Hospital assessment
Currently, each hospital, including each critical access hospital, must pay an
assessment for the privilege of doing business in this state. 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 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 MA program, including the federal and state share of MA, 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 MA 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 44.21 percent, thus
increasing the amount of payments that must be made to critical access hospitals and
other hospitals under the MA program.
MA hospital reimbursement
The bill requires DHS to increase the reimbursement rates paid to hospitals
under the MA program in fiscal years 2023-24 and 2024-25 if the state implements
the Medicaid expansion under the ACA. DHS must limit the payments made with
these increases to the upper payment limit set forth under federal law. The increase
is $7,605,400 in fiscal year 2023-24 and $15,506,100 in fiscal year 2024-25 as the
state share of the increase, and in addition, DHS must provide the matching federal
share of payments.
Health information exchange pay-for-performance system
The bill requires DHS to develop and implement for non-hospital providers in
the MA program, including physicians, clinics, health departments, home health
agencies, and post-acute care facilities, a payment system based on performance to
incentivize participation in the health information exchange as specified in the bill.
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.
Graduate medical education grants
The bill extends from three years to five years the maximum term for grants
awarded by DHS to assist rural hospitals and groups of rural hospitals in procuring
infrastructure and increasing case volume to develop accredited graduate medical
training programs. The bill also increases the maximum amounts that DHS may
award each fiscal year in grants to hospitals to support existing graduate medical
training programs. Under current law, DHS may not distribute more than $225,000
to a particular hospital or more than $75,000 to fund an individual position in an
existing graduate medical training program during a given fiscal year. The bill
increases those limits to $450,000 and $150,000 per fiscal year, respectively.
Children
Tribal administration of subsidized guardianships
Under current law, a county department of human services or social services
(county department) or DCF in a county having a population of 750,000 or more must
provide monthly subsidized guardianship payments to the guardian of a child who
has been adjudged to be in need of protection or services (CHIPS) if certain conditions
have been met, including the conditions that 1) the child, if 14 years of age or over,
has been consulted regarding the guardianship arrangement; 2) the guardian has a
strong commitment to caring for the child permanently; 3) the guardian is licensed
as the child's foster parent, which licensing includes an inspection of the guardian's
home under administrative rules promulgated by DCF; 4) the guardian and all adult
residents of the guardian's home have passed a criminal background investigation;
and 5) prior to being named as guardian of the child, the guardian entered into a
subsidized guardianship agreement with the county department or DCF. Under
current law, a county department is reimbursed by DCF for the subsidized
guardianship payments it makes, including guardianships of children ordered by
tribal courts under a law substantially similar to the state's guardianship law (tribal
guardianship law).
The bill allows DCF to enter into an agreement with the governing body of an
Indian tribe to allow that governing body to administer subsidized guardianships
ordered by a tribal court under a tribal guardianship law. Under such an agreement,
the Indian tribe must comply with all requirements for administering subsidized
guardianship that apply to counties and DCF, including eligibility. Under the bill,
DCF reimburses Indian tribes for subsidized guardianship payments in the same
way that it reimburses county departments under current law. The bill also specifies
that a county department may provide subsidized guardianship payments for
guardianships of children ordered by a tribal court if the county department has
entered into an agreement with an Indian tribe to do so.
Kinship care eligibility expansion and placement options
Under current law, a juvenile court may place a child in certain placements that
provide out-of-home care under the Children's Code and the Juvenile Justice Code.
Under current law, those placements include specific types of licensed facilities, a
licensed foster home, or the home of a relative other than a parent. Under current
law, a relative other than a parent does not typically need to acquire a license in order
to receive a relative child. The bill allows a juvenile court to similarly place a child
with unlicensed individuals who qualify as “like-kin” under the Children's Code and
the Juvenile Justice Code.
