Amendment AA3-SB70

SB70-AA3,270 Section 270. 49.46 (2) (bv) of the statutes is created to read:

SB70-AA3,211,11 49.46 (2) (bv) 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 services by a psychiatric residential treatment facility. If the federal department of health and human services approves the request or if no federal approval is necessary, the department shall provide reimbursement under par. (b) 14c. If the federal department of health and human services disapproves the request, the department may not provide reimbursement for services under par. (b) 14c.

SB70-AA3,271 Section 271. 51.044 of the statutes is created to read:

SB70-AA3,211,18 51.044 Psychiatric residential treatment facilities. (1) Definition. In this section, “psychiatric residential treatment facility” is 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.

SB70-AA3,211,22 (2) Certification required; exemption. (a) No person may operate a psychiatric residential treatment facility without a certification from the department. The department may limit the number of certifications it grants to operate a psychiatric residential treatment facility.

SB70-AA3,211,24 (b) A psychiatric residential treatment facility that has a certification from the department under this section is not subject to facility regulation under ch. 48.

SB70-AA3,211,25 (3) Rules. The department may promulgate rules to implement this section.

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

SB70-AA3,212,14 (1) Emergency rules on psychiatric residential treatment facilities. The department of health services may promulgate emergency rules under s. 227.24 implementing certification of psychiatric residential treatment facilities under s. 51.044, including development of a new provider type and a reimbursement model for psychiatric residential treatment facilities under the Medical Assistance program under subch. IV of ch. 49. Notwithstanding s. 227.24 (1) (a) and (3), the department of health services is not required to provide evidence that promulgating a rule under this subsection as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this subsection. Notwithstanding s. 227.24 (1) (c) and (2), emergency rules promulgated under this subsection remain in effect until July 1, 2025, or the date on which permanent rules take effect, whichever is sooner.”.

SB70-AA3,212,15 246. Page 374, line 11: after that line insert:

SB70-AA3,212,16 “ Section 272. 46.48 (22) of the statutes is created to read:

SB70-AA3,212,20 46.48 (22) Health care provider innovation grants. The department may distribute not more than $14,550,000 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.”.

SB70-AA3,212,21 247. Page 374, line 11: after that line insert:

SB70-AA3,212,22 “ Section 9119. Nonstatutory provisions; Health Services.

SB70-AA3,212,23 (4u) Complex patient pilot program.

SB70-AA3,212,24 (a) In this subsection, “department” means the department of health services.

SB70-AA3,213,5 (b) The department shall form an advisory group to assist with development and implementation of a complex patient pilot program. The secretary of health services, or his or her designee, shall be the chair of the advisory group. Members of the advisory group under this paragraph shall have clinical, financial, or administrative expertise in government programs, acute care, or post-acute care.

SB70-AA3,213,8 (c) The department shall use its request-for-proposal procedure to select partnership groups to be designated as participating sites for the complex patient pilot program under this subsection.

SB70-AA3,213,14 (d) The advisory group formed under this subsection shall develop a request for proposal for the complex patient pilot program that includes eligibility requirements. For purposes of the pilot program under this subsection, only partnerships of hospitals and post-acute facilities are eligible to submit proposals. An eligible partnership shall include at least one hospital and at least one post-acute facility, but may include more than one hospital or post-acute facility.

SB70-AA3,213,17 (e) Each partnership group that applies to the department to be designated as a site for the complex patient pilot program shall specifically address all of the following issues:

SB70-AA3,213,18 1. The number of beds that would be set aside in the post-acute facility.

SB70-AA3,213,20 2. The goals of the partnership during the pilot program and after the pilot program.

SB70-AA3,213,21 3. The types of complex patients for whom care would be provided.

SB70-AA3,213,23 4. Expertise to successfully implement the proposal, including a discussion of at least all of the following issues:

SB70-AA3,213,24 a. Experience of the partners working together.

SB70-AA3,213,25 b. Plan for staffing the unit.

SB70-AA3,214,1 c. Ability to electronically exchange health information.

SB70-AA3,214,2 d. Clinical expertise.

SB70-AA3,214,3 e. Hospital and post-acute facility survey history over the past 3 years.

SB70-AA3,214,4 f. Acute care partner readmissions history over the past 3 years.

SB70-AA3,214,5 g. Discharge planning and patient intake resources.

SB70-AA3,214,10 h. Stability of finances to support the proposal, including matching funds that could be dedicated to the pilot program under this subsection. No applicant is required to provide matching funds or a contribution, but the advisory group and the department of health services may take into consideration the availability of matching funds or a contribution in evaluating an application.

SB70-AA3,214,12 5. The per diem rate requested to adequately compensate the hospital or hospitals and the post-acute facility or facilities.

SB70-AA3,214,13 6. A post-acute bed reserve rate.

SB70-AA3,214,15 7. Anticipated impediments to successful implementation and how the applicant partnership group intends to overcome the anticipated impediments.

SB70-AA3,214,16 (f) The advisory group formed under this subsection shall do all of the following:

SB70-AA3,214,20 1. Determine and recommend to the department an amount of the funding budgeted for the complex patient pilot program under s. 20.435 (7) (d) to be reserved for reconciliation to ensure that participants in the pilot program are held harmless from unanticipated financial loss.

SB70-AA3,215,2 2. Develop a methodology to evaluate the complex patient pilot program, including a recommendation on whether the department should contract with an independent organization to evaluate the complex patient pilot program. The department may contract with an independent organization to complete the evaluation described under this subdivision and, if the department does so, the department may pay the fee of the organization selected from the appropriation under s. 20.435 (7) (d).

SB70-AA3,215,5 3. Make recommendations to the secretary of health services regarding which partnership groups should receive designation as a participating site for the complex patient pilot program.

SB70-AA3,215,9 (g) 1. No later than 90 days after the effective date of this subdivision, the advisory group shall complete development of the request for proposal for partnership groups to be designated as participating sites in the complex patient pilot program and provide its recommendations to the secretary of health services.

SB70-AA3,215,14 2. No later than 150 days after the effective date of this subdivision, the advisory group shall review all applications submitted in response to the request for proposal and select up to 4 partnership groups to recommend to the secretary of health services for designation as participating sites for the complex patient pilot program under this subsection.

SB70-AA3,215,23 3. Between 6 months and 18 months after the effective date of this subdivision, the partnership groups designated by the department as participating sites in the complex patient pilot program shall implement the pilot program and meet quarterly with both the department and the advisory group or any independent organization hired by the department for the purpose of evaluating the pilot program to discuss experiences relating to the pilot program. From the appropriation under s. 20.435 (7) (d), the department shall provide payments to partnership groups designated as participating sites for care provided during the course of the pilot program under this subsection.

SB70-AA3,216,3 4. No later than June 30, 2025, the advisory group or any independent organization hired by the department for the purpose of evaluating the complex patient pilot program shall complete and submit to the secretary of health services an evaluation of the complex patient pilot program under this subsection, including a written report and recommendations.

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

SB70-AA3,216,6 (1u) Complex patient pilot program. The repeal of s. 20.435 (7) (d) takes effect on July 1, 2025.”.

SB70-AA3,216,7 248. Page 374, line 11: after that line insert:

SB70-AA3,216,8 “ Section 273. 20.455 (1) (hn) of the statutes is created to read:

SB70-AA3,216,10 20.455 (1) (hn) Payments to relators. All moneys received by the department that are owed to a relator, to provide payments owed to a relator.

SB70-AA3,274 Section 274. 20.9315 of the statutes is created to read:

SB70-AA3,216,12 20.9315 False claims; actions by or on behalf of state. (1) In this section:

SB70-AA3,216,15 (a) 1. “Claim” means any request or demand, whether under a contract or otherwise, for money or property, whether the state has title to the money or property, that is any of the following:

SB70-AA3,216,16 a. Presented to an officer, employee, agent, or other representative of the state.

