AB1088: Bill Text

AB1088,,42 (a) Definitions. In this subsection, “department” means the department of health services.

AB1088,,43 (b) Applicability. Beginning on July 1, 2024, the department shall allocate 250 nursing home beds as provided under this subsection.

AB1088,,44 (c) Applications. The department shall request applications for nursing home beds allocated under this subsection. An applicant for nursing home beds allocated under this subsection shall submit an application to the department on a form provided by the department. The application shall include a plan for the applicant to satisfy all of the following criteria within 18 months of department approval:

AB1088,,45 1. Become licensed under subch. I of ch. 50 for the nursing home beds that the applicant requested in the application.

AB1088,,46 2. Become certified as a provider under the medical assistance program under subch. IV of ch. 49.

AB1088,,47 3. Hire sufficient health care personnel and expend sufficient resources to provide 24-hour nursing services.

AB1088,,48 (d) Approval.

AB1088,,49 1. Within 30 days of receipt of an application under this subsection, the department shall review the application and, if it contains reasonable plans to satisfy the criteria under par. (c) within 18 months of approval, approve the application. The department shall review and approve applications in the order that the applications are received. If the department approves an application under this paragraph, the department shall award the applicant the number of nursing home beds requested in the application, subject to subd. 2.

AB1088,,50 2. If there is not a sufficient number of beds remaining under this subsection to award an applicant the number of nursing home beds requested in the application, the department shall contact the applicant and determine whether the applicant will accept some or all of the remaining beds under this subsection instead of the beds requested in the application. If the applicant is willing to accept some or all of the remaining beds under this subsection instead of the beds requested in the application, the department shall award those beds. If the applicant is not willing to accept some or all of the remaining beds under this subsection, the department shall discard the application.

AB1088,,51 3. The department shall continue to request applications for nursing home beds and approve applications as provided under this paragraph until the department awards all nursing home beds allocated under this subsection.

AB1088,,52 (e) Conditions of approval. As a condition of being awarded nursing home beds under this subsection, an applicant shall agree to do all of the following:

AB1088,,53 1. Prioritize admissions of patients with complex needs and conditions, such as patients with mental health and behavioral needs, serious wound care needs, bariatrics, substance use disorder, nonambulatory disability, intravenous therapy needs, or dialysis needs.

AB1088,,54 2. Prioritize admissions of patients who have been unable to find appropriate placement at another facility.

AB1088,,55 (f) Compliance. Each person awarded nursing home beds under this subsection shall biennially or upon request from the department report to the department whether the person has satisfied the criteria under par. (c) and the conditions under par. (e), including all of the following information:

AB1088,,56 1. The number of patients served utilizing the nursing home beds awarded under this subsection.

AB1088,,57 2. The complex conditions that were served utilizing the nursing home beds awarded under this subsection.

AB1088,,58 3. The number of patients served and the number of patient days for each of those complex conditions under subd. 2.

AB1088,,59 4. Any other information required by the department.

AB1088,,60 (g) Miscellaneous.

AB1088,,61 1. No application under this subsection may be for more than 50 nursing home beds.

AB1088,,62 2. If an applicant that is awarded nursing home beds under par. (d) fails to satisfy any of the criteria under par. (c) within 24 months following department approval under par. (d), the applicant shall reapply for the awarded nursing home beds by submitting an application to the department as provided under par. (c) or surrender the awarded nursing home beds.

AB1088,,63 3. If any nursing home beds awarded under this subsection are surrendered, the department shall request applications for the surrendered nursing home beds as provided under par. (c).

AB1088,,64 (h) Reporting. By September 1, 2025, and biennially thereafter, the department shall submit to the chief clerk of each house of the legislature, for distribution to the appropriate standing committees in the manner required under s. 13.172 (3), a report on the performance of the program under this subsection, including the total number of patients served, the complex conditions addressed, the number of patients served and the number of patient days for each complex condition, and any cost savings associated with the program.

AB1088,,65 (2) Complex patient pilot program.

AB1088,,66 (a) In this subsection:

AB1088,,67 1. “Department” means the department of health services.

AB1088,,68 2. “Partnership group” means one or more hospitals in partnership with one or more post-acute facilities.

AB1088,,69 (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.

AB1088,,70 (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.

AB1088,,71 (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:

AB1088,,72 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.

AB1088,,73 2. Defined goals and measurable outcomes of the partnership group during the pilot program and after the pilot program.

AB1088,,74 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.

AB1088,,75 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:

AB1088,,76 a. Estimated patient revenues from other sources, including the Medical Assistance program under subch. IV of ch. 49, and estimated total costs.

AB1088,,77 b. A margin to account for reserved beds.

AB1088,,78 5. The partnership group’s expertise to successfully implement the proposal, which may include a discussion of the following issues:

AB1088,,79 a. Documented experience of the partners working together to serve complex patients.

AB1088,,80 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.

AB1088,,81 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.

AB1088,,82 d. Ability to electronically exchange health information.

AB1088,,83 e. Resources to conduct patient intake and discharge planning from the post-acute facility, including case managers and social workers.

AB1088,,84 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.

AB1088,,85 g. Ability to conduct monthly quality assurance reviews.

AB1088,,86 h. Ability of the treatment model to be replicated by other healthcare systems.

AB1088,,87 i. Plans to document decreases in lengths of stay for complex patients in hospitals and avoided hospital days.

AB1088,,88 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.

AB1088,,89 k. Description of anticipated impediments to successful implementation and how the partnership group intends to overcome the anticipated impediments.

AB1088,,90 (e) In implementing this subsection, the department shall do all of the following:

AB1088,,91 1. Reserve 10 percent of the funding appropriated under s. 20.435 (7) (d) for the complex patient pilot program for reconciliation to help address unanticipated costs.

AB1088,,92 2. 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).

AB1088,,93 3. Give additional weight to partnership groups that would ensure geographic diversity.

AB1088,,94 (end)