Amendment AA2-ASA1-AB56

AB56-ASA1-AA2,14,15 49.45 (24L) Critical access reimbursement payments to dental providers. (a) Based on the criteria in pars. (b) and (c), the department shall increase reimbursements to dental providers that meet quality of care standards, as established by the department.

AB56-ASA1-AA2,14,17 (b) In order to be eligible for enhanced reimbursement under this subsection, the provider must meet one of the following qualifications:

AB56-ASA1-AA2,14,20 1. For a nonprofit or public provider, 50 percent or more of the individuals served by the provider are individuals who are without dental insurance or are enrolled in the Medical Assistance program.

AB56-ASA1-AA2,14,22 2. For a for-profit provider, 5 percent or more of the individuals served by the provider are enrolled in the Medical Assistance program.

AB56-ASA1-AA2,15,8 (c) For dental services rendered on or after January 1, 2020, by a qualified nonprofit critical access dental provider, the department shall increase reimbursement by 50 percent above the reimbursement rate that would otherwise be paid to that provider. For dental services rendered on or after January 1, 2020, by a qualified for-profit critical access dental provider, the department shall increase reimbursement by 30 percent above the reimbursement rate that would otherwise be paid to that provider. For dental providers rendering services to individuals in managed care under the Medical Assistance program, for services rendered on or after January 1, 2020, the department shall increase reimbursement to pay an additional amount on the basis of the rate that would have been paid to the dental provider had the individual not been enrolled in managed care.

AB56-ASA1-AA2,15,11 (d) If a provider has more than one service location, the thresholds described under par. (b) apply to each location, and payment for each service location would be determined separately.”.

AB56-ASA1-AA2,15,13 63. Page 352, line 24: delete the material beginning with that line and ending with page 353, line 8, and substitute:

AB56-ASA1-AA2,15,23 “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.”.

AB56-ASA1-AA2,15,24 64. Page 353, line 9: delete that line and substitute:

AB56-ASA1-AA2,16,1 “ Section 678b. 49.45 (29y) (d) of the statutes is repealed.

AB56-ASA1-AA2,679p Section 679p. 49.45 (30y) of the statutes is created to read:

AB56-ASA1-AA2,16,5 49.45 (30y) Certified doula services; pilot project. (a) In this subsection, “certified doula" means an individual who has received certification from a doula certifying organization recognized by the department.

AB56-ASA1-AA2,16,8 (b) For purposes of this subsection, services provided by certified doulas include continuous emotional and physical support during labor and birth of a child and intermittent services during the prenatal and postpartum periods.

AB56-ASA1-AA2,16,13 (c) Subject to par. (d), the department shall reimburse under the Medical Assistance program benefits as provided under this subsection for pregnant women enrolled in the Medical Assistance program who reside in the counties of Brown, Dane, Milwaukee, Rock, or Sheboygan, or another county as determined by the department.

AB56-ASA1-AA2,16,19 (d) The department shall request from the secretary of the federal department of health and human services any approval necessary to allow reimbursement under the Medical Assistance program for services provided by a certified doula. The department may not pay reimbursement unless federal approval is not required or any required federal approval allowing reimbursement under s. 49.46 (2) (b) 12p. is approved and in effect.”.

AB56-ASA1-AA2,16,21 65. Page 353, line 11: delete the material beginning with that line and ending with page 354, line 17, and substitute:

AB56-ASA1-AA2,17,3 “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.

AB56-ASA1-AA2,17,12 (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.

AB56-ASA1-AA2,681b Section 681b. 49.45 (41) (c) of the statutes is created to read:

AB56-ASA1-AA2,17,16 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:

AB56-ASA1-AA2,17,21 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.

AB56-ASA1-AA2,17,25 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.

AB56-ASA1-AA2,18,4 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. may not include any part of the nonfederal share of the amount under subd. 2.”.

AB56-ASA1-AA2,18,5 66. Page 355, line 6: after that line insert:

AB56-ASA1-AA2,18,6 “ Section 685b. 49.46 (1) (a) 1m. of the statutes is amended to read:

AB56-ASA1-AA2,18,10 49.46 (1) (a) 1m. Any pregnant woman whose income does not exceed the standard of need under s. 49.19 (11) and whose pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th day or, if approved by the federal government, the 365th day after the last day of the pregnancy falls.”.

AB56-ASA1-AA2,18,11 67. Page 355, line 21: after that line insert:

AB56-ASA1-AA2,18,12 “ Section 688b. 49.46 (1) (j) of the statutes is amended to read:

AB56-ASA1-AA2,18,17 49.46 (1) (j) An individual determined to be eligible for benefits under par. (a) 9. remains eligible for benefits under par. (a) 9. for the balance of the pregnancy and to the last day of the month in which the 60th day or, if approved by the federal government, the 365th day after the last day of the pregnancy falls without regard to any change in the individual's family income.”.

AB56-ASA1-AA2,18,18 68. Page 356, line 2: after that line insert:

AB56-ASA1-AA2,18,19 “ Section 690p. 49.46 (2) (b) 12p. of the statutes is created to read:

AB56-ASA1-AA2,18,21 49.46 (2) (b) 12p. Subject to the limitations under s. 49.45 (30y), services provided by a certified doula.”.

AB56-ASA1-AA2,18,22 69. Page 356, line 4: delete lines 4 and 5 and substitute:

AB56-ASA1-AA2,18,24 “49.46 (2) (b) 15. Mental health crisis Crisis intervention services under s. 49.45 (41).”.

AB56-ASA1-AA2,19,1 70. Page 356, line 5: after that line insert:

AB56-ASA1-AA2,19,2 “ Section 691d. 49.46 (2) (b) 21. of the statutes is created to read:

AB56-ASA1-AA2,19,4 49.46 (2) (b) 21. Subject to par. (bv), nonmedical services that contribute to the determinants of health.

AB56-ASA1-AA2,691g Section 691g. 49.46 (2) (bv) of the statutes is created to read:

AB56-ASA1-AA2,19,12 49.46 (2) (bv) The department shall determine those services under par. (b) 21. that contribute to the determinants of health. The department shall seek any necessary state plan amendment or request any waiver of federal Medicaid law to implement this paragraph. The department is not required to provided the services under this paragraph as a benefit under the Medical Assistance program if the federal department of health and human services does not provide federal financial participation for the services under this paragraph.”.

AB56-ASA1-AA2,19,13 71. Page 356, line 5: after that line insert:

AB56-ASA1-AA2,19,14 “ Section 695b. 49.47 (4) (ag) 2. of the statutes is amended to read:

AB56-ASA1-AA2,19,17 49.47 (4) (ag) 2. Pregnant and the woman's pregnancy is medically verified Eligibility continues to the last day of the month in which the 60th day or, if approved by the federal government, the 365th day after the last day of the pregnancy falls.”.

AB56-ASA1-AA2,19,18 72. Page 356, line 23: after that line insert:

AB56-ASA1-AA2,19,19 “ Section 699c. 49.471 (1) (cr) of the statutes is created to read:

AB56-ASA1-AA2,19,21 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

AB56-ASA1-AA2,700c Section 700c. 49.471 (4) (a) 4. b. of the statutes is amended to read:

AB56-ASA1-AA2,20,3 49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133 percent of the poverty line before application of the 5 percent income disregard under 42 CFR 435.603 (d).

AB56-ASA1-AA2,701c Section 701c. 49.471 (4) (a) 8. of the statutes is created to read:

AB56-ASA1-AA2,20,5 49.471 (4) (a) 8. An individual who meets all of the following criteria:

AB56-ASA1-AA2,20,6 a. The individual is an adult under the age of 65.

AB56-ASA1-AA2,20,8 b. The adult has a family income that does not exceed 133 percent of the poverty line, except as provided in sub. (4g).

AB56-ASA1-AA2,20,10 c. The adult is not otherwise eligible for the Medical Assistance program under this subchapter or the Medicare program under 42 USC 1395 et seq.

