Currently, physical therapy, occupational therapy, and services for speech,
hearing, or language disorders (therapy services) are covered under MA if they are
provided by a person who is certified by DHS to provide the services.
This bill provides that if a county spends more to provide therapy services for
children participating in the Birth to 3 Program, under which counties provide
services to infants and toddlers with developmental delays, than the county is
reimbursed under standard MA reimbursement rates, and the federal government
reimburses the state the federal share of MA for the county expenditures that are in
excess of the standard MA reimbursement, DHS may disburse the federal share on
the excess county expenditures to the county.
DHS currently does not certify special educators to provide therapy services
under MA. This bill provides that services to assess and promote skill acquisition
that are provided by special educators to children participating in the Birth to 3
Program are covered under MA if the county pays the entire state share of MA for
the services. The bill requires DHS to establish certification criteria for special
educators.
This bill requires DHS to request a waiver of federal Medicaid law to allow the
state to provide home and community-based services under MA to children who
participate in the Birth to 3 Program. The bill provides that if the waiver is granted,
counties must pay the nonfederal share of MA costs for services provided under the
waiver.
This bill specifies that DHS may implement through MA the state plan option
under the federal Social Security Act, which provides federal funding for home and
community-based services for people with mental illness.
Under current law, DHS reimburses certain costs of services provided by a state
center for the developmentally disabled. Under the community integration program
for residents of state centers for the developmentally disabled (the CIP IA program),
DHS must reduce the reimbursement to a center by $325 per day following the
relocation of an individual from the center to a community setting. This bill
eliminates the fixed amount of the reduction.
Under current law, if a person under the age of 22 or a person over the age of
64 is civilly committed in a state mental health institute, DHS pays the portion not
paid by the federal government of the costs of the services the state mental health
institute provides. Under this bill, the county must pay the portion not paid by the
federal government.
Under current law, DHS has a waiver of federal Medicaid law to conduct a
demonstration project to provide family planning services under MA to women
between the ages of 15 and 44 with family incomes of not more than 200 percent of
the federal poverty level. This bill allows DHS to request an amended waiver from
the federal Department of Health and Human Services to expand the current family
planning demonstration project to include men.
Under current law, DHS administers the Senior Care Program to provide
prescription drugs to certain elderly persons at reduced prices. Pharmacies may
charge a Senior Care enrollee only the program payment rate for prescription drugs,
until the enrollee has met an annual deductible, if applicable, and thereafter may
charge the enrollee only a specified copayment amount. When an enrollee pays only
the copayment, DHS reimburses the pharmacy the program payment rate minus the
copayment. The program payment rate is equal to 105 percent of the MA
prescription drug payment rate plus a dispensing fee. This bill reduces the program
payment rate to 100 percent of the MA prescription drug payment rate plus a
dispensing fee.
Current law requires that DHS establish a mechanism for reviewing petitions
from nursing homes for modification of MA payments and develop criteria for
granting modifications. Upon conducting a review, DHS may modify an MA payment
to a nursing home, as long as the modified payment does not exceed federal
maximum reimbursement levels. This bill repeals the requirement that DHS
establish a mechanism for reviewing petitions from nursing homes to modify MA
payments.
Current law requires the Board of Regents of the UW System to transfer
$15,000,000 to the Medical Assistance trust fund in each fiscal year through
2010-11. This bill increases the amount that the Board of Regents must annually
transfer to the Medical Assistance trust fund to $27,500,000, effective for fiscal year
2008-09, and requires the Board of Regents to make the transfer through fiscal year
2012-13.
Currently, the federal government pays a specified percentage of the allowable
costs of MA benefits. Currently, for some MA benefits, the provider contributes the
entire state share of the cost of providing the benefit and the state disburses to the
provider the federal share of the allowable costs of providing the benefit.
This bill provides that regardless of whether the specified federal percentages
for federal fiscal years 2009 or 2010 are increased above the percentages published
on November 28, 2007, and November 26, 2008, for certain benefits for which the
state disburses the federal share to the provider, the state shall use the percentages
published on those dates to calculate the federal share for benefits provided between
October 1, 2008, and December 31, 2010.