SB70-AA3,216,21 b. Made to a contractor, grantee, or other person if the money or property is to be spent or used on the state's behalf or to advance a state program or interest and if the state provides any portion of the money or property that is requested or demanded or will reimburse directly or indirectly the contractor, grantee, or other person for any portion of the money or property that is requested or demanded.

SB70-AA3,216,23 2. “Claim” includes a request or demand for services from a state agency or as part of a state program.

SB70-AA3,217,3 3. “Claim” does not include requests or demands for money or property that the state has paid to an individual as compensation for state employment or as an income subsidy with no restriction on that individual's use of the money or property.

SB70-AA3,217,7 (b) “Knowingly" means, with respect to information, having actual knowledge of the information, acting in deliberate ignorance of the truth or falsity of the information, or acting in reckless disregard of the truth or falsity of the information. “Knowingly" does not mean specifically intending to defraud.

SB70-AA3,217,9 (c) “Material” means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property or the receipt of services.

SB70-AA3,217,10 (d) “Medical assistance" has the meaning given under s. 49.43 (8).

SB70-AA3,217,11 (e) “Obligation” has the meaning given in 31 USC 3729 (b) (3).

SB70-AA3,217,12 (f) “Original source” has the meaning given in 31 USC 3730 (e) (4) (B).

SB70-AA3,217,15 (g) “Proceeds" includes damages, civil penalties, surcharges, payments for costs of compliance, and any other economic benefit realized by this state as a result of an action or settlement of a claim.

SB70-AA3,217,20 (2) Except as provided in sub. (3), any person who does any of the following is liable to this state for 3 times the amount of the damages that were sustained by the state or would have been sustained by the state,whichever is greater, because of the actions of the person and shall forfeit, for each violation, an amount within the range specified under 31 USC 3729 (a):

SB70-AA3,217,22 (a) Knowingly presents or causes to be presented a false or fraudulent claim to a state agency, including a false or fraudulent claim for medical assistance.

SB70-AA3,217,25 (b) Knowingly makes, uses, or causes to be made or used a false record or statement material to a false or fraudulent claim to a state agency, including a false or fraudulent claim for medical assistance.

SB70-AA3,218,5 (c) Knowingly makes, uses, or causes to be made or used a false record or statement material to an obligation to pay or transmit money or property to the Medical Assistance program, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the Medical Assistance program.

SB70-AA3,218,9 (d) Knowingly makes, uses, or causes to be made or used a false record or statement material to an obligation to pay or transmit money or property to a state agency or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to a state agency.

SB70-AA3,218,10 (e) Conspires to commit a violation under par. (a), (b), (c), or (d).

SB70-AA3,218,14 (3) The court may assess against a person who violates sub. (2) not less than 2 nor more than 3 times the amount of the damages sustained by the state because of the acts of the person, and shall not assess any forfeiture, if the court finds all of the following:

SB70-AA3,218,17 (a) The person who commits the acts furnished the attorney general with all information known to the person about the acts within 30 days after the date on which the person obtained the information.

SB70-AA3,218,18 (b) The person fully cooperated with any investigation by this state of the acts.

SB70-AA3,218,22 (c) At the time that the person furnished the attorney general with information concerning the acts, no criminal prosecution or civil or administrative enforcement action had been commenced with respect to any such act, and the person did not have actual knowledge of the existence of any investigation into any such act.

SB70-AA3,218,25 (5) (a) Except as provided in subs. (10) and (12), any person may bring a civil action as a qui tam plaintiff against a person who commits an act in violation of sub. (2) for the person and the state in the name of the state.

SB70-AA3,219,8 (b) The plaintiff under par. (a) shall serve upon the attorney general a copy of the complaint and documents disclosing substantially all material evidence and information that the plaintiff possesses. The plaintiff shall file a copy of the complaint with the court for inspection in camera. Except as provided in par. (c), the complaint shall remain under seal for a period of 60 days from the date of filing and shall not be served upon the defendant until the court so orders. Within 60 days from the date of service upon the attorney general of the complaint, evidence, and information under this paragraph, the attorney general may intervene in the action.

SB70-AA3,219,13 (bm) Any complaint filed by the state in intervention, whether filed separately or as an amendment to the qui tam plaintiff's complaint, shall relate back to the filing date of the qui tam plaintiff's complaint to the extent that the state's claim arises out of the conduct, transactions, or occurrences set forth, or attempted to be set forth, in the qui tam plaintiff's complaint.

SB70-AA3,219,16 (c) The attorney general may, for good cause shown, move the court for one or more extensions of the period during which a complaint in an action under this subsection remains under seal.

SB70-AA3,219,18 (d) Before the expiration of the period during which the complaint remains under seal, the attorney general shall do one of the following:

SB70-AA3,219,20 1. Proceed with the action or an alternate remedy under sub. (10), in which case the action or proceeding under sub. (10) shall be prosecuted by the state.

SB70-AA3,219,22 2. Notify the court that he or she declines to proceed with the action, in which case the person bringing the action may proceed with the action.

SB70-AA3,219,25 (e) If a person brings a valid action under this subsection, no person other than the state may intervene or bring a related action based upon the same facts underlying the original action while the original action is pending.

SB70-AA3,220,3 (f) In any action brought under this subsection or other proceeding under sub. (10), the plaintiff is required to prove all essential elements of the cause of action or complaint, including damages, by a preponderance of the evidence.

SB70-AA3,220,7 (6) If the state proceeds with an action under sub. (5) or an alternate remedy under sub. (10), the state has primary responsibility for prosecuting the action under sub. (5) or proceeding under sub. (10). The state is not bound by any act of the person bringing the action, but that person has the right to continue as a party to the action.

SB70-AA3,220,15 (7) (b) With the approval of the governor, the attorney general may compromise and settle an action under sub. (5) or an administrative proceeding under sub. (10) to which the state is a party, notwithstanding objection of the person bringing the action, if the court determines, after affording to the person bringing the action the right to a hearing at which the person is afforded the opportunity to present evidence in opposition to the proposed settlement, that the proposed settlement is fair, adequate, and reasonable considering the relevant circumstances pertaining to the violation.

SB70-AA3,220,22 (c) Upon a showing by the state that unrestricted participation in the prosecution of an action under sub. (5) or an alternate proceeding under sub. (10) to which the state is a party by the person bringing the action would interfere with or unduly delay the prosecution of the action or proceeding, or would result in consideration of repetitious or irrelevant evidence or evidence presented for purposes of harassment, the court may limit the person's participation in the prosecution, such as:

SB70-AA3,220,23 1. Limiting the number of witnesses that the person may call.

SB70-AA3,220,24 2. Limiting the length of the testimony of the witnesses.

SB70-AA3,220,25 3. Limiting the cross-examination of witnesses by the person.

SB70-AA3,221,2 4. Otherwise limiting the participation by the person in the prosecution of the action or proceeding.

SB70-AA3,221,7 (d) Upon a showing by a defendant that unrestricted participation in the prosecution of an action under sub. (5) or alternate proceeding under sub. (10) to which the state is a party by the person bringing the action would result in harassment or would cause the defendant undue burden or unnecessary expense, the court may limit the person's participation in the prosecution.

SB70-AA3,221,14 (8) Except as provided in sub. (7), if the state elects not to participate in an action filed under sub. (5), the person bringing the action may prosecute the action. If the attorney general so requests, the attorney general shall, at the state's expense, be served with copies of all pleadings and deposition transcripts in the action. If the person bringing the action initiates prosecution of the action, the court, without limiting the status and rights of that person, may permit the state to intervene at a later date upon a showing by the state of good cause for the proposed intervention.