Amendment ASA1-AB64

AB64-ASA1,923d Section 923d. 49.34 (5m) (b) 2. of the statutes is repealed.

AB64-ASA1,923e Section 923e. 49.34 (5m) (b) 3. of the statutes is repealed.

AB64-ASA1,923f Section 923f. 49.34 (5m) (b) 4. of the statutes is created to read:

AB64-ASA1,515,7 49.34 (5m) (b) 4. If on December 31 of any year the provider's accumulated surplus from all contract periods ending during that year for a rate-based service exceeds the allowable retention rate under subd. 1., the provider shall provide written notice of that excess to all purchasers of the rate-based service. Upon the written request of such a purchaser received no later than 6 months after the date of the notice, the provider shall refund the purchaser's proportional share of that excess. If the department determines based on an audit or fiscal review that the amount of the excess identified by the provider was incorrect, the department may seek to recover funds after the 6-month period has expired. The department shall commence any audit or fiscal review under this subdivision within 6 years after the end of the contract period.

AB64-ASA1,923g Section 923g. 49.34 (5m) (b) 5. of the statutes is created to read:

AB64-ASA1,515,11 49.34 (5m) (b) 5. The department, in consultation with the department of health services and the department of corrections, shall promulgate rules to implement this subsection including all of the following:

AB64-ASA1,515,16 a. Requiring that contracts for rate-based services under this subsection allow a provider to retain from any surplus revenue up to 5 percent of the total revenue received under the contract, or a different percentage rate determined by the department. The percentage rate established under this subd. 5. a. shall apply uniformly to all rate-based service contracts under this subsection.

AB64-ASA1,515,18 b. Establishing a procedure for reviewing rate-based service contracts to determine whether a contract complies with the provisions of this subsection.

AB64-ASA1,923h Section 923h. 49.34 (5m) (em) of the statutes is amended to read:

AB64-ASA1,516,2 49.34 (5m) (em) Notwithstanding par. (b) 1. and 2., a county department under s. 46.215, 51.42, or 51.437 providing client services in a county having a population of 750,000 or more or a nonstock, nonprofit corporation providing client services in such a county may not retain a surplus generated by a rate-based service or accumulate funds from more than one contract period for a rate-based service from revenues that are used to meet the maintenance-of-effort requirement under the federal temporary assistance for needy families program under 42 USC 601 to 619.

AB64-ASA1,923i Section 923i. 49.343 (5) (c) of the statutes is amended to read:

AB64-ASA1,516,5 49.343 (5) (c) The identification of the measurements specified in sub. (6) (a) and the development of the payment levels specified in sub. (6) (a).

AB64-ASA1,923j Section 923j. 49.343 (6) (a) (intro.) and 1. of the statutes are consolidated, renumbered 49.343 (6) (a) and amended to read:

AB64-ASA1,516,13 49.343 (6) (a) For purposes of implementing a performance-based contracting system, the department, in cooperation with the advisory committee created under sub. (5), shall do all of the following: 1. Identify identify measurements by which to evaluate the performance of providers in meeting both the goals for the children placed in their care and the goals for the out-of-home care system in this state and adjust, as needed, those measurements.

AB64-ASA1,923k Section 923k. 49.343 (6) (a) 2. of the statutes is repealed.

AB64-ASA1,923L Section 923L. 49.343 (6) (b) of the statutes is repealed.

AB64-ASA1,923m Section 923m. 49.343 (6) (c) and (d) of the statutes are amended to read:

AB64-ASA1,516,21 49.343 (6) (c) Beginning on January 1, 2011, the department shall select a representative sample of providers and evaluate the performance of those providers in attaining the measurements identified under par. (a) 1. Based on that evaluation, the department, in consultation with the advisory committee created under sub. (5), shall adjust, as needed, those measurements by December 31, 2011.

AB64-ASA1,517,2 (d) Beginning on January 1, 2013, the department shall evaluate the performance of all providers in this state in attaining the measurements identified under par. (a) 1. Based on that evaluation, the department, in consultation with the advisory committee created under sub. (5), shall adjust, as needed, those measurements by December 31, 2013, and in subsequent years as determined necessary by the department.

AB64-ASA1,924 Section 924 . 49.37 of the statutes is created to read:

AB64-ASA1,517,7 49.37 Offender reentry demonstration project. (1) Beginning in fiscal year 2017-18, the department of children and families shall establish a 5-year offender reentry demonstration project focused on noncustodial fathers in a 1st class city.

AB64-ASA1,517,10 (2) Upon completion of the demonstration project under sub. (1) and by June 30, 2023, the department of children and families shall conduct an evaluation of the demonstration project.

AB64-ASA1,924p Section 924p. 49.45 (3m) (a) (intro.) and (b) 3. a. of the statutes are amended to read:

AB64-ASA1,517,19 49.45 (3m) (a) (intro.) Subject to par. (c) 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 $15,000,000 $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:

AB64-ASA1,517,20 (b) 3. a. No single hospital receives more than $2,500,000 $4,600,000.

AB64-ASA1,924r Section 924r. 49.45 (3p) of the statutes is created to read:

AB64-ASA1,518,6 49.45 (3p) Rural critical care access supplement. (a) Subject to par. (c) 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 would meet the criteria under sub. (3m) (a) except that the hospitals do not provide obstetric services an amount equal to the sum of $250,000, 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 a calculation method determined by the department that provides a fee-for-service supplemental payment that increases as the hospital's percentage of inpatient days for Medical Assistance recipients at the hospital increases.

AB64-ASA1,518,8 (b) The department shall ensure that the total amount of moneys available to pay hospitals described under this subsection is distributed in each fiscal year.

AB64-ASA1,518,11 (c) The department shall limit the maximum payment to hospitals under this subsection such that the amount of payment is in accordance with federal rules concerning any hospital specific limit.

AB64-ASA1,518,19 (d) The department shall seek any necessary approval from the federal department of health and human services to implement the hospital payment supplement described under par. (a). If approval is necessary and approval from the federal department of health and human services is received, the department shall implement the payment methodology described under par. (a). If approval is necessary and the federal department of health and human services does not approve, the department may not implement the hospital payment supplement under par. (a).

AB64-ASA1,926p Section 926p. 49.45 (9r) of the statutes is created to read:

AB64-ASA1,518,21 49.45 (9r) Complex rehabilitation technology. (a) In this subsection:

AB64-ASA1,518,23 1. “Complex needs patient" means an individual with a diagnosis or medical condition that results in significant physical impairment or functional limitation.

AB64-ASA1,519,3 2. “Complex rehabilitation technology" means items classified within Medicare as durable medical equipment that are individually configured for individuals to meet their specific and unique medical, physical, and functional needs and capacities for basic activities of daily living and instrumental activities of daily living identified as medically necessary.

AB64-ASA1,519,10 3. “Individually configured" means having a combination of sizes, features, adjustments, or modifications that a qualified complex rehabilitation technology supplier can customize to the specific individual by measuring, fitting, programming, adjusting, or adapting as appropriate so that the device operates in accordance with an assessment or evaluation of the individual by a qualified health care professional and is consistent with the individual's medical condition, physical and functional needs and capacities, body size, period of need, and intended use.

AB64-ASA1,519,12 4. “Medicare" means coverage under Part A or Part B of Title XVIII of the federal Social Security Act, 42 USC 1395 et seq.

AB64-ASA1,519,15 5. “Qualified complex rehabilitation technology professional" means an individual who is certified as an assistive technology professional by the Rehabilitation Engineering and Assistive Technology Society of North America.

AB64-ASA1,519,17 6. “Qualified complex rehabilitation technology supplier" means a company or entity that meets all of the following criteria:

AB64-ASA1,519,19 a. Is accredited by a recognized accrediting organization as a supplier of complex rehabilitation technology.

AB64-ASA1,519,22 b. Is an enrolled supplier for purposes of Medicare reimbursement that meets the supplier and quality standards established for durable medical equipment suppliers, including those for complex rehabilitation technology under Medicare.

AB64-ASA1,520,3 c. Is an employer of at least one qualified complex rehabilitation technology professional to analyze the needs and capacities of the complex needs patient in consultation with qualified health care professionals, to participate in the selection of appropriate complex rehabilitation technology for those needs and capacities of the complex needs patient, and to provide training in the proper use of the complex rehabilitation technology.

AB64-ASA1,520,6 d. Requires a qualified complex rehabilitation technology professional to be physically present for the evaluation and determination of appropriate complex rehabilitation technology for a complex needs patient.

AB64-ASA1,520,8 e. Has the capability to provide service and repair by qualified technicians for all complex rehabilitation technology it sells.

AB64-ASA1,520,12 f. Provides written information at the time of delivery of the complex rehabilitation technology to the complex needs patient stating how the complex needs patient may receive service and repair for the complex rehabilitation technology.

AB64-ASA1,520,13 7. “Qualified health care professional" means any of the following:

AB64-ASA1,520,14 a. A physician or physician assistant licensed under subch. II of ch. 448.

AB64-ASA1,520,15 b. A physical therapist licensed under subch. III of ch. 448.

AB64-ASA1,520,16 c. An occupational therapist licensed under subch VII of ch. 448.

AB64-ASA1,520,19 (b) The department shall promulgate rules and other policies for use of complex rehabilitation technology by recipients of Medical Assistance. The department shall include in the rules all of the following:

AB64-ASA1,520,23 1. Designation of billing codes as complex rehabilitation technology including creation of new billing codes or modification of existing billing codes. The department shall include provisions allowing quarterly updates to the designations under this subdivision.

AB64-ASA1,521,3 2. Establishment of specific supplier standards for companies or entities that provide complex rehabilitation technology and limiting reimbursement only to suppliers that are qualified complex rehabilitation technology suppliers.

AB64-ASA1,521,6 3. A requirement that Medical Assistance recipients who need a manual wheelchair, power wheelchair, or other seating component to be evaluated by all of the following:

AB64-ASA1,521,8 a. A qualified health care professional who does not have a financial relationship with a qualified complex rehabilitation technology supplier.

AB64-ASA1,521,9 b. A qualified complex rehabilitation technology professional.

AB64-ASA1,521,14 4. Establishment and maintenance of payment rates for complex rehabilitation technology that are adequate to ensure complex needs patients have access to complex rehabilitation technology, taking into account the significant resources, infrastructure, and staff needed to appropriately provide complex rehabilitation technology to meet the unique needs of complex needs patients.

AB64-ASA1,521,17 5. A requirement for contracts with the department that managed care plans providing services to Medical Assistance recipients comply with this subsection and the rules promulgated under this subsection.

AB64-ASA1,521,19 6. Protection of access to complex rehabilitation technology for complex needs patients.

AB64-ASA1,927 Section 927 . 49.45 (23) (g) 1. f. of the statutes is created to read:

AB64-ASA1,521,22 49.45 (23) (g) 1. f. Provide employment and training services to childless adults receiving Medical Assistance under this subsection.

AB64-ASA1,928b Section 928b. 49.45 (23) (g) 2. of the statutes is repealed.

AB64-ASA1,928d Section 928d. 49.45 (23) (g) 3. and 4. of the statutes are created to read:

AB64-ASA1,522,5 49.45 (23) (g) 3. If the secretary of the federal department of health and human services approves any portion of the waiver amendment requested under subd. 1., the department shall, no later than the first day of the 4th month beginning after that approval, submit to the joint committee on finance a report that includes all of the following:

AB64-ASA1,522,7 a. A description of each component of the waiver amendment that is approved and any pertinent information on the department's plan for implementation.

AB64-ASA1,522,11 b. An estimate of the effect of implementation of the approved portions of the waiver amendment on enrollment in and the budget of the Medical Assistance program in the fiscal biennium in which approval occurs and in future fiscal bienniums.

AB64-ASA1,522,24 4. The department may not implement any approved portion of the waiver amendment requested under subd. 1. unless the joint committee on finance meets under s. 13.10 and approves the implementation of that portion of the waiver amendment. In a meeting under s. 13.10 to review the report submitted under subd. 3., the joint committee on finance may approve or disapprove of the waiver amendment portions that are approved by the federal department of health and human services or may modify the waiver amendment only by removing one or more components of the waiver amendment. The department may implement the waiver amendment only as approved by the joint committee on finance, including any modifications. The department shall, if necessary to implement the waiver amendment as modified by the joint committee on finance, submit a subsequent waiver amendment request to the federal department of health and human services that is consistent with the committee's actions.

AB64-ASA1,928f Section 928f. 49.45 (24n) of the statutes is created to read:

AB64-ASA1,523,9 49.45 (24n) Reimbursement for dental services by facilities serving individuals with disabilities. (a) Subject to approval of the federal department of health and human services under par. (b), the department shall distribute moneys in each fiscal year to increase the Medical Assistance reimbursement rates for all eligible dental services rendered by facilities that provide at least 90 percent of their dental services to individuals with cognitive and physical disabilities, as determined by the department. Under this subsection, the enhanced reimbursement rates for dental services would equal 200 percent of the Medical Assistance reimbursement rates that would otherwise be paid for these dental services.

AB64-ASA1,523,15 (b) The department shall request any waiver from and submit any amendments to the state Medical Assistance plan to the federal department of health and human services necessary for the Medical Assistance reimbursement rate increase under par. (a). If any necessary waiver request or state plan amendment request is approved, the department shall implement par. (a) beginning on the effective date of the waiver or plan amendment.

AB64-ASA1,928g Section 928g. 49.45 (26g) of the statutes is created to read:

AB64-ASA1,523,21 49.45 (26g) Intensive care coordination program. (a) Subject to par. (h), the department shall create and implement a program to reimburse hospitals and health care systems for intensive care coordination services provided to recipients of Medical Assistance under this subchapter who are not enrolled in coverage under Medicare, 42 USC 1395 et seq.

AB64-ASA1,523,24 (b) The department shall select hospitals and health care systems to receive reimbursement under this subsection that submit to the department a description of their intensive care coordination program that includes all of the following:

AB64-ASA1,524,4 1. A statement that the hospital or health care system will use emergency department utilization data to identify recipients of Medical Assistance to receive intensive care coordination to reduce use of the emergency department by those Medical Assistance recipients.

AB64-ASA1,524,10 2. The method the hospital or health care system uses to identify for intensive care coordination a Medical Assistance recipient who uses the emergency department frequently. The hospital or health care system shall specify how it defines frequent emergency department use and may use criteria such as whether a recipient of Medical Assistance visits the emergency room 3 or more times within 30 days, 6 or more times within 90 days, or 7 or more times within 12 months.

AB64-ASA1,524,14 3. A description of the hospital's or health care system's intensive care coordination team consisting of health care providers other than solely physicians, such as nurses; social workers, case managers, or care coordinators ; behavioral health specialists; and schedulers.

AB64-ASA1,524,17 4. That the hospital or health care system provides to a Medical Assistance recipient enrolled in intensive care coordination through the hospital or health care system all of the following, as appropriate to his or her care:

AB64-ASA1,524,18 a. Discharge instructions and contacts for following up on care and treatment.

AB64-ASA1,524,19 b. Referral information.

AB64-ASA1,524,20 c. Appointment scheduling.

AB64-ASA1,524,21 d. Medication instructions.

AB64-ASA1,524,24 e. Intensive care coordination by a social worker, case manager, or care coordinator to connect the Medical Assistance recipient to a primary care provider or to a managed care organization.

AB64-ASA1,525,2 f. Information about other health and social resources, such as transportation and housing.

AB64-ASA1,525,8 5. The outcomes intended to result from intensive care coordination by the hospital or health care system. Outcomes for a Medical Assistance recipient during a 6-month or 12-month period may include successful connection to primary care or the managed care organization as evidenced by 2 or 3 primary care appointments, successful connection to behavioral health resources and alcohol and other drug abuse resources, as needed, or a decrease in use of the emergency room.

AB64-ASA1,525,9 (c) The department shall do all of the following:

AB64-ASA1,525,12 1. Respond to the hospital or health care system indicating if additional information is required to determine eligibility for the reimbursement program under this subsection.

AB64-ASA1,525,15 2. If the hospital or health care system is eligible for the reimbursement program under this subsection, provide a description of the process for enrolling Medical Assistance recipients in intensive care coordination for reimbursement.

AB64-ASA1,525,25 (d) The department shall provide as reimbursement for intensive care coordination to eligible hospitals and health care systems participating in the program under this subsection $500 for each Medical Assistance recipient who is not enrolled in coverage under Medicare, 42 USC 1395 et seq., the hospital or health care system enrolls in intensive care coordination. The initial enrollment for each recipient lasts for 6 months, and the health care provider may enroll the Medical Assistance recipient in one additional 6-month period for an additional $500 reimbursement payment. The department shall pay no more than $1,500,000 cumulatively in each fiscal year from all funding sources for reimbursements under this paragraph.

AB64-ASA1,526,3 (e) Annually, each hospital and health care system that is eligible for the reimbursement program under this subsection shall submit a report to the department containing all of the following:

AB64-ASA1,526,5 1. The number of Medical Assistance recipients served by intensive care coordination.

AB64-ASA1,526,10 2. For each Medical Assistance recipient who is not enrolled in coverage under Medicare, 42 USC 1395 et seq., the number of emergency department visits for a period before enrollment of that recipient in intensive care coordination and the number of emergency department visits for the same recipient during the same period after enrollment in intensive care coordination.