SB59: Bill Text

SB59,539,6 49.45 (19) (c) If the mother of a child was enrolled in a health maintenance organization or other prepaid health care plan under medical assistance at the time of the child's birth, The state may not seek recovery of birth expenses that may be recovered by the state under this subsection are the birth expenses incurred by the health maintenance organization or other prepaid health care plan.

SB59,672 Section 672 . 49.45 (23) of the statutes, as affected by 2019 Wisconsin Act .... (this act), is repealed.

SB59,673 Section 673 . 49.45 (23) (g) of the statutes is repealed.

SB59,674 Section 674 . 49.45 (23b) of the statutes is repealed.

SB59,675 Section 675. 49.45 (24k) of the statutes is repealed.

SB59,676 Section 676. 49.45 (24L) of the statutes is created to read:

SB59,539,16 49.45 (24L) Critical access reimbursement payments to dental providers. (a) Based on the criteria in pars. (b) and (c), the department shall increase reimbursements to dental providers that meet quality of care standards, as established by the department.

SB59,539,18 (b) In order to be eligible for enhanced reimbursement under this subsection, the provider must meet one of the following qualifications:

SB59,539,21 1. For a nonprofit or public provider, 50 percent or more of the individuals served by the provider are individuals who are without dental insurance or are enrolled in the Medical Assistance program.

SB59,539,23 2. For a for-profit provider, 5 percent or more of the individuals served by the provider are enrolled in the Medical Assistance program.

SB59,540,9 (c) For dental services rendered on or after January 1, 2020, by a qualified nonprofit critical access dental provider, the department shall increase reimbursement by 50 percent above the reimbursement rate that would otherwise be paid to that provider. For dental services rendered on or after January 1, 2020, by a qualified for-profit critical access dental provider, the department shall increase reimbursement by 30 percent above the reimbursement rate that would otherwise be paid to that provider. For dental providers rendering services to individuals in managed care under the Medical Assistance program, for services rendered on or after January 1, 2020, the department shall increase reimbursement to pay an additional amount on the basis of the rate that would have been paid to the dental provider had the individual not been enrolled in managed care.

SB59,540,12 (d) If a provider has more than one service location, the thresholds described under par. (b) apply to each location, and payment for each service location would be determined separately.

SB59,677 Section 677. 49.45 (29w) (b) 1. b. of the statutes is amended to read:

SB59,540,23 49.45 (29w) (b) 1. b. “Telehealth" is means a service provided from a remote location using a combination of interactive video, audio, and externally acquired images through a networking environment between an individual or a provider at an originating site and a provider at a remote location with the service being of sufficient audio and visual fidelity and clarity as to be functionally equivalent to face-to-face contact; or, in circumstances determined by the department, an asynchronous transmission of digital clinical information through a secure electronic communications system from one provider to another provider. “Telehealth" does not include telephone conversations or Internet-based communications between providers or between providers and individuals.

SB59,678 Section 678. 49.45 (29y) (d) of the statutes is repealed.

SB59,679 Section 679. 49.45 (30y) of the statutes is created to read:

SB59,541,3 49.45 (30y) Certified doula services; pilot project. (a) In this subsection, “certified doula" means an individual who has received certification from a doula certifying organization recognized by the department.

SB59,541,6 (b) For purposes of this subsection, services provided by certified doulas include continuous emotional and physical support during labor and birth of a child and intermittent services during the prenatal and postpartum periods.

SB59,541,11 (c) Subject to par. (d), the department shall reimburse under the Medical Assistance program benefits as provided under this subsection for pregnant women enrolled in the Medical Assistance program who reside in the counties of Brown, Dane, Milwaukee, Rock, or Sheboygan, or another county as determined by the department.

SB59,541,17 (d) The department shall request from the secretary of the federal department of health and human services any approval necessary to allow reimbursement under the Medical Assistance program for services provided by a certified doula. The department may not pay reimbursement unless federal approval is not required or any required federal approval allowing reimbursement under s. 49.46 (2) (b) 12p. is approved and in effect.

SB59,680 Section 680. 49.45 (41) of the statutes is amended to read:

SB59,541,24 49.45 (41) Mental health crisis Crisis intervention services. (a) In this subsection, “mental health crisis intervention services" means crisis intervention services for the treatment of mental illness, intellectual disability, substance abuse, and dementia that are provided by a mental health crisis intervention program operated by, or under contract with, a county, if the county is certified as a medical assistance provider.

SB59,542,9 (b) If a county elects to become certified as a provider of mental health crisis intervention services, the county may provide mental health crisis intervention services under this subsection in the county to medical assistance recipients through the medical assistance program. A county that elects to provide the services shall pay the amount of the allowable charges for the services under the medical assistance program that is not provided by the federal government. The department shall reimburse the county under this subsection only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.

SB59,681 Section 681. 49.45 (41) (c) of the statutes is created to read:

SB59,542,13 49.45 (41) (c) Notwithstanding par. (b), if a county elects to deliver crisis intervention services under the Medical Assistance program on a regional basis according to criteria established by the department, all of the following apply:

SB59,542,17 1. After January 1, 2020, the department shall require the county to annually contribute for the crisis intervention services an amount equal to 75 percent of the county's expenditures for crisis intervention services under this subsection in calendar year 2017, as determined by the department.

SB59,542,21 2. The department shall reimburse the provider of crisis intervention services in the county the amount of allowable charges for those services under the Medical Assistance program, including both the federal share and nonfederal share of those charges, that exceeds the amount of the county contribution required under subd. 1.

SB59,542,25 3. If a county submits a certified cost report under s. 49.45 (52) (b) to claim federal medical assistance funds, the claim based on certified costs made by a county for amounts under subd. 2. may not include any part of the nonfederal share of the amount under subd. 2.

SB59,682 Section 682. 49.45 (47) (b) of the statutes is amended to read:

SB59,543,5 49.45 (47) (b) No person may receive reimbursement under s. 46.27 (11) for the provision of services to clients in an adult day care center unless the adult day care center is certified by the department under sub. (2) (a) 11. as a provider of medical assistance.

SB59,683 Section 683 . 49.45 (47) (dm) of the statutes is created to read:

SB59,543,14 49.45 (47) (dm) Every 24 months, on a schedule determined by the department, an adult day care center shall submit through an online system prescribed by the department a report in the form and containing the information that the department requires, including payment of any fee due under par. (c). If a complete report is not timely filed, the department shall issue a warning to the operator of the adult day care center. The department may revoke an adult day care center's certification for failure to timely and completely report within 60 days after the report date established under the schedule determined by the department.

SB59,684 Section 684. 49.45 (60) of the statutes is repealed.

SB59,685 Section 685. 49.46 (1) (a) 1m. of the statutes is amended to read:

SB59,543,20 49.46 (1) (a) 1m. Any pregnant woman whose income does not exceed the standard of need under s. 49.19 (11) and whose pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th day or, if approved by the federal government, the 365th day after the last day of the pregnancy falls.

SB59,686 Section 686. 49.46 (1) (a) 14. of the statutes is amended to read:

SB59,544,2 49.46 (1) (a) 14. Any person who would meet the financial and other eligibility requirements for home or community-based services under s. 46.27 (11), 46.277, or 46.2785 but for the fact that the person engages in substantial gainful activity under 42 USC 1382c (a) (3), if a waiver under s. 49.45 (38) is in effect or federal law permits federal financial participation for medical assistance coverage of the person and if funding is available for the person under s. 46.27 (11), 46.277, or 46.2785.

SB59,687 Section 687. 49.46 (1) (em) of the statutes is amended to read:

SB59,544,10 49.46 (1) (em) To the extent approved by the federal government, for the purposes of determining financial eligibility and any cost-sharing requirements of an individual under par. (a) 6m., 14., or 14m., (d) 2., or (e), the department or its designee shall exclude any assets accumulated in a person's independence account, as defined in s. 49.472 (1) (c), and any income or assets from retirement benefits earned or accumulated from income or employer contributions while employed and receiving state-funded benefits under s. 46.27 or medical assistance under s. 49.472.

SB59,688 Section 688. 49.46 (1) (j) of the statutes is amended to read:

SB59,544,16 49.46 (1) (j) An individual determined to be eligible for benefits under par. (a) 9. remains eligible for benefits under par. (a) 9. for the balance of the pregnancy and to the last day of the month in which the 60th day or, if approved by the federal government, the 365th day after the last day of the pregnancy falls without regard to any change in the individual's family income.

SB59,689 Section 689. 49.46 (2) (b) 8. of the statutes is amended to read:

SB59,544,21 49.46 (2) (b) 8. Home or community-based services, if provided under s. 46.27 (11), 46.275, 46.277, 46.278, 46.2785, 46.99, or under the family care benefit if a waiver is in effect under s. 46.281 (1d), or under the disabled children's long-term support program, as defined in s. 46.011 (1g).

SB59,690 Section 690 . 49.46 (2) (b) 12p. of the statutes is created to read:

SB59,544,24 49.46 (2) (b) 12p. Subject to the limitations under s. 49.45 (30y), services provided by a certified doula.

SB59,691 Section 691. 49.46 (2) (b) 15. of the statutes is amended to read:

SB59,545,2 49.46 (2) (b) 15. Mental health crisis Crisis intervention services under s. 49.45 (41).

SB59,692 Section 692. 49.46 (2) (b) 21. of the statutes is created to read:

SB59,545,5 49.46 (2) (b) 21. Subject to par. (bv), nonmedical services that contribute to the determinants of health.

SB59,693 Section 693. 49.46 (2) (bv) of the statutes is created to read:

SB59,545,13 49.46 (2) (bv) The department shall determine those services under par. (b) 21. that contribute to the determinants of health. The department shall seek any necessary state plan amendment or request any waiver of federal Medicaid law to implement this paragraph. The department is not required to provided the services under this paragraph as a benefit under the Medical Assistance program if the federal department of health and human services does not provide federal financial participation for the services under this paragraph.

SB59,694 Section 694. 49.463 of the statutes is repealed.

SB59,695 Section 695. 49.47 (4) (ag) 2. of the statutes is amended to read:

SB59,545,18 49.47 (4) (ag) 2. Pregnant and the woman's pregnancy is medically verified Eligibility continues to the last day of the month in which the 60th day or, if approved by the federal government, the 365th day after the last day of the pregnancy falls.

SB59,696 Section 696. 49.47 (4) (as) 1. of the statutes is amended to read:

SB59,545,24 49.47 (4) (as) 1. The person would meet the financial and other eligibility requirements for home or community-based services under s. 46.27 (11), 46.277, or 46.2785 or under the family care benefit if a waiver is in effect under s. 46.281 (1d) but for the fact that the person engages in substantial gainful activity under 42 USC 1382c (a) (3).

SB59,697 Section 697. 49.47 (4) (as) 3. of the statutes is amended to read:

SB59,546,2 49.47 (4) (as) 3. Funding is available for the person under s. 46.27 (11), 46.277, or 46.2785 or under the family care benefit if a waiver is in effect under s. 46.281 (1d).

SB59,698 Section 698. 49.47 (4) (b) (intro.) of the statutes is amended to read:

SB59,546,11 49.47 (4) (b) (intro.) Eligibility exists if the applicant's property, subject to the exclusion of any amounts under the Long-Term Care Partnership Program established under s. 49.45 (31), any amounts in an independence account, as defined in s. 49.472 (1) (c), or any retirement assets that accrued from employment while the applicant was eligible for the community options program under s. 46.27 (11), 2017 stats., or any other Medical Assistance program, including deferred compensation or the value of retirement accounts in the Wisconsin Retirement System or under the federal Social Security Act, does not exceed the following:

SB59,699 Section 699 . 49.471 (1) (cr) of the statutes is created to read:

SB59,546,14 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

SB59,700 Section 700 . 49.471 (4) (a) 4. b. of the statutes is amended to read:

SB59,546,18 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).

SB59,701 Section 701 . 49.471 (4) (a) 8. of the statutes is created to read:

SB59,546,20 49.471 (4) (a) 8. An individual who meets all of the following criteria:

SB59,546,21 a. The individual is an adult under the age of 65.

SB59,546,23 b. The adult has a family income that does not exceed 133 percent of the poverty line, except as provided in sub. (4g).

SB59,546,25 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.

SB59,702 Section 702. 49.471 (4g) of the statutes is created to read:

SB59,547,9 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.

SB59,703 Section 703. 49.471 (6) (b) of the statutes is amended to read:

SB59,547,15 49.471 (6) (b) A pregnant woman who is determined to be eligible for benefits under sub. (4) remains eligible for benefits under sub. (4) for the balance of the pregnancy and to the last day of the month in which the 60th day or, if approved by the federal government, the 365th day after the last day of the pregnancy falls without regard to any change in the woman's family income.

SB59,704 Section 704. 49.471 (6) (L) of the statutes is created to read:

SB59,547,22 49.471 (6) (L) The department shall request from the federal department of health and human services approval of a state plan amendment, a waiver of federal Medicaid law, or approval of a demonstration project to maintain eligibility for post-partum women to the last day of the month in which the 365th day after the last day of the pregnancy falls under ss. 49.46 (1) (a) 1m. and 9. and (j), 49.47 (4) (ag) 2., and 49.471 (4) (a) 1g. and 1m., (6) (b), and (7) (b) 1.

SB59,705 Section 705. 49.471 (7) (b) 1. of the statutes is amended to read:

SB59,548,9 49.471 (7) (b) 1. A pregnant woman whose family income exceeds 300 percent of the poverty line may become eligible for coverage under this section if the difference between the pregnant woman's family income and the applicable income limit under sub. (4) (a) is obligated or expended for any member of the pregnant woman's family for medical care or any other type of remedial care recognized under state law or for personal health insurance premiums or for both. Eligibility obtained under this subdivision continues without regard to any change in family income for the balance of the pregnancy and to the last day of the month in which the 60th day or, if approved by the federal government, the 365th day after the last day of the woman's pregnancy falls. Eligibility obtained by a pregnant woman under this subdivision extends to all pregnant women in the pregnant woman's family.

SB59,706 Section 706. 49.472 (3) (b) of the statutes is amended to read:

SB59,548,18 49.472 (3) (b) The individual's assets do not exceed $15,000. In determining assets, the department may not include assets that are excluded from the resource calculation under 42 USC 1382b (a), assets accumulated in an independence account, and, to the extent approved by the federal government, assets from retirement benefits accumulated from income or employer contributions while employed and receiving medical assistance under this section or state-funded benefits under s. 46.27, 2017 stats. The department may exclude, in whole or in part, the value of a vehicle used by the individual for transportation to paid employment.

SB59,707 Section 707. 49.472 (3) (f) of the statutes is amended to read:

SB59,548,23 49.472 (3) (f) The individual maintains premium payments under sub. (4) (am) and, if applicable and to the extent approved by the federal government, premium payments calculated by the department in accordance with sub. (4) (bm), unless the individual is exempted from premium payments under sub. (4) (dm) or (5).

SB59,708 Section 708. 49.472 (4) (am) of the statutes is amended to read:

SB59,549,3 49.472 (4) (am) To the extent approved by the federal government and except as provided in pars. (dm) and (em) and sub. (5), an individual who receives medical assistance under this section shall pay a monthly premium of $25 to the department.

SB59,709 Section 709. 49.472 (5) of the statutes is repealed.

SB59,710 Section 710 . 49.485 of the statutes is renumbered 20.9315 (19) and amended to read: