The department may make such additional investigation as it considers necessary. Notice of the hearing shall be given to the applicant or recipient and, if a county department under s. 46.215, 46.22, or 46.23 is responsible for making the medical assistance determination, to the county clerk of the county. The county may be represented at such hearing. The department shall render its decision as soon as possible after the hearing and shall send a certified copy of its decision to the applicant or recipient, to the county clerk, and to any county officer charged with administration of the Medical Assistance program. The decision of the department shall have the same effect as an order of a county officer charged with the administration of the Medical Assistance program. The decision shall be final, but may be revoked or modified as altered conditions may require. The department shall deny a petition for a hearing or shall refuse to grant relief if:

9,664 Section 664. 49.45 (5) (b) 1. d. of the statutes is created to read:

49.45 (5) (b) 1. d. The issue is an adverse benefit determination described in par. (ag) 1. to 7. made by a care management organization or managed care organization and the person requesting the hearing has not exhausted the internal appeal procedure with the organization.

9,664r Section 664r. 49.45 (6m) (ar) 1. a. of the statutes is amended to read:

49.45 (6m) (ar) 1. a. The department shall establish standards for payment of allowable direct care costs under par. (am) 1. bm., for facilities that do not primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state and separate standards for payment of allowable direct care costs, for facilities that primarily serve the developmentally disabled, that take into account direct care costs for a sample of all of those facilities in this state. The standards shall be adjusted by the department for regional labor cost variations. The department shall in the single labor region that is composed of Milwaukee, Ozaukee, Washington, and Waukesha counties include Racine County and shall adjust pay ment so that the direct care cost targets of facilities in Milwaukee, Ozaukee, Washington, and Waukesha counties are not reduced as a result of including facilities in Racine County in this labor region. The department shall treat as a single labor region the counties of Dane, Dodge, Iowa, Columbia, Richland, Sauk, and Rock and shall adjust payment so that the direct care cost targets of facilities in Dane, Iowa, Columbia, and Sauk counties are not reduced as a result of including facilities in Dodge, Richland, and Rock Counties in this labor region. For facilities in Douglas, Dunn, Pierce, and St. Croix counties, the department shall perform the adjustment by use of the wage index that is used by the federal department of health and human services for hospital reimbursement under 42 USC 1395 to 1395ggg.

9,665 Section 665. 49.45 (6m) (c) 5. of the statutes is amended to read:

49.45 (6m) (c) 5. Admit only patients assessed or who waive or are exempt from the requirement of assessment under s. 46.27 (6) (a) or, if required under s. 50.035 (4n) or 50.04 (2h), who have been referred to a resource center.

9,666 Section 666. 49.45 (6m) (L) of the statutes is amended to read:

49.45 (6m) (L) For purposes of ss. 46.27 (11) (c) 7. and s. 46.277 (5) (e), the department shall, by July 1 annually, determine the statewide medical assistance daily cost of nursing home care and submit the determination to the department of administration for review. The department of administration shall approve the determination before payment may be made under s. 46.27 (11) (c) 7. or 46.277 (5) (e).

9,677 Section 677. 49.45 (29w) (b) 1. b. of the statutes is amended to read:

49.45 (29w) (b) 1. b. “Telehealth" is means a service provided from a remote location using a combination of interactive video, audio, and externally acquired images through a networking environment between an individual or a provider at an originating site and a provider at a remote location with the service being of sufficient audio and visual fidelity and clarity as to be functionally equivalent to face-to-face contact; or, in circumstances determined by the department, an asynchronous transmission of digital clinical information through a secure electronic communications system from one provider to another provider. “Telehealth" does not include telephone conversations or Internet-based communications between providers or between providers and individuals.

9,678 Section 678. 49.45 (29y) (d) of the statutes is repealed.

9,680 Section 680. 49.45 (41) of the statutes is amended to read:

49.45 (41) Mental health crisis Crisis intervention services. (a) In this subsection, “mental health crisis intervention services" means crisis intervention services for the treatment of mental illness, intellectual disability, substance abuse, and dementia that are provided by a mental health crisis intervention program operated by, or under contract with, a county, if the county is certified as a medical assistance provider.

(b) If a county elects to become certified as a provider of mental health crisis intervention services, the county may provide mental health crisis intervention services under this subsection in the county to medical assistance recipients through the medical assistance program. A county that elects to provide the services shall pay the amount of the allowable charges for the services under the medical assistance program that is not provided by the federal government. The department shall reimburse the county under this subsection only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.

9,681 Section 681. 49.45 (41) (c) of the statutes is created to read:

49.45 (41) (c) Notwithstanding par. (b), if a county elects to deliver crisis intervention services under the Medical Assistance program on a regional basis according to criteria established by the department, all of the following apply:

1. After January 1, 2020, the department shall require the county to annually contribute for the crisis intervention services an amount equal to 75 percent of the annual average of the county's expenditures for crisis intervention services under this subsection in calendar years 2016, 2017, and 2018, as determined by the department.

2. The department shall reimburse the provider of crisis intervention services in the county the amount of allowable charges for those services under the Medical Assistance program, including both the federal share and nonfederal share of those charges, that exceeds the amount of the county contribution required under subd. 1.

3. If a county submits a certified cost report under s. 49.45 (52) (b) to claim federal medical assistance funds, the claim based on certified costs made by a county for amounts under subd. 2. cannot include any part of the nonfederal share of the amount under subd. 2.

9,682 Section 682. 49.45 (47) (b) of the statutes is amended to read:

49.45 (47) (b) No person may receive reimbursement under s. 46.27 (11) for the provision of services to clients in an adult day care center unless the adult day care center is certified by the department under sub. (2) (a) 11. as a provider of medical assistance.

9,683 Section 683. 49.45 (47) (dm) of the statutes is created to read:

49.45 (47) (dm) Every 24 months, on a schedule determined by the department, an adult day care center shall submit through an online system prescribed by the department a report in the form and containing the information that the department requires, including payment of any fee due under par. (c). If a complete report is not timely filed, the department shall issue a warning to the operator of the adult day care center. The department may revoke an adult day care center's certification for failure to timely and completely report within 60 days after the report date established under the schedule determined by the department.

9,686 Section 686. 49.46 (1) (a) 14. of the statutes is amended to read:

49.46 (1) (a) 14. Any person who would meet the financial and other eligibility requirements for home or community-based services under s. 46.27 (11), 46.277 , or 46.2785 but for the fact that the person engages in substantial gainful activity under 42 USC 1382c (a) (3), if a waiver under s. 49.45 (38) is in effect or federal law permits federal financial participation for medical assistance coverage of the person and if funding is available for the person under s. 46.27 (11), 46.277, or 46.2785.

9,687 Section 687. 49.46 (1) (em) of the statutes is amended to read:

49.46 (1) (em) To the extent approved by the federal government, for the purposes of determining financial eligibility and any cost-sharing requirements of an individual under par. (a) 6m., 14., or 14m., (d) 2., or (e), the department or its designee shall exclude any assets accumulated in a person's independence account, as defined in s. 49.472 (1) (c), and any income or assets from retirement benefits earned or accumulated from income or employer contributions while employed and receiving state-funded benefits under s. 46.27 or medical assistance under s. 49.472.