Under current law, with certain exceptions, the 3-member cost containment
commission is responsible for reviewing and approving the following proposed
projects:
1. A capital expenditure in excess of $1,000,000 made by or on behalf of a
hospital.
2. The implementation of new services to a hospital that exceed $500,000 in a
12-month period.
3. An expenditure in excess of $500,000 made by or on behalf of a hospital,
independent practitioner, limited liability company, partnership, unincorporated
medical group or service corporation for clinical medical equipment.
4. The purchase or acquisition of a hospital.
5. The construction or operation of an ambulatory surgery center or a home
health agency.
Current law sets forth criteria that the commission must use in its review of an
application for project approval. These criteria focus on the economic efficiency of
and need for the proposed projects. The first priority of the commission in applying
the criteria must be cost containment.
The cost containment council represents economic, provider, scientific and
consumer viewpoints. It advises the commission, reviews proposed commission
rules and periodically reports on the performance of the commission and its
operations.
This bill eliminates the cost containment commission, the cost containment
council and the capital expenditure review program.
Under current law, DHSS must investigate the concept of regulating a new
category of health care providers known as rural medical centers.
This bill eliminates that requirement and establishes rural medical centers as
a category of health care providers that, beginning on January 1, 1997, must be
licensed, inspected and otherwise regulated by DHSS. Under the bill, a facility may
be regulated as a rural medical center if it is located in a county, city, town or village
that has a population of less than 15,000 and in an area that the federal bureau of
the census has not defined as an urbanized area, and if it provides 2 or more health
care services. "Health care services" means those provided by a hospital, nursing
home, hospice, rural health clinic or ambulatory surgery center; or home health
services, outpatient physical therapy services, end-stage renal disease services or
other services that are specified by DHSS by rule.
The bill establishes licensing procedures and requires that DHSS promulgate
rules that establish standards for operation of rural medical centers, minimum
requirements for license issuance, licensure fee amounts, and procedures and
criteria for waiver of or variance from standards and requirements. The bill
authorizes DHSS to conduct unannounced inspections of rural medical centers and
requires a rural medical center to provide access to any patient health care records
necessary to fulfill the purpose of any DHSS inspections or investigations. The bill
prohibits an unlicensed entity from using the phrase "rural medical center" to
describe itself, prohibits intentional interference with any investigation by DHSS of
alleged violations, prohibits certain intentional retaliation or discrimination against
employes or patients and prohibits intentional destruction or modification of original
inspection reports.
Under current law, DHSS allocates $50,000 in each fiscal year as a grant for the
provision of direct health care services to migrant workers and their families. A
migrant worker is any person who temporarily leaves a principal place of residence
outside of this state and comes to this state for not more than 10 months in a year
to accept seasonal employment related to unmanufactured agricultural or
horticultural commodities. This bill eliminates the migrant health care program.
Under current law, DHSS is authorized to conduct plan reviews of all capital
construction and remodeling for nursing homes and hospitals, to ensure compliance
with certain federal life safety code requirements for nursing homes and with certain
physical plant requirements. At the same time, DILHR must examine plans of public
buildings (which include hospitals and nursing homes) for compliance with building
code requirements. Both DHSS and DILHR charge fees for these plan reviews.
Beginning on October 1, 1995, this bill exempts hospitals and nursing homes
from DILHR's review for compliance with building code requirements. Instead, the
bill requires DHSS to conduct plan reviews of hospitals and nursing homes for
compliance with both the building code requirements and with the physical plant
and life safety code requirements. The bill requires DHSS to promulgate rules that
establish fees for the reviews that are less than the sum of the amounts collected by
both DHSS and DILHR. However, until DHSS promulgates these rules or until June
30, 1996, whichever is earlier, the bill permits DHSS to collect fees that are equal to
the amounts collected by both DHSS and DILHR.
Under current law, a community-based residential facility (C-BRF) is
annually licensed by DHSS and annually pays a fee, plus a per resident fee, based
on the C-BRF's licensed capacity. Certain adult family homes are annually licensed
by county departments of social services, human services, community programs or
developmental disabilities services or by DHSS.
Beginning on January 1, 1996, this bill changes the licensure period for a
C-BRF and for a licensed adult family home to 2 years, increases biennial license fees
for C-BRFs and establishes license fees for licensed adult family homes.
Under current law, DHSS may order certain sanctions against a C-BRF that
violates specific statutes or rules and, if the C-BRF fails to comply with such an
order, may directly assess forfeitures (civil monetary penalties). Under this bill, if
DHSS provides notice and explanations of sanctions or penalties, DHSS may,
without issuing an order, assess forfeitures against a C-BRF that violates statutes
or rules.
Under current law, DHSS must award grants to local health departments to
fund specified activities related to lead poisoning or lead exposure, including
educational programs, screening, care coordination and follow-up services such as
lead inspection. Certain grants are awarded under criteria that ensure that funding
is provided for areas, including Milwaukee, with significant incidence of lead
poisoning or lead exposure. This bill eliminates these grants under the program.
Under current law, DHSS provides funds to the Marquette University School
of Dentistry to provide dental services at clinics in the city of Milwaukee. This bill
provides that the school of dentistry must also use the funds to provide dental
services at correctional centers in Milwaukee County.
Under current law, DHSS is authorized to award grants to provide
mammography services to women who are 40 years or older. The women must live
in any of 12 rural counties that are specified in rules promulgated by DHSS as having
the highest incidence of late-stage breast cancer in this state.
This bill expands the purpose of grants for mammography services to include
breast cancer screening services and makes these services available statewide to
women who are 40 years of age or older.
Under current law, DHSS must carry out a statewide immunization program
to eliminate mumps, measles, German measles, diptheria, whooping cough,
poliomyelitis and any other diseases that DHSS has specified by rule and to protect
against tetanus. Annually by July 1 until July 1, 1994, DHSS must submit a report
for distribution to the standing committees of the legislature on the success of the
statewide immunization program. This bill extends the reporting requirement until
July 1, 1996.
Under current law, DHSS is required to distribute not more than $375,600 in
fiscal year 1993-94 and not more than $491,500 in fiscal year 1994-95 to reimburse
or supplement the reimbursement of the cost of certain drugs for certain individuals
who are infected with the human immunodeficiency virus (HIV). This bill removes
this statutory allocation. This allows DHSS to determine the amount that will be
used for drug reimbursement for HIV-infected individuals, subject to the
availability of funds in the pertinent appropriation.
Children
Under current law, DHSS investigates and licenses child welfare agencies,
group homes, shelter care facilities (nonsecure places of temporary care and physical
custody for children) and day care centers. Currently, DHSS, a county department
and, if licensed to do so by DHSS, a child welfare agency investigate and license foster
homes and treatment foster homes. This bill requires that, as part of the prelicensing
investigation of a child welfare agency, group home, shelter care facility or day care
center, DHSS, with the assistance of DOJ, conduct a background investigation of the
applicant for the license. If the applicant is applying for a license to operate a day
care center for 4 to 8 children, DHSS must also conduct a background investigation
of the employes and prospective employes of the day care center. The bill also
requires a shelter care facility, child welfare agency, group home or day care center
that cares for 9 or more children to conduct a background investigation of all
employes and prospective employes as a condition of initial licensure or license
renewal. Under the bill, if the person being investigated is a nonresident, or at any
time within the preceding 5 years has been a nonresident, or if the person conducting
the investigation has a reasonable basis for further investigation of the person, the
person conducting the investigation must require the person to be photographed and
fingerprinted and DOJ may submit the fingerprints to the federal bureau of
investigation for the purpose of verifying the identity of the person fingerprinted and
obtaining his or her arrest and conviction record. DHSS may not issue a license to
or renew the license of, and a shelter care facility, child welfare agency, group home
or day care center may not employ, any person who has been convicted of a felony
drug violation, who has had imposed on him or her an increased penalty for habitual
criminality, for certain domestic abuse offenses, for use of a dangerous weapon, for
committing a violent crime in a school zone, for use of a bulletproof garment, for
concealing his or her identity or for a hate crime or, subject to certain exceptions, who
has been convicted of a crime against life and bodily security, a crime against sexual
morality or a crime against children. DHSS may order a child welfare agency, group
home, shelter care facility or day care center that employs a person who has been so
convicted or so punished to terminate the employment of that person immediately
on receipt of the order. The bill also requires DHSS, a county department or a child
welfare agency to conduct the same background investigation of an applicant for a
foster home or a treatment foster home license and any adult resident of the home
and to deny licensure to any applicant who has been so convicted or so punished.
Under current law, no person may establish a shelter care facility without first
obtaining a license from DHSS. Current law does not specify a licensure period or
a license fee for shelter care facilities. This bill establishes a 2-year licensure period
for shelter care facilities and a biennial fee of $180, plus $24 per child, based on
licensed capacity.
Under current law, a child welfare agency that provides care and maintenance
for children must pay a biennial license fee of $75, plus $10 per child, based on
licensed capacity. This bill raises that fee to $180, plus $24 per child, based on
licensed capacity.
Under current law, a child welfare agency that places children in foster homes
or group homes must pay a biennial license fee of $200. This bill raises that fee to
$220.
Under current law, a group home must pay a biennial license fee of $75, plus
$10 per child, based on licensed capacity. This bill raises that fee to $180, plus $24
per child, based on licensed capacity.
Under current law, a day care center that provides care and supervision for 9
or more children must pay a biennial license fee of $25, plus $5 per child, based on
licensed capacity. This bill raises the per child fee to $10 per child.
Under current law, DHSS may order certain sanctions against a child welfare
agency, shelter care facility, group home or day care center (licensee) that violates a
provision of licensure or a rule promulgated by DHSS. If the licensee fails to comply
with such an order, DHSS may, after providing notice and an explanation of the
penalties and appeal process, directly assess forfeitures (civil monetary penalties) of
not less than $10 or more than $50 for each day of violation. This bill increases that
maximum daily forfeiture amount to $1,000. The bill also permits DHSS, after
providing notice and an explanation of the penalties and appeal process, to assess a
forfeiture against a licensee that violates a provision of licensure or a rule, without
first ordering a sanction against the licensee.
Under current law, a person whose birth parent's rights have been terminated,
or who has been adopted, in this state may request DHSS to provide the person, after
the person reaches 18 years of age, with medical or genetic information filed with
DHSS by the person's birth parents, with a copy of the person's original birth
certificate and with the identity and location of the person's birth parents. If the
person's birth parent has not filed the medical or genetic information with DHSS or
has not filed an affidavit authorizing DHSS to disclose the person's original birth
certificate or the identity and location of the birth parent, DHSS must conduct a
search for the birth parent to obtain the medical or genetic information or to inform
the birth parent that he or she may file an affidavit authorizing that disclosure. This
process is called the adoption search program. This bill permits DHSS to contract
with a county department or a licensed child welfare agency to administer the
adoption search program.
Under current law, DHSS provides adoption services for children with special
needs. This bill requires DHSS to develop a plan by July 1, 1997, for contracting out
the adoption services currently provided by DHSS for children with special needs.
Under current law, DHSS administers various child care grant programs.
Current law specifies certain procedures and eligibility criteria that DHSS must
follow in awarding grants under those programs. This bill simplifies those
procedures and criteria by eliminating certain requirements specified in current law.
Under current law, DHSS distributes state revenues, as community aids, and
federal child care grant moneys to counties for child care services for parents who are
gainfully employed and who need child care services (low-income child care); for
parents who are at-risk of becoming eligible for AFDC (at-risk child care); and for
parents who need child care services to prevent or remedy child abuse or neglect, to
alleviate stress in the family or to preserve the family unit (respite child care). This
bill requires DHSS to recover overpayments made for low-income, at-risk and
respite child care. The bill requires DHSS to promulgate rules regarding the
recovery of those child care overpayments.
Currently, if the at-risk child care funds distributed to a county are insufficient
to meet the needs of all eligible parents, the county must distribute those funds to
the following persons according to the following order of priority: 1) to parents who
are working and who have been recipients of AFDC within the last 12 months
(transitional child care); 2) to parents who are working and who have been recipients
of AFDC, but not within the last 12 months (post-transitional child care); and 3) to
participants in the new hope project (a program to assist low-income people in
finding jobs). This bill eliminates the order of priority for at-risk child care funds.
Under current law, unspent or unencumbered child care funds that DHSS
carries forward from one calendar year to the next may be used to provide child care
in counties with unmet needs, to provide child care start-up and expansion grants
and to provide training for child care providers. This bill eliminates the use of those
funds for child care start-up and expansion grants and permits DHSS to use those
funds to provide child care for certain recipients of AFDC and for former recipients
of AFDC and to automate state child care licensing.
Current law appropriates a sum sufficient to provide state aid for certain
county-administered public assistance programs, including AFDC, and for the cost
of foster care and treatment foster care provided by certain nonlegally responsible
relatives under state-administered or county-administered programs. Currently,
this aid for the cost of this foster care by nonlegally responsible relatives is provided
by reimbursing counties for their costs of providing this foster care. As a result,
counties need not use community aids foster care funds for foster care provided by
nonlegally responsible relatives under state-administered or county-administered
programs. This bill limits the amount that may be paid from the sum sufficient
appropriation to a county for foster care provided by nonlegally responsible relatives
to the amount that the county received for these reimbursements in 1994.
Under current law, the child abuse and neglect prevention board awards
general purpose revenues (GPR), program revenues (PR) received by the board as
contributions, gifts, grants and bequests and segregated revenues (SEG) received by
the children's trust fund as contributions, gifts, grants and bequests, to nonprofit
organizations and public agencies to provide parenting education services and
culturally competent outreach services to the parents of newborn infants (right from
the start program). This bill eliminates GPR funding for this program and provides
instead for PR funding from duplicate birth certificate fees for the program. The bill
also increases the fee for a copy of a birth certificate from $10 to $15 and increases
the amount of that fee that is credited to the board from $5 to $7.50.
Under current law, DHSS awards grants to counties that have high numbers
of substantiated cases of child abuse and neglect to provide 24-hour crisis and
respite care for abused and neglected children (children-in-crisis program). This
bill eliminates this program.
Under current law, DHSS must allocate $250,000 in each fiscal year to enter
into a contract with an organization to provide services in Milwaukee County to
divert youths from gang activities. In addition, current law requires DHSS to
allocate $300,000 in each fiscal year to that organization for alcohol and other drug
abuse (AODA) education and treatment services for participants in the
organization's youth diversion program. This bill eliminates the allocation to that
organization for AODA education and treatment.
Mental illness and developmental disabilities
Under current law, a law enforcement officer or a juvenile court intake worker
may take a person into custody, in a process known as emergency detention, if the
officer or worker has cause to believe that the person is mentally ill, drug dependent
or developmentally disabled and if the person evidences certain dangerousness. The
law enforcement officer must transport the person to a mental health treatment
facility, where the treatment director must, within 24 hours, determine if the person
must be detained and, if the person consents, treated. If the person is detained, he
or she must be released within 72 hours, excluding holidays and weekends, or a
petition for commitment must be filed against the person. Individuals who act in
accordance with the authorization provided by these laws are not liable in civil court
for actions taken in good faith.
This bill authorizes a treatment director of a mental health treatment facility
or his or her designee to evaluate and diagnose, as well as treat, an individual who
so consents and who has been transported to the facility under emergency detention
or who has voluntarily entered the facility. The immunity in civil court that is
provided to individuals who act in accordance with the laws under emergency
detention is, by the bill, extended to the evaluation and diagnosis of persons under
emergency detention or who voluntarily enter mental health treatment facilities.
The bill also specifically extends immunity to the making of a determination that an
individual has or does not have mental illness or is or is not dangerous. Lastly, the
bill extends immunity to a director of a treatment facility, or his or her designee, who
under a court order evaluates, diagnoses or treats an individual who is confined in
a jail.
This bill requires DHSS to investigate the feasibility of and analyze the
potential savings and efficiencies of contracting with a private vendor to operate the
state centers for the developmentally disabled and selling the state centers for the
developmentally disabled to such a private vendor. By June 30, 1996, DHSS must
report the findings resulting from its investigation and analysis to the appropriate
standing committees of the legislature and to the governor.
Under this bill, beginning on January 1, 1996, a county must annually
establish, from the sum of the county's annual allocation of moneys under the
community integration program for persons relocated or meeting reimbursable
levels of care (commonly known as "CIP II") and under the community options
program, a maximum amount of not more than 25% for expenditure for services to
persons residing in C-BRFs. The county must deny eligibility to these persons if they
are initially applying for CIP II or community options program services and if the
funding for their care would exceed the 25% maximum, unless DHSS, under criteria
promulgated as rules, grants an exception based on the person's hardship that would
result if the requirement is enforced. If a county's services, under CIP II or the
community options program, to persons residing in community-based residential
facilities exceed the 25% maximum as of January 1, 1996, the county may seek a
waiver of the requirement from DHSS. DHSS must provide technical assistance to
counties to explore alternative methods of providing services. DHSS also must
submit, by October 1, 1995, rules establishing criteria for hardship exceptions, as
proposed, and the proposed standards for granting variances to counties to DOA for
review and approval.
Under this bill, community options program services that are funded solely
from state general purpose revenues may not be used to provide services in a C-BRF
with more than 8 beds unless DHSS approves. DHSS is authorized to approve the
provision if the C-BRF is composed of independent apartments for certain disabled
or elderly residents or if the C-BRF meets standards that, under the bill, DHSS must
establish by January 1, 1996. DHSS must submit the proposed standards to DOA
for approval by October 1, 1995.
This bill requires DHSS to develop, by January 1, 1996, a model contract for
purchase of long-term community support services under the community options
program for persons who reside in C-BRFs. Under the bill, county departments of
social services, human services, community programs or developmental disabilities
services, agencies of county and tribal governments that are directed by county or
tribal commissions on aging and private nonprofit agencies that contract with
providers for these services must use the model contract.
Under current law, long-term support services under the community options
program are funded from state revenues; under a waiver of federal medicaid laws,
home and community-based services under the community options program are
funded from a combination of state revenues and federal medicaid funds. The latter
funding is commonly known as "COP waiver" funding. If a person who is eligible for
community options program services and for medical assistance refuses the offer of
community options program services that are funded under the "COP waiver", the
person may not receive community options program services that are funded solely
from state revenues, except for services funded during a 90-day period in which an
application for "COP waiver" funding is processed. A person who is denied services
on this basis may not request a hearing to review the denial.
This bill expands the limitation on use of solely state-funded community
options program services by denying these services to persons who are eligible for
and are offered and yet refuse home and community-based services under the
community integration programs for persons who are relocated from certain
institutions or who meet certain level-of-care requirements.
Current federal medicaid law prohibits federal funding, under this state's
medical assistance program, of mentally ill persons aged 21 to 64 who receive
services in a facility that the federal health care financing administration finds is an
institution for mental diseases (IMD). Currently, 2 programs under DHSS fund,
from state revenues, services for persons who reside in or who are relocated into
communities from facilities that are found to be IMDs.
This bill expands eligibility for a program that funds services for persons who
reside in or who are relocated from IMDs. The bill permits funding, at a rate that
is 90% of the medical assistance reimbursement rate for the IMD in fiscal year
1987-88, for community-based care for persons who are at least 65 and are relocated
from an IMD, if the IMD closes a bed for the relocation.
This bill eliminates an appropriation to DHSS to provide community mental
health protection and advocacy services.
This bill eliminates a program under which DHSS must award a grant to a
private nonprofit organization to collect and disseminate information on Alzheimer's
disease, to coordinate public awareness activities related to the disease and to
provide training, technical assistance and training material to certain entities that
provide services to persons with the disease.
This bill revises the program of mental health services for severely emotionally
disturbed children. The bill authorizes DHSS to transfer funds, for use as inpatient
and community mental health services for severely emotionally disturbed children,
from the medical assistance appropriation for distribution to applying counties that
meet certain requirements. In order to receive the funding, a county must be the
recipient of a federal grant for comprehensive community mental health services for
children with serious emotional disturbances; be the recipient of any other grant for
services for severely emotionally disturbed children; or meet requirements for
participating in the integrated services programs for children with severe
disabilities and meet certain other requirements. The bill requires that a county that
is applying for the funds submit a proposed plan for children who are served under
the program to be enrolled in a limited services health organization at the time that
the program terminates. Funding that is used under this revised program that is not
encumbered by a recipient county by the June 30 that is 24 months after the fiscal
year in which the funds were distributed lapses to the medical assistance
appropriation.
The bill also permits moneys received as payments in restitution of property
that is damaged at the Mendota or Winnebago mental health institutes or at the
state centers for the developmentally disabled and money that is received from the
sale of surplus property at the mental health institutes or state centers for the
developmentally disabled to be used for replacement of the damaged property.
Other health and social services
This bill changes the name of DHSS, on July 1, 1996, to the department of
health and family services.
