Amendment AA3-SB70

SB70-AA3,91,17 (c) 1. The upper payment limit established under this subsection shall apply to all purchases and payor reimbursements of the prescription drug product dispensed or administered to individuals in this state in person, by mail, or by other means.

SB70-AA3,92,3 2. Notwithstanding subd. 1., while state-sponsored and state-regulated health plans and health programs shall limit drug reimbursements and drug payment to no more than the upper payment limit established under this subsection, a plan subject to the Employee Retirement Income Security Act of 1974 or Part D of Medicare under 42 USC 1395w-101 et seq. may choose to reimburse more than the upper payment limit. A provider who dispenses and administers a prescription drug product in this state to an individual in this state may not bill a payor more than the upper payment limit to the patient regardless of whether a plan subject to the Employee Retirement Income Security Act of 1974 or Part D of Medicare under 42 USC 1395w-101 et seq. chooses to reimburse the provider above the upper payment limit.

SB70-AA3,92,5 (5) Public inspection. Information submitted to the board under this section shall be open to public inspection only as provided under ss. 19.31 to 19.39.

SB70-AA3,92,9 (6) No prohibition on marketing. Nothing in this section may be construed to prevent a manufacturer from marketing a prescription drug product approved by the federal food and drug administration while the prescription drug product is under review by the board.

SB70-AA3,92,14 (7) Appeals. A person aggrieved by a decision of the board may request an appeal of the decision no later than 30 days after the board makes the determination. The board shall hear the appeal and make a final decision no later than 60 days after the appeal is requested. A person aggrieved by a final decision of the board may petition for judicial review in a court of competent jurisdiction.

SB70-AA3,9123 Section 9123. Nonstatutory provisions; Insurance.

SB70-AA3,92,21 (1u) Staggered terms for board. Notwithstanding the length of terms specified for the members of the board under s. 15.735 (1) (b) to (e), 2 of the initial members shall be appointed for terms expiring on May 1, 2025; 2 of the initial members shall be appointed for terms expiring on May 1, 2026; 2 of the initial members shall be appointed for terms expiring on May 1, 2027; and 2 of the initial members shall be appointed for terms expiring on May 1, 2028.

SB70-AA3,9423 Section 9423. Effective dates; Insurance.

SB70-AA3,93,2 (1v) Prescription drug affordability review board. The treatment of ss. 15.07 (3) (bm) 7., 15.735, 601.78, 601.785, and 601.79 and subch. VI (title) of ch. 601 and Section 9123 (1u) of this act take effect on the first day of the 7th month beginning after publication.”.

SB70-AA3,93,3 206. Page 374, line 11: after that line insert:

SB70-AA3,93,5 “ Section 84. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table

SB70-AA3,85 Section 85. 20.435 (5) (ch) of the statutes is created to read:

SB70-AA3,93,8 20.435 (5) (ch) Suicide and crisis lifeline grants. The amounts in the schedule for grants under s. 46.533.

SB70-AA3,86 Section 86. 46.533 of the statutes is created to read:

SB70-AA3,93,12 46.533 Suicide and crisis lifeline; grants. (1) In this section, “national crisis hotline” means the telephone or text access number “988,” or its successor, that is maintained under the federally administered program under 42 USC 290bb-36c.

SB70-AA3,93,16 (2) From the appropriation under s. 20.435 (5) (ch), the department shall award grants to organizations that provide crisis intervention services and crisis care coordination to individuals who contact the national crisis hotline from anywhere within this state.”.

SB70-AA3,93,17 207. Page 374, line 11: after that line insert:

SB70-AA3,93,18 “ Section 87. 49.79 (9) (f) of the statutes is repealed.”.

SB70-AA3,93,19 208. Page 374, line 11: after that line insert:

SB70-AA3,93,20 “ Section 88. 46.48 (36) of the statutes is created to read:

SB70-AA3,94,7 46.48 (36) Amyotrophic lateral sclerosis. From the appropriation under s. 20.435 (1) (b), the department shall award $250,000 in each fiscal year as a grant to an organization that supports and provides services to individuals with amyotrophic lateral sclerosis for the purposes of assisting individuals diagnosed with amyotrophic lateral sclerosis and their families with the costs of respite care and costs associated with amyotrophic lateral sclerosis that are not covered by insurance.”.

SB70-AA3,94,8 209. Page 374, line 11: after that line insert:

SB70-AA3,94,9 “ Section 9119. Nonstatutory provisions; Health Services.

SB70-AA3,94,23 (1) Low-value care analysis grant. From the appropriation under s. 20.435 (1) (b), in the 2023-24 and 2024-25 fiscal years, the department of health services shall award a grant in an amount not to exceed $900,000 in each fiscal year to an organization for the purpose of conducting a data analysis of claims under the medical assistance program administered by the department of health services and claims under health care coverage plans offered by the state under s. 40.51 (6) to identify low-value care. The recipient of the grant under this subsection shall report the organization's findings, including any recommendations for providing effective and efficient care, to the department of health services and the department of employee trust funds. The department of health services and the department of employee trust funds shall distribute the findings reported under this subsection to health care providers that provide services covered by the medical assistance program or a health care coverage plan and to health maintenance organizations and insurance companies that provide health insurance to state employees.”.

SB70-AA3,94,24 210. Page 374, line 11: after that line insert:

SB70-AA3,95,2 “ Section 89. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table - See PDF for table

SB70-AA3,90 Section 90. 20.435 (1) (ex) of the statutes is created to read:

SB70-AA3,95,6 20.435 (1) (ex) Maternal and infant mortality prevention and response. The amounts in the schedule for the prevention of and response to maternal and infant mortality under s. 253.143.

SB70-AA3,91 Section 91. 253.143 of the statutes is created to read:

SB70-AA3,95,10 253.143 Maternal and infant mortality prevention and response. From the appropriation under s. 20.435 (1) (ex), the department shall do all of the following:

SB70-AA3,95,12 (1) Annually award grants to community organizations whose goal is the prevention of maternal and infant mortality.

SB70-AA3,95,16 (2) Annually award grants to support the expansion of fetal and infant mortality review and maternal mortality review teams statewide and expand technical assistance and support for existing fetal and infant mortality review and child death review teams.

SB70-AA3,95,18 (3) Provide funding and technical assistance to community-based organizations aimed at preventing infant morality.

SB70-AA3,96,2 (4) Provide funding for grief and bereavement programming for those impacted by infant loss.

SB70-AA3,9119 Section 9119. Nonstatutory provisions; Health Services.

SB70-AA3,96,8 (1) Maternal and infant mortality prevention and response. The authorized FTE positions for the department of health services are increased by 2.0 FTE positions, to be funded from the appropriation under s. 20.435 (1) (ex), for the purpose of administering the maternal and infant mortality prevention and response program.”.

SB70-AA3,96,9 211. Page 374, line 11: after that line insert:

SB70-AA3,96,10 “ Section 92. 49.45 (7m) of the statutes is created to read:

SB70-AA3,96,18 49.45 (7m) Pay-for-performance; health information exchange. The department shall develop and implement for non-hospital providers in the Medical Assistance program, including physicians, clinics, health departments, home health agencies, and post-acute care facilities, a payment system based on performance to incentivize participation in health information data sharing to facilitate better patient care, reduced costs, and easier access to patient information. The department shall establish performance metrics for the payment system under this subsection that satisfy all of the following:

SB70-AA3,96,20 (a) The metric shall include participation by providers in a health information exchange at a minimum level of patient record access.

SB70-AA3,96,22 (b) The payment under the payment system shall increase as the participation level in the health information exchange increases.

SB70-AA3,96,23 (c) The payment system shall begin in the 2024 rate year.

SB70-AA3,97,2 (d) For purposes of the payment system, the department shall seek any available federal moneys.”.

SB70-AA3,97,3 212. Page 374, line 11: after that line insert:

SB70-AA3,97,4 “ Section 93. 49.45 (30p) of the statutes is created to read:

SB70-AA3,97,5 49.45 (30p) Detoxification and stabilization services. (a) In this subsection:

SB70-AA3,97,18 1. “Adult residential integrated behavioral health stabilization service” means a residential behavioral health treatment service, delivered under the oversight of a medical director, that provides withdrawal management and intoxication monitoring, as well as integrated behavioral health stabilization services, and includes nursing care on site for medical monitoring available on a 24-hour basis. “Adult residential integrated behavioral health stabilization service” may include the provision of services including screening, assessment, intake, evaluation and diagnosis, medical care, observation and monitoring, physical examination, determination of medical stability, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, recovery support services, and crisis intervention services, to ameliorate acute behavioral health symptoms and stabilize functioning.

SB70-AA3,97,21 2. “Community-based withdrawal management” means a medically managed withdrawal management service delivered on an outpatient basis by a physician or other service personnel acting under the supervision of a physician.

SB70-AA3,97,24 3. “Detoxification and stabilization services” means adult residential integrated behavioral health stabilization service, residential withdrawal management service, or residential intoxication monitoring service.

SB70-AA3,98,9 4. “Residential intoxication monitoring service” means a residential service that provides 24-hour observation to monitor the safe resolution of alcohol or sedative intoxication and to monitor for the development of alcohol withdrawal for intoxicated patients who are not in need of emergency medical or behavioral healthcare. “Residential intoxication monitoring service” may include the provision of services including screening, assessment, intake, evaluation and diagnosis, observation and monitoring, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, and recovery support services.

SB70-AA3,98,22 5. “Residential withdrawal management service” means a residential substance use treatment service that provides withdrawal management and intoxication monitoring, and includes medically managed 24-hour on-site nursing care, under the supervision of a physician. “Residential withdrawal management service” may include the provision of services, including screening, assessment, intake, evaluation and diagnosis, medical care, observation and monitoring, physical examination, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, and recovery support services, to ameliorate symptoms of acute intoxication and withdrawal and to stabilize functioning. “Residential withdrawal management service” may also include community-based withdrawal management and intoxication monitoring services.

SB70-AA3,99,2 (b) Subject to par. (c), the department shall provide reimbursement for detoxification and stabilization services under the Medical Assistance program under s. 49.46 (2) (b) 14r. The department shall certify providers under the Medical Assistance program to provide detoxification and stabilization services in accordance with this subsection.

SB70-AA3,99,10 (c) 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 detoxification and stabilization services as described in this subsection. If the federal department approves the request or if no federal approval is necessary, the department shall provide the reimbursement under par. 49.46 (2) (b) 14r. If the federal department disapproves the request, the department may not provide the reimbursement described in this subsection.

SB70-AA3,94 Section 94. 49.46 (2) (b) 14r. of the statutes is created to read:

SB70-AA3,99,13 49.46 (2) (b) 14r. Detoxification and stabilization services as specified under s. 49.45 (30p).”.

SB70-AA3,99,14 213. Page 374, line 11: after that line insert:

SB70-AA3,99,15 “ Section 95. 49.45 (6xm) of the statutes is created to read:

SB70-AA3,99,19 49.45 (6xm) Pediatric inpatient supplement. (a) From the appropriations under s. 20.435 (4) (b), (o), and (w), the department shall, using a method determined by the department, distribute a total sum of $2,000,000 in each state fiscal year to hospitals that meet all of the following criteria:

SB70-AA3,99,20 1. The hospital is an acute care hospital located in this state.

SB70-AA3,99,23 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 subdivision, 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.

SB70-AA3,100,7 (b) Notwithstanding par. (a), from the appropriations under s. 20.435 (4) (b), (o), and (w), the department may, using a method determined by the department, distribute an additional total sum of $10,000,000 in each state fiscal year to hospitals that are freestanding pediatric teaching hospitals located in Wisconsin that have a percentage calculated under s. 49.45 (3m) (b) 1. a. greater than 45 percent.”.

SB70-AA3,100,8 214. Page 374, line 11: after that line insert:

SB70-AA3,100,9 “ Section 96. 49.45 (3) (e) 12. of the statutes is amended to read:

SB70-AA3,100,17 49.45 (3) (e) 12. The department shall use a portion of the moneys collected under s. 50.38 (2) (b) to pay for services provided by critical access hospitals under the Medical Assistance Program under this subchapter, including services reimbursed on a fee-for-service basis and services provided under a managed care system. For each state fiscal year, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (b) for the fiscal year divided by 61.68 44.21 percent.”.

SB70-AA3,100,18 215. Page 374, line 11: after that line insert:

SB70-AA3,100,19 “ Section 97. 49.45 (3) (e) 11. of the statutes is amended to read:

SB70-AA3,101,7 49.45 (3) (e) 11. The department shall use a portion of the moneys collected under s. 50.38 (2) (a) to pay for services provided by eligible hospitals, as defined in s. 50.38 (1), other than critical access hospitals, under the Medical Assistance Program under this subchapter, including services reimbursed on a fee-for-service basis and services provided under a managed care system. For state fiscal year 2008-09, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (a) for fiscal year 2008-09 divided by 57.75 percent. For each state fiscal year after state fiscal year 2008-09, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (a) for the fiscal year divided by 61.68 44.21 percent.”.

SB70-AA3,101,8 216. Page 374, line 11: after that line insert:

SB70-AA3,101,9 “ Section 98. 20.435 (4) (jw) of the statutes is amended to read:

SB70-AA3,101,17 20.435 (4) (jw) BadgerCare Plus and hospital assessment. All moneys received from payment of enrollment fees under the program under s. 49.45 (23), all moneys transferred under s. 50.38 (9), all moneys transferred from the appropriation account under par. (jz), and 10 percent of all moneys received from penalty assessments under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), to provide a portion of the state share of administrative costs for the BadgerCare Plus Medical Assistance program under s. 49.471, and for administration of the hospital assessment under s. 50.38.

SB70-AA3,99 Section 99. 49.45 (2p) of the statutes is repealed.

SB70-AA3,100 Section 100. 49.45 (23) of the statutes is repealed.

SB70-AA3,101 Section 101. 49.45 (23b) of the statutes is repealed.

SB70-AA3,102 Section 102. 49.471 (1) (cr) of the statutes is created to read:

SB70-AA3,101,23 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

SB70-AA3,103 Section 103. 49.471 (4) (a) 4. b. of the statutes is amended to read:

SB70-AA3,102,3 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).

SB70-AA3,104 Section 104. 49.471 (4) (a) 8. of the statutes is created to read:

SB70-AA3,102,5 49.471 (4) (a) 8. An individual who meets all of the following criteria:

SB70-AA3,102,6 a. The individual is an adult under the age of 65.

SB70-AA3,102,8 b. The adult has a family income that does not exceed 133 percent of the poverty line, except as provided in sub. (4g).

SB70-AA3,102,10 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.

SB70-AA3,105 Section 105. 49.471 (4g) of the statutes is created to read:

SB70-AA3,102,19 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.

SB70-AA3,106 Section 106. 49.686 (3) (d) of the statutes is amended to read:

SB70-AA3,103,2 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).

SB70-AA3,107 Section 107. 2017 Wisconsin Act 370, section 44 (2) and (3) are repealed.

SB70-AA3,9119 Section 9119. Nonstatutory provisions; Health Services.

SB70-AA3,103,12 (2h) Childless adults demonstration project. The department of health services shall submit any necessary request to the federal department of health and human services for a state plan amendment or waiver of federal Medicaid law or to modify or withdraw from any waiver of federal Medicaid law relating to the childless adults demonstration project under s. 49.45 (23), 2021 stats., to reflect the incorporation of recipients of Medical Assistance under the demonstration project into the BadgerCare Plus program under s. 49.471 and the termination of the demonstration project.