AB56-ASA1-AA2,702c Section 702c. 49.471 (4g) of the statutes is created to read:

AB56-ASA1-AA2,20,19 49.471 (4g) Medicaid expansion; federal medical assistance percentage. For services provided to individuals described under sub. (4) (a) 8., the department shall comply with all federal requirements to qualify for the highest available enhanced federal medical assistance percentage. The department shall submit any amendment to the state medical assistance plan, request for a waiver of federal Medicaid law, or other approval request required by the federal government to provide services to the individuals described under sub. (4) (a) 8. and qualify for the highest available enhanced federal medical assistance percentage.”.

AB56-ASA1-AA2,20,20 73. Page 356, line 23: after that line insert:

AB56-ASA1-AA2,20,21 “ Section 703b. 49.471 (6) (b) of the statutes is amended to read:

AB56-ASA1-AA2,21,2 49.471 (6) (b) A pregnant woman who is determined to be eligible for benefits under sub. (4) remains eligible for benefits under sub. (4) for the balance of the pregnancy and to the last day of the month in which the 60th day or, if approved by the federal government, the 365th day after the last day of the pregnancy falls without regard to any change in the woman's family income.

AB56-ASA1-AA2,704b Section 704b. 49.471 (6) (L) of the statutes is created to read:

AB56-ASA1-AA2,21,9 49.471 (6) (L) The department shall request from the federal department of health and human services approval of a state plan amendment, a waiver of federal Medicaid law, or approval of a demonstration project to maintain eligibility for post-partum women to the last day of the month in which the 365th day after the last day of the pregnancy falls under ss. 49.46 (1) (a) 1m. and 9. and (j), 49.47 (4) (ag) 2., and 49.471 (4) (a) 1g. and 1m., (6) (b), and (7) (b) 1.

AB56-ASA1-AA2,705b Section 705b. 49.471 (7) (b) 1. of the statutes is amended to read:

AB56-ASA1-AA2,21,21 49.471 (7) (b) 1. A pregnant woman whose family income exceeds 300 percent of the poverty line may become eligible for coverage under this section if the difference between the pregnant woman's family income and the applicable income limit under sub. (4) (a) is obligated or expended for any member of the pregnant woman's family for medical care or any other type of remedial care recognized under state law or for personal health insurance premiums or for both. Eligibility obtained under this subdivision continues without regard to any change in family income for the balance of the pregnancy and to the last day of the month in which the 60th day or, if approved by the federal government, the 365th day after the last day of the woman's pregnancy falls. Eligibility obtained by a pregnant woman under this subdivision extends to all pregnant women in the pregnant woman's family.”.

AB56-ASA1-AA2,21,22 74. Page 357, line 18: after that line insert:

AB56-ASA1-AA2,21,23 “ Section 711c. 49.686 (3) (d) of the statutes is amended to read:

AB56-ASA1-AA2,22,6 49.686 (3) (d) Has applied for coverage under and has been denied eligibility for medical assistance within 12 months prior to application for reimbursement under sub. (2). This paragraph does not apply to an individual who is eligible for benefits under the demonstration project for childless adults under s. 49.45 (23) BadgerCare Plus under s. 49.471 (4) (a) 8. or to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471 (11).”.

AB56-ASA1-AA2,22,7 75. Page 363, line 8: after that line insert:

AB56-ASA1-AA2,22,8 “ Section 746t. 51.03 (7) of the statutes is created to read:

AB56-ASA1-AA2,22,12 51.03 (7) From the appropriation under s. 20.435 (5) (dg), the department shall award grants to regional crisis stabilization facilities for adults. The department shall establish criteria for a regional crisis stabilization facility to receive a grant under this subsection.”.

AB56-ASA1-AA2,22,14 76. Page 364, line 14: delete the material beginning with that line and ending with page 365, line 8, and substitute:

AB56-ASA1-AA2,22,15 “ Section 750b. 51.422 (1) of the statutes is amended to read:

AB56-ASA1-AA2,22,23 51.422 (1) Program creation. The department shall create 2 or 3 new, regional comprehensive opioid treatment programs, and in the 2017-19 fiscal biennium, shall create 2 or 3 additional regional comprehensive opioid and methamphetamine treatment programs, to provide treatment for opioid and opiate addiction and methamphetamine addiction in underserved, high-need areas. The department shall obtain and review proposals for opioid and methamphetamine treatment programs in accordance with its request-for-proposal procedures. A program under this section may not offer methadone treatment.

