Mike Johnson grants
The bill increases from $4,000,000 to $4,500,000 the annual maximum amount of Mike Johnson life care and early intervention services grants that DHS awards to organizations for HIV-related services, including needs assessments, assistance in procuring services, counseling and therapy, home care services and supplies, advocacy, case management services, and early intervention services.
Grants for pediatric health psychology residency and fellowship training programs
Under current law, DHS awards grants for certain community programs. The bill allows DHS to distribute up to $600,000 in each fiscal year as grants to support pediatric health psychology residency and fellowship training programs.
Trauma resilience grant
The bill allows DHS, through the grants program it is required to administer, to distribute up to $250,000 in fiscal year 2025–26 and up to $250,000 in fiscal year 2026–27 as a grant to an organization in the city of Milwaukee to support the needs of individuals impacted by trauma and to develop the capacity of organizations to treat and prevent trauma.
Behavioral health and developmental disabilities
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 nonhospital 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 Medical Assistance 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 Medical Assistance program.
Under current law, DHS must 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.
988 Suicide and Crisis Lifeline grants
The bill requires DHS to award 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 the state. Currently, DHS partners with Wisconsin Lifeline to provide statewide 988 crisis hotline services.
Crisis stabilization facilities grants
The bill requires DHS to award grants for services at facilities providing crisis stabilization services. Under the bill, “crisis stabilization services” are optional emergency mental health services that provide short-term, intensive, community-based services to avoid the need for inpatient hospitalization.
Crisis program enhancement grants
The bill expands the crisis program enhancement grant program to include grants to counties, regions comprising multiple counties, or municipalities to establish and enhance law enforcement and behavioral health services emergency response collaboration programs. Under current law, the crisis program enhancement grant program requires DHS to award grants to counties or regions of multiple counties to establish or enhance crisis programs to serve individuals having crises in rural areas. The bill instructs DHS to annually award a total amount of $2,000,000 in each fiscal biennium to establish and enhance law enforcement and behavioral health services emergency response collaboration programs. The bill requires any entity that receives a grant to establish and enhance law enforcement and behavioral health services emergency response collaboration programs to contribute at least 25 percent of the grant amount awarded for the purpose that the grant money is received.
Crisis urgent care and observation facilities
The bill amends a biennial appropriation to DHS for grants to support crisis urgent care and observation facilities to make it a continuing appropriation. Biennial appropriations are appropriations that are expendable for the fiscal biennium for which they are made. Continuing appropriations are appropriations that are expendable until fully depleted or repealed by a subsequent action of the legislature.
Extended intensive treatment surcharge
Under current law, an individual may be placed at or transferred to a state center for the developmentally disabled if DHS and the individual’s county of residence agree upon a maximum discharge date for the individual, among other requirements. Currently, DHS may impose a surcharge on a county for certain services provided at a center for the developmentally disabled after an individual’s maximum discharge date. Under current law, all moneys received as payment for the surcharge must be provided to counties for onetime costs associated with relocating individuals from a center for the developmentally disabled. Under the bill, the surcharge must be used instead for the provision of alternative services by mental health institutes and centers for the developmentally disabled, such as residential, dental, and mental health services.
Funding for Winnebago Mental Health Institute
The bill transfers moneys from the general fund to a program revenue appropriation for DHS to support the operations of Winnebago Mental Health Institute.
Mental health consultation program
The bill combines the child psychiatry consultation program with additional services into a new mental health consultation program. The bill also splits off funding for the existing addiction medicine consultation program into a separate appropriation.
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. Current law 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 is eliminated in the bill along with the separate child psychiatry consultation program. Under current law, the addiction medicine consultation program assists participating clinicians in providing care to patients with substance use addiction and provides referral support and additional services. The bill retains the program, but establishes a new appropriation to fund the 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 2025–26 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: ensure that mental health providers providing services through the MHCP have the appropriate credentials as described in the bill, maintain infrastructure to provide services statewide on every weekday, provide consultation services as promptly as practicable, report to DHS any information DHS requires, conduct surveys of participating clinicians as described in the bill, and provide certain specified services. Those specified services are the following: support for clinicians participating in the MHCP to assist in the management of mental health concerns; triage-level assessments to determine the most appropriate response; diagnostics and therapeutic feedback when medically appropriate; and 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.
HOUSING
WHEDA housing programs modifications
The bill makes modifications to three housing programs administered by WHEDA: the residential housing infrastructure revolving loan program, also known as the Infrastructure Access program; the main street housing rehabilitation revolving loan program, also known as the Restore Main Street program; and the commercial-to-housing conversion revolving loan program, also known as the Vacancy-to-Vitality program.
For the Infrastructure Access program, the bill does all of the following:
1. Allows a loan to a developer to provide for up to 33 percent of total project costs and a loan to a governmental unit to provide for up to 25 percent of total project costs. Under current law, a loan to developers may provide for up to 20 percent of total project costs and a loan to a governmental unit may provide for up to 10 percent of total project costs.
2. Permits up to 25 percent of the amount of a loan to a developer to be used for improvements to private infrastructure. Under current law, a loan may be used for improvements to only infrastructure that is or will be owned, maintained, or provided for or to a governmental unit or infrastructure in a rural area that is transferred to public use.
3. Allows tribal housing authorities to receive loans as developers of eligible projects.
For the Restore Main Street program, the bill does all of the following:
1. Allows a loan to provide for up to $50,000 per dwelling unit or 33 percent of total project costs, whichever is less. Under current law, a loan may provide for up to $20,000 per dwelling unit or 25 percent of total project costs, whichever is less.
2. Allows loans to be awarded to projects under the jurisdiction of a federally recognized American Indian tribe or band.
For the Vacancy-to-Vitality program, the bill does all of the following:
1. Allows a loan to provide for up to 33 percent of total project costs. Under current law, a loan may provide up to $1,000,000 per project or 20 percent of total project costs, whichever is less.
2. Permits housing developments with fewer than six dwelling units to be eligible for a loan. Under current law, an eligible housing development must have fewer than 16 dwelling units.
3. Allows loans to be awarded to projects under the jurisdiction of a federally recognized American Indian tribe or band.
In addition, the bill does the following for each of the three programs:
1. Removes the requirements that a governmental unit have updated the housing element of its comprehensive plan within five years in order to be eligible for a loan and permits projects to benefit from a tax incremental district and to use historic tax credits.
2. For the purpose of establishing that a governmental unit has reduced the costs of housing as part of applying for a loan, allows the governmental unit to submit to WHEDA measures taken by the governmental unit on or after January 1, 2015. Under current law, a governmental unit or political subdivision must show cost-reduction measures taken on or after January 1, 2023.
3. Allows a loan to be awarded for projects on tribal reservation or trust lands not subject to property taxes in this state.
Discrimination in housing based on receipt of rental or housing assistance
Current open housing law prohibits discrimination in housing based on sex; race; color; sexual orientation; disability; religion; national origin; marital status; family status; status as a victim of domestic abuse, sexual assault, or stalking; lawful source of income; age; or ancestry. The bill prohibits discrimination in housing based on receipt of rental or housing assistance in the form of a contribution from a third party.
Capital reserve fund bonding limit
Under current law, WHEDA issues notes and bonds for most WHEDA programs, including housing programs for individuals and families of low or moderate income. Current law prohibits WHEDA from issuing notes and bonds that are secured by a capital reserve fund if the total aggregate outstanding principal amount would exceed $1,000,000,000. The bill increases this limit to $1,300,000,000.
Low-income housing tax credit
Under current law, WHEDA may certify a person to claim, for a period of up to six years, a state tax credit if the person has an ownership interest in a low-income housing project in Wisconsin and qualifies for the federal low-income housing tax credit program. The bill increases the amount of credits that WHEDA may annually certify from $42,000,000 to $100,000,000. The bill also requires that the project be allocated the federal credit and financed with tax-exempt bonds that are not subject to the federal credit’s volume cap—as opposed to any tax-exempt bonds, as required under current law—and allows WHEDA to waive these requirements to the extent that WHEDA anticipates that sufficient tax-exempt private activity bond volume cap under federal law will not be available to finance low-income housing projects in any year.
Affordable housing and workforce development grants
The bill requires DOA to establish a competitive grant program to award grants to cities, villages, towns, counties, school districts, and businesses, whether operated for profit or not for profit, to fund the start-up of programs focused on developing the skilled workforce by building or rehabilitating affordable housing in their communities.
Grants to incentivize eliminating zoning barriers to affordable housing
The bill requires DOA to establish a competitive grant program to award grants to cities, villages, towns, counties, and federally recognized American Indian tribes and bands in the state that adopt one or more of the policy initiatives enumerated in the bill to eliminate zoning barriers for the creation or expansion of affordable housing.
Homeless case management services grants
Under current law, DOA may award up to 10 grants of up to $50,000 each year to shelter facilities for case management services provided to homeless families. The bill eliminates the limit on the number of grants that may be awarded and raises the grant limit to $75,000.
Geographic distribution of housing grants
Under current law, DOA may award grants to provide homeless individuals with housing and other supportive services to facilitate their movement to independent living. DOA must ensure that the funds for the grants are reasonably balanced among geographic areas of the state that correspond to the geographic areas served by each continuum of care organization designated by the federal Department of Housing and Urban Development. Under the bill, the geographic areas of the state among which DOA must balance funds for the grants need not correspond to the geographic areas served by each continuum of care organization.
Grants to Milwaukee County Housing First
The bill directs DOA to award two grants of $100,000 in fiscal years 2025–26 and 2026–27 to the Milwaukee County Department of Health and Human Services to support Milwaukee County’s Housing First initiative.
Whole-home upgrade grants
The bill establishes a pilot program under which DOA must award one or more grants to Walnut Way Conservation Corp. for the purpose of funding home improvements in low-income households in a first class city (presently only Milwaukee) that have one or more of the following goals: 1) reducing carbon emissions; 2) reducing energy burdens; 3) creating cost savings; or 4) creating healthier living environments. The bill authorizes DOA to establish eligibility requirements and other program guidelines for the grant program and allows a grant recipient to use grant moneys for administrative costs.
Housing quality standards grants
The bill requires DOA to award grants to owners of rental housing units in Wisconsin for purposes of satisfying applicable housing quality standards.
INSURANCE
Prescription Drug Affordability Review Board
The bill creates the Prescription Drug Affordability Review Board, whose purpose is to protect Wisconsin residents and other stakeholders from the high costs of prescription drugs. The board consists of the commissioner of insurance and the following members, all of whom are appointed by the governor for four-year terms:
1. Two members who represent the pharmaceutical drug industry, at least one of whom is a licensed pharmacist.
2. Two members who represent the health insurance industry.
3. Two members who represent the health care industry, at least one of whom is a licensed practitioner.
4. Two members who represent the interests of the public.
The bill requires the board to meet in open session at least four times per year to review prescription drug pricing information. The board must provide at least two weeks’ public notice of its meetings, make the meeting’s materials publicly available at least one week prior to meeting, and provide the opportunity for public comment. The bill imposes conflict of interest requirements for the board relating to recusal and public disclosure of certain conflicts. The bill directs the board to access and assess drug pricing information, to the extent practicable, by accessing and assessing information from other states, by assessing spending for the drug in Wisconsin, and by accessing other available pricing information.
Under the bill, the board must conduct drug cost affordability reviews. The first step in the reviews is for the board to identify prescription drugs whose launch wholesale acquisition cost exceeds specified thresholds, prescription drugs whose increase in wholesale acquisition cost exceeds specified thresholds, and other prescription drugs that may create affordability challenges for the health care system in Wisconsin. For each identified prescription drug, the board must determine whether to conduct an affordability review by seeking stakeholder input and considering the average patient cost share for the drug. During an affordability review, the board must determine whether use of the prescription drug that is fully consistent with the labeling approved by the federal Food and Drug Administration or standard medical practice has led or will lead to an affordability challenge for the health care system in Wisconsin. In making this determination, the bill requires the board to consider a variety of factors, which include the following:
1. The drug’s wholesale acquisition cost.
2. The average monetary price concession, discount, or rebate the manufacturer provides, or is expected to provide, for the drug to health plans.
3. The total amount of price concessions, discounts, and rebates the manufacturer provides to each pharmacy benefit manager for the drug.
4. The price at which therapeutic alternatives have been sold and the average monetary concession, discount, or rebate the manufacturer provides, or is expected to provide, to health plan payors and pharmacy benefit managers for therapeutic alternatives.
5. The costs to health plans based on patient access consistent with federal labeled indications and recognized standard medical practice.
6. The impact on patient access resulting from the drug’s cost relative to insurance benefit design.
7. The current or expected dollar value of drug-specific patient access programs that are supported by the manufacturer.
8. The relative financial impacts to health, medical, or social services costs that can be quantified and compared to baseline effects of existing therapeutic alternatives.
9. The average patient copay or other cost sharing for the drug.
If the board determines that a prescription drug will lead to an affordability challenge, the bill directs the board to establish an upper payment limit for that drug that applies to all purchases and payor reimbursements of the drug dispensed or administered to individuals in Wisconsin. In establishing the upper payment limit, the board must consider the cost of administering the drug, the cost of delivering it to consumers, and other relevant administrative costs. For certain drugs, the board must solicit information from the manufacturer regarding the price increase and, if the board determines that the price increase is not a result of the need for increased manufacturing capacity or other effort to improve patient access during a public health emergency, the board must establish an upper payment limit equal to the drug’s cost prior to the price increase.
Office of the Public Intervenor
The bill creates the Office of the Public Intervenor, attached to OCI. Under the bill, the Office of the Public Intervenor assists individuals with claims, policies, appeals, and other legal actions related to pursuing insurance coverage for medical procedures, prescription medications, and other health care services. The bill authorizes the office to levy an assessment on insurance providers based upon their premium volume for health insurance policies written in the state.
Prescription drug importation program
The bill requires the commissioner of insurance, in consultation with persons interested in the sale and pricing of prescription drugs and federal officials and agencies, to design and implement a prescription drug importation program for the benefit of and that generates savings for Wisconsin residents. The bill establishes requirements for the program, including all of the following: 1) the commissioner must designate a state agency to become a licensed wholesale distributor or contract with a licensed wholesale distributor and to seek federal certification and approval to import prescription drugs; 2) the program must comply with certain federal regulations and import from Canadian suppliers only prescription drugs that are not brand-name drugs, have fewer than four competitor drugs in this country, and for which importation creates substantial savings; 3) the commissioner must ensure that prescription drugs imported under the program are not distributed, dispensed, or sold outside of Wisconsin; and 4) the program must have an audit procedure to ensure the program complies with certain requirements specified in the bill. Before submitting the proposed program to the federal government for certification, the commissioner must submit the proposed program to JCF for its approval.
State prescription drug purchasing entity
