Amendment ASA1-AB240

LRBs0055/1

MLJ&TJD:cdc

2021 - 2022 LEGISLATURE

ASSEMBLY SUBSTITUTE AMENDMENT 1, TO ASSEMBLY BILL 240

April 13, 2021 - Offered by Representatives Anderson, Baldeh, Billings, Bowen, Brostoff, Cabrera, Conley, Considine, Doyle, Drake, Emerson, Goyke, Haywood, Hebl, Hesselbein, Hintz, Hong, McGuire, B. Meyers, Milroy, Moore Omokunde, L. Myers, Neubauer, Ohnstad, Ortiz-Velez, Pope, Riemer, S. Rodriguez, Shankland, Shelton, Sinicki, Snodgrass, Spreitzer, Stubbs, Subeck, Vining and Vruwink.

AB240-ASA1,1,8 An Act to repeal 49.45 (2p) and 49.45 (23); to renumber and amend 323.29 (3) (a); to amend 20.435 (4) (jw), 49.45 (23b) (title), 49.45 (23b) (b), 49.45 (23b) (c), 49.45 (23b) (e), 49.471 (4) (a) 4. b. and 49.686 (3) (d); and to create 49.471 (1) (cr), 49.471 (4) (a) 8., 49.471 (4g), 323.29 (3) (a) 2. and 323.29 (3) (b) 3. of the statutes; relating to: eligibility expansion under the Medical Assistance program, a statewide public safety interoperable communication system, emergency services IP network contracts, a geographic information systems database, and mental health treatment capacity.

Analysis by the Legislative Reference Bureau

Eligibility expansion under the Medical Assistance program

BadgerCare Plus and BadgerCare Plus Core are programs under the state's Medical Assistance program, which provides health services to individuals who have limited financial resources. The federal Patient Protection and Affordable Care Act allows a state to receive an enhanced federal medical assistance percentage payment for providing benefits to certain individuals through a state's Medical Assistance program. This bill changes the family income eligibility level to up to 133 percent of the federal poverty line for parents and caretaker relatives under BadgerCare Plus and for childless adults currently covered under BadgerCare Plus Core and who are incorporated into BadgerCare Plus in this bill. The bill requires the Department of Health Services to comply with all federal requirements and to request any amendment to the state Medical Assistance plan, waiver of Medicaid law, or other federal approval necessary to qualify for the highest available enhanced federal medical assistance percentage for childless adults under the BadgerCare Plus program.

Under current law, certain parents and caretaker relatives with incomes of not more than 100 percent of the federal poverty line, before a 5 percent income disregard is applied, are eligible for BadgerCare Plus benefits. Under current law, childless adults who 1) are under age 65; 2) have family incomes that do not exceed 100 percent of the federal poverty line, before the 5 percent income disregard is applied; and 3) are not otherwise eligible for Medical Assistance, including BadgerCare Plus, are eligible for benefits under BadgerCare Plus Core. The bill eliminates the childless adults demonstration project, known as BadgerCare Plus Core, as a separate program.

Statewide public safety interoperable communication system

Under current law, the Department of Military Affairs provides staff support for the Interoperability Council and is charged with overseeing the development and operation of a statewide public safety interoperable communication system, which is a system that allows various public safety entities, public works and transportation agencies, hospitals, and volunteer emergency services agencies to communicate via radio or other communication technology in an emergency.

The bill provides that DMA must also administer any current or future statewide public safety interoperable communication system, and allows DMA to enter into agreements for maintenance and support of, upgrades to, and enhancements for the statewide public safety interoperable communication system. The bill provides $66,000,000 to DMA in the 2021-22 fiscal year to develop an updated statewide public safety interoperable communication system.

Emergency services IP network contracts

Under current law, DMA must contract for the creation, operation, and maintenance of an emergency services IP network to provide all public safety answering points with the necessary infrastructure to implement Next Generation 911. The bill provides $37,000,000 to DMA in the 2021-22 fiscal year for contracts to develop the emergency services IP network.

Geographic information systems database

The bill provides $3,400,000 to DMA in the 2021-22 fiscal year to develop a statewide geographic information systems database.

Grants for regional psychiatric bed and crisis stabilization capacity

This bill allows the Building Commission to award grants to entities in the cumulative amount of $30,000,000 for the purpose of expanding capacity psychiatric beds and for crisis stabilization. An entity that is awarded a grant under the bill must do all of the following: 1) serve individuals who meet the criteria for emergency detention or are in need of crisis stabilization services and who are from one of the Northwest Wisconsin counties specified in the bill; 2) identify measures the entity believes will serve the needs of residents with mental health needs, especially in reducing the burden on the Winnebago Mental Health Institute; 3) report annually to the legislature on the services provided with grant moneys; and 4) recognize that it is liable to repay the grant to the state if the entity fails to maintain continued expanded services as described in the bill. Emergency detention is a current law procedure for temporary involuntary commitment of individuals who are believed to be mentally ill, drug dependent, or developmentally disabled and who demonstrate a substantial probability of causing harm to themselves or others or an inability to satisfy certain basic needs due to a mental illness. If the entity's space for which the grant is awarded under this bill is not used for the purpose agreed to when the grant is awarded, the state retains an ownership interest in the entity's expansion space to the amount of the state's grant.

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

AB240-ASA1,1c Section 1c. 20.435 (4) (jw) of the statutes is amended to read:

AB240-ASA1,3,9 20.435 (4) (jw) BadgerCare Plus and hospital assessment. All moneys received from payment of enrollment fees under the program under s. 49.45 (23), all moneys transferred under s. 50.38 (9), all moneys transferred from the appropriation account under par. (jz), and 10 percent of all moneys received from penalty assessments under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), to provide a portion of the state share of administrative costs for the BadgerCare Plus Medical Assistance program under s. 49.471, and for administration of the hospital assessment under s. 50.38.

AB240-ASA1,1e Section 1e. 49.45 (2p) of the statutes is repealed.

AB240-ASA1,1g Section 1g. 49.45 (23) of the statutes is repealed.

AB240-ASA1,1h Section 1h. 49.45 (23b) (title) of the statutes is amended to read:

AB240-ASA1,3,14 49.45 (23b) (title) Childless adults demonstration project reform waiver implementation required.

AB240-ASA1,1j Section 1j. 49.45 (23b) (b) of the statutes is amended to read:

AB240-ASA1,4,5 49.45 (23b) (b) Beginning as soon as practicable after October 31, 2018, and ending no sooner than December 31, 2023, the department shall do all of the following with regard to the childless adults demonstration project under sub. (23) s. 49.471 (4) (a) 8.:

AB240-ASA1,4,11 1. Require in each month persons, except exempt individuals, who are eligible to receive Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. and who are at least 19 years of age but have not attained the age of 50 to participate in, document, and report 80 hours per calendar month of community engagement activities. The department, after finding good cause, may grant a temporary exemption from the requirement under this subdivision upon request of a Medical Assistance recipient.

AB240-ASA1,4,14 2. Require persons with incomes of at least 50 percent of the poverty line to pay premiums in accordance with par. (c) as a condition of eligibility for Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.

AB240-ASA1,4,16 3. Require as a condition of eligibility for Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. completion of a health risk assessment.

AB240-ASA1,4,19 4. Charge recipients of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. an $8 copayment for nonemergency use of the emergency department in accordance with 42 USC 1396o-1 (e) (1) and 42 CFR 447.54.

AB240-ASA1,4,24 5. Disenroll from Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. for 6 months any individual who does not pay a required premium under subd. 2. and any individual who is required under subd. 1. to participate in a community engagement activity but who does not participate for 48 aggregate months in the community engagement activity.

AB240-ASA1,1k Section 1k. 49.45 (23b) (c) of the statutes is amended to read:

AB240-ASA1,5,6 49.45 (23b) (c) 1. Persons who are eligible for the demonstration project under sub. (23) s. 49.471 (4) (a) 8. and who have monthly household income that exceeds 50 percent of the poverty line shall pay a monthly premium amount of $8 per household. A person who is eligible to receive an item or service furnished by an Indian health care provider is exempt from the premium requirement under this subdivision.

AB240-ASA1,5,12 2. The department may disenroll under par. (b) 5. a person for nonpayment of a required monthly premium only at annual eligibility redetermination after providing notice and reasonable opportunity for the person to pay. If a person who is disenrolled for nonpayment of premiums pays all owed premiums or becomes exempt from payment of premiums, he or she may reenroll in Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.

AB240-ASA1,5,16 3. The department shall reduce the amount of the required household premium by up to half for a recipient of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. who does not engage in certain behaviors that increase health risks or who attests to actively managing certain unhealthy behaviors.

AB240-ASA1,1m Section 1m. 49.45 (23b) (e) of the statutes is amended to read:

AB240-ASA1,5,22 49.45 (23b) (e) Before December 31, 2023, the demonstration project requirements under this subsection may not be withdrawn and the department may not request from the federal government withdrawal, suspension, or termination of the demonstration project requirements under this subsection unless legislation has been enacted specifically allowing for the withdrawal, suspension, or termination.

AB240-ASA1,1p Section 1p. 49.471 (1) (cr) of the statutes is created to read:

AB240-ASA1,5,25 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

AB240-ASA1,1q Section 1q. 49.471 (4) (a) 4. b. of the statutes is amended to read:

AB240-ASA1,6,4 49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133 percent of the poverty line before application of the 5 percent income disregard under 42 CFR 435.603 (d).

AB240-ASA1,1r Section 1r. 49.471 (4) (a) 8. of the statutes is created to read:

AB240-ASA1,6,6 49.471 (4) (a) 8. An individual who meets all of the following criteria:

AB240-ASA1,6,7 a. The individual is an adult under the age of 65.

AB240-ASA1,6,9 b. The individual has a family income that does not exceed 133 percent of the poverty line, except as provided in sub. (4g).

AB240-ASA1,6,11 c. The individual is not otherwise eligible for the Medical Assistance program under this subchapter or the Medicare program under 42 USC 1395 et seq.

AB240-ASA1,1s Section 1s. 49.471 (4g) of the statutes is created to read:

AB240-ASA1,6,22 49.471 (4g) Medicaid expansion; federal medical assistance percentage. For services provided to individuals described under sub. (4) (a) 8., the department shall comply with all federal requirements to qualify for the highest available enhanced federal medical assistance percentage. The department shall submit any amendment to the state medical assistance plan, request for a waiver of federal Medicaid law, or other approval request required by the federal government to provide services to the individuals described under sub. (4) (a) 8. and qualify for the highest available enhanced federal medical assistance percentage. Sections 20.940 and 49.45 (2t) do not apply to a submission to the federal government under this subsection.

AB240-ASA1,1t Section 1t. 49.686 (3) (d) of the statutes is amended to read:

AB240-ASA1,7,4 49.686 (3) (d) Has applied for coverage under and has been denied eligibility for medical assistance within 12 months prior to application for reimbursement under sub. (2). This paragraph does not apply to an individual who is eligible for benefits under the demonstration project for childless adults under s. 49.45 (23) or to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471 (4) (a) 8. or (11).

AB240-ASA1,1v Section 1 v. 323.29 (3) (a) of the statutes is renumbered 323.29 (3) (a) (intro.) and amended to read:

AB240-ASA1,7,7 323.29 (3) (a) (intro.) The department shall provide do all of the following:

AB240-ASA1,7,8 1. Provide staff support for the council and oversight of.

AB240-ASA1,7,10 3. Oversee the development and operation of a any current or future statewide public safety interoperable communication system.

AB240-ASA1,2 Section 2 . 323.29 (3) (a) 2. of the statutes is created to read:

AB240-ASA1,7,13 323.29 (3) (a) 2. Administer any current or future statewide public safety interoperable communication system.