2013 - 2014 LEGISLATURE
February 3, 2014 - Introduced by Senators Schultz, L. Taylor, Lehman, Wirch, T.
, Carpenter and Harris, cosponsored by Representatives Mason,
Pasch, Milroy, Barnes, Johnson, Kolste, Ohnstad, Jorgensen, Hebl,
Berceau, Goyke, Ringhand, Hulsey, Pope, Zamarripa, Richards, Shankland
and Wright. Referred to Committee on Health and Human Services.
SB546,2,18 1An Act to repeal 441.15 (1) (a) and 655.001 (7t) (b); to renumber and amend
2655.001 (7t) and 655.001 (7t) (a); to amend 48.983 (4) (a) 4m., 48.983 (4) (b),
348.983 (6) (a) (intro.), 48.983 (6) (a) 1., 48.983 (6) (a) 2., 48.983 (6) (a) 3., 48.983
4(6) (a) 4., 48.983 (6) (a) 4m., 48.983 (6) (a) 6., 48.983 (6) (a) 6m., 48.983 (6) (b)
51., 48.983 (6) (c), 48.983 (6g) (a) and (b), 48.983 (6m), 48.983 (6r), 48.983 (7)
6(title) and (a) (intro.), 48.983 (7) (ag), 48.983 (7) (ar), 48.983 (7) (b), 48.983 (7)
7(c), 48.983 (8), 71.07 (9e) (aj) (intro.), 253.15 (2), 253.15 (6), 253.15 (7) (e), 441.15
8(2) (b), 441.15 (3) (c), 441.15 (4), 448.02 (3) (a), 619.04 (3), 655.002 (1) (a),
9655.002 (1) (b) (intro.), 655.002 (1) (b) 1., 655.002 (1) (b) 2., 655.002 (1) (b) 3.,
10655.002 (1) (c), 655.002 (1) (d), 655.002 (1) (e), 655.002 (1) (em), 655.002 (2) (a),
11655.002 (2) (b), 655.003 (1), 655.003 (3), 655.005 (2) (a), 655.005 (2) (a), 655.005
12(2) (b), 655.23 (5m), 655.27 (3) (a) 4. and 655.27 (3) (b) 2m.; and to create 36.25
13(54), 38.04 (33), 48.983 (9), 49.45 (24w), 49.815, 50.36 (2m), 50.36 (3i), 69.02 (2)
14(c), 69.14 (1) (i), 71.07 (9e) (h), 253.162, 253.18, 441.15 (1) (am), 441.15 (1) (c),

1441.15 (4m), 448.35, 448.40 (2) (am), 655.001 (7t) (b), 655.001 (9c), 655.003 (4),
2655.27 (3) (b) 2f. and 655.275 (5) (b) 3. of the statutes; relating to: expanding
3eligibility for the earned income tax credit; hospital best practices for
4postpartum patients and newborns; hospital staff privileges and written
5agreements required for nurse-midwives; coverage of nurse-midwives under
6the injured patients and families compensation fund; a report on information
7related to hospital neonatal intensive care units; an electronic application and
8information system to determine eligibility and register for public assistance
9programs; directing the Department of Health Services to request a Medical
10Assistance waiver; evidence-based home visitation program services for
11persons who are at risk of poor birth outcomes or of abusing or neglecting their
12children; designating race and ethnicity on birth certificates; a report on fetal
13and infant mortality and birth outcomes; requiring informed consent for
14performance on pregnant women of certain elective procedures prior to the full
15gestational term of a fetus; cultural competency training for certain students
16enrolled in the University of Wisconsin System and the technical college
17system; granting rule-making authority; and requiring the exercise of
18rule-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
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
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
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
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

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
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:
SB546,1 1Section 1. 36.25 (54) of the statutes is created to read: