AB68: Bill Text

AB68,748,25 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.

AB68,749,8 (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.

AB68,1017 Section 1017. 49.45 (18) (ac) of the statutes is amended to read:

AB68,749,21 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.

AB68,1018 Section 1018. 49.45 (18) (ag) of the statutes is repealed.

AB68,1019 Section 1019. 49.45 (18) (b) 8. of the statutes is created to read:

AB68,749,24 49.45 (18) (b) 8. Prescription drugs.

AB68,1020 Section 1020. 49.45 (18) (d) of the statutes is repealed.

AB68,1021 Section 1021. 49.45 (23) of the statutes is repealed.

AB68,1022 Section 1022 . 49.45 (23b) of the statutes is repealed.

AB68,1023 Section 1023 . 49.45 (24L) of the statutes is created to read:

AB68,750,7 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.

AB68,750,9 (b) In order to be eligible for enhanced reimbursement under this subsection, the provider must meet one of the following qualifications:

AB68,750,12 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.

AB68,750,14 2. For a for-profit provider, 5 percent or more of the individuals served by the provider are enrolled in the Medical Assistance program.

AB68,750,25 (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.

AB68,751,3 (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.

AB68,751,5 (e) Any provider that receives reimbursement through the pilot project under sub. (24k) is not eligible for reimbursement under this subsection.

AB68,1024 Section 1024 . 49.45 (25) (bj) of the statutes is amended to read:

AB68,751,14 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).

AB68,1025 Section 1025 . 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:

AB68,751,23 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).

AB68,1026 Section 1026. 49.45 (25r) of the statutes is created to read:

AB68,751,25 49.45 (25r) Community health worker services. (a) In this subsection:

AB68,752,2 1. “Community health services” means services provided by a community health worker.

AB68,752,10 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.

AB68,752,18 (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.

AB68,1027 Section 1027. 49.45 (30e) (a) 2. of the statutes is repealed.

AB68,1028 Section 1028. 49.45 (30e) (b) 3. of the statutes is amended to read:

AB68,752,23 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.

AB68,1029 Section 1029. 49.45 (30e) (c) of the statutes is renumbered 49.45 (30e) (c) 1. and amended to read:

AB68,753,7 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.

AB68,1030 Section 1030. 49.45 (30e) (c) 2. of the statutes is created to read:

AB68,753,11 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.

AB68,1031 Section 1031. 49.45 (30e) (d) of the statutes is amended to read:

AB68,753,20 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.

AB68,1032 Section 1032. 49.45 (30t) of the statutes is created to read:

AB68,753,22 49.45 (30t) Doula services. (a) In this subsection:

AB68,753,24 1. “Certified doula” means an individual who has received certification from a doula certifying organization recognized by the department.

AB68,754,3 2. “Doula services” means childbirth education and support services, including emotional and physical support provided during pregnancy, labor, birth, and the postpartum period.

AB68,754,9 (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.

AB68,1033 Section 1033. 49.46 (1) (a) 1m. of the statutes is amended to read:

AB68,754,14 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.

AB68,1034 Section 1034. 49.46 (1) (j) of the statutes is amended to read:

AB68,754,19 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.

AB68,1035 Section 1035. 49.46 (2) (b) 8m. of the statutes is created to read:

AB68,754,22 49.46 (2) (b) 8m. Room and board for residential substance use disorder treatment.

AB68,1036 Section 1036. 49.46 (2) (b) 9m. of the statutes is created to read:

AB68,754,24 49.46 (2) (b) 9m. Community health services, as specified under s. 49.45 (25r).

AB68,1037 Section 1037 . 49.46 (2) (b) 11m. of the statutes is created to read:

AB68,755,2 49.46 (2) (b) 11m. Subject to par. (bx), acupuncture provided by an acupuncturist who holds a certificate under ch. 451.

AB68,1038 Section 1038. 49.46 (2) (b) 12p. of the statutes is created to read:

AB68,755,5 49.46 (2) (b) 12p. Doula services provided by a certified doula, as specified under s. 49.45 (30t).

AB68,1039 Section 1039. 49.46 (2) (b) 24. of the statutes is created to read:

AB68,755,8 49.46 (2) (b) 24. Subject to par. (bv), nonmedical services that contribute to the determinants of health.

AB68,1040 Section 1040. 49.46 (2) (bv) of the statutes is created to read:

AB68,755,16 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.

AB68,1041 Section 1041 . 49.46 (2) (bx) of the statutes is created to read:

AB68,755,24 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.

AB68,1042 Section 1042. 49.47 (4) (ag) 2. of the statutes is amended to read:

AB68,756,3 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.

AB68,1043 Section 1043 . 49.471 (1) (b) 2. of the statutes is amended to read:

AB68,756,5 49.471 (1) (b) 2. A stepfather, stepmother stepparent, stepbrother, or stepsister.

AB68,1044 Section 1044 . 49.471 (1) (cr) of the statutes is created to read:

AB68,756,8 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

AB68,1045 Section 1045 . 49.471 (4) (a) 4. b. of the statutes is amended to read:

AB68,756,12 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).

AB68,1046 Section 1046 . 49.471 (4) (a) 8. of the statutes is created to read:

AB68,756,14 49.471 (4) (a) 8. An individual who meets all of the following criteria:

AB68,756,15 a. The individual is an adult under the age of 65.

AB68,756,17 b. The adult has a family income that does not exceed 133 percent of the poverty line, except as provided in sub. (4g).

AB68,756,19 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.

AB68,1047 Section 1047 . 49.471 (4g) of the statutes is created to read:

AB68,757,3 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.

AB68,1048 Section 1048. 49.471 (6) (b) of the statutes is amended to read:

AB68,757,9 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.

AB68,1049 Section 1049. 49.471 (6) (L) of the statutes is created to read:

AB68,757,21 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.

AB68,1050 Section 1050. 49.471 (7) (b) 1. of the statutes is amended to read:

AB68,758,8 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.

AB68,1051 Section 1051 . 49.485 of the statutes is renumbered 20.9315 (19) and amended to read:

AB68,758,16 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.

AB68,1052 Section 1052 . 49.686 (3) (d) of the statutes is amended to read:

AB68,758,23 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).

AB68,1053 Section 1053 . 49.79 (1) (b) of the statutes is amended to read:

AB68,759,4 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.