The bill requires hospitals to provide a patient or, if applicable, a patient's legal
guardian with an opportunity to designate a caregiver who will receive, before the
patient is discharged from the hospital, instruction regarding assistance with the
patient's care after discharge.
Under the bill, a hospital must, no later than 24 hours following a patient's
admission to a hospital and before the patient is discharged or transferred, provide
at least one opportunity for a patient or, if applicable, a patient's legal guardian to
designate at least one caregiver. If a patient is unconscious or otherwise
incapacitated when admitted, the hospital shall provide an opportunity for caregiver
designation within 24 hours after the patient regains consciousness or capacity. If
a patient or legal guardian designates a caregiver, a hospital must promptly record
the name and contact information of the caregiver. If a patient or legal guardian
declines to designate a caregiver, the hospital must also promptly document that
information. Patients are not required to designate a caregiver under the bill and,
further, the designation of a caregiver does not obligate any individual to provide
aftercare for the patient. A patient may elect to change the designated caregiver at
any time, and the hospital must record the change within 24 hours.
The bill requires that if a patient designates a caregiver, the hospital must
promptly request written consent to release medical information to the patient's
caregiver. If the patient or the patient's legal guardian declines to provide consent,
the hospital is relieved of its notification and consultation obligations.
Under current law, patient medical records are kept confidential except in
certain limited circumstances, including if a patient or a person authorized by the
patient gives consent to the disclosure. Even without agreement, a health care
provider may provide to the patient's immediate family, another relative, a close
personal friend of the patient, or an individual identified by the patient, that portion
of information from the health care record directly relevant to that individual's
involvement in the patient's care. The bill adds designated caregivers to the list of
individuals permitted access to information directly relevant to that individual's
involvement in the patient's care.
Pediatric inpatient supplement
The bill establishes in statute reference to supplemental funding totaling
$2,000,000 to be distributed by DHS to certain acute care hospitals located in
Wisconsin that have a total of more than 12,000 inpatient days in the hospital's acute
care pediatric units and intensive care pediatric units, not including neonatal
intensive care units. In addition, under the bill, DHS may distribute additional
funding of $7,500,000 in each state fiscal year to hospitals that are free-standing
pediatric teaching hospitals located in Wisconsin that have a Medicaid inpatient
utilization rate greater than 45 percent if DHS has expanded eligibility for the
Medical Assistance program under the federal Patient Protection and Affordable
Care Act.
Tailored caregiver assessment and referral (TCARE) pilot program
The bill requires DHS to conduct, during fiscal year 2021-22, a one-year
Tailored Caregiver Assessment and Referral pilot program as described in the
September 2020 report of the Governor's Task Force on Caregiving. Tailored
Caregiver Assessment and Referral, commonly referred to as TCARE or a family
caregiver survey, is an evidence-based care management protocol designed to
support family members who are providing care to adults of any age with chronic or
acute health conditions. TCARE includes both a pre-screening tool and a full
assessment that seeks information from the family or informal caregiver in order to
assess their health and well-being, stress levels, challenges, skills needed to perform
care, their informal support system, and strengths that enable them to provide care.
Title V and Title X family planning funding
Current law requires DHS to apply for federal Title X grant funds and to
distribute any funds received to public entities for family planning and related
preventive health services. The bill eliminates that requirement.
Under current law, DHS must allocate women's health funds, which are federal
Title V funds and women's health block grant funds, to develop and maintain an
integrated system of community health services and maximize coordination of
family planning services. Current law excludes from the definition of “family
planning” the performance, promotion, encouragement, or counseling in favor of, or
referral either directly or through an intermediary for, voluntary termination of
pregnancy but includes in the definition of “family planning” the provision of
nondirective information explaining prenatal care and delivery or infant care, foster
care, or adoption. DHS must distribute women's health funds only to public entities.
Currently, those public entities may provide some or all of the funds to other public
entities or private entities as long as the recipients of the funds do not provide
abortion services, make referrals for abortion services, or have an affiliate that
provides abortion services or makes referrals for abortion services. The bill retains
the authorization for the public entity that receives funds from DHS to provide some
or all of the funds to other public or private entities but eliminates the restriction on
which public or private entities may receive those funds. The bill also includes in the
definition of “family planning” the provision of nondirective information explaining
pregnancy termination.
Grants to free and charitable clinics
Under current law, DHS is required to award grants each fiscal year to several
classes of community health centers. A community health center is a health care
entity that provides primary health care, health education, and social services to
low-income individuals. The 2019 biennial budget act,
2019 Wisconsin Act 9,
required DHS to annually award $500,000 in grants to free and charitable clinics
from the same community health services appropriation. The bill continues the
grant for free and charitable clinics and directs DHS to annually award $2,500,000
in grants to free and charitable clinics. The bill defines “free and charitable clinics”
as health care organizations that use a volunteer and staff model to provide health
services to uninsured, underinsured, underserved, economically and socially
disadvantaged, and vulnerable populations and that meet criteria specified in the
bill.
Black women's health and infant and maternal mortality
The bill instructs DHS to annually award $1,750,000 in grants to
community-serving organizations that are led by Black women that improve Black
women's health in Dane, Milwaukee, Rock, and Kenosha Counties. Further, the bill
directs DHS to annually award $1,750,000 in grants to organizations that work to
reduce racial disparities related to infant and maternal mortality. Additionally, the
bill instructs DHS to award a grant totaling $500,000 in fiscal year 2021-22 and
another grant totaling $500,000 in fiscal year 2022-23 to an entity to coordinate
efforts between the state, public and private sector organizations, and community
organizations to support a statewide strategy to advance Black women's health.
Alzheimer's family and caregiver support
Under current law, DHS distributes funds for certain community aids,
including for the Alzheimer's family and caregiver support program. The bill
increases the community aid funding available for the Alzheimer's family and
caregiver support program from not more than $2,558,900 each fiscal year to not
more than $3,058,900 each fiscal year, and broadens financial eligibility for the
program by increasing the maximum joint income an individual and the individual's
spouse may earn per year and remain financially eligible from $48,000 to $55,000.
Health equity grants
The bill directs DHS to award grants to community organizations to implement
community health worker care models. The bill also directs DHS to award grants
to community organizations and local or tribal health departments to hire health
equity strategists and to implement health equity action plans.
Lead screening and outreach grants
Under current law, DHS must award grants related to lead poisoning and lead
exposure prevention. The bill increases the amount of money granted to fund lead
screening and outreach activities at community-based human service agencies that
provide primary health care, health education, and social services to low-income
individuals in first class cities from $125,000 each fiscal year to $175,000. Currently,
the only first class city is Milwaukee.
Wisconsin drug repository program
Under current law, DHS is required to maintain a drug repository program
under which persons may donate certain drugs or supplies that may be used by other
individuals identified by the department by rule. The bill allows DHS to partner
with out-of-state drug repository programs. The bill also allows out-of-state
persons to donate to the drug repository program in Wisconsin, and persons in
Wisconsin to donate to participating drug repository programs in other states.
Further, the bill directs DHS to study and implement a centralized physical drug
repository program.
Surgical quality improvement grant
The bill allows, but does not require, DHS to award a onetime grant up to a total
amount of $335,000 in fiscal year 2021-22 to support surgical quality improvement
activities. The bill allows DHS to transfer moneys appropriated for this grant from
fiscal year 2021-22 to fiscal year 2022-23.
Spinal cord injury research grants and symposia
The bill requires DHS to establish a program to award grants to persons in this
state for research into spinal cord injuries. The grants must support research into
new and innovative treatments and rehabilitative efforts for the functional
improvement of people with spinal cord injuries. Research topics may include
pharmaceutical, medical device, brain stimulus, and rehabilitative approaches and
techniques. DHS must make annual reports to the legislature about the grants. The
bill also allows DHS to hold symposia every two years for grant recipients to present
their research findings. The bill biennially appropriates general purpose revenues
not exceeding $3,000,000 for the grants and symposia.
The bill also requires DHS to appoint a Spinal Cord Injury Council with one
member representing the University of Wisconsin School of Medicine and Public
Health, one member representing the Medical College of Wisconsin, and the
following members: 1) a person with a spinal cord injury; 2) a family member of a
person with a spinal cord injury; 3) a veteran with a spinal cord injury; 4) a physician
specializing in the treatment of spinal cord injuries; 5) a neurosurgery researcher;
and 6) a researcher employed by the Veterans Health Administration of the U.S.
Department of Veterans Affairs. If DHS is unable to appoint any of the foregoing
members, the bill allows DHS to appoint, in lieu of that member, a member
representing the general public. Members of the council have two-year terms. The
bill requires the council to develop criteria for DHS to evaluate and award grants,
review and make recommendations on grant applications, and perform other duties
specified by DHS. Council members must make written disclosures of financial
interests in organizations that the council recommends for grants.
Public health campaign to prevent tobacco and vapor product use
The bill allows DHS to develop and carry out a public health campaign aimed
at the prevention of initiation of tobacco and vapor product use. The bill also allows
DHS to distribute grants to local and regional organizations working on youth
vaping and providing cessation services.
Direct support professional training pilot program
The bill directs DHS to develop and implement a pilot program in the 2021-23
biennium to provide person-centered direct support professional training to achieve
consistent standards of health care practice. The bill instructs DHS to collaborate
with DWD, TCS, and health care providers in developing and implementing the pilot
program. Further, the bill directs DHS to develop a career plan that describes the
steps that lead to potential certification as a nurse aide.
Behavioral health and developmental disabilities
Guardianship training requirements
The bill establishes mandatory initial training requirements for certain
guardians. Under current law, a guardian of the person is a person appointed by a
court to act to secure any necessary care or services for the ward that are in the ward's
best interests, and a guardian of the estate is a person appointed by a court to provide
a ward with the greatest amount of independence and self-determination with
respect to property management. Currently, there are no training requirements for
guardians of the person or guardians of the estate.
Under the bill, guardians of the person must complete training on all of the
following topics: 1) the duties and responsibilities of a guardian of the person under
the law and limits of the guardian of the person's decision-making authority; 2)
alternatives to guardianship, included supported decision-making and powers of
attorney; 3) rights retained by the ward; 4) best practices for a guardian to solicit and
understand the wishes and preferences of a ward, to involve a ward in
decision-making, and to take a ward's wishes and preferences into account in
decisions made by the guardian; 5) restoration of a ward's rights and the process for
removal of guardianship; 6) future planning and identification of a potential standby
or successor guardian; and 7) resources and technical support for guardians. The bill
also requires that guardians of the estate complete training on the duties and
responsibilities of a guardian of the estate under the law, limits of a guardian of the
estate's decision-making authority, and inventory and accounting requirements.
The bill provides limited exemptions for guardians of minors and children and
certain corporate and volunteer guardians.
Under the bill, a proposed guardian of the person or a proposed guardian of the
estate must submit, as part of the guardianship case, a sworn and notarized
statement to the court that the proposed guardian has completed the training
requirements.
The bill requires DHS to award a grant to administer and conduct the required
guardian training. DHS must require, in the request for proposal, that the grantee
have expertise in state guardianship law, experience with technical assistance and
support to guardians and wards, and knowledge of common challenges and questions
encountered by guardians and wards. In addition, the grantee selected to develop
training shall develop plain-language, web-based training modules using
adult-learning design principles that can be accessed for free by training topic and
in formats that maximize accessibility, with printed versions available for free upon
request.
Early intervention services for children with lead in their blood
Under current law, DHS implements a statewide program, referred to as the
Birth to 3 program, that provides early intervention services for children aged three
and under who are developmentally delayed or are diagnosed as having a condition
that is likely to result in significantly delayed development. The bill ensures that
children with a concentration of lead in their blood of at least 5 micrograms per 100
milliliters of blood are eligible for services under the Birth to 3 program.
Crisis response system
The bill requires DHS to award grants to entities to provide a continuum of
mental health crisis services, including crisis urgent care and observation centers,
crisis stabilization and inpatient psychiatric beds, and crisis stabilization facilities.
