AB68-SSA1,1035
11Section
1035. 49.45 (3) (e) 11. of the statutes is amended to read:
AB68-SSA1,561,212
49.45
(3) (e) 11. The department shall use a portion of the moneys collected
13under s. 50.38 (2) (a) to pay for services provided by eligible hospitals, as defined in
14s. 50.38 (1), other than critical access hospitals, under the Medical Assistance
15Program under this subchapter, including services reimbursed on a fee-for-service
16basis and services provided under a managed care system. For state fiscal year
172008-09, total payments required under this subdivision, including both the federal
18and state share of Medical Assistance, shall equal the amount collected under s.
1950.38 (2) (a) for fiscal year 2008-09 divided by 57.75 percent. For each state fiscal
20year after state fiscal year 2008-09, total payments required under this subdivision,
21including both the federal and state share of Medical Assistance, shall equal the
22amount collected under s. 50.38 (2) (a) for the fiscal year divided by 61.68 percent
,
23except that if the department has expanded eligibility under section 2001 (a) (1) (C)
24of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical
1Assistance program under this subchapter, the amount collected for the fiscal year
2shall be divided by 53.69 percent.
AB68-SSA1,1036
3Section 1036
. 49.45 (3) (e) 12. of the statutes is amended to read:
AB68-SSA1,561,144
49.45
(3) (e) 12. The department shall use a portion of the moneys collected
5under s. 50.38 (2) (b) to pay for services provided by critical access hospitals under
6the Medical Assistance Program under this subchapter, including services
7reimbursed on a fee-for-service basis and services provided under a managed care
8system. For each state fiscal year, total payments required under this subdivision,
9including both the federal and state share of Medical Assistance, shall equal the
10amount collected under s. 50.38 (2) (b) for the fiscal year divided by 61.68 percent
,
11except that if the department has expanded eligibility under section 2001 (a) (1) (C)
12of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical
13Assistance program under this subchapter, the amount collected for the fiscal year
14shall be divided by 53.69 percent.
AB68-SSA1,1037
15Section
1037. 49.45 (3m) (a) (intro.) of the statutes is amended to read:
AB68-SSA1,561,2216
49.45
(3m) (a) (intro.) Subject to par.
(c) (d) and notwithstanding sub. (3) (e),
17from the appropriations under s. 20.435 (4) (b) and (o), in each fiscal year, the
18department shall pay to hospitals that serve a disproportionate share of low-income
19patients an amount equal to the sum of $27,500,000, as the state share of payments,
20and the matching federal share of payments. The department may make a payment
21to a hospital under this subsection under the calculation method described in par. (b)
22if the hospital meets all of the following criteria:
AB68-SSA1,1038
23Section
1038. 49.45 (3m) (cm) of the statutes is created to read:
AB68-SSA1,562,524
49.45
(3m) (cm) Notwithstanding the total amount of state share paid to
25hospitals under par. (a) and the limit paid to a single hospital under par. (b) 3. a., if
1the department has expanded eligibility under section 2001 (a) (1) (C) of the Patient
2Protection and Affordable Care Act, P.L.
111-148, for the Medical Assistance
3program under this subchapter, the department shall pay as the state share to
4hospitals $47,500,000 under par. (a) and pay no single hospital more than $7,950,000
5under par. (b) 3. a.
AB68-SSA1,1039
6Section
1039. 49.45 (5g) of the statutes is created to read:
AB68-SSA1,562,167
49.45
(5g) Payments to tribes. (a)
Tribal care coordination agreements. A
8tribal health care provider's care coordination agreement with a nontribal health
9care provider shall meet federal requirements, including that a service provided by
10the nontribal health care provider be at the request of the tribal health care provider
11on behalf of a tribal member who remains in the tribal health care provider's care
12according to the care coordination agreement; that both the tribal health care
13provider and nontribal health care provider are providers, as defined in s. 49.43 (10);
14that an established relationship exists between the tribal health care provider and
15the tribal member; and that the care be provided pursuant to a written care
16coordination agreement.