AB56-ASA1-AA2,751b Section 751b. 51.422 (2) of the statutes is amended to read:

AB56-ASA1-AA2,23,10 51.422 (2) Program components. An opioid or methamphetamine treatment program created under this section shall offer an assessment to individuals in need of service to determine what type of treatment is needed. The program shall transition individuals to a certified residential program, if that level of treatment is necessary. The program shall provide counseling, medication-assisted treatment, including both long-acting opioid antagonist and partial agonist medications that have been approved by the federal food and drug administration if for treating opioid addiction, and abstinence-based treatment. The program shall transition individuals who have completed treatment to county-based or private post-treatment care.”.

AB56-ASA1-AA2,23,11 77. Page 365, line 9: delete lines 9 to 16 and substitute:

AB56-ASA1-AA2,23,12 “ Section 752b. 51.441 of the statutes is created to read:

AB56-ASA1-AA2,23,19 51.441 Comprehensive mental health consultation program. The department shall convene a statewide group of interested persons, including at least one representative of the Medical College of Wisconsin, to develop a concept paper, business plan, and standards for a comprehensive mental health consultation program that incorporates general psychiatry, geriatric psychiatry, addiction medicine and psychiatry, a perinatal psychiatry consultation program, and the child psychiatry consultation program under s. 51.442.”.

AB56-ASA1-AA2,23,20 78. Page 433, line 4: after that line insert:

AB56-ASA1-AA2,23,21 “ Section 1891b. 250.048 of the statutes is created to read:

AB56-ASA1-AA2,24,3 250.048 Prescription drug importation program. (1) Importation program requirements. The department, in consultation with persons interested in the sale and pricing of prescription drugs and appropriate officials and agencies of the federal government, shall design and implement a prescription drug importation program for the benefit of residents of this state, that generates savings for residents, and that satisfies all of the following:

AB56-ASA1-AA2,24,6 (a) The department shall designate a state agency to become a licensed wholesale distributor or to contract with a licensed wholesale distributor and shall seek federal certification and approval to import prescription drugs.

AB56-ASA1-AA2,24,9 (b) The prescription drug importation program under this section shall comply with relevant requirements of 21 USC 384, including safety and cost savings requirements.

AB56-ASA1-AA2,24,12 (c) The prescription drug importation program under this section shall import prescription drugs from Canadian suppliers regulated under any appropriate Canadian or provincial laws.

AB56-ASA1-AA2,24,15 (d) The prescription drug importation program under this section shall have a process to sample the purity, chemical composition, and potency of imported prescription drugs.

AB56-ASA1-AA2,24,19 (e) The prescription drug importation program under this section shall import only those prescription drugs for which importation creates substantial savings for residents of the state and only those prescription drugs that are not brand-name drugs and that have fewer than 4 competitor prescription drugs in the United States.

AB56-ASA1-AA2,24,22 (f) The department shall ensure that prescription drugs imported under the program under this section are not distributed, dispensed, or sold outside of the state.

AB56-ASA1-AA2,24,24 (g) The prescription drug importation program under this section shall ensure all of the following:

AB56-ASA1-AA2,25,2 1. Participation by any pharmacy or health care provider in the program is voluntary.

AB56-ASA1-AA2,25,4 2. Any pharmacy or health care provider participating in the program has the appropriate license or other credential in this state.

AB56-ASA1-AA2,25,7 3. Any pharmacy or health care provider participating in the program charges a consumer or health plan the actual acquisition cost of the imported prescription drug that is dispensed.

AB56-ASA1-AA2,25,11 (h) The prescription drug importation program under this section shall ensure that a payment by a health plan or health insurance policy for a prescription drug imported under the program reimburses no more than the actual acquisition cost of the imported prescription drug that is dispensed.