LRB-5151/1
SWB/TJD/MIM:cdc
2021 - 2022 LEGISLATURE
February 2, 2022 - Introduced by Representatives Vining, Spreitzer, Riemer,
Andraca, Baldeh, Billings, Brostoff, Cabrera, Conley, Considine, Doyle,
Drake, Emerson, Goyke, Hebl, Hesselbein, Hintz, Hong, Ohnstad, S.
Rodriguez, Shankland, Shelton, Snodgrass, Stubbs, Subeck, Vruwink and
Sinicki, cosponsored by Senators Erpenbach, Agard, Bewley, Carpenter,
Larson, Roys and Smith. Referred to Committee on Insurance.
AB955,1,10
1An Act to repeal 49.45 (2p) and 49.45 (23);
to amend 20.435 (4) (jw), 49.45 (23b)
2(title), 49.45 (23b) (b), 49.45 (23b) (c), 49.45 (23b) (e), 49.471 (4) (a) 4. b., 49.686
3(3) (d), 103.025 (title), 103.10 (1) (c), 103.10 (2) (c), 103.10 (5) (a), 103.10 (8),
4103.10 (9) (a) and (b), 103.10 (9) (c) 4., 103.10 (9) (d) and 103.10 (12) (d); and
to
5create 16.34, 20.435 (4) (bu), 20.505 (1) (ft), 49.471 (1) (cr), 49.471 (4) (a) 8.,
649.471 (4g), 49.681, 103.025 (1) (bm), 103.025 (3), 103.10 (1) (dm), 103.10 (4m),
7609.887 and 632.895 (14f) of the statutes;
relating to: hazard pay, paid medical
8leave, and health coverage for frontline health care workers, eligibility
9expansion under the Medical Assistance program, granting rule-making
10authority, and making an appropriation.
Analysis by the Legislative Reference Bureau
Generally, this bill provides certain benefits for certain health care workers,
including hazard pay, paid medical leave, state-funded testing and treatment for
those uninsured, and insurance coverage for testing and treatment. The bill also
accepts the Medicaid expansion.
Employment
The bill requires employers to provide hazard pay to certain health care
workers during a public health emergency. The bill also requires employers to
provide at least 15 days of paid medical leave for certain health care workers who
contract a communicable disease. Under the bill, an employer may request a
reimbursement from the Department of Administration for the paid medical leave
and hazard pay.
State coverage for treatment of uninsured health care workers and
insurance coverage for health care workers
The bill requires the Department of Health Services to provide state payment
for the testing and treatment for health care workers who have been diagnosed with
or are under investigation of having COVID-19 or any other communicable disease.
State coverage is available only if the individual has no other form of coverage or
funding for treatment available from insurance, a health care coverage program, or
under any grant, contract, or other contractual arrangement.
The bill requires every health insurance policy and every self-insured
governmental health plan that generally covers testing for and treatment of
infectious disease to provide coverage of testing for and treatment of COVID-19 or
any other communicable disease for a frontline health care worker who has been
diagnosed with or is under investigation of having COVID-19 or any other
communicable disease without imposing any copayment or coinsurance. A health
insurance policy is referred to in the bill as a disability insurance policy. For purposes
of required insurance coverage and for the state coverage for uninsured health care
workers, the treatment that must be covered is any treatment that is medically
necessary and reasonably related to COVID-19 or any other communicable disease
or complications from COVID-19 or other communicable disease.
Medicaid expansion
This bill accepts the Medicaid expansion by changing the family income
eligibility level to up to 133 percent of the federal poverty line for parents and
caretaker relatives under BadgerCare Plus and for childless adults currently
covered under BadgerCare Plus Core and who are incorporated into BadgerCare
Plus in this bill. BadgerCare Plus and BadgerCare Plus Core are programs under
the state's Medical Assistance program, which provides health services to
individuals who have limited financial resources. The federal Patient Protection and
Affordable Care Act allows a state to receive an enhanced federal medical assistance
percentage payment for providing benefits to certain individuals through a state's
Medical Assistance program. The bill requires DHS to comply with all federal
requirements and to request any amendment to the state Medical Assistance plan,
waiver of Medicaid law, or other federal approval necessary to qualify for the highest
available enhanced federal medical assistance percentage for childless adults under
the BadgerCare Plus program. DHS must ensure that any increased funding
resulting from the bill is used to improve access to and affordability of health care
and to support health care quality for Wisconsin residents.
Under current law, certain parents and caretaker relatives with incomes of not
more than 100 percent of the federal poverty line, before a 5 percent income disregard
is applied, are eligible for BadgerCare Plus benefits. Under current law, childless
adults who 1) are under age 65; 2) have family incomes that do not exceed 100 percent
of the federal poverty line, before a 5 percent income disregard is applied; and 3) are
not otherwise eligible for Medical Assistance, including BadgerCare Plus, are
eligible for benefits under BadgerCare Plus Core. The bill eliminates the childless
adults demonstration project known as BadgerCare Plus Core.
This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.
For further information see the state 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:
AB955,1
1Section
1. 16.34 of the statutes is created to read:
AB955,3,5
216.34 Hazard pay during a public health emergency; paid medical
3leave for frontline health care workers. (1)
Definition. In this section,
4“frontline health care worker” means an individual who is any of the following, who
5is not exempt under
29 USC 213, and whose annual pay does not exceed $99,999:
AB955,3,76
(a) A provider of direct care to patients in a hospital, nursing home, or residence
7or for an ambulance service provider, as defined in s. 256.01 (3).
AB955,3,98
(b) An employee who works in a patient care area of a facility that provides
9direct patient care.
AB955,3,1110
(c) An individual who handles patient specimens within this state within the
11scope of the individual's employment.
AB955,3,1312
(d) An employee who works in an area where patient specimens are handled
13at a facility that handles patient specimens within this state.
AB955,4,2
14(2) Hazard pay grant program for work during a public health emergency.
15(a) From the appropriation under s. 20.505 (1) (ft), the department shall award
16grants to employers for the payment of hazard pay to frontline health care workers
1who work during a public health emergency declared by the governor under s. 323.10
2or the secretary of health services under s. 252.02, as set forth in s. 103.025 (3).
AB955,4,83
(b) The department shall establish and administer a program to subsidize, as
4provided in s. 103.025 (3), the hazard pay costs for frontline health care workers. The
5department shall require, at a minimum, that the employer provide a sworn affidavit
6of compliance, and payroll records if requested by the department. The governor or
7his or her designee within the department may determine the period of applicability
8of this subsection.
AB955,4,12
9(3) Paid medical leave grant program for frontline health care workers.
10(a) From the appropriation under s. 20.505 (1) (ft), the department shall award
11grants to employers for the provision of paid medical leave to frontline health care
12workers who contract a communicable disease, as set forth in s. 103.10 (4m).
AB955,4,1813
(b) The department shall establish and administer a program to subsidize, as
14provided in s. 103.10 (4m), the paid medical leave costs for frontline health care
15workers. The department shall require, at a minimum, that the employer provide
16a sworn affidavit of compliance, and payroll records if requested by the department.
17The governor or his or her designee within the department may determine the period
18of applicability of this subsection.
AB955,4,22
19(4) Coverage of COVID-19 for health care workers. (a) From the
20appropriation under s. 20.505 (1) (ft), the department shall award grants to insurers
21for the provision of health insurance coverage to frontline health care workers as set
22forth in s. 632.895 (14f).
AB955,5,223
(b) The department shall establish and administer a program to subsidize, as
24provided in s. 632.895 (14f), the costs of providing coverage for frontline health care
25workers at no additional cost to the covered individuals. The governor or his or her
1designee within the department may determine the period of applicability of this
2subsection.
AB955,2
3Section
2. 20.435 (4) (bu) of the statutes is created to read:
AB955,5,114
20.435
(4) (bu)
COVID-19 and other communicable disease aids for frontline
5health care workers. A sum sufficient not to exceed, in fiscal year 2021-22, the
6difference between $170,000,000 and the amount after payments have been made
7under s. 16.34, for testing and treatment of frontline health care workers under s.
849.681 and not to exceed, in fiscal year 2022-23 and each fiscal year thereafter, the
9difference between $300,000,000 and the amount after payments have been made
10under s. 16.34, for testing and treatment of frontline health care workers under s.
1149.681.
AB955,3
12Section
3. 20.435 (4) (jw) of the statutes is amended to read:
AB955,5,2013
20.435
(4) (jw)
BadgerCare Plus and hospital assessment. All
moneys received
14from payment of enrollment fees under the program under s. 49.45 (23), all moneys
15transferred under s. 50.38 (9), all moneys transferred from the appropriation account
16under par. (jz), and 10 percent of all moneys received from penalty assessments
17under s. 49.471 (9) (c),
for administration of the program under s. 49.45 (23), to
18provide a portion of the state share of administrative costs for the BadgerCare Plus
19Medical Assistance program under s. 49.471
, and for administration of the hospital
20assessment under s. 50.38.
AB955,4
21Section
4. 20.505 (1) (ft) of the statutes is created to read:
AB955,5,2522
20.505
(1) (ft)
Health care coverage and employee benefits relating to COVID-19
23and other communicable diseases. A sum sufficient not to exceed $170,000,000 in
24fiscal year 2021-22 and not to exceed $300,000,000 in each fiscal year thereafter for
25payments under s. 16.34 (2), (3), and (4).
AB955,5
1Section
5. 49.45 (2p) of the statutes is repealed.
AB955,6
2Section
6. 49.45 (23) of the statutes is repealed.
AB955,7
3Section
7. 49.45 (23b) (title) of the statutes is amended to read:
AB955,6,54
49.45
(23b) (title)
Childless adults demonstration project reform waiver
5implementation required.
AB955,8
6Section
8. 49.45 (23b) (b) of the statutes is amended to read:
AB955,6,107
49.45
(23b) (b) Beginning as soon as practicable after October 31, 2018, and
8ending no sooner than December 31, 2023, the department shall do all of the
9following with regard to
the childless adults
demonstration project under
sub. (23)
10s. 49.471 (4) (a) 8.:
AB955,6,1611
1. Require in each month persons, except exempt individuals, who are eligible
12to receive Medical Assistance under
sub. (23)
s. 49.471 (4) (a) 8. and who are at least
1319 years of age but have not attained the age of 50 to participate in, document, and
14report 80 hours per calendar month of community engagement activities. The
15department, after finding good cause, may grant a temporary exemption from the
16requirement under this subdivision upon request of a Medical Assistance recipient.
AB955,6,1917
2. Require persons with incomes of at least 50 percent of the poverty line to pay
18premiums in accordance with par. (c) as a condition of eligibility for Medical
19Assistance under
sub. (23) s. 49.471 (4) (a) 8.
AB955,6,2120
3. Require as a condition of eligibility for Medical Assistance under
sub. (23) 21s. 49.471 (4) (a) 8. completion of a health risk assessment.
AB955,6,2422
4. Charge recipients of Medical Assistance under
sub. (23) s. 49.471 (4) (a) 8.
23an $8 copayment for nonemergency use of the emergency department in accordance
24with
42 USC 1396o-1 (e) (1) and
42 CFR 447.54.
AB955,7,5
15. Disenroll from Medical Assistance under
sub. (23) s. 49.471 (4) (a) 8. for 6
2months any individual who does not pay a required premium under subd. 2. and any
3individual who is required under subd. 1. to participate in a community engagement
4activity but who does not participate for 48 aggregate months in the community
5engagement activity.
AB955,9
6Section
9. 49.45 (23b) (c) of the statutes is amended to read:
AB955,7,127
49.45
(23b) (c) 1. Persons who are eligible
for the demonstration project under
8sub. (23) s. 49.471 (4) (a) 8. and who have monthly household income that exceeds
950 percent of the poverty line shall pay a monthly premium amount of $8 per
10household. A person who is eligible to receive an item or service furnished by an
11Indian health care provider is exempt from the premium requirement under this
12subdivision.
AB955,7,1813
2. The department may disenroll under par. (b) 5. a person for nonpayment of
14a required monthly premium only at annual eligibility redetermination after
15providing notice and reasonable opportunity for the person to pay. If a person who
16is disenrolled for nonpayment of premiums pays all owed premiums or becomes
17exempt from payment of premiums, he or she may reenroll in Medical Assistance
18under
sub. (23) s. 49.471 (4) (a) 8.
AB955,7,2219
3. The department shall reduce the amount of the required household premium
20by up to half for a recipient of Medical Assistance under
sub. (23) s. 49.471 (4) (a) 8. 21who does not engage in certain behaviors that increase health risks or who attests
22to actively managing certain unhealthy behaviors.
AB955,10
23Section
10. 49.45 (23b) (e) of the statutes is amended to read:
AB955,8,324
49.45
(23b) (e) Before December 31, 2023, the
demonstration project 25requirements under this subsection may not be withdrawn and the department may
1not request from the federal government withdrawal, suspension, or termination of
2the
demonstration project requirements under this subsection unless legislation has
3been enacted specifically allowing for the withdrawal, suspension, or termination.
AB955,11
4Section
11. 49.471 (1) (cr) of the statutes is created to read:
AB955,8,65
49.471
(1) (cr) “Enhanced federal medical assistance percentage" means a
6federal medical assistance percentage described under
42 USC 1396d (y) or (z).
AB955,12
7Section
12. 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB955,8,108
49.471
(4) (a) 4. b. The individual's family income does not exceed
100 133 9percent of the poverty line
before application of the 5 percent income disregard under
1042 CFR 435.603 (d).
AB955,13
11Section
13. 49.471 (4) (a) 8. of the statutes is created to read:
AB955,8,1212
49.471
(4) (a) 8. An individual who meets all of the following criteria:
AB955,8,1313
a. The individual is an adult under the age of 65.
AB955,8,1514
b. The adult has a family income that does not exceed 133 percent of the poverty
15line, except as provided in sub. (4g).
AB955,8,1716
c. The adult is not otherwise eligible for the Medical Assistance program under
17this subchapter or the Medicare program under
42 USC 1395 et seq.
AB955,14
18Section
14. 49.471 (4g) of the statutes is created to read:
AB955,9,319
49.471
(4g) Medicaid expansion; federal medical assistance percentage. For
20services provided to individuals described under sub. (4) (a) 8., the department shall
21comply with all federal requirements to qualify for the highest available enhanced
22federal medical assistance percentage. The department shall submit any
23amendment to the state medical assistance plan, request for a waiver of federal
24Medicaid law, or other approval request required by the federal government to
25provide services to the individuals described under sub. (4) (a) 8. beginning on
1January 1, 2022, and qualify for the highest available enhanced federal medical
2assistance percentage. Sections 20.940 and 49.45 (2t) do not apply to a submission
3to the federal government under this subsection.
AB955,15
4Section
15. 49.681 of the statutes is created to read:
AB955,9,6
549.681 COVID-19 and other communicable disease aids for frontline
6health care workers. (1) In this section
:
AB955,9,77
(a) “COVID-19” means an infection caused by the SARS-CoV-2 coronavirus.
AB955,9,88
(b) “Frontline health care worker” has the meaning given in s. 16.34 (1).
AB955,9,15
9(2) From the appropriation under s. 20.435 (4) (bu), subject to sub. (3), the
10department shall pay, at a rate determined by the department under sub. (4), for
11testing for and any treatment that is medically necessary and reasonably related to
12COVID-19 or any other communicable disease or complications from COVID-19 or
13other communicable disease for frontline health care workers who have been
14diagnosed with or are a patient under investigation of having COVID-19 or any
15other communicable disease.
AB955,9,23
16(3) No payment may be made under this section unless the recipient has no
17other form of coverage available from the federal Medicare program, from private
18health, accident, sickness, medical, and hospital insurance coverage, from any other
19available state, federal, or other health care coverage program, or under any grant,
20contract, or other contractual arrangement. If at any time federal or private
21insurance aid, other health care coverage, or a grant, contract, or other contractual
22arrangement becomes available during the treatment period, state aid under this
23section shall be terminated.
AB955,9,25
24(4) Payment for services provided under this section shall be at a rate
25determined by the department that does not exceed the allowable charges under the
1federal Medicare program. In no case shall state rates for individual service
2elements exceed the federally defined allowable costs. The rate of charges for
3services not covered by public and private insurance shall not exceed the reasonable
4charges as established by Medicare fee determination procedures. A person that
5provides to a patient a service for which payment is provided under this section shall
6accept the amount paid under this section for the service as payment in full and may
7not bill the patient for any amount by which the charge for the service exceeds the
8amount paid for the service under this section.
AB955,10,10
9(5) The department may promulgate rules to establish a process for individuals
10to establish eligibility and apply for and receive benefits under this section.