Amendment AA8-ASA2-AB50

AB50-ASA2-AA8,205,3 81. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,205,4 “Section 9219. Fiscal changes; Health Services.

AB50-ASA2-AA8,205,14 (1) Cardiac arrest registry to enhance survival. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (1) (a), the dollar amount for fiscal year 2025-26 is increased by $25,000 to fund automatic data uploading privileges in the Cardiac Arrest Registry to Enhance Survival (CARES) digital registry of out-of-hospital cardiac arrests. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (1) (a), the dollar amount for fiscal year 2026-27 is increased by $25,000 to fund automatic data uploading privileges in the Cardiac Arrest Registry to Enhance Survival (CARES) digital registry of out-of-hospital cardiac arrests.”.

AB50-ASA2-AA8,205,15 82. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,205,16 “Section 9119. Nonstatutory provisions; Health Services.

AB50-ASA2-AA8,206,2 (1) Senior care reestimate. For fiscal year 2025-26, to reflect a reestimate of benefit costs under the senior care program, the GPR funding for senior care shall be decreased by $4,402,700; the FED funding for senior care shall be increased by $1,357,800; and the PR funding for senior care shall be decreased by $32,679,200. For fiscal year 2026-27, to reflect a reestimate of benefit costs under the senior care program, the GPR funding for senior care shall be decreased by $1,646,400; the FED funding for senior care shall be increased by $1,288,400; and the PR funding for senior care shall be decreased by $29,613,000.”.

AB50-ASA2-AA8,206,3 83. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,206,4 “Section 356. 46.995 (4) of the statutes is created to read:

AB50-ASA2-AA8,206,8 46.995 (4) The department shall ensure that any child who is eligible and who applies for the disabled children’s long-term support program that is operating under a waiver of federal law receives services under the disabled children’s long‑term support program that is operating under a waiver of federal law.”.

AB50-ASA2-AA8,206,9 84. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,206,10 “Section 9219. Fiscal changes; Health Services.

AB50-ASA2-AA8,206,18 (1) Community aids basic county allocations. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (7) (b), the dollar amount for fiscal year 2025-26 is increased by $1,698,200 to increase basic county allocations under the community aids program.. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (7) (b), the dollar amount for fiscal year 2026-27 is increased by $5,162,600 to increase basic county allocations under the community aids program.”.

AB50-ASA2-AA8,206,19 85. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,206,20 “Section 357. 20.435 (4) (bm) of the statutes is amended to read:

AB50-ASA2-AA8,207,15 20.435 (4) (bm) Medical Assistance, food stamps, and Badger Care administration; contract costs, insurer reports, and resource centers. Biennially, the amounts in the schedule to provide a portion of the state share of administrative contract costs for the Medical Assistance program under subch. IV of ch. 49 and the Badger Care health care program under s. 49.665 and to provide the state share of administrative costs for the food stamp program under s. 49.79, other than payments under s. 49.78 (8), to develop and implement a registry of recipient immunizations, to reimburse 3rd parties for their costs under s. 49.475, for costs associated with outreach activities, for state administration of state supplemental grants to supplemental security income recipients under s. 49.77, for grants under ss. 46.73 and 46.74, and for services of resource centers under s. 46.283. No state positions may be funded in the department of health services from this appropriation, except positions for the performance of duties under a contract in effect before January 1, 1987, related to the administration of the Medical Assistance program between the subunit of the department primarily responsible for administering the Medical Assistance program and another subunit of the department. Total administrative funding authorized for the program under s. 49.665 may not exceed 10 percent of the amounts budgeted under pars. (p) and (x).

AB50-ASA2-AA8,358 Section 358. 20.435 (4) (pa) of the statutes is amended to read:

AB50-ASA2-AA8,207,23 20.435 (4) (pa) Federal aid; Medical Assistance and food stamp contracts administration. All federal moneys received for the federal share of the cost of contracting for payment and services administration and reporting, other than moneys received under pars. (nn) and (np), to reimburse 3rd parties for their costs under s. 49.475, for administrative contract costs for the food stamp program under s. 49.79, for grants under ss. 46.73 and 46.74, and for services of resource centers under s. 46.283.

