AB754: Bill Text

Under current law, a 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 those treatments. A physician who violates this requirement is guilty of unprofessional conduct and may be subject to discipline by the Medical Examining Board (MEB), which may warn or reprimand the physician, or limit, suspend, or revoke his or her license to practice medicine and surgery. Current law requires the MEB to promulgate rules implementing these informed consent requirements.

The bill specifically prohibits a physician from performing an elective caesarean section on a pregnant woman, and prohibits a physician or a nurse-midwife from performing an elective procedure intended to induce labor in a pregnant 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 provides that a woman's consent is informed only if she receives timely information orally and in person from the physician or nurse-midwife regarding potential negative effects to the fetus of early delivery, including long-term learning and behavioral problems. Under the bill, a physician who violates the prohibition in the bill is guilty of unprofessional conduct and may be subject to the same disciplinary consequences as violations of the informed consent provisions under current law. The Board of Nursing may similarly revoke, limit, suspend, or deny renewal of the license of a nurse-midwife who violates the prohibition. The bill directs the MEB to promulgate rules implementing the provisions of the newly created prohibition and directs both the MEB and the Board of Nursing to promulgate rules defining "elective" for purposes of the prohibition in the bill.

Evidence-based home visitation services

Under current law, the Department of Children and Families (DCF) administers the Child Abuse and Neglect Prevention Program under which DCF awards grants to counties, private agencies, and Indian tribes that offer voluntary home visitation services to parents who are eligible for MA and who are at risk of poor birth outcomes or of perpetrating child abuse or neglect. Current law requires a grant applicant to provide information on how the applicant's home visitation program incorporates: 1) practice standards that have been developed for home visitation programs by entities concerned with the prevention of poor birth outcomes and child abuse and neglect; and 2) practice standards and critical elements that have been developed for successful home visitation programs by a nationally recognized home visitation program model.

This bill specifies that home visitation program services provided by a county, private agency, or Indian tribe under a child abuse and neglect prevention grant from DCF must be evidence-based. The bill also requires DCF to enter into a memorandum of understanding with DHS that provides for collaboration between DCF and DHS in carrying out those evidence-based home visitation program services.

Neonatal intensive care unit reports

The bill requires DHS to collect all of the following information from a hospital that has a neonatal intensive care unit: 1) the daily census of the neonatal intensive care unit; and 2) the criteria for admission to the neonatal intensive care unit. DHS must annually prepare a report that includes all of the information collected from hospitals from the previous calendar year. DHS must make the reports available to the public and post the report on its Internet site.

Best practices for postpartum patients and newborns at hospitals

The bill requires DHS to promulgate rules requiring hospitals to ensure that best practices for postpartum patients and newborns are supported in the hospital, including rules that: 1) require hospitals to develop, for each postpartum patient, an appropriate discharge plan that ensures that, to the extent practicable, an appointment with a health care provider has been scheduled for the newborn within an appropriate time after discharge and that the postpartum patient is consulted and provided with assistance regarding health care resources and safe transportation for the newborn; 2) require, prior to discharge from the hospital, that education be provided, orally and in person, to each postpartum patient on certain topics; and 3) require that health care providers, including physicians, recommend and actively support breastfeeding for all newborns for whom breastfeeding is not medically contraindicated; provide parents with complete, up-to-date information to ensure that feeding decisions are fully informed; and provide, upon a parent's request, referrals to lactation specialists or public health nurses for home visits.

Cultural competency training for students at higher educational institutions

The bill directs the University of Wisconsin System Board of Regents and the Technical College System Board to ensure that students enrolled in health care or social work programs receive training in cultural competency to improve patient-centered care.

Indication of race on birth certificates

The bill requires a birth certificate to include the race and ethnicity of the child, as reported by the mother of the registrant, and requires DHS to promulgate rules establishing designations of race and ethnicity to be used for reporting race and ethnicity. The bill provides that the designations must be sufficiently detailed to enable compilation and analysis of data related to births and birth outcomes among all significant racial and ethnic populations in the state and to assist in the design and evaluation of programs and policies designed to improve birth outcomes. In addition, the rules must establish procedures to ensure that the racial and ethnic designations included on each certificate of birth accurately reflect the race and ethnicity of the registrant as directly reported by the child's mother.

