Amendment AA3-SB70

SB70-AA3,96,9 211. Page 374, line 11: after that line insert:

SB70-AA3,96,10 “ Section 92. 49.45 (7m) of the statutes is created to read:

SB70-AA3,96,18 49.45 (7m) Pay-for-performance; health information exchange. The department shall develop and implement for non-hospital providers in the Medical Assistance program, including physicians, clinics, health departments, home health agencies, and post-acute care facilities, a payment system based on performance to incentivize participation in health information data sharing to facilitate better patient care, reduced costs, and easier access to patient information. The department shall establish performance metrics for the payment system under this subsection that satisfy all of the following:

SB70-AA3,96,20 (a) The metric shall include participation by providers in a health information exchange at a minimum level of patient record access.

SB70-AA3,96,22 (b) The payment under the payment system shall increase as the participation level in the health information exchange increases.

SB70-AA3,96,23 (c) The payment system shall begin in the 2024 rate year.

SB70-AA3,97,2 (d) For purposes of the payment system, the department shall seek any available federal moneys.”.

SB70-AA3,97,3 212. Page 374, line 11: after that line insert:

SB70-AA3,97,4 “ Section 93. 49.45 (30p) of the statutes is created to read:

SB70-AA3,97,5 49.45 (30p) Detoxification and stabilization services. (a) In this subsection:

SB70-AA3,97,18 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.

SB70-AA3,97,21 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.

SB70-AA3,97,24 3. “Detoxification and stabilization services” means adult residential integrated behavioral health stabilization service, residential withdrawal management service, or residential intoxication monitoring service.

SB70-AA3,98,9 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 healthcare. “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.

SB70-AA3,98,22 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.

SB70-AA3,99,2 (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.

SB70-AA3,99,10 (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 par. 49.46 (2) (b) 14r. If the federal department disapproves the request, the department may not provide the reimbursement described in this subsection.

SB70-AA3,94 Section 94. 49.46 (2) (b) 14r. of the statutes is created to read:

SB70-AA3,99,13 49.46 (2) (b) 14r. Detoxification and stabilization services as specified under s. 49.45 (30p).”.

SB70-AA3,99,14 213. Page 374, line 11: after that line insert:

SB70-AA3,99,15 “ Section 95. 49.45 (6xm) of the statutes is created to read:

SB70-AA3,99,19 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 in each state fiscal year to hospitals that meet all of the following criteria:

SB70-AA3,99,20 1. The hospital is an acute care hospital located in this state.

SB70-AA3,99,23 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 subdivision, 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.

SB70-AA3,100,7 (b) Notwithstanding par. (a), from the appropriations under s. 20.435 (4) (b), (o), and (w), the department may, using a method determined by the department, distribute an additional total sum of $10,000,000 in each state fiscal year to hospitals that are freestanding pediatric teaching hospitals located in Wisconsin that have a percentage calculated under s. 49.45 (3m) (b) 1. a. greater than 45 percent.”.

SB70-AA3,100,8 214. Page 374, line 11: after that line insert:

SB70-AA3,100,9 “ Section 96. 49.45 (3) (e) 12. of the statutes is amended to read:

SB70-AA3,100,17 49.45 (3) (e) 12. The department shall use a portion of the moneys collected under s. 50.38 (2) (b) to pay for services provided by critical access hospitals under the Medical Assistance Program under this subchapter, including services reimbursed on a fee-for-service basis and services provided under a managed care system. For each state fiscal year, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (b) for the fiscal year divided by 61.68 44.21 percent.”.

SB70-AA3,100,18 215. Page 374, line 11: after that line insert:

SB70-AA3,100,19 “ Section 97. 49.45 (3) (e) 11. of the statutes is amended to read:

SB70-AA3,101,7 49.45 (3) (e) 11. The department shall use a portion of the moneys collected under s. 50.38 (2) (a) to pay for services provided by eligible hospitals, as defined in s. 50.38 (1), other than critical access hospitals, under the Medical Assistance Program under this subchapter, including services reimbursed on a fee-for-service basis and services provided under a managed care system. For state fiscal year 2008-09, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (a) for fiscal year 2008-09 divided by 57.75 percent. For each state fiscal year after state fiscal year 2008-09, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (a) for the fiscal year divided by 61.68 44.21 percent.”.