DHS must also award up to five grants for services at facilities providing crisis
stabilization services. The bill also allows DHS to create a certification for crisis
urgent care and observation centers and establish criteria for that certification by
rule. If DHS creates the certification, then no one may operate a crisis urgent care
and observation center without a certification.
Bed tracking system
Currently, DHS is required to award a grant to the entity that collects data on
hospitals for the purpose of developing and operating a system to show the
availability of inpatient psychiatric beds. To receive the grant, the entity must use
a secure website to allow reporting of and access to information on the availability
and location of psychiatric beds by hospitals and inpatient units. The bill expands
the system to include reporting of availability of peer run respite and crisis
stabilization beds by facilities, centers, and programs and expands access to the
system to county departments and any other entity that is involved in identifying
placement options. The bill also increases the amount of the grant awarded in each
fiscal year.
Crisis program enhancement grants
The bill expands the crisis program enhancement grant program to include
grants to establish and enhance law enforcement and behavioral health emergency
response collaboration services and grants to Milwaukee County to enhance mobile
crisis teams. Under current law, the program requires DHS to award grants to
counties or regions of counties to establish or enhance crisis programs to serve
individuals having crises in rural areas. The bill instructs DHS to annually award
at least $1,250,000 to establish and enhance law enforcement and behavioral health
services emergency response collaboration programs, and at least $850,000 to
Milwaukee County to enhance mobile crisis teams.
The bill requires any entity, including a county or region, that receives a grant
to establish and enhance law enforcement and behavioral health services emergency
response collaboration programs to contribute at least 25 percent of the grant
amount awarded for the purpose that the grant money is received.
County crisis call center support
Under current law, DHS awards several grants during each fiscal biennium to
certain entities for various programs involving mental health and crisis
intervention. The bill directs DHS to annually award grants to support mental
health professionals to provide supervision and consultation to individuals who
support crisis call center services. The bill specifies that each county or multicounty
program that receives supervision and consultation services from a mental health
professional awarded a grant under this program shall contribute at least 10 percent
of the costs of the services that the mental health professional incurs for the purpose
that the grant is received.
Trauma response teams
The bill directs DHS to annually award a grant equal to $450,000 for the
Milwaukee Trauma Response Team, which is a joint venture between the City of
Milwaukee, the Milwaukee Police Department, and Wraparound Milwaukee's
Mobile Urgent Treatment Team to provide support and guidance for children who
have witnessed or have been exposed to potentially traumatic events.
Deaf, Hard of Hearing, and Deaf-Blind Behavioral Health Treatment
Center
The bill allows DHS, as part of the grants DHS is required to award for
community programs, to distribute up to $1,936,000 in each fiscal year starting with
fiscal year 2022-23 to a statewide provider of behavioral health treatment services
for individuals who are deaf, hard of hearing, or deaf-blind.
Opioid and methamphetamine data system
The bill requires DOA to issue a request for proposals to establish and maintain
an opioid and methamphetamine data system to collect, format, analyze, and
disseminate information on opioid and methamphetamine use as specified in the bill.
DOA must collaborate with and collect data from DHS, DOC, DOJ, DSPS, and DCF
and any other applicable agencies for the opioid and methamphetamine data system.
Under the bill, DOA administers the contract with a vendor to operate the opioid and
methamphetamine data system, has access to the data contained in the opioid and
methamphetamine data system, and works with the vendor to disseminate
information and advanced analytics from the opioid and methamphetamine data
system in as close to real time as possible. The opioid and methamphetamine data
system must allow the state agencies that submit data to the opioid and
methamphetamine data system access to the data in the opioid and
methamphetamine data system as appropriate for the agency to fulfill its functions
and as allowed by state and federal confidentiality laws. The bill requires DOA to
submit a report to the governor and appropriate standing committees of the
legislature summarizing the information from the opioid and methamphetamine
data system and analyzing trends in that information across years of data collection.
Behavioral health technology grants
The bill appropriates general purpose revenue to DHS to provide grants to
behavioral health providers to implement electronic health records systems and
connect to health information exchanges.
Medication-assisted treatment grants
The bill directs DHS, as part of the grants DHS is required to award for
community programs, to award up to $500,000 in grants in fiscal year 2021-22 and
then up to $1,000,000 annually thereafter to develop or support entities that offer
medication-assisted treatment. Medication-assisted treatment addresses opioid
use disorder and opioid dependence.
Substance use harm reduction grant
The bill allows DHS, as part of the grants DHS is required to award for
community programs, to annually award up to $250,000 to organizations with
comprehensive harm reduction strategies for the development or support of
substance use harm reduction programs, as determined by DHS.
Addiction treatment platform
The bill directs DHS to contract in fiscal year 2022-23 for the development of
a substance use disorder treatment platform that allows for the comparison of
substance use disorder treatment programs in the state. Substance use disorder
treatment programs treat individuals for substance use disorder by offering services
including counseling, medication management, and recovery coaching. The bill
requires that DHS may spend no more than $300,000 on the contract.
Training for methamphetamine addiction treatment
The bill appropriates general purpose revenue to DHS to provide grants to
provide trainings to substance use disorder treatment providers on treatment
models for methamphetamine addiction.
General health and human services
Making references in the statutes gender neutral
The bill recognizes same-sex marriage by making references in the statutes to
spouses gender neutral, with the intent of harmonizing the Wisconsin Statutes with
the holding of the U.S. Supreme Court in Obergefell v. Hodges, 135 S. Ct. 2584, 192
L. Ed. 2d 609 (2015), which recognizes that same-sex couples have a fundamental
constitutional right to marriage. The bill also recognizes legal parentage for
same-sex couples under certain circumstances and adopts gender neutral parentage
terminology.
The bill provides that marriage may be contracted between persons of the same
sex and confers the same rights and responsibilities on married persons of the same
sex that married persons of different sexes have under current law. The bill defines
“spouse" as a person who is legally married to another person of the same sex or a
different sex and replaces every reference to “husband" or “wife" in current law with
“spouse." The bill makes applicable to married persons of the same sex all provisions
under current law that apply to married persons of different sexes. These provisions
relate to such diverse areas of the law as income tax, marital property, inheritance
rights, divorce, child and spousal support, insurance coverage, family and spousal
recreational licenses, consent to conduct an autopsy, domestic abuse, and eligibility
for various types of benefits, such as retirement or death benefits and medical
assistance.
In addition to making statutory references to spouses gender neutral, the bill
specifies ways in which married couples of the same sex may be the legal parents of
a child and, with some exceptions, makes current references in the statutes to
“mother" and “father," and related terms, gender neutral.
Under current law, all of the following may adopt a child: a husband and wife
jointly, a husband or wife whose spouse is the parent of the child, and an unmarried
adult. Because the bill makes references in the statutes to spouses gender neutral,
same-sex spouses jointly may adopt a child and become the legal parents of the child,
and a same-sex spouse of a person who is the parent of a minor child may adopt the
child and become the legal parent of his or her spouse's child.
Under current law, if a woman is artificially inseminated under the supervision
of a physician with semen donated by a man who is not her husband and the husband
consents in writing to the artificial insemination of his wife, the husband is the
natural father of any child conceived. Under the bill, one spouse may also consent
to the artificial insemination of his or her spouse and is the natural parent of the child
conceived. The artificial insemination is not required to take place under the
supervision of a physician, but, if it does not, the semen used for the insemination
must have been obtained from a sperm bank.
Under current law, a man is presumed to be the father of a child if he and the
child's natural mother 1) were married to each other when the child was conceived
or born or 2) married each other after the child was born but had a relationship with
each other when the child was conceived and no other man has been adjudicated to
be the father or is presumed to be the father because the man was married to the
mother when the child was conceived or born. The paternity presumption may be
rebutted in a legal action or proceeding by the results of a genetic test showing that
the statistical probability of another man's parentage is 99.0 percent or higher. The
bill expands this presumption into a parentage presumption, so that a person is
presumed to be the natural parent of a child if he or she 1) was married to the child's
established natural parent when the child was conceived or born or 2) married the
child's established natural parent after the child was born but had a relationship
with the established natural parent when the child was conceived and no person has
been adjudicated to be the father and no other person is presumed to be the child's
parent because he or she was married to the mother when the child was conceived
or born. The parentage presumption may still be rebutted by the results of a genetic
test showing that the statistical probability of another person's parentage is 99.0
percent or higher. Expanding on current law, the bill allows for a paternity action
to be brought for the purpose of rebutting the parentage presumption, regardless of
whether that presumption applies to a male or female spouse.
Current law provides that a mother and a man may sign a statement
acknowledging paternity and file it with the state registrar. If the state registrar has
received such a statement, the man is presumed to be the father of the child. Under
current law, either person who has signed a statement acknowledging paternity may
rescind the statement before an order is filed in an action affecting the family
concerning the child or within 60 days after the statement is filed, whichever occurs
first. Under current law, a man who has filed a statement acknowledging paternity
that is not rescinded within the time period is conclusively determined to be the
father of the child. The bill provides that two people may sign a statement
acknowledging parentage and file it with the state registrar. If the state registrar
has received such a statement, the people who have signed the statement are
presumed to be the parents of the child. Under the bill, a statement acknowledging
parentage that is not rescinded conclusively establishes parentage with regard to the
person who did not give birth to the child and who signed the statement.
The bill defines “natural parent" as a parent of a child who is not an adoptive
parent, whether the parent is biologically related to the child or not. Thus, a person
who is a biological parent, a parent by consenting to the artificial insemination of his
or her spouse, or a parent under the parentage presumption is a natural parent of
a child. The definition applies throughout the statutes wherever the term “natural
parent" is used. In addition, the bill expands some references in the statutes to
“biological parent" by changing the reference to “natural parent."
Gender neutral references on birth certificates
Generally, the bill substitutes the term “spouse" for “husband" in the birth
certificate statutes and enters the spouse, instead of the husband, of the person who
has given birth on the birth certificate at times when a husband would currently be
entered on a birth certificate. The name of the person who has given birth is entered
on a birth certificate when the person gives birth to a child, and current law specifies
when another name should be entered on the birth certificate. Current law requires
that if a birth mother is married at any time from the conception to the birth of a
child, then her husband's name is entered on the birth certificate as the legal father
of the child. Under the bill, if a person who gives birth is married at any time from
the conception to the birth of the child, then that person's spouse's name is entered
as a legal parent of the child. The bill also specifies that, in the instance that a second
parent's name is initially omitted from the birth certificate, if the state registrar
receives a signed acknowledgement of parentage by people presumed to be parents
because the two people married after the birth of the child, the two people had a
relationship during the time the child was conceived, no person is adjudicated to be
the father, and no other person is presumed to be the parent, then the state registrar
must enter the name of the spouse of the person who gave birth as a parent on the
birth certificate.
Health information exchange grants
The bill requires DHS to provide a grant of $655,000 in each of fiscal years
2021-22 and 2022-23 to support health information exchange activities. Health
information exchange, generally, is the sharing of patient information between
health care providers or health care systems. The bill allows DHS to transfer moneys
appropriated for these grants between fiscal years.
Home care provider registry
The bill requires DHS to conduct a one-year pilot program to create a home care
provider registry to support home and community-based long-term care support
programs and clients and vendors of care services. DHS is required to use its
competitive request-for-proposals procedures to select a vendor of the software
platform for the registry.
housing
Homelessness
Priority for homeless children
The bill creates a two-year pilot program that gives priority to homeless
children and their families, as defined under federal law, on the waiting list that
WHEDA, or a public housing agency or other entity that contracts with WHEDA,
maintains under the federal Housing Choice Voucher Program. Under the bill,
WHEDA is required to develop policies and procedures for the pilot program.
Report on homeless children and youths
The bill requires DPI to annually submit a report to the legislature on the
number of homeless children and youths in the public schools of this state. Under
the bill, “homeless children and youths” is defined by reference to federal law
providing homeless assistance.
Rental assistance grants for homeless veterans
The bill requires DOA to award grants to each continuum of care organization
in Wisconsin for the purpose of providing tenant-based rental assistance to homeless
veterans. A continuum of care organization is an organization designated by the
federal Department of Housing and Urban Development that provides funding and
services to alleviate homelessness.
