Amendment SA4-SSA2-SB45

SB45-SSA2-SA4,16,19 46.73 Community dental health coordinators. From the appropriations under s. 20.435 (4) (bm) and (pa), the department shall award grants to support community dental health coordinators in rural regions of the state.

SB45-SSA2-SA4,47 Section 47. 46.74 of the statutes is created to read:

SB45-SSA2-SA4,16,23 46.74 Grants for mobile dental clinics. The department shall award grants to community health centers, as defined in s. 250.15 (1) (a), to procure and operate mobile dental clinics.

SB45-SSA2-SA4,48 Section 48. 46.995 (4) of the statutes is created to read:

SB45-SSA2-SA4,17,4 46.995 (4) The department shall ensure that any child who is eligible and who applies for the disabled children’s long-term support program that is operating under a waiver of federal law receives services under the disabled children’s long‑term support program that is operating under a waiver of federal law.

SB45-SSA2-SA4,49 Section 49. 48.375 (4) (a) 1. of the statutes is amended to read:

SB45-SSA2-SA4,17,15 48.375 (4) (a) 1. The person or the person’s agent has, either directly or through a referring physician or his or her agent, received and made part of the minor’s medical record, under the requirements of s. 253.10, the voluntary and informed written consent of the minor and the voluntary and informed written consent of one of her parents; or of the minor’s guardian or legal custodian, if one has been appointed; or of an adult family member of the minor; or of one of the minor’s foster parents, if the minor has been placed in a foster home and the minor’s parent has signed a waiver granting the department, a county department, or the foster parent the authority to consent to medical services or treatment on behalf of the minor.

SB45-SSA2-SA4,50 Section 50. 49.45 (2p) of the statutes is repealed.

SB45-SSA2-SA4,51 Section 51. 49.45 (2t) of the statutes is repealed.

SB45-SSA2-SA4,52 Section 52. 49.45 (3h) of the statutes is created to read:

SB45-SSA2-SA4,17,24 49.45 (3h) Payments to rural health clinics. (a) For services provided by a rural health clinic on or after the effective date of this paragraph .... [LRB inserts date], and before July 1, 2026, to a recipient of the Medical Assistance program under this subchapter, the department shall reimburse the rural health clinic under a payment methodology in effect on July 1, 2025, and in accordance with 42 USC 1396a (bb) (6).

SB45-SSA2-SA4,18,6 (b) For services provided by a rural health clinic on or after July 1, 2026, to a recipient of the Medical Assistance program under this subchapter, the department shall reimburse the rural health clinic using a payment methodology based on the Medicaid prospective payment system under 42 USC 1396a (bb) (1) to (3). The department shall consult with rural health clinics in developing the payment methodology under this paragraph.

SB45-SSA2-SA4,53 Section 53. 49.45 (6xm) of the statutes is created to read:

SB45-SSA2-SA4,18,11 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:

SB45-SSA2-SA4,18,12 1. The hospital is an acute care hospital located in this state.

SB45-SSA2-SA4,18,17 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.

SB45-SSA2-SA4,18,22 (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 $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.

SB45-SSA2-SA4,54 Section 54. 49.45 (19) (a) of the statutes is amended to read:

SB45-SSA2-SA4,19,6 49.45 (19) (a) As a condition of eligibility for medical assistance, a person shall, notwithstanding other provisions of the statutes except as provided in par. (cm), be deemed to have assigned to the state, by applying for or receiving medical assistance, any rights to medical support or other payment of medical expenses from any other person, including rights to unpaid amounts accrued at the time of application for medical assistance as well as any rights to support accruing during the time for which medical assistance is paid.

SB45-SSA2-SA4,55 Section 55. 49.45 (19) (c) of the statutes is repealed.

SB45-SSA2-SA4,56 Section 56. 49.45 (19) (cm) of the statutes is created to read:

SB45-SSA2-SA4,19,10 49.45 (19) (cm) Notwithstanding par. (a), birth expenses may not be recovered by the state under this subsection.

SB45-SSA2-SA4,57 Section 57. 49.45 (23) of the statutes is repealed.

SB45-SSA2-SA4,58 Section 58. 49.45 (23b) of the statutes is repealed.

