AB754: Bill Text

LRB-3724/1

MD/TD/FK/PG/GM/Ms:cjs:rs

2013 - 2014 LEGISLATURE

2013 Assembly BILL 754

February 11, 2014 - Introduced by Representatives Mason, Pasch, Milroy, Barnes, Johnson, Kolste, Ohnstad, Jorgensen, Hebl, Berceau, Goyke, Ringhand, Hulsey, Pope, Zamarripa, Richards, Shankland, Wright and Kahl, cosponsored by Senators Schultz, L. Taylor, Lehman, Wirch, T. Cullen, Carpenter and Harris. Referred to Committee on Health.

AB754,2,18 An Act to repeal 441.15 (1) (a) and 655.001 (7t) (b); to renumber and amend 655.001 (7t) and 655.001 (7t) (a); to amend 48.983 (4) (a) 4m., 48.983 (4) (b), 48.983 (6) (a) (intro.), 48.983 (6) (a) 1., 48.983 (6) (a) 2., 48.983 (6) (a) 3., 48.983 (6) (a) 4., 48.983 (6) (a) 4m., 48.983 (6) (a) 6., 48.983 (6) (a) 6m., 48.983 (6) (b) 1., 48.983 (6) (c), 48.983 (6g) (a) and (b), 48.983 (6m), 48.983 (6r), 48.983 (7) (title) and (a) (intro.), 48.983 (7) (ag), 48.983 (7) (ar), 48.983 (7) (b), 48.983 (7) (c), 48.983 (8), 71.07 (9e) (aj) (intro.), 253.15 (2), 253.15 (6), 253.15 (7) (e), 441.15 (2) (b), 441.15 (3) (c), 441.15 (4), 448.02 (3) (a), 619.04 (3), 655.002 (1) (a), 655.002 (1) (b) (intro.), 655.002 (1) (b) 1., 655.002 (1) (b) 2., 655.002 (1) (b) 3., 655.002 (1) (c), 655.002 (1) (d), 655.002 (1) (e), 655.002 (1) (em), 655.002 (2) (a), 655.002 (2) (b), 655.003 (1), 655.003 (3), 655.005 (2) (a), 655.005 (2) (a), 655.005 (2) (b), 655.23 (5m), 655.27 (3) (a) 4. and 655.27 (3) (b) 2m.; and to create 36.25 (54), 38.04 (33), 48.983 (9), 49.45 (24w), 49.815, 50.36 (2m), 50.36 (3i), 69.02 (2) (c), 69.14 (1) (i), 71.07 (9e) (h), 253.162, 253.18, 441.15 (1) (am), 441.15 (1) (c), 441.15 (4m), 448.35, 448.40 (2) (am), 655.001 (7t) (b), 655.001 (9c), 655.003 (4), 655.27 (3) (b) 2f. and 655.275 (5) (b) 3. of the statutes; relating to: expanding eligibility for the earned income tax credit; hospital best practices for postpartum patients and newborns; hospital staff privileges and written agreements required for nurse-midwives; coverage of nurse-midwives under the injured patients and families compensation fund; a report on information related to hospital neonatal intensive care units; an electronic application and information system to determine eligibility and register for public assistance programs; directing the Department of Health Services to request a Medical Assistance waiver; evidence-based home visitation program services for persons who are at risk of poor birth outcomes or of abusing or neglecting their children; designating race and ethnicity on birth certificates; a report on fetal and infant mortality and birth outcomes; requiring informed consent for performance on pregnant women of certain elective procedures prior to the full gestational term of a fetus; cultural competency training for certain students enrolled in the University of Wisconsin System and the technical college system; granting rule-making authority; and requiring the exercise of rule-making authority.

Analysis by the Legislative Reference Bureau

Medical Assistance programs and services

This bill requires the Department of Health Services (DHS) to request from the secretary of the federal Department of Health and Human Services a waiver of federal Medicaid law to permit DHS to provide services and support under the Medical Assistance (MA) program to pregnant women who face an increased risk of having a low birth weight baby, a preterm birth, or other negative birth outcome. DHS must implement the MA programs and services in Milwaukee, Racine, Kenosha, Rock, and Dane counties and in a rural multicounty region identified by DHS in collaboration with the Great Lakes Intertribal Council. The bill specifies certain services or programs that DHS must consider including in its Medicaid waiver request. DHS must evaluate the programs and services implemented under the waiver request and must develop a plan to implement the effective programs and services statewide. DHS must also consider prohibiting reimbursement under the MA program for elective induction of labor or cesarean sections performed before 39 weeks gestation, unless medically indicated.

Under federal law, the earned income tax credit (EITC) is a refundable tax credit for low-income workers. If the amount of the claim exceeds the worker's tax liability, the claimant receives a check for the excess amount from the Internal Revenue Service. The amount of the credit for which a claimant is eligible is based, in part, on the claimant's filing status and whether the claimant has no qualifying children, one qualifying child, or more than one qualifying child.

Under current law, the refundable Wisconsin EITC may be claimed in an amount equal to a certain percentage of the federal EITC. To be eligible for the Wisconsin EITC, an individual must have one or more qualifying children who have the same principal place of abode as the claimant.

Under this bill, an individual may claim the Wisconsin EITC even if, with regard to the child about whom the claim is made, the child does not have the same principal place of abode as the claimant and even if another person claims the federal and Wisconsin credits for that child, provided that the claimant meets a statutory definition of "parent" with respect to that child and provided that the claimant is subject to and in compliance with a child support order with respect to that child.

Written agreements required for nurse-midwives

Under current law, the Board of Nursing licenses nurse-midwives. Nurse-midwives are health care professionals authorized to practice nurse-midwifery, which is defined as the management of women's health care, pregnancy, childbirth, postpartum care for newborns, family planning, and gynecological services consistent with the standards of practice of the American College of Nurse-Midwives and the education, training, and experience of the nurse-midwife.

A nurse-midwife may only practice nurse-midwifery in a health care facility approved by the Board of Nursing, in collaboration with a physician with postgraduate training in obstetrics, and pursuant to a written agreement with that physician. A nurse-midwife who discovers evidence that any aspect of care involves any complication that jeopardizes the health or life of a newborn or mother (serious complication) must consult with the collaborating physician or the collaborating physician's designee, or make a referral as specified in the written agreement with the collaborating physician.

This bill does the following with respect to these provisions governing nurse-midwives:

1. Eliminates the restriction providing that a nurse-midwife may only practice in collaboration with a physician with postgraduate training in obstetrics.

2. Provides that, in the case of a serious complication, the nurse-midwife must instead consult with a qualified health care professional, as defined in the bill, or make a referral.

Hospital staff privileges for nurse-midwives and coverage of nurse-midwives under the injured patients and families compensation fund

Under current law, certain health care providers (covered health care providers), who meet certain criteria, are covered by the injured patients and families compensation fund (fund) for claims for damages for bodily injury or death due to acts or omissions of those covered health care providers. Any claims filed against a covered health care provider must follow the procedures and are subject to the restrictions in current law.

Covered health care providers, under current law, are required to maintain certain liability insurance or to qualify as a self-insurer. The insurance policy under which a covered health care provider is covered must meet certain requirements under current law. If the covered health care provider satisfies the requirements of current law, he or she is liable for malpractice for no more than the prescribed limits of a self-insured covered health care provider or no more than the maximum liability limit for which the covered health care provider is insured. The fund pays any portion of a medical malpractice claim against a covered health care provider that is in excess of the self-insured limits or the liability insurance limit, except if the damages for injury or death are caused by an intentional crime. Covered health care providers pay an annual assessment, which is deposited in the fund.

The bill adds nurse-midwives to the law pertaining to the fund and to the malpractice claims, and therefore, under the bill, nurse-midwives are covered by the fund and are subject to the restrictions to be covered by the fund.

The bill allows a hospital to grant to a licensed nurse-midwife who is covered under the injured patients and families compensation fund any hospital staff privilege that a hospital must afford to licensed physicians or podiatrists, including hospital staff privileges to admit, treat, and discharge any patient for whom a nurse-midwife is qualified to provide care.

Statewide systems for public assistance programs

Currently, DHS administers an electronic application and information system that enables a person to determine his or her eligibility for and register for multiple public assistance programs, including BadgerCare Plus, the Women, Infants and Children (WIC) program, and FoodShare. This bill requires DHS to expand the current electronic application and information system to include information regarding all programs designed to assist low-income persons, including housing assistance, rental assistance, and temporary child care assistance.

The bill also requires DHS to develop a statewide electronic data management and information system for all public assistance programs. Under the bill, the system must allow a person to register for multiple public assistance programs with a single application or registration. The system must also allow an administrator of a public assistance program to access data related to an individual that was previously collected for purposes of a different public assistance program. Finally, the system must provide automated individual care plans that identify service activities to address assessed risks and include a scheduling or referral component that identifies available providers for individuals' service needs.

Informed consent for certain elective caesarean section and labor-inducing procedures

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.