LRB-2351/1
TJD&KP:amn
2021 - 2022 LEGISLATURE
March 5, 2021 - Introduced by Representatives VanderMeer, Loudenbeck,
Sortwell and Kurtz. Referred to Committee on Health.
AB148,1,4
1An Act to create 49.45 (3) (e) 9m., 49.45 (4r), 50.33 (2d), 50.36 (5m), 50.49 (6m)
2(d) and 440.094 of the statutes;
relating to: state response to COVID-19
3related to health services and practice of health care providers licensed outside
4of this state.
Analysis by the Legislative Reference Bureau
Medical Assistance payment for hospitals for nursing facility care
This bill requires the Department of Health Services to provide reimbursement
or a supplemental payment to hospitals under the Medical Assistance program for
providing nursing-facility-level custodial care. To receive reimbursement or a
supplemental payment, the hospital must notify DHS that it is participating as a
swing bed hospital under the Medical Assistance program and providing custodial
care for which federal financial participation is approved to an individual who is
eligible for discharge after receiving inpatient care in the hospital, who needs
nursing-facility-level care, and for whom the hospital is unable to locate a nursing
facility that accepts the individual for admission. If providing reimbursement
instead of a supplemental payment, DHS must pay the hospital the statewide
average per-diem rate paid to nursing facilities. DHS must use the same standards
and eligibility criteria as the federal Medicare program uses to determine
reimbursement for swing beds or, for hospitals that are not critical access hospitals,
the terms of a federal waiver issued during the federally declared national
emergency related to the 2019 novel coronavirus. This requirement to reimburse
hospitals for providing nursing facility care applies until January 1, 2022, or until
the termination of any public health emergency declared by the secretary of the
federal Department of Health and Human Services related to the 2019 novel
coronavirus, whichever is earlier.
Payment for outpatient services provided by hospitals
The bill requires DHS to provide reimbursement or a supplemental payment
through the Medical Assistance program to a hospital for services provided on an
outpatient basis that are usually reimbursed when provided at the hospital's
inpatient facility but are provided at the hospital's outpatient facility due to the 2019
novel coronavirus pandemic. To receive reimbursement or supplemental payment
under the bill, the outpatient services must be approved for federal financial
participation and must be provided in a facility that is operated by the hospital and
is certified for outpatient services under the federal Medicare program, including
under the terms of a federal waiver issued during the federally declared national
emergency related to the 2019 novel coronavirus. DHS must seek any federal
approval necessary to provide the reimbursement or supplemental payment. The
payment requirement applies until the conclusion of a public health emergency
declared by the secretary of the federal Department of Health and Human Services
in response to the 2019 novel coronavirus or until January 1, 2022, whichever is
earlier.
Utilization data in the Medical Assistance program
The bill requires DHS to provide, semiannually, to any health care data
aggregator all fee-for-service and managed care encounter claims data and data
specifications for the Medical Assistance program. A health care data aggregator is
a data organization or entity that collects, analyzes, and disseminates health care
information under current law and requests that DHS provide the data to it. Current
law provides that a data organization contracts with the state to analyze and report
health care claims information collected from insurers and administrators and
provides that an entity is under contract to collect, analyze, and disseminate claims
and other health information from hospitals and ambulatory surgery centers. Either
the data organization, the entity, or both could be a health care data aggregator
under the bill.
Under the bill, after DHS provides a health care data aggregator with the
Medical Assistance data, the health care data aggregator, within five days or a longer
period specified by DHS, must create a data set with information from which has
been eliminated the ability to trace the information back to a specific patient and
then destroy the original data. Once the patient information cannot be traced back
to a specific patient the information is known as de-identified health information.
The health care data aggregator must make the de-identified data set available to
the public and may disseminate custom data sets and reports containing
de-identified health information. This de-identified health information must meet
the requirements in the federal Health Insurance Portability and Accountability
Act, or HIPAA, for ensuring that patient information is not individually identifiable.
HIPAA generally requires that health information that identifies a specific
individual be kept confidential except for treatment, billing, and other limited
purposes but allows the use of health information if it cannot identify the individual.
The health care data aggregator, in its treatment of the Medical Assistance data
received under the bill, must comply with the same patient confidentiality
requirements as apply to its collection of data under current law.
Hospital services provided in a home setting
The bill specifies standards for certain services provided by hospitals in a home
setting and reimbursement under the Medical Assistance program for those
services. These “hospital-associated services” are defined in the bill as health care
services that are the same type of services as those provided by a hospital in an
inpatient or outpatient facility, that are of the type for which a federal Medicare
payment could be claimed as a hospital service, and that are provided in a home
setting and not in a setting that is approved as a hospital by DHS. If the federal
Centers of Medicare and Medicaid Services (CMS) has approved a hospital to provide
any hospital-associated service, DHS may apply and enforce as the state standard
for the service the CMS rule or standard on the hospital. A hospital that complies
with the bill is not required to be licensed as a home health agency to provide
hospital-associated services.
The Medical Assistance program is a joint federal and state program that
provides health services to individuals who have limited financial resources, and the
Medical Assistance program certifies and provides reimbursement to providers,
including hospitals, for those health services that are covered by the program. The
bill specifies that hospital-associated services provided by a hospital in accordance
with the bill and that are of the type for which Medicare payment could be claimed
as inpatient hospital services must be included and reimbursed or paid as inpatient
services under the Medical Assistance program. All of the bill's provisions regarding
services provided by a hospital in a home setting apply only before January 1, 2022.
Practice by health care providers from other states
The bill authorizes, in certain situations, health care providers licensed in
another state or territory to provide services for which they are licensed or certified.
Under the bill, a person who satisfies certain requirements and holds a valid,
unexpired credential in another state or territory as any of the following may provide
services in this state: 1) a physician, physician assistant, or perfusionist; 2) a nurse;
3) a dentist; 4) a pharmacist; 5) a psychologist; 6) a social worker, marriage and
family therapist, professional counselor, or clinical substance abuse counselor; 7) a
chiropractor; 8) a physical therapist; 9) a podiatrist; 10) a dietitian; 11) an athletic
trainer; 12) an occupational therapist; 13) an optometrist; 14) an acupuncturist; 15)
a speech-language pathologist or audiologist; or 16) a massage or bodywork
therapist. Generally, these practitioners may practice in this state and the
Department of Safety and Professional Services must grant them a temporary
credential if they apply for a temporary credential within 30 days of beginning to
practice for a health care employer.
The bill also specifies that a health care provider granted a temporary
credential under the bill may provide services through telehealth to a patient located
in this state.
Current law generally prohibits a person from engaging in certain health
care–related practices without holding a required credential.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB148,1
1Section
1. 49.45 (3) (e) 9m. of the statutes is created to read:
AB148,4,32
49.45
(3) (e) 9m. a. In this subdivision, “hospital-associated service” has the
3meaning given in s. 50.33 (2d).
AB148,4,84
b. Before January 1, 2022, any hospital-associated service that is provided by
5a hospital in accordance with s. 50.36 (5m) that is of the type for which payment could
6be claimed as an inpatient hospital service under the federal Medicare program,
42
7USC 1395 et seq., shall be included as part of and reimbursed or paid as an inpatient
8service under this section.
AB148,2
9Section
2. 49.45 (4r) of the statutes is created to read:
AB148,4,1310
49.45
(4r) Utilization data. (a) In this subsection, “health care data
11aggregator” means a data organization or entity that collects, analyzes, and
12disseminates health care information under subch. I of ch. 153 and that requests the
13department to provide data under this subsection.
AB148,4,1614
(b) Semiannually, the department shall provide to any health care data
15aggregator all Medical Assistance program fee-for-service and managed care
16encounter claims data and data specifications maintained by the department.
AB148,5,417
(c) Within 5 business days or a longer period specified by the department, of the
18receipt of data under par. (b), a health care data aggregator shall create a data set
19from the data received that is de-identified health information, as described in
42
20CFR 164.514 (a), and that meets the requirements for de-identification described in
2142 CFR 164.514 (b) and then shall destroy the original data provided by the
1department under par. (b). The health care data aggregator shall make the
2de-identified data set available to the public and may disseminate custom data sets
3and reports if the data sets and reports contain only de-identified health
4information.
AB148,5,95
(d) Data provided by the department to a health care data aggregator under
6par. (b) are not subject to inspection or copying under s. 19.35. A health care data
7aggregator shall comply with the requirements under s. 153.50 (3) to ensure
8protection of patient identity with regard to data received and made available or
9disseminated under this subsection.
AB148,3
10Section
3. 50.33 (2d) of the statutes is created to read:
AB148,5,1211
50.33
(2d) “Hospital-associated service” means a health care service that
12meets all of the following conditions:
AB148,5,1413
(a) The service is of the same type as those furnished by a hospital in an
14inpatient or outpatient facility.
AB148,5,1615
(b) The service is of a type for which a payment could be claimed as a hospital
16service under the federal Medicare program,
42 USC 1395 et seq.
AB148,5,1817
(c) The service is provided at a location other than in a facility approved by the
18department under s. 50.35.
AB148,5,1919
(d) The service is provided in a home setting before January 1, 2022.
AB148,4
20Section
4. 50.36 (5m) of the statutes is created to read:
AB148,6,221
50.36
(5m) If the federal centers for medicare and medicaid services has
22approved a hospital to provide any hospital-associated service, the department may
23apply to and enforce upon the hospital as the state standard for the
24hospital-associated service any rule or standard that is required by the centers for
1medicare and medicaid services for the service. This subsection does not apply on
2or after January 1, 2022.
AB148,5
3Section
5. 50.49 (6m) (d) of the statutes is created to read:
AB148,6,54
50.49
(6m) (d) A hospital that is providing hospital-associated services in
5accordance with s. 50.36 (5m).
AB148,6
6Section
6. 440.094 of the statutes is created to read:
AB148,6,8
7440.094 Practice by health care providers from other states. (1) 8Definitions. In this section:
AB148,6,99
(a) “Credential” means a license, permit, certificate, or registration.
AB148,6,1210
(b) “Health care employer” means a system, care clinic, care provider,
11long-term care facility, or any entity whose employed, contracted, or affiliated staff
12provide health care service to individuals in this state.
AB148,6,1613
(c) “Health care provider” means an individual who holds a valid, unexpired
14credential granted by another state or territory that authorizes or qualifies the
15individual to perform acts that are substantially the same as the acts that any of the
16following are licensed or certified to perform:
AB148,6,1817
1. A registered nurse, licensed practical nurse, or nurse midwife licensed under
18ch. 441, or advanced practice nurse prescriber certified under ch. 441.
AB148,6,1919
2. A chiropractor licensed under ch. 446.
AB148,6,2020
3. A dentist licensed under ch. 447.
AB148,6,2221
4. A physician, physician assistant, perfusionist, or respiratory care
22practitioner licensed or certified under subch. II of ch. 448.
AB148,6,2423
5. A physical therapist or physical therapist assistant licensed under subch. III
24of ch. 448 or who holds a compact privilege under subch. IX of ch. 448.
AB148,6,2525
6. A podiatrist licensed under subch. IV of ch. 448.
AB148,7,1
17. A dietitian certified under subch. V of ch. 448.
AB148,7,22
8. An athletic trainer licensed under subch. VI of ch. 448.
AB148,7,43
9. An occupational therapist or occupational therapy assistant licensed under
4subch. VII of ch. 448.
AB148,7,55
10. An optometrist licensed under ch. 449.
AB148,7,66
11. A pharmacist licensed under ch. 450.
AB148,7,77
12. An acupuncturist certified under ch. 451.
AB148,7,88
13. A psychologist licensed under ch. 455.
AB148,7,119
14. A social worker, marriage and family therapist, or professional counselor
10certified or licensed under ch. 457 or a clinical substance abuse counselor certified
11under s. 440.88.
AB148,7,1312
15. A speech-language pathologist or audiologist licensed under subch. II of ch.
13459.
AB148,7,1414
16. A massage therapist or bodywork therapist licensed under ch. 460.
AB148,7,22
15(2) Practice by health care providers from other states. (a)
16Notwithstanding ss. 441.06 (4), 441.15 (2), 441.16, 446.02 (1), 447.03 (1) and (2),
17448.03 (1) (a), (b), and (c) and (1m), 448.51 (1), 448.61, 448.76, 448.961 (1) and (2),
18449.02 (1), 450.03 (1), 451.04 (1), 455.02 (1m), 457.04 (4), (5), (6), and (7), 459.02 (1),
19459.24 (1), and 460.02, a health care provider may provide services within the scope
20of the credential that the health care provider holds and the department shall grant
21the health care provider a temporary credential to practice under this section if all
22of the following apply:
AB148,8,223
1. The health care provider applies to the department for a temporary
24credential under this section within 30 days of beginning to provide health care
1services for a health care employer. The health care provider shall include in the
2application an attestation of all of the following:
AB148,8,43
a. The date on which the health care provider first provided health care services
4in this state under this section.
AB148,8,65
b. That the health care provider holds a valid, unexpired credential granted in
6another state.