Amendment SSA1-AB68

AB68-SSA1,1035 Section 1035. 49.45 (3) (e) 11. of the statutes is amended to read:

AB68-SSA1,561,2 49.45 (3) (e) 11. The department shall use a portion of the moneys collected under s. 50.38 (2) (a) to pay for services provided by eligible hospitals, as defined in s. 50.38 (1), other than critical access hospitals, under the Medical Assistance Program under this subchapter, including services reimbursed on a fee-for-service basis and services provided under a managed care system. For state fiscal year 2008-09, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (a) for fiscal year 2008-09 divided by 57.75 percent. For each state fiscal year after state fiscal year 2008-09, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (a) for the fiscal year divided by 61.68 percent, except that if the department has expanded eligibility under section 2001 (a) (1) (C) of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical Assistance program under this subchapter, the amount collected for the fiscal year shall be divided by 53.69 percent.

AB68-SSA1,1036 Section 1036 . 49.45 (3) (e) 12. of the statutes is amended to read:

AB68-SSA1,561,14 49.45 (3) (e) 12. The department shall use a portion of the moneys collected under s. 50.38 (2) (b) to pay for services provided by critical access hospitals under the Medical Assistance Program under this subchapter, including services reimbursed on a fee-for-service basis and services provided under a managed care system. For each state fiscal year, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (b) for the fiscal year divided by 61.68 percent, except that if the department has expanded eligibility under section 2001 (a) (1) (C) of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical Assistance program under this subchapter, the amount collected for the fiscal year shall be divided by 53.69 percent.

AB68-SSA1,1037 Section 1037. 49.45 (3m) (a) (intro.) of the statutes is amended to read:

AB68-SSA1,561,22 49.45 (3m) (a) (intro.) Subject to par. (c) (d) and notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b) and (o), in each fiscal year, the department shall pay to hospitals that serve a disproportionate share of low-income patients an amount equal to the sum of $27,500,000, as the state share of payments, and the matching federal share of payments. The department may make a payment to a hospital under this subsection under the calculation method described in par. (b) if the hospital meets all of the following criteria:

AB68-SSA1,1038 Section 1038. 49.45 (3m) (cm) of the statutes is created to read:

AB68-SSA1,562,5 49.45 (3m) (cm) Notwithstanding the total amount of state share paid to hospitals under par. (a) and the limit paid to a single hospital under par. (b) 3. a., if the department has expanded eligibility under section 2001 (a) (1) (C) of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical Assistance program under this subchapter, the department shall pay as the state share to hospitals $47,500,000 under par. (a) and pay no single hospital more than $7,950,000 under par. (b) 3. a.

AB68-SSA1,1039 Section 1039. 49.45 (5g) of the statutes is created to read:

AB68-SSA1,562,16 49.45 (5g) Payments to tribes. (a) Tribal care coordination agreements. A tribal health care provider's care coordination agreement with a nontribal health care provider shall meet federal requirements, including that a service provided by the nontribal health care provider be at the request of the tribal health care provider on behalf of a tribal member who remains in the tribal health care provider's care according to the care coordination agreement; that both the tribal health care provider and nontribal health care provider are providers, as defined in s. 49.43 (10); that an established relationship exists between the tribal health care provider and the tribal member; and that the care be provided pursuant to a written care coordination agreement.

AB68-SSA1,563,2 (b) Amount and distribution of payments. 1. From the appropriation account under s. 20.435 (4) (b), the department shall make payments to eligible governing bodies of federally recognized American Indian tribes or bands or tribal health care providers in an amount and manner determined by the department. The department shall determine payment amounts on the basis of the difference between the state share of medical assistance payments paid for services rendered to tribal members for whom a care coordination agreement with nontribal health care providers is in place and the state share of medical assistance payments that would have been paid for those services absent a care coordination agreement with nontribal partners.

AB68-SSA1,563,5 2. The department shall withhold from the payments under subd. 1. the state share of administrative costs associated with carrying out this subsection, not to exceed 10 percent of the amounts calculated in subd. 1.

AB68-SSA1,563,8 3. Federally recognized American Indian tribes or bands may use funds paid under this subsection for health-related purposes. The department shall consult biennially with tribes to determine the timing and distribution of payments.

AB68-SSA1,1040 Section 1040. 49.45 (6m) (a) 6. of the statutes is repealed.

AB68-SSA1,1041 Section 1041. 49.45 (6m) (ag) 3p. a. to c. of the statutes are amended to read:

AB68-SSA1,563,13 49.45 (6m) (ag) 3p. a. The system may incorporate acuity measurements under the most recent Resource Utilization Groupings methodology to determine factors for case-mix adjustment.

AB68-SSA1,563,17 b. Four times annually, for For each facility resident who is a Medical Assistance recipient on March 31, June 30, September 30, or December 31, as applicable, the system shall determine the average case-mix index by use of the factors specified under subd. 3p. a.

AB68-SSA1,563,19 c. The system shall may incorporate payment adjustments for dementia, behavioral needs, or other complex medical conditions.

AB68-SSA1,1042 Section 1042. 49.45 (6xm) of the statutes is created to read:

AB68-SSA1,563,24 49.45 (6xm) Pediatric inpatient supplement. (a) From the appropriations under s. 20.435 (4) (b), (o), and (w), the department shall, using a method determined by the department, distribute a total sum of $2,000,000 each state fiscal year to hospitals that meet all of the following criteria:

AB68-SSA1,563,25 1. The hospital is an acute care hospital located in this state.

AB68-SSA1,564,5 2. During the hospital's fiscal year, the inpatient days in the hospital's acute care pediatric units and intensive care pediatric units totaled more than 12,000 days, not including neonatal intensive care units. For purposes of this subsection, the hospital's fiscal year is the hospital's fiscal year that ended in the 2nd calendar year preceding the beginning of the state fiscal year.

AB68-SSA1,564,13 (b) Notwithstanding par. (a), from the appropriations under s. 20.435 (4) (b), (o), and (w), if the department has expanded eligibility under section 2001 (a) (1) (C) of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical Assistance program under this subchapter, then the department may, using a method determined by the department, distribute an additional total sum of $7,500,000 in each state fiscal year to hospitals that are free-standing pediatric teaching hospitals located in Wisconsin that have a percentage calculated under s. 49.45 (3m) (b) 1. a. greater than 45 percent.

AB68-SSA1,1043 Section 1043. 49.45 (18) (ac) of the statutes is amended to read:

AB68-SSA1,565,2 49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag) (c), any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the benefits under s. 49.46 (2) (a) and (b) under s. 49.471 shall pay up to the maximum amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided under s. 49.46 (2). The service provider shall collect the specified or allowable copayment, coinsurance, or deductible, unless the service provider determines that the cost of collecting the copayment, coinsurance, or deductible exceeds the amount to be collected. The department shall reduce payments to each provider by the amount of the specified or allowable copayment, coinsurance, or deductible. No provider may deny care or services because the recipient is unable to share costs, but an inability to share costs specified in this subsection does not relieve the recipient of liability for these costs.

AB68-SSA1,1044 Section 1044. 49.45 (18) (ag) of the statutes is repealed.

AB68-SSA1,1045 Section 1045. 49.45 (18) (b) 8. of the statutes is created to read:

AB68-SSA1,565,5 49.45 (18) (b) 8. Prescription drugs.

AB68-SSA1,1046 Section 1046. 49.45 (18) (d) of the statutes is repealed.

AB68-SSA1,1047 Section 1047 . 49.45 (23) of the statutes is repealed.

AB68-SSA1,1048 Section 1048 . 49.45 (23b) of the statutes is repealed.

AB68-SSA1,1049 Section 1049 . 49.45 (24L) of the statutes is created to read:

AB68-SSA1,565,13 49.45 (24L) Critical access reimbursement payments to dental providers. (a) Based on the criteria in pars. (b) and (c), the department shall increase reimbursements to dental providers that meet quality of care standards, as established by the department.

AB68-SSA1,565,15 (b) In order to be eligible for enhanced reimbursement under this subsection, the provider must meet one of the following qualifications:

AB68-SSA1,565,18 1. For a nonprofit or public provider, 50 percent or more of the individuals served by the provider are individuals who are without dental insurance or are enrolled in the Medical Assistance program.

AB68-SSA1,565,20 2. For a for-profit provider, 5 percent or more of the individuals served by the provider are enrolled in the Medical Assistance program.

AB68-SSA1,566,6 (c) For dental services rendered on or after January 1, 2022, by a qualified nonprofit or public dental provider, the department shall increase reimbursement by 50 percent above the reimbursement rate that would otherwise be paid to that provider. For dental services rendered on or after January 1, 2022, by a qualified for-profit dental provider, the department shall increase reimbursement by 30 percent above the reimbursement rate that would otherwise be paid to that provider. For dental providers rendering services to individuals in managed care under the Medical Assistance program, for services rendered on or after January 1, 2022, the department shall increase reimbursement to pay an additional amount on the basis of the rate that would have been paid to the dental provider had the individual not been enrolled in managed care.

AB68-SSA1,566,9 (d) If a provider has more than one service location, the thresholds described under par. (b) apply to each location, and the department will determine the payment for each separate service location.

AB68-SSA1,566,11 (e) Any provider that receives reimbursement through the pilot project under sub. (24k) is not eligible for reimbursement under this subsection.

AB68-SSA1,1050 Section 1050 . 49.45 (25) (bj) of the statutes is amended to read:

AB68-SSA1,566,20 49.45 (25) (bj) The department of corrections may elect to provide case management services under this subsection to persons who are under the supervision of that department under s. 938.183, 938.34 (4h), (4m), or (4n), or 938.357 (3) or (4), who are Medical Assistance beneficiaries, and who meet one or more of the conditions specified in par. (am). The amount of the allowable charges for those services under the Medical Assistance program that is not provided by the federal government shall be paid from the appropriation account under s. 20.410 (3) (hm), (ho), or (hr).

AB68-SSA1,1051 Section 1051 . 49.45 (25) (bj) of the statutes, as affected by 2019 Wisconsin Act 8 and 2021 Wisconsin Act .... (this act), is repealed and recreated to read:

AB68-SSA1,567,4 49.45 (25) (bj) The department of corrections may elect to provide case management services under this subsection to persons who are under the supervision of that department under s. 938.183, 938.34 (4m), or 938.357 (3) or (4), who are Medical Assistance beneficiaries, and who meet one or more of the conditions specified in par. (am). The amount of the allowable charges for those services under the Medical Assistance program that is not provided by the federal government shall be paid from the appropriation account under s. 20.410 (3) (hm), (ho), or (hr).

AB68-SSA1,1052 Section 1052. 49.45 (25r) of the statutes is created to read:

AB68-SSA1,567,6 49.45 (25r) Community health worker services. (a) In this subsection:

AB68-SSA1,567,8 1. “Community health services” means services provided by a community health worker.

AB68-SSA1,567,16 2. “Community health worker” means a frontline public health worker who is a trusted member of or has a close understanding of the community served, enabling the worker to serve as a liaison, link, or intermediary between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery, and who builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support, and advocacy.

AB68-SSA1,567,24 (b) The department shall request any necessary waiver from, or submit any necessary amendments to the state Medical Assistance plan to, the secretary of the federal department of health and human services to provide community health services to eligible Medical Assistance recipients. If the waiver or state plan amendment is granted, the department shall reimburse certified providers for those community health services approved by the federal department of health and human services for Medical Assistance coverage and as provided to Medical Assistance recipients under s. 49.46 (2) (b) 9m.

AB68-SSA1,1053 Section 1053. 49.45 (30e) (a) 2. of the statutes is repealed.

AB68-SSA1,1054 Section 1054. 49.45 (30e) (b) 3. of the statutes is amended to read:

AB68-SSA1,568,4 49.45 (30e) (b) 3. Requirements for certification of community-based psychosocial service programs. The department may certify county-based providers and providers that are not county-based providers.

AB68-SSA1,1055 Section 1055. 49.45 (30e) (c) of the statutes is renumbered 49.45 (30e) (c) 1. and amended to read:

AB68-SSA1,568,13 49.45 (30e) (c) 1. A The department shall reimburse a county that elects to make the provide services under s. 49.46 (2) (b) 6. Lm. available shall reimburse a provider of the services for the amount of the allowable charges for those services under the medical assistance Medical Assistance program that is not provided by the federal government. The department shall reimburse the provider only for and the amount of the allowable charges for those services under the medical assistance Medical Assistance program that is provided by the federal government.

AB68-SSA1,1056 Section 1056. 49.45 (30e) (c) 2. of the statutes is created to read:

AB68-SSA1,568,17 49.45 (30e) (c) 2. The department shall reimburse to a provider that is not a county-based provider for services under s. 49.46 (2) (b) 6. Lm. for both the federal and nonfederal share of a fee schedule that is determined by the department.

AB68-SSA1,1057 Section 1057. 49.45 (30e) (d) of the statutes is amended to read:

AB68-SSA1,569,2 49.45 (30e) (d) Provision of services on regional basis. Notwithstanding par. (c) 1. and subject to par. (e), in counties that elect to deliver provide the services under s. 49.46 (2) (b) 6. Lm. through the Medical Assistance program on a regional basis according to criteria established by the department, the department shall reimburse a provider of the services for the amount of the allowable charges for those services under the Medical Assistance program that is provided by the federal government and for the amount of the allowable charges that is not provided by the federal government.

AB68-SSA1,1058 Section 1058. 49.45 (30t) of the statutes is created to read:

AB68-SSA1,569,4 49.45 (30t) Doula services. (a) In this subsection:

AB68-SSA1,569,6 1. “Certified doula” means an individual who has received certification from a doula certifying organization recognized by the department.