SB70-AA3,101,8 216. Page 374, line 11: after that line insert:

SB70-AA3,101,9 “ Section 98. 20.435 (4) (jw) of the statutes is amended to read:

SB70-AA3,101,17 20.435 (4) (jw) BadgerCare Plus and hospital assessment. All moneys received from payment of enrollment fees under the program under s. 49.45 (23), all moneys transferred under s. 50.38 (9), all moneys transferred from the appropriation account under par. (jz), and 10 percent of all moneys received from penalty assessments under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), to provide a portion of the state share of administrative costs for the BadgerCare Plus Medical Assistance program under s. 49.471, and for administration of the hospital assessment under s. 50.38.

SB70-AA3,99 Section 99. 49.45 (2p) of the statutes is repealed.

SB70-AA3,100 Section 100. 49.45 (23) of the statutes is repealed.

SB70-AA3,101 Section 101. 49.45 (23b) of the statutes is repealed.

SB70-AA3,102 Section 102. 49.471 (1) (cr) of the statutes is created to read:

SB70-AA3,101,23 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

SB70-AA3,103 Section 103. 49.471 (4) (a) 4. b. of the statutes is amended to read:

SB70-AA3,102,3 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).

SB70-AA3,104 Section 104. 49.471 (4) (a) 8. of the statutes is created to read:

SB70-AA3,102,5 49.471 (4) (a) 8. An individual who meets all of the following criteria:

SB70-AA3,102,6 a. The individual is an adult under the age of 65.

SB70-AA3,102,8 b. The adult has a family income that does not exceed 133 percent of the poverty line, except as provided in sub. (4g).

SB70-AA3,102,10 c. The adult is not otherwise eligible for the Medical Assistance program under this subchapter or the Medicare program under 42 USC 1395 et seq.

SB70-AA3,105 Section 105. 49.471 (4g) of the statutes is created to read:

SB70-AA3,102,19 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.

SB70-AA3,106 Section 106. 49.686 (3) (d) of the statutes is amended to read:

SB70-AA3,103,2 49.686 (3) (d) Has applied for coverage under and has been denied eligibility for medical assistance within 12 months prior to application for reimbursement under sub. (2). This paragraph does not apply to an individual who is eligible for benefits under the demonstration project for childless adults under s. 49.45 (23) or to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471 (4) (a) 8. or (11).

SB70-AA3,107 Section 107. 2017 Wisconsin Act 370, section 44 (2) and (3) are repealed.

SB70-AA3,9119 Section 9119. Nonstatutory provisions; Health Services.

SB70-AA3,103,12 (2h) Childless adults demonstration project. The department of health services shall submit any necessary request to the federal department of health and human services for a state plan amendment or waiver of federal Medicaid law or to modify or withdraw from any waiver of federal Medicaid law relating to the childless adults demonstration project under s. 49.45 (23), 2021 stats., to reflect the incorporation of recipients of Medical Assistance under the demonstration project into the BadgerCare Plus program under s. 49.471 and the termination of the demonstration project.

SB70-AA3,9419 Section 9419. Effective dates; Health Services.

SB70-AA3,103,17 (2r) Medicaid expansion. The treatment of ss. 20.435 (4) (jw), 49.45 (2p), 49.45 (23) and (23b), 49.471 (1) (cr), (4) (a) 4. b. and 8., and (4g), and 49.686 (3) (d), and 2017 Wisconsin Act 370, section 44 (2) and (3), and Section 9119 (2h) of this act take effect on July 1, 2023.”.

SB70-AA3,103,18 217. Page 374, line 11: after that line insert:

SB70-AA3,103,20 “ Section 108. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table - See PDF for table

SB70-AA3,109 Section 109. 20.435 (1) (bc) of the statutes is created to read:

SB70-AA3,104,4 20.435 (1) (bc) Emergency medical services grants. As a continuing appropriation, the amounts in the schedule for grants to providers of emergency medical services under s. 256.42.

SB70-AA3,110 Section 110. 256.42 of the statutes is created to read:

SB70-AA3,104,10 256.42 Emergency medical services grants. From the appropriation under s. 20.435 (1) (bc), the department may award grants to providers of emergency medical services for reasonable operating expenses related to emergency medical services, including expenses related to supplies, equipment, training, staffing, and vehicles.”.

SB70-AA3,104,11 218. Page 374, line 11: after that line insert:

SB70-AA3,104,12 “ Section 9119. Nonstatutory provisions; Health Services.

SB70-AA3,104,17 (1) Office of Caregiver Quality position increase. The authorized FTE positions for the department of health services are increased by 2.8 FED positions, beginning in fiscal year 2023-24, to be funded from the appropriation under s. 20.435 (6) (n) for the purpose of increasing staffing in the division of the department responsible for caregiver quality.”.

SB70-AA3,104,18 219. Page 374, line 11: after that line insert:

SB70-AA3,104,19 “ Section 1. 252.12 (2) (a) 8. (intro.) of the statutes is amended to read:

SB70-AA3,105,9 252.12 (2) (a) 8. `Mike Johnson life care and early intervention services grants.' (intro.) The department shall award not more than $4,000,000 $5,000,000 in each fiscal year in grants to applying AIDS service organizations for the provision of needs assessments; assistance in procuring financial, medical, legal, social and pastoral services; counseling and therapy; homecare services and supplies; advocacy; and case management services. These services shall include early intervention services. The department shall also award not more than $74,000 in each year from the appropriation account under s. 20.435 (5) (md) for the services under this subdivision. The state share of payment for case management services that are provided under s. 49.45 (25) (be) to recipients of medical assistance shall be paid from the appropriation account under s. 20.435 (1) (am). All of the following apply to grants awarded under this subdivision:”.

SB70-AA3,105,10 220. Page 374, line 11: after that line insert:

SB70-AA3,105,12 “ Section 111. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table - See PDF for table

SB70-AA3,112 Section 112. 20.435 (1) (ew) of the statutes is created to read:

SB70-AA3,106,2 20.435 (1) (ew) Congenital disorders; general purpose revenue. The amounts in the schedule to provide diagnostic services, special dietary treatment, and follow-up counseling for congenital disorders and periodic evaluation of infant screening programs as specified under s. 253.13, to provide referrals under s. 253.115, to administer the programs under ss. 253.115 and 253.13, and for the costs of consulting with appropriate experts as specified in s. 253.13 (5).”.

SB70-AA3,106,3 221. Page 374, line 11: after that line insert:

SB70-AA3,106,4 “ Section 113. 20.250 (2) (title) of the statutes is amended to read:

SB70-AA3,106,5 20.250 (2) (title) Research and community support.

SB70-AA3,114 Section 114. 20.250 (2) (a) of the statutes is created to read:

SB70-AA3,106,10 20.250 (2) (a) Violence prevention grants. Biennially, the amounts in the schedule to make violence prevention grants supporting local, evidence-informed activities that enhance the safety and well-being of children, youth, and families throughout this state.”.

SB70-AA3,106,11 222. Page 374, line 11: after that line insert:

SB70-AA3,106,13 “ Section 115. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table - See PDF for table

SB70-AA3,116 Section 116. 20.435 (1) (fL) of the statutes is created to read:

SB70-AA3,106,17 20.435 (1) (fL) Nurse aide training and recruitment grants. The amounts in the schedule for grants to train and recruit individuals to work as nurse aides in nursing homes under s. 146.41.

SB70-AA3,117 Section 117. 146.41 of the statutes is created to read:

SB70-AA3,107,1 146.41 Nurse aide training and recruitment grants. (1) In this section:

SB70-AA3,107,2 (a) “Nurse aide” has the meaning given in s. 146.40 (1) (d).

SB70-AA3,107,3 (b) “Nursing home" has the meaning given in s. 50.01 (3).

SB70-AA3,107,6 (2) Beginning in fiscal year 2024-25, the department shall award grants to train and recruit individuals to work as nurse aides in nursing homes. The grants awarded under this subsection shall include grants for all of the following:

SB70-AA3,107,8 (a) The cost for an individual to complete an instructional program for nurse aides in a program approved under s. 146.40 (3) and (3g).

SB70-AA3,107,10 (b) The cost for an individual to complete a competency evaluation for nurse aides in a program approved under s. 146.40 (3m).

SB70-AA3,107,12 (c) A retention bonus for an individual who has worked for at least 6 months as a nurse aide in a nursing home.

SB70-AA3,107,16 (3) The department may partner with nonprofit organizations, private entities, the board on aging and long term care, and the technical college system board to award the grants under sub. (2) and recruit individuals to work as nurse aides in nursing homes.”.