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AB56-SA2,19,1616 e. Denial, in whole or in part, of payment for a service.
AB56-SA2,19,1917 f. The failure of a care management organization to act within the time frames
18provided in 42 CFR 438.408 (b) (1) and (2) regarding the standard resolution of
19grievances and appeals.
AB56-SA2,19,2220 g. Denial of an enrollee's request to dispute financial liability, including
21copayments, premiums, deductibles, coinsurance, other cost sharing, and other
22member financial liabilities.
AB56-SA2,19,2523 h. Denial of an enrollee, who is a resident of a rural area with only one care
24management organization, to obtain services outside the care management
25organization's network of contracted providers.
AB56-SA2,20,6
1i. Development of a plan of care that is unacceptable to the enrollee because the
2plan of care requires the enrollee to live in a place that is unacceptable to the enrollee;
3the plan of care does not provide sufficient care, treatment, or support to meet the
4enrollee's needs and support the enrollee's identified outcomes; or the plan of care
5requires the enrollee to accept care, treatment, or support that is unnecessarily
6restrictive or unwanted by the enrollee.
AB56-SA2,20,77 j. Involuntary disenrollment from the care management organization.
AB56-SA2,480b 8Section 480b. 46.287 (2) (b) of the statutes is amended to read:
AB56-SA2,20,179 46.287 (2) (b) An enrollee may contest a decision, omission or action of a care
10management organization other than those specified in par. (a), or may contest the
11choice of service provider. In these instances, the enrollee shall first send a written
12request for review by the unit of the department that monitors care management
13organization contracts. This unit shall review and attempt to resolve the dispute.
141m. by filing a grievance with the care management organization. If the dispute
15grievance is not resolved to the satisfaction of the enrollee, he or she may request
16a hearing under the procedures specified in par. (a) 1. (intro.) that the department
17review the decision of the care management organization
.
AB56-SA2,481b 18Section 481b. 46.288 (2) (intro.) of the statutes is renumbered 46.288 (2) and
19amended to read:
AB56-SA2,20,2520 46.288 (2) Criteria and procedures for determining functional eligibility under
21s. 46.286 (1) (a), financial eligibility under s. 46.286 (1) (b), and cost sharing under
22s. 46.286 (2) (a). The rules for determining functional eligibility under s. 46.286 (1)
23(a) 1m. shall be substantially similar to eligibility criteria for receipt of the long-term
24support community options program under s. 46.27. Rules under this subsection
25shall include definitions of the following terms applicable to s. 46.286:
AB56-SA2,482b
1Section 482b. 46.288 (2) (d) to (j) of the statutes are repealed.
AB56-SA2,483b 2Section 483b. 46.2896 (1) (a) of the statutes is amended to read:
AB56-SA2,21,63 46.2896 (1) (a) “Long-term care program" means the long-term care program
4under s. 46.27, 46.275, 46.277, 46.278, or 46.2785; the family care program providing
5the benefit under s. 46.286; the Family Care Partnership program; or the long-term
6care program defined in s. 46.2899 (1).”.
AB56-SA2,21,7 767. Page 304, line 10: delete lines 10 to 18 and substitute:
AB56-SA2,21,8 8 Section 484p. 46.536 of the statutes is amended to read:
AB56-SA2,21,16 946.536 Mobile crisis team Crisis program enhancement grants. From
10the appropriation under s. 20.435 (5) (cf), the department shall award grants in the
11total amount of $250,000 in each fiscal biennium to counties or regions comprised of
12multiple counties to establish certified or enhance crisis programs that create mental
13health mobile crisis teams
to serve individuals having mental health crises in rural
14areas. The department shall award a grant under this section in an amount equal
15to one-half the amount of money the county or region provides to establish certified
16or enhance crisis programs that create mobile crisis teams.”.
AB56-SA2,21,17 1768. Page 304, line 19: after that line insert:
AB56-SA2,21,18 18 Section 485m. 46.854 of the statutes is created to read:
AB56-SA2,21,21 1946.854 Healthy aging grant program. From the appropriation under s.