AB68-SSA1,563,217
(b)
Amount and distribution of payments. 1. From the appropriation account
18under s. 20.435 (4) (b), the department shall make payments to eligible governing
19bodies of federally recognized American Indian tribes or bands or tribal health care
20providers in an amount and manner determined by the department. The
21department shall determine payment amounts on the basis of the difference between
22the state share of medical assistance payments paid for services rendered to tribal
23members for whom a care coordination agreement with nontribal health care
24providers is in place and the state share of medical assistance payments that would
1have been paid for those services absent a care coordination agreement with
2nontribal partners.
AB68-SSA1,563,53
2. The department shall withhold from the payments under subd. 1. the state
4share of administrative costs associated with carrying out this subsection, not to
5exceed 10 percent of the amounts calculated in subd. 1.
AB68-SSA1,563,86
3. Federally recognized American Indian tribes or bands may use funds paid
7under this subsection for health-related purposes. The department shall consult
8biennially with tribes to determine the timing and distribution of payments.
AB68-SSA1,1040
9Section
1040. 49.45 (6m) (a) 6. of the statutes is repealed.
AB68-SSA1,1041
10Section
1041. 49.45 (6m) (ag) 3p. a. to c. of the statutes are amended to read:
AB68-SSA1,563,1311
49.45
(6m) (ag) 3p. a. The system may incorporate acuity measurements
under
12the most recent Resource Utilization Groupings methodology to determine factors
13for case-mix adjustment.
AB68-SSA1,563,1714
b.
Four times annually, for For each facility resident who is a Medical
15Assistance recipient
on March 31, June 30, September 30, or December 31, as
16applicable, the system shall determine the average case-mix index by use of the
17factors specified under subd. 3p. a.
AB68-SSA1,563,1918
c. The system
shall may incorporate payment adjustments for dementia,
19behavioral needs, or other complex medical conditions.
AB68-SSA1,1042
20Section
1042. 49.45 (6xm) of the statutes is created to read:
AB68-SSA1,563,2421
49.45
(6xm) Pediatric inpatient supplement. (a) From the appropriations
22under s. 20.435 (4) (b), (o), and (w), the department shall, using a method determined
23by the department, distribute a total sum of $2,000,000 each state fiscal year to
24hospitals that meet all of the following criteria:
AB68-SSA1,563,2525
1. The hospital is an acute care hospital located in this state.
AB68-SSA1,564,5
12. During the hospital's fiscal year, the inpatient days in the hospital's acute
2care pediatric units and intensive care pediatric units totaled more than 12,000 days,
3not including neonatal intensive care units. For purposes of this subsection, the
4hospital's fiscal year is the hospital's fiscal year that ended in the 2nd calendar year
5preceding the beginning of the state fiscal year.
AB68-SSA1,564,136
(b) Notwithstanding par. (a), from the appropriations under s. 20.435 (4) (b),
7(o), and (w), if the department has expanded eligibility under section 2001 (a) (1) (C)
8of the Patient Protection and Affordable Care Act, P.L.
111-148, for the Medical
9Assistance program under this subchapter, then the department may, using a
10method determined by the department, distribute an additional total sum of
11$7,500,000 in each state fiscal year to hospitals that are free-standing pediatric
12teaching hospitals located in Wisconsin that have a percentage calculated under s.
1349.45 (3m) (b) 1. a. greater than 45 percent.
AB68-SSA1,1043
14Section
1043. 49.45 (18) (ac) of the statutes is amended to read:
AB68-SSA1,565,215
49.45
(18) (ac) Except as provided in pars. (am) to
(d), and subject to par. (ag) 16(c), any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for
17the benefits under s. 49.46 (2) (a) and (b) under s. 49.471 shall pay up to the maximum
18amounts allowable under
42 CFR 447.53 to
447.58 for purchases of services provided
19under s. 49.46 (2). The service provider shall collect the specified or allowable
20copayment, coinsurance, or deductible, unless the service provider determines that
21the cost of collecting the copayment, coinsurance, or deductible exceeds the amount
22to be collected. The department shall reduce payments to each provider by the
23amount of the specified or allowable copayment, coinsurance, or deductible. No
24provider may deny care or services because the recipient is unable to share costs, but
1an inability to share costs specified in this subsection does not relieve the recipient
2of liability for these costs.
