AB68: Bill Text

AB68,997 Section 997 . 49.19 (4) (d) 2. of the statutes is amended to read:

AB68,741,21 49.19 (4) (d) 2. Is the wife spouse of a husband person who is incarcerated or who is a convicted offender permitted to live at home but precluded from earning a wage because the husband person is required by a court imposed sentence to perform unpaid public work or unpaid community service; or

AB68,998 Section 998 . 49.19 (4) (d) 3. of the statutes is amended to read:

AB68,741,25 49.19 (4) (d) 3. Is the wife spouse of a husband person who has been committed to the department pursuant to ch. 975, irrespective of the probable period of such commitment; or

AB68,999 Section 999. 49.19 (4) (d) 4. of the statutes is amended to read:

AB68,742,4 49.19 (4) (d) 4. Is the wife spouse of a husband person who has continuously abandoned or failed to support him or her, if proceedings have been commenced against the husband person under ch. 769; or

AB68,1000 Section 1000 . 49.19 (4) (d) 5. of the statutes is amended to read:

AB68,742,9 49.19 (4) (d) 5. Has been divorced and is without a husband spouse or legally separated from his or her husband spouse and is unable through use of the provisions of law to compel his or her former husband spouse to adequately support the child for whom aid is sought; or

AB68,1001 Section 1001. 49.343 (1g) of the statutes is amended to read:

AB68,742,22 49.343 (1g) Establishment of rates. For services provided beginning on January 1, 2011, the department shall establish the per client rate that a residential care center for children and youth or a group home may charge for its services, and the per client administrative rate that a child welfare agency may charge for the administrative portion of its foster care services, as provided in this section. In establishing rates for a placement specified in s. 938.357 (4) (c) 1. or 2., 2019 stats., the department shall consult with the department of corrections. A residential care center for children and youth and a group home shall charge all purchasers the same rate for the same services and a child welfare agency shall charge all purchasers the same administrative rate for the same foster care services. The department shall determine the levels of care created under the rules promulgated under s. 48.62 (8) to which this section applies.

AB68,1002 Section 1002 . 49.345 (2) of the statutes is amended to read:

AB68,743,19 49.345 (2) Except as provided in sub. (14) (b) and (c), any person, including a person placed under s. 48.32 (1) (am) or (b), 48.345 (3), 48.357 (1) or (2m), 938.183, 938.34 (3) or (4d), or 938.357 (1), (2m), (4), or (5) (e), receiving care, maintenance, services, and supplies provided by any institution in this state, in which the state is chargeable with all or part of the person's care, maintenance, services, and supplies, and the person's property and estate, including the homestead, and the spouse of the person, and the spouse's property and estate, including the homestead, and, in the case of a minor child, the parents of the person, and their property and estates, including their homestead, and, in the case of a foreign child described in s. 48.839 (1) who became dependent on public funds for his or her primary support before an order granting his or her adoption, the resident of this state appointed guardian of the child by a foreign court who brought the child into this state for the purpose of adoption, and his or her property and estate, including his or her homestead, shall be liable for the cost of the care, maintenance, services, and supplies in accordance with the fee schedule established by the department under s. 49.32 (1). If a spouse, widow surviving spouse, or minor, or an incapacitated person may be lawfully dependent upon the property for his or her support, the court shall release all or such part of the property and estate from the charges that may be necessary to provide for the person. The department shall make every reasonable effort to notify the liable persons as soon as possible after the beginning of the maintenance, but the notice or the receipt of the notice is not a condition of liability.

AB68,1003 Section 1003 . 49.345 (2) of the statutes, as affected by 2021 Wisconsin Act .... (this act), is amended to read:

AB68,744,17 49.345 (2) Except as provided in sub. (14) (b) and (c), any person, including a person placed under s. 48.32 (1) (am) or (b), 48.345 (3), 48.357 (1) or (2m), 938.183, 938.34 (3) or (4d), or 938.357 (1), (2m), (4), or (5) (e), receiving care, maintenance, services, and supplies provided by any institution in this state, in which the state is chargeable with all or part of the person's care, maintenance, services, and supplies, and the person's property and estate, including the homestead, and the spouse of the person, and the spouse's property and estate, including the homestead, and, in the case of a minor child, the parents of the person, and their property and estates, including their homestead, and, in the case of a foreign child described in s. 48.839 (1) who became dependent on public funds for his or her primary support before an order granting his or her adoption, the resident of this state appointed guardian of the child by a foreign court who brought the child into this state for the purpose of adoption, and his or her property and estate, including his or her homestead, shall be liable for the cost of the care, maintenance, services, and supplies in accordance with the fee schedule established by the department under s. 49.32 (1). If a spouse, surviving spouse, or minor, or an incapacitated person may be lawfully dependent upon the property for his or her support, the court shall release all or such part of the property and estate from the charges that may be necessary to provide for the person. The department shall make every reasonable effort to notify the liable persons as soon as possible after the beginning of the maintenance, but the notice or the receipt of the notice is not a condition of liability.

AB68,1004 Section 1004. 49.37 (1) of the statutes is amended to read:

AB68,744,21 49.37 (1) Beginning in fiscal year 2017-18, the department of children and families shall establish a 5-year 6-year offender reentry demonstration project focused on noncustodial fathers in a 1st class city.

AB68,1005 Section 1005. 49.37 (2) of the statutes is amended to read:

AB68,744,25 49.37 (2) Upon completion of the demonstration project under sub. (1) and by June 30, 2023 2024, the department of children and families shall conduct an evaluation of the demonstration project.

AB68,1006 Section 1006. 49.43 (12) of the statutes is amended to read:

AB68,745,4 49.43 (12) “Spouse" means the legal husband or wife of person to whom the beneficiary is legally married, whether or not the person is eligible for medical assistance.

AB68,1007 Section 1007. 49.45 (2p) of the statutes is repealed.

AB68,1008 Section 1008. 49.45 (2t) of the statutes is repealed.

AB68,1009 Section 1009. 49.45 (3) (e) 11. of the statutes is amended to read:

AB68,745,22 49.45 (3) (e) 11. The department shall use a portion of the moneys collected under s. 50.38 (2) (a) to pay for services provided by eligible hospitals, as defined in s. 50.38 (1), other than critical access hospitals, under the Medical Assistance Program under this subchapter, including services reimbursed on a fee-for-service basis and services provided under a managed care system. For state fiscal year 2008-09, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (a) for fiscal year 2008-09 divided by 57.75 percent. For each state fiscal year after state fiscal year 2008-09, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (a) for the fiscal year divided by 61.68 percent, except that if the department has expanded eligibility under section 2001 (a) (1) (C) of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical Assistance program under this subchapter, the amount collected for the fiscal year shall be divided by 53.69 percent.

AB68,1010 Section 1010 . 49.45 (3) (e) 12. of the statutes is amended to read:

AB68,746,9 49.45 (3) (e) 12. The department shall use a portion of the moneys collected under s. 50.38 (2) (b) to pay for services provided by critical access hospitals under the Medical Assistance Program under this subchapter, including services reimbursed on a fee-for-service basis and services provided under a managed care system. For each state fiscal year, total payments required under this subdivision, including both the federal and state share of Medical Assistance, shall equal the amount collected under s. 50.38 (2) (b) for the fiscal year divided by 61.68 percent, except that if the department has expanded eligibility under section 2001 (a) (1) (C) of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical Assistance program under this subchapter, the amount collected for the fiscal year shall be divided by 53.69 percent.

AB68,1011 Section 1011. 49.45 (3m) (a) (intro.) of the statutes is amended to read:

AB68,746,17 49.45 (3m) (a) (intro.) Subject to par. (c) (d) and notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b) and (o), in each fiscal year, the department shall pay to hospitals that serve a disproportionate share of low-income patients an amount equal to the sum of $27,500,000, as the state share of payments, and the matching federal share of payments. The department may make a payment to a hospital under this subsection under the calculation method described in par. (b) if the hospital meets all of the following criteria:

AB68,1012 Section 1012. 49.45 (3m) (cm) of the statutes is created to read:

AB68,746,25 49.45 (3m) (cm) Notwithstanding the total amount of state share paid to hospitals under par. (a) and the limit paid to a single hospital under par. (b) 3. a., if the department has expanded eligibility under section 2001 (a) (1) (C) of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical Assistance program under this subchapter, the department shall pay as the state share to hospitals $47,500,000 under par. (a) and pay no single hospital more than $7,950,000 under par. (b) 3. a.

AB68,1013 Section 1013. 49.45 (5g) of the statutes is created to read:

AB68,747,11 49.45 (5g) Payments to tribes. (a) Tribal care coordination agreements. A tribal health care provider's care coordination agreement with a nontribal health care provider shall meet federal requirements, including that a service provided by the nontribal health care provider be at the request of the tribal health care provider on behalf of a tribal member who remains in the tribal health care provider's care according to the care coordination agreement; that both the tribal health care provider and nontribal health care provider are providers, as defined in s. 49.43 (10); that an established relationship exists between the tribal health care provider and the tribal member; and that the care be provided pursuant to a written care coordination agreement.

AB68,747,21 (b) Amount and distribution of payments. 1. From the appropriation account under s. 20.435 (4) (b), the department shall make payments to eligible governing bodies of federally recognized American Indian tribes or bands or tribal health care providers in an amount and manner determined by the department. The department shall determine payment amounts on the basis of the difference between the state share of medical assistance payments paid for services rendered to tribal members for whom a care coordination agreement with nontribal health care providers is in place and the state share of medical assistance payments that would have been paid for those services absent a care coordination agreement with nontribal partners.

AB68,747,24 2. The department shall withhold from the payments under subd. 1. the state share of administrative costs associated with carrying out this subsection, not to exceed 10 percent of the amounts calculated in subd. 1.

AB68,748,3 3. Federally recognized American Indian tribes or bands may use funds paid under this subsection for health-related purposes. The department shall consult biennially with tribes to determine the timing and distribution of payments.

AB68,1014 Section 1014. 49.45 (6m) (a) 6. of the statutes is repealed.

AB68,1015 Section 1015. 49.45 (6m) (ag) 3p. a. to c. of the statutes are amended to read:

AB68,748,8 49.45 (6m) (ag) 3p. a. The system may incorporate acuity measurements under the most recent Resource Utilization Groupings methodology to determine factors for case-mix adjustment.

AB68,748,12 b. Four times annually, for For each facility resident who is a Medical Assistance recipient on March 31, June 30, September 30, or December 31, as applicable, the system shall determine the average case-mix index by use of the factors specified under subd. 3p. a.

AB68,748,14 c. The system shall may incorporate payment adjustments for dementia, behavioral needs, or other complex medical conditions.

AB68,1016 Section 1016. 49.45 (6xm) of the statutes is created to read:

AB68,748,19 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 each state fiscal year to hospitals that meet all of the following criteria:

AB68,748,20 1. The hospital is an acute care hospital located in this state.

AB68,748,25 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 subsection, 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.

AB68,749,8 (b) Notwithstanding par. (a), from the appropriations under s. 20.435 (4) (b), (o), and (w), if the department has expanded eligibility under section 2001 (a) (1) (C) of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical Assistance program under this subchapter, then 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.

AB68,1017 Section 1017. 49.45 (18) (ac) of the statutes is amended to read:

AB68,749,21 49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag) (c), any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for the benefits under s. 49.46 (2) (a) and (b) under s. 49.471 shall pay up to the maximum amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided under s. 49.46 (2). The service provider shall collect the specified or allowable copayment, coinsurance, or deductible, unless the service provider determines that the cost of collecting the copayment, coinsurance, or deductible exceeds the amount to be collected. The department shall reduce payments to each provider by the amount of the specified or allowable copayment, coinsurance, or deductible. No provider may deny care or services because the recipient is unable to share costs, but an inability to share costs specified in this subsection does not relieve the recipient of liability for these costs.

AB68,1018 Section 1018. 49.45 (18) (ag) of the statutes is repealed.

AB68,1019 Section 1019. 49.45 (18) (b) 8. of the statutes is created to read:

AB68,749,24 49.45 (18) (b) 8. Prescription drugs.

AB68,1020 Section 1020. 49.45 (18) (d) of the statutes is repealed.

AB68,1021 Section 1021. 49.45 (23) of the statutes is repealed.

AB68,1022 Section 1022 . 49.45 (23b) of the statutes is repealed.

AB68,1023 Section 1023 . 49.45 (24L) of the statutes is created to read:

AB68,750,7 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.

AB68,750,9 (b) In order to be eligible for enhanced reimbursement under this subsection, the provider must meet one of the following qualifications:

AB68,750,12 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.

AB68,750,14 2. For a for-profit provider, 5 percent or more of the individuals served by the provider are enrolled in the Medical Assistance program.

AB68,750,25 (c) For dental services rendered on or after January 1, 2022, by a qualified nonprofit or public 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, 2022, by a qualified for-profit 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, 2022, 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.

AB68,751,3 (d) If a provider has more than one service location, the thresholds described under par. (b) apply to each location, and the department will determine the payment for each separate service location.

AB68,751,5 (e) Any provider that receives reimbursement through the pilot project under sub. (24k) is not eligible for reimbursement under this subsection.

AB68,1024 Section 1024 . 49.45 (25) (bj) of the statutes is amended to read:

AB68,751,14 49.45 (25) (bj) The department of corrections may elect to provide case management services under this subsection to persons who are under the supervision of that department under s. 938.183, 938.34 (4h), (4m), or (4n), or 938.357 (3) or (4), who are Medical Assistance beneficiaries, and who meet one or more of the conditions specified in par. (am). The amount of the allowable charges for those services under the Medical Assistance program that is not provided by the federal government shall be paid from the appropriation account under s. 20.410 (3) (hm), (ho), or (hr).

AB68,1025 Section 1025 . 49.45 (25) (bj) of the statutes, as affected by 2019 Wisconsin Act 8 and 2021 Wisconsin Act .... (this act), is repealed and recreated to read:

AB68,751,23 49.45 (25) (bj) The department of corrections may elect to provide case management services under this subsection to persons who are under the supervision of that department under s. 938.183, 938.34 (4m), or 938.357 (3) or (4), who are Medical Assistance beneficiaries, and who meet one or more of the conditions specified in par. (am). The amount of the allowable charges for those services under the Medical Assistance program that is not provided by the federal government shall be paid from the appropriation account under s. 20.410 (3) (hm), (ho), or (hr).

AB68,1026 Section 1026. 49.45 (25r) of the statutes is created to read:

AB68,751,25 49.45 (25r) Community health worker services. (a) In this subsection:

AB68,752,2 1. “Community health services” means services provided by a community health worker.

AB68,752,10 2. “Community health worker” means a frontline public health worker who is a trusted member of or has a close understanding of the community served, enabling the worker to serve as a liaison, link, or intermediary between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery, and who builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support, and advocacy.

AB68,752,18 (b) The department shall request any necessary waiver from, or submit any necessary amendments to the state Medical Assistance plan to, the secretary of the federal department of health and human services to provide community health services to eligible Medical Assistance recipients. If the waiver or state plan amendment is granted, the department shall reimburse certified providers for those community health services approved by the federal department of health and human services for Medical Assistance coverage and as provided to Medical Assistance recipients under s. 49.46 (2) (b) 9m.

AB68,1027 Section 1027. 49.45 (30e) (a) 2. of the statutes is repealed.

AB68,1028 Section 1028. 49.45 (30e) (b) 3. of the statutes is amended to read:

AB68,752,23 49.45 (30e) (b) 3. Requirements for certification of community-based psychosocial service programs. The department may certify county-based providers and providers that are not county-based providers.

AB68,1029 Section 1029. 49.45 (30e) (c) of the statutes is renumbered 49.45 (30e) (c) 1. and amended to read:

AB68,753,7 49.45 (30e) (c) 1. A The department shall reimburse a county that elects to make the provide services under s. 49.46 (2) (b) 6. Lm. available shall reimburse a provider of the services for the amount of the allowable charges for those services under the medical assistance Medical Assistance program that is not provided by the federal government. The department shall reimburse the provider only for and the amount of the allowable charges for those services under the medical assistance Medical Assistance program that is provided by the federal government.

AB68,1030 Section 1030. 49.45 (30e) (c) 2. of the statutes is created to read:

AB68,753,11 49.45 (30e) (c) 2. The department shall reimburse to a provider that is not a county-based provider for services under s. 49.46 (2) (b) 6. Lm. for both the federal and nonfederal share of a fee schedule that is determined by the department.

AB68,1031 Section 1031. 49.45 (30e) (d) of the statutes is amended to read:

AB68,753,20 49.45 (30e) (d) Provision of services on regional basis. Notwithstanding par. (c) 1. and subject to par. (e), in counties that elect to deliver provide the services under s. 49.46 (2) (b) 6. Lm. through the Medical Assistance program on a regional basis according to criteria established by the department, the department shall reimburse a provider of the services 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 that is not provided by the federal government.

AB68,1032 Section 1032. 49.45 (30t) of the statutes is created to read:

AB68,753,22 49.45 (30t) Doula services. (a) In this subsection:

AB68,753,24 1. “Certified doula” means an individual who has received certification from a doula certifying organization recognized by the department.

AB68,754,3 2. “Doula services” means childbirth education and support services, including emotional and physical support provided during pregnancy, labor, birth, and the postpartum period.

AB68,754,9 (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.

AB68,1033 Section 1033. 49.46 (1) (a) 1m. of the statutes is amended to read:

AB68,754,14 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 365th day after the last day of the pregnancy falls.