Health
Current law prohibits smoking in mass transit vehicles and specified indoor
locations, including inpatient health care facilities, such as community
based-residential facilities and nursing homes, prisons and jails, restaurants, and
governmental buildings.
With limited exceptions, a smoking area may be designated at an indoor
location by the person who is in charge of that location.
Under this bill, smoking areas at the specified indoor locations may no longer
be designated, resulting in a complete ban on indoor smoking at those locations with
exceptions for private residences, a limited number of designated rooms in lodging
establishments and certain residence rooms in assisted living facilities. In addition
to the specified indoor locations listed under current law, the bill prohibits smoking
in any public place or place of employment.
Current law provides exemptions from the prohibition against smoking for
bowling centers, taverns, halls used for private functions, rooms in which the main
occupants are smokers, and areas of facilities that are used to manufacture or
assemble goods, products, or merchandise. This bill eliminates these exemptions.
Current law allows smoking in any restaurant that has a seating capacity of no
more than 50 individuals, or that holds a liquor license, if the sale of alcohol
beverages accounts for more than 50 percent of the restaurant's receipts. This bill
prohibits smoking in any restaurant regardless of the seating capacity or the number
of liquor sale receipts.
Current law allows smoking in any tavern holding a "Class B" intoxicating
liquor license or Class "B" fermented malt beverages license issued by a municipality.
This bill prohibits smoking in any tavern. The bill also specifically prohibits smoking
in private clubs.
Under current law, smoking is prohibited outside in limited instances. This bill
adds a general prohibition against smoking outside within less than a reasonable
distance from any entrance to a building, a window that may be opened, or a
ventilation opening that draws air inside. The bill also specifically prohibits smoking
in sports arenas and bus shelters.
Current law does not limit the authority of a municipality or county to enact
smoking ordinances that protect the public's health and comfort. This bill makes no
change in this provision.
This bill requires that persons in charge of places where smoking is prohibited
enforce the prohibitions by taking certain steps to ensure compliance, such as asking
a person who is smoking to leave and refusing to serve the person if the place is a
restaurant, tavern, or private club.
Under current law, the Group Insurance Board, attached to DETF, administers
a pharmacy benefits purchasing program that is available for all public and private
sector employers in this state and all residents of this state. The program for private
sector employers and other residents of this state, developed under contract with
Navitus Health Solutions, is called BadgerRx Gold. This bill transfers the BadgerRx
Gold program to DHS.
Under current law, DHS awards grants to organizations to provide mental
health treatment and other services to women who are convicted of non-violent
offenses and their dependent children. This bill eliminates this grant program.
Long-term care
Currently, the state imposes a monthly, per-bed assessment on nursing homes
that may not exceed $75. This bill increases the maximum amount of the assessment
to $150 in fiscal year 2009-10 and $170 in each fiscal year thereafter.
Current law imposes a cap on the number of nursing home beds that may be
licensed statewide. DHS allocates the number of authorized licensed beds among
seven planning areas and to nursing homes within the planning areas. A nursing
home may transfer an authorized licensed bed to another nursing home if the
receiving nursing home is in the same planning area as the transferring nursing
home or in a county adjoining the planning area and the transferring and receiving
nursing homes are under common ownership. This bill allows a nursing home to
transfer an authorized licensed bed to another nursing home regardless of location
or ownership of the nursing homes as long as the nursing homes notify DHS and DHS
approves the transfer.
Currently, DHS may place a monitor in, and the secretary of health services
may petition for appointment of a receiver for, a nursing home or community-based
residential facility (CBRF) when any of several conditions (for example, operating
without a license or in the event of an emergency) exist. This bill specifies two
additional conditions for placement of a monitor or petitioning for appointment of a
receiver: 1) DHS or the nursing home or CBRF determines that estimated operating
expenses of the nursing home or CBRF significantly exceed anticipated revenues;
and 2) the nursing home or CBRF or its operator has been charged with or convicted
of MA fraud, fraud under the federal Medicare Program, or the abuse or neglect of
residents of the nursing home or CBRF. The bill also permits a monitor placed in a
nursing home or CBRF to assist in financial management.
Currently, licensure fees for CBRFs and adult family homes (AFHs), as well as
the certification fee for adult day care centers (ADCCs), are established by statute,
though DHS may increase the certification fee for ADCCs by rule. This bill increases
the licensure fees for CBRFs and AFHs and the certification fee for ADCCs. In
addition, the bill authorizes DHS to increase the licensure fees for CBRFs and AFHs
by rule.
This bill authorizes DHS to assess a $200 fee against a hospital, nursing home,
CBRF, residential care apartment complex, AFH, hospice, home health agency, or
ADCC if DHS takes enforcement action against the facility or provider and
subsequently conducts an on-site inspection to review the facility's or provider's
action to correct the violation.
Under current law, the long-term care ombudsman investigates complaints of
improper care in, and serves as an advocate for residents of, nursing homes, CBRFs,
AFHs, hospices, facilities providing care under continuing care contracts, and swing
beds in hospitals.
This bill authorizes the ombudsman to investigate complaints in, and serve as
an advocate for residents of, residential care apartment complexes, and requires
residential care apartment complexes to post a notice regarding the ombudsman
program.
Mental illness and developmental disabilities
Under current law, a person on supervised release after being institutionalized
as a sexually violent person is in the custody and control of DHS and is subject to
conditions and rules. For the first year of supervised release, such a person is
restricted to his or her home except for limited outings supervised by an escort from
DOC. This bill authorizes DHS to permit an outing without direct escort supervision.
Under current law, if a court has reason to doubt the competency of a criminal
defendant, the court may require an examination to determine whether the
defendant is competent to proceed to trial. If the examiner determines that the
defendant is not competent, but may attain competency with treatment, the court
must suspend the criminal proceedings and commit the defendant to DHS for
placement in a mental health institution for up to 12 months, or for the maximum
sentence specified for the most serious offense with which the defendant is charged,
whichever is less. This bill reduces the maximum commitment time to six months,
or the maximum sentence specified for the most serious offense with which the
defendant is charged, whichever is less.
Under current law, if a defendant is found not guilty of a crime by reason of
mental disease or mental defect, the court must commit the person to either
institutional care or conditional release. If the court lacks sufficient information to
decide between institutional care and conditional release, the court may order a
predisposition investigation of the person or a supplementary mental examination,
or both. Under this bill, the court may order only a predisposition investigation.
Children
Out-of-home care
Under current law, any person who provides care and maintenance for four or
fewer children must obtain a license to operate a foster home and any person who
provides care and maintenance and structured, professional treatment for four or
fewer children must obtain a license to operate a treatment foster home. A foster
parent is reimbursed for basic maintenance according to age-related rates specified
by law and may receive a supplement for special needs, exceptional circumstances,
and initial clothing allowances according to DCF rules. In addition, a treatment
foster parent receives a supplement for providing treatment foster care. A relative
who provides care and maintenance for a child is not required to obtain a foster or
treatment foster home license, but may be eligible for kinship care payments of $215
per month.
This bill eliminates kinship care payments and treatment foster homes as a
separate licensing category effective on January 1, 2010. Instead, the bill requires
DCF to promulgate rules as follows:
1. Rules specifying levels of care that a foster home is licensed to provide. The
levels must be based on the knowledge, skill, training, experience, and other
qualifications that are required of the licensee, the licensee's responsibilities, the
needs of the children placed with the licensee, and any other requirements that DCF
may promulgate by rule.
2. Rules establishing a standardized tool to assess the needs of a child placed
outside the home, to determine the level of care that is required to meet those needs,
and to place the child in a placement that meets those needs. A foster home may
provide foster care for any child whose needs are assessed at or below the level of care
that the foster home is licensed to provide.
3. Rules providing monthly reimbursement rates for foster care that are
commensurate with the level of care that the foster home is licensed to provide and
the needs of the child who is placed in the foster home. Those rates are added to the
basic maintenance rates for foster care (which the bill increases by 5 percent on
January 1, 2010, and by an additional 5 percent on January 1, 2011) and must
include supplemental payment rates for special needs, exceptional circumstances,
and initial clothing allowances for children placed in a foster home.
4. Rules providing a monthly fee for a foster home that agrees to maintain
openings for emergency placements.