AB68-SSA1,1044
3Section
1044. 49.45 (18) (ag) of the statutes is repealed.
AB68-SSA1,1045
4Section
1045. 49.45 (18) (b) 8. of the statutes is created to read:
AB68-SSA1,565,55
49.45
(18) (b) 8. Prescription drugs.
AB68-SSA1,1046
6Section
1046. 49.45 (18) (d) of the statutes is repealed.
AB68-SSA1,1047
7Section 1047
. 49.45 (23) of the statutes is repealed.
AB68-SSA1,1048
8Section 1048
. 49.45 (23b) of the statutes is repealed.
AB68-SSA1,1049
9Section 1049
. 49.45 (24L) of the statutes is created to read:
AB68-SSA1,565,1310
49.45
(24L) Critical access reimbursement payments to dental providers. (a)
11Based on the criteria in pars. (b) and (c), the department shall increase
12reimbursements to dental providers that meet quality of care standards, as
13established by the department.
AB68-SSA1,565,1514
(b) In order to be eligible for enhanced reimbursement under this subsection,
15the provider must meet one of the following qualifications:
AB68-SSA1,565,1816
1. For a nonprofit or public provider, 50 percent or more of the individuals
17served by the provider are individuals who are without dental insurance or are
18enrolled in the Medical Assistance program.
AB68-SSA1,565,2019
2. For a for-profit provider, 5 percent or more of the individuals served by the
20provider are enrolled in the Medical Assistance program.
AB68-SSA1,566,621
(c) For dental services rendered on or after January 1, 2022, by a qualified
22nonprofit or public dental provider, the department shall increase reimbursement by
2350 percent above the reimbursement rate that would otherwise be paid to that
24provider. For dental services rendered on or after January 1, 2022, by a qualified
25for-profit dental provider, the department shall increase reimbursement by 30
1percent above the reimbursement rate that would otherwise be paid to that provider.
2For dental providers rendering services to individuals in managed care under the
3Medical Assistance program, for services rendered on or after January 1, 2022, the
4department shall increase reimbursement to pay an additional amount on the basis
5of the rate that would have been paid to the dental provider had the individual not
6been enrolled in managed care.
AB68-SSA1,566,97
(d) If a provider has more than one service location, the thresholds described
8under par. (b) apply to each location, and the department will determine the payment
9for each separate service location.
AB68-SSA1,566,1110
(e) Any provider that receives reimbursement through the pilot project under
11sub. (24k) is not eligible for reimbursement under this subsection.
AB68-SSA1,1050
12Section 1050
. 49.45 (25) (bj) of the statutes is amended to read:
AB68-SSA1,566,2013
49.45
(25) (bj) The department of corrections may elect to provide case
14management services under this subsection to persons who are under the
15supervision of that department under s. 938.183, 938.34
(4h), (4m), or (4n), or
16938.357 (3) or (4), who are Medical Assistance beneficiaries, and who meet one or
17more of the conditions specified in par. (am). The amount of the allowable charges
18for those services under the Medical Assistance program that is not provided by the
19federal government shall be paid from the appropriation account under s. 20.410 (3)
20(hm), (ho), or (hr).
AB68-SSA1,567,423
49.45
(25) (bj) The department of corrections may elect to provide case
24management services under this subsection to persons who are under the
25supervision of that department under s. 938.183, 938.34 (4m), or 938.357 (3) or (4),
1who are Medical Assistance beneficiaries, and who meet one or more of the conditions
2specified in par. (am). The amount of the allowable charges for those services under
3the Medical Assistance program that is not provided by the federal government shall
4be paid from the appropriation account under s. 20.410 (3) (hm), (ho), or (hr).
AB68-SSA1,1052
5Section
1052. 49.45 (25r) of the statutes is created to read:
AB68-SSA1,567,66
49.45
(25r) Community health worker services. (a) In this subsection:
AB68-SSA1,567,87
1. “Community health services” means services provided by a community
8health worker.
AB68-SSA1,567,169
2. “Community health worker” means a frontline public health worker who is
10a trusted member of or has a close understanding of the community served, enabling
11the worker to serve as a liaison, link, or intermediary between health and social
12services and the community to facilitate access to services and improve the quality
13and cultural competence of service delivery, and who builds individual and
14community capacity by increasing health knowledge and self-sufficiency through a
15range of activities such as outreach, community education, informal counseling,
16social support, and advocacy.
AB68-SSA1,567,2417
(b) The department shall request any necessary waiver from, or submit any
18necessary amendments to the state Medical Assistance plan to, the secretary of the
19federal department of health and human services to provide community health
20services to eligible Medical Assistance recipients. If the waiver or state plan
21amendment is granted, the department shall reimburse certified providers for those
22community health services approved by the federal department of health and human
23services for Medical Assistance coverage and as provided to Medical Assistance
24recipients under s. 49.46 (2) (b) 9m.
AB68-SSA1,1053
25Section
1053. 49.45 (30e) (a) 2. of the statutes is repealed.
AB68-SSA1,1054
1Section
1054. 49.45 (30e) (b) 3. of the statutes is amended to read:
AB68-SSA1,568,42
49.45
(30e) (b) 3. Requirements for certification of community-based
3psychosocial service programs.
The department may certify county-based providers
4and providers that are not county-based providers.
AB68-SSA1,1055
5Section
1055. 49.45 (30e) (c) of the statutes is renumbered 49.45 (30e) (c) 1.
6and amended to read:
AB68-SSA1,568,137
49.45
(30e) (c) 1.
A The department shall reimburse a county that elects to
8make the provide services under s. 49.46 (2) (b) 6. Lm.
available shall reimburse a
9provider of the services for the amount of the allowable charges for those services
10under the
medical assistance Medical Assistance program that is not provided by the
11federal government
. The department shall reimburse the provider only for and the
12amount of the allowable charges for those services under the
medical assistance 13Medical Assistance program that is provided by the federal government.
AB68-SSA1,1056
14Section
1056. 49.45 (30e) (c) 2. of the statutes is created to read:
AB68-SSA1,568,1715
49.45
(30e) (c) 2. The department shall reimburse to a provider that is not a
16county-based provider for services under s. 49.46 (2) (b) 6. Lm. for both the federal
17and nonfederal share of a fee schedule that is determined by the department.
AB68-SSA1,1057
18Section
1057. 49.45 (30e) (d) of the statutes is amended to read:
AB68-SSA1,569,219
49.45
(30e) (d)
Provision of services on regional basis. Notwithstanding par.
20(c)
1. and subject to par. (e), in counties that elect to
deliver provide the services under
21s. 49.46 (2) (b) 6. Lm. through the Medical Assistance program on a regional basis
22according to criteria established by the department, the department shall reimburse
23a provider of the services for the amount of the allowable charges for those services
24under the Medical Assistance program that is provided by the federal government
1and for the amount of the allowable charges that is not provided by the federal
2government.
AB68-SSA1,1058
3Section
1058. 49.45 (30t) of the statutes is created to read:
AB68-SSA1,569,44
49.45
(30t) Doula services. (a) In this subsection:
AB68-SSA1,569,65
1. “Certified doula” means an individual who has received certification from a
6doula certifying organization recognized by the department.
AB68-SSA1,569,97
2. “Doula services” means childbirth education and support services, including
8emotional and physical support provided during pregnancy, labor, birth, and the
9postpartum period.
AB68-SSA1,569,1510
(b) The department shall request from the secretary of the federal department
11of health and human services any required waiver or any required amendment to the
12state plan for Medical Assistance to allow reimbursement for doula services provided
13by a certified doula. If the waiver or state plan amendment is granted, the
14department shall reimburse a certified doula under s. 49.46 (2) (b) 12p. for the
15allowable charges for doula services provided to Medical Assistance recipients.
AB68-SSA1,1059
16Section
1059. 49.46 (1) (a) 1m. of the statutes is amended to read:
AB68-SSA1,569,2017
49.46
(1) (a) 1m. Any pregnant woman whose income does not exceed the
18standard of need under s. 49.19 (11) and whose pregnancy is medically verified.
19Eligibility continues to the last day of the month in which the
60th 365th day after
20the last day of the pregnancy falls.
AB68-SSA1,1060
21Section
1060. 49.46 (1) (j) of the statutes is amended to read:
AB68-SSA1,569,2522
49.46
(1) (j) An individual determined to be eligible for benefits under par. (a)
239. remains eligible for benefits under par. (a) 9. for the balance of the pregnancy and
24to the last day of the month in which the
60th
365th day after the last day of the
25pregnancy falls without regard to any change in the individual's family income.
AB68-SSA1,1061
1Section
1061. 49.46 (2) (b) 8m. of the statutes is created to read:
AB68-SSA1,570,32
49.46
(2) (b) 8m. Room and board for residential substance use disorder
3treatment.
AB68-SSA1,1062
4Section
1062. 49.46 (2) (b) 9m. of the statutes is created to read:
AB68-SSA1,570,55
49.46
(2) (b) 9m. Community health services, as specified under s. 49.45 (25r).
AB68-SSA1,1063
6Section 1063
. 49.46 (2) (b) 11m. of the statutes is created to read:
AB68-SSA1,570,87
49.46
(2) (b) 11m. Subject to par. (bx), acupuncture provided by an
8acupuncturist who holds a certificate under ch. 451.
AB68-SSA1,1064
9Section
1064. 49.46 (2) (b) 12p. of the statutes is created to read:
AB68-SSA1,570,1110
49.46
(2) (b) 12p. Doula services provided by a certified doula, as specified
11under s. 49.45 (30t).
AB68-SSA1,1065
12Section
1065. 49.46 (2) (b) 24. of the statutes is created to read:
AB68-SSA1,570,1413
49.46
(2) (b) 24. Subject to par. (bv), nonmedical services that contribute to the
14determinants of health.
AB68-SSA1,1066
15Section
1066. 49.46 (2) (bv) of the statutes is created to read:
AB68-SSA1,570,2216
49.46
(2) (bv) The department shall determine those services under par. (b) 24.
17that contribute to the determinants of health. The department shall seek any
18necessary state plan amendment or request any waiver of federal Medicaid law to
19implement this paragraph. The department is not required to provide the services
20under this paragraph as a benefit under the Medical Assistance program if the
21federal department of health and human services does not provide federal financial
22participation for the services under this paragraph.
AB68-SSA1,1067
23Section 1067
. 49.46 (2) (bx) of the statutes is created to read:
AB68-SSA1,571,524
49.46
(2) (bx) The department shall submit to the federal department of health
25and human services any request for a state plan amendment, waiver, or other federal
1approval necessary to provide reimbursement for the benefit under par. (b) 11m. If
2the federal department approves the request or if no federal approval is necessary,
3the department shall provide the benefit and reimbursement under par. (b) 11m. If
4the federal department disapproves the request, the department may not provide the
5benefit or reimbursement for the benefit described under par. (b) 11m.
AB68-SSA1,1068
6Section
1068. 49.47 (4) (ag) 2. of the statutes is amended to read:
AB68-SSA1,571,97
49.47
(4) (ag) 2. Pregnant and the woman's pregnancy is medically verified
8Eligibility continues to the last day of the month in which the
60th 365th day after
9the last day of the pregnancy falls.
AB68-SSA1,1069
10Section 1069
. 49.471 (1) (b) 2. of the statutes is amended to read:
AB68-SSA1,571,1111
49.471
(1) (b) 2. A
stepfather, stepmother stepparent, stepbrother, or stepsister.
AB68-SSA1,1070
12Section 1070
. 49.471 (1) (cr) of the statutes is created to read:
AB68-SSA1,571,1413
49.471
(1) (cr) “Enhanced federal medical assistance percentage" means a
14federal medical assistance percentage described under
42 USC 1396d (y) or (z).
AB68-SSA1,1071
15Section 1071
. 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB68-SSA1,571,1816
49.471
(4) (a) 4. b. The individual's family income does not exceed
100 133 17percent of the poverty line
before application of the 5 percent income disregard under
1842 CFR 435.603 (d).
AB68-SSA1,1072
19Section 1072
. 49.471 (4) (a) 8. of the statutes is created to read: