The bill requires DHS to request any necessary waiver or amendment to the
state Medical Assistance plan to allow Medical Assistance reimbursement for doula
services and, if any necessary waiver or amendment is approved, directs DHS to
reimburse certified doulas for doula services provided to Medical Assistance
recipients. Doula services consist of childbirth education and support services,
including emotional and physical support provided during pregnancy, labor, birth,
and the postpartum period.
Community health worker services
The bill requires DHS to request any necessary waiver or amendment to the
state Medical Assistance plan to allow Medical Assistance reimbursement for
community health services. Under the bill, community health services are those
services provided by a community health worker. A community health worker is one
who serves as a liaison 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 engaging in
a range of activities such as outreach, community education, informal counseling,
social support, and advocacy.
Services that contribute to determinants of health
The bill includes nonmedical services, as determined by DHS, that contribute
to the determinants of health as a benefit under the Medical Assistance program.
The Medical Assistance program is a joint federal and state program that provides
health services to individuals who have limited financial resources. The bill requires
DHS to seek any necessary state plan amendment or request any waiver of federal
Medicaid law to provide the services but does not require DHS to provide the services
as a Medical Assistance benefit if the federal Department of Health and Human
Services does not provide federal financial participation for the services.
Coverage of group physical therapy under Medical Assistance
The bill directs DHS to promulgate rules by July 1, 2022, to include group
physical therapy as one of the physical therapy services authorized for
reimbursement under the Medical Assistance program. The bill allows DHS to
promulgate emergency rules to authorize group physical therapy for reimbursement
under the Medical Assistance program.
Coverage of substance abuse treatment room and board under Medical
Assistance
The bill directs DHS to pay allowable charges on behalf of recipients of Medical
Assistance for room and board for residential substance use disorder treatment.
Community-based psychosocial services
Currently, community-based psychosocial services provided to Medical
Assistance recipients are reimbursed only when the federal government agrees to
provide its financial participation for the services, when the recipient's needs require
more than outpatient level services but less than provided by a community support
program, when the recipient's county has made the services available, when the
provider is certified by DHS under its rules, and when any other requirements
established by DHS by rule are met. The bill allows DHS to also provide
community-based psychosocial services to Medical Assistance recipients and
provide reimbursement for those services through providers other than those made
available by a county. Reimbursement to providers that are not county-based will
be both the federal and nonfederal share based on a fee schedule that is determined
by DHS. For a county that elects to provide the services, DHS must reimburse the
county for the federal and nonfederal amount of allowable charges under the Medical
Assistance program.
Medical Assistance program coverage of acupuncture services
The bill includes acupuncture that is provided by a certified acupuncturist as
a reimbursable benefit under the Medical Assistance program. The bill requires
DHS to submit to the federal government any request for federal approval necessary
to provide the reimbursement for an acupuncture benefit under the Medical
Assistance program.
Children's long-term support waiver program
The bill requires DHS to ensure that any eligible child who applies for the
disabled children's long-term support waiver program receives services under that
program. The disabled children's long-term support waiver program provides
services to children who have developmental, physical, or severe emotional
disabilities and who are living at home or in another community-based setting.
Acuity-based billing in nursing homes and community-based residential
facilities
Under current law, payment for health care provided in a nursing home or a
community-based residential facility under the Medical Assistance program is
determined by prospective payment systems updated annually by DHS. DHS is
required to implement an acuity-based payment rate system for determining
payments to nursing homes and community-based residential facilities for all
allowable, nonbillable services of a registered nurse, licensed practical nurse, or
nurse aide. The bill makes several changes to the acuity-based payment rate system
implemented by DHS to allow DHS to align the state's rate-setting methodology
with an updated Patient Driven Payment Model established by the federal Centers
for Medicare and Medicaid Services. Currently, DHS follows a Resource Utilization
Groupings model. Further, the bill allows DHS to use data from calendar years other
than calendar year 2020 or calendar year 2021 if DHS determines that either or both
of those years are inappropriate bases for prospective rate setting due to fluctuations
in costs caused by the COVID-19 pandemic.
Statewide minimum rate band for home and community-based long-term
health care supports
The bill directs DHS to develop a statewide rate band that would establish
equitable and sustainable minimum rates for home and community-based
long-term care supports. Home and community-based long-term care supports are
Medical Assistance programs designed to deliver long-term care to patients in their
own home or other community-based setting, rather than a nursing home or other
institutional setting. The bill also requires DHS to include in its 2023-25 biennial
budget request a proposal to implement the statewide rate band.
Payments for direct care in nursing and intermediate care facilities
The bill requires DHS to increase Medical Assistance payments, from the
increase in reimbursement for nursing facilities, also known as nursing homes, and
intermediate care facilities for persons with an intellectual disability, by an amount
specified in the bill, including the state and federal shares, to support staff who
provide direct care to residents of those facilities.
Hospital assessment
Currently, each hospital, including each critical access hospital, must pay an
assessment for the privilege of doing business in Wisconsin. The percentage of gross
patient revenues that each hospital must pay is adjusted so that the total amount
of assessments collected for all hospitals that are not critical access hospitals totals
$414,507,300 in each state fiscal year. The same percentage of gross patient
revenues is also assessed on critical access hospitals, though the amount is collected
separately from and deposited into a separate fund from that of other hospitals.
Current law requires DHS to use a portion of this total to pay for services provided
by hospitals under the Medical Assistance program, including the federal and state
share of Medical Assistance, in a total amount that equals the amount collected from
hospitals divided by 61.68 percent. Similarly, current law requires DHS to use a
portion of the amount collected from critical access hospitals to make payments to
critical access hospitals for Medical Assistance services in a total amount that equals
the amount collected from critical access hospitals divided by 61.68 percent. The bill
decreases the 61.68 percent to 53.69 percent if the state adopts the Medicaid
expansion, thus increasing the amount of payments that must be made to critical
access hospitals and other hospitals under the Medical Assistance program. The
Medicaid expansion, as authorized under the Patient Protection and Affordable Care
Act, allows a state to provide benefits under the Medicaid program to individuals who
have an income up to 133 percent of the federal poverty line and who were previously
ineligible for Medicaid, and in exchange, the Affordable Care Act then provides that
the federal government pays an increased percentage of the cost of the benefits for
those newly eligible individuals.
Medical Assistance reimbursement rates for direct care in personal care
agencies
The bill requires DHS to increase the reimbursement rates paid for direct care
under the Medical Assistance program to agencies that provide personal care
services to support staff in those agencies that provide direct care. For purposes of
Medical Assistance, “personal care services” are defined as medically oriented
activities that assist recipients with activities of daily living that are necessary to
maintain the individual in his or her residence in the community, such as eating,
bathing, dressing, meal preparation, or shopping for food.
Disproportionate share hospital payments
Current law requires DHS to make payments under the Medical Assistance
program to hospitals that serve a disproportionate share of low-income patients.
These hospitals are referred to as “disproportionate share hospitals,” and the
payments are known as DSH payments. DHS must pay $27,500,000 in each fiscal
year, cumulatively, as the state share of DSH payments and must also pay to the
disproportionate share hospitals the amounts contributed by the federal
government. For a hospital to receive a DSH payment under current law, the
hospital must be a Wisconsin hospital providing a wide array of services that meets
applicable requirements under federal law and for which at least 6 percent of all total
inpatient days at the hospital are Medical Assistance recipients' inpatient days.
Current law provides mechanisms for determining how DSH payments are
distributed among eligible hospitals and imposes some limits on payments,
including that no single hospital may receive more than $4,600,000 per fiscal year.
The bill increases, if the state adopts the Medicaid expansion, the state share of the
cumulative amount of DSH payments in a fiscal year to $47,500,000 and increases
the single hospital limit to $7,950,000. The Medicaid expansion, as authorized under
the Patient Protection and Affordable Care Act, allows a state to provide benefits
under the Medicaid program to individuals who have an income up to 133 percent
of the federal poverty line and who were previously ineligible for Medicaid, and in
exchange, the Affordable Care Act then provides that the federal government pays
an increased percentage of the cost of the benefits for those newly eligible
individuals.
Critical access reimbursement payments to dental providers
The bill requires DHS to provide enhanced reimbursement payments under the
Medical Assistance program to dental providers who meet certain qualifications. In
order to qualify, a provider must meet quality of care standards established by DHS.
In addition, at least 50 percent of individuals served by a nonprofit or public provider
must be without dental insurance or enrolled in the Medical Assistance program for
the provider to qualify for enhanced reimbursement, and a for-profit provider must
have at least 5 percent of patients enrolled in the Medical Assistance program.
For services rendered by a qualified nonprofit or public dental provider, DHS
must increase reimbursement by 50 percent above the reimbursement rate
otherwise paid to that provider. For services provided by a qualified for-profit
provider, DHS must increase reimbursement by 30 percent above the
reimbursement rate otherwise paid to that provider. For qualified providers serving
individuals in managed care under the Medical Assistance program, DHS must
increase reimbursement to pay an additional amount on the basis of the rate that
would have been paid to the provider had the individual not been enrolled in
managed care. If a provider has more than one service location, reimbursement is
determined separately for each location. Under the bill, any providers receiving
reimbursement through the existing dental reimbursement pilot project are not
eligible for critical access reimbursement payments.
Eliminating prescription drug copayments under Medical Assistance
Under current law, states may require recipients of Medical Assistance to
contribute a share of the costs of their health care. Such a contribution is referred
to as a copayment or cost sharing. The bill eliminates all copayment requirements
for prescription drugs under the state Medical Assistance plan and specifies that the
receipt of prescription drugs is a service that is not subject to recipient cost sharing.
Payments to tribes for medical assistance administration
The bill directs DHS to make payments to eligible tribal governing bodies or
tribal health care providers for the administration and reimbursement of Medical
Assistance services. DHS must 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 is in place and
the state share of Medical Assistance payments that would have been paid for those
services absent care coordination agreements. The bill specifies that care
coordination agreements must be in compliance with federal requirements.
Children
Qualified residential treatment programs
The bill allows for the certification of qualified residential treatment programs
and establishes certain procedures that apply when a child is placed in one.
The bill allows DCF to certify a residential care center for children and youth,
group home, or shelter care facility to operate a qualified residential treatment
program (QRTP) if it determines that the program meets the federal requirements
for such a program to receive Title IV-E child welfare funding and DCF's
requirements for such a program. The bill allows DCF to monitor compliance with
certification requirements, including by inspection authority, and to deny, suspend,
restrict, refuse to renew, or otherwise withhold a certification for failure to comply
with those requirements. Under the bill, DCF may promulgate rules for the
establishment, certification, operation, and monitoring of, and the placement of a
child in, a QRTP.
Currently, when a child or juvenile (collectively referred to as “child”
) alleged
or adjudged to be in need of protection or services is removed from his or her home
in a proceeding under the Children's Code or Juvenile Justice Code, the agency
responsible for that child's removal is required to prepare a permanency plan,
designed to ensure that the child is reunified with his or her family whenever
appropriate, or that the child quickly attains a placement or home providing
long-term stability. Current law requires the juvenile court to periodically review
the plan and to periodically hold a hearing on the plan.
Under the bill, if a child is placed in a certified QRTP, the agency must assemble
a family permanency team to participate in permanency planning for the child, and
invite appropriate biological family members, relatives, like-kin, and professionals
who serve as a resource for the family to participate. The bill requires the agency to
include in the permanency plan information about the family permanency team and
its meetings and recommendations.
The bill requires that, in a review or hearing on a permanency plan for a child
who is placed in a certified QRTP, the agency that prepared the permanency plan
must present to the juvenile court certain information that the juvenile court must
consider when determining the continuing necessity for and the safety and
appropriateness of the placement, including 1) whether the placement is supported
by assessment of the child's needs, is the most effective and appropriate level of care
in the least restrictive environment, and meets the goals for the child in the
permanency plan; 2) the specific treatment or service needs that the placement will
meet and how long the child will need that treatment or service; and 3) the efforts
made by the agency to prepare the child to return home or to be placed with a relative,
guardian, or adoptive parent or in a foster home.
Under the bill, if a child is placed or proposed to be placed in a certified QRTP
in juvenile court proceedings for a temporary physical custody (TPC) hearing, a
change in placement (CIP), consent decree, or a disposition, a qualified individual
must conduct an assessment, using a tool determined by DCF, of the strengths and
needs of the child to determine the appropriateness of that placement (standardized
assessment). The bill creates a definition for “qualified individual” to match the term
used in federal law, meaning a trained professional or licensed clinician who is not
an employee of the state and who is not connected to, or affiliated with, any
placement setting in which children are placed by the state. The federal law
definition provides that a state may request a waiver from this definition, and on
December 14, 2020, Wisconsin requested such a waiver to allow state and county
child welfare staff to serve as qualified individuals.
The bill requires the qualified individual to develop a recommendation on all
of the following: 1) whether the proposed placement will provide the child with the
most effective and appropriate level of care in the least restrictive environment; 2)
how the placement is consistent with the short-term and long-term goals for the
child in the permanency plan; 3) the reasons why the child's needs can or cannot be
met by the child's family or in a foster home (and a shortage or lack of foster homes
is not an acceptable reason); and 4) the placement preference of the family
permanency team and, if it is not the placement recommended by the qualified
individual, why that recommended placement is not preferred. Then, depending on
the type of proceeding, the intake worker, agency primarily responsible for providing
services under a temporary custody, person or agency primarily responsible for
implementing the dispositional order, or agency appointed as the guardian of the
child must submit the standardized assessment and the qualified individual's
recommendation to the juvenile court and any person who is required to receive a
copy of the notice or request in the proceeding.
Under the bill, the standardized assessment and recommendation must be
submitted by the time of a TPC hearing, by the time the notice or request is filed in
a CIP proceeding, by the time the consent decree is entered, or by the time the
disposition report is filed. With respect to most CIP proceedings, if not available by
the time the notice or request is filed, the bill generally requires it to be submitted
within 10 days after the filing of the CIP notice, except this does not apply to a CIP
requested by someone other than the intake worker, agency, district attorney, or
corporation counsel or from in-home to out-of-home, to a consent decree, or to a
disposition. In all cases, if the required information is not available by these first
deadlines, it must be submitted no later than 30 days after the date on which the
placement is made.
The bill requires the juvenile court to make the following findings when it
issues an order placing a child in a certified QRTP: 1) whether the needs of the child
can be met through placement in a foster home; 2) whether placement of the child
in a certified QRTP provides the most effective and appropriate level of care for the
child in the least restrictive environment; 3) whether the placement is consistent
with the short-term and long-term goals for the child in the permanency plan; and
4) whether the juvenile court approves or disapproves the placement. The answers
to these questions do not affect whether the placement may be made. If the
standardized assessment and recommendation of the qualified individual are not
available at the time of this order, the bill requires the juvenile court to defer making
the findings. However, by no later than 60 days after the date on which the
placement was made the juvenile court must issue an order making those findings.
The bill requires that, for youth in out-of-home care who are parenting or
pregnant, a permanency plan must include 1) a list of the services or programs to be
provided to or on behalf of the child to ensure that the child, if pregnant, is prepared
and, if a parent, is able to be a parent; and 2) the out-of-home care prevention
strategy for any child born to the parenting or pregnant child.
Foster and kinship care rates
The bill increases the rates that are paid to a foster parent or a kinship care
relative (a relative other than a parent) who is providing care and maintenance for
a child.
The bill increases the monthly basic maintenance rates that are paid by the
state or a county to all foster parents for the care and maintenance of a child by 2.5
percent beginning on January 1, 2022, and increases the age-based monthly basic
maintenance rates paid to parents providing higher than level one care by an
additional 2.5 percent beginning on January 1, 2023. Beginning on January 1, 2022,
the monthly rates are $300 for a child of any age in a foster home certified to provide
level one care and, for a foster home certified to provide higher than level one care,
$431 for a child under five years of age, $472 for a child 5 to 11 years of age, $535 for
a child 12 to 14 years of age, and $559 for a child 15 years of age or over. Beginning
on January 1, 2023, the monthly rates for a foster home certified to provide higher
than level one care are increased to $442 for a child under five years of age, $484 for
a child 5 to 11 years of age, $548 for a child 12 to 14 years of age, and $573 for a child
15 years of age or over.
The bill also increases the monthly basic maintenance rates that are paid by the
state or a county to a kinship care relative (a relative other than a parent) who is
providing care and maintenance for a child. These rates are the same as for a foster
home certified to provide level one care.
Youth aids; allocations
Under current law, DCF is required to allocate to counties community youth
and family aids (youth aids) funding. Youth aids funding comes from various state
and federal moneys and is used to pay for state-provided juvenile correctional
services and local delinquency-related and juvenile justice services. The bill updates
the allocation of youth aids funding that is available to counties for the 2021-23 fiscal
biennium.
Under current law, some of the youth aids funding is allocated to reimburse
counties that are purchasing community supervision services from DOC for
juveniles, and some of the funding is allocated for alcohol and other drug abuse
treatment programs. The bill eliminates these earmarks and instead provides that
DCF may use youth aids funding to reimburse counties for the costs associated with
the care and maintenance of juveniles who are adjudged delinquent and who are
placed in certain secured juvenile facilities under the supervision of a county or the
state.
Youth aids; administration
Current law allocates some youth aids for the purchase of juvenile correctional
services, emergencies, provision of community supervision services for juveniles,
and for alcohol and other drug abuse treatment programs. Also under current law,
DCF may award funding to counties for early intervention services for first offenders
under the Community Intervention Program (CIP).
The bill replaces CIP with the Youth Justice System Improvements Program.
Under the bill, DCF may use funding for the Youth Justice System Improvements
Program to support diversion programs, to address emergencies related to youth
aids, or to fund other activities required of DCF under youth aids.
Under current law, youth aids funding is allocated to counties on a calendar
year basis. Youth aids funds that are not spent in the calendar year can be carried
forward three ways: 1) DCF may carry forward 5 percent of a county's allocation for
that county for use in the subsequent calendar year; 2) DCF may carry forward
$500,000 or 10 percent of its unspent youth aids funds, whichever is larger, for use
in the subsequent two calendar years; and 3) DCF may carry forward any unspent
emergency funds for use in the subsequent two calendar years.
The bill changes the way that unspent youth aids are reallocated. Under the
bill, DCF may still carry forward 5 percent of a county's allocation for that county to
use in the next calendar year. However, instead of carrying forward $500,000 or 10
percent of its unspent youth aids funds, whichever is larger, for use in the next two
calendar years, under the bill, DCF may transfer 10 percent of unspent youth aids
funds to the Youth Justice System Improvements Program.
Child abuse and neglect prevention program; home visitation
Under current law, DCF provides funding to counties, cities, private agencies,
and Indian tribes to provide home visitation program services to individuals who are
determined, through a risk assessment, to be at risk of poor birth outcomes or of
abusing or neglecting his or her child. The bill requires DCF to allocate an additional
$500,000 per year to the Nurse Family Partnership home visitation program in
Milwaukee county, beginning in fiscal year 2021-22.
Recruitment for adoptive placements
The bill requires DCF to provide $300,000 annually to the Wendy's Wonderful
Kids program at the Children's Hospital of Wisconsin, which provides support in
finding adoptive placements for children with special needs in foster care. The bill
specifies that the funding is to recruit adoptive placements for children in Milwaukee
County.
Grants to support foster parents and children
2017 Wisconsin Act 260 established a one-year pilot program for DCF to
distribute grants to counties, nonprofit organizations, and tribes for the purpose of
supporting foster parents and providing normalcy for children in out-of-home care.
The bill makes the grant program permanent and specifies that grants under the
program may be distributed for the purpose of sibling reconnection.
Five-county pilot program for representation of parents in CHIPS
proceedings.
Under current law, a parent is generally not entitled to representation by a
public defender in a proceeding under the Children's Code in which a child is alleged
to be in need of protection or services. However, a pilot program that began in 2018
requires the state public defender to assign counsel to any nonpetitioning parent in
these cases in the counties of Brown, Outagamie, Racine, Kenosha, and Winnebago.
This five-county pilot program is set to expire on June 30, 2021. The bill extends the
expiration date of the pilot program to June 30, 2023.
Congregate care facility staff training
The bill specifies that DCF is authorized to provide training to staff or
contractors of a congregate care facility or a child welfare agency.
Grants for youth services
The bill consolidates certain DCF youth services programs into a new youth
services grant program. Under current law, the following DCF programs provide
youth services: grants for services for homeless and runaway youth, treatment and
services for children who are the victims of sex trafficking, grants for children's
community programs, and the Brighter Futures Initiative. Under the bill, these
programs are consolidated into the youth services grant program, under which DCF
must distribute grants to public agencies, nonprofit corporations, and Indian tribes
to provide programs that accomplish one or more of the following purposes:
1. Increasing youth access to housing.
2. Increasing youth self-sufficiency through employment, education, and
training.
3. Increasing youth social and emotional health by promoting healthy and
stable adult connections, social engagement, and connection with necessary
services.
4. Preventing sex trafficking of children and youth.
5. Providing treatment and services for documented and suspected victims of
child and youth sex trafficking.
6. Preventing and reducing the incidence of youth violence and other
delinquent behavior.
7. Preventing and reducing the incidence of youth alcohol and other drug use
and abuse.
8. Preventing and reducing the incidence of child abuse and neglect.
9. Preventing and reducing the incidence of teen pregnancy.
Under current law, DCF must allocate in each fiscal year specific amounts of
money, including federal moneys received under the Temporary Assistance for
Needy Families (TANF) block grant program, for various public assistance
programs, including $500,000 for the Brighter Futures Initiative for programs to
provide evidence-based programs and practices for substance abuse prevention to
at-risk youth and their families. Under the bill, this amount is allocated instead to
the grants for youth services.
Under current law, DHS transfers amounts to DCF for the Brighter Futures
Initiative. Under the bill, DHS transfers those amounts to DCF for the grants for
youth services. The bill maintains a requirement, currently under the Brighter
Futures Initiative, that DCF distribute $55,000 in each fiscal year to Diverse and
Resilient, Inc., to provide youth services, as part of the new youth services grant
program.
Safety promotion and placement prevention services
The bill creates new authority for DCF to provide funding for services or to
provide direct evidence-based services or support to agencies for the provision of
evidence-based services aimed at preventing the removal of children from the home
under the Children's Code and the Juvenile Justice Code.
The bill also creates a new GPR appropriation for DCF to provide services that
allow a child to remain at home in lieu of an out-of-home placement.
Children and family services
Under current law, DCF must distribute not more than $80,125,200 in fiscal
year 2019-20 and $101,145,500 in fiscal year 2020-21 to counties for children and
family services. The bill increases the maximum amount DCF must distribute to
counties for these services to $106,389,600 in fiscal year 2021-22 and $111,868,900
in fiscal year 2022-23.
Diversity, equity, and inclusion grants
The bill requires DCF to award grants to public, private, or nonprofit entities
that promote diversity and advance equity and inclusion.
Health
