2017 Wisconsin Act 370 requires DHS to submit to JCF under its passive review
process any proposed Medical Assistance state plan amendment and any proposed
change to a reimbursement rate for or supplemental payment to a Medical
Assistance provider that has an expected fiscal effect of $7,500,000 from all revenue
sources over a 12-month period. This bill eliminates this requirement to submit for
JCF review Medical Assistance state plan amendments, changes to reimbursement
rates, or supplemental payments.
4. Repealing implementation of childless adult demonstration waiver
2017 Wisconsin Act 370 requires by statute DHS to implement the BadgerCare
Reform waiver as it relates to childless adults as approved by the federal Department
of Health and Human Services effective October 31, 2018. The 2015-17 and 2017-19
biennial budget acts required DHS to submit a waiver request to the federal
Department of Health and Human Services authorizing DHS to take certain actions
including imposing premiums on, requiring a health risk assessment of, and
time-limiting eligibility for recipients of BadgerCare Plus under the childless adults
demonstration project waiver. Act 370 requires DHS to implement the childless
adults BadgerCare Reform waiver by no later than November 1, 2019. If JCF
determines that DHS has not complied with the implementation deadline, has not
made sufficient progress in implementing the BadgerCare Reform waiver, or has not
complied with other requirements relating to approved waiver implementation, Act
370 allows JCF to reduce from moneys allocated for state operations or
administrative functions DHS's appropriation or expenditure authority, whichever
is applicable, or change the authorized level of full-time equivalent positions for
DHS related to the Medical Assistance program. This bill eliminates the statutory
implementation requirement for the BadgerCare Reform waiver, including the
deadline and penalties, eliminates the statutory requirement for DHS to seek the
waiver, and allows DHS to modify or withdraw the waiver.
5. Post-partum eligibility
This bill requires DHS to seek approval from the federal Department of Health
and Human Services to extend to women who are eligible for Medical Assistance
when pregnant Medical Assistance benefits until the last day of the month in which
the 365th day after the last day of the pregnancy falls. Currently, post-partum
women are eligible for Medical Assistance benefits until the last day of the month in
which the 60th day after the last day of the pregnancy falls.
6. Medical Assistance reimbursement for doula services
This bill requires DHS to request any necessary federal approval to allow
Medical Assistance program reimbursement for doula services. Under current law,
DHS administers the Medical Assistance program, which is a joint federal and state
program that provides health services to individuals who have limited resources.
DHS is required to pay allowable charges to certified providers for Medical
Assistance on behalf of eligible recipients for certain federally mandated benefits
and other additional services. Subject to any required federal approval, the bill adds
doula services as one of the benefits covered under the Medical Assistance program
and establishes a pilot program to provide reimbursement for services provided 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 DHS. Under the bill, doula services include continuous emotional and
physical support during labor and birth of a child and intermittent services during
the prenatal and postpartum periods.
The bill also requires DHS to award in fiscal year 2019-20 grants totaling
$192,000 to public or private entities, American Indian tribes or tribal organizations,
or community-based organizations for community-based doulas. The recipients
must use the grants to identify and train local community workers to mentor
pregnant women.
7. Eliminating dental reimbursement pilot project
This bill discontinues the dental reimbursement pilot project that, under
current law, requires DHS to distribute moneys to increase Medical Assistance
reimbursement rates for pediatric dental care and adult emergency dental services
provided in Brown, Marathon, Polk, and Racine counties.
8. Critical access reimbursement payments to dental providers
This bill requires DHS to provide enhanced reimbursement payments under
the Medical Assistance program to dental providers who meet certain qualifications.
In order to qualify, a provider must meet quality of care standards established by
DHS. In addition, at least 50 percent of those individuals served by a nonprofit or
public provider must be without dental insurance or enrolled in the Medical
Assistance program for the provider to qualify for enhanced reimbursement and
for-profit providers must have at least 5 percent of patients enrolled in the Medical
Assistance program.
For services rendered by a qualified nonprofit critical access dental provider,
DHS must increase reimbursement by 50 percent above the reimbursement rate
otherwise paid to that provider. For services provided by a for-profit provider, DHS
must increase reimbursement by 30 percent above the reimbursement rate
otherwise paid to that provider. For providers serving individuals in managed care
under the Medical Assistance program, DHS must increase reimbursement to pay
an additional amount on the basis of the rate that would have been paid to the
provider had the individual not been enrolled in managed care. If a provider has
more than one service location, reimbursement is determined separately for each
location.
9. Reimbursement rate increase for direct care for nursing homes and
ICF-IIDs
This bill requires DHS to increase the rates paid for direct care to nursing
homes, also known as nursing facilities, and intermediate care facilities for persons
with an intellectual disability. A portion of the increase is related to an increase in
patient acuity in those facilities and an additional increase is designated to support
staff in those facilities who perform direct care.
10. Reimbursement rate increase for direct care in personal care agencies
This bill requires DHS to increase the rates paid for direct care to agencies that
provide personal care services. A 1.5 percent increase per year is designated to
support staff in those agencies who perform direct care.
11. Services that contribute to determinants of health
This bill includes services, as determined by DHS, that contribute to the
determinants of health as a benefit under the Medical Assistance program. DHS is
required to seek any necessary state plan amendment or request any waiver of
federal Medicaid law to provide the benefit but is not required to provided the
services as a Medical Assistance benefit if the federal Department of Health and
Human Services does not provide federal financial participation for the services.
12. Definition of “telehealth”; reimbursement
This bill expands the definition of “telehealth” for the purposes of
reimbursement of mental health services provided through telehealth under the
Medical Assistance program. Currently, the definition of “telehealth” includes only
real-time communications between individuals and health care providers. The bill
includes in the definition real-time communications between providers and, in
circumstances determined by DHS, asynchronous transmissions of digital images or
data between providers, known as store-and-forward technology. The definition of
“telehealth” currently and under the bill does not include telephone conversations
or Internet-based communications between providers or between providers and
individuals.
This bill requires DHS to establish, by rule, a method of reimbursement for
providers of Medical Assistance services that are covered under the Medical
Assistance program and are provided via a type of telehealth described in the bill.
One of the telehealth types for which the bill requires reimbursement is when a
service is a consultation between a provider at an originating site and a provider at
a remote location using a combination of interactive video, audio, and externally
acquired images through a networking environment. The other telehealth method
is store-and-forward either between providers or between a provider and a Medical
Assistance recipient.
13. Crisis intervention services
Currently, mental health crisis intervention services are a benefit provided by
the Medical Assistance program. Current law specifies that for a county that
becomes certified as a Medical Assistance provider, the county pays the nonfederal
share of the Medical Assistance reimbursement and DHS reimburses the county for
the federal share of the Medical Assistance reimbursement. This bill changes the
name of the services to “crisis intervention services” and specifies that those services
are for the treatment of mental illness, intellectual disability, substance abuse, and
dementia. The bill also specifies that for a county that elects to deliver crisis
intervention services under the Medical Assistance program on a regional basis,
DHS reimburses the service provider both the federal and nonfederal share of the
allowable charges for the amount that exceeds a required annual county
contribution. After January 1, 2020, the required annual county contribution is
equal to 75 percent of the county's expenditures for crisis intervention services in
calendar year 2017, as determined by DHS.
14. Mental health consultation reimbursement
Current law requires DHS to reimburse clinical consultations for students who
are under 21 years of age under the Medical Assistance program until June 30, 2019.
Clinical consultations are communications from a mental health professional or
qualified treatment trainee to another individual to inform, inquire, and instruct on
the symptoms, strategies for care and intervention, and treatment expectations for
the student and to direct and coordinate clinical service components. The bill
eliminates the June 30, 2019, termination date for the clinical consultation
reimbursement.
15. Dental services for individuals who have disabilities
This bill requires DHS to allocate $2,000,000 in fiscal year 2019-20 and
$3,000,000 in fiscal year 2020-21 from all funding sources to increase
reimbursement rates for Medical Assistance dental services that are provided to
Medical Assistance recipients who have disabilities.
16. Disproportionate share hospital payments
This bill increases the amount that DHS is required to pay to hospitals that
serve a disproportionate share of low-income patients and meet certain other
criteria, including that a) the hospital is located in this state; b) the hospital provides
a wide array of services, including services provided through an emergency
department; c) the inpatient days for Medical Assistance recipients at the hospital
were at least 6 percent of the total inpatient days at that hospital during the most
recent year for which such information is available; and d) the hospital meets
applicable, minimum requirements to be a disproportionate share hospital under
federal law.
The bill also increases the maximum amount that DHS may pay a single such
hospital in a fiscal year, provided there is no conflict with federal rules, from
$4,600,000 to $9,200,000, except that a hospital located in Wisconsin that is a
free-standing pediatric teaching hospital that has a Medicaid inpatient utilization
rate greater than 50 percent may receive up to $12,000,000 each fiscal year.
17. Hospital assessment
Currently, each hospital, including each critical access hospital, must pay an
assessment for the privilege of doing business in Wisconsin. The percentage of gross
patient revenues that each hospital must pay is adjusted so that the total amount
of assessments collected for all hospitals that are not critical access hospitals totals
$414,507,300 in each state fiscal year. The same percentage of gross patient
revenues is also assessed on critical access hospitals, though the amount is collected
separately from and deposited into a separate fund from that of other hospitals.
Current law requires DHS to use a portion of this total to pay for services provided
by hospitals under the Medical Assistance program, including the federal and state
share of Medical Assistance, in a total amount that equals the amount collected from
hospitals divided by 61.68 percent. Similarly, current law requires DHS to use a
portion of the amount collected from critical access hospitals to make payments to
critical access hospitals for Medical Assistance services in a total amount that equals
the amount collected from critical access hospitals divided by 61.68 percent. This bill
decreases the 61.68 percent to 53.69 percent, thus increasing the amount of
payments that must be made to critical access hospitals and other hospitals under
the Medical Assistance program.
18. Rural critical care access hospital supplemental payment
This bill increases the amount of payments made to rural critical care access
hospitals. Currently, DHS pays rural critical care access hospitals a Medical
Assistance fee-for-service supplemental payment in a total amount of $250,000 as
the state share of payments plus the matching federal share of payments. A hospital
must satisfy the following criteria to be eligible for this supplemental payment: the
Wisconsin hospital serves a disproportionate share of low-income patients and
meets the federal qualifications to be considered a disproportionate share hospital,
the hospital provides a wide array of services including emergency department
services but excluding obstetric services, and the inpatient days for Medical
Assistance recipients at the hospital are at least 6 percent of the total inpatient days
at that hospital during the most recent year for which such information is available.
The bill changes the criteria for a hospital's eligibility for the rural critical care access
supplement to the following: the hospital is not eligible for a disproportionate share
hospital payment; the hospital is located in Wisconsin and provides a wide array of
services, including emergency department services; and the percentage of the
hospital's overall charges for service that are charges to the Medical Assistance
program for services provided to Medical Assistance recipients is at least 6 percent.
The bill increases to $500,000 the total amount of the state share of payments for the
rural critical care access hospital supplement.
19. Pediatric inpatient supplement
This bill establishes in statute reference to supplemental funding totaling
$2,000,000 to be distributed by DHS to certain acute care hospitals located in
Wisconsin that have a total of more than 12,000 inpatient days in the hospital's acute
care pediatric units and intensive care pediatric units, not including neonatal
intensive care units. In addition, under the bill, DHS may distribute additional
funding of $10,000,000 in each state fiscal year to hospitals that are free-standing
pediatric teaching hospitals located in Wisconsin that have a Medicaid inpatient
utilization rate greater than 45 percent.
20. Children's long-term support waiver program
This bill requires DHS to ensure that any eligible child who applies for the
disabled children's long-term support waiver program receives services under that
program. The disabled children's long-term support waiver program provides
services to children who have developmental, physical, or severe emotional
disabilities and who are living at home or in another community-based setting.
21. Eliminating child support compliance requirement
2017 Wisconsin Act 268 prohibits the following individuals from being eligible
for the Medical Assistance program: certain able-bodied adults and able-bodied
parents who refuse to cooperate in determining the paternity of a child, establishing
or enforcing any support order, or obtaining any other payments or property to which
the adult or the child has rights, and certain parents who are delinquent in child
support payments without satisfying an exception or who refuse to cooperate in
providing or obtaining support for their child. This bill eliminates this prohibition
and reinstates the pre-Act 268 requirement that a person seeking Medical
Assistance benefits must cooperate, in accordance with federal law, in good faith with
efforts directed at establishing the paternity of a nonmarital child and obtaining
support payments or any other payments or property to which the person and the
dependent child or children may have rights.
22. Eliminating savings account program
2017 Wisconsin Act 271 requires DHS to submit a request to the federal
government to establish and implement a savings account program, similar in
function and operation to health savings accounts, in the Medical Assistance
program. This bill eliminates that requirement.
23. Long-term care programs; managed care
This bill generally makes changes to certain long-term care programs that
receive funding under the Medical Assistance program. The Family Care program
concluded its expansion statewide replacing the Community Options Program,
known as COP. The bill eliminates the statutory language for the COP program, a
requirement that DHS certify availability of an aging and disability resource center,
and a requirement that aging and disability resource centers perform outreach in
new Family Care program counties. The bill requires aging and disability resource
centers to provide information and assistance on the self-directed services option,
known as IRIS; the Family Care Partnership program; and the program of
all-inclusive care for the elderly, known as PACE, in addition to the current
requirement to provide information and assistance on the Family Care program.
The bill eliminates regional long-term care advisory committees, which, among
other things, evaluate the care management organizations that administer the
Family Care program.
Current law specifies a 45-day deadline by which an applicant for or recipient
of Medical Assistance must file an appeal of his or her eligibility determination. The
bill specifies that for appeals of the adverse benefit determinations described in the
bill made by a care management organization or managed care organization, the
Medical Assistance recipient has 90 days to appeal. The bill also specifies that the
individual seeking an appeal must exhaust the internal appeal procedures of the
care management organization or managed care organization first.
Public assistance
Drug screening and testing requirements
This bill eliminates provisions under current law that, with certain exceptions,
require controlled substance abuse screening and, in some cases, testing and
treatment of all of the following: a) individuals who apply to participate in certain
work experience programs administered by DCF and DWD; b) noncustodial parents
who apply for Wisconsin Works (W-2), administered by DCF; and c) with respect to
the W-2 program, every adult member of an individual's W-2 group whose income
or assets are included in determining the individual's eligibility for a W-2 program.
2. Eliminating FSET drug testing requirement
2015 Wisconsin Act 55 required DHS to promulgate rules to develop and
implement a drug screening, testing, and treatment policy, which DHS promulgated
as DHS 38, Wis. Adm. Code.
2017 Wisconsin Act 370 incorporated into statutes DHS
38 relating to drug screening, testing, and treatment for recipients of the FoodShare
employment and training program, known as FSET. This bill eliminates the
requirement to implement a drug screening, testing, and treatment policy and
removes from the statutes the language incorporated by Act 370.
3. Temporary Assistance for Needy Families allocations
Under current law, DCF allocates federal moneys, including child care
development funds and moneys received under the Temporary Assistance for Needy
Families (TANF) block grant program for various public assistance programs. This
bill modifies certain TANF allocations. This bill specifies that, with respect to a
TANF-funded contract for services, “allocation” means the amount under the
contract that DCF is obligated to pay.
4. TANF reallocations
Under current law, DCF may reallocate funds for one purpose under the TANF
allocations for any other purpose under the TANF allocations through passive review
by JCF. Also under current law, if the TANF moneys received from the federal
government are less than the amounts appropriated for the purposes under the
TANF schedule, DCF is required to create a plan for reducing the amounts of moneys
allocated under the TANF allocations and to carry it out subject to passive review by
JCF. This bill replaces passive review by JCF with a requirement that the secretary
of administration approve a reallocation or a plan to reduce the moneys allocated
under TANF.
5. FSET requirement
2017 Wisconsin Act 264 requires DHS, beginning on October 1, 2019, to require
all able-bodied adults, with some limited exceptions, who seek benefits from the
FoodShare program to participate in the FoodShare employment and training
program, known as FSET, unless they are already employed. This bill eliminates
that requirement for able-bodied adults with dependents but retains the
requirement for able-bodied adults without dependents. FoodShare is also known
as the food stamp program and the federal Supplemental Nutrition Assistance
Program.
6. Eliminating FSET pay-for-performance requirement
2017 Wisconsin Act 266 requires DHS to create and implement a payment
system based on performance for entities that perform administrative functions for
the FoodShare employment and training program, known as FSET. Act 266
specified performance outcomes on which the pay-for-performance system must be
based. This bill eliminates the requirement for DHS to create a pay-for-performance
system for FSET vendors.
7. FoodShare paternity and child support compliance
2017 Wisconsin Act 59 prohibits from being eligible for FoodShare benefits
certain individuals and parents who refuse to cooperate in obtaining child support
or determining the paternity of a child or who are delinquent in child support
payments and do not satisfy an exception. Act 59 prohibits DHS from implementing
these ineligibility provisions unless DCF determines the implementation may be
done in a budget-neutral manner, DHS or DCF has approval from the federal
government to implement the ineligibility provisions in a budget-neutral manner,
and DHS and DCF notify the governor and JCF of the federal approval and
implementation. This bill eliminates all of the ineligibility provisions in FoodShare
for failing to comply with paternity and child support requirements in Act 59.
8. Transform Milwaukee Jobs for Childless Adults program
This bill provides funding for and requires DCF to establish the Transform
Milwaukee Jobs for Childless Adults program, which is identical to the Transform
Milwaukee Jobs program except that it is open to childless adults. Under current
law, the Transform Milwaukee Jobs program provides a wage subsidy for placement
into jobs for qualifying individuals in Milwaukee County. Under current law, in
order to qualify for the Transform Milwaukee Jobs program, a participant must be
a parent or relative who is a primary caregiver of a child.
9. Foster care youth driver's licensing
This bill requires DCF to establish or contract for a driver education program
for individuals who are 15 years of age or older and in out-of-home care. The bill
requires the program to provide assistance with identifying and enrolling in an
appropriate driver education course, obtaining an operator's license, and obtaining
motor vehicle liability insurance. The bill authorizes DCF to pay, for any individual
in the program, any fees required to enroll in a driver education course or to obtain
an operator's license and the cost of motor vehicle liability insurance on the vehicle
owned or used by the individual during the program and after the individual obtains
an operator's license.
10. Grants to support child care in Milwaukee
This bill authorizes DCF to 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 DCF, in the city of Milwaukee. To receive the
grants, child care providers must contribute matching funds or in-kind goods or
services equal to 25 percent of the grant. This bill also authorizes DCF to award
grants to child care providers and their employees, and to educational institutions
for the purpose of educating employees of child care providers, to improve the overall
child care quality in that geographic area.
11. Grants for services for homeless and runaway youth
This bill provides an additional $250,000 per year in funding for grants
administered by DCF to support programs that provide services for homeless and
runaway youth. Under current law, DCF awards $150,000 per year for this purpose.
12. Tribal family services grants
This bill requires tribal family services grants, administered by DCF, to be
funded using Indian gaming receipts. The grants may be used for tribal services for
adolescents or victims of domestic abuse, tribal child care, or tribal child welfare
services.
13. Special Supplemental Nutrition Program for Women, Infants, and
Children
This bill makes various changes to the Special Supplemental Nutrition
Program for Women, Infants, and Children, known as the WIC program. The WIC
program provides supplemental foods, nutrition education, and other services to
low-income women, infants, and children that meet eligibility criteria under federal
law. DHS administers portions of the WIC program including authorization of
vendors and distribution centers to accept the method of payment that participants
in the WIC program use to obtain foods approved under the program. Specifically,
the bill does all of the following:
a. Allows DHS to identify an alternate participant, who is someone authorized
by a WIC program participant to request benefits and otherwise participate in the
WIC program, as the WIC program cardholder for purposes of electronic
administration.
b. Adds to the criteria to be an authorized vendor or authorized distribution
center that the vendor or distribution center has an electronic benefit
transfer-capable cash register system or payment device that meets the criteria
specified in the bill.
c. Specifies that, except for certain mobile stores specially authorized in
accordance with federal law, each store is a separate vendor, must have a single, fixed
location, and must be separately authorized under the WIC program.
d. Adds to the activities prohibited under the WIC program engaging in
trafficking. Trafficking in WIC benefits is defined in the bill as engaging in any of
the following: buying, selling, stealing, or otherwise exchanging, including
exchanging firearms, ammunition, explosives, or controlled substances, a payment
method of obtaining WIC-approved foods for cash or consideration other than WIC
approved foods; intentionally purchasing and reselling for cash or consideration a
product that is obtained using a method of obtaining WIC-approved foods; or
intentionally purchasing with cash or consideration a product that was originally
purchased with a method of obtaining WIC-approved foods. A person who performs
any of the prohibited practices under the bill or under current law is subject to a
felony with a penalty of a fine not to exceed $10,000 or imprisonment not to exceed
three years and six months, or both for the first offense and for a second or
subsequent offense a felony with a penalty of a fine not to exceed $10,000 or
imprisonment not to exceed six years, or both.
e. Incorporates infant formula suppliers into the types of entities for which
DHS must promulgate rules regarding standards for authorization.
f. Adds civil monetary penalty, warning letter, and implementation of a
corrective action plan to the list of consequences for violating a rule promulgated by
DHS relating to the WIC program.
g. Specifies that information about an applicant for, participant in, or vendor
in the WIC program is confidential and then specifies who may access that
confidential information and for what purposes.
h. Makes some additional changes to the language of the WIC program
statutes.
Wisconsin Works
W-2 lifetime maximum
The Wisconsin Works (W-2) program under current law, which DCF
administers, provides work experience and benefits for low-income custodial
parents who are at least 18 years old. This bill increases the lifetime maximum for
W-2 participation of an individual or any adult member of the individual's W-2
group from 48 months to 60 months. Under current law, a W-2 group includes any
nonmarital coparent or any spouse of an individual who resides in the same
household as the individual.
2. W-2 work experience programs
Under current law, the W-2 program provides a work experience program
known as the “Trial Employment Match Program,” or “TEMP.” Under current law,
participants in TEMP are placed in a job and the agency administering the W-2
program subsidizes the participants' employment for up to 40 hours per week. This
bill changes the name of TEMP to “Subsidized Employment Placement,” removes the
40-hour per week cap on the subsidy, and allows a W-2 agency to negotiate with the
employer a maximum number of hours per week for which the participant is eligible
to receive a subsidy. This bill also removes the current 24-month participation limit
for TEMP and community service and transitional placement jobs, which are also
under W-2.
3. Work experience program: educational and training component
The work experience programs under W-2 currently include educational and
training components, not to exceed ten hours per week in the community service job
program or 12 hours per week in the transitional placement program. This bill
removes the time limitations on educational and training components of a W-2
program. Also under current law, a person may participate in a technical college
education program under W-2, as long as the person works in a community service
job or transitional placement for 25 hours per week in addition to participating in the
technical college educational program. This bill removes the 25-hour requirement
of the work component for participation in the technical college education program
under W-2.
4. Program time limit for caretaker of an infant