Fetal and infant mortality and birth outcome report

The bill requires DHS to annually prepare a report relating to fetal and infant mortality and birth outcomes in this state. The report must include data related to births and birth outcomes in this state in the previous calendar year and an analysis of that data. DHS must collaborate with local health departments, tribes, and other interested parties about the data and the report. DHS must ensure that the report, to the greatest extent possible, includes data and analysis that are necessary and useful for the development and evaluation of programs to address disparities in birth outcomes among racial and ethnic groups in this state and must periodically consult with interested parties to review and update the data and analysis to be included in the report as needed to ensure that this goal continues to be met.

DHS must include certain specified information about infant births and deaths in the annual report and must, in collaboration with the aforementioned persons and entities, consider including in the report data related to the type of prenatal care, if any, received by the mother of each infant whose birth data is included in the report.

DHS must annually submit the report to the appropriate standing committees of the legislature; post the report on its Internet site; and post, on its Internet site, the raw data used for the report in a manner that does not disclose or enable the identification of any individual infant, mother, or birth attendant.

Finally, DHS must explore whether any of the costs of collecting the data and creating the annual report may be funded by the MA program.

For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB754,1 Section 1. 36.25 (54) of the statutes is created to read:

AB754,7,10 36.25 (54) Cultural competency training. The board shall ensure that all students enrolled in the University of Wisconsin-Madison School of Medicine and Public Health, or in any program providing instruction for a health care or social work occupation, receive training in cultural competency to improve patient-centered care, which shall include evidence-based training related to implicit bias and emerging evidence related to cultural humility, in order to increase the students' cultural awareness and to improve the students' ability to communicate with, and effectively deliver health care to, patients from different racial and ethnic backgrounds.

AB754,2 Section 2. 38.04 (33) of the statutes is created to read:

AB754,8,7 38.04 (33) Cultural competency training. The board shall ensure that technical college students enrolled in health care occupation programs receive training in cultural competency to improve patient-centered care, which shall include evidence-based training related to implicit bias and emerging evidence related to cultural humility, in order to increase the students' cultural awareness and to improve the students' ability to communicate with, and effectively deliver health care to, patients from different racial and ethnic backgrounds.

AB754,3 Section 3. 48.983 (4) (a) 4m. of the statutes is amended to read:

AB754,8,14 48.983 (4) (a) 4m. To reimburse a case management provider under s. 49.45 (25) (b) for the amount of the allowable charges under the Medical Assistance program that is not provided by the federal government for case management services provided to a Medical Assistance beneficiary described in s. 49.45 (25) (am) 9. who is a child and who is a member of a family that receives evidence-based home visitation program services under par. (b) 1.

AB754,4 Section 4. 48.983 (4) (b) of the statutes is amended to read:

AB754,9,19 48.983 (4) (b) Home Evidence-based home visitation program services. 1. A county, private agency, or Indian tribe that is selected to participate in the program under this section shall offer all pregnant women in the county, the area in which that private agency is providing services, or the reservation of the tribe who are eligible for Medical Assistance under subch. IV of ch. 49 an opportunity to undergo an assessment through use of a risk assessment instrument to determine whether the person assessed presents risk factors for poor birth outcomes or for perpetrating child abuse or neglect. Persons who agree to be assessed shall be assessed during the prenatal period. The risk assessment instrument shall be developed by the department and shall be based on risk assessment instruments developed by the department for similar programs that are in operation. The department need not promulgate as rules under ch. 227 the risk assessment instrument developed under this subdivision. A person who is assessed to be at risk of poor birth outcomes or of abusing or neglecting his or her child shall be offered evidence-based home visitation program services that shall be commenced during the prenatal period. Home Evidence-based home visitation program services may be provided to a family with a child identified as being at risk of child abuse or neglect until the identified child reaches 3 years of age. If a family has been receiving evidence-based home visitation program services continuously for not less than 12 months, those services may continue to be provided to the family until the identified child reaches 3 years of age, regardless of whether the child continues to be eligible for Medical Assistance under subch. IV of ch. 49. If risk factors for child abuse or neglect with respect to the identified child continue to be present when the child reaches 3 years of age, evidence-based home visitation program services may be provided until the identified child reaches 5 years of age. Home Evidence-based home visitation program services may not be provided to a person unless the person gives his or her written informed consent to receiving those services or, if the person is a child, unless the child's parent, guardian, or legal custodian gives his or her written informed consent for the child to receive those services.

