Amendment AA8-ASA2-AB50

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.

AB50-ASA2-AA8,217,12 (b) “Program” means the mental health consultation program under this section.

AB50-ASA2-AA8,217,21 (2) During fiscal year 2025-26, the department shall contract with the organization that provided consultation services through the child psychiatry consultation program under s. 51.442, 2023 stats., as of January 1, 2025, to administer the mental health consultation program described under this section. Beginning in fiscal year 2026-27, the department shall contract with the organization that provided consultation services through the child psychiatry consultation program under s. 51.442, 2023 stats., as of January 1, 2025, or another organization to administer the mental health consultation program under this section.

AB50-ASA2-AA8,218,4 (3) The contracting organization under sub. (2) shall administer a mental health consultation program that incorporates a comprehensive set of mental health consultation services, which may include perinatal, child, adult, geriatric, pain, veteran, and general mental health consultation services, and may contract with any other entity to perform any operations and satisfy any requirements under this section for the program.

AB50-ASA2-AA8,218,6 (4) As a condition of providing services through the program, the contracting organization under sub. (2) shall do all of the following:

AB50-ASA2-AA8,218,14 (a) Ensure that all mental health care providers who are providing services through the program have the applicable credential from this state; if a psychiatric professional, that the provider is eligible for certification or is certified by the American Board of Psychiatry and Neurology for adult psychiatry, child and adolescent psychiatry, or both; and if a psychologist, that the provider is registered in a professional organization, including the American Psychological Association, National Register of Health Service Psychologists, Association for Psychological Science, or the National Alliance of Professional Psychology Providers.

AB50-ASA2-AA8,218,16 (b) Maintain the infrastructure necessary to provide the program’s services statewide.

AB50-ASA2-AA8,218,18 (c) Operate the program on weekdays during normal business hours of 8 a.m. to 5 p.m.

AB50-ASA2-AA8,218,20 (d) Provide consultation services under the program as promptly as is practicable.

AB50-ASA2-AA8,219,2 (e) Have the capability to provide consultation services by, at a minimum, telephone and email. Consultation through the program may be provided by teleconference, video conference, voice over Internet protocol, email, pager, in- person conference, or any other telecommunication or electronic means.

AB50-ASA2-AA8,219,3 (f) Provide all of the following services through the program:

AB50-ASA2-AA8,219,5 1. Support for participating clinicians to assist in the management of mental health concerns.

AB50-ASA2-AA8,219,8 2. Triage-level assessments to determine the most appropriate response to each request, including appropriate referrals to any community providers and health systems.

AB50-ASA2-AA8,219,9 3. When medically appropriate, diagnostics and therapeutic feedback.

AB50-ASA2-AA8,219,11 4. Recruitment of other clinicians into the program as participating clinicians when possible.

AB50-ASA2-AA8,219,12 (g) Report to the department any information requested by the department.

AB50-ASA2-AA8,219,22 (h) Conduct annual surveys of participating clinicians who use the program to assess the quality of care provided, self-perceived levels of confidence in providing mental health services, and satisfaction with the consultations and other services provided through the program. Immediately after participating clinicians begin using the program and again 6 to 12 months later, the contracting organization under sub. (2) may conduct assessments of participating clinicians to assess the barriers to and benefits of participation in the program to make future improvements and to determine the participating clinicians’ treatment abilities, confidence, and awareness of relevant resources before and after beginning to use the program.

AB50-ASA2-AA8,220,3 (5) Services provided under sub. (4) (b) to (h) are eligible for funding from the department. The contracting organization under sub. (2) also may provide any of the following services under the program that are eligible for funding from the department:

AB50-ASA2-AA8,220,6 (a) Second opinion diagnostic and medication management evaluations and community resource referrals conducted by either a psychiatrist or allied health professionals.

AB50-ASA2-AA8,220,9 (b) In-person or web-based educational seminars and refresher courses on a medically appropriate topic within mental or behavioral health care provided to any participating clinician who uses the program.

AB50-ASA2-AA8,220,10 (c) Data evaluation and assessment of the program.

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

AB50-ASA2-AA8,220,17 (1) Comprehensive mental health consultation program. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (5) (bw), the dollar amount for fiscal year 2025-26 is increased by $2,000,000 and the dollar amount for fiscal year 2026-27 is increased by $2,000,000 to support a comprehensive mental health consultation program under s. 51.443.”.

AB50-ASA2-AA8,220,18 90. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,220,19 “Section 9219. Fiscal changes; Health Services.

AB50-ASA2-AA8,221,5 (1) Contracted community services. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (2) (bj), the dollar amount for fiscal year 2025-26 is increased by $3,742,500 to fund contracts for community-based mental health services for the treatment and monitoring for forensic and sexually violent persons programs. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (2) (bj), the dollar amount for fiscal year 2026-27 is increased by $6,305,000 to fund contracts for community-based mental health services for the treatment and monitoring for forensic and sexually violent persons programs.”.

AB50-ASA2-AA8,221,6 91. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,221,7 “Section 9219. Fiscal changes; Health Services.

AB50-ASA2-AA8,221,8 (1) Coverage of continuous glucose monitoring devices.

AB50-ASA2-AA8,221,13 (a) In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (4) (b), the dollar amount for fiscal year 2026-27 is increased by $4,647,100 to support the cost of providing coverage for continuous glucose monitoring devices and insulin pumps for diabetic care as a pharmacy benefit.

AB50-ASA2-AA8,221,18 (b) In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (4) (j), the dollar amount for fiscal year 2026-27 is increased by $9,600,000 to support the cost of providing coverage for continuous glucose monitoring devices and insulin pumps for diabetic care as a pharmacy benefit.”.

AB50-ASA2-AA8,221,19 92. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,221,20 “Section 374. 49.45 (30t) of the statutes is created to read:

AB50-ASA2-AA8,221,21 49.45 (30t) Doula services. (a) In this subsection:

AB50-ASA2-AA8,221,23 1. “Certified doula” means an individual who has received certification from a doula certifying organization recognized by the department.

AB50-ASA2-AA8,222,3 2. “Doula services” means childbirth education and support services, including emotional and physical support provided during pregnancy, labor, birth, and the postpartum period.

AB50-ASA2-AA8,222,10 (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.