Amendment SA4-SSA2-SB70

SB70-SSA2-SA4,154,18 (g) 1. No later than 90 days after the effective date of this subdivision, the advisory group shall complete development of the request for proposal for partnership groups to be designated as participating sites in the complex patient pilot program and provide its recommendations to the secretary of health services.

SB70-SSA2-SA4,154,23 2. No later than 150 days after the effective date of this subdivision, the advisory group shall review all applications submitted in response to the request for proposal and select up to 4 partnership groups to recommend to the secretary of health services for designation as participating sites for the complex patient pilot program under this subsection.

SB70-SSA2-SA4,155,7 3. Between 6 months and 18 months after the effective date of this subdivision, the partnership groups designated by the department as participating sites in the complex patient pilot program shall implement the pilot program and meet quarterly with both the department and the advisory group or any independent organization hired by the department for the purpose of evaluating the pilot program to discuss experiences relating to the pilot program. From the appropriation under s. 20.435 (7) (d), the department shall provide payments to partnership groups designated as participating sites for care provided during the course of the pilot program under this subsection.

SB70-SSA2-SA4,155,12 4. No later than June 30, 2025, the advisory group or any independent organization hired by the department for the purpose of evaluating the complex patient pilot program shall complete and submit to the secretary of health services an evaluation of the complex patient pilot program under this subsection, including a written report and recommendations.

SB70-SSA2-SA4,9419 Section 9419. Effective dates; Health Services.

SB70-SSA2-SA4,155,15 (1u) Complex patient pilot program. The repeal of s. 20.435 (7) (d) takes effect on July 1, 2025.”.

SB70-SSA2-SA4,155,16 188. Page 374, line 11: after that line insert:

SB70-SSA2-SA4,155,18 “ Section 178. 49.45 (41) (a) of the statutes is renumbered 49.45 (41) (a) (intro.) and amended to read:

SB70-SSA2-SA4,155,21 49.45 (41) (a) (intro.) In this subsection, “crisis intervention services" means crisis intervention services for the treatment of mental illness, intellectual disability, substance abuse, and dementia that are provided by a any of the following:

SB70-SSA2-SA4,155,23 2. A crisis intervention program operated by, or under contract with, a county, if the county is certified as a medical assistance provider.

SB70-SSA2-SA4,179 Section 179. 49.45 (41) (a) 1. of the statutes is created to read:

SB70-SSA2-SA4,156,2 49.45 (41) (a) 1. A crisis urgent care and observation facility certified under s. 51.036.

SB70-SSA2-SA4,180 Section 180. 49.45 (41) (b) of the statutes is amended to read:

SB70-SSA2-SA4,156,12 49.45 (41) (b) If a county elects to become certified as a provider of crisis intervention services under par. (a) 2., the county may provide crisis intervention services under this subsection in the county to medical assistance recipients through the medical assistance program. A county that elects to provide the services shall pay the amount of the allowable charges for the services under the medical assistance program that is not provided by the federal government. The department shall reimburse the county under this subsection only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.

SB70-SSA2-SA4,181 Section 181. 49.45 (41) (c) (intro.) of the statutes is amended to read:

SB70-SSA2-SA4,156,17 49.45 (41) (c) (intro.) Notwithstanding par. (b), if a county elects, pursuant to par. (a) 2., to deliver crisis intervention services under the Medical Assistance program on a regional basis according to criteria established by the department, all of the following apply:

SB70-SSA2-SA4,182 Section 182. 49.45 (41) (d) of the statutes is created to read:

SB70-SSA2-SA4,156,25 49.45 (41) (d) The department shall request any necessary federal approval required to provide reimbursement to crisis urgent care and observation facilities certified under s. 51.036 for crisis intervention services under this subsection. If federal approval is granted or no federal approval is required, the department shall provide reimbursement under s. 49.46 (2) (b) 15. If federal approval is necessary but is not granted, the department may not provide reimbursement for crisis intervention services provided by crisis urgent care and observation facilities.

SB70-SSA2-SA4,183 Section 183. 51.036 of the statutes is created to read:

SB70-SSA2-SA4,157,3 51.036 Crisis urgent care and observation facilities. (1) Definitions. In this section:

SB70-SSA2-SA4,157,8 (a) “Crisis” means a situation caused by an individual's apparent mental or substance use disorder that results in a high level of stress or anxiety for the individual, persons providing care for the individual, or the public and that is not resolved by the available coping methods of the individual or by the efforts of those providing ordinary care or support for the individual.

