AB43: Bill Text

****Note: This is reconciled s. 49.45 (23b). The elimination from this draft has been affected by drafts with the following LRB numbers: -1103/P1 and -0696/P1.

AB43,1076 Section 1076. 49.45 (3) (e) 11. of the statutes is amended to read:

AB43,,2552 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 44.21 percent.

AB43,1077 Section 1077. 49.45 (3) (e) 12. of the statutes is amended to read:

AB43,,2554 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 44.21 percent.

AB43,1078 Section 1078. 49.45 (3) (em) of the statutes is amended to read:

AB43,,2556 49.45 (3) (em) The department shall expend moneys collected under s. 256.23 (2), less amounts transferred under s. 256.23 (6), to supplement reimbursement for eligible ambulance service providers, as defined in s. 256.23 (1) (a), for services provided under the Medical Assistance program under this subchapter, including services reimbursed on a fee-for-service basis and provided under managed care, by eligible ambulance service providers. Health plans shall be indemnified and held harmless for any errors made by the department or its agents in calculation of any supplemental reimbursement made under this paragraph.

AB43,1079 Section 1079. 49.45 (6xm) of the statutes is created to read:

AB43,,2558 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:

AB43,,2559 1. The hospital is an acute care hospital located in this state.

AB43,,2560 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.

AB43,,2561 (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 $10,000,000 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.

AB43,1080 Section 1080. 49.45 (7m) of the statutes is created to read:

AB43,,2563 49.45 (7m) Pay-for-performance; health information exchange. The department shall develop and implement for non-hospital providers in the Medical Assistance program, including physicians, clinics, health departments, home health agencies, and post-acute care facilities, a payment system based on performance to incentivize participation in health information data sharing to facilitate better patient care, reduced costs, and easier access to patient information. The department shall establish performance metrics for the payment system under this subsection that satisfy all of the following:

AB43,,2564 (a) The metric shall include participation by providers in a health information exchange at a minimum level of patient record access.

AB43,,2565 (b) The payment under the payment system shall increase as the participation level in the health information exchange increases.

AB43,,2566 (c) The payment system shall begin in the 2024 rate year.

AB43,,2567 (d) For purposes of the payment system, the department shall seek any available federal moneys.

AB43,1081 Section 1081. 49.45 (23) of the statutes is repealed.

****Note: This is reconciled s. 49.45 (23). This Section has been affected by drafts with the following LRB numbers: -0696/P1 and -1103/P1.

AB43,1082 Section 1082. 49.45 (23b) of the statutes is repealed.

****Note: This is reconciled s. 49.45 (23b). This Section has been affected by drafts with the following LRB numbers: -0696/P1 and -1103/P1.

AB43,1083 Section 1083. 49.45 (30) (a) of the statutes is repealed.

AB43,1084 Section 1084. 49.45 (30) (b) of the statutes is renumbered 49.45 (30) and amended to read:

AB43,,2572 49.45 (30) Service 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.

AB43,1085 Section 1085. 49.45 (30e) (a) 2. of the statutes is repealed.

AB43,1086 Section 1086. 49.45 (30e) (b) 3. of the statutes is amended to read:

AB43,,2575 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.

AB43,1087 Section 1087. 49.45 (30e) (c) of the statutes is renumbered 49.45 (30e) (c) 1. and amended to read:

AB43,,2577 49.45 (30e) (c) 1. A For a county that elects to make provide the 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 program that is not provided by the federal government. The, the department shall reimburse the provider county only for the amount of the allowable charges for those services under the medical assistance Medical Assistance program that is provided by the federal government.

AB43,1088 Section 1088. 49.45 (30e) (c) 2. of the statutes is created to read:

AB43,,2579 49.45 (30e) (c) 2. The department shall reimburse 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.

AB43,1089 Section 1089. 49.45 (30e) (d) of the statutes is amended to read:

AB43,,2581 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.

AB43,1090 Section 1090. 49.45 (30j) (title) of the statutes is amended to read:

AB43,,2583 49.45 (30j) (title) Reimbursement for peer recovery coach and certified peer specialist services.

AB43,1091 Section 1091. 49.45 (30j) (a) 1. and 2. of the statutes are renumbered 49.45 (30j) (a) 2m. and 3.

AB43,1092 Section 1092. 49.45 (30j) (a) 1m. of the statutes is created to read:

AB43,,2586 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.

AB43,1093 Section 1093. 49.45 (30j) (bm) of the statutes is created to read:

AB43,,2588 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:

AB43,,2589 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.

AB43,,2590 2. The certified peer specialist provides the service under the supervision of a competent mental health professional.

AB43,,2591 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.

AB43,,2592 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.

AB43,1094 Section 1094. 49.45 (30j) (c) of the statutes is amended to read:

AB43,,2594 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.

AB43,1095 Section 1095. 49.45 (30p) of the statutes is created to read:

AB43,,2596 49.45 (30p) Detoxification and stabilization services. (a) In this subsection:

AB43,,2597 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.

AB43,,2598 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.

AB43,,2599 3. “Detoxification and stabilization services” means adult residential integrated behavioral health stabilization service, residential withdrawal management service, or residential intoxication monitoring service.

AB43,,2600 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 healthcare. “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.

AB43,,2601 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.

AB43,,2602 (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.

AB43,,2603 (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 par. 49.46 (2) (b) 14r. If the federal department disapproves the request, the department may not provide the reimbursement described in this subsection.

AB43,1096 Section 1096. 49.45 (30t) of the statutes is created to read:

AB43,,2605 49.45 (30t) Doula services. (a) In this subsection:

AB43,,2606 1. “Certified doula” means an individual who has received certification from a doula certifying organization recognized by the department.

AB43,,2607 2. “Doula services” means childbirth education and support services, including emotional and physical support provided during pregnancy, labor, birth, and the postpartum period.

AB43,,2608 (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.

AB43,1097 Section 1097. 49.45 (39) (b) 1. of the statutes is amended to read:

AB43,,2610 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.

AB43,1098 Section 1098. 49.45 (39) (b) 2. of the statutes is amended to read:

AB43,,2612 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.

AB43,1099 Section 1099. 49.45 (41) (a) of the statutes is renumbered 49.45 (41) (a) (intro.) and amended to read:

AB43,,2614 49.45 (41) (a) (intro.) In this subsection, “crisis intervention services” means crisis intervention services for the treatment of mental illness, intellectual disability, substance abuse, and dementia that are provided by a any of the following:

AB43,,2615 2. A crisis intervention program operated by, or under contract with, a county, if the county is certified as a medical assistance provider.

AB43,1100 Section 1100. 49.45 (41) (a) 1. of the statutes is created to read:

AB43,,2617 49.45 (41) (a) 1. A crisis urgent care and observation facility certified under s. 51.036.

AB43,1101 Section 1101. 49.45 (41) (b) of the statutes is amended to read:

AB43,,2619 49.45 (41) (b) If a county elects to become certified as a provider of crisis intervention services under par. (a) 2., the county may provide 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.

AB43,1102 Section 1102. 49.45 (41) (c) (intro.) of the statutes is amended to read:

AB43,,2621 49.45 (41) (c) (intro.) Notwithstanding par. (b), if a county elects, pursuant to par. (a) 2., 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:

AB43,1103 Section 1103. 49.45 (41) (d) of the statutes is created to read:

AB43,,2623 49.45 (41) (d) The department shall request 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 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.

AB43,1104 Section 1104. 49.45 (52) (a) 1. of the statutes is amended to read:

AB43,,2625 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).

AB43,1105 Section 1105. 49.45 (52) (b) 1. of the statutes is amended to read:

AB43,,2627 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.

AB43,1106 Section 1106. 49.46 (1) (a) 1m. of the statutes is amended to read:

AB43,,2629 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 90th 365th day after the last day of the pregnancy falls.

AB43,1107 Section 1107. 49.46 (1) (j) of the statutes is amended to read:

AB43,,2631 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 90th 365th day after the last day of the pregnancy falls without regard to any change in the individual’s family income.

AB43,1108 Section 1108. 49.46 (2) (b) 8m. of the statutes is created to read:

AB43,,2633 49.46 (2) (b) 8m. Room and board for residential substance use disorder treatment.

AB43,1109 Section 1109. 49.46 (2) (b) 11m. of the statutes is created to read:

AB43,,2635 49.46 (2) (b) 11m. Subject to par. (bx), acupuncture provided by an acupuncturist who holds a certificate under ch. 451.

AB43,1110 Section 1110. 49.46 (2) (b) 12p. of the statutes is created to read: