Amendment SA4-SSA2-SB45

SB45-SSA2-SA4,111 Section 111. 146.615 (title) of the statutes is amended to read:

SB45-SSA2-SA4,40,18 146.615 (title) Advanced practice clinician Health care provider training grants.

SB45-SSA2-SA4,112 Section 112. 146.615 (1) (ag) and (ar) of the statutes are created to read:

SB45-SSA2-SA4,40,23 146.615 (1) (ag) “Allied health professional” means any individual who is a health care provider other than a physician, dentist, pharmacist, chiropractor, or podiatrist and who provides diagnostic, technical, therapeutic, or direct patient care and support services to a patient.

SB45-SSA2-SA4,41,2 (ar) “Behavioral health provider” means any individual who is licensed as a psychologist or is certified as a social worker or licensed as a clinical social worker, a marriage and family therapist, or a professional counselor.

SB45-SSA2-SA4,113 Section 113. 146.615 (2) of the statutes is amended to read:

SB45-SSA2-SA4,41,10 146.615 (2) Beginning in fiscal year 2018-19 2025-26, from the appropriation under s. 20.435 (1) (fk), subject to sub. (3), the department shall distribute grants to hospitals, health systems, and clinics that provide new training opportunities for advanced practice clinicians. The department shall distribute the grants under this section subsection to hospitals, health systems, and clinics that apply, in the form and manner determined by the department, to receive grants and that satisfy the criteria under sub. (3).

SB45-SSA2-SA4,114 Section 114. 146.615 (2g) and (2r) of the statutes are created to read:

SB45-SSA2-SA4,41,18 146.615 (2g) Beginning in fiscal year 2025-26, from the appropriation under s. 20.435 (1) (fk), subject to sub. (3), the department shall distribute grants to hospitals, health systems, clinics, and educational entities that form health care education and training consortia for allied health professionals. The department shall distribute the grants under this subsection to hospitals, health systems, clinics, and educational entities that apply, in the form and manner determined by the department, to receive a grant.

SB45-SSA2-SA4,42,2 (2r) Beginning in fiscal year 2025-26, from the appropriation under s. 20.435 (1) (fk), subject to sub. (3), the department shall distribute grants to hospitals, health systems, clinics, and educational entities that form health care education and training consortia for behavioral health providers. The department shall distribute the grants under this subsection to hospitals, health systems, clinics, and educational entities that apply, in the form and manner determined by the department, to receive a grant.

SB45-SSA2-SA4,115 Section 115. 146.615 (3) (a) of the statutes is repealed.

SB45-SSA2-SA4,116 Section 116. 146.615 (3) (b) of the statutes is amended to read:

SB45-SSA2-SA4,42,11 146.615 (3) (b) If the department distributes a grant to a hospital or clinic that has not previously received a grant under this section, the hospital or clinic receiving the grant may use the grant to create the education and infrastructure for training advanced practice clinicians or for activities authorized under par. (c). In distributing grants under this section, the department shall give preference to advanced practice clinician clinical training programs that include rural hospitals and rural clinics as clinical training locations.

SB45-SSA2-SA4,117 Section 117. 146.615 (3) (bm) of the statutes is created to read:

SB45-SSA2-SA4,42,16 146.615 (3) (bm) Acceptable uses of grant moneys received under this section include reasonable expenses incurred by a trainee to fully succeed in training and eventual placement, expenses related to planning and implementing a training program, and up to $5,000 in equipment expenses.

SB45-SSA2-SA4,118 Section 118. 146.615 (3) (c) and (d) of the statutes are repealed.

SB45-SSA2-SA4,119 Section 119. 146.616 of the statutes is repealed.

SB45-SSA2-SA4,120 Section 120. 146.691 of the statutes is created to read:

SB45-SSA2-SA4,42,21 146.691 Reporting of medical debt to a consumer reporting agency. (1) In this section:

SB45-SSA2-SA4,42,22 (a) “Consumer reporting agency” has the meaning given in s. 100.54 (1) (c).

SB45-SSA2-SA4,42,23 (b) “Health care provider” has the meaning given in s. 146.81 (1).

SB45-SSA2-SA4,42,24 (c) “Patient” has the meaning given in s. 146.81 (3).

SB45-SSA2-SA4,43,4 (2) No health care provider that provided services to a patient, and no billing administrator or debt collector acting on behalf of that health care provider, may report to a consumer reporting agency that a debt arising from services provided by the health care provider is in collections status unless all of the following are true:

SB45-SSA2-SA4,43,8 (a) The health care provider, billing administrator, or debt collector sent a written statement to the patient describing the unpaid amount and due date and that included the name and address of the health care provider that provided the services.

SB45-SSA2-SA4,43,10 (b) The written statement under par. (a) includes a statement indicating that if payment is not received, the debt may be reported to a credit reporting agency.

SB45-SSA2-SA4,43,12 (c) Six months have passed since the due date listed on the statement under par. (a).

SB45-SSA2-SA4,43,13 (d) The patient does not dispute the charges.

SB45-SSA2-SA4,121 Section 121. 146.82 (2) (a) 8m. of the statutes is created to read:

SB45-SSA2-SA4,43,19 146.82 (2) (a) 8m. To the Population Health Institute, or its successor, at the University of Wisconsin-Madison School of Medicine and Public Health under s. 255.18 (2) and to the persons specified under s. 36.47 (3) (f). The release of a patient health care record under this subdivision shall be limited to the information specified in the list under s. 36.47 (3) (d).

SB45-SSA2-SA4,122 Section 122. 150.31 (1) (intro.) of the statutes is amended to read:

SB45-SSA2-SA4,44,3 150.31 (1) (intro.) In order to enable the state to budget accurately for medical assistance and to allocate fiscal resources most appropriately, the maximum number of licensed nursing home beds statewide is 51,795 25,415 and the maximum number of beds statewide in facilities primarily serving the developmentally disabled is 3,704. The department may adjust these limits on licensed beds as provided in subs. (2) to (6). The department shall also biennially recommend changes to this limit based on the following criteria:

SB45-SSA2-SA4,123 Section 123. 150.31 (8) of the statutes is amended to read:

SB45-SSA2-SA4,44,7 150.31 (8) The Subject to sub. (9), the department may allocate or distribute nursing home beds in a manner, developed by rule, that is consistent with the criteria specified in sub. (1) (a) to (f) and s. 150.39.

SB45-SSA2-SA4,124 Section 124. 150.31 (9) of the statutes is created to read:

SB45-SSA2-SA4,44,10 150.31 (9) The department shall allocate 125 nursing home beds to persons that apply for the beds and agree to do all of the following:

SB45-SSA2-SA4,44,11 (a) Prioritize admissions of patients with complex needs.

SB45-SSA2-SA4,44,13 (b) Prioritize admissions of patients who have been unable to find appropriate placement at another facility.

SB45-SSA2-SA4,125 Section 125. Subchapter IX of chapter 150 [precedes 150.99] of the statutes is created to read:

SB45-SSA2-SA4,44,16 CHAPTER 150

SB45-SSA2-SA4,44,18 SUBCHAPTER IX HEALTH CARE ENTITY OVERSIGHT AND TRANSPARENCY

SB45-SSA2-SA4,126 Section 126. 150.99 of the statutes is created to read:

SB45-SSA2-SA4,44,20 150.99 Definitions. In this subchapter:

SB45-SSA2-SA4,45,2 (1) “Acquisition” means the direct or indirect purchase, including lease, transfer, exchange, option, receipt of a conveyance, or creation of a joint venture, or any other manner of purchase, such as by a health care system, private equity group, hedge fund, publicly traded company, real estate investment trust, management services organization, insurance carrier, or any subsidiaries thereof, of a material amount of the assets or operations of a health care entity.

SB45-SSA2-SA4,45,3 (2) “Affiliate” means any of the following:

SB45-SSA2-SA4,45,6 (a) A person, entity, or organization that directly, indirectly, or through one or more intermediaries controls, is controlled by, or is under common control or ownership of another person, entity, or organization.

SB45-SSA2-SA4,45,10 (b) A person whose business is operated under a lease, management, or operating agreement by another entity, or a person substantially all of whose property is operated under a management or operating agreement with that other entity.

SB45-SSA2-SA4,45,12 (c) An entity that operates the business or substantially all the property of another entity under a lease, management, or operating agreement.

SB45-SSA2-SA4,45,15 (d) Any out-of-state operations and corporate affiliates of an affiliate as defined in pars. (a) to (c), including significant equity investors, health care real estate investment trusts, or management services organizations.

SB45-SSA2-SA4,45,20 (3) “Arrangement” includes any agreement, association, partnership, joint venture, management services agreement, professional services agreement, health care staffing company agreement, or other arrangement that results in a change of governance or control of a health care entity or a department, subdivision, or subsidiary of a health care entity.

SB45-SSA2-SA4,45,23 (4) “Change of control” means an arrangement in which any person, corporation, partnership, or any entity acquires direct or indirect control over the operations of a health care entity in whole or in substantial part.

