LRB-4332/5
TJD:wlj&emw
2017 - 2018 LEGISLATURE
January 22, 2018 - Introduced by Representatives Rodriguez, Sanfelippo,
Ballweg, Berceau, Bernier, Brandtjen, Edming, Fields, Genrich, Hutton,
Katsma, Kitchens, Kolste, Kooyenga, Nygren, Petryk, Pope, Quinn, Riemer,
Rohrkaste, Sinicki, Skowronski, Spiros, Subeck, Thiesfeldt, Tittl,
Weatherston and Crowley, cosponsored by Senators Darling, Feyen,
Bewley, Carpenter, Cowles, Johnson, LeMahieu, Olsen and L. Taylor.
Referred to Committee on Health.
AB871,1,3 1An Act to create 49.45 (26g), 946.91 (3) (c) 3. and 946.93 (5) (c) 3. of the statutes;
2relating to: intensive care coordination program in the Medical Assistance
3program.
Analysis by the Legislative Reference Bureau
This bill requires the Department of Health Services to create a program to
reimburse hospitals and health care systems for intensive care coordination services
provided to Medical Assistance recipients. Subject to some limitations, DHS must
develop a process for selecting hospitals and health care systems that submit an
application including a description of their programs as specified in the bill,
including a statement that the hospital or health care system will use emergency
department utilization data to identify Medical Assistance recipients to receive
intensive care coordination to reduce use of the emergency department.
Under the bill, DHS reimburses a hospital or health care system participating
in the program $250 initially for each Medical Assistance recipient who is not a
Medicare recipient who is enrolled in intensive care coordination for six months. If
the participant demonstrates progress in reducing emergency department visits for
at least half of its enrollee population, the participant receives an additional $250 per
enrollee. The program participant may enroll each Medical Assistance recipient in
the program for an additional six months for an additional initial reimbursement of
$250 per enrollee and, if the participant demonstrates progress in reducing
emergency department visits for at least half of its enrollee population, $250 per
enrollee at the end of the additional six months.

Annually, each hospital and health care system that is eligible for
reimbursement shall submit a report containing certain information, as specified in
the bill, from which DHS must calculate the costs saved to the Medical Assistance
program by avoiding emergency department visits. If DHS calculates a cost savings,
DHS must distribute savings to the hospital or health care system as specified in the
bill. The bill requires DHS to obtain any necessary approval from the federal
Department of Health and Human Services to implement the reimbursement
program. DHS may implement any part of the program if the federal department
disapproves. The bill requires DHS to implement at least two pilot programs for
intensive care coordination by a deadline specified in the bill.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB871,1 1Section 1. 49.45 (26g) of the statutes is created to read:
AB871,2,62 49.45 (26g) Intensive care coordination program. (a) Subject to par. (i), the
3department shall create and implement a program to reimburse participating
4hospitals and health care systems for intensive care coordination services provided
5to recipients of Medical Assistance under this subchapter who are not enrolled in
6coverage under Medicare, 42 USC 1395 et seq.
AB871,2,107 (b) To apply to participate in the reimbursement program under this
8subsection, a hospital or health care system shall submit to the department a
9description of its intensive care coordination program that includes all of the
10following:
AB871,2,1411 1. A statement that the hospital or health care system will use emergency
12department utilization data to identify recipients of Medical Assistance to receive
13intensive care coordination to reduce use of the emergency department by those
14Medical Assistance recipients.
AB871,3,6
12. The method the hospital or health care system uses to identify for intensive
2care coordination a Medical Assistance recipient who uses the emergency
3department frequently. The hospital or health care system shall specify how it
4defines frequent emergency department use and may use criteria such as whether
5a recipient of Medical Assistance visits the emergency room 3 or more times within
630 days, 6 or more times within 90 days, or 7 or more times within 12 months.
AB871,3,107 3. A description of the hospital's or health care system's intensive care
8coordination team consisting of health care providers other than solely physicians,
9such as nurses; social workers, case managers, or care coordinators ; behavioral
10health specialists; and schedulers.
AB871,3,1311 4. A statement that the hospital or health care system will provide to a Medical
12Assistance recipient enrolled in intensive care coordination through the hospital or
13health care system all of the following, as appropriate to his or her care:
AB871,3,1414 a. Discharge instructions and contacts for following up on care and treatment.
AB871,3,1515 b. Referral information.
AB871,3,1616 c. Appointment scheduling.
AB871,3,1717 d. Medication instructions.
AB871,3,2018 e. Intensive care coordination by a social worker, case manager, nurse, or care
19coordinator to connect the Medical Assistance recipient to a primary care provider
20or to a managed care organization.
AB871,3,2221 f. Information about other health and social resources, such as transportation
22and housing.
AB871,3,2523 5. A statement that the hospital or health care system agrees to share
24information with the state-designated entity for health information exchange or
25with another appropriate data-sharing mechanism.
AB871,4,6
16. The outcomes intended to result from intensive care coordination by the
2hospital or health care system. Outcomes for a Medical Assistance recipient during
3a 6-month or 12-month period may include successful connection to primary care
4or a managed care organization as evidenced by 2 or 3 primary care appointments,
5successful connection to behavioral health resources and alcohol and other drug
6abuse resources, as needed, or a decrease in use of the emergency room.
AB871,4,77 (c) The department shall do all of the following:
AB871,4,188 1. Encourage, but not require, any hospital or health care system that seeks
9to apply to participate in the reimbursement program under this subsection to
10collaborate with any managed care organization with which it has an agreement to
11provide services to Medical Assistance recipients. The department may not limit
12patient populations eligible to participate in the intensive care coordination program
13under this subsection to either those individuals enrolled in managed care to receive
14Medical Assistance services or those individuals currently receiving Medical
15Assistance services on a fee-for-service basis. The department may not deny a
16hospital or health care system applicant for the reimbursement program under this
17subsection solely because the applicant does not have an agreement to implement an
18intensive care coordination program with a managed care organization.
AB871,4,2119 2. Respond to the hospital or health care system indicating whether additional
20information is required to evaluate the application for the reimbursement program
21under this subsection.
AB871,4,2322 3. After consulting with hospitals, health care systems, and other providers,
23develop uniform outcome measures to use in determining the efficacy of the program.
AB871,5,3
14. If the hospital or health care system is selected for the reimbursement
2program under this subsection, provide a description of the process for enrolling
3Medical Assistance recipients in intensive care coordination for reimbursement.
AB871,5,64 5. If the department does not receive a proposal for the reimbursement program
5under this subsection, solicit proposals for the reimbursement program under this
6subsection from other health care providers under s. 146.81 (1).
AB871,5,207 (d) The department shall provide as reimbursement for intensive care
8coordination to participants in the program under this subsection $250 initially for
9each Medical Assistance recipient who is not enrolled in coverage under Medicare,
1042 USC 1395 et seq., the hospital or health care system enrolls in intensive care
11coordination. The initial enrollment for each recipient lasts for 6 months, and if the
12participant demonstrates progress in reducing emergency department visits for at
13least half of its enrollee population, the participant receives an additional $250 for
14each enrollee at the end of the 6 months. The program participant may enroll each
15Medical Assistance recipient in one additional 6-month period for an additional
16$250 per enrollee initial reimbursement payment and $250 per enrollee at the end
17of the additional 6-month period if the participant demonstrates progress in
18reducing emergency department visits for at least half of its enrollee population. The
19department shall pay no more than $1,500,000 cumulatively in each fiscal year from
20all funding sources for reimbursements under this paragraph.
AB871,5,2321 (e) Annually, each hospital and health care system that is participating in the
22reimbursement program under this subsection shall submit a report to the
23department containing all of the following:
AB871,5,2524 1. The number of Medical Assistance recipients served by intensive care
25coordination.
AB871,6,5
12. For each Medical Assistance recipient who is not enrolled in coverage under
2Medicare, 42 USC 1395 et seq., the number of emergency department visits for a
3period before enrollment of that recipient in intensive care coordination and the
4number of emergency department visits for the same recipient during the same
5period after enrollment in intensive care coordination.
AB871,6,76 3. Any demonstrated outcomes, as specified by the department under par. (c)
73., for Medical Assistance recipients.
AB871,6,88 4. Any other information required by the department.
AB871,6,239 (f) For each hospital or health care system eligible for the reimbursement
10program under this subsection, the department shall calculate the costs saved to the
11Medical Assistance program by avoiding emergency department visits by
12subtracting the sum of reimbursements made under par. (d) to the participant from
13the sum of costs of visits to the emergency department as reported under par. (e) 2.
14that were expected to occur without intensive care coordination but did not because
15of enrollment in the program under this subsection. If the result of the calculation
16is positive in the first 6 months of the recipient's enrollment in the program under
17this subsection, the department shall distribute 25 percent of the amount saved to
18the hospital, health care system, or managed care organization subject to pars. (g)
19and (i). If the result of the calculation is positive after 12 months of the recipient's
20enrollment in the program under this subsection, the department shall distribute a
21share of the savings to the hospital, health care system, or managed care
22organization such that the total amount of shared savings payments made equals
23half of the savings for the entire 12-month period, subject to pars. (g) and (i).
AB871,7,924 (g) If a hospital or health care system participating in the program under this
25subsection provides services to Medical Assistance recipients enrolled in managed

1care, the department shall make any payment under the program under this
2subsection under par. (d) or (f) to the managed care organization with which the
3hospital or health care system has an agreement to provide services to Medical
4Assistance recipients. The managed care organization shall pass the payments
5made under pars. (d) and (f) on to the hospital or health care system no later than
630 days after receiving the payment from the department. The department shall
7make payments under pars. (d) and (f) to a hospital or health care system that
8provides services to Medical Assistance recipients who are not enrolled in managed
9care directly to the hospital or health care system.
AB871,7,1410 (h) No later than 24 months after the date on which the first hospital or health
11care system is able to enroll individuals in the intensive care coordination program
12under this subsection, the department shall submit a report to the joint committee
13on finance summarizing the information reported under par. (e) including the costs
14saved by avoiding emergency department visits as calculated under par. (f).
AB871,7,2015 (i) The department shall seek any necessary approval from the federal
16department of health and human services to implement the program under this
17subsection. If the federal department of health and human services disapproves the
18request for approval, the department may implement the reimbursement under par.
19(d), the savings distribution under par. (f), or both or any part of the program under
20this subsection.
AB871,7,2521 (j) If the federal department of health and human services does not disapprove
22a request for approval under par. (i) or if federal approval is not required, the
23department shall implement at least 2 pilot programs under this subsection by the
24later of September 1, 2018, or the date that is 30 days after the date of federal
25approval, if approval is needed.
AB871,2
1Section 2. 946.91 (3) (c) 3. of the statutes is created to read:
AB871,8,32 946.91 (3) (c) 3. Any payment made for sharing of cost savings under s. 49.45
3(26g).
AB871,3 4Section 3. 946.93 (5) (c) 3. of the statutes is created to read:
AB871,8,65 946.93 (5) (c) 3. Any payment made for sharing of cost savings under s. 49.45
6(26g).
AB871,4 7Section 4 . Nonstatutory provisions.
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