SB70-SSA2-SA4,157,12 (b) “Crisis urgent care and observation facility” means a treatment facility that admits an individual to prevent, de-escalate, or treat the individual's mental health or substance use disorder and includes the necessary structure and staff to support the individual's needs relating to the mental health or substance use disorder.

SB70-SSA2-SA4,157,22 (2) Certification required; exemption. (a) The department shall establish a certification process for crisis urgent care and observation facilities and may establish criteria by rule for the certification of crisis urgent care and observation facilities. The department may limit the number of certifications it grants to operate crisis urgent care and observation facilities. No person may operate a crisis urgent care and observation facility without a certification under this section. The department shall establish by rule a process for crisis urgent care and observation facilities to apply to the department for certification of the facility for the receipt of funds for services provided as a benefit to a recipient under the Medical Assistance program.

SB70-SSA2-SA4,158,2 (b) A crisis urgent care and observation facility certified under this section is not subject to facility regulation under ch. 50, unless otherwise required due to the facility's licensure or certification for other services or purposes. A crisis urgent care and observation facility is not a hospital under s. 50.32 and nothing in this paragraph limits services a hospital may provide under s. 50.32.

SB70-SSA2-SA4,158,4 (c) A crisis urgent care and observation facility certified under this section shall do all of the following:

SB70-SSA2-SA4,158,8 1. Accept referrals for crisis services for both youths and adults, including involuntary patients under emergency detention, voluntary patients, walk-ins, and individuals brought by law enforcement, emergency medical responders, and other emergency medical services practitioners.

SB70-SSA2-SA4,158,10 2. Abstain from having a requirement for medical clearance before admission assessment.

SB70-SSA2-SA4,158,12 3. Provide assessments for physical health, substance use disorder, and mental health.

SB70-SSA2-SA4,158,13 4. Provide screens for suicide and violence risk.

SB70-SSA2-SA4,158,14 5. Provide medication management and therapeutic counseling.

SB70-SSA2-SA4,158,15 6. Provide coordination of services for basic needs.

SB70-SSA2-SA4,158,20 7. Have adequate staffing 24 hours a day, 7 days a week, with a multidisciplinary team including, as needed, psychiatrists or psychiatric nurse practitioners, nurses, licensed clinicians capable of completing assessments and providing necessary treatment, peers with lived experience, and other appropriate staff.

SB70-SSA2-SA4,158,24 8. Allow for voluntary and involuntary treatment of individuals in crisis as a means to avoid unnecessary placement of those individuals in hospital inpatient beds and allow for an effective conversion to voluntary stabilization when warranted in the same setting.

SB70-SSA2-SA4,159,5 (3) Admission. (a) A crisis urgent care and observation facility certified under this section may accept individuals for voluntary stabilization, observation and treatment, including for assessments for mental health or substance use disorder, screening for suicide and violence risk, and medication management and therapeutic counseling.

SB70-SSA2-SA4,159,12 (b) A crisis urgent care and observation facility certified under this section may accept individuals for emergency detention under s. 51.15 if the facility agrees to accept the individual. A county crisis assessment under s. 51.15 (2) (c) is required prior to acceptance of an individual for purposes of emergency detention at a crisis urgent care and observation facility certified under this section. Medical clearance is not required before admission, but the facility shall provide necessary medical services on site.

SB70-SSA2-SA4,159,15 (4) Grants. From the appropriation under s. 20.435 (5) (ck), the department shall award grants to individuals and entities to develop and support crisis urgent care and observation facilities under this section.

SB70-SSA2-SA4,159,25 (5) Rules. The department may promulgate rules to implement this section, including requirements for admitting and holding individuals for purposes of emergency detention. The department may promulgate the rules under this section as emergency rules under s. 227.24. Notwithstanding s. 227.24 (1) (c) and (2), a rule promulgated under this subsection may remain in effect for not more than 24 months. Notwithstanding s. 227.24 (1) (a) and (3), the department is not required to provide evidence that promulgating a rule under this subsection as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this subsection.”.

SB70-SSA2-SA4,160,1 189. Page 374, line 11: after that line insert:

SB70-SSA2-SA4,160,2 “ Section 184. 46.48 (35) of the statutes is created to read:

SB70-SSA2-SA4,160,5 46.48 (35) Psychiatric residential treatment facilities. The department may distribute not more than $1,790,000 in each fiscal year to support psychiatric residential treatment facilities.