2020.435 (1) (bk), the department shall award in each fiscal year a grant of $250,000
21to an entity that conducts programs in healthy aging.
AB56-SA2,485w 22Section 485w. 46.995 (4) of the statutes is created to read:
AB56-SA2,22,223 46.995 (4) The department shall ensure that any child who is eligible and who
24applies for the disabled children's long-term support program that is operating

1under a waiver of federal law receives services under the disabled children's
2long-term support program that is operating under a waiver of federal law.”.
AB56-SA2,22,3 369. Page 346, line 3: delete lines 3 to 5 and substitute:
AB56-SA2,22,6 4“(u) Prevention services. For services to prevent child abuse or neglect,
5$5,289,600 in each fiscal year $6,302,100 in fiscal year 2019-20 and $7,464,600 in
6fiscal year 2020-21
.”.
AB56-SA2,22,7 770. Page 348, line 15: after that line insert:
AB56-SA2,22,8 8 Section 652c. 49.45 (2p) of the statutes is repealed.
AB56-SA2,653t 9Section 653t. 49.45 (2t) of the statutes is repealed.”.
AB56-SA2,22,10 1071. Page 348, line 21: after that line insert:
AB56-SA2,22,11 11 Section 654f. 49.45 (3) (e) 11. of the statutes is amended to read:
AB56-SA2,22,2312 49.45 (3) (e) 11. The department shall use a portion of the moneys collected
13under s. 50.38 (2) (a) to pay for services provided by eligible hospitals, as defined in
14s. 50.38 (1), other than critical access hospitals, under the Medical Assistance
15Program under this subchapter, including services reimbursed on a fee-for-service
16basis and services provided under a managed care system. For state fiscal year
172008-09, total payments required under this subdivision, including both the federal
18and state share of Medical Assistance, shall equal the amount collected under s.
1950.38 (2) (a) for fiscal year 2008-09 divided by 57.75 percent. For each state fiscal
20year after state fiscal year 2008-09, total payments required under this subdivision,
21including both the federal and state share of Medical Assistance, shall equal the
22amount collected under s. 50.38 (2) (a) for the fiscal year divided by 61.68 53.69
23percent.
AB56-SA2,654h 24Section 654h. 49.45 (3) (e) 12. of the statutes is amended to read:
AB56-SA2,23,8
149.45 (3) (e) 12. The department shall use a portion of the moneys collected
2under s. 50.38 (2) (b) to pay for services provided by critical access hospitals under
3the Medical Assistance Program under this subchapter, including services
4reimbursed on a fee-for-service basis and services provided under a managed care
5system. For each state fiscal year, total payments required under this subdivision,
6including both the federal and state share of Medical Assistance, shall equal the
7amount collected under s. 50.38 (2) (b) for the fiscal year divided by 61.68 53.69
8percent.
AB56-SA2,657b 9Section 657b. 49.45 (3m) (a) (intro.) of the statutes is amended to read:
AB56-SA2,23,1610 49.45 (3m) (a) (intro.) Subject to par. (c) and notwithstanding sub. (3) (e), from
11the appropriations under s. 20.435 (4) (b) and (o), in each fiscal year, the department
12shall pay to hospitals that serve a disproportionate share of low-income patients an
13amount equal to the sum of $27,500,000 $56,500,000, as the state share of payments,
14and the matching federal share of payments. The department may make a payment
15to a hospital under this subsection under the calculation method described in par. (b)
16if the hospital meets all of the following criteria:
AB56-SA2,658b 17Section 658b. 49.45 (3m) (b) 3. a. of the statutes is amended to read:
AB56-SA2,23,2118 49.45 (3m) (b) 3. a. No single hospital receives more than $4,600,000
19$9,200,000, except that a hospital that is a free-standing pediatric teaching hospital
20located in Wisconsin that has a percentage calculated under subd. 1. a. greater than
2150 percent may receive up to $12,000,000 each fiscal year
.”.