SB45-SSA2-SA4,46,2 (5) “Control,” “controlling,” “controlled by,” and “under common control with” means the direct or indirect power through ownership, contractual agreement, or otherwise to do any of the following:

SB45-SSA2-SA4,46,4 (a) Vote 10 percent or more of any class of voting shares or interests of a health care entity.

SB45-SSA2-SA4,46,5 (b) Direct the actions or policies of the specified entity.

SB45-SSA2-SA4,46,12 (6) “Health care facility” means an institution that provides health care services or a health care setting, including hospitals and other inpatient facilities, health systems consisting of one or more health care entities that are jointly owned or managed, ambulatory surgical or treatment centers, skilled nursing facilities, residential treatment centers, diagnostic, laboratory, and imaging centers, freestanding emergency facilities, outpatient clinics, and rehabilitation and other therapeutic health settings.

SB45-SSA2-SA4,46,15 (7) “Health care provider” means any person, corporation, partnership, governmental unit, state institution, medical practice, or other entity that performs or provides health care services to persons in the state.

SB45-SSA2-SA4,46,18 (8) “Health care services” means services and payments for the care, prevention, diagnosis, treatment, cure, or relief of a medical, dental, or behavioral health condition, illness, injury, or disease, including any of the following:

SB45-SSA2-SA4,46,21 (a) Inpatient, outpatient, habilitative, rehabilitative, dental, palliative, therapeutic, supportive, home health, or behavioral services provided by a health care entity.

SB45-SSA2-SA4,46,23 (b) Pharmacy, retail, and specialty, including any drug, device, or medical supply.

SB45-SSA2-SA4,46,24 (c) Performance of functions to refer, arrange, or coordinate care.

SB45-SSA2-SA4,47,2 (d) Equipment used such as durable medical equipment, diagnostic, surgical devices, or infusion.

SB45-SSA2-SA4,47,5 (e) Technology associated with the provision of services or equipment in pars. (a) to (d) above, such as telehealth, electronic health records, software, claims processing, or utilization systems.

SB45-SSA2-SA4,47,11 (9) “Health care staffing company” means a person, firm, corporation, partnership, or other business entity engaged in the business of providing or procuring, for temporary employment or contracting by a health care facility, any health care personnel, but does not include an individual who independently provides the individual’s own services on a temporary basis to health care facilities as an employee or contractor.

SB45-SSA2-SA4,47,14 (10) “Licensee” means an individual who is licensed in the state as a physician, a doctor of osteopathy, or a physician assistant or a nurse practitioner who is authorized to diagnose and treat in the applicable clinical setting.

SB45-SSA2-SA4,47,18 (11) “Management services organization” means any organization or entity that contracts with a health care provider or provider organization to perform management or administrative services relating to, supporting, or facilitating the provision of health care services.

SB45-SSA2-SA4,47,22 (12) “Medical practice” means a corporate entity or partnership organized for the purpose of practicing medicine and permitted to practice medicine in the state, including partnerships, professional corporations, limited liability companies, and limited liability partnerships.

SB45-SSA2-SA4,48,6 (13) “Noncompetition agreement” means a written agreement between a licensee and another person under which the licensee agrees that the licensee, either alone or as an employee, associate, or affiliate of a third person, will not compete with the other person in providing products, processes, or services that are similar to the other person’s products, processes, or services for a period of time or within a specified geographic area after termination of employment or termination of a contract under which the licensee supplied goods to or performed services for the other person.

SB45-SSA2-SA4,48,11 (14) “Nondisclosure agreement” means a written agreement under the terms of which a licensee must refrain from disclosing partially, fully, directly, or indirectly to any person, other than another party to the written agreement or to a person specified in the agreement as a 3rd-party beneficiary of the agreement, any of the following:

SB45-SSA2-SA4,48,16 (a) A policy or practice that a party to the agreement required the licensee to use in patient care, other than individually identifiable health information that the licensee may not disclose under the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, in effect on the effective date of this paragraph .... [LRB inserts date].

SB45-SSA2-SA4,48,19 (b) A policy, practice, or other information about or associated with the licensee’s employment, conditions of employment, or rate or amount of pay or other compensation.

SB45-SSA2-SA4,49,2 (c) Any other information the licensee possesses or to which the licensee has access by reason of the licensee’s employment by, or provision of services for or on behalf of, a party to the agreement, other than information that is subject to protection under applicable law as a trade secret of, or as otherwise proprietary to, another party to the agreement or to a person specified in the agreement as a third- party beneficiary of the agreement.

SB45-SSA2-SA4,49,8 (15) “Nondisparagement agreement” means a written agreement under which a licensee must refrain from making to a 3rd party a statement about another party to the agreement or about another person specified in the agreement as a 3rd-party beneficiary of the agreement, the effect of which causes or threatens to cause harm to the other party’s or person’s reputation, business relations, or other economic interests.

SB45-SSA2-SA4,49,9 (16) “Ownership or investment interest” means any of the following:

SB45-SSA2-SA4,49,11 (a) Direct or indirect possession of equity in the capital, stock, or profits totaling more than 5 percent of an entity.

SB45-SSA2-SA4,49,14 (b) Interest held by an investor or group of investors who engages in the raising or returning of capital and who invests, develops, or disposes of specified assets.

SB45-SSA2-SA4,49,18 (c) Interest held by a pool of funds by investors, including a pool of funds managed or controlled by private limited partnerships, if those investors or the management of that pool or private limited partnership employ investment strategies of any kind to earn a return on that pool of funds.

SB45-SSA2-SA4,49,22 (17) “Private equity fund” means a publicly traded or nonpublicly traded company that collects capital investments from individuals or entities and purchases a direct or indirect ownership share or controlling interest of a health care entity.

SB45-SSA2-SA4,50,7 (18) “Provider organization” means any corporation, partnership, business trust, association, or organized group of persons that is in the business of health care delivery or management, whether incorporated or not, that represents one or more health care providers in contracting with insurance carriers for the payments of health care services. “Provider organization” includes physician organizations, physician-hospital organizations, independent practice associations, provider networks, accountable care organizations, management services organizations, and any other organization that contracts with insurance carriers for payment for health care services.

SB45-SSA2-SA4,50,8 (19) “Significant equity investor” means any of the following:

SB45-SSA2-SA4,50,10 (a) Any private equity fund with a direct or indirect ownership or investment interest in a health care entity.

SB45-SSA2-SA4,50,13 (b) Any investor, group of investors, or other entity with a direct or indirect possession of equity in the capital, stock, or profits totaling more than 10 percent of a health care provider or provider organization.

SB45-SSA2-SA4,50,17 (c) Any private equity fund, investor, group of investors, or other entity with a direct or indirect controlling interest in a health care entity or that operates the business or substantially all of the property of a health care entity under a lease, management, or operating agreement.

SB45-SSA2-SA4,127 Section 127. 150.992 of the statutes is created to read:

SB45-SSA2-SA4,50,24 150.992 Material change transactions. (1) Notice. (a) Any health care entity shall, before consummating any material change transaction, submit written notice to the department not fewer than 180 days before the date of the proposed material change transaction. The department shall promulgate rules to define, for purposes of this subchapter, what entities are considered health care entities and what constitutes a material change transaction.

SB45-SSA2-SA4,51,5 (b) Written notice shall include and contain the information the department determines is required. The health care entity may include any additional information supporting the written notice of the material change transaction. Notice is complete when the department determines that all required information has been received.

SB45-SSA2-SA4,51,19 (c) All information provided by the submitter as part of the notice shall be treated as public record unless the submitter designates documents or information as confidential when submitting the notice and the department concurs with the designation in accordance with a process specified by the department by rule. Information that is otherwise publicly available, or that has not been confidentially maintained by the source, shall be considered public. The department shall maintain the confidentiality of all confidential information obtained in relation to a material change transaction, except that the department may share confidential information with other appropriate state agencies and departments to carry out their respective authorities under this section and may disclose any information to an expert or consultant under contract with the department, provided that the expert or consultant is bound by the same confidentiality requirements as the department. The confidential information and documents may not be treated as public records and are not subject to inspection or copying under s. 19.35.

SB45-SSA2-SA4,52,2 (d) The department shall post on its publicly available website information about the material change transaction no less than 30 days before the anticipated implementation of the material change transaction or, if the department is notified less than 30 days before the anticipated implementation, as soon as is practicable. The department shall include in the information posted on its website under this paragraph at least all of the following information regarding the material change transaction:

SB45-SSA2-SA4,52,4 1. A summary of the proposed transaction, including the identity of the parties to the transaction.

SB45-SSA2-SA4,52,6 2. A description of the groups or individuals likely to be affected by the transaction.

SB45-SSA2-SA4,52,9 3. Information about services currently provided by the health care entity, commitments by the health care entity to continue such services, and any services that will be reduced or eliminated.