AB64-ASA1,520,64 d. Requires a qualified complex rehabilitation technology professional to be
5physically present for the evaluation and determination of appropriate complex
6rehabilitation technology for a complex needs patient.
AB64-ASA1,520,87 e. Has the capability to provide service and repair by qualified technicians for
8all complex rehabilitation technology it sells.
AB64-ASA1,520,129 f. Provides written information at the time of delivery of the complex
10rehabilitation technology to the complex needs patient stating how the complex
11needs patient may receive service and repair for the complex rehabilitation
12technology.
AB64-ASA1,520,1313 7. “Qualified health care professional" means any of the following:
AB64-ASA1,520,1414 a. A physician or physician assistant licensed under subch. II of ch. 448.
AB64-ASA1,520,1515 b. A physical therapist licensed under subch. III of ch. 448.
AB64-ASA1,520,1616 c. An occupational therapist licensed under subch VII of ch. 448.
AB64-ASA1,520,1917 (b) The department shall promulgate rules and other policies for use of complex
18rehabilitation technology by recipients of Medical Assistance. The department shall
19include in the rules all of the following:
AB64-ASA1,520,2320 1. Designation of billing codes as complex rehabilitation technology including
21creation of new billing codes or modification of existing billing codes. The
22department shall include provisions allowing quarterly updates to the designations
23under this subdivision.
AB64-ASA1,521,3
12. Establishment of specific supplier standards for companies or entities that
2provide complex rehabilitation technology and limiting reimbursement only to
3suppliers that are qualified complex rehabilitation technology suppliers.
AB64-ASA1,521,64 3. A requirement that Medical Assistance recipients who need a manual
5wheelchair, power wheelchair, or other seating component to be evaluated by all of
6the following:
AB64-ASA1,521,87 a. A qualified health care professional who does not have a financial
8relationship with a qualified complex rehabilitation technology supplier.
AB64-ASA1,521,99 b. A qualified complex rehabilitation technology professional.
AB64-ASA1,521,1410 4. Establishment and maintenance of payment rates for complex rehabilitation
11technology that are adequate to ensure complex needs patients have access to
12complex rehabilitation technology, taking into account the significant resources,
13infrastructure, and staff needed to appropriately provide complex rehabilitation
14technology to meet the unique needs of complex needs patients.
AB64-ASA1,521,1715 5. A requirement for contracts with the department that managed care plans
16providing services to Medical Assistance recipients comply with this subsection and
17the rules promulgated under this subsection.
AB64-ASA1,521,1918 6. Protection of access to complex rehabilitation technology for complex needs
19patients.
AB64-ASA1,927 20Section 927 . 49.45 (23) (g) 1. f. of the statutes is created to read:
AB64-ASA1,521,2221 49.45 (23) (g) 1. f. Provide employment and training services to childless adults
22receiving Medical Assistance under this subsection.
AB64-ASA1,928b 23Section 928b. 49.45 (23) (g) 2. of the statutes is repealed.
AB64-ASA1,928d 24Section 928d. 49.45 (23) (g) 3. and 4. of the statutes are created to read:
AB64-ASA1,522,5
149.45 (23) (g) 3. If the secretary of the federal department of health and human
2services approves any portion of the waiver amendment requested under subd. 1.,
3the department shall, no later than the first day of the 4th month beginning after
4that approval, submit to the joint committee on finance a report that includes all of
5the following:
AB64-ASA1,522,76 a. A description of each component of the waiver amendment that is approved
7and any pertinent information on the department's plan for implementation.
AB64-ASA1,522,118 b. An estimate of the effect of implementation of the approved portions of the
9waiver amendment on enrollment in and the budget of the Medical Assistance
10program in the fiscal biennium in which approval occurs and in future fiscal
11bienniums.
AB64-ASA1,522,2412 4. The department may not implement any approved portion of the waiver
13amendment requested under subd. 1. unless the joint committee on finance meets
14under s. 13.10 and approves the implementation of that portion of the waiver
15amendment. In a meeting under s. 13.10 to review the report submitted under subd.
163., the joint committee on finance may approve or disapprove of the waiver
17amendment portions that are approved by the federal department of health and
18human services or may modify the waiver amendment only by removing one or more
19components of the waiver amendment. The department may implement the waiver
20amendment only as approved by the joint committee on finance, including any
21modifications. The department shall, if necessary to implement the waiver
22amendment as modified by the joint committee on finance, submit a subsequent
23waiver amendment request to the federal department of health and human services
24that is consistent with the committee's actions.
AB64-ASA1,928f 25Section 928f. 49.45 (24n) of the statutes is created to read:
AB64-ASA1,523,9
149.45 (24n) Reimbursement for dental services by facilities serving
2individuals with disabilities.
(a) Subject to approval of the federal department of
3health and human services under par. (b), the department shall distribute moneys
4in each fiscal year to increase the Medical Assistance reimbursement rates for all
5eligible dental services rendered by facilities that provide at least 90 percent of their
6dental services to individuals with cognitive and physical disabilities, as determined
7by the department. Under this subsection, the enhanced reimbursement rates for
8dental services would equal 200 percent of the Medical Assistance reimbursement
9rates that would otherwise be paid for these dental services.
AB64-ASA1,523,1510 (b) The department shall request any waiver from and submit any
11amendments to the state Medical Assistance plan to the federal department of health
12and human services necessary for the Medical Assistance reimbursement rate
13increase under par. (a). If any necessary waiver request or state plan amendment
14request is approved, the department shall implement par. (a) beginning on the
15effective date of the waiver or plan amendment.
AB64-ASA1,928g 16Section 928g. 49.45 (26g) of the statutes is created to read:
AB64-ASA1,523,2117 49.45 (26g) Intensive care coordination program. (a) Subject to par. (h), the
18department shall create and implement a program to reimburse hospitals and health
19care systems for intensive care coordination services provided to recipients of
20Medical Assistance under this subchapter who are not enrolled in coverage under
21Medicare, 42 USC 1395 et seq.
AB64-ASA1,523,2422 (b) The department shall select hospitals and health care systems to receive
23reimbursement under this subsection that submit to the department a description
24of their intensive care coordination program that includes all of the following:
AB64-ASA1,524,4
11. A statement that the hospital or health care system will use emergency
2department utilization data to identify recipients of Medical Assistance to receive
3intensive care coordination to reduce use of the emergency department by those
4Medical Assistance recipients.
AB64-ASA1,524,105 2. The method the hospital or health care system uses to identify for intensive
6care coordination a Medical Assistance recipient who uses the emergency
7department frequently. The hospital or health care system shall specify how it
8defines frequent emergency department use and may use criteria such as whether
9a recipient of Medical Assistance visits the emergency room 3 or more times within
1030 days, 6 or more times within 90 days, or 7 or more times within 12 months.
AB64-ASA1,524,1411 3. A description of the hospital's or health care system's intensive care
12coordination team consisting of health care providers other than solely physicians,
13such as nurses; social workers, case managers, or care coordinators ; behavioral
14health specialists; and schedulers.
AB64-ASA1,524,1715 4. That the hospital or health care system provides to a Medical Assistance
16recipient enrolled in intensive care coordination through the hospital or health care
17system all of the following, as appropriate to his or her care:
AB64-ASA1,524,1818 a. Discharge instructions and contacts for following up on care and treatment.
AB64-ASA1,524,1919 b. Referral information.
AB64-ASA1,524,2020 c. Appointment scheduling.
AB64-ASA1,524,2121 d. Medication instructions.
AB64-ASA1,524,2422 e. Intensive care coordination by a social worker, case manager, or care
23coordinator to connect the Medical Assistance recipient to a primary care provider
24or to a managed care organization.
AB64-ASA1,525,2
1f. Information about other health and social resources, such as transportation
2and housing.
AB64-ASA1,525,83 5. The outcomes intended to result from intensive care coordination by the
4hospital or health care system. Outcomes for a Medical Assistance recipient during
5a 6-month or 12-month period may include successful connection to primary care
6or the managed care organization as evidenced by 2 or 3 primary care appointments,
7successful connection to behavioral health resources and alcohol and other drug
8abuse resources, as needed, or a decrease in use of the emergency room.
AB64-ASA1,525,99 (c) The department shall do all of the following:
AB64-ASA1,525,1210 1. Respond to the hospital or health care system indicating if additional
11information is required to determine eligibility for the reimbursement program
12under this subsection.
AB64-ASA1,525,1513 2. If the hospital or health care system is eligible for the reimbursement
14program under this subsection, provide a description of the process for enrolling
15Medical Assistance recipients in intensive care coordination for reimbursement.
AB64-ASA1,525,2516 (d) The department shall provide as reimbursement for intensive care
17coordination to eligible hospitals and health care systems participating in the
18program under this subsection $500 for each Medical Assistance recipient who is not
19enrolled in coverage under Medicare, 42 USC 1395 et seq., the hospital or health care
20system enrolls in intensive care coordination. The initial enrollment for each
21recipient lasts for 6 months, and the health care provider may enroll the Medical
22Assistance recipient in one additional 6-month period for an additional $500
23reimbursement payment. The department shall pay no more than $1,500,000
24cumulatively in each fiscal year from all funding sources for reimbursements under
25this paragraph.
AB64-ASA1,526,3
1(e) Annually, each hospital and health care system that is eligible for the
2reimbursement program under this subsection shall submit a report to the
3department containing all of the following:
AB64-ASA1,526,54 1. The number of Medical Assistance recipients served by intensive care
5coordination.
AB64-ASA1,526,106 2. For each Medical Assistance recipient who is not enrolled in coverage under
7Medicare, 42 USC 1395 et seq., the number of emergency department visits for a
8period before enrollment of that recipient in intensive care coordination and the
9number of emergency department visits for the same recipient during the same
10period after enrollment in intensive care coordination.
AB64-ASA1,526,1211 3. Any demonstrated outcomes, such as those described in par. (b) 5., for
12Medical Assistance recipients.
AB64-ASA1,526,2013 (f) For each hospital or health care system eligible for the reimbursement
14program under this subsection, the department shall calculate the costs saved to the
15Medical Assistance program by avoiding emergency department visits by
16subtracting the sum of reimbursements made under par. (d) to the hospital or health
17care system from the sum of costs of visits to the emergency department as reported
18under par. (e) 2. that were expected to occur without intensive care coordination. If
19the result of the calculation is positive, the department shall distribute half of the
20amount saved to the hospital or health care system subject to par. (h).
AB64-ASA1,526,2521 (g) No later than 24 months after the date on which the first hospital or health
22care system is able to enroll individuals in the intensive care coordination program
23under this subsection, the department shall submit a report to the joint committee
24on finance summarizing the information reported under par. (e) including the costs
25saved by avoiding emergency department visits as calculated under par. (f).
AB64-ASA1,527,6
1(h) The department shall seek any necessary approval from the federal
2department of health and human services to implement the program under this
3subsection. If the federal department of health and human services disapproves the
4request for approval, the department may implement the reimbursement under par.
5(d), the savings distribution under par. (f), or both or any part of the program under
6this subsection.
AB64-ASA1,928h 7Section 928h. 49.45 (29y) of the statutes is created to read:
AB64-ASA1,527,138 49.45 (29y) Mental health consultation reimbursement. (a) In this
9subsection, “clinical consultation" means, for a student up to age 21, communication
10from a mental health professional or a qualified treatment trainee working under the
11supervision of a mental health professional to another individual who is working
12with the client to inform, inquire, and instruct regarding all of the following and to
13direct and coordinate clinical service components:
AB64-ASA1,527,1414 1. The client's symptoms.
AB64-ASA1,527,1515 2. Strategies for effective engagement, care, and intervention for the client.
AB64-ASA1,527,1616 3. Treatment expectations for the client across service settings.
AB64-ASA1,527,1917 (b) The department shall, subject to any approval necessary from the federal
18department of health and human services, reimburse clinical consultation from the
19Medical Assistance program under this subchapter.
AB64-ASA1,527,2220 (c) By March 31, 2019, the department shall submit a report to the joint
21committee on finance on the utilization of the clinical consultation services under
22this subsection.
AB64-ASA1,527,2423 (d) The department may not provide the reimbursement for clinical
24consultation that occurs after June 30, 2019.
AB64-ASA1,928n 25Section 928n. 49.45 (39) (bm) of the statutes is repealed.
AB64-ASA1,928r
1Section 928r. 49.45 (47m) of the statutes is created to read:
AB64-ASA1,528,42 49.45 (47m) Family Care funding. (a) In this subsection, “care management
3organization” means a care management organization under contract with the
4department of health services as described under s. 46.284.
AB64-ASA1,528,85 (b) The department shall collaborate with care management organizations and
6the federal centers for Medicare and Medicaid services to develop an allowable
7payment mechanism to increase the direct care and services portion of the capitation
8rates to address the direct caregiver workforce challenges in the state.
AB64-ASA1,528,119 (c) By December 31, 2017, the department shall seek any federal approval
10necessary from the federal centers for Medicare and Medicaid services to implement
11the payment mechanism developed under par. (b).
AB64-ASA1,528,2112 (d) The department may not implement the plan developed under this
13subsection unless the department receives federal approval under par. (c). The
14department may submit one or more requests to the joint committee on finance under
15s. 13.10 to supplement the appropriation under s. 20.435 (4) (b) from the
16appropriation under s. 20.865 (4) (a) for implementation of the payment mechanism
17under par. (b). The department may only use moneys for the payment mechanism
18under par. (b) if the joint committee on finance approves the request under this
19paragraph. Notwithstanding s. 13.101, the joint committee on finance is not
20required to find that an emergency exists before making a supplementation under
21this paragraph.
AB64-ASA1,928t 22Section 928t. 49.45 (53m) of the statutes is created to read:
AB64-ASA1,529,223 49.45 (53m) Coverage program for institutions for mental disease. Subject
24to any necessary waiver approval of the federal department of health and human
25services, or as otherwise permitted under federal law, the department may, if federal

1funding participation is available, provide Medical Assistance coverage of services
2provided in an institution for mental disease to persons ages 21 to 64.
AB64-ASA1,929 3Section 929 . 49.45 (54) (b) of the statutes is repealed.
AB64-ASA1,930 4Section 930 . 49.45 (54) (c) of the statutes is created to read:
AB64-ASA1,529,125 49.45 (54) (c) Special services. From the appropriations under s. 20.435 (4) (b)
6and (o) and (7) (bt), the department may pay the costs of services provided under the
7early intervention program under s. 51.44 that are included in program participant's
8individualized family service plan and that were not authorized for payment under
9the state Medicaid plan or a department policy before July 1, 2017, including any
10services under the early intervention program under s. 51.44 that are delivered by
11a type of provider that becomes certified to provide Medical Assistance service on
12July 1, 2017, or after.
AB64-ASA1,931 13Section 931 . 49.46 (1) (em) of the statutes is created to read:
AB64-ASA1,529,2014 49.46 (1) (em) To the extent approved by the federal government, for the
15purposes of determining financial eligibility and any cost-sharing requirements of
16an individual under par. (a) 6m., 14., or 14m., (d) 2., or (e), the department or its
17designee shall exclude any assets accumulated in a person's independence account,
18as defined in s. 49.472 (1) (c), and any income or assets from retirement benefits
19earned or accumulated from income or employer contributions while employed and
20receiving state-funded benefits under s. 46.27 or medical assistance under s. 49.472.
AB64-ASA1,931n 21Section 931n. 49.46 (2) (b) 6. dm. of the statutes is created to read:
AB64-ASA1,529,2322 49.46 (2) (b) 6. dm. Durable medical equipment that is considered complex
23rehabilitation technology, subject to the requirements under s. 49.45 (9r).
AB64-ASA1,931p 24Section 931p. 49.46 (2) (b) 6. e. of the statutes is amended to read:
AB64-ASA1,530,5
149.46 (2) (b) 6. e. Subject to the limitation under s. 49.45 (30r), inpatient
2hospital, skilled nursing facility and intermediate care facility services for patients
3of any institution for mental diseases who are under 21 years of age, are under 22
4years of age and who were receiving these services immediately prior to reaching age
521, or are 65 years of age or older, or are otherwise permitted under s. 49.45 (53m).
AB64-ASA1,932 6Section 932 . 49.46 (2) (b) 17. of the statutes is amended to read:
AB64-ASA1,530,97 49.46 (2) (b) 17. Services under s. 49.45 (54) (b) (c) for children participating
8in the early intervention program under s. 51.44, that are provided by a special
9educator
.
AB64-ASA1,932n 10Section 932n. 49.46 (2) (dm) of the statutes is amended to read:
AB64-ASA1,530,1811 49.46 (2) (dm) Benefits Except as provided under s. 49.45 (53m), benefits under
12this section may not include payment for services to individuals aged 21 to 64 who
13are residents of an institution for mental diseases and who are otherwise eligible for
14medical assistance, except for individuals under 22 years of age who were receiving
15these services immediately prior to reaching age 21 and continuously thereafter and
16except for services to individuals who are on convalescent leave or are conditionally
17released from the institution for mental diseases. For purposes of this paragraph,
18the department shall define “convalescent leave" and “conditional release" by rule.
AB64-ASA1,933 19Section 933 . 49.47 (4) (c) 1. of the statutes is amended to read:
AB64-ASA1,531,620 49.47 (4) (c) 1. Except To the extent approved by the federal government and
21except
as provided in par. (am), eligibility exists if income does not exceed 133 1/3 100
22percent of the maximum aid to families with dependent children payment under s.
2349.19 (11)
poverty line for the applicant's family size or the combined benefit amount
24available under supplemental security income under 42 USC 1381 to 1383c and state
25supplemental aid under s. 49.77 whichever is lower
. In this subdivision “ income"

1includes earned or unearned income that would be included in determining
2eligibility for the individual or family under s. 49.19 or 49.77, or for the aged, blind
3or disabled under 42 USC 1381 to 1385. “Income" does not include earned or
4unearned income which would be excluded in determining eligibility for the
5individual or family under s. 49.19 or 49.77, or for the aged, blind or disabled
6individual under 42 USC 1381 to 1385.
AB64-ASA1,933n 7Section 933n. 49.47 (6) (c) 4. of the statutes is amended to read:
AB64-ASA1,531,158 49.47 (6) (c) 4. Services Except as provided under s. 49.45 (53m), services to
9individuals aged 21 to 64 who are residents of an institution for mental diseases and
10who are otherwise eligible for medical assistance, except for individuals under 22
11years of age who were receiving these services immediately prior to reaching age 21
12and continuously thereafter and except for services to individuals who are on
13convalescent leave or are conditionally released from the institution for mental
14diseases. For purposes of this subdivision, the department shall define “convalescent
15leave" and “conditional release" by rule.
AB64-ASA1,934 16Section 934 . 49.472 (3) (a) of the statutes is amended to read:
AB64-ASA1,531,2317 49.472 (3) (a) The individual's family's net income is less than 250 percent of
18the poverty line for a family the size of the individual's family. In calculating the net
19income, the department shall apply all of the exclusions specified under 42 USC
201382a
(b) and to the extent approved by the federal government shall exclude
21medical and remedial expenditures and long-term care costs in excess of $500 per
22month that would be incurred by the individual in absence of coverage under the
23medical assistance purchase plan or a Medicaid long-term care program
.
AB64-ASA1,935 24Section 935 . 49.472 (3) (b) of the statutes is amended to read:
AB64-ASA1,532,8
149.472 (3) (b) The individual's assets do not exceed $15,000. In determining
2assets, the department may not include assets that are excluded from the resource
3calculation under 42 USC 1382b (a) or, assets accumulated in an independence
4account, and, to the extent approved by the federal government, assets from
5retirement benefits accumulated from income or employer contributions while
6employed and receiving medical assistance under this section or state-funded
7benefits under s. 46.27
. The department may exclude, in whole or in part, the value
8of a vehicle used by the individual for transportation to paid employment.
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