The bill directs DHS to pay allowable charges on behalf of MA recipients for room and board for residential substance use disorder treatment.
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