AB754,9,23 1m. No person who is required or permitted to report suspected or threatened abuse or neglect under s. 48.981 (2) may make or threaten to make such a report based on a refusal of a person to receive or to continue receiving evidence-based home visitation program services under subd. 1.

AB754,9,25 3. A county, private agency, or Indian tribe that is providing evidence-based home visitation program services under subd. 1. shall provide to a person receiving those services the information relating to shaken baby syndrome and impacted babies required under s. 253.15 (6).

AB754,5 Section 5. 48.983 (6) (a) (intro.) of the statutes is amended to read:

AB754,10,6 48.983 (6) (a) (intro.) The part of an application, other than a renewal application, submitted by a county, private agency, or Indian tribe that relates to evidence-based home visitation programs shall include all of the following:

AB754,6 Section 6. 48.983 (6) (a) 1. of the statutes is amended to read:

AB754,10,14 48.983 (6) (a) 1. Information on how the applicant's home visitation program is evidence-based, comprehensive, incorporates practice standards that have been developed for home visitation programs by entities concerned with the prevention of poor birth outcomes and child abuse and neglect and that are acceptable to the department, and incorporates practice standards and critical elements that have been developed for successful home visitation programs by a nationally recognized home visitation program model and that are acceptable to the department.

AB754,7 Section 7. 48.983 (6) (a) 2. of the statutes is amended to read:

AB754,10,21 48.983 (6) (a) 2. Documentation that the application was developed through collaboration among public and private organizations that provide services to children and families, especially children who are at risk of child abuse or neglect and families that are at risk of poor birth outcomes, or that are otherwise interested in child welfare and a description of how that collaboration effort will support a comprehensive, evidence-based home visitation program.

AB754,8 Section 8. 48.983 (6) (a) 3. of the statutes is amended to read:

AB754,11,2 48.983 (6) (a) 3. An identification of existing poor birth outcome and child abuse and neglect prevention services that are available to residents of the county, the area in which the private agency is providing services, or the reservation of the Indian tribe and a description of how those services and any additional needed services will support a comprehensive, evidence-based home visitation program.

AB754,9 Section 9. 48.983 (6) (a) 4. of the statutes is amended to read:

AB754,11,7 48.983 (6) (a) 4. An explanation of how the evidence-based home visitation program will build on existing poor birth outcome and child abuse and neglect prevention programs, including programs that provide support to families, and how the evidence-based home visitation program will coordinate with those programs.

AB754,10 Section 10. 48.983 (6) (a) 4m. of the statutes is amended to read:

AB754,11,11 48.983 (6) (a) 4m. An explanation of how the applicant will encourage private organizations to provide services under the applicant's evidence-based home visitation program.

AB754,11 Section 11. 48.983 (6) (a) 6. of the statutes is amended to read:

AB754,11,17 48.983 (6) (a) 6. An identification of how the evidence-based home visitation program is comprehensive and incorporates the practice standards and critical elements for successful home visitation programs referred to in subd. 1., including how services will vary in intensity levels depending on the needs and strengths of the participating family.

AB754,12 Section 12. 48.983 (6) (a) 6m. of the statutes is amended to read:

AB754,11,21 48.983 (6) (a) 6m. An explanation of how the services to be provided under the evidence-based home visitation program, including the risk assessment under sub. (4) (b) 1., will be provided in a culturally competent manner.

AB754,13 Section 13. 48.983 (6) (b) 1. of the statutes is amended to read:

AB754,12,8 48.983 (6) (b) 1. `Flexible fund for evidence-based home visitation programs.' The applicant demonstrates in the application that the applicant has established, or has plans to establish, if selected, a fund from which payments totaling not less than $250 per calendar year may be made for appropriate expenses of each family that is participating in the evidence-based home visitation program under sub. (4) (b) 1. or that is receiving home visitation services under s. 49.45 (44). The payments shall be authorized by an individual designated by the applicant. If an applicant makes a payment to or on behalf of a family under this subdivision, one-half of the payment shall be from grant moneys received under this section and one-half of the payment shall be from moneys provided by the applicant from sources other than grant moneys received under this section.

AB754,14 Section 14. 48.983 (6) (c) of the statutes is amended to read:

AB754,12,15 48.983 (6) (c) Case management benefit. The applicant states in the grant application that it has elected, or, if selected, that it will elect, under s. 49.45 (25) (b), to make the case management benefit under s. 49.45 (25) available to the category of beneficiaries under s. 49.45 (25) (am) 9. who are children and who are members of families receiving evidence-based home visitation program services under sub. (4) (b) 1.

AB754,15 Section 15. 48.983 (6g) (a) and (b) of the statutes are amended to read:

AB754,13,2 48.983 (6g) (a) Except as permitted or required under s. 48.981 (2), no person may use or disclose any information concerning any individual who is selected for an assessment under sub. (4) (b), including an individual who declines to undergo the assessment, or concerning any individual who is offered services under a an evidence-based home visitation program funded under this section, including an individual who declines to receive those services, unless the use or disclosure is connected with the administration of the evidence-based home visitation program or the administration of the Medical Assistance program under ss. 49.43 to 49.497 or unless the individual has given his or her written informed consent to the use or disclosure.

AB754,13,8 (b) A county, private agency, or Indian tribe that is selected to participate in the program under this section shall provide or shall designate an individual or entity to provide an explanation of the confidentiality requirements under par. (a) to each individual who is offered an assessment under sub. (4) (b) or who is offered services under the evidence-based home visitation program of the county, private agency, or Indian tribe.

AB754,16 Section 16. 48.983 (6m) of the statutes is amended to read:

AB754,13,18 48.983 (6m) Notification of parent prior to making abuse or neglect report. If a person who is providing services under a an evidence-based home visitation program under sub. (4) (b) 1. determines that he or she is required or permitted to make a report under s. 48.981 (2) about a child in a family to which the person is providing those services, the person shall, prior to making the report under s. 48.981 (2), make a reasonable effort to notify the child's parent that a report under s. 48.981 (2) will be made and to encourage the parent to contact a county department to request assistance. The notification requirements under this subsection do not affect the reporting requirements under s. 48.981 (2).

AB754,17 Section 17. 48.983 (6r) of the statutes is amended to read:

AB754,13,24 48.983 (6r) Home Evidence-based home visitation program informational materials. Any informational materials about a an evidence-based home visitation program under sub. (4) (b) 1. that are distributed to a person who is offered or who is receiving home visitation program services under that program shall state the sources of funding for the program.

AB754,18 Section 18. 48.983 (7) (title) and (a) (intro.) of the statutes are amended to read:

AB754,14,7 48.983 (7) (title) Home Evidence-based home visitation program evaluation. (a) (intro.) The department shall conduct or shall select an evaluator to conduct an evaluation of the evidence-based home visitation program. The evaluation shall measure all of the following criteria in families that have participated in the home visitation that program and that are selected for evaluation:

AB754,19 Section 19. 48.983 (7) (ag) of the statutes is amended to read:

AB754,14,13 48.983 (7) (ag) The department shall evaluate the availability of evidence-based home visitation programs in the state and determine whether there are gaps in evidence-based home visitation services in the state. The department shall cooperate with counties, private agencies, and Indian tribes providing evidence-based home visitation programs to address any gaps in services identified.

AB754,20 Section 20. 48.983 (7) (ar) of the statutes is amended to read:

AB754,14,19 48.983 (7) (ar) Each county, private agency, and Indian tribe providing a an evidence-based home visitation program shall collect and report data to the department, as required by the department. The department shall require each county, private agency, and Indian tribe providing a an evidence-based home visitation program to collect data using forms prescribed by the department.

AB754,21 Section 21. 48.983 (7) (b) of the statutes is amended to read:

AB754,14,23 48.983 (7) (b) In the evaluation, the department shall determine the number of families who remained in the evidence-based home visitation program for the time recommended in the family's case plan.

AB754,22 Section 22. 48.983 (7) (c) of the statutes is amended to read:

AB754,15,9 48.983 (7) (c) Each county, private agency, and Indian tribe providing a an evidence-based home visitation program shall develop a plan for evaluating the effectiveness of its program for approval by the department. The plan shall demonstrate how the county, private agency, or Indian tribe will use the evaluation of its program to improve the quality and outcomes of the program and to ensure continued compliance with the home visitation program criteria under sub. (6) (a). The plan shall demonstrate how the outcomes will be tracked and measured. Under the plan, the extent to which all of the following outcomes are achieved shall be tracked and measured:

AB754,15,12 1. Parents receiving evidence-based home visitation services acquiring knowledge of early learning and child development and interacting with their children in ways that enhance the children's development and early learning.

AB754,15,13 2. Children receiving evidence-based home visitation services being healthy.

AB754,15,15 3. Children receiving evidence-based home visitation services living in a safe environment.

AB754,15,17 4. Families receiving evidence-based home visitation services accessing formal and informal support networks.

AB754,15,19 5. Children receiving evidence-based home visitation services achieving milestones in development and early learning.

AB754,15,21 6. Children receiving evidence-based home visitation services who have developmental delays receiving appropriate intervention services.

AB754,23 Section 23. 48.983 (8) of the statutes is amended to read:

AB754,16,5 48.983 (8) Technical assistance and training. The department shall provide technical assistance and training to counties, private agencies, and Indian tribes that are selected to participate in the program under this section. The training may not be limited to a particular evidence-based home visitation model. The training shall include training in best practices regarding basic skills, uniform administration of screening and assessment tools, the issues and challenges that families face, and supervision and personnel skills for program managers. The training may also include training on data collection and reporting.

AB754,24 Section 24. 48.983 (9) of the statutes is created to read:

AB754,16,10 48.983 (9) Memorandum of understanding. The department shall enter into a memorandum of understanding with the department of health services that provides for collaboration between those departments in carrying out evidence-based home visiting programs under sub. (4) (b) 1.

AB754,25 Section 25. 49.45 (24w) of the statutes is created to read:

AB754,16,24 49.45 (24w) Services for pregnant women. (a) The department shall request a waiver of federal Medicaid law from the secretary of the federal department of health and human services to permit the department to provide services and support under Medical Assistance for pregnant women who face an increased risk of having a low birth weight baby, a preterm birth, or other negative birth outcome because of medical or nonmedical factors, such as psychosocial, behavioral, environmental, educational, or nutritional factors. The department shall implement the programs and services authorized by this waiver in Milwaukee, Racine, Kenosha, Rock, and Dane counties, and in a rural multicounty region identified by the department in collaboration with the Great Lakes Intertribal Council. The multicounty region shall include counties experiencing the largest disparities in birth outcomes between Caucasian and Native American populations and shall be of sufficient size to enable meaningful implementation and evaluation of the programs and services.

AB754,17,2 (b) The department shall consider including all of the following as covered services or programs in the waiver request under par. (a):

AB754,17,5 1. Evidence-based social marketing of programs designed to reduce fetal and infant mortality, improve birth outcomes, and address needs of infants and their families.

AB754,17,7 2. Evidence-based social-support programs, including fatherhood initiatives designed to reduce fetal and infant mortality and improve birth outcomes.

AB754,17,11 3. Transportation services for persons who accompany a pregnant woman to prenatal appointments and transportation for the pregnant woman and her children to other destinations including social services offices and locations where child care is provided for her children.

AB754,17,15 4. Data collection, including the pregnancy risk assessment and monitoring system, fetal and infant mortality review, vital statistics information, information from Medical Assistance data and chart reviews, and an assessment of nonmedical factors that may contribute to poor birth outcomes.

AB754,17,18 5. Full reimbursement for evidence-based group prenatal care, such as a multifaceted model of care that integrates health assessment, education, and support into a unified program within a group setting.

AB754,17,19 6. Mental health services.

AB754,17,20 7. Smoking cessation services.