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.
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.