A person who is licensed to operate a treatment foster home on December 31,
2009, is deemed licensed to operate a foster home beginning on January 1, 2010, and
must be reimbursed for foster care at the rate determined under the DCF rules. A
recipient of kinship care payments on December 31, 2009, is deemed licensed to
operate a foster home beginning on January 1, 2010, and must be reimbursed at that
rate, if the person passes the background investigation required of foster parents.
Under current law, a residential care center for children and youth (residential
care center) and a group home must establish a per client rate for their services and
must submit that rate and any change in that rate to DCF before charging any
purchaser of those services.
This bill requires DCF to establish the per client rate. DCF must also establish
per client "administrative rate" that a child welfare agency may charge for the
administrative portion of its treatment foster care services provided beginning on
January 1, 2011. The administrative rate is the difference between the rate charged
by a child welfare agency to a purchaser of treatment foster care services and the rate
paid by the child welfare agency to a treatment foster parent for the care and
maintenance of a child. The bill also freezes for 2010 at the 2009 level the per client
rate that a residential care center or a group home may charge for its services and
the per client administrative rate that a child welfare agency may charge for the
administrative portion of its treatment foster care services.
Under the bill, DCF must determine whether a rate proposed by a residential
care center, group home, or child welfare agency is appropriate to the level of services
to be provided; the qualifications of the residential care center, group home, or child
welfare agency to provide those services; and the reasonable and necessary costs of
providing those services. If DCF determines that a proposed rate is appropriate,
DCF must approve it. If DCF does not approve a proposed rate, DCF must negotiate
a rate with the residential care center, group home, or child welfare agency. If
negotiations fail, the parties must engage in mediation. If mediation fails, the
residential care center, group home, or child welfare agency may not provide the
service for which the rate was proposed.
Current law requires a treatment foster parent to receive training before a child
is placed in his or her home and requires ongoing training in the specific needs of the
treatment foster parent after licensing. Additionally, a foster or treatment foster
parent caring for a child with special needs may voluntarily participate in an
education program. This bill requires all foster and treatment foster parents to
successfully complete training in the care and support needs of children who are
placed in foster or treatment foster care.
Under current law, when a person applies for or receives kinship care payments
for the care of a child, any right of the child or of the child's parent to support or
maintenance from any other person, including any right to unpaid amounts accrued
at the time of application for those payments or that aid (pre-assistance arrears), is
assigned to the state. Beginning on October 1, 2009, this bill eliminates assignment
to the state of any right of a child or parent to pre-assistance arrears and releases
any right to pre-assistance arrears assigned to the state before that date to the
person who assigned that right to the state.
Child abuse and neglect
Under current law, immediately after receiving a report of child abuse or
neglect, a county must determine whether a caregiver of the child is suspected of the
abuse or neglect. If so, the county must investigate to determine whether the child
is in need of protection or services. If another person is suspected of the abuse or
neglect, the county may investigate. If the report is of child sexual abuse, the county
must refer the report to the sheriff or police department. Within 60 days after
receiving a report that it investigates, a county must determine whether abuse or
neglect has occurred or is likely to occur. If a county determines that a specific person
has abused or neglected a child, that person may appeal under procedures
promulgated by DCF by rule.
This bill requires DCF to establish a pilot program under which a county must
respond to such a report as follows:
1. If the county finds reason to suspect that substantial abuse or neglect has
occurred or is likely to occur or that an investigation is otherwise necessary to ensure
the safety of the child and his or her family, the county must investigate the report
as provided under current law.
2. If the county finds reason to suspect that abuse or neglect, other than
substantial abuse or neglect, has occurred or is likely to occur, but that there is no
immediate threat to the safety of the child and his or her family and intervention by
the juvenile court is not necessary, the county must conduct a comprehensive
assessment of the safety of the child and his or her family, the risk of subsequent
abuse or neglect, and the strengths and needs of the child's family to determine
whether services are needed. Based on the assessment, the county must offer
services to the child's family on a voluntary basis or refer the child's family to a
service provider in the community. If the county conducts an assessment, the county
is not required to refer the report to the sheriff or police department or determine
whether abuse or neglect has occurred or is likely to occur or whether a specific
person has abused or neglected the child.
3. If the county finds no reason to suspect that abuse or neglect has occurred
or is likely to occur, the county must refer the child's family to a service provider in
the community but is not required to conduct an assessment, refer the report to the
sheriff or police department, or determine whether abuse or neglect has occurred or
is likely to occur or whether a specific person has abused or neglected the child.
Under the current Child Abuse and Neglect Prevention Program, DCF awards
grants to no more than six rural counties, three urban counties, and two Indian tribes
that offer voluntary home visitation services to first-time parents who are eligible
for MA. Current law requires DCF to determine the amount of a grant awarded to
a county or an Indian tribe in excess of $10,000 based on the number of births that
are funded by MA in that county or the reservation of that Indian tribe in proportion
to the number of those births in all of the counties and the reservations of all of the
Indian tribes to which grants are awarded. Currently, a grant may be used to make
payments totalling not more than $1,000 per year for the appropriate expenses of a
participating family. A county, other than Milwaukee County, or an Indian tribe may
also use a grant to provide case management services for a participating family.
This bill makes all of the following changes to the Child Abuse and Neglect
Prevention Program:
1. Eliminates the caps on the number of counties and Indian tribes that may
be selected to participate.
2. Requires DCF to determine the amount of a grant in excess of $10,000 based
on the number of births that are funded by MA in a county or a reservation of an
Indian tribe, without regard to the number of those births in other counties and
reservations, and on the rate of poor birth outcomes, including infant mortality,
premature births, low birth weights, and racial or ethnic disproportionality in the
rate of those outcomes, in the county or reservation.
3. Provides that if a family with a child who is at risk of abuse or neglect has
been continuously receiving home visitation services for not less than 12 months,
those services may continue until the child reaches three years of age, whether or not
the child continues to be eligible for MA.
4. Permits Milwaukee County to use grant funds to provide case management
services.
5. Eliminates the cap on the amount that a county or Indian tribe may pay per
year for the expenses of a family participating in the program and instead requires
a county or Indian tribe to pay not less than $250 per year for those expenses.
6. Eliminates the authority of a county or Indian tribe that receives a grant to
provide home visitation services to a person who is not eligible for the program, but
who is at risk for perpetrating child abuse or neglect.
7. Requires a county or Indian tribe that receives a grant to do all of the
following:
a. Agree to match at least 25 percent of the grant amount.
b. Offer voluntary home visitation services to all, not just first-time, pregnant
women who are eligible for MA and to commence those services during the prenatal
period.
c. Reinvest in the program a portion of the MA reimbursement received by the
county or Indian tribe.
d. Implement strategies, in collaboration with local prenatal care coordination
providers, aimed at achieving healthy birth outcomes.
Child care
Under current law, a day care center licensed by DCF may be reimbursed under
the W-2 program for child care provided for a person who is eligible for a child care
subsidy. This bill requires DCF to provide a quality rating system for licensed day
care centers that are reimbursed under W-2 or that volunteer for rating under the
system. The rating information must be made available, including on DCF's Internet
site, to parents, guardians, and legal custodians of children who are recipients, or
prospective recipients, of care and supervision from a rated day care center.
Under current law, a child care provider, other than a day care center licensed
by DCF or established or contracted by a school board, must be certified by a county
in order to be reimbursed for child care provided to a person who is eligible for a child
care subsidy under W-2. This bill permits DCF to contract with a W-2 agency, child
care resource and referral agency, or other agency to certify child care providers in
a particular geographic area or Indian tribal unit for purposes of reimbursement
under W-2.
Under current law, a day care center that provides care and supervision for nine
or more children must pay a biennial license fee of $30.25, plus $10.33 per child based
on licensed capacity. This bill raises the per child fee to $16.94.
Other health and human services
Under current law, DHS may recover payments for health care services under
MA resulting from a misstatement or omission of fact by a person supplying
information in an application for benefits. If DHS provides any medical assistance
to a person as a result of an injury, for example, that was caused by a third party, DHS
may recover from the third party the amount of the medical assistance provided.
Also under current law, if an individual is delinquent in the payment of
court-ordered child or family support (support) or maintenance, his or her name,
social security number, and amount of support or maintenance owed is posted on a
statewide support lien docket.
This bill requires every insurer authorized to do business in this state, before
paying any claim of $500 or more, to verify with DHS that the individual to whom
the claim is to be paid does not owe an amount that was incorrectly paid under MA
or an amount that DHS may recover because of medical assistance provided to
another person (medical assistance liability) and to ensure that the individual does
not have an overdue support or maintenance obligation (support liability). If the
individual has a support or medical assistance liability, the insurer must pay the
claim proceeds, up to the amount of the support or medical assistance liability, to
DCF or DHS and pay any remainder to the individual.
Under current law, the fee for a copy of a birth certificate, death certificate,
marriage certificate, or divorce or annulment certificate is $20, the fee for expedited
issuance of a copy of one of these certificates is $20, and the fee for an additional copy
of the same birth certificate at the same time is $3. Current law reduces these fees,
effective July 1, 2010, to the following amounts: for a copy of a birth certificate, $12;
for a copy of a death certificate, marriage certificate, or divorce or annulment
certificate, $7; and for expedited issuance of a copy of a certificate, $10.
This bill repeals the scheduled fee reductions for certificates, increases the fee
for a copy of a birth certificate to $22, and increases the fee for an additional copy to
$5.
Under current law, with few exceptions, a patient's health information is
confidential unless the patient gives informed consent to release the information.
Hospitals, physicians, and certain laboratories, however, must report to DHS
information concerning any person diagnosed as having cancer or a precancerous
condition.
This bill allows DHS to disclose otherwise confidential cancer report
information to a cancer researcher who submits an application with his or her
qualifications, a written research protocol, documentation of approval of the protocol
by an institutional review board, and any information that DHS requests. The bill
prohibits the researcher from disclosing the cancer information obtained from DHS
except in certain circumstances. Anyone who discloses a patient's confidential
cancer information is liable to that patient for damages and may be subject to a fine
or imprisonment.
Under the current childless adults program, DHS provides health care
coverage to adults under the age of 65 who have incomes not exceeding 200 percent
of the federal poverty line and who are not otherwise eligible for MA or Medicare.
One of the eligibility criteria under the AZT-reimbursement is that an individual
must have applied for coverage under and been denied eligibility for MA within 12
months before applying for reimbursement. With a number of exceptions for
different types of MA coverage, including coverage under the childless adults
program, persons who are eligible for MA are not eligible for coverage under HIRSP.
This bill provides that individuals who are eligible for coverage under the
Benchmark Plan under BC+ are not for that reason ineligible for HIRSP. The bill
also eliminates the requirement under the AZT-reimbursement program, that an
individual must have applied for coverage under and been denied eligibility for MA
within 12 months before applying for reimbursement, for individuals who are
eligible for the childless adults program or the Benchmark Plan under BC+.
Under current law, DHS awards grants totaling $225,000 annually for respite
care for individuals with special needs or individuals who are at risk of abuse or
neglect. This bill eliminates this program.
This bill eliminates the requirement for DHS or its attached entities to make
recommendations regarding physical disabilities and hunger prevention, to collect
information on hospital newborn hearing screenings, and to submit reports on the
following subjects: the impact of the relocations of residents of state centers for the
developmentally disabled on state employees, motor vehicle use by physically
disabled persons, hunger prevention, the Badger Care Program, medical assistance
certified pharmacists, care and service facilities, nursing home Class A violations,
rehabilitation requests under the caregiver background requirements, the Birth to
3 Program, activities related to treatment of alcoholism, the state emergency medical
services plan, statewide immunization, newborn hearing screening, birth defect
surveillance, and tobacco use cessation grants.
insurance
Health Insurance
Independent review
Under current law, every insurer that issues a group or individual health
benefit plan must have an internal grievance procedure and an independent review
procedure for certain adverse decisions after the internal grievance procedure has
been exhausted. Generally, the adverse decision must relate to the insurer's denial,
reduction, or termination of a health care service or payment for a health care service
on the basis that the service was experimental or did not meet the plan's
requirements for medical necessity, appropriateness, health care setting, level of
care, or effectiveness. An independent review may be conducted only by an
independent review organization that has been certified by OCI.