SB70-SSA2-SA4,185 Section 185. 49.46 (2) (b) 14c. of the statutes is created to read:

SB70-SSA2-SA4,160,8 49.46 (2) (b) 14c. Subject to par. (bv), services by a psychiatric residential treatment facility.

SB70-SSA2-SA4,186 Section 186. 49.46 (2) (bv) of the statutes is created to read:

SB70-SSA2-SA4,160,17 49.46 (2) (bv) 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 services by a psychiatric residential treatment facility. If the federal department of health and human services approves the request or if no federal approval is necessary, the department shall provide reimbursement under par. (b) 14c. If the federal department of health and human services disapproves the request, the department may not provide reimbursement for services under par. (b) 14c.

SB70-SSA2-SA4,187 Section 187. 51.044 of the statutes is created to read:

SB70-SSA2-SA4,160,24 51.044 Psychiatric residential treatment facilities. (1) Definition. In this section, “psychiatric residential treatment facility” is a non-hospital facility that provides inpatient comprehensive mental health treatment services to individuals under the age of 21 who, due to mental illness, substance use, or severe emotional disturbance, need treatment that can most effectively be provided in a residential treatment facility.

SB70-SSA2-SA4,161,4 (2) Certification required; exemption. (a) No person may operate a psychiatric residential treatment facility without a certification from the department. The department may limit the number of certifications it grants to operate a psychiatric residential treatment facility.

SB70-SSA2-SA4,161,6 (b) A psychiatric residential treatment facility that has a certification from the department under this section is not subject to facility regulation under ch. 48.

SB70-SSA2-SA4,161,7 (3) Rules. The department may promulgate rules to implement this section.

SB70-SSA2-SA4,9119 Section 9119. Nonstatutory provisions; Health Services.

SB70-SSA2-SA4,161,21 (1) Emergency rules on psychiatric residential treatment facilities. The department of health services may promulgate emergency rules under s. 227.24 implementing certification of psychiatric residential treatment facilities under s. 51.044, including development of a new provider type and a reimbursement model for psychiatric residential treatment facilities under the Medical Assistance program under subch. IV of ch. 49. Notwithstanding s. 227.24 (1) (a) and (3), the department of health services is not required to provide evidence that promulgating a rule under this subsection as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this subsection. Notwithstanding s. 227.24 (1) (c) and (2), emergency rules promulgated under this subsection remain in effect until July 1, 2025, or the date on which permanent rules take effect, whichever is sooner.”.

SB70-SSA2-SA4,161,22 190. Page 374, line 11: after that line insert:

SB70-SSA2-SA4,161,23 “ Section 188. 20.435 (5) (bw) of the statutes is amended to read:

SB70-SSA2-SA4,162,5 20.435 (5) (bw) Child psychiatry and addiction medicine consultation programs Mental health consultation program. Biennially, the amounts in the schedule for operating the child psychiatry consultation program under s. 51.442 and the addiction medicine consultation program under s. 51.448 mental health consultation program under s. 51.443.

SB70-SSA2-SA4,189 Section 189. 20.435 (5) (bx) of the statutes is created to read:

SB70-SSA2-SA4,162,9 20.435 (5) (bx) Addiction medicine consultation program. Biennially, the amounts in the schedule for operating the addiction medicine consultation program under s. 51.448.

SB70-SSA2-SA4,190 Section 190. 20.435 (5) (ct) of the statutes is repealed.

SB70-SSA2-SA4,191 Section 191. 51.441 of the statutes is repealed.

SB70-SSA2-SA4,192 Section 192. 51.442 of the statutes is repealed.

SB70-SSA2-SA4,193 Section 193. 51.443 of the statutes is created to read:

SB70-SSA2-SA4,162,14 51.443 Mental health consultation program. (1) In this section:

SB70-SSA2-SA4,162,17 (a) “Participating clinicians” includes physicians, nurse practitioners, physician assistants, and medically appropriate members of the care teams of physicians, nurse practitioners, and physician assistants.

SB70-SSA2-SA4,162,19 (b) “Program” means the mental health consultation program under this section.

SB70-SSA2-SA4,163,2 (2) During the fiscal year 2023-24, the department shall contract with the organization that provided consultation services through the child psychiatry consultation program under s. 51.442, 2021 stats., as of January 1, 2023, to administer the mental health consultation program described under this section. In subsequent fiscal years, the department shall contract with the organization that provided consultation services through the child psychiatry consultation program under s. 51.442, 2021 stats., as of January 1, 2023, or another organization to administer the mental health consultation program under this section.

SB70-SSA2-SA4,163,8 (3) The contracting organization under sub. (2) shall administer a mental health consultation program that incorporates a comprehensive set of mental health consultation services, which may include perinatal, child, adult, geriatric, pain, veteran, and general mental health consultation services, and may contract with any other entity to perform any operations and satisfy any requirements under this section for the program.

SB70-SSA2-SA4,163,10 (4) As a condition of providing services through the program, the contracting organization under sub. (2) shall do all of the following:

SB70-SSA2-SA4,163,18 (a) Ensure that all mental health care providers who are providing services through the program have the applicable credential from this state; if a psychiatric professional, that the provider is eligible for certification or is certified by the American Board of Psychiatry and Neurology for adult psychiatry, child and adolescent psychiatry, or both; and if a psychologist, that the provider is registered in a professional organization, including the American Psychological Association, National Register of Health Service Psychologists, Association for Psychological Science, or the National Alliance of Professional Psychology Providers.

SB70-SSA2-SA4,163,20 (b) Maintain the infrastructure necessary to provide the program's services statewide.

SB70-SSA2-SA4,163,22 (c) Operate the program on weekdays during normal business hours of 8 a.m. to 5 p.m.

SB70-SSA2-SA4,163,24 (d) Provide consultation services under the program as promptly as is practicable.

SB70-SSA2-SA4,164,4 (e) Have the capability to provide consultation services by, at a minimum, telephone and email. Consultation through the program may be provided by teleconference, video conference, voice over Internet protocol, email, pager, in-person conference, or any other telecommunication or electronic means.

SB70-SSA2-SA4,164,5 (f) Provide all of the following services through the program:

SB70-SSA2-SA4,164,7 1. Support for participating clinicians to assist in the management of mental health concerns.

SB70-SSA2-SA4,164,10 2. Triage-level assessments to determine the most appropriate response to each request, including appropriate referrals to any community providers and health systems.

SB70-SSA2-SA4,164,11 3. When medically appropriate, diagnostics and therapeutic feedback.

SB70-SSA2-SA4,164,13 4. Recruitment of other clinicians into the program as participating clinicians when possible.

SB70-SSA2-SA4,164,14 (g) Report to the department any information requested by the department.

SB70-SSA2-SA4,164,23 (h) Conduct annual surveys of participating clinicians who use the program to assess the quality of care provided, self-perceived levels of confidence in providing mental health services, and satisfaction with the consultations and other services provided through the program. Immediately after participating clinicians begin using the program and again 6 to 12 months later, the contracting organization under sub. (2) may conduct assessments of participating clinicians to assess the barriers to and benefits of participation in the program to make future improvements and to determine the participating clinicians' treatment abilities, confidence, and awareness of relevant resources before and after beginning to use the program.

SB70-SSA2-SA4,165,2 (5) Services provided under sub. (4) (b) to (h) are eligible for funding from the department. The contracting organization under sub. (2) also may provide any of the following services under the program that are eligible for funding from the department:

SB70-SSA2-SA4,165,5 (a) Second opinion diagnostic and medication management evaluations and community resource referrals conducted by either a psychiatrist or allied health professionals.

SB70-SSA2-SA4,165,8 (b) In-person or web-based educational seminars and refresher courses on a medically appropriate topic within mental or behavioral health care provided to any participating clinician who uses the program.

SB70-SSA2-SA4,165,9 (c) Data evaluation and assessment of the program.”.

SB70-SSA2-SA4,165,10 191. Page 374, line 11: after that line insert:

SB70-SSA2-SA4,165,11 “ Section 194. 46.48 (22) of the statutes is created to read:

SB70-SSA2-SA4,165,15 46.48 (22) Health care provider innovation grants. The department may distribute not more than $14,550,000 in each fiscal year as grants to health care providers and long-term care providers to implement best practices and innovative solutions to increase worker recruitment and retention.”.

SB70-SSA2-SA4,165,16 192. Page 374, line 11: after that line insert:

SB70-SSA2-SA4,165,17 “ Section 195. 20.435 (4) (jw) of the statutes is amended to read:

SB70-SSA2-SA4,166,2 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 under s. 256.23 (6), 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, and for administration of the ambulance service provider fee under s. 256.23.

SB70-SSA2-SA4,196 Section 196. 20.435 (4) (xm) of the statutes is created to read: