Amendment SSA1-AB1

Payment for outpatient services provided by hospitals

The bill requires DHS to provide reimbursement or a supplemental payment through the Medical Assistance program to a hospital for services provided on an outpatient basis that are usually reimbursed when provided at the hospital's inpatient facility but are provided at the hospital's outpatient facility due to the 2019 novel coronavirus pandemic. To receive reimbursement or supplemental payment under the bill, the outpatient services must be approved for federal financial participation and must be provided in a facility that is operated by the hospital and is certified for outpatient services under the federal Medicare program, including under the terms of a federal waiver issued during the federally declared national emergency related to the 2019 novel coronavirus. DHS must seek any federal approval necessary to provide the reimbursement or supplemental payment. The payment requirement applies until the conclusion of a public health emergency declared by the secretary of the federal Department of Health and Human Services in response to the 2019 novel coronavirus or until June 30, 2021, whichever is earlier.

Medical Assistance reimbursement for COVID-19 vaccines and tests administered by pharmacies

The bill requires DHS to ensure that vaccines against SARS-CoV-2 coronavirus and tests for COVID-19 that are otherwise covered and reimbursed under the Medical Assistance program are covered and reimbursed when administered by a pharmacy. DHS must certify pharmacies as Medical Assistance providers as necessary to cover and reimburse pharmacies for administering COVID-19 vaccines and tests as the bill requires. Current law requires DHS to reimburse pharmacists for administering vaccines to children if the federal Department of Health and Human Services has approved the request by DHS to amend the state's Medical Assistance plan to allow such reimbursement and if the pharmacist enrolls in the federal Vaccines for Children Program.

Coverage of vaccinations under SeniorCare

DHS administers the SeniorCare program, which provides assistance to individuals who are elderly in the purchase of prescription drugs. 2019 Wisconsin Act 185 requires DHS to include under the SeniorCare program coverage of vaccinations that are recommended for administration to adults by the federal Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices and approved by DHS. DHS must also provide payments to health care providers that administer the vaccinations and submit claims for payment in the manner required. SeniorCare is operated under a waiver of federal Medicaid laws, but DHS is required to operate the program regardless of whether a waiver is received from the federal government. The bill clarifies that DHS must cover and reimburse vaccinations under SeniorCare as required under 2019 Wisconsin Act 185 by January 15, 2021, regardless of whether a federal waiver is received.

Prescription order extensions

Current law allows a pharmacist to extend a prescription order under certain circumstances in the event that the prescription cannot otherwise be refilled, subject to certain criteria and limitations. However, current law also includes an alternative authorization for a pharmacist to extend a prescription during the public health emergency declared on March 12, 2020, by executive order 72, and for 30 days after the conclusion of that public health emergency. Under this alternative authorization, a pharmacist is exempt from having to contact the prescribing practitioner or his or her office, the pharmacist may extend the prescription by up to a 30-day supply, and certain other requirements also do not apply. The bill provides that this alternative authorization to extend a prescription order also applies beginning on the bill's effective date and continuing until June 30, 2021.

Cremation permits and electronic signature of death certificates

Under current law, a coroner or medical examiner must view the corpse of a deceased person before issuing a cremation permit, and the corpse may not be cremated within 48 hours after the death unless the death was caused by a contagious or infectious disease. Under this bill, until the conclusion of a national emergency declared by the U.S. president under 50 USC 1621 in response to the 2019 novel coronavirus, if a physician, coroner, or medical examiner has signed the death certificate of a deceased person and listed COVID-19 as the cause of death, a coroner or medical examiner must issue a cremation permit without viewing the corpse of a deceased person and a coroner or medical examiner must issue the permit within 48 hours after the time of death. The bill also requires that if the underlying cause of a death is determined to be COVID-19, the person required to sign the death certificate shall provide an electronic signature on the death certificate within 48 hours after the death occurs. These changes to the requirements were enacted in 2019 Wisconsin Act 185, but applied only during the state of emergency related to public health declared on March 12, 2020.

Child Care and Development Fund block grant funding

Under this bill, federal Child Care and Development Fund block grant funds received by the state under the federal Consolidated Appropriations Act of 2021 are credited to federal block grant appropriations, and the purposes for the expenditure of those funds are subject to passive review by the Joint Committee on Finance.

Immunity for health care providers during COVID-19 response

2019 Wisconsin Act 185 provided immunity from civil liability for health care professionals and providers and employees, agents, or contractors of those professionals or providers for death, injury, or damages caused by actions or omissions taken during the state of emergency related to public health declared by the governor in response to COVID-19 on March 12, 2020, and for 60 days following the termination of the state of emergency, which ended July 10, 2020. To be immune from civil liability, the actions or omissions must not involve reckless or wanton conduct or intentional misconduct and must relate to health services provided or not provided in good faith or be substantially consistent with either a direction, guidance, recommendation, or other statement made by a federal, state, or local office or any published guidance of DHS or the federal Department of Health and Human Services relied upon in good faith. The bill continues the immunity from civil liability beginning on July 10, 2020, during any public health emergency declared by the secretary of the federal Department of Health and Human Services, and until 90 days after the termination of the emergency declared by the federal secretary. The circumstances under which this immunity applies are the same as under Act 185. The immunity extended under the bill does not apply to actions filed before the bill goes into effect.

Nursing home or assisted living facility visitation by essential visitors

The bill allows a nursing home or assisted living facility resident, or his or her guardian or health care agent, to designate an essential visitor to visit and provide support for the resident. The resident's guardian or health care agent under a power of attorney is also considered an essential visitor. A nursing home or assisted living facility must allow at least one essential visitor, who agrees to comply with the public health policies of the nursing home or assisted living facility, to enter the nursing home or assisted living facility to visit the resident in compassionate care situations. The nursing home or assisted living facility may refuse access to an essential visitor who refuses to comply with those public health policies. If the federal Centers for Medicare and Medicaid Services issues guidance that restricts visitation more than this bill does, a nursing home or assisted living facility is allowed to comply with that guidance instead of the bill. The requirement to allow visitation of an essential visitor in this bill applies when the nursing home or assisted living facility limits visitors to the nursing home or assisted living facility due to an outbreak or epidemic of communicable disease in the community.

Insurance

Coverage limits on certain prescription drugs

The bill prohibits insurers that offer health insurance, self-insured governmental health plans, and pharmacy benefit managers from requiring, until June 30, 2021, prior authorization for early refills of a prescription drug or otherwise restricting the period in which a prescription drug may be refilled and from imposing a limit on the quantity of prescription drugs that may be obtained if the quantity is no more than a 90-day supply. These prohibitions do not apply if the prescription drug is a controlled substance. The bill reinstates the prohibitions that were enacted in 2019 Wisconsin Act 185 but that expired with the termination of the state of emergency related to public health declared on March 12, 2020, by the governor.

Liability insurance for physicians and nurse anesthetists

The bill specifies that, until the earlier of the conclusion of a national emergency declared by the U.S. president in response to the 2019 novel coronavirus or June 30, 2021, a physician or nurse anesthetist for whom Wisconsin is not a principal place of practice but who is temporarily authorized to practice in Wisconsin may fulfill financial responsibility requirements by filing with the commissioner of insurance a certificate of insurance for a policy of health care liability insurance issued by an insurer authorized in a certain jurisdiction specified in the bill. Additionally, under those same circumstances, the physician or nurse anesthetist may elect to be covered by Wisconsin's health care liability laws. These liability insurance provisions were enacted in 2019 Wisconsin Act 185 but expired with the expiration of the state of emergency related to public health declared on March 12, 2020, by the governor.

Out-of-network costs related to health coverage

The bill prohibits, until the conclusion of a national emergency declared by the U.S. president in response to the 2019 novel coronavirus or June 30, 2021, whichever is earlier, a defined network plan, including a health maintenance organization, or preferred provider plan from requiring an enrollee of the plan to pay more for a service, treatment, or supply provided by an out-of-network provider than if the service, treatment, or supply is provided by an in-network provider. This prohibition applies to any service, treatment, or supply that is related to the diagnosis of or treatment for COVID-19 and that is provided by an out-of-network provider because a participating provider is unavailable due to the emergency. For a service, treatment, or supply provided under those circumstances, the bill requires the plan to reimburse the out-of-network provider at 225 percent of the federal Medicare program rate. Also, under those circumstances, any health care provider or facility that provides a service, treatment, or supply to an enrollee of a plan but is not a participating provider of that plan shall accept as payment in full any payment by a plan that is at least 225 percent of the federal Medicare program rate and may not charge the enrollee an amount that exceeds the amount that the provider or facility is reimbursed by the plan. Similar prohibitions and requirements to these were created in 2019 Wisconsin Act 185, but those prohibitions and requirements applied only during the state of emergency related to public health declared on March 12, 2020, by the governor and for 60 days following the termination of that state of emergency.

Coverage of COVID-19 testing without cost sharing

Current law, as created in 2019 Wisconsin Act 185, requires health insurance policies and self-insured governmental health plans to cover, until March 13, 2021, testing for COVID-19 without imposing any copayment or coinsurance. A health insurance policy is referred to in the bill as a disability insurance policy. The bill extends the Act 185 coverage requirement for testing and adds a requirement to cover vaccines against SARS-CoV-2, which causes COVID-19 until the earlier of the conclusion of a national emergency declared by the U.S. president in response to the 2019 novel coronavirus or June 30, 2021.

legislature

Transfer of moneys from sum sufficient appropriations

JCF may currently transfer moneys between sum certain and continuing appropriations if JCF finds that unnecessary duplication of functions can be eliminated, more efficient and effective methods for performing programs will result, or legislative intent will be more effectively carried out because of the transfer.

The bill authorizes JCF to transfer moneys from sum sufficient appropriations until the conclusion of a national emergency declared by the U.S. president in response to the 2019 novel coronavirus or until June 30, 2021, whichever is earlier. The total amount that may be transferred from all sum sufficient appropriations may not exceed $100,000,000.

Public utilities

Loans to assist municipal utilities in maintaining liquidity

Under current law, the Board of Commissioners of Public Lands manages the common school fund, the normal school fund, the university fund, and the agricultural college fund (trust funds). Current law authorizes BCPL to manage and invest moneys belonging to the trust funds in good faith and with the care an ordinary prudent person in a like position would exercise under similar circumstances.

This bill authorizes BCPL to loan moneys belonging to the trust funds to cities, villages, and towns to ensure that a municipal utility under the control of the city, village, or town is able to maintain liquidity. A municipal utility is a public utility that is a city, village, or town or that is wholly owned or operated by a city, village, or town. Each trust fund loan BCPL awards to a city, village, or town under the bill is secured in the same manner as other trust fund loans BCPL awards to cities, villages, and towns under current law. BCPL may not award a loan under the bill after April 15, 2021.

retirement and group insurance

WRS annuities for critical workers

Under current law, certain people who receive a retirement or disability annuity from the Wisconsin Retirement System and who are hired by an employer that participates in the WRS must suspend that annuity and may not receive a WRS annuity payment until the person is no longer in a WRS-covered position. This suspension applies to a person who 1) has reached his or her normal retirement date; 2) is appointed to a position with a WRS-participating employer, or provides employee services as a contractor to a WRS-participating employer; and 3) is expected to work at least two-thirds of what is considered full-time employment by the Department of Employee Trust Funds.

This bill creates an exception to this suspension if 1) the person is either hired or provides employee services as a contractor in a critical position before the end of the national emergency declared by the U.S. president in response to the 2019 novel coronavirus or June 30, 2021, whichever is earlier; 2) at the time the person initially retires from covered employment with a participating employer, the person does not have an agreement with any participating employer to return to employment; and 3) the person elects to not become a participating employee at the time the person is rehired or enters into a contract after retirement. In other words, the bill allows a WRS annuitant who is either hired or provides employee services as a contractor in a critical position before the earlier of the end of the national emergency declared by the U.S. president in response to the 2019 novel coronavirus or June 30, 2021, to return to work with an employer that participates in the WRS and continue to receive his or her annuity.

safety and professional services

Optional licensure of third-party logistics providers

This bill creates an optional license for third-party logistics providers that are located in the state or are located outside the state but provide third-party logistics provider services in the state. A third-party logistics provider is defined under current law as a person that contracts with a prescription drug manufacturer to provide or coordinate warehousing, distribution, or other services on behalf of the manufacturer but that does not take title to the manufacturer's prescription drug or have general responsibility to direct the prescription drug's sale or disposition.

The bill requires an applicant for a third-party logistics provider license to submit certain information prior to licensure, including proof of a recent facility inspection, and a personal statement relating to a designated representative of the facility. The license created by this bill will no longer apply if the federal Food and Drug Administration establishes a licensing program for third-party logistics providers under federal law and the Pharmacy Examining Board determines that state licensure is not required for a resident third-party logistics provider to provide third-party logistics services in another state.

The bill also directs the Pharmacy Examining Board to promulgate rules that regulate third-party logistics providers and out-of-state third-party logistics providers consistent with federal law. The authority of the Pharmacy Examining Board to promulgate rules is restricted to only rules that are equivalent to requirements under federal law, and only rules that do not mandate licensing under state law.

This bill requires the Pharmacy Examining Board to issue interim licenses for third-party logistics providers and out-of-state third-party logistics providers between the date of enactment until permanent or emergency rules take effect, whichever is sooner, if, in the opinion of the board, the applicant is currently in compliance with federal law relating to third-party logistics providers. An interim license to act as a third-party logistics provider or out-of-state third-party logistics provider expires 90 days after the date that emergency rules take effect, or 90 days after the date that permanent rules take effect, whichever is sooner. No fee is required for an interim license to act as a third-party logistics provider or an out-of-state third-party logistics provider.

Finally, the bill requires third-party logistics providers, whether or not licensed under the bill, to cooperate with inspections of their facilities and delivery vehicles.

Practice by health care providers from other states

The bill authorizes, in certain situations, health care providers licensed in another state or territory to provide services for which they are licensed or certified. Under the bill, a person who satisfies certain requirements and holds a valid, unexpired credential in another state or territory as any of the following may provide services in this state: 1) a physician, physician assistant, or perfusionist; 2) a nurse; 3) a dentist; 4) a pharmacist; 5) a psychologist; 6) a social worker, marriage and family therapist, professional counselor, or clinical substance abuse counselor; 7) a chiropractor; 8) a physical therapist; 9) a podiatrist; 10) a dietitian; 11) an athletic trainer; 12) an occupational therapist; 13) an optometrist; 14) an acupuncturist; 15) a speech-language pathologist or audiologist; or 16) a massage or bodywork therapist. Generally, these practitioners may practice in this state and the Department of Safety and Professional Services must grant them a temporary credential if they apply for a temporary credential within 30 days of beginning to practice for a health care employer.

The bill also specifies that a health care provider granted a temporary credential under the bill may provide services through telehealth to a patient located in this state.

Current law generally prohibits a person from engaging in certain health care–related practices without holding a required credential.

Authorizing first- and second-year pharmacy students to administer COVID-19 vaccines

Current law authorizes pharmacy students who have completed two years of pharmacy school to administer vaccines under the supervision of a pharmacist. The bill authorizes pharmacy students in their first or second year of pharmacy school to administer vaccines under the supervision of a pharmacist. A first- or second-year pharmacy student must complete 12 hours of training in vaccine storage, protocols, administration technique, emergency procedures, and record keeping to administer COVID-19 vaccines under the bill.

state government

Transfer of employees between executive branch agencies

This bill authorizes the secretary of administration to transfer employees from any executive branch agency to another executive branch agency to provide services for that agency. The transfer remains in effect until rescinded by the secretary of administration or June 30, 2021, whichever is earlier. Under the bill, the agency to which an employee is transferred must pay all salary and fringe benefit costs of that employee.

This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB1-SSA1,1 Section 1 . 13.101 (4d) of the statutes is amended to read:

AB1-SSA1,12,8 13.101 (4d) During the public health emergency declared on March 12, 2020, by executive order 72, and for a period of 90 days after termination of the emergency Until the conclusion of a national emergency declared by the U.S. president under 50 USC 1621 in response to the 2019 novel coronavirus or June 30, 2021, whichever is earlier, the committee may transfer under sub. (4) an amount not to exceed $75,000,000 $100,000,000 from sum sufficient appropriations, as defined under s. 20.001 (3) (d), to be used for expenditures related to the emergency.

AB1-SSA1,2 Section 2 . 36.11 (44) of the statutes is created to read:

AB1-SSA1,12,13 36.11 (44) Satisfaction of course requirements through certain activities. (a) In this subsection, “eligible activity” of a student means volunteering or working, for at least one semester, to assist Wisconsin in responding to the COVID-19 pandemic.

AB1-SSA1,12,16 (b) The board shall ensure that each institution offers students an opportunity to use hours engaged in an eligible activity to satisfy related course requirements to the extent appropriate, as determined by the institution.

AB1-SSA1,3 Section 3. 38.04 (33) of the statutes is created to read:

AB1-SSA1,13,5 38.04 (33) Satisfaction of course requirements through certain activities. (a) In this subsection, “eligible activity” of a student means volunteering or working, for at least one semester, to assist Wisconsin in responding to the COVID-19 pandemic.

AB1-SSA1,13,8 (b) The board shall ensure that each district board offers students an opportunity to use hours engaged in an eligible activity to satisfy related course requirements to the extent appropriate, as determined by the district board.

AB1-SSA1,4 Section 4 . 40.26 (5m) of the statutes is amended to read:

AB1-SSA1,13,16 40.26 (5m) During the public health Until the conclusion of a national emergency declared on March 12, 2020, by executive order 72 the U.S. president under 50 USC 1621 in response to the 2019 novel coronavirus or June 30, 2021, whichever is earlier, sub. (5) does not apply if at least 15 days have elapsed between the termination of employment with a participating employer and becoming a participating employee if the position for which the participant is hired is a critical position, as determined by the secretary of health services under s. 323.19 (3).

AB1-SSA1,5 Section 5 . 40.26 (6) (intro.) of the statutes is amended to read:

AB1-SSA1,13,23 40.26 (6) (intro.) A Until the conclusion of a national emergency declared by the U.S. president under 50 USC 1621 in response to the 2019 novel coronavirus or June 30, 2021, whichever is earlier, a participant who is hired during the public health emergency declared on March 12, 2020, by executive order 72, may elect to not suspend his or her retirement annuity or disability annuity under sub. (1m) for the duration of the state of emergency if all of the following conditions are met:

AB1-SSA1,6 Section 6 . 49.45 (39n) of the statutes is created to read:

AB1-SSA1,14,9 49.45 (39n) Pharmacy reimbursement for vaccines and COVID-19 tests. The department shall ensure that any vaccine against SARS-CoV-2 coronavirus and any test for COVID-19, which is the infection caused by the SARS-CoV-2 coronavirus, that are covered under this subchapter and for which reimbursement for administration is made to any provider, are covered and reimbursed when the vaccine or test is administered by a pharmacy. As necessary to comply with this subsection, the department shall certify pharmacies as providers of Medical Assistance services for the purposes of covering and reimbursing pharmacies for administering vaccines and tests described in this subsection.

AB1-SSA1,7 Section 7 . 50.083 of the statutes is created to read:

AB1-SSA1,14,12 50.083 Visitation by essential visitor. (1) In this section, “essential visitor” means any of the following:

AB1-SSA1,14,16 (a) An individual to visit and provide support to a resident in a nursing home or assisted living facility who is designated by the nursing home resident or assisted living facility resident or by the resident's guardian or health care agent under a power of attorney.

AB1-SSA1,14,19 (b) The guardian of a nursing home or assisted living facility resident or the health care agent under a power of attorney for health care for a nursing home or assisted living facility resident.

AB1-SSA1,14,24 (2) Subject to sub. (2m), each nursing home and assisted living facility shall allow at least one essential visitor, who agrees to comply with any public health policies of the nursing home or assisted living facility, to enter the nursing home or assisted living facility to visit the resident in compassionate care situations, including any of the following:

AB1-SSA1,15,3 (a) The resident has recently been admitted to the nursing home or assisted living facility and is experiencing difficulty in adjusting to the change in environment and lack of family presence.

AB1-SSA1,15,4 (b) The resident is grieving the recent death of a friend or family member.

AB1-SSA1,15,6 (c) The resident is experiencing weight loss or dehydration due to lack of support from family or caregivers when eating or drinking.

AB1-SSA1,15,8 (d) The resident is experiencing emotional distress or a decline in ability or willingness to communicate.

AB1-SSA1,15,11 (2m) A nursing home or assisted living facility may refuse to allow access for visitation to any essential visitor who refuses to comply with public health policies of the nursing home or assisted living facility.

AB1-SSA1,15,15 (3) If the federal centers for medicare and medicaid services issues guidance that is more restrictive in allowing visitation than sub. (2), a nursing home or assisted living facility may comply with that guidance instead of complying with sub. (2).

AB1-SSA1,15,19 (4) This section applies at any time a nursing home or assisted living facility limits visitors to the nursing home or assisted living facility due to an outbreak or epidemic of communicable disease in the community in which the nursing home or assisted living facility is located.

AB1-SSA1,8 Section 8 . 108.04 (3) (b) of the statutes is amended to read:

AB1-SSA1,15,25 108.04 (3) (b) Paragraph (a) does not apply with respect to benefit years that begin after March 12, 2020, and before February 7 March 14, 2021. The department shall seek the maximum amount of federal reimbursement for benefits that are, during the time period specified in this paragraph, payable for the first week of a claimant's benefit year as a result of the application of this paragraph.

AB1-SSA1,9 Section 9. 108.062 (20) (intro.) of the statutes is amended to read:

AB1-SSA1,16,10 108.062 (20) Suspensions of certain provisions. (intro.) Notwithstanding sub. (2), this subsection, and not sub. (2), applies to work-share plans submitted on or after April 17, 2020, and before December 31, 2020 the conclusion of a national emergency declared by the U.S. president under 50 USC 1621 in response to the 2019 novel coronavirus or July 4, 2021, whichever is earlier, subject to sub. (19). During that period, prior to implementing a work-share program, an employer shall submit a work-share plan for the approval of the department. In its submittal, the employer shall certify that its plan is in compliance with all requirements under this section. Each plan shall:

AB1-SSA1,10 Section 10 . 108.07 (5) (bm) 1. of the statutes is amended to read:

AB1-SSA1,16,16 108.07 (5) (bm) 1. The Subject to subd. 1m., the department shall, when processing initial claims for regular benefits, determine whether a claim or plan is related to the public health emergency declared on March 12, 2020, by executive order 72. If a claim is so related, the regular benefits for that claim shall, except as provided in subd. 2., be paid as provided in subd. 3.