SB45-SSA2-SA4,59 Section 59. 49.45 (24k) (c) of the statutes is repealed.

SB45-SSA2-SA4,60 Section 60. 49.45 (24L) of the statutes is created to read:

SB45-SSA2-SA4,19,20 49.45 (24L) Statewide dental contract. The department 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 to implement a statewide contract for dental benefits through a single vendor under the Medical Assistance program. If the federal government disapproves the amendment or waiver request, the department is not required to implement this subsection.

SB45-SSA2-SA4,61 Section 61. 49.45 (25c) of the statutes is created to read:

SB45-SSA2-SA4,20,3 49.45 (25c) Children’s behavioral health specialty managed care. The department may request a waiver from the federal department of health and human services to administer a children’s behavioral health specialty managed care program under the Medical Assistance program. If the waiver is granted, the department may administer the children’s behavioral health specialty managed care program under this subsection.

SB45-SSA2-SA4,62 Section 62. 49.45 (25d) of the statutes is created to read:

SB45-SSA2-SA4,20,9 49.45 (25d) Health-related social needs. The department shall request a waiver from the federal department of health and human services to provide reimbursement for services for health-related social needs under the Medical Assistance program. If the waiver is granted, the department shall provide reimbursement for services for health-related social needs under this subsection.

SB45-SSA2-SA4,63 Section 63. 49.45 (30) (a) of the statutes is repealed.

SB45-SSA2-SA4,64 Section 64. 49.45 (30) (b) of the statutes is renumbered 49.45 (30) and amended to read:

SB45-SSA2-SA4,20,18 49.45 (30) Services provided by community support programs. The department shall reimburse a provider of county that provides services under s. 49.46 (2) (b) 6. L. only 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 for those services under the Medical Assistance program that is not provided by the federal government.

SB45-SSA2-SA4,65 Section 65. 49.45 (30j) (title) of the statutes is amended to read:

SB45-SSA2-SA4,20,21 49.45 (30j) (title) Reimbursement for peer recovery coach and certified peer specialist services.

SB45-SSA2-SA4,66 Section 66. 49.45 (30j) (a) 1. and 2. of the statutes are renumbered 49.45 (30j) (a) 2m. and 3.

SB45-SSA2-SA4,67 Section 67. 49.45 (30j) (a) 1m. of the statutes is created to read:

SB45-SSA2-SA4,21,4 49.45 (30j) (a) 1m. “Certified peer specialist” means an individual who has experience in the mental health and substance use services system, who is trained to provide support to others, and who has received peer specialist or parent peer specialist certification under the rules established by the department.

SB45-SSA2-SA4,68 Section 68. 49.45 (30j) (bm) of the statutes is created to read:

SB45-SSA2-SA4,21,8 49.45 (30j) (bm) The department shall reimburse under the Medical Assistance program under this subchapter any service provided by a certified peer specialist if the service satisfies all of the following conditions:

SB45-SSA2-SA4,21,10 1. The recipient of the service provided by a certified peer specialist is in treatment for or recovery from a mental illness or a substance use disorder.

SB45-SSA2-SA4,21,12 2. The certified peer specialist provides the service under the supervision of a competent mental health professional.

SB45-SSA2-SA4,21,15 3. The certified peer specialist provides the service in coordination with the Medical Assistance recipient’s individual treatment plan and in accordance with the recipient’s individual treatment goals.

SB45-SSA2-SA4,21,18 4. The certified peer specialist providing the service has completed training requirements, as established by the department by rule, after consulting with members of the recovery community.

SB45-SSA2-SA4,69 Section 69. 49.45 (30j) (c) of the statutes is amended to read:

SB45-SSA2-SA4,21,22 49.45 (30j) (c) The department shall certify under Medical Assistance peer recovery coaches and certified peer specialists to provide services in accordance with this subsection.

SB45-SSA2-SA4,70 Section 70. 49.45 (30p) of the statutes is created to read:

SB45-SSA2-SA4,22,2 49.45 (30p) Detoxification and stabilization services. (a) In this subsection:

SB45-SSA2-SA4,22,15 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.

SB45-SSA2-SA4,22,18 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.

SB45-SSA2-SA4,22,21 3. “Detoxification and stabilization services” means adult residential integrated behavioral health stabilization service, residential withdrawal management service, or residential intoxication monitoring service.

SB45-SSA2-SA4,23,7 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.

SB45-SSA2-SA4,23,20 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.

SB45-SSA2-SA4,24,2 (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.

SB45-SSA2-SA4,24,10 (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 s. 49.46 (2) (b) 14r. If the federal department disapproves the request, the department may not provide the reimbursement described in this subsection.

SB45-SSA2-SA4,71 Section 71. 49.45 (30t) of the statutes is created to read:

SB45-SSA2-SA4,24,12 49.45 (30t) Doula services. (a) In this subsection:

SB45-SSA2-SA4,24,14 1. “Certified doula” means an individual who has received certification from a doula certifying organization recognized by the department.

SB45-SSA2-SA4,24,17 2. “Doula services” means childbirth education and support services, including emotional and physical support provided during pregnancy, labor, birth, and the postpartum period.

SB45-SSA2-SA4,25,2 (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.

SB45-SSA2-SA4,72 Section 72. 49.45 (39) (b) 1. of the statutes is amended to read:

SB45-SSA2-SA4,26,13 49.45 (39) (b) 1. ‘Payment for school medical services.’ If a school district or a cooperative educational service agency elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the school district or the cooperative educational service agency for 60 100 percent of the federal share of allowable charges for the school medical services that it provides and, as specified in subd. 2., for allowable administrative costs. If the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing elects to provide school medical services and meets all requirements under par. (c), the department shall reimburse the department of public instruction for 60 100 percent of the federal share of allowable charges for the school medical services that the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing provides and, as specified in subd. 2., for allowable administrative costs. A school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired, or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, claims for common carrier transportation costs as a school medical service unless the department receives notice from the federal health care financing administration that, under a change in federal policy, the claims are not allowed. If the department receives the notice, a school district, cooperative educational service agency, the Wisconsin Center for the Blind and Visually Impaired, or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing may submit, and the department shall allow, unreimbursed claims for common carrier transportation costs incurred before the date of the change in federal policy. The department shall promulgate rules establishing a methodology for making reimbursements under this paragraph. All other expenses for the school medical services provided by a school district or a cooperative educational service agency shall be paid for by the school district or the cooperative educational service agency with funds received from state or local taxes. The school district, the Wisconsin Center for the Blind and Visually Impaired, the Wisconsin Educational Services Program for the Deaf and Hard of Hearing, or the cooperative educational service agency shall comply with all requirements of the federal department of health and human services for receiving federal financial participation.

SB45-SSA2-SA4,73 Section 73. 49.45 (39) (b) 2. of the statutes is amended to read:

SB45-SSA2-SA4,27,2 49.45 (39) (b) 2. ‘Payment for school medical services administrative costs.’ The department shall reimburse a school district or a cooperative educational service agency specified under subd. 1. and shall reimburse the department of public instruction on behalf of the Wisconsin Center for the Blind and Visually Impaired or the Wisconsin Educational Services Program for the Deaf and Hard of Hearing for 90 100 percent of the federal share of allowable administrative costs, using time studies, beginning in fiscal year 1999-2000. A school district or a cooperative educational service agency may submit, and the department of health services shall allow, claims for administrative costs incurred during the period that is up to 24 months before the date of the claim, if allowable under federal law.

SB45-SSA2-SA4,74 Section 74. 49.45 (41) (d) of the statutes is amended to read:

SB45-SSA2-SA4,27,17 49.45 (41) (d) The department shall, in accordance with all procedures set forth under s. 20.940, request a waiver under 42 USC 1315 or submit a Medical Assistance state plan amendment to the federal department of health and human services to obtain any necessary federal approval required to provide reimbursement to crisis urgent care and observation facilities certified under s. 51.036 for crisis intervention services under this subsection. If the department determines submission of a state plan amendment is appropriate, the department shall, notwithstanding whether the expected fiscal effect of the amendment is $7,500,000 or more, submit the amendment to the joint committee on finance for review in accordance with the procedures under sub. (2t). If federal approval is granted or no federal approval is required, the department shall provide reimbursement under s. 49.46 (2) (b) 15. If federal approval is necessary but is not granted, the department may not provide reimbursement for crisis intervention services provided by crisis urgent care and observation facilities.

SB45-SSA2-SA4,75 Section 75. 49.45 (52) (a) 1. of the statutes is amended to read:

SB45-SSA2-SA4,28,7 49.45 (52) (a) 1. If the department provides the notice under par. (c) selecting the payment procedure in this paragraph, the department may, from the appropriation account under s. 20.435 (7) (b), make Medical Assistance payment adjustments to county departments under s. 46.215, 46.22, 46.23, 51.42, or 51.437 or to local health departments, as defined in s. 250.01 (4), as appropriate, for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating in the early intervention program under s. 51.44. Payment adjustments under this paragraph shall include the state share of the payments. The total of any payment adjustments under this paragraph and Medical Assistance payments made from appropriation accounts under s. 20.435 (4) (b), (gm), (o), and (w), may not exceed applicable limitations on payments under 42 USC 1396a (a) (30) (A).

SB45-SSA2-SA4,76 Section 76. 49.45 (52) (b) 1. of the statutes is amended to read:

SB45-SSA2-SA4,28,14 49.45 (52) (b) 1. Annually, a county department under s. 46.215, 46.22, 46.23, 51.42, or 51.437 shall submit a certified cost report that meets the requirements of the federal department of health and human services for covered services under s. 49.46 (2) (a) 2. and 4. d. and f. and (b) 6. b., c., f., fm., g., j., k., L., Lm., and m., 9., 12., 12m., 13., 15., and 16., except for services specified under s. 49.46 (2) (b) 6. b. and c. provided to children participating in the early intervention program under s. 51.44.

SB45-SSA2-SA4,77 Section 77. 49.45 (62) of the statutes is created to read:

SB45-SSA2-SA4,28,22 49.45 (62) Prerelease coverage of incarcerated individuals. (a) The department may submit to the secretary of the federal department of health and human services a request for a waiver of federal Medicaid law to conduct a demonstration project to provide incarcerated individuals prerelease health care coverage for certain services under the Medical Assistance program for up to 90 days preceding the incarcerated individual’s release if the individual is otherwise eligible for coverage under the Medical Assistance program.

SB45-SSA2-SA4,29,3 (b) If a waiver submitted by the department under par. (a) is approved by the federal department of health and human services, the department may provide reimbursement under the Medical Assistance program for both the federal and nonfederal share of services, including case management services, provided to incarcerated individuals under the approved waiver.

SB45-SSA2-SA4,78 Section 78. 49.46 (2) (a) 3. of the statutes is amended to read:

SB45-SSA2-SA4,29,5 49.46 (2) (a) 3. Rural health clinic services, as provided in s. 49.45 (3h).

SB45-SSA2-SA4,79 Section 79. 49.46 (2) (b) 1. j. of the statutes is created to read:

SB45-SSA2-SA4,29,7 49.46 (2) (b) 1. j. Nonsurgical treatment of temporomandibular joint disorder.

SB45-SSA2-SA4,80 Section 80. 49.46 (2) (b) 12p. of the statutes is created to read:

SB45-SSA2-SA4,29,10 49.46 (2) (b) 12p. Doula services provided by a certified doula, as specified under s. 49.45 (30t).

SB45-SSA2-SA4,81 Section 81. 49.46 (2) (b) 14c. of the statutes is created to read:

SB45-SSA2-SA4,29,13 49.46 (2) (b) 14c. Subject to par. (bv), services by a psychiatric residential treatment facility.

SB45-SSA2-SA4,82 Section 82. 49.46 (2) (b) 14p. of the statutes is amended to read:

SB45-SSA2-SA4,29,16 49.46 (2) (b) 14p. Subject to s. 49.45 (30j), services provided by a peer recovery coach or a certified peer specialist.

SB45-SSA2-SA4,83 Section 83. 49.46 (2) (b) 14r. of the statutes is created to read:

SB45-SSA2-SA4,29,19 49.46 (2) (b) 14r. Detoxification and stabilization services as specified under s. 49.45 (30p).

SB45-SSA2-SA4,84 Section 84. 49.46 (2) (bv) of the statutes is created to read:

SB45-SSA2-SA4,30,4 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.

SB45-SSA2-SA4,85 Section 85. 49.471 (1) (cr) of the statutes is created to read: