Amendment SSA1-AB68

AB68-SSA1,1048 Section 1048 . 49.45 (23b) of the statutes is repealed.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

AB68-SSA1,571,20 49.471 (4) (a) 8. An individual who meets all of the following criteria:

AB68-SSA1,571,21 a. The individual is an adult under the age of 65.

AB68-SSA1,571,23 b. The adult has a family income that does not exceed 133 percent of the poverty line, except as provided in sub. (4g).

AB68-SSA1,571,25 c. The adult is not otherwise eligible for the Medical Assistance program under this subchapter or the Medicare program under 42 USC 1395 et seq.

AB68-SSA1,1073 Section 1073. 49.471 (4g) of the statutes is created to read:

AB68-SSA1,572,9 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.

AB68-SSA1,1074 Section 1074. 49.471 (6) (b) of the statutes is amended to read:

AB68-SSA1,572,15 49.471 (6) (b) A pregnant woman who is determined to be eligible for benefits under sub. (4) remains eligible for benefits under sub. (4) 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 woman's family income.

AB68-SSA1,1075 Section 1075. 49.471 (6) (L) of the statutes is created to read:

AB68-SSA1,573,2 49.471 (6) (L) The department shall request from the federal department of health and human services approval of a state plan amendment, a waiver of federal Medicaid law, or approval of a demonstration project to maintain eligibility for postpartum women to the last day of the month in which the 365th day after the last day of the pregnancy falls under ss. 49.46 (1) (a) 1m. and 9. and (j), 49.47 (4) (ag) 2., and 49.471 (4) (a) 1g. and 1m., (6) (b), and (7) (b) 1. The department shall cover and provide reimbursement for services under ss. 49.46 (1) (a) 1m. and 9. and (j), 49.47 (4) (ag) 2., and 49.471 (4) (a) 1g. and 1m., (6) (b), and (7) (b) 1. regardless of whether a state plan amendment, waiver of federal Medicaid law, or approval of a demonstration project related to coverage or reimbursement of these services is granted by the federal department of human services.

AB68-SSA1,1076 Section 1076. 49.471 (7) (b) 1. of the statutes is amended to read:

AB68-SSA1,573,14 49.471 (7) (b) 1. A pregnant woman whose family income exceeds 300 percent of the poverty line may become eligible for coverage under this section if the difference between the pregnant woman's family income and the applicable income limit under sub. (4) (a) is obligated or expended for any member of the pregnant woman's family for medical care or any other type of remedial care recognized under state law or for personal health insurance premiums or for both. Eligibility obtained under this subdivision continues without regard to any change in family income 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 woman's pregnancy falls. Eligibility obtained by a pregnant woman under this subdivision extends to all pregnant women in the pregnant woman's family.

AB68-SSA1,1077 Section 1077 . 49.485 of the statutes is renumbered 20.9315 (19) and amended to read:

AB68-SSA1,573,22 20.9315 (19) Whoever knowingly presents or causes to be presented to any officer, employee, or agent of this state a false claim for medical assistance shall forfeit not less than $5,000 nor more than $10,000, plus 3 times the amount of the damages that were sustained by the state or would have been sustained by the state, whichever is greater, as a result of the false claim. The attorney general may bring an action on behalf of the state to recover any forfeiture incurred under this section.

AB68-SSA1,1078 Section 1078 . 49.686 (3) (d) of the statutes is amended to read:

AB68-SSA1,574,4 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).

AB68-SSA1,1079 Section 1079 . 49.79 (1) (b) of the statutes is amended to read:

AB68-SSA1,574,9 49.79 (1) (b) “Controlled substance" has the meaning given in 21 USC 802 (6), except “controlled substance” does not include tetrahydrocannabinols in any form, including tetrahydrocannabinols contained in marijuana, obtained from marijuana, or chemically synthesized.

AB68-SSA1,1080 Section 1080. 49.79 (7r) (d) of the statutes is created to read:

AB68-SSA1,574,13 49.79 (7r) (d) The department may expend from the appropriation under s. 20.435 (4) (bt) no more than $425,000 per fiscal year for the pilot program under this subsection.

AB68-SSA1,1081 Section 1081. 49.79 (9) (a) 1g. of the statutes is amended to read:

AB68-SSA1,574,23 49.79 (9) (a) 1g. Except as provided in subds. 2. and 3., beginning October 1, 2019, the department shall require, to the extent allowed by the federal government, all able-bodied adults without dependents in this state to participate in the employment and training program under this subsection, except for able-bodied adults without dependents who are employed, as determined by the department. The department may require other able individuals who are 18 to 60 years of age, or a subset of those individuals to the extent allowed by the federal government, who are not participants in a Wisconsin Works employment position to participate in the employment and training program under this subsection.

AB68-SSA1,1082 Section 1082. 49.79 (9) (d) of the statutes is repealed.

AB68-SSA1,1083 Section 1083. 49.79 (9) (f) of the statutes is repealed.

AB68-SSA1,1084 Section 1084. 49.791 of the statutes is repealed.

AB68-SSA1,1085 Section 1085 . 49.90 (4) of the statutes is amended to read:

AB68-SSA1,576,4 49.90 (4) The circuit court shall in a summary way hear the allegations and proofs of the parties and by order require maintenance from these relatives, if they have sufficient ability, considering their own future maintenance and making reasonable allowance for the protection of the property and investments from which they derive their living and their care and protection in old age, in the following order: First the husband or wife spouse; then the father and the mother parents; and then the grandparents in the instances in which sub. (1) (a) 2. applies. The order shall specify a sum which that will be sufficient for the support of the dependent person under sub. (1) (a) 1. or the maintenance of a child of a dependent person under sub. (1) (a) 2., to be paid weekly or monthly, during a period fixed by the order or until the further order of the court. If the court is satisfied that any such relative is unable wholly to maintain the dependent person or the child, but is able to contribute to the person's support or the child's maintenance, the court may direct 2 or more of the relatives to maintain the person or the child and prescribe the proportion each shall contribute. If the court is satisfied that these relatives are unable together wholly to maintain the dependent person or the child, but are able to contribute to the person's support or the child's maintenance, the court shall direct a sum to be paid weekly or monthly by each relative in proportion to ability. Contributions directed by court order, if for less than full support, shall be paid to the department of health services or the department of children and families, whichever is appropriate, and distributed as required by state and federal law. An order under this subsection that relates to maintenance required under sub. (1) (a) 2. shall specifically assign responsibility for and direct the manner of payment of the child's health care expenses, subject to the limitations under subs. (1) (a) 2. and (11). Upon application of any party affected by the order and upon like notice and procedure, the court may modify such an order. Obedience to such an order may be enforced by proceedings for contempt.

AB68-SSA1,1086 Section 1086. 50.379 of the statutes is created to read:

AB68-SSA1,576,6 50.379 Designated caregivers. (1) Definitions. In this section:

AB68-SSA1,576,12 (a) “Aftercare assistance” means any assistance provided by a caregiver to a patient under this section after the patient's discharge and related to the patient's condition at the time of discharge, including assisting with basic activities of daily living or instrumental activities of daily living, or carrying out medical or nursing tasks, such as managing wound care, assisting in administering medications, or operating medical equipment.