The bill defines “like-kin” for the purposes of such a placement to be a person
who has a significant relationship with a child or the child's family if that person 1)
prior to the child's placement with the person, had an existing relationship with the
child or child's family that is similar to a familial relationship; 2) during the child's
placement with the person, developed a relationship with the child or child's family
that is similar to a familial relationship; or 3) for an Indian child, is identified by the
child's tribe as kin or like-kin according to tribal tradition, custom or resolution,
code, or law. Under the bill, “like-kin” does not include a current or former foster
parent of a child for placement purposes.
Under current law, a relative other than a parent who is providing care and
maintenance for a child under a court order (kinship care provider) may receive
monthly kinship care payments from DCF or a county department. The bill includes
as kinship care providers first cousins once removed and like-kin persons.
Under current law, for the purposes of permanency planning, a family
permanency team may include like-kin. The current law definition of “like-kin,” for
the purpose of determining the family permanency team, is similar to the definition
of “like-kin” for placement purposes in the bill, except that the current law definition
1) does not exclude a current or former foster parent and 2) does not include
individuals identified by the child's tribe if the child is an Indian child. Under the
bill, the definition of “like-kin” for determining a family permanency team does not
exclude a current or former foster parent but does include individuals identified by
the child's tribe if the child is an Indian child.
Kinship care flexible support
The bill creates flexible support for a kinship care provider. Support provided
under the bill may include additional flexible payments or services to a kinship care
provider who DCF determines qualifies. Under the bill, DCF may promulgate
administrative rules to specify qualifying costs and services and eligibility criteria
for the flexible support.
Foster care and kinship care rates and payments
The bill changes the monthly basic maintenance rates that the state or a county
pays to foster parents certified to provide level one care and to all kinship care
providers, which under current law are $300 per month for a child of any age, to be
the same as the age-based monthly basic maintenance rates paid to foster parents
providing higher than level one care. The bill also increases these age-based
monthly basic maintenance rates by 5 percent. Beginning on January 1, 2024, the
monthly rates are $441 for a child under five years of age, $483 for a child 5 to 11 years
of age, $548 for a child 12 to 14 years of age, and $572 for a child 15 years of age or
over.
The bill provides that, in addition to the monthly rates currently paid to a
kinship care provider, DCF or, with DCF's approval, a county department may make
emergency payments for kinship care to a kinship care provider if any of the
following conditions are met:
1. The governor has declared a state of emergency, or the federal government
has declared a major disaster, that covers the locality of the home of the kinship care
provider (home).
2. This state has received federal funding to be used for child welfare purposes
due to an emergency or disaster declared for the locality of the home.
3. DCF has determined that conditions in this state or in the locality of the
home have resulted in a temporary increase in the costs borne by foster homes and
kinship care providers, including a pandemic or other public health threat, a natural
disaster, or unplanned school closures of five consecutive days or more.
The bill provides that DCF must determine the amount of an emergency
payment based on available funding and may promulgate administrative rules
governing the provision of the payments.
The bill changes the statutes and the administrative code to make kinship care
providers and foster homes certified to provide level one care eligible to receive
exceptional payments to enable siblings or a minor parent and minor children to
reside together and to receive an initial clothing allowance. Under current law, these
payments are only available to foster homes certified to provide higher than level one
care.
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.
The bill allocates $500,000 in Temporary Assistance for Needy Families
funding to the grants for youth services that under current law is allocated 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 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.
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 2023-25 fiscal
biennium.
The bill eliminates a current law provision that allocates some of the youth aids
funding to reimburse counties that are purchasing community supervision services
from DOC for juveniles, and some for alcohol and other drug abuse treatment
programs.
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 improvement program.
Under the bill, DCF may use funding for the youth justice system improvement
program to support diversion programs, to address emergencies related to youth
aids, and 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 carried forward. 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 appropriation for the youth justice system improvement program.
Children and family services
Under current law, DCF must distribute not more than $101,154,200 in fiscal
year 2021-22 and $101,162,800 in fiscal year 2022-23 to counties for children and
family services. The bill updates those amounts to $101,564,700 in fiscal year
2023-24 and $101,961,600 in fiscal year 2024-25.
Intensive family preservation services
The bill creates new authority for DCF to provide intensive family preservation
services or to provide funding for a county department, a nonprofit or for-profit
corporation, a tribe, or a child welfare agency to provide intensive family
preservation services. The bill defines “intensive family preservation services” to
mean evidence-informed services or support aimed at preventing the removal of
children from the home under the Children's Code or the Juvenile Justice Code,
promoting the safety of children in the home, or serving children who are placed in
out-of-home care or who are involved in the juvenile justice system.
The bill also creates a new GPR appropriation for DCF to provide intensive
family preservation services.
Group care referral clearinghouse
The bill creates new authority for DCF to create, maintain, and require the use
of a group care referral clearinghouse, and to promulgate administrative rules
necessary to accomplish this.
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 CHIPS proceeding. However, a pilot program
that began in 2018 requires the state public defender to assign counsel to any
nonpetitioning parent in these cases in Brown, Outagamie, Racine, Kenosha, and
Winnebago Counties. This five-county pilot program is set to expire on June 30,
2023. The bill extends the expiration date of the pilot program to June 30, 2025.
Tribal family services grants and funding for out-of-home-care placements
by tribal courts
Current law uses Indian gaming receipts to fund tribal family service grants
and unexpected or unusually high-cost out-of-home-care placements of Indian
children by tribal courts. The bill appropriates GPR moneys for those purposes as
well.
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.
Sibling connections scholarships
The bill requires DCF to provide scholarships to adopted children and their
biological siblings who do not reside in the same household to attend programs
together in order to build sibling connections.
Child care partnership grant program
The bill authorizes DCF to establish a grant program to award funding to
businesses that provide or wish to provide child care services for their employees.
The bill allows such a grant to be used to reserve child care placements for local
business employees, pay child care tuition, and other costs related to child care.
Under the bill, a grant recipient must provide at least 25 percent matching funds.
The bill allows DCF to promulgate administrative rules to administer the grant
program, including to determine eligibility for a grant.
Emergency services
Ambulance assessment and certified public expenditures program
The bill creates an appropriation to make payments from the ambulance
service provider trust fund to eligible ambulance service providers as specified under
2021 Wisconsin Act 228. Act 228 implemented an ambulance service provider
assessment on private ambulance service providers for supplemental
reimbursements under the MA program and a supplemental reimbursement under
the MA program to public ambulance service providers through certified public
expenditures. Generally, under the MA program, the state provides its share of the
funding for benefits and the federal government then contributes its designated
share of funding, also known as federal financial participation. Act 228 imposes on
each private ambulance service provider a fee for the privilege of doing business in
this state and establishes an ambulance service provider trust fund for the fees
collected.
The bill also requires DHS to transfer moneys annually from the ambulance
service provider trust fund to cover the administrative costs associated with
administering the ambulance assessment and making supplemental
reimbursements to ambulance providers.
Certification of emergency medical responders
Under current law, no individual may act as an emergency medical responder
unless he or she is certified by DHS as an emergency medical responder. To be
eligible for certification as an emergency medical responder, current law requires an
individual to be at least 18 years of age, to be capable of performing the actions
required of an emergency medical responder, and to have completed an emergency
medical responder course that meets or exceeds the guidelines issued by the federal
National Highway Traffic Safety Administration. The bill requires DHS to certify
individuals as emergency medical responders who complete a certified training
program for emergency medical responders or pass the National Registry of
Emergency Medical Technicians (NREMT) examination for emergency medical
responders without requiring any further examination. However, the bill provides
that any relevant education, training, instruction, or other experience that an
applicant obtained in connection with any military service satisfies the completion
of a certified training program if the applicant demonstrates that the education,
training, instruction, or other experience obtained is substantially equivalent to the
certified course. The bill allows DHS, in consultation with the Emergency Medical
Services Board, to promulgate administrative rules to establish educational
standards for training programs for emergency medical responders and minimum
examination standards for training programs for emergency medical responders.
Further, the bill prohibits emergency medical responders from replacing emergency
medical technicians as members of an ambulance crew unless the emergency
medical responder has passed the NREMT examination for emergency medical
responders.
Epinephrine for ambulances
The bill requires that DHS reimburse ambulance service providers for a set of
two epinephrine auto-injectors or a set of two draw-up epinephrine kits for each
ambulance operating in this state. Under the bill, an ambulance service provider
means an ambulance service provider that is a public agency, volunteer fire
department, or nonprofit corporation. The bill also requires that, on an ongoing
basis, DHS must, upon request, reimburse ambulance service providers for
replacement sets of epinephrine auto-injectors or draw-up epinephrine kits. DHS
may only reimburse ambulance service providers for epinephrine if each ambulance
for which the ambulance service provider is reimbursed is staffed with an emergency
medical services provider who is qualified to administer the epinephrine.
Emergency medical services flex grant
During the 2021-23 fiscal biennium, DHS administered a grant program,
known as the Emergency Medical Services Flex grant program, under which DHS
awarded grants to emergency medical services providers for reasonable operating
expenses related to providing emergency medical services. The EMS Flex grants
were funded with moneys provided under the federal American Rescue Plan Act of
2021.
The bill allows DHS to award grants to emergency medical services providers
for the same purposes as DHS awarded grants under the EMS Flex grant program.
The bill provides GPR funding for this purpose as a continuing appropriation, which
means that any unencumbered balance at the end of a fiscal year does not lapse to
the general fund. In other words, DHS may continue to expend moneys appropriated
for grants to emergency medical services providers until the appropriation is fully
depleted.
Ambulance inspection
Under current law, prior to issuing a registration for an ambulance, DOT must
inspect the ambulance to determine whether it meets requirements for
specifications, medical equipment, supplies, and sanitation.
The bill provides that DHS, rather than DOT, must inspect an ambulance to
determine whether it meets requirements for medical equipment and prohibits DOT
from issuing a registration for an ambulance until DHS has conducted the
inspection. The bill authorizes DHS to promulgate administrative rules to establish
these medical equipment requirements for ambulances.
Health
Complex patient pilot program
The bill requires DHS to form an advisory group to assist with development and
implementation of a complex patient pilot program. Under the bill, the secretary of
health services shall serve as chair of the advisory group, and members must have
clinical, financial, or administrative expertise in government programs, acute care,
or post-acute care. The bill requires the advisory group to develop a request for
proposal from partnership groups that would be designated as participating sites for
the pilot program. Under the bill, only partnership groups that include at least one
hospital and at least one post-acute facility are eligible to participate, but
partnership groups could include more than one hospital or post-acute facility. The
bill requires applicant partnership groups to address certain issues in the
application, including 1) the number of beds that would be set aside in the post-acute
facility; 2) the goals of the partnership during the pilot program and after the pilot
program; 3) the types of complex patients for whom care would be provided; 4)
expertise to successfully implement the proposal; 5) the per diem rate requested to
adequately compensate the hospital or hospitals and the post-acute facility or
facilities; 6) a post-acute bed reserve rate; and 7) anticipated impediments to
successful implementation and how the applicant partnership group intends to
overcome the anticipated impediments.
Under the bill, the advisory group must also determine and recommend to DHS
an amount of the funding budgeted for the pilot program to be reserved for
reconciliation to ensure that participants are held harmless from unanticipated
financial loss. The bill also requires the advisory group to develop a methodology to
evaluate the complex patient pilot program and make recommendations to the
secretary of health services regarding which partnership groups should receive
designation as participating sites for the pilot program. The bill allows DHS to
contract with an independent organization to evaluate the complex patient pilot
program. The advisory group or any independent organization hired to complete the
evaluation of the pilot program must complete and submit to the secretary of health
services an evaluation of the pilot program, including a written report and
recommendations, no later than June 30, 2025.
Funding for opioid antagonists
The bill directs DHS to annually award up to $2,000,000 to entities for the
purchase of opioid antagonists.
Health care provider innovation grants
Under current law, DHS is required to award grants for certain community
programs. The bill allows DHS to distribute up to $15,000,000 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.
