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
Under current law, a person who meets the eligibility requirements for W-2 and
who is the custodial parent of a child who is eight weeks old or less may receive
monthly grants of $673 and may not be required to work in a W-2 employment
position during that time, unless another adult member of the custodial parent's
W-2 group is participating in, or is eligible to participate in, a W-2 employment
position or is employed in unsubsidized employment. This bill extends these
monthly benefits to the custodial parent of a child who is 12 weeks old or less.
5. Wisconsin Shares maximum reimbursement rate
Under the Wisconsin Shares program under W-2, an individual who is the
parent of a child under the age of 13 or, if the child is disabled, under the age of 19
who needs child care services to participate in various education or work activities,
and who satisfies other eligibility criteria, may receive a subsidy for child care
services.
DCF determines the maximum subsidy rates for Wisconsin Shares child care
subsidies. DCF also determines the maximum subsidy rates for services provided
by certified family child care providers, but may set the rate for Level I certified
family child care providers at no more than 75 percent of the licensed child care rate
and for Level II certified family child care providers at no more than 50 percent of
the licensed child care rate. Under this bill, the maximum rate for Level I or Level
II certified family child care providers may not exceed the licensed child care rate.
6. Internet service provider subscriptions
This bill allows a person who meets the eligibility requirements for W-2 to
apply for and receive from DCF a monthly amount sufficient to pay the cost of an
Internet service provider subscription or $57, whichever is lower.
Health
Medical marijuana
Current law prohibits a person from manufacturing, distributing, or delivering
tetrahydrocannabinols; possessing THC with the intent to manufacture, distribute,
or deliver it; possessing or attempting to possess THC; using drug paraphernalia; or
possessing drug paraphernalia. This bill creates a medical use defense to such
THC-related prosecutions and forfeiture actions for a person who is registered with
DHS as having a specified debilitating medical condition or undergoing a specified
debilitating treatment. The bill also prohibits the arrest or prosecution of such a
person for those offenses. The defense and prohibition do not apply under certain
circumstances, such as a) if the person does not have a valid registry identification
card; b) if the amount of cannabis involved is more than 12 plants or three ounces of
leaves or flowers; c) if, while under the influence of THC, the person drives a motor
vehicle or engages in other conduct that endangers another person; or d) if the person
smokes cannabis on a school bus or public transit or on school premises.
Under the bill, DHS must establish a medical cannabis registry, and a person
may apply to DHS for a registry identification card. The bill specifies that the
following medical conditions or treatments qualify a person for the registry: cancer,
glaucoma, AIDS or HIV, Crohn's disease, a hepatitis C virus infection, Alzheimer's
disease, amytrophic lateral sclerosis, nail-patella syndrome, Ehlers-Danlos
Syndrome, post-traumatic stress disorder, or the treatment of these conditions;
opioid abatement or reduction or treatment for opioid addiction; a chronic or
debilitating disease or medical condition or the treatment of such a disease or
condition that causes cachexia, severe pain, severe nausea, seizures, or severe and
persistent muscle spasms; and any other medical condition or treatment DHS
designates as a debilitating medical condition or treatment. DHS must issue a
qualified applicant a registry identification card unless, in the previous ten years,
the applicant was serving a sentence or on probation for certain violent felony
convictions. DHS must keep registry information and applications confidential
except for verifying status for law enforcement purposes.
Under the bill, DATCP must license and regulate dispensaries to facilitate
medical THC. The bill prohibits a dispensary from being located within 500 feet of
a school, from distributing to one person more than 12 cannabis plants or three
ounces of cannabis leaves or flowers, and from possessing an excessive quantity of
cannabis. An applicant for a dispensary license must pay an initial application fee
determined by DATCP, but a minimum of $250, and a dispensary must pay an annual
fee determined by DHS, but a minimum of $5,000.
The bill requires DATCP to determine policies that allow entities to grow
cannabis and distribute it to dispensaries. The bill also requires DATCP to register
entities as THC-testing laboratories. The bill also imposes a surcharge on the sale
of cannabis and tetrahydrocannabinols by a dispensary. The surcharge is equal to
10 percent of the sales price.
This bill affirmatively states that no employer is required to permit or
accommodate the use, consumption, possession, transfer, display, transportation,
sale, or cultivation of medical marijuana at a place of employment by an employee.
The bill expressly allows an employer to have a policy regarding marijuana use by
its employees.
2. Prescription drug importation program
This bill requires DHS, in consultation with persons interested in the sale and
pricing of prescription drugs and federal officials and agencies, to design and
implement a prescription drug importation program for the benefit of and that
generates savings for Wisconsin residents. The bill establishes requirements for the
program including all of the following: DHS must designate a state agency to become
or contract with a licensed wholesale distributor and seek federal certification and
approval to import prescription drugs; the importation program must comply with
certain federal regulations and import from Canadian suppliers only prescription
drugs that are not brand-name drugs, have fewer than four competitor drugs in this
country, and for which importation creates substantial savings; DHS must ensure
that prescription drugs imported under the program are not distributed, dispensed,
or sold outside of Wisconsin; and the importation program must have an audit
procedure to ensure the program complies with certain requirements specified in the
bill. Before submitting the proposed implementation program to the federal
government for certification, DHS must submit the proposed importation to JCF for
its approval.
3. Dental therapy training program
This bill requires DHS to award onetime grants on a competitive basis to
educational institutions for costs associated with beginning a dental therapy
training program.
4. Evidence-based oral health grants and Seal-A-Smile program
This bill expands the grants awarded annually by DHS for the Seal-A-Smile
program and modifies the scope of other grants awarded by DHS from fluoride
programs to include grants for fluoride varnish and other evidence-based oral health
activities. Under current law, DHS annually awards grants totaling $25,000 for
fluoride supplements, $25,000 for a fluoride mouth-rinse program, and $120,000 for
a school-based dental sealant program. Under the bill, DHS is required to award
grants totaling no less than $50,000 for fluoride varnish and other evidence-based
oral health activities, $700,000 for school-based preventive dental services, and
$100,000 for school-based restorative dental services, except that in fiscal year
2019-20, DHS is required to award $525,000 for school-based preventive dental
services, $100,000 for school-based restorative dental services, and $50,000 for
fluoride varnish and other evidence-based oral health activities.
5. Minority health grant funding
This bill modifies the funding for the DHS minority health program through
which DHS annually awards grants to organizations for activities to improve the
health status of economically disadvantaged minority group members. Under
current law, DHS awards grants of up to $50,000 per year per applicant from
program revenues. The bill instead uses general purpose revenues for these grants
and eliminates the program revenues appropriation. Current law requires that
applicants that are not federally qualified health centers receive priority for grants.
The bill requires that applicants providing maternal and child health services also
receive priority for these grants.
Under current law, DHS is also required to award, from the same program
revenues appropriation, a grant of up to $50,000 to a private nonprofit corporation
to conduct a public information campaign on minority health. Under the bill, this
grant is also funded by general purpose revenues.
6. Infant mortality prevention program
This bill requires DHS to allocate five of its full-time equivalent positions to
staff an infant mortality prevention program.
7. Title V and Title X family planning funding
Current law requires DHS to apply for federal Title X grant funds and to
distribute any funds received to public entities for family planning and related
preventive health services. This bill eliminates that requirement.
Under current law, DHS must allocate women's health funds, which are federal
Title V funds and women's health block grant funds, to develop and maintain an
integrated system of community health services and maximize coordination of
family planning services. Current law excludes from the definition of “family
planning” performance, promotion, encouragement, or counseling in favor of, or
referral either directly or through an intermediary for, voluntary termination of
pregnancy but includes in the definition of “family planning” the provision of
nondirective information explaining prenatal care and delivery or infant care, foster
care, or adoption. DHS must distribute women's health funds only to public entities.
Currently, those public entities may provide some or all of the funds to other public
entities or private entities as long as the recipients of the funds do not provide
abortion services, make referrals for abortion services, or have an affiliate that
provides abortion services or makes referrals for abortion services. The bill retains
the authorization for the public entity that receives funds from DHS to provide some
or all of the funds to other public or private entities but eliminates the restriction on
which public or private entities may receive those funds. The bill also includes in the
definition of “family planning” the provision of nondirective information explaining
pregnancy termination.
8. Multiple sclerosis services
This bill allows DHS to allocate and expend, as part of its implementation of the
Well-Woman Program, up to $60,000 as reimbursement for the provision of multiple
sclerosis services to women. Current law requires DHS to allocate and expend at
least $60,000 for these services; the bill sets a limit of $60,000.
9. Youth wellness program
This bill provides funding to American Indian tribes to fund architectural plans
for a youth wellness center.
10. Dementia training for health care providers
This bill requires DHS to establish a two-year academic detailing primary care
clinic dementia training program for health care providers in ten primary care clinics
in the state through a contract with the Wisconsin Alzheimer's Institute. As part of
the training program, DHS must provide primary care providers with clinical
training and access to educational resources on best practices for diagnosis and
management of common cognitive disorders and referral strategies to dementia
specialists for complicated or rare cognitive or behavioral disorders. DHS must also
ensure that the program includes at least the following components: a) the most
current research on effective clinical treatments and practices is systematically
evaluated by the academic detailing team; b) information gathered and evaluated
regarding the effective clinical treatments and practices is packaged into an easily
accessible format that is clinically relevant, rigorously sourced, and compellingly
formatted; and c) training is provided for clinicians to serve as academic detailers.
11. Healthy aging grant program
This bill requires DHS to award in each fiscal year a grant of $250,000 to an
entity that conducts programs in healthy aging.
12. Graduate medical training support grants
This bill combines, in a continuing appropriation, funding for grants DHS
awards to assist rural hospitals and groups of rural hospitals in procuring
infrastructure and increasing case volume to develop accredited graduate medical
training programs with funding for grants DHS awards to hospitals to support
existing graduate medical training programs. The bill also expands eligibility for
both types of grants to all specialties. Under current law, in order to be eligible for
a grant, a hospital has to have an existing graduate medical training program in
certain prescribed specialty areas or a plan to develop a graduate medical training
program in one or more of those specialties.
13. Assisted living reporting and fees
This bill requires certain assisted living facilities, specifically adult day
centers, community-based residential facilities, and residential care apartment
complexes, to submit biennial reports to DHS through an online system prescribed
by DHS. Under current law, some assisted living facilities have no statutory
reporting requirements and others have annual rather than biennial requirements.
Current law also requires written reports rather than online submissions.
14. Residential lead abatement grants
Under this bill, DHS must award grants for residential lead abatement and
residential lead hazard reduction and for training lead abatement workers.
Children
Family first prevention services
This bill makes certain changes to child welfare laws to allow foster care
payments to be made on behalf of a child who is placed with his or her parent in a
licensed family-based residential alcohol or drug abuse treatment facility under a
voluntary agreement or under an order of the court assigned to exercise jurisdiction
under the Children's Code (juvenile court) in order to claim federal funding under
Title IV-E of the federal Social Security Act. Under current law, the juvenile court
has jurisdiction over a child alleged to be in need of protection or services (CHIPS).
Current law establishes the grounds for alleging CHIPS. This bill adds that the
juvenile court has jurisdiction over a child whose parent is residing in a residential
family-based alcohol or drug abuse treatment program, if the parent requests
jurisdiction in order to have his or her child reside at the program. The bill requires
DCF to prepare a permanency plan for such a child, and allows DCF to place the child
with the parent at the treatment program under a voluntary agreement or by an
order of the juvenile court if the parent consents and if such a placement is
recommended by the permanency plan. If a child is placed with his or her parent
under such a voluntary agreement or an order of the juvenile court, the bill
authorizes DCF to provide foster care funding for the placement.
2. Background checks for congregate care workers
This bill requires a licensing entity to perform a fingerprint-based background
check for all workers at a congregate care facility, as required under federal law. The
bill defines a congregate care facility to be a group home, shelter care facility, or
residential care center for children and youth. Under current law, only caregivers
and nonclient residents of a congregate care facility are required to receive a
background check.
3. Read to Lead program
This bill eliminates the Read to Lead Development Council, which is under
DCF, and the read to lead development fund. Under current law, the council makes
recommendations to the secretary of DCF and the state superintendent of public
instruction regarding recipients of grants for school boards from the fund to support
literacy or early childhood development programs. The secretary and the state
superintendent may then make grants to school boards from the fund.
4. Subsidized guardianship payments
Under current law, in a county having a population of 750,000 or more, and in
other counties under certain circumstances, DCF must provide monthly subsidized
guardianship payments to the guardian of a child who has been adjudged to be in
need of protection or services, and to an interim caretaker or successor guardian
upon the death or incapacity of the guardian. This bill changes the appropriations
from which DCF must make monthly subsidized guardianship payments.
5. Foster and kinship care rates
The bill increases the monthly basic maintenance rates that are paid by the
state or a county to a foster parent for the care and maintenance of a child by 2
percent beginning on January 1, 2020, and by an additional 2 percent beginning on
January 1, 2021. Beginning on January 1, 2020, the monthly rates are $249 for a
child of any age in a foster home certified to provide level one care and, for a foster
home certified to provide higher than level one care, $412 for a child under five years
of age, $451 for a child 5 to 11 years of age, $512 for a child 12 to 14 years of age, and
$534 for a child 15 years of age or over. Beginning on January 1, 2021, the monthly
rates are increased to $254 for a child of any age in a foster home certified to provide
level one care and, for a foster home certified to provide higher than level one care,
$420 for a child under five years of age, $460 for a child 5 to 11 years of age, $522 for
a child 12 to 14 years of age, and $545 for a child 15 years of age or over.
The bill also increases the monthly basic maintenance rates that are paid by the
state or a county to a kinship care relative (a relative other than a parent) who is
providing care and maintenance for a child. These rates are the same as for a foster
home certified to provide level one care.
6. Children and family services
Under current law, DCF must distribute not more than $74,308,000 in each
fiscal year to counties for children and family services. This bill increases the
maximum amount DCF must distribute to counties for these services to $78,708,100
in fiscal year 2019-20 and $90,478,400 in fiscal year 2020-21.
7. Background checks for child care programs
This bill makes various definitional changes, changes who can conduct a
rehabilitation review, and changes the timeline for an appeal of a decision of DCF in
the context of the background check requirements for people who work or reside at
a child care program.
Mental health and developmental disabilities
Methadone use in opioid treatment programs
Under current law, DHS is required to create two or three comprehensive opioid
treatment programs and two or three additional opioid and methamphetamine
treatment programs to provide treatment for opioid, opiate, and methamphetamine
addiction in underserved, high-need areas. The programs must provide counseling,
medication-assisted treatment, and abstinence-based treatment. Current law
prohibits these treatment programs from offering methadone treatment, and this
bill removes that prohibition.
2. Regional crisis stabilization facilities for adults
This bill requires DHS to award grants to regional crisis stabilization facilities
for adults based on criteria established by DHS. Current law requires certification
by DHS in order to operate a youth crisis stabilization facility, which is a facility
designed to prevent or de-escalate the minor's mental health crisis and avoid
admission of the minor to a more restrictive setting.
3. Crisis program enhancement grants
This bill requires DHS to award grants each fiscal biennium to counties or
regions comprising multiple counties to establish or enhance crisis programs to serve
individuals having crises in rural areas. Under current law, DHS is required to
award grants, but only for the purpose of establishing certified crisis programs that
create mental health mobile crisis teams. The bill allows DHS to award grants for
the purpose of establishing or enhancing crisis programs.
4. Mental health consultation program
This bill requires DHS to convene a statewide group of interested persons to
develop a concept paper, business plan, and standards for a comprehensive mental
health consultation program that incorporates general, geriatric, and addiction
psychiatry, a perinatal psychiatry consultation program, and the child psychiatry
consultation program, which operates under current law.
insurance
Coverage of individuals with preexisting conditions, essential health
benefits, and preventive services
This bill requires certain health plans to guarantee access to coverage;
prohibits plans from imposing preexisting condition exclusions; prohibits plans from
setting premiums or cost-sharing amounts based on a health status-related factors;
prohibits plans from setting lifetime or annual limits on benefits; requires plans to
cover certain essential health benefits; and requires coverage of certain preventive
services by plans without a cost-sharing contribution by an enrollee.
This bill requires every individual health insurance policy, known in the bill as
a health benefit plan, to accept every individual who, and every group health
insurance policy to accept every employer that, applies for coverage, regardless of
sexual orientation, gender identity, or whether an employee or individual has a
preexisting condition. The bill allows health benefit plans to restrict enrollment in
coverage to open or special enrollment periods and requires the commissioner of
insurance to establish a statewide open enrollment period of no shorter than 30 days
for every individual health benefit plan. The bill prohibits a group health insurance
policy, including a self-insured governmental health plan, from imposing a
preexisting condition exclusion. The bill also prohibits an individual health
insurance policy from reducing or denying a claim or loss incurred or disability
commencing under the policy on the ground that a disease or physical condition
existed prior to the effective date of coverage.
A health benefit plan offered on the individual or small employer market or a
self-insured governmental health plan may not vary premium rates for a specific
plan except on the basis of whether the plan covers an individual or family, area in
the state, age, and tobacco use as specified in the bill. An individual health benefit
plan or self-insured health plan is prohibited under the bill from establishing rules
for the eligibility of any individual to enroll based on health-status related factors,
which are specified in the bill. A self-insured health plan or an insurer offering an
individual health benefit plan is also prohibited from requiring an enrollee to pay a
greater premium, contribution, deductible, copayment, or coinsurance amount than
is required of a similarly situated enrollee based on a health-status related factor.
Current state law prohibits group health benefit plans from establishing rules of
eligibility or requiring greater premium or contribution amounts based on a
health-status related factor. The bill adds to these current law requirements for
group health benefit plans that the plan may not require a greater deductible,
copayment, or coinsurance amount based on a health-status related factor.
Under the bill, an individual or group health benefit plan or a self-insured
governmental health plan may not establish lifetime or annual limits on the dollar
value of benefits for an enrollee or a dependent of an enrollee under the plan.
The requirements and prohibitions in this bill related to coverage of individuals
with preexisting conditions and prohibition of lifetime and annual benefit limits also
apply to short-term, limited-duration health insurance policies.
This bill requires certain health insurance policies, known in the bill as
disability insurance policies, and governmental self-insured health plans to cover
essential health benefits that will be specified by the commissioner of insurance by
rule. The bill specifies a list of requirements that the commissioner must follow when
establishing the essential health benefits including certain limitations on cost
sharing and the following general categories of benefits, items, or services in which
the commissioner must require coverage: ambulatory patient services, emergency
services, hospitalization, maternity and newborn care, mental health and substance
use disorder services, prescription drugs, rehabilitative and habilitative services
and devices, laboratory services, preventive and wellness services and chronic
disease management, and pediatric services. If an essential health benefit specified
by the commissioner is also subject to its own mandated coverage requirement, the
bill requires the disability insurance policy or self-insured health plan to provide
coverage under whichever requirement provides the insured or plan participant with
more comprehensive coverage.
This bill requires health insurance policies and governmental self-insured
health plans to cover certain preventive services and to provide coverage of those
preventive services without subjecting that coverage to deductibles, copayments, or
coinsurance. The preventive services for which coverage is required are specified in
the bill. The bill also specifies certain instances when cost-sharing amounts may be
charged for an office visit associated with a preventive service.
2. Registration of pharmacy benefit managers; drug cost reporting
This bill generally requires certain prescription drug cost reporting by drug
manufacturers, pharmacy benefit managers, insurers, and hospitals. The bill also
requires pharmacy benefit managers to register with OCI in order to perform
activities of a pharmacy benefit manager in Wisconsin.
Under the bill, each insurer that offers a health insurance policy that covers
prescription drugs must submit to OCI an annual report that identifies the 25
prescription drugs that are the highest cost to the insurer and the 25 prescription
drugs that have the highest cost increases over the 12 months before the submission
of the report. Health insurance policies are referred to in the bill as disability
insurance policies.
The bill requires a drug manufacturer to notify OCI if it increases the wholesale
acquisition cost of a brand-name or generic drug on the market in this state by more
that an amount specified in the bill, or if it intends to introduce to market a
brand-name or generic drug that has an annual wholesale acquisition cost of more
than a specified amount. The manufacturer must include with the notice
justification for and documentation regarding the price increase. The bill requires
each manufacturer to provide OCI an annual description of each
manufacturer-sponsored patient assistance program in effect during the previous
year. Each manufacturer must also report to OCI the value of price concessions
provided to each pharmacy benefit manager for each drug sold.
The bill requires pharmacy benefit managers to report to OCI the amount
received from manufacturers as drug rebates and the value of price concessions
provided by manufacturers for each drug. The bill also requires each hospital
participating in the federal drug-pricing program, known as the 340B program, to
report to OCI the per unit margin for each drug covered under the 340B program
dispensed in the previous year, the total margin, and how the margin revenue was
used. OCI is required under the bill to publicly post information submitted, analyze
data collected, publish a report on emerging trends in prescription prices and price
increases, and annually conduct a public hearing based on that analysis. OCI must
also conduct a statistically-valid survey of pharmacies in this state regarding
whether the pharmacy agreed to not disclose that customer drug benefit cost sharing
exceeds the cost of the dispensed drug.
The bill requires OCI to ensure that every health insurance policy that covers
prescription drugs does not restrict a pharmacy or pharmacist from or penalize a
pharmacy or pharmacist for informing an insured of a difference between the price
of a drug or biological product under the policy and the price the insured would pay
without using health insurance coverage.