AB56-SA2,23,23 2272. Page 348, line 23: delete the material beginning with that line and ending
23with page 349, line 11, and substitute:
AB56-SA2,24,14
1“49.45 (3p) (a) Subject to par. (c) and notwithstanding sub. (3) (e), from the
2appropriations under s. 20.435 (4) (b) and (o), in each fiscal year, the department
3shall pay to hospitals that would are not eligible for payments under sub. (3m) but
4that
meet the criteria under sub. (3m) (a) except that the hospitals do not provide
5obstetric services
1. and 2. and that, in the most recent year for which information
6is available, charged at least 6 percent of overall charges for services to the Medical
7Assistance program for services provided to Medical Assistance recipients
an
8amount equal to the sum of $250,000 $500,000, as the state share of payments, and
9the matching federal share of payments. The department may make a payment to
10a hospital under this subsection under a calculation method determined by the
11department that provides a fee-for-service supplemental payment that increases as
12the hospital's percentage of inpatient days for Medical Assistance recipients at the
13hospital
the total amount of the hospital's overall charges for services that are
14charges to the Medical Assistance program
increases.”.
AB56-SA2,24,16 1573. Page 349, line 12: delete the material beginning with that line and ending
16with page 351, line 15, and substitute:
AB56-SA2,24,17 17 Section 660b. 49.45 (5) (a) of the statutes is amended to read:
AB56-SA2,24,2318 49.45 (5) (a) Any person whose application for medical assistance is denied or
19is not acted upon promptly or who believes that the payments made in the person's
20behalf have not been properly determined or that his or her eligibility has not been
21properly determined may file an appeal with the department pursuant to par. (b).
22Review is unavailable if the decision or failure to act arose more than 45 days before
23submission of the petition for a hearing, except as provided in par. (ag) or (ar).
AB56-SA2,661b 24Section 661b. 49.45 (5) (ag) of the statutes is created to read:
AB56-SA2,25,6
149.45 (5) (ag) A person shall request a hearing within 90 days of the date of
2receipt of a notice from a care management organization or managed care
3organization upholding its adverse benefit determination relating to any of the
4following or within 90 days of the date the care management organization or
5managed care organization failed to act on the contested matter within the time
6specified by the department:
AB56-SA2,25,97 1. Denial or limited authorization of a requested services, including a
8determination based on the type or level of service, requirement for medical
9necessity, appropriateness, setting, or effectiveness of a covered benefit.
AB56-SA2,25,1210 2. Reduction, suspension, or termination of a previously authorized service,
11unless the service was only authorized for a limited amount or duration and that
12amount or duration has been completed.
AB56-SA2,25,1313 3. Denial, in whole or in part, of payment for a service.
AB56-SA2,25,1414 4. Failure to provide services in a timely manner.
AB56-SA2,25,1715 5. Failure of a care management organization or managed care organization
16to act within the time frames provided in 42 CFR 438.408 (b) (1) and (2) regarding
17the standard resolution of grievances and appeals.
AB56-SA2,25,2018 6. Denial of an enrollee's request to dispute financial liability, including
19copayments, premiums, deductibles, coinsurance, other cost sharing, and other
20member financial liabilities.
AB56-SA2,25,2321 7. Denial of an enrollee, who is a resident of a rural area with only one care
22management organization or managed care organization, to obtain services outside
23the organization's network of contracted providers.
AB56-SA2,662b 24Section 662b. 49.45 (5) (ar) of the statutes is created to read:
AB56-SA2,26,2
149.45 (5) (ar) If a federal regulation specifies a different time limit to request
2a hearing than par. (a) or (ag), the time limit in the federal regulation shall apply.
AB56-SA2,663b 3Section 663b. 49.45 (5) (b) 1. (intro.) of the statutes is amended to read:
AB56-SA2,26,174 49.45 (5) (b) 1. (intro.) Upon receipt of a timely petition under par. (a) the
5department shall give the applicant or recipient reasonable notice and opportunity
6for a fair hearing. The department may make such additional investigation as it
7considers necessary. Notice of the hearing shall be given to the applicant or recipient
8and, if a county department under s. 46.215, 46.22, or 46.23 is responsible for making
9the medical assistance determination, to the county clerk of the county. The county
10may be represented at such hearing. The department shall render its decision as
11soon as possible after the hearing and shall send a certified copy of its decision to the
12applicant or recipient, to the county clerk, and to any county officer charged with
13administration of the Medical Assistance program. The decision of the department
14shall have the same effect as an order of a county officer charged with the
15administration of the Medical Assistance program. The decision shall be final, but
16may be revoked or modified as altered conditions may require. The department shall
17deny a petition for a hearing or shall refuse to grant relief if:
AB56-SA2,664b 18Section 664b. 49.45 (5) (b) 1. d. of the statutes is created to read:
AB56-SA2,26,2219 49.45 (5) (b) 1. d. The issue is an adverse benefit determination described in
20par. (ag) 1. to 7. made by a care management organization or managed care
21organization and the person requesting the hearing has not exhausted the internal
22appeal procedure with the organization.”.
AB56-SA2,26,23 2374. Page 352, line 22: after that line insert:
AB56-SA2,26,24 24 Section 667b. 49.45 (6xm) of the statutes is created to read:
AB56-SA2,27,4
149.45 (6xm) Pediatric inpatient supplement. (a) From the appropriations
2under s. 20.435 (4) (b), (o), and (w), the department shall, using a method determined
3by the department, distribute a total sum of $2,000,000 each state fiscal year to
4hospitals that meet all of the following criteria:
AB56-SA2,27,55 1. The hospital is an acute care hospital located in this state.
AB56-SA2,27,106 2. During the hospital's fiscal year, the inpatient days in the hospital's acute
7care pediatric units and intensive care pediatric units totaled more than 12,000 days,
8not including neonatal intensive care units. For purposes of this subsection, the
9hospital's fiscal year is the hospital's fiscal year that ended in the 2nd calendar year
10preceding the beginning of the state fiscal year.
AB56-SA2,27,1511 (b) Notwithstanding par. (a), from the appropriations under s. 20.435 (4) (b),
12(o), and (w), the department may, using a method determined by the department,
13distribute an additional total sum of $10,000,000 in each state fiscal year to hospitals
14that are free-standing pediatric teaching hospitals located in Wisconsin that have
15a percentage calculated under s. 49.45 (3m) (b) 1. a. greater than 45 percent.
AB56-SA2,668h 16Section 668h. 49.45 (19) (title) of the statutes is amended to read:
AB56-SA2,27,1817 49.45 (19) (title) Assigning Establishing paternity and assigning medical
18support rights.
AB56-SA2,669m 19Section 669m. 49.45 (19) (a) of the statutes is amended to read:
AB56-SA2,28,220 49.45 (19) (a) As Except as provided in par. (c), as a condition of eligibility for
21medical assistance, a person shall, notwithstanding other provisions of the statutes,
22be deemed to have assigned to the state, by applying for or receiving medical
23assistance, any rights to medical support or other payment of medical expenses from
24any other person, including rights to unpaid amounts accrued at the time of

1application for medical assistance as well as any rights to support accruing during
2the time for which medical assistance is paid.
AB56-SA2,670h 3Section 670h. 49.45 (19) (am) of the statutes is created to read:
AB56-SA2,28,114 49.45 (19) (am) As a condition of eligibility for medical assistance, a person
5shall cooperate in good faith with efforts directed at establishing the paternity of a
6nonmarital child and obtaining support payments or any other payments or property
7to which the person and the dependent child or children may have rights. This
8cooperation shall be in accordance with federal law and regulations applying to
9paternity establishment and collection of support payments and may not be required
10if the person has good cause for refusing to cooperate, as determined by the
11department in accordance with federal law and regulations.
AB56-SA2,671m 12Section 671m. 49.45 (19) (c) of the statutes is amended to read:
AB56-SA2,28,1713 49.45 (19) (c) If the mother of a child was enrolled in a health maintenance
14organization or other prepaid health care plan under medical assistance at the time
15of the child's birth,
The state may not seek recovery of birth expenses that may be
16recovered by the state under this subsection are the birth expenses incurred by the
17health maintenance organization or other prepaid health care plan
.
AB56-SA2,672c 18Section 672c. 49.45 (23) of the statutes is repealed.
AB56-SA2,673g 19Section 673g. 49.45 (23) (g) of the statutes is repealed.
AB56-SA2,674g 20Section 674g. 49.45 (23b) of the statutes is repealed.
AB56-SA2,676m 21Section 676m. 49.45 (24L) of the statutes is created to read:
AB56-SA2,28,2522 49.45 (24L) Critical access reimbursement payments to dental providers. (a)
23Based on the criteria in pars. (b) and (c), the department shall increase
24reimbursements to dental providers that meet quality of care standards, as
25established by the department.
AB56-SA2,29,2
1(b) In order to be eligible for enhanced reimbursement under this subsection,
2the provider must meet one of the following qualifications:
AB56-SA2,29,53 1. For a nonprofit or public provider, 50 percent or more of the individuals
4served by the provider are individuals who are without dental insurance or are
5enrolled in the Medical Assistance program.
AB56-SA2,29,76 2. For a for-profit provider, 5 percent or more of the individuals served by the
7provider are enrolled in the Medical Assistance program.
AB56-SA2,29,188 (c) For dental services rendered on or after January 1, 2020, by a qualified
9nonprofit critical access dental provider, the department shall increase
10reimbursement by 50 percent above the reimbursement rate that would otherwise
11be paid to that provider. For dental services rendered on or after January 1, 2020,
12by a qualified for-profit critical access dental provider, the department shall increase
13reimbursement by 30 percent above the reimbursement rate that would otherwise
14be paid to that provider. For dental providers rendering services to individuals in
15managed care under the Medical Assistance program, for services rendered on or
16after January 1, 2020, the department shall increase reimbursement to pay an
17additional amount on the basis of the rate that would have been paid to the dental
18provider had the individual not been enrolled in managed care.
AB56-SA2,29,2119 (d) If a provider has more than one service location, the thresholds described
20under par. (b) apply to each location, and payment for each service location would be
21determined separately.”.
AB56-SA2,29,23 2275. Page 352, line 24: delete the material beginning with that line and ending
23with page 353, line 8, and substitute:
AB56-SA2,30,10
1“49.45 (29w) (b) 1. b. “Telehealth" is means a service provided from a remote
2location using a combination of interactive video, audio, and externally acquired
3images through a networking environment between an individual or a provider at
4an originating site and a provider at a remote location with the service being of
5sufficient audio and visual fidelity and clarity as to be functionally equivalent to
6face-to-face contact; or, in circumstances determined by the department, an
7asynchronous transmission of digital clinical information through a secure
8electronic communications system from one provider to another provider
.
9“Telehealth" does not include telephone conversations or Internet-based
10communications between providers or between providers and individuals.”.
AB56-SA2,30,11 1176. Page 353, line 9: delete that line and substitute:
AB56-SA2,30,12 12 Section 678b. 49.45 (29y) (d) of the statutes is repealed.
AB56-SA2,679p 13Section 679p. 49.45 (30y) of the statutes is created to read:
AB56-SA2,30,1614 49.45 (30y) Certified doula services; pilot project. (a) In this subsection,
15“certified doula" means an individual who has received certification from a doula
16certifying organization recognized by the department.
AB56-SA2,30,1917 (b) For purposes of this subsection, services provided by certified doulas include
18continuous emotional and physical support during labor and birth of a child and
19intermittent services during the prenatal and postpartum periods.
AB56-SA2,30,2420 (c) Subject to par. (d), the department shall reimburse under the Medical
21Assistance program benefits as provided under this subsection for pregnant women
22enrolled in the Medical Assistance program who reside in the counties of Brown,
23Dane, Milwaukee, Rock, or Sheboygan, or another county as determined by the
24department.
AB56-SA2,31,6
1(d) The department shall request from the secretary of the federal department
2of health and human services any approval necessary to allow reimbursement under
3the Medical Assistance program for services provided by a certified doula. The
4department may not pay reimbursement unless federal approval is not required or
5any required federal approval allowing reimbursement under s. 49.46 (2) (b) 12p. is
6approved and in effect.”.
AB56-SA2,31,8 777. Page 353, line 11: delete the material beginning with that line and ending
8with page 354, line 17, and substitute:
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