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.
Defining lead poisoning or lead exposure
The bill modifies the definition of lead poisoning or lead exposure from a level of lead in the blood of five or more micrograms per 100 milliliters of blood to 3.5 or more micrograms per 100 milliliters of blood. The bill also changes the circumstances under which DHS is required to conduct, or ensure there is conducted, a lead investigation of a dwelling or premises. Under current law, DHS is required to conduct, or ensure there is conducted, a lead investigation of a dwelling or premises when DHS is notified that an occupant of the dwelling or premises who is under the age of six has an elevated blood lead level, which current law defines as a level of lead in the blood that is either 1) 20 or more micrograms per 100 milliliters of blood, as confirmed by one venous blood test; or 2) 15 or more micrograms per 100 milliliters of blood, as confirmed by two venous blood tests that are performed at least 90 days apart. Under the bill, DHS is required to conduct, or ensure there is conducted, a lead investigation of a dwelling or premises when DHS is notified that an occupant of the dwelling or premises who is under the age of six has lead poisoning or lead exposure. The bill also requires that when DHS receives such a notification, DHS must present official credentials to the owner or occupant of the dwelling or premises or a representative of the owner and request admission to conduct a lead investigation of the dwelling or premises. As under current law, if an owner or occupant refuses to grant admission, DHS may seek a warrant to investigate the dwelling or premises.
Maternal and infant mortality prevention and response
The bill requires the DHS to do all of the following for the prevention of and response to maternal and infant mortality, including 1) award grants to community organizations with the aim of preventing maternal and infant mortality, 2) award grants to support the expansion of fetal and infant mortality review and maternal mortality review teams statewide and expand technical assistance and support for existing fetal and infant mortality review and child death review teams, 3) provide funding and technical assistance to community-based organizations aimed at preventing infant morality, and 4) provide funding for grief and bereavement programming for those impacted by infant loss.
Funding for infant testing programs
Under current law, DHS and the Wisconsin State Laboratory of Hygiene operate a newborn screening program under which newborn babies are tested for certain blood disorders, in addition to hearing loss and critical congenital heart disease. Current law appropriates funding for the program from fees charged for various costs associated with the program. The bill creates an additional GPR appropriation to provide funding for the program and various costs associated with the program.
Personal protective equipment stockpile
The bill provides funding to DHS to establish and maintain a state stockpile of personal protective equipment.
Grants for tribal long-term care system development
The bill requires DHS to annually allocate up to $5,500,000 to federally recognized American Indian tribes and bands located in this state for capital improvements to tribal facilities serving tribal members with long-term care needs and for improvements and repairs to homes of tribal members with long-term care needs to enable tribal members to receive long-term care services at home.
Funding for free and charitable clinics
The bill increases from $1,500,000 to $2,000,000 the amount DHS is required to award in grants to free and charitable clinics each fiscal year.
Grants to free-standing pediatric teaching hospitals
The bill directs DHS to award grants to free-standing pediatric teaching hospitals to fund programming related to parenting, educational needs of and supports for chronically ill children, and case management for children with asthma. The bill specifies that only free-standing pediatric teaching hospitals for which at least 45 percent of total inpatient days are provided to MA recipients are eligible for the grant.
Low-value care analysis grant
In each of the 2023-24 and 2024-25 fiscal years, the bill requires DHS to award a grant of up to $900,000 to an organization for the purpose of conducting a data analysis of claims under the MA program and under health insurance plans offered to state employees to identify low-value care. The grant recipient must report its findings, including any recommendations for providing effective and efficient care, to DHS and ETF, who must then distribute the grant recipient’s findings to certain health care providers, health care maintenance organizations, and insurance companies.
Amyotrophic lateral sclerosis grant
The bill requires DHS to annually award $250,000 to an organization that supports and provides services to individuals with amyotrophic lateral sclerosis (ALS) to assist individuals with ALS and their families with respite care costs and costs associated with ALS that are not covered by insurance.
Alzheimer’s family and caregiver support
Under current law, DHS distributes funds for certain community aids, including the Alzheimer’s family and caregiver support program. The bill increases the community aid funding available for the Alzheimer’s family and caregiver support program from not more than $2,558,900 each fiscal year to not more than $3,308,900 each fiscal year, and broadens financial eligibility for the program by increasing the maximum joint income an individual and the individual’s spouse may earn per year and remain financially eligible from $48,000 to $60,000.
Healthy aging grant program
The bill requires DHS to award in each fiscal year a grant of $600,000 to an entity that conducts programs in healthy aging.
Behavioral health and developmental disabilities
Crisis urgent care and observation facilities
The bill requires DHS to award grants to individuals and entities to develop and support crisis urgent care and observation facilities. The bill also requires DHS to create a certification process for crisis urgent care and observation facilities. DHS may limit the number of certifications it grants to operate these facilities, and no person may operate a crisis urgent care and observation facility without a certification from DHS. The bill requires DHS to request any necessary federal approval to add services provided by a crisis urgent care and observation facility as a type of crisis intervention service reimbursable under the MA program. Under the bill, if federal approval is either unnecessary or is necessary and is granted, DHS may provide reimbursement for these services. The bill also requires DHS to include a process for crisis urgent care and observation facilities to apply for certification of the facility for the reimbursement of services provided under the MA program.
Mental health consultation program
The bill combines the child psychiatry consultation program with additional services into a new mental health consultation program. Currently, the child psychiatry consultation program assists participating clinicians in providing care to children with mental health care needs and provides referral support and additional services. The 2019-21 biennial budget act requires DHS to convene interested persons, including the Medical College of Wisconsin, to develop a plan and standards for a comprehensive mental health consultation program incorporating various psychiatry specialties, including addiction medicine; a perinatal psychiatry consultation program; and the child psychiatry consultation program. This requirement from the 2019-21 biennial budget act is eliminated in the bill along with the separate child psychiatry consultation program. The addiction medicine consultation program currently assists participating clinicians in providing care to patients with substance use addiction and provides referral support and additional services, and the bill retains the addiction medicine consultation program as a separate program.
The bill requires an organization to administer a mental health consultation program (MHCP) that incorporates a comprehensive set of mental health consultation services and may include perinatal, child, adult, geriatric, pain, veteran, and general mental health consultation services. Under the bill, the organization that currently administers the child psychiatry consultation program must administer the MHCP during the 2023-24 fiscal year, but DHS may contract with another organization in subsequent fiscal years. The contracting organization may contract with any other entity to perform any operations and satisfy any requirements of the MHCP. The contracting organization must do all of the following: 1) ensure that mental health providers providing services through the MHCP have the appropriate credentials as described in the bill, 2) maintain infrastructure to provide services statewide on every weekday, provide consultation services as promptly as practicable, 3) report to DHS any information DHS requires, 4) conduct surveys of participating clinicians as described in the bill, and 5) provide certain specified services. Those specified services are the following: 1) support for clinicians participating in the MHCP to assist in the management of mental health problems; 2) triage-level assessments to determine the most appropriate response; 3) diagnostics and therapeutic feedback when medically appropriate; and 4) recruitment of other practices to a provider’s services. The MHCP must be able to provide consultation services by telephone and email but may also provide services by other means. In addition to the services required in the bill, which are eligible for funding by DHS, the contracting organization may provide any of the services specified in the bill that are eligible for funding by DHS.
Repeal of school-based mental health consultation pilot program
The bill repeals a school-based mental health consultation pilot program created by 2019 Wisconsin Act 117. Under the current law pilot program, DHS is required to administer a school-based mental health consultation pilot program in Outagamie County to assist participating school-based providers in providing enhanced care to student with mental health care needs, to provide referral support for those students, and to provide additional services. Under current law, DHS must conduct annual surveys of the participating school-based providers who use the consultation pilot program and was required to submit a report on the program to the appropriate standing committees of the legislature by August 1, 2022. Grants for peer recovery centers
The bill allows DHS to distribute not more than $260,000 in each fiscal year to regional recovery centers for individuals experiencing mental health and substance abuse issues.
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.