AB50-ASA2-AA8,359 Section 359. 46.73 of the statutes is created to read:

AB50-ASA2-AA8,208,4 46.73 Community dental health coordinators. From the appropriations under s. 20.435 (4) (bm) and (pa), the department shall award grants to support community dental health coordinators in rural regions of the state.

AB50-ASA2-AA8,360 Section 360. 46.74 of the statutes is created to read:

AB50-ASA2-AA8,208,8 46.74 Grants for mobile dental clinics. The department shall award grants to community health centers, as defined in s. 250.15 (1) (a), to procure and operate mobile dental clinics.”.

AB50-ASA2-AA8,208,9 86. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,208,10 “Section 361. 49.45 (30) (a) of the statutes is repealed.

AB50-ASA2-AA8,362 Section 362. 49.45 (30) (b) of the statutes is renumbered 49.45 (30) and amended to read:

AB50-ASA2-AA8,208,18 49.45 (30) Services provided by community support programs. The department shall reimburse a provider of county that provides services under s. 49.46 (2) (b) 6. L. only for the amount of the allowable charges for those services under the Medical Assistance program that is provided by the federal government and for the amount of the allowable charges for those services under the Medical Assistance program that is not provided by the federal government.

AB50-ASA2-AA8,363 Section 363. 49.45 (52) (a) 1. of the statutes is amended to read:

AB50-ASA2-AA8,209,9 49.45 (52) (a) 1. If the department provides the notice under par. (c) selecting the payment procedure in this paragraph, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payment adjustments to county departments under s. 46.215, 46.22, 46.23, 51.42, or 51.437 or to local health departments, as defined in s. 250.01 (4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating in the early intervention program under s. 51.44. Payment adjustments under this paragraph shall include the state share of the payments. The total of any payment adjustments under this paragraph and Medical Assistance payments made from appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

AB50-ASA2-AA8,364 Section 364. 49.45 (52) (b) 1. of the statutes is amended to read:

AB50-ASA2-AA8,209,16 49.45 (52) (b) 1. Annually, a county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437 shall submit a certified cost report that meets the requirements of the federal department of health and human services for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating in the early intervention program under s. 51.44.

AB50-ASA2-AA8,9219 Section 9219. Fiscal changes; Health Services.

AB50-ASA2-AA8,210,2 (1) Community support program; state payment of nonfederal share. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (4) (a), the dollar amount for fiscal year 2025-26 is increased by $19,616,200 for Medical Assistance services provided under the community support program. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (4) (a), the dollar amount for fiscal year 2026-27 is increased by $21,467,000 for Medical Assistance services provided under the community support program.”.

AB50-ASA2-AA8,210,3 87. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,210,4 “Section 365. 46.48 (27) of the statutes is created to read:

AB50-ASA2-AA8,210,11 46.48 (27) Community-based withdrawal management centers. From the appropriation under s. 20.435 (5) (bc), the department shall distribute not more than $500,000 in each fiscal year for grants to community-based withdrawal centers, including those certified as an adult residential integrated behavioral health stabilization service, residential intoxication monitoring service, or residential withdrawal management service, as those terms are defined under s. 49.45 (30p) (a) 1., 4., and 5.

AB50-ASA2-AA8,366 Section 366. 49.45 (30p) of the statutes is created to read:

AB50-ASA2-AA8,210,14 49.45 (30p) Detoxification and stabilization services. (a) In this subsection:

AB50-ASA2-AA8,211,4 1. “Adult residential integrated behavioral health stabilization service” means a residential behavioral health treatment service, delivered under the oversight of a medical director, that provides withdrawal management and intoxication monitoring, as well as integrated behavioral health stabilization services, and includes nursing care on site for medical monitoring available on a 24- hour basis. “Adult residential integrated behavioral health stabilization service” may include the provision of services including screening, assessment, intake, evaluation and diagnosis, medical care, observation and monitoring, physical examination, determination of medical stability, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, recovery support services, and crisis intervention services, to ameliorate acute behavioral health symptoms and stabilize functioning.

AB50-ASA2-AA8,211,7 2. “Community-based withdrawal management” means a medically managed withdrawal management service delivered on an outpatient basis by a physician or other service personnel acting under the supervision of a physician.

AB50-ASA2-AA8,211,10 3. “Detoxification and stabilization services” means adult residential integrated behavioral health stabilization service, residential withdrawal management service, or residential intoxication monitoring service.

AB50-ASA2-AA8,211,19 4. “Residential intoxication monitoring service” means a residential service that provides 24-hour observation to monitor the safe resolution of alcohol or sedative intoxication and to monitor for the development of alcohol withdrawal for intoxicated patients who are not in need of emergency medical or behavioral health care. “Residential intoxication monitoring service” may include the provision of services including screening, assessment, intake, evaluation and diagnosis, observation and monitoring, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, and recovery support services.

AB50-ASA2-AA8,212,9 5. “Residential withdrawal management service” means a residential substance use treatment service that provides withdrawal management and intoxication monitoring, and includes medically managed 24-hour on-site nursing care, under the supervision of a physician. “Residential withdrawal management service” may include the provision of services, including screening, assessment, intake, evaluation and diagnosis, medical care, observation and monitoring, physical examination, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, and recovery support services, to ameliorate symptoms of acute intoxication and withdrawal and to stabilize functioning. “Residential withdrawal management service” may also include community-based withdrawal management and intoxication monitoring services.

AB50-ASA2-AA8,212,14 (b) Subject to par. (c), the department shall provide reimbursement for detoxification and stabilization services under the Medical Assistance program under s. 49.46 (2) (b) 14r. The department shall certify providers under the Medical Assistance program to provide detoxification and stabilization services in accordance with this subsection.

AB50-ASA2-AA8,212,22 (c) The department shall submit to the federal department of health and human services any request for a state plan amendment, waiver, or other federal approval necessary to provide reimbursement for detoxification and stabilization services as described in this subsection. If the federal department approves the request or if no federal approval is necessary, the department shall provide the reimbursement under s. 49.46 (2) (b) 14r. If the federal department disapproves the request, the department may not provide the reimbursement described in this subsection.

AB50-ASA2-AA8,367 Section 367. 49.46 (2) (b) 14r. of the statutes is created to read:

AB50-ASA2-AA8,213,2 49.46 (2) (b) 14r. Detoxification and stabilization services as specified under s. 49.45 (30p).”

AB50-ASA2-AA8,213,3 88. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,213,4 “Section 9119. Nonstatutory provisions; Health Services.

AB50-ASA2-AA8,213,5 (1) Complex patient pilot program.

AB50-ASA2-AA8,213,6 (a) In this subsection:

AB50-ASA2-AA8,213,7 1. “Department” means the department of health services.

AB50-ASA2-AA8,213,9 2. “Partnership group” means one or more hospitals in partnership with one or more post-acute facilities.

AB50-ASA2-AA8,213,13 (b) The department shall use a competitive grant selection process to select partnership groups to be designated as participating sites for a complex patient pilot program under this subsection and, from the appropriation under s. 20.435 (7) (d), award grants to the groups selected.

AB50-ASA2-AA8,213,18 (c) The department shall solicit feedback regarding the complex patient pilot program from representatives of healthcare system organizations, long-term care provider organizations, long-term care operator organizations, patient advocate groups, insurers, and any other organization determined to be relevant by the secretary of health services.

AB50-ASA2-AA8,213,21 (d) The department shall require that each partnership group that applies to the department to be designated as a site for the complex patient pilot program shall address all of the following issues in its application:

AB50-ASA2-AA8,214,2 1. The number of complex patient care beds that will be set aside in a post- acute facility or through implementation of an innovative model of patient care in a post-acute facility to which participating hospitals agree, such as dedicated staffing for dementia or a behavioral health unit.

AB50-ASA2-AA8,214,4 2. Defined goals and measurable outcomes of the partnership group during the pilot program and after the pilot program.

AB50-ASA2-AA8,214,8 3. The types of complex patients for whom care will be provided, which may include patients needing total care for multiple conditions or comorbidities such as cardiac and respiratory diseases, obesity, mental health, substance use, or dementia.

AB50-ASA2-AA8,214,11 4. An operating budget for the proposed site that details how fiscal responsibility will be shared among members of the partnership group and includes all of the following:

AB50-ASA2-AA8,214,13 a. Estimated patient revenues from other sources, including the Medical Assistance program under subch. IV of ch. 49, and estimated total costs.

AB50-ASA2-AA8,214,14 b. A margin to account for reserved beds.

AB50-ASA2-AA8,214,16 5. The partnership group’s expertise to successfully implement the proposal, which may include a discussion of the following issues:

AB50-ASA2-AA8,214,18 a. Documented experience of the partners working together to serve complex patients.

AB50-ASA2-AA8,214,21 b. The implementation timeline and the plan for post-acute facilities to accept admissions and transfer patients within 72 hours of a request submitted by a hospital.

AB50-ASA2-AA8,215,2 c. The plan for an interdisciplinary team that will staff the unit in the post- acute facility, including the availability of staff with appropriate expertise that includes physicians, nurses, advance practice health professionals, pharmacists, physical therapists, occupational therapists, and social workers.

AB50-ASA2-AA8,215,3 d. Ability to electronically exchange health information.

AB50-ASA2-AA8,215,5 e. Resources to conduct patient intake and discharge planning from the post- acute facility, including case managers and social workers.

AB50-ASA2-AA8,215,8 f. Ability to conduct monthly case management reviews with the interdisciplinary team for every complex care patient that cover care plan progress and any readmissions to an acute care hospital.

AB50-ASA2-AA8,215,9 g. Ability to conduct monthly quality assurance reviews.

AB50-ASA2-AA8,215,10 h. Ability of the treatment model to be replicated by other healthcare systems.

AB50-ASA2-AA8,215,12 i. Plans to document decreases in lengths of stay for complex patients in hospitals and avoided hospital days.

AB50-ASA2-AA8,215,17 j. Documentation of stable finances among partnership group members to support the proposal, including matching funds that could be dedicated to the pilot program under this subsection. No applicant may be required to provide matching funds or a contribution, but the department may take into consideration the availability of matching funds or a contribution in evaluating an application.

AB50-ASA2-AA8,215,19 k. Description of anticipated impediments to successful implementation and how the partnership group intends to overcome the anticipated impediments.

AB50-ASA2-AA8,215,21 (e) In implementing this subsection, the department shall do all of the following:

AB50-ASA2-AA8,216,2 1. Develop a methodology to evaluate the complex patient pilot program and contract with an independent organization to complete the evaluation. The department may pay the fee of the organization selected from the appropriation under s. 20.435 (7) (d).

AB50-ASA2-AA8,216,4 2. Give additional weight to partnership groups that would ensure geographic diversity.

AB50-ASA2-AA8,216,7 (f) Upon completion of the evaluation required under par. (e) 1., the independent organization contracted by the department to complete the evaluation shall provide the evaluation to the department.

AB50-ASA2-AA8,9219 Section 9219. Fiscal changes; Health Services.

AB50-ASA2-AA8,216,14 (1) Complex patient pilot program. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (7) (d), the dollar amount for fiscal year 2025-26 is increased by $15,000,000 to fund, on a one- time basis, a complex patient pilot program to help facilitate the transfer of complex patients from acute care settings, such as hospitals, to post-acute care facilities, in the 2025-27 biennium.”.

AB50-ASA2-AA8,216,15 89. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,216,16 “Section 368. 20.435 (5) (bw) of the statutes is amended to read:

AB50-ASA2-AA8,216,21 20.435 (5) (bw) Child psychiatry and addiction medicine consultation programs Mental health consultation program. Biennially, the amounts in the schedule for operating the child psychiatry consultation program under s. 51.442 and the addiction medicine consultation program under s. 51.448 mental health consultation program under s. 51.443.

AB50-ASA2-AA8,369 Section 369. 20.435 (5) (bx) of the statutes is created to read:

AB50-ASA2-AA8,217,2 20.435 (5) (bx) Addiction medicine consultation program. Biennially, the amounts in the schedule for operating the addiction medicine consultation program under s. 51.448.

AB50-ASA2-AA8,370 Section 370. 20.435 (5) (ct) of the statutes is repealed.

AB50-ASA2-AA8,371 Section 371. 51.441 of the statutes is repealed.

AB50-ASA2-AA8,372 Section 372. 51.442 of the statutes is repealed.

AB50-ASA2-AA8,373 Section 373. 51.443 of the statutes is created to read:

AB50-ASA2-AA8,217,7 51.443 Mental health consultation program. (1) In this section:

AB50-ASA2-AA8,217,10 (a) “Participating clinicians” includes physicians, nurse practitioners, physician assistants, and medically appropriate members of the care teams of physicians, nurse practitioners, and physician assistants.