AB43: Bill Text

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:

AB43,,2637 49.46 (2) (b) 12p. Doula services provided by a certified doula, as specified under s. 49.45 (30t).

AB43,1111 Section 1111. 49.46 (2) (b) 14c. of the statutes is created to read:

AB43,,2639 49.46 (2) (b) 14c. Subject to par. (bv), services by a psychiatric residential treatment facility.

AB43,1112 Section 1112. 49.46 (2) (b) 14p. of the statutes is amended to read:

AB43,,2641 49.46 (2) (b) 14p. Subject to s. 49.45 (30j), services provided by a peer recovery coach or a certified peer specialist.

AB43,1113 Section 1113. 49.46 (2) (b) 14r. of the statutes is created to read:

AB43,,2643 49.46 (2) (b) 14r. Detoxification and stabilization services as specified under s. 49.45 (30p).

AB43,1114 Section 1114. 49.46 (2) (b) 24. of the statutes is created to read:

AB43,,2645 49.46 (2) (b) 24. Subject to par. (by), nonmedical services that contribute to the determinants of health.

AB43,1115 Section 1115. 49.46 (2) (bv) of the statutes is created to read:

AB43,,2647 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.

AB43,1116 Section 1116. 49.46 (2) (bx) of the statutes is created to read:

AB43,,2649 49.46 (2) (bx) 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 the benefit under par. (b) 11m. If the federal department approves the request or if no federal approval is necessary, the department shall provide the benefit and reimbursement under par. (b) 11m. If the federal department disapproves the request, the department may not provide the benefit or reimbursement for the benefit described under par. (b) 11m.

AB43,1117 Section 1117. 49.46 (2) (by) of the statutes is created to read:

AB43,,2651 49.46 (2) (by) The department shall determine those services under par. (b) 24. 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 provide 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.

AB43,1118 Section 1118. 49.47 (4) (ag) 2. of the statutes is amended to read:

AB43,,2653 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 90th 365th day after the last day of the pregnancy falls.

AB43,1119 Section 1119. 49.471 (1) (b) 2. of the statutes is amended to read:

AB43,,2655 49.471 (1) (b) 2. A stepfather, stepmother stepparent, stepbrother, or stepsister.

AB43,1120 Section 1120. 49.471 (1) (cr) of the statutes is created to read:

AB43,,2657 49.471 (1) (cr) “Enhanced federal medical assistance percentage” means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

AB43,1121 Section 1121. 49.471 (4) (a) 4. b. of the statutes is amended to read:

AB43,,2659 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).

AB43,1122 Section 1122. 49.471 (4) (a) 8. of the statutes is created to read:

AB43,,2661 49.471 (4) (a) 8. An individual who meets all of the following criteria:

AB43,,2662 a. The individual is an adult under the age of 65.

AB43,,2663 b. The adult has a family income that does not exceed 133 percent of the poverty line, except as provided in sub. (4g).

AB43,,2664 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.

AB43,1123 Section 1123. 49.471 (4g) of the statutes is created to read:

AB43,,2666 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.

****Note: This is reconciled s. 49.471 (4g). This Section has been affected by drafts with the following LRB numbers: LRB-0696/P2 and LRB-1103/P2.

AB43,1124 Section 1124. 49.471 (6) (b) of the statutes is amended to read:

AB43,,2668 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 90th 365th day after the last day of the pregnancy falls without regard to any change in the woman’s family income.

AB43,1125 Section 1125. 49.471 (7) (b) 1. of the statutes is amended to read:

AB43,,2670 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 90th 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.

AB43,1126 Section 1126. 49.485 of the statutes is renumbered 20.9315 (19) and amended to read:

AB43,,2672 20.9315 (19) Whoever knowingly presents or causes to be presented to any officer, employee, or agent of this state a false claim for medical assistance shall forfeit not less than $5,000 nor more than $10,000, plus 3 times the amount of the damages that were sustained by the state or would have been sustained by the state, whichever is greater, as a result of the false claim. The attorney general may bring an action on behalf of the state to recover any forfeiture incurred under this section.

AB43,1127 Section 1127. 49.686 (3) (d) of the statutes is amended to read:

AB43,,2674 49.686 (3) (d) Has applied for coverage under and has been denied eligibility for medical assistance within 12 months prior to application for reimbursement under sub. (2). This paragraph does not apply to an individual who is eligible for benefits under the demonstration project for childless adults under s. 49.45 (23) or to an individual who is eligible for benefits under BadgerCare Plus under s. 49.471 (4) (a) 8. or (11).

AB43,1128 Section 1128. 49.79 (1) (b) of the statutes is amended to read:

AB43,,2676 49.79 (1) (b) “Controlled substance” has the meaning given in 21 USC 802 (6), except that “controlled substance” does not include tetrahydrocannabinols in any form, including tetrahydrocannabinols contained in marijuana, obtained from marijuana, or chemically synthesized.

AB43,1129 Section 1129. 49.79 (7m) of the statutes is created to read:

AB43,,2678 49.79 (7m) Healthy eating incentives. (a) In this subsection, “fruit and vegetables” means “any variety of fresh, canned, dried, or frozen whole or cut fruits or vegetables without added sugars, fats, oils, or salt.