Amendment AA2-ASA2-AB68

AB68-ASA2-AA2,26,17 49.45 (5g) Payments to tribes. (a) Tribal care coordination agreements. A tribal health care provider's care coordination agreement with a nontribal health care provider shall meet federal requirements, including that a service provided by the nontribal health care provider be at the request of the tribal health care provider on behalf of a tribal member who remains in the tribal health care provider's care according to the care coordination agreement; that both the tribal health care provider and nontribal health care provider are providers, as defined in s. 49.43 (10); that an established relationship exists between the tribal health care provider and the tribal member; and that the care be provided pursuant to a written care coordination agreement.

AB68-ASA2-AA2,27,3 (b) Amount and distribution of payments. 1. From the appropriation account under s. 20.435 (4) (b), the department shall make payments to eligible governing bodies of federally recognized American Indian tribes or bands or tribal health care providers in an amount and manner determined by the department. The department shall determine payment amounts on the basis of the difference between the state share of medical assistance payments paid for services rendered to tribal members for whom a care coordination agreement with nontribal health care providers is in place and the state share of medical assistance payments that would have been paid for those services absent a care coordination agreement with nontribal partners.

AB68-ASA2-AA2,27,6 2. The department shall withhold from the payments under subd. 1. the state share of administrative costs associated with carrying out this subsection, not to exceed 10 percent of the amounts calculated in subd. 1.

AB68-ASA2-AA2,27,9 3. Federally recognized American Indian tribes or bands may use funds paid under this subsection for health-related purposes. The department shall consult biennially with tribes to determine the timing and distribution of payments.”.

AB68-ASA2-AA2,27,10 88. Page 292, line 12: after that line insert:

AB68-ASA2-AA2,27,11 “ Section 229c. 49.45 (6xm) of the statutes is created to read:

AB68-ASA2-AA2,27,15 49.45 (6xm) Pediatric inpatient supplement. (a) From the appropriations under s. 20.435 (4) (b), (o), and (w), the department shall, using a method determined by the department, distribute a total sum of $2,000,000 each state fiscal year to hospitals that meet all of the following criteria:

AB68-ASA2-AA2,27,16 1. The hospital is an acute care hospital located in this state.

AB68-ASA2-AA2,27,21 2. During the hospital's fiscal year, the inpatient days in the hospital's acute care pediatric units and intensive care pediatric units totaled more than 12,000 days, not including neonatal intensive care units. For purposes of this subsection, the hospital's fiscal year is the hospital's fiscal year that ended in the 2nd calendar year preceding the beginning of the state fiscal year.

AB68-ASA2-AA2,28,5 (b) Notwithstanding par. (a), from the appropriations under s. 20.435 (4) (b), (o), and (w), if the department has expanded eligibility under section 2001 (a) (1) (C) of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical Assistance program under this subchapter, then the department may, using a method determined by the department, distribute an additional total sum of $7,500,000 in each state fiscal year to hospitals that are free-standing pediatric teaching hospitals located in Wisconsin that have a percentage calculated under s. 49.45 (3m) (b) 1. a. greater than 45 percent.

AB68-ASA2-AA2,229d Section 229d. 49.45 (23) of the statutes is repealed.

AB68-ASA2-AA2,229f Section 229f. 49.45 (23b) (title) of the statutes is amended to read:

AB68-ASA2-AA2,28,9 49.45 (23b) (title) Childless adults demonstration project reform waiver implementation required.

AB68-ASA2-AA2,229g Section 229g. 49.45 (23b) (b) of the statutes is amended to read:

AB68-ASA2-AA2,28,14 49.45 (23b) (b) Beginning as soon as practicable after October 31, 2018, and ending no sooner than December 31, 2023, the department shall do all of the following with regard to the childless adults demonstration project under sub. (23) s. 49.471 (4) (a) 8.:

AB68-ASA2-AA2,28,20 1. Require in each month persons, except exempt individuals, who are eligible to receive Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. and who are at least 19 years of age but have not attained the age of 50 to participate in, document, and report 80 hours per calendar month of community engagement activities. The department, after finding good cause, may grant a temporary exemption from the requirement under this subdivision upon request of a Medical Assistance recipient.

AB68-ASA2-AA2,28,23 2. Require persons with incomes of at least 50 percent of the poverty line to pay premiums in accordance with par. (c) as a condition of eligibility for Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.

AB68-ASA2-AA2,28,25 3. Require as a condition of eligibility for Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. completion of a health risk assessment.

AB68-ASA2-AA2,29,3 4. Charge recipients of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. an $8 copayment for nonemergency use of the emergency department in accordance with 42 USC 1396o-1 (e) (1) and 42 CFR 447.54.

AB68-ASA2-AA2,29,8 5. Disenroll from Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. for 6 months any individual who does not pay a required premium under subd. 2. and any individual who is required under subd. 1. to participate in a community engagement activity but who does not participate for 48 aggregate months in the community engagement activity.

AB68-ASA2-AA2,229h Section 229h. 49.45 (23b) (c) of the statutes is amended to read:

AB68-ASA2-AA2,29,15 49.45 (23b) (c) 1. Persons who are eligible for the demonstration project under sub. (23) s. 49.471 (4) (a) 8. and who have monthly household income that exceeds 50 percent of the poverty line shall pay a monthly premium amount of $8 per household. A person who is eligible to receive an item or service furnished by an Indian health care provider is exempt from the premium requirement under this subdivision.

AB68-ASA2-AA2,29,21 2. The department may disenroll under par. (b) 5. a person for nonpayment of a required monthly premium only at annual eligibility redetermination after providing notice and reasonable opportunity for the person to pay. If a person who is disenrolled for nonpayment of premiums pays all owed premiums or becomes exempt from payment of premiums, he or she may reenroll in Medical Assistance under sub. (23) s. 49.471 (4) (a) 8.

AB68-ASA2-AA2,29,25 3. The department shall reduce the amount of the required household premium by up to half for a recipient of Medical Assistance under sub. (23) s. 49.471 (4) (a) 8. who does not engage in certain behaviors that increase health risks or who attests to actively managing certain unhealthy behaviors.

AB68-ASA2-AA2,229j Section 229j. 49.45 (23b) (e) of the statutes is amended to read:

AB68-ASA2-AA2,30,6 49.45 (23b) (e) Before December 31, 2023, the demonstration project requirements under this subsection may not be withdrawn and the department may not request from the federal government withdrawal, suspension, or termination of the demonstration project requirements under this subsection unless legislation has been enacted specifically allowing for the withdrawal, suspension, or termination.

AB68-ASA2-AA2,229m Section 229m. 49.45 (24L) of the statutes is created to read:

AB68-ASA2-AA2,30,11 49.45 (24L) Critical access reimbursement payments to dental providers. (a) Based on the criteria in pars. (b) and (c), the department shall increase reimbursements to dental providers that meet quality of care standards, as established by the department.

AB68-ASA2-AA2,30,13 (b) In order to be eligible for enhanced reimbursement under this subsection, the provider must meet one of the following qualifications:

AB68-ASA2-AA2,30,16 1. For a nonprofit or public provider, 50 percent or more of the individuals served by the provider are individuals who are without dental insurance or are enrolled in the Medical Assistance program.

AB68-ASA2-AA2,30,18 2. For a for-profit provider, 5 percent or more of the individuals served by the provider are enrolled in the Medical Assistance program.

AB68-ASA2-AA2,31,4 (c) For dental services rendered on or after January 1, 2022, by a qualified nonprofit or public dental provider, the department shall increase reimbursement by 50 percent above the reimbursement rate that would otherwise be paid to that provider. For dental services rendered on or after January 1, 2022, by a qualified for-profit dental provider, the department shall increase reimbursement by 30 percent above the reimbursement rate that would otherwise be paid to that provider. For dental providers rendering services to individuals in managed care under the Medical Assistance program, for services rendered on or after January 1, 2022, the department shall increase reimbursement to pay an additional amount on the basis of the rate that would have been paid to the dental provider had the individual not been enrolled in managed care.

AB68-ASA2-AA2,31,7 (d) If a provider has more than one service location, the thresholds described under par. (b) apply to each location, and the department will determine the payment for each separate service location.

AB68-ASA2-AA2,31,9 (e) Any provider that receives reimbursement through the pilot project under sub. (24k) is not eligible for reimbursement under this subsection.

AB68-ASA2-AA2,229p Section 229p. 49.45 (25r) of the statutes is created to read:

AB68-ASA2-AA2,31,11 49.45 (25r) Community health worker services. (a) In this subsection:

AB68-ASA2-AA2,31,13 1. “Community health services” means services provided by a community health worker.

AB68-ASA2-AA2,31,21 2. “Community health worker” means a front-line public health worker who is a trusted member of or has a close understanding of the community served, enabling the worker to serve as a liaison, link, or intermediary between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery, and who builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support, and advocacy.

AB68-ASA2-AA2,32,4 (b) The department shall request any necessary waiver from, or submit any necessary amendments to the state Medical Assistance plan to, the secretary of the federal department of health and human services to provide community health services to eligible Medical Assistance recipients. If the waiver or state plan amendment is granted, the department shall reimburse certified providers for those community health services approved by the federal department of health and human services for Medical Assistance coverage and as provided to Medical Assistance recipients under s. 49.46 (2) (b) 9m.

AB68-ASA2-AA2,229r Section 229r. 49.45 (30e) (a) 2. of the statutes is repealed.

AB68-ASA2-AA2,229s Section 229s. 49.45 (30e) (b) 3. of the statutes is amended to read:

AB68-ASA2-AA2,32,9 49.45 (30e) (b) 3. Requirements for certification of community-based psychosocial service programs. The department may certify county-based providers and providers that are not county-based providers.

AB68-ASA2-AA2,229t Section 229t. 49.45 (30e) (c) of the statutes is renumbered 49.45 (30e) (c) 1. and amended to read:

AB68-ASA2-AA2,32,18 49.45 (30e) (c) 1. A The department shall reimburse a county that elects to make the provide services under s. 49.46 (2) (b) 6. Lm. available shall reimburse a provider of the services for the amount of the allowable charges for those services under the medical assistance Medical Assistance program that is not provided by the federal government. The department shall reimburse the provider only for and the amount of the allowable charges for those services under the medical assistance Medical Assistance program that is provided by the federal government.

AB68-ASA2-AA2,229u Section 229u. 49.45 (30e) (c) 2. of the statutes is created to read:

AB68-ASA2-AA2,32,22 49.45 (30e) (c) 2. The department shall reimburse to a provider that is not a county-based provider for services under s. 49.46 (2) (b) 6. Lm. for both the federal and nonfederal share of a fee schedule that is determined by the department.

AB68-ASA2-AA2,229v Section 229v. 49.45 (30e) (d) of the statutes is amended to read:

AB68-ASA2-AA2,33,6 49.45 (30e) (d) Provision of services on regional basis. Notwithstanding par. (c) 1. and subject to par. (e), in counties that elect to deliver provide the services under s. 49.46 (2) (b) 6. Lm. through the Medical Assistance program on a regional basis according to criteria established by the department, the department shall reimburse a provider of the services 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 that is not provided by the federal government.

AB68-ASA2-AA2,229x Section 229x. 49.45 (30t) of the statutes is created to read:

AB68-ASA2-AA2,33,8 49.45 (30t) Doula services. (a) In this subsection:

AB68-ASA2-AA2,33,10 1. “Certified doula” means an individual who has received certification from a doula certifying organization recognized by the department.

AB68-ASA2-AA2,33,13 2. “Doula services” means childbirth education and support services, including emotional and physical support provided during pregnancy, labor, birth, and the postpartum period.

AB68-ASA2-AA2,33,19 (b) The department shall request from the secretary of the federal department of health and human services any required waiver or any required amendment to the state plan for Medical Assistance to allow reimbursement for doula services provided by a certified doula. If the waiver or state plan amendment is granted, the department shall reimburse a certified doula under s. 49.46 (2) (b) 12p. for the allowable charges for doula services provided to Medical Assistance recipients.”.

AB68-ASA2-AA2,33,21 89. Page 292, line 13: delete the material beginning with that line and ending with page 294, line 2, and substitute:

AB68-ASA2-AA2,33,22 “ Section 230b. 49.46 (1) (a) 1m. of the statutes is amended to read:

AB68-ASA2-AA2,34,2 49.46 (1) (a) 1m. Any pregnant woman whose income does not exceed the standard of need under s. 49.19 (11) and whose pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th 365th day after the last day of the pregnancy falls.

AB68-ASA2-AA2,230d Section 230d. 49.46 (1) (j) of the statutes is amended to read:

AB68-ASA2-AA2,34,7 49.46 (1) (j) An individual determined to be eligible for benefits under par. (a) 9. remains eligible for benefits under par. (a) 9. for the balance of the pregnancy and to the last day of the month in which the 60th 365th day after the last day of the pregnancy falls without regard to any change in the individual's family income.

AB68-ASA2-AA2,230f Section 230f. 49.46 (2) (b) 8m. of the statutes is created to read:

AB68-ASA2-AA2,34,10 49.46 (2) (b) 8m. Room and board for residential substance use disorder treatment.

AB68-ASA2-AA2,230h Section 230h. 49.46 (2) (b) 9m. of the statutes is created to read:

AB68-ASA2-AA2,34,12 49.46 (2) (b) 9m. Community health services, as specified under s. 49.45 (25r).

AB68-ASA2-AA2,230j Section 230j. 49.46 (2) (b) 11m. of the statutes is created to read:

AB68-ASA2-AA2,34,15 49.46 (2) (b) 11m. Subject to par. (bx), acupuncture provided by an acupuncturist who holds a certificate under ch. 451.

AB68-ASA2-AA2,230k Section 230k. 49.46 (2) (b) 12p. of the statutes is created to read:

AB68-ASA2-AA2,34,18 49.46 (2) (b) 12p. Doula services provided by a certified doula, as specified under s. 49.45 (30t).

AB68-ASA2-AA2,230n Section 230n. 49.46 (2) (b) 24. of the statutes is created to read:

AB68-ASA2-AA2,34,21 49.46 (2) (b) 24. Subject to par. (bv), nonmedical services that contribute to the determinants of health.

AB68-ASA2-AA2,230p Section 230p. 49.46 (2) (bv) of the statutes is created to read:

AB68-ASA2-AA2,35,4 49.46 (2) (bv) The department shall determine those services under par. (b) 24. that contribute to the determinants of health. The department shall seek any necessary state plan amendment or request any waiver of federal Medicaid law to implement this paragraph. The department is not required to provide the services under this paragraph as a benefit under the Medical Assistance program if the federal department of health and human services does not provide federal financial participation for the services under this paragraph.

AB68-ASA2-AA2,230r Section 230r. 49.46 (2) (bx) of the statutes is created to read:

AB68-ASA2-AA2,35,12 49.46 (2) (bx) 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 the benefit under par. (b) 11m. If the federal department approves the request or if no federal approval is necessary, the department shall provide the benefit and reimbursement under par. (b) 11m. If the federal department disapproves the request, the department may not provide the benefit or reimbursement for the benefit described under par. (b) 11m.

AB68-ASA2-AA2,230u Section 230u. 49.47 (4) (ag) 2. of the statutes is amended to read:

AB68-ASA2-AA2,35,16 49.47 (4) (ag) 2. Pregnant and the woman's pregnancy is medically verified Eligibility continues to the last day of the month in which the 60th 365th day after the last day of the pregnancy falls.

AB68-ASA2-AA2,231b Section 231b. 49.471 (1) (cr) of the statutes is created to read:

AB68-ASA2-AA2,35,19 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

AB68-ASA2-AA2,231d Section 231d. 49.471 (4) (a) 4. b. of the statutes is amended to read:

AB68-ASA2-AA2,35,23 49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133 percent of the poverty line before application of the 5 percent income disregard under 42 CFR 435.603 (d).

AB68-ASA2-AA2,231f Section 231f. 49.471 (4) (a) 8. of the statutes is created to read:

AB68-ASA2-AA2,35,25 49.471 (4) (a) 8. An individual who meets all of the following criteria:

AB68-ASA2-AA2,36,1 a. The individual is an adult under the age of 65.

AB68-ASA2-AA2,36,3 b. The individual has a family income that does not exceed 133 percent of the poverty line, except as provided in sub. (4g).

AB68-ASA2-AA2,36,5 c. The individual is not otherwise eligible for the Medical Assistance program under this subchapter or the Medicare program under 42 USC 1395 et seq.

AB68-ASA2-AA2,231j Section 231j. 49.471 (4g) of the statutes is created to read:

AB68-ASA2-AA2,36,16 49.471 (4g) Medicaid expansion; federal medical assistance percentage. For services provided to individuals described under sub. (4) (a) 8., the department shall comply with all federal requirements to qualify for the highest available enhanced federal medical assistance percentage. The department shall submit any amendment to the state medical assistance plan, request for a waiver of federal Medicaid law, or other approval request required by the federal government to provide services to the individuals described under sub. (4) (a) 8. and qualify for the highest available enhanced federal medical assistance percentage. Sections 20.940 and 49.45 (2t) do not apply to a submission to the federal government under this subsection.

AB68-ASA2-AA2,231m Section 231m. 49.471 (6) (b) of the statutes is amended to read:

AB68-ASA2-AA2,36,22 49.471 (6) (b) A pregnant woman who is determined to be eligible for benefits under sub. (4) remains eligible for benefits under sub. (4) for the balance of the pregnancy and to the last day of the month in which the 60th 365th day after the last day of the pregnancy falls without regard to any change in the woman's family income.

AB68-ASA2-AA2,231p Section 231p. 49.471 (6) (L) of the statutes is created to read:

AB68-ASA2-AA2,37,9 49.471 (6) (L) The department shall request from the federal department of health and human services approval of a state plan amendment, a waiver of federal Medicaid law, or approval of a demonstration project to maintain eligibility for postpartum women to the last day of the month in which the 365th day after the last day of the pregnancy falls under ss. 49.46 (1) (a) 1m. and 9. and (j), 49.47 (4) (ag) 2., and 49.471 (4) (a) 1g. and 1m., (6) (b), and (7) (b) 1. The department shall cover and provide reimbursement for services under ss. 49.46 (1) (a) 1m. and 9. and (j), 49.47 (4) (ag) 2., and 49.471 (4) (a) 1g. and 1m., (6) (b), and (7) (b) 1. regardless of whether a state plan amendment, waiver of federal Medicaid law, or approval of a demonstration project related to coverage or reimbursement of these services is granted by the federal department of human services.