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.
This bill adds the rescission of a policy or certificate and a coverage denial
determination based on a preexisting condition exclusion to the types of adverse
decisions that are eligible for independent review. The bill also eliminates the $25
fee for an independent review. In addition, the bill requires every insurer that issues
individual health benefit plans to report to OCI annually the number of plans issued
by the insurer in the preceding year and the number of plans with respect to which
the insurer initiated or completed a cancellation or rescission in the preceding year.
Preexisting condition exclusions
Under current law, an insurer may impose a preexisting condition exclusion for
up to two years under an individual health insurance policy and there is no limit on
how long before an insured's coverage began a condition may have existed to be
treated as a preexisting condition. Under a group health insurance policy, a
preexisting condition exclusion generally may not exceed one year and the insurer
may impose an exclusion only with respect to conditions for which treatment was
received or recommended within six months before coverage began. This bill
provides that under an individual health insurance policy, an insurer may impose a
preexisting condition exclusion for up to one year for a condition for which treatment
was received or recommended within one year before the insured's coverage began.
Modifications at renewal of individual health insurance
Currently, with some exceptions, an insurer must renew an individual health
insurance policy at the request of the insured. At renewal, the insurer may modify
the policy form uniformly among all individuals with coverage under that policy
form. This bill requires an insurer, at renewal of an individual health insurance
policy and at the request of the insured, to issue comparable coverage that the
insurer currently offers or coverage currently offered by the insurer that has more
limited benefits or a higher deductible or to provide a higher deductible under the
insured's current coverage. An insurer must annually mail to each insured under
an individual policy issued a notice that informs the insured of his or her right to elect
alternative coverage and that describes the alternatives and the procedure for
electing the alternative coverage.
Uniform application for individual health insurance
This bill requires OCI to prescribe uniform questions and the format for
applications that all insurers offering individual health insurance policies must use
on an application for such a policy.
Dependent coverage
Current law contains a number of provisions related to coverage of dependents
under health insurance policies, such as requiring a health insurer that covers a
child of an insured also to cover any child of the insured's child until the insured's
child is 18 years old and prohibiting a health insurer from terminating coverage of
a dependent child who reaches the age at which the insurer no longer covers
dependents if, and while, the child is incapable of self-sustaining employment
because of mental retardation or physical handicap and is dependent on the insured
for support and maintenance. Current law, however, does not require a health
insurer to cover a dependent of an insured up to any particular age or, for example,
because a dependent is a full-time student.
Under this bill, a health insurer that provides coverage for dependents must
cover any child of an insured if the child is unmarried, is under 27 years old, does not
have other health care coverage, and is not employed full time by an employer that
offers health care coverage to its employees. The coverage requirement applies to
both individual and group health insurance policies and plans, including those
offered by the state, and to self-insured health plans of counties, cities, villages,
towns, school districts, and the state.
Requirement for health insurer to cover claims
This bill prohibits a health insurer from refusing to cover claims for health care
services provided to an insured on the basis that there may be coverage for those
services under a liability insurance policy.
Motor Vehicle insurance
Proof of financial responsibility
Current law imposes certain financial responsibility requirements on owners
and operators of motor vehicles involved in accidents. If a motor vehicle accident
results in injury, death, or property damage of $1,000 or more, DOT must notify the
operator and owner of the vehicle that the person must deposit with DOT security
for the accident in an amount that DOT has determined is sufficient to satisfy any
resulting judgment for damages. Unless an exception applies, if a person fails to
timely deposit security after this notice, DOT must suspend the person's operating
privilege if the person was the vehicle operator and suspend all vehicle registrations
of the person if the person was the vehicle owner. One exception applies to a person
who provides proof of financial responsibility. In addition, if DOT receives a certified
copy of a judgment for damages of $500 or more arising out of a motor vehicle
accident, DOT must immediately suspend the operating privilege and all
registrations of the judgment debtor unless he or she can provide proof of financial
responsibility. In both situations, proof of financial responsibility includes coverage
under a motor vehicle liability insurance policy with the following minimum limits
for any single accident: $25,000 for bodily injury to or death of one person, $50,000
for bodily injury to or death of more than one person, and $10,000 for property
damage.
This bill increases the minimum limits required under a policy that is
acceptable proof of financial responsibility to $100,000 for bodily injury to or death
of one person, $300,000 for bodily injury to or death of more than one person, and
$25,000 for property damage.
Uninsured motorist and medical payments coverages
Under current law, all motor vehicle liability insurance policies must include
uninsured motorist coverage of at least $25,000 per person and $50,000 per accident
and medical payments coverage of at least $1,000 per person. Uninsured motorist
coverage provides coverage for persons who are legally entitled to recover damages
for bodily injury from owners or operators of motor vehicles that are not insured.
Medical payments coverage pays for medical or chiropractic services provided to
persons who are injured while using the insured motor vehicle.
This bill increases the required level of uninsured motorist coverage to
$100,000 per person and $300,000 per accident, and increases the level of required
medical payments coverage to $10,000.
Underinsured motorist coverage
Current law, while not requiring that motor vehicle liability policies include
underinsured motorist coverage, requires insurers to provide written notice of the
availability of that coverage to one insured under each policy written after, or in
effect on, October 1, 1995, that does not include the coverage. If an insured accepts
the coverage after receiving notice of its availability, the policy must include the
coverage in limits of at least $50,000 per person and $100,000 per accident.
Underinsured motorist coverage provides coverage for persons who are legally
entitled to damages for bodily injury from owners or operators of underinsured motor
vehicles. "Underinsured motor vehicle" is not defined in the statutes.
This bill requires every motor vehicle liability insurance policy to include
underinsured motorist coverage of at least $100,000 per person and $300,000 per
accident. In addition, the bill defines an underinsured motor vehicle as a motor
vehicle that is involved in an accident with an insured and which, at the time of the
accident, was covered by a motor vehicle liability insurance policy with limits that
are less than the amount needed to fully compensate the insured for his or her
damages.
Umbrella and excess liability insurance policies
Current law exempts umbrella and excess liability insurance policies from the
requirement that a policy covering motor vehicle liability include uninsured motorist
coverage. Nothing in current law, however, exempts an insurer writing umbrella or
excess liability insurance policies from the requirement to provide notice of the
availability of underinsured motorist coverage.
This bill affirmatively requires an insurer that writes umbrella or excess
liability policies that cover motor vehicle liability to make a written offer of both
uninsured motorist coverage and underinsured motorist coverage whenever
application is made for such a policy. The bill provides that, if an insurer fails to
provide a required written offer of uninsured or underinsured motorist coverage and
the umbrella or excess liability policy does not include the coverage, or coverages, for
which an offer was not given, a court must, on the request of the insured, reform the
policy to include the coverage or coverages with the same limits as the liability
coverage limits under the policy.
Miscellaneous motor vehicle liability insurance provisions
Under current law, uninsured motorist coverage does not apply if an accident
occurs without actual contact between two vehicles. This bill provides that actual
contact is not necessary for uninsured motorist coverage to apply.
Current law specifies a number of provisions that are permissible in a motor
vehicle liability insurance policy and a number of provisions that are prohibited in
such a policy. This bill prohibits the following currently permissible provisions
prohibited in a motor vehicle liability insurance policy:
1. Providing that, regardless of the number of policies, persons, or vehicles
involved, the limits for coverage under the policy may not be added to the limits for
similar coverage applying to other motor vehicles to determine an overall limit of
coverage available for a person in any one accident.
2. Providing that the maximum amount of uninsured or underinsured motorist
coverage available for bodily injury or death suffered by a person not using a motor
vehicle in an accident (such as a pedestrian) is any single limit of uninsured or
underinsured motorist coverage for any vehicle with respect to which the person is
insured at the time of the accident.
