Psychiatric residential treatment facilities
The bill establishes a DHS certification process for psychiatric residential treatment facilities. The bill defines a psychiatric residential treatment facility as 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. Psychiatric residential treatment facilities must be certified by DHS to operate.
The bill also provides that services through a psychiatric residential treatment facility are reimbursable under the MA program. The bill requires DHS to submit to the federal government any request for federal approval necessary to provide the reimbursement for services by a psychiatric residential treatment facility under the MA program.
Under current law, DHS is required to award grants for certain community programs. The bill allows DHS to distribute up to $1,790,000 each fiscal year to support psychiatric residential treatment facilities.
COVID-19 health care workforce pilot project
The bill requires DHS to distribute $621,000 in fiscal year 2024-25 to support a pilot project in Dane County relating to the impact of the COVID-19 pandemic on the health care workforce.
Suicide prevention program
The bill requires DHS to implement a suicide prevention program, coordinate suicide prevention activities with other state agencies, administer grant programs involving suicide prevention, and perform various other functions specified in the bill to promote efforts to prevent suicide. The bill also specifically requires DHS to award grants to organizations or coalitions of organizations, including cities, villages, towns, counties, and federally recognized American Indian tribes or bands in this state, for 1) training staff at a firearm retailer or firearm range on how to recognize a person that may be considering suicide; 2) providing suicide prevention materials for distribution at a firearm retailer or firearm range; or 3) providing voluntary, temporary firearm storage. A grant recipient must contribute matching funds or in-kind services having a value equal to at least 20 percent of the grant amount. The bill specifies that DHS may award up to $500,000 in grants for the suicide prevention program each fiscal year, including up to $75,000 per fiscal year for the grants related to preventing suicide by firearm.
988 Suicide and Crisis Lifeline grants
The bill requires DHS to awards grants to organizations that provide crisis intervention services and crisis care coordination to individuals who contact the national 988 Suicide and Crisis Lifeline from anywhere within this state. Currently, DHS partners with Wisconsin Lifeline to provide statewide 988 crisis hotline services.
Stimulant prevention and treatment response programs
Under current law, DHS awards grants for certain community programs. The bill allows DHS to distribute up to $1,644,000 in each fiscal year to support stimulant use prevention and treatment programs and services.
Grants for youth crisis stabilization facilities
The bill requires DHS to award grants to organizations to develop and support youth crisis stabilization facilities. Under current law, a youth crisis stabilization facility is a treatment facility with a maximum of eight beds that admits minors to prevent or de-escalate a mental health crisis and avoid admission to a more restrictive setting. Youth crisis stabilization facilities must be certified by DHS to operate.
Peer run respite centers
The bill makes changes to how DHS may distribute grant moneys to regional peer run respite centers for individuals with mental health and substance abuse concerns. Under current law, DHS may distribute not more than $1,200,000 in each fiscal year for this purpose and may use any of three appropriations to fund the grants. The bill removes the limitation on the amount that DHS may annually distribute and requires DHS to use only one appropriation to fund the grants.
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 3.5 micrograms per 100 milliliters of blood are eligible for services under the Birth to 3 program. The bill also allows DHS to develop a methodology to allocate funding for early intervention services across county programs.
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 2024-25 to a statewide provider of behavioral health treatment services for individuals who are deaf, hard of hearing, or deaf-blind.
Service dog training grants
The bill requires DHS to annually award grants to organizations that train service dogs for the purpose of assisting providers in attaining accreditation specific to post-traumatic stress disorder training from Assistance Dog International.
General health and human services
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 on 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 also requires DHS to appoint a Spinal Cord Injury Council with one member representing the UW 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.
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 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 each 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 married woman is artificially inseminated under the supervision of a physician with semen donated by a man who is not her husband and the woman’s 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 individuals may sign a statement acknowledging parentage and file it with the state registrar. If the state registrar has received such a statement, the individuals 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 individual 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 provisions of the statutes relating to birth certificates 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 persons presumed to be parents because the two persons married after the birth of the child, the two persons 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.
Transfer of security operations at Wisconsin Resource Center
The bill transfers security operations at the Wisconsin Resource Center from DOC to DHS. The transfer includes the transfer of assets, liabilities, position authorizations and the incumbent employees holding those positions, tangible personal property, contracts, and any currently pending matters.
Electrocardiogram screening pilot project for middle school and high school athletes in Milwaukee and Waukesha Counties
The bill directs DHS to develop a pilot program to provide electrocardiogram screenings for participants in middle school and high school athletics programs in Milwaukee and Waukesha Counties. DHS is required to award $4,172,000 in grants in fiscal year 2024-25 to local health departments to implement the program. The bill specifies that participation in the program by participants in middle school and high school athletics programs must be optional.
State long-term care ombudsman
Under current law, the Board on Aging and Long-term Care appoints an executive director of the Office of Long-term Care Ombudsman. The bill requires the executive director to employ the state long-term care ombudsman within the classified service and allows the state long-term care ombudsman to delegate operation of the office to staff.
HOUSING
Low-income housing tax credit
Under current law, WHEDA may certify a person to claim, for a period of up to six years, a state tax credit if the person has an ownership interest in a low-income housing project in Wisconsin and qualifies for the federal low-income housing tax credit program. The bill increases the period for which the credit may be claimed from six years to 10 years and increases the amount of credits that WHEDA may annually certify from $42,000,000 to $100,000,000. The bill also requires that the project be allocated the federal credit and financed with tax-exempt bonds that are not subject to the federal credit’s volume cap—as opposed to any tax-exempt bonds, as required under current law—and allows WHEDA to waive these requirements to the extent that WHEDA anticipates that a sufficient tax-exempt private activity bond volume cap under federal law will not be available to finance low-income housing projects in any year.
Capital reserve fund bonding limit
Under current law, WHEDA issues notes and bonds for most WHEDA programs, including housing programs for individuals and families of low or moderate income. Current law prohibits WHEDA from issuing notes and bonds that are secured by a capital reserve fund if the total aggregate outstanding principal amount would exceed $800,000,000. The bill increases that limit to $1,200,000,000.
Workforce housing rehabilitation fund
Under current law, as created by 2021 Wisconsin Act 221, WHEDA may make workforce housing rehabilitation loans to eligible applicants for the cost of certain kinds of rehabilitation to the applicant’s home, subject to certain requirements. Currently, WHEDA makes those loans from WHEDA’s housing rehabilitation loan fund, which preexisted the creation of the workforce housing rehabilitation loan program in Act 221. The bill establishes a workforce housing rehabilitation fund under the jurisdiction and control of WHEDA for the purpose of providing workforce housing rehabilitation loans. At WHEDA’s discretion, the workforce housing rehabilitation fund may additionally be used for purposes of marketing WHEDA’s programs and services to the public. The fund consists in part of general purpose revenues transferred to the fund.
The bill also makes certain changes to the workforce housing rehabilitation loan program, including requiring that an eligible residence be the loan applicant’s primary residence and authorizing WHEDA to defer or forgive the payment of a workforce housing rehabilitation loan under certain criteria established by WHEDA.
Rental housing safety grants
The bill establishes a pilot program under which DOA must award one or more grants to a first class city (presently only Milwaukee) for activities that support the improvement of rental housing safety in the city, including the enhancement or creation of a property inspection program and the development and launch of a searchable online database that discloses the history of rental properties within the city. The bill authorizes DOA to establish program guidelines for the grant program under this subsection. Under the bill, the grant program sunsets on June 30, 2025.
Rental assistance grants for homeless veterans
The bill requires DOA to award grants to each continuum of care organization in this state 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.
Homeless case management services grants
Under current law, DOA may award up to 10 grants of up to $50,000 each year to shelter facilities for case management services provided to homeless families. The bill eliminates the limit on the number of grants that may be awarded and raises the grant limit to $75,000.
Whole-home upgrade grants
The bill establishes a pilot program under which DOA must award one or more grants to the Walnut Way Conservation Corporation and Elevate, Inc., for the purpose of funding home improvements in low-income households in a first class city (presently only Milwaukee). The grants must have one or more of the following goals: 1) reducing carbon emissions, 2) reducing energy burdens, 3) creating cost savings, or 4) creating healthier living environments.
The bill authorizes DOA to establish eligibility requirements and other program guidelines for the grant program. Under the bill, the grant program sunsets on July 1, 2025.
Affordable housing grants
The bill requires DOA to award grants to municipalities for the purpose of increasing the availability of affordable workforce housing within the municipalities.
Water utility assistance program for low-income households
The bill creates a water utility assistance program for low-income households that is administered by DOA. Under the program, low-income households may apply for assistance from the state to help pay the cost of their water utility bills. Although the program is administered by DOA, DOA may contract with a county department or other local governmental agency or a private nonprofit organization to process applications and make assistance payments. DOA must establish a payments schedule for the program. If the number of household applicants exceeds the number anticipated to apply, payments to households may be reduced and DOA may suspend additional applications for assistance. Under the bill, a household eligible for water utility assistance may also be eligible for a crisis assistance payment if the household is experiencing or at risk of experiencing a water utility-related emergency, as defined by DOA.
Municipal home rehabilitation grants
The bill requires DOA to award grants to municipalities to fund initiatives to rehabilitate and restore blighted residential properties within the municipality. The bill authorizes DOA to establish eligibility requirements and other program guidelines for the grant program.
Housing quality standards grants
The bill requires DOA to award grants to owners of rental housing units in Wisconsin for purposes of satisfying applicable housing quality standards.
INSURANCE
Coverage of individuals with preexisting conditions and other insurance market regulations
The bill requires certain health plans to guarantee access to coverage; prohibits plans from imposing preexisting condition exclusions; prohibits plans from setting premiums or cost-sharing amounts based on health status-related factors; prohibits plans from setting lifetime or annual limits on benefits; requires plans to cover certain essential health benefits; requires coverage of certain preventive services by plans without a cost-sharing contribution by an enrollee; sets a maximum annual amount of cost sharing for enrollees; and designates risk pool, medical loss ratio, and actuarial value requirements.
The bill requires every individual health insurance policy, known in the bill as a health benefit plan, to accept every individual who applies for coverage and requires every group health insurance policy to accept every employer that applies for coverage, regardless of the individual’s or any employee’s sexual orientation or gender identity and regardless of whether the individual or any employee has a preexisting condition. The bill allows health benefit plans to restrict enrollment in coverage to open or special enrollment periods and requires the commissioner of insurance to establish a statewide open enrollment period of no shorter than 30 days for every individual health benefit plan. The bill prohibits a group health insurance policy, including a self-insured governmental health plan, from imposing a preexisting condition exclusion. The bill also prohibits an individual health insurance policy from reducing or denying a claim or loss incurred or disability commencing under the policy on the ground that a disease or physical condition existed prior to the effective date of coverage.
A health benefit plan offered on the individual or small employer market or a self-insured governmental health plan may not vary premium rates for a specific plan except on the basis of whether the plan covers an individual or family, area in the state, age, and tobacco use as specified in the bill. An individual health benefit plan or self-insured health plan is prohibited under the bill from establishing rules for the eligibility of any individual to enroll based on health status-related factors, which are specified in the bill. A self-insured health plan or an insurer offering an individual health benefit plan is also prohibited from requiring an enrollee to pay a greater premium, contribution, deductible, copayment, or coinsurance amount than is required of a similarly situated enrollee based on a health status-related factor. Current state law prohibits group health benefit plans from establishing rules of eligibility or requiring greater premium or contribution amounts based on a health status-related factor. The bill adds to these current law requirements for group health benefit plans that the plan may not require a greater deductible, copayment, or coinsurance amount based on a health status-related factor.
Under the bill, an individual or group health benefit plan or a self-insured governmental health plan may not establish lifetime or annual limits on the dollar value of benefits for an enrollee or a dependent of an enrollee under the plan. The bill specifies a maximum amount of cost sharing that a plan may impose as the amount calculated under the federal Patient Protection and Affordable Care Act (ACA).
The bill requires individual and small employer plans to have either a single statewide risk pool for the individual market and a single pool for the small employer market or a single statewide risk pool for a combination of the individual and small employer markets. The bill requires individual and small employer plans to have a medical loss ratio of at least 80 percent and larger group plans to have a medical loss ratio of at least 85 percent. The medical loss ratio is the proportion of premium revenues that the plan spends on clinical services and quality improvement. The bill also requires individual and small employer plans to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to at least 60 percent of the full actuarial value of the benefits provided under the plan. An actuarial value of 60 percent corresponds to a bronze tier plan under the ACA.
Health insurance policies are referred to as disability insurance policies in the bill, and a self-insured governmental health plan is a self-funded health plan of the state or a county, city, village, town, or school district. The bill requires certain health insurance policies and governmental self-insured health plans to cover essential health benefits that will be specified by the commissioner of insurance by rule. The bill specifies a list of requirements that the commissioner must follow when establishing the essential health benefits, including certain limitations on cost sharing and the following general categories of benefits, items, or services in which the commissioner must require coverage: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services. If an essential health benefit specified by the commissioner is also subject to its own mandated coverage requirement, the bill requires the disability insurance policy or self-insured health plan to provide coverage under whichever requirement provides the insured or plan participant with more comprehensive coverage.
The bill requires health insurance policies and governmental self-insured health plans to cover certain preventive services and to provide coverage of those preventive services without subjecting that coverage to deductibles, copayments, or coinsurance. The preventive services for which coverage is required are specified in the bill. The bill also specifies certain instances when cost-sharing amounts may be charged for an office visit associated with a preventive service.
Balance billing for emergency medical services and other items and services
The bill requires defined network plans, such as health maintenance organizations, and certain preferred provider plans and self-insured governmental plans that cover benefits or services provided in either an emergency department of a hospital or independent freestanding emergency department to cover emergency medical services without requiring a prior authorization determination and without regard to whether the health care provider providing the emergency medical services is a participating provider or facility. If the emergency medical services for which coverage is required are provided by a nonparticipating provider, the plan must 1) not impose a prior authorization requirement or other limitation that is more restrictive than if the service was provided by a participating provider; 2) not impose cost sharing on an enrollee that is greater than the cost sharing required if the service was provided by a participating provider; 3) calculate the cost-sharing amount to be equal to the recognized amount specified under federal law; 4) provide, within 30 days of the provider’s or facility’s bill, an initial payment or denial notice to the provider or facility and then pay a total amount to the provider or facility that is equal to the amount by which an out-of-network rate exceeds the amount it received in cost sharing from the enrollee; and 5) count any cost-sharing payment made by the enrollee for the emergency medical services toward any in-network deductible or out-of-pocket maximum as if the cost-sharing payment was made for services provided by a participating provider or facility.
For coverage of an item or service that is provided by a nonparticipating provider in a participating facility, a plan must 1) not impose a cost-sharing requirement for the item or service that is greater than the cost-sharing requirement that would have been imposed if the item or service was provided by a participating provider; 2) calculate the cost-sharing amount to be equal to the recognized amount specified under federal law; 3) provide, within 30 days of the provider’s bill, an initial payment or denial notice to the provider and then pay a total amount to the provider that is equal to the amount by which the out-of-network rate exceeds the amount it received in cost sharing from the enrollee; and 4) count any cost-sharing payment made by the enrollee for the items or services toward any in-network deductible or out-of-pocket maximum as if the cost-sharing payment was made for items or services provided by a participating provider. A nonparticipating provider providing an item or service in a participating facility may not bill or hold liable an enrollee for more than the cost-sharing amount unless the provider provides notice and obtains consent as described in the bill. However, if the nonparticipating provider is providing an ancillary item or service that is specified in the bill, and the commissioner of insurance has not specifically allowed balance billing for that item or service by rule, the nonparticipating provider providing the ancillary item or service in a participating facility may not bill or hold liable an enrollee for more than the cost-sharing amount.
Under the bill, a provider or facility that is entitled to a payment for an emergency medical service or other item or service may initiate open negotiations with the defined network plan, preferred provider plan, or self-insured governmental health plan to determine the amount of payment. If the open negotiation period terminates without determination of the payment amount, the provider, facility, or plan may initiate the independent dispute resolution process as specified by the commissioner of insurance.
If an enrollee of a plan is a continuing care patient, as defined in the bill, and is obtaining services from a participating provider or facility, and the contract is terminated because of a change in the terms of the participation of the provider or facility in the plan or the contract is terminated resulting in a loss of benefits under the plan, the plan must notify the enrollee of the enrollee’s right to elect to continue transitional care, provide the enrollee an opportunity to notify the plan of the need for transitional care, and allow the enrollee to continue to have the benefits provided under the plan under the same terms and conditions as would have applied without the termination until either 90 days after the termination notice date or the date on which the enrollee is no longer a continuing care patient, whichever is earlier.
Fiduciary duty of pharmacy benefit managers
The bill imposes fiduciary and disclosure requirements on pharmacy benefit managers. Pharmacy benefit managers contract with health plans that provide prescription drug benefits to administer those benefits for the plans. Pharmacy benefit managers also have contracts with pharmacies and pay the pharmacies for providing the drugs to the plan beneficiaries.
The bill provides that a pharmacy benefit manager owes a fiduciary duty to a plan sponsor. The bill also requires that a pharmacy benefit manager annually disclose all of the following information to the plan sponsor:
1. The indirect profit received by the pharmacy benefit manager from owning a pharmacy or service provider.
