LRB-4186/1
FFK/TKK/GMM:jld/cjs/med:jm
2011 - 2012 LEGISLATURE
February 29, 2012 - Introduced by Joint Legislative Council. Referred to
Committee on Health.
SB532,2,2 1An Act to amend 48.983 (title), 48.983 (4) (a) 4m., 48.983 (4) (b), 48.983 (6) (a)
2(intro.), 48.983 (6) (a) 1., 48.983 (6) (a) 2., 48.983 (6) (a) 3., 48.983 (6) (a) 4.,
348.983 (6) (a) 4m., 48.983 (6) (a) 6., 48.983 (6) (a) 6m., 48.983 (6) (b) 1., 48.983
4(6) (c), 48.983 (6g) (a) and (b), 48.983 (6m), 48.983 (6r), 48.983 (7) (title) and (a)
5(intro.), 48.983 (7) (ag), 48.983 (7) (ar), 48.983 (7) (b), 48.983 (7) (c), 48.983 (8),
6253.15 (2), 253.15 (6), 253.15 (7) (e), 441.15 (3) (c) and 448.02 (3) (a); and to
7create
48.983 (9), 69.02 (2) (c), 69.14 (1) (i), 441.15 (1) (am), 441.15 (4m), 448.35
8and 448.40 (2) (am) of the statutes; relating to: evidence-based home
9visitation program services for persons who are at risk of poor birth outcomes
10or of abusing or neglecting their children; designating race and ethnicity on
11birth certificates; requiring informed consent for performance of certain

1elective procedures prior to the full gestational term of a fetus; and granting
2rule-making authority.
Analysis by the Legislative Reference Bureau
This bill is explained in the Notes provided by the Joint Legislative Council in
the bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
Joint Legislative Council prefatory note: This bill was prepared for the Joint
Legislative Council's Special Committee on Infant Mortality.
Under current law, an infant's race or ethnicity is not required to appear on the
infant's birth certificate. This bill specifies that a birth certificate must include the race
and ethnicity of the infant, as reported by the infant's mother.
The bill also requires the Department of Health Services to promulgate
administrative rules to establish the designations of race and ethnicity to be used on birth
certificates and procedures to be followed to ensure that the designation recorded on a
birth certificate is that directly reported by an infant's mother. The designations of race
and ethnicity must be sufficiently detailed to enable data collection on births and birth
outcomes among all significant racial and ethnic populations in the state and to assist in
the development and evaluation of the efficacy of programs and policies designed to
improve birth outcomes.
The bill specifies that home visitation services provided by a county, private agency,
or Indian tribe to a person who is at risk of poor birth outcomes or of abusing or neglecting
his or her child under a child abuse and neglect prevention grant from the Department
of Children and Families (DCF) must be evidence-based.
The bill also requires DCF to enter into a memorandum of understanding with the
Department of Health Services that provides for collaboration between these
departments in carrying out home visitation program services.
Under current law, any physician who treats a patient must inform the patient
about the availability of all alternate, viable medical modes of treatment and about the
benefits and risks of these treatments. A physician who violates this requirement is
subject to discipline by the Medical Examining Board (MEB) for unprofessional conduct.
If the MEB finds that the physician has engaged in unprofessional conduct, the MEB may
warn or reprimand the physician, or limit, suspend, or revoke any license, certificate, or
limited permit granted to the physician. The statutes direct the MEB to promulgate rules
implementing this requirement. Those rules are found at Chapter Med. 18 of the
Wisconsin Administrative Code.
Under current law, there is no requirement that a mother be specifically informed
about possible negative effects to her infant of inducing labor or performing a Caesarean
section prior to full gestational term.
This bill prohibits a physician from performing an elective Caesarean section or an
elective procedure intended to induce labor in a woman before the completion of a
gestational period of 39 weeks unless the physician has first obtained the informed
consent of the woman. The bill specifies that a woman's consent is informed only if she
receives timely information orally and in person from the physician regarding potential
negative effects to the child of early delivery, including long-term learning and
behavioral problems.

Under the bill, persons who violate the newly created prohibition are subject to the
same penalties and discipline as persons who violate the duty to provide information on
alternate modes of treatment. Specifically, the MEB may warn or reprimand the
physician, or limit, suspend, or revoke any license, certificate, or limited permit granted
by the MEB to the physician.
The bill directs the MEB to promulgate rules implementing the provisions of the
newly created prohibition and to define "elective" for purposes of the prohibition.
The bill also prohibits a person licensed by the Board of Nursing (board) to practice
nurse-midwifery from performing an elective procedure intended to induce labor in a
woman before the completion of a gestational period of 39 weeks unless the
nurse-midwife has first obtained the informed consent of the woman. The bill specifies
that a woman's consent is informed only if she receives timely information regarding
potential negative effects to the child of early delivery, including long-term learning and
behavioral problems. A nurse-midwife who is found to have violated the prohibition may
be subject to discipline by the board, including the suspension, revocation or limiting of
the nurse-midwife's license.
SB532, s. 1 1Section 1. 48.983 (title) of the statutes is amended to read:
SB532,3,3 248.983 (title) Child abuse and neglect prevention and evidence-based
3home visitation
program.
SB532, s. 2 4Section 2. 48.983 (4) (a) 4m. of the statutes is amended to read:
SB532,3,105 48.983 (4) (a) 4m. To reimburse a case management provider under s. 49.45 (25)
6(b) for the amount of the allowable charges under the Medical Assistance program
7that is not provided by the federal government for case management services
8provided to a Medical Assistance beneficiary described in s. 49.45 (25) (am) 9. who
9is a child and who is a member of a family that receives evidence-based home
10visitation program services under par. (b) 1.
SB532, s. 3 11Section 3. 48.983 (4) (b) of the statutes is amended to read:
SB532,4,2312 48.983 (4) (b) Home Evidence-based home visitation program services. 1. A
13county, private agency, or Indian tribe that is selected to participate in the program
14under this section shall offer all pregnant women in the county, the area in which
15that private agency is providing services, or the reservation of the tribe who are
16eligible for Medical Assistance under subch. IV of ch. 49 an opportunity to undergo
17an assessment through use of a risk assessment instrument to determine whether

1the person assessed presents risk factors for poor birth outcomes or for perpetrating
2child abuse or neglect. Persons who agree to be assessed shall be assessed during
3the prenatal period. The risk assessment instrument shall be developed by the
4department and shall be based on risk assessment instruments developed by the
5department for similar programs that are in operation. The department need not
6promulgate as rules under ch. 227 the risk assessment instrument developed under
7this subdivision. A person who is assessed to be at risk of poor birth outcomes or of
8abusing or neglecting his or her child shall be offered evidence-based home visitation
9program services that shall be commenced during the prenatal period. Home
10Evidence-based home visitation program services may be provided to a family with
11a child identified as being at risk of child abuse or neglect until the identified child
12reaches 3 years of age. If a family has been receiving evidence-based home visitation
13program services continuously for not less than 12 months, those services may
14continue to be provided to the family until the identified child reaches 3 years of age,
15regardless of whether the child continues to be eligible for Medical Assistance under
16subch. IV of ch. 49. If risk factors for child abuse or neglect with respect to the
17identified child continue to be present when the child reaches 3 years of age,
18evidence-based home visitation program services may be provided until the
19identified child reaches 5 years of age. Home Evidence-based home visitation
20program services may not be provided to a person unless the person gives his or her
21written informed consent to receiving those services or, if the person is a child, unless
22the child's parent, guardian, or legal custodian gives his or her written informed
23consent for the child to receive those services.
SB532,5,224 1m. No person who is required or permitted to report suspected or threatened
25abuse or neglect under s. 48.981 (2) may make or threaten to make such a report

1based on a refusal of a person to receive or to continue receiving evidence-based
2home visitation program services under subd. 1.
SB532,5,63 3. A county, private agency, or Indian tribe that is providing evidence-based
4home visitation program services under subd. 1. shall provide to a person receiving
5those services the information relating to shaken baby syndrome and impacted
6babies required under s. 253.15 (6).
SB532, s. 4 7Section 4. 48.983 (6) (a) (intro.) of the statutes is amended to read:
SB532,5,108 48.983 (6) (a) (intro.) The part of an application, other than a renewal
9application, submitted by a county, private agency, or Indian tribe that relates to
10evidence-based home visitation programs shall include all of the following:
SB532, s. 5 11Section 5. 48.983 (6) (a) 1. of the statutes is amended to read:
SB532,5,1812 48.983 (6) (a) 1. Information on how the applicant's home visitation program
13is evidence-based, comprehensive, incorporates practice standards that have been
14developed for home visitation programs by entities concerned with the prevention of
15poor birth outcomes and child abuse and neglect and that are acceptable to the
16department, and incorporates practice standards and critical elements that have
17been developed for successful home visitation programs by a nationally recognized
18home visitation program model and that are acceptable to the department.
SB532, s. 6 19Section 6. 48.983 (6) (a) 2. of the statutes is amended to read:
SB532,5,2520 48.983 (6) (a) 2. Documentation that the application was developed through
21collaboration among public and private organizations that provide services to
22children and families, especially children who are at risk of child abuse or neglect and
23families that are at risk of poor birth outcomes, or that are otherwise interested in
24child welfare and a description of how that collaboration effort will support a
25comprehensive, evidence-based home visitation program.
SB532, s. 7
1Section 7. 48.983 (6) (a) 3. of the statutes is amended to read:
SB532,6,62 48.983 (6) (a) 3. An identification of existing poor birth outcome and child abuse
3and neglect prevention services that are available to residents of the county, the area
4in which the private agency is providing services, or the reservation of the Indian
5tribe and a description of how those services and any additional needed services will
6support a comprehensive, evidence-based home visitation program.
SB532, s. 8 7Section 8. 48.983 (6) (a) 4. of the statutes is amended to read:
SB532,6,118 48.983 (6) (a) 4. An explanation of how the evidence-based home visitation
9program will build on existing poor birth outcome and child abuse and neglect
10prevention programs, including programs that provide support to families, and how
11the evidence-based home visitation program will coordinate with those programs.
SB532, s. 9 12Section 9. 48.983 (6) (a) 4m. of the statutes is amended to read:
SB532,6,1513 48.983 (6) (a) 4m. An explanation of how the applicant will encourage private
14organizations to provide services under the applicant's evidence-based home
15visitation program.
SB532, s. 10 16Section 10. 48.983 (6) (a) 6. of the statutes is amended to read:
SB532,6,2117 48.983 (6) (a) 6. An identification of how the evidence-based home visitation
18program is comprehensive and incorporates the practice standards and critical
19elements for successful home visitation programs referred to in subd. 1., including
20how services will vary in intensity levels depending on the needs and strengths of the
21participating family.
SB532, s. 11 22Section 11. 48.983 (6) (a) 6m. of the statutes is amended to read:
SB532,6,2523 48.983 (6) (a) 6m. An explanation of how the services to be provided under the
24evidence-based home visitation program, including the risk assessment under sub.
25(4) (b) 1., will be provided in a culturally competent manner.
SB532, s. 12
1Section 12. 48.983 (6) (b) 1. of the statutes is amended to read:
SB532,7,122 48.983 (6) (b) 1. `Flexible fund for evidence-based home visitation programs.'
3The applicant demonstrates in the application that the applicant has established, or
4has plans to establish, if selected, a fund from which payments totaling not less than
5$250 per calendar year may be made for appropriate expenses of each family that is
6participating in the evidence-based home visitation program under sub. (4) (b) 1. or
7that is receiving home visitation services under s. 49.45 (44). The payments shall be
8authorized by an individual designated by the applicant. If an applicant makes a
9payment to or on behalf of a family under this subdivision, one-half of the payment
10shall be from grant moneys received under this section and one-half of the payment
11shall be from moneys provided by the applicant from sources other than grant
12moneys received under this section.
SB532, s. 13 13Section 13. 48.983 (6) (c) of the statutes is amended to read:
SB532,7,1914 48.983 (6) (c) Case management benefit. The applicant states in the grant
15application that it has elected, or, if selected, that it will elect, under s. 49.45 (25) (b),
16to make the case management benefit under s. 49.45 (25) available to the category
17of beneficiaries under s. 49.45 (25) (am) 9. who are children and who are members
18of families receiving evidence-based home visitation program services under sub. (4)
19(b) 1.
SB532, s. 14 20Section 14. 48.983 (6g) (a) and (b) of the statutes are amended to read:
SB532,8,521 48.983 (6g) (a) Except as permitted or required under s. 48.981 (2), no person
22may use or disclose any information concerning any individual who is selected for an
23assessment under sub. (4) (b), including an individual who declines to undergo the
24assessment, or concerning any individual who is offered services under a an
25evidence-based
home visitation program funded under this section, including an

1individual who declines to receive those services, unless the use or disclosure is
2connected with the administration of the evidence-based home visitation program
3or the administration of the Medical Assistance program under ss. 49.43 to 49.497
4or unless the individual has given his or her written informed consent to the use or
5disclosure.
SB532,8,116 (b) A county, private agency, or Indian tribe that is selected to participate in the
7program under this section shall provide or shall designate an individual or entity
8to provide an explanation of the confidentiality requirements under par. (a) to each
9individual who is offered an assessment under sub. (4) (b) or who is offered services
10under the evidence-based home visitation program of the county, private agency, or
11Indian tribe.
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