AB68-SSA1,569,9 2. “Doula services” means childbirth education and support services, including emotional and physical support provided during pregnancy, labor, birth, and the postpartum period.

AB68-SSA1,569,15 (b) The department shall request from the secretary of the federal department of health and human services any required waiver or any required amendment to the state plan for Medical Assistance to allow reimbursement for doula services provided by a certified doula. If the waiver or state plan amendment is granted, the department shall reimburse a certified doula under s. 49.46 (2) (b) 12p. for the allowable charges for doula services provided to Medical Assistance recipients.

AB68-SSA1,1059 Section 1059. 49.46 (1) (a) 1m. of the statutes is amended to read:

AB68-SSA1,569,20 49.46 (1) (a) 1m. Any pregnant woman whose income does not exceed the standard of need under s. 49.19 (11) and whose pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th 365th day after the last day of the pregnancy falls.

AB68-SSA1,1060 Section 1060. 49.46 (1) (j) of the statutes is amended to read:

AB68-SSA1,569,25 49.46 (1) (j) An individual determined to be eligible for benefits under par. (a) 9. remains eligible for benefits under par. (a) 9. for the balance of the pregnancy and to the last day of the month in which the 60th 365th day after the last day of the pregnancy falls without regard to any change in the individual's family income.

AB68-SSA1,1061 Section 1061. 49.46 (2) (b) 8m. of the statutes is created to read:

AB68-SSA1,570,3 49.46 (2) (b) 8m. Room and board for residential substance use disorder treatment.

AB68-SSA1,1062 Section 1062. 49.46 (2) (b) 9m. of the statutes is created to read:

AB68-SSA1,570,5 49.46 (2) (b) 9m. Community health services, as specified under s. 49.45 (25r).

AB68-SSA1,1063 Section 1063 . 49.46 (2) (b) 11m. of the statutes is created to read:

AB68-SSA1,570,8 49.46 (2) (b) 11m. Subject to par. (bx), acupuncture provided by an acupuncturist who holds a certificate under ch. 451.

AB68-SSA1,1064 Section 1064. 49.46 (2) (b) 12p. of the statutes is created to read:

AB68-SSA1,570,11 49.46 (2) (b) 12p. Doula services provided by a certified doula, as specified under s. 49.45 (30t).

AB68-SSA1,1065 Section 1065. 49.46 (2) (b) 24. of the statutes is created to read:

AB68-SSA1,570,14 49.46 (2) (b) 24. Subject to par. (bv), nonmedical services that contribute to the determinants of health.

AB68-SSA1,1066 Section 1066. 49.46 (2) (bv) of the statutes is created to read:

AB68-SSA1,570,22 49.46 (2) (bv) The department shall determine those services under par. (b) 24. that contribute to the determinants of health. The department shall seek any necessary state plan amendment or request any waiver of federal Medicaid law to implement this paragraph. The department is not required to provide the services under this paragraph as a benefit under the Medical Assistance program if the federal department of health and human services does not provide federal financial participation for the services under this paragraph.

AB68-SSA1,1067 Section 1067 . 49.46 (2) (bx) of the statutes is created to read:

AB68-SSA1,571,5 49.46 (2) (bx) The department shall submit to the federal department of health and human services any request for a state plan amendment, waiver, or other federal approval necessary to provide reimbursement for the benefit under par. (b) 11m. If the federal department approves the request or if no federal approval is necessary, the department shall provide the benefit and reimbursement under par. (b) 11m. If the federal department disapproves the request, the department may not provide the benefit or reimbursement for the benefit described under par. (b) 11m.

AB68-SSA1,1068 Section 1068. 49.47 (4) (ag) 2. of the statutes is amended to read:

AB68-SSA1,571,9 49.47 (4) (ag) 2. Pregnant and the woman's pregnancy is medically verified Eligibility continues to the last day of the month in which the 60th 365th day after the last day of the pregnancy falls.

AB68-SSA1,1069 Section 1069 . 49.471 (1) (b) 2. of the statutes is amended to read:

AB68-SSA1,571,11 49.471 (1) (b) 2. A stepfather, stepmother stepparent, stepbrother, or stepsister.

AB68-SSA1,1070 Section 1070 . 49.471 (1) (cr) of the statutes is created to read:

AB68-SSA1,571,14 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

AB68-SSA1,1071 Section 1071 . 49.471 (4) (a) 4. b. of the statutes is amended to read:

AB68-SSA1,571,18 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).

AB68-SSA1,1072 Section 1072 . 49.471 (4) (a) 8. of the statutes is created to read: