2021 - 2022 LEGISLATURE
February 24, 2021 - Introduced by Senators Bewley,
Erpenbach, Johnson, Larson, Pfaff, Ringhand, Roys, Smith and Wirch,
cosponsored by Representatives
Hintz, Anderson, Andraca, Baldeh,
Billings, Bowen, Brostoff, Cabrera, Conley, Considine, Doyle, Drake,
Emerson, Goyke, Haywood, Hebl, Hesselbein, Hong, McGuire, B. Meyers,
Milroy, Moore Omokunde, L. Myers, Neubauer, Ohnstad, Ortiz-Velez,
Pope, Riemer, S. Rodriguez, Shankland, Shelton, Sinicki, Snodgrass,
Spreitzer, Stubbs, Subeck, Vining and Vruwink. Referred to Committee on
Government Operations, Legal Review and Consumer Protection.
1An Act relating to: Medical Assistance payments for outpatient services
2provided by hospitals.
Analysis by the Legislative Reference Bureau
This bill requires the Department of Health Services 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 June 30, 2021, whichever is earlier.
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:
(1) Payment for outpatient services provided by hospitals.
(a) Until the conclusion of a public health emergency declared under 42 USC
by the secretary of the federal department of health and human services in 5
response to the 2019 novel coronavirus or until June 30, 2021, whichever is earlier, 6
the department of health services shall provide reimbursement or a supplemental 7
payment under the Medical Assistance program to a hospital for providing any 8
outpatient service when all of the following criteria are satisfied:
1. The facility at which the outpatient service is performed is operated by the 10
hospital and certified under the Medicare program under 42 USC 1395
et seq., 11
including under the terms of a federal waiver approved under section 1135 of the 12
federal social security act, for outpatient services.
2. The outpatient service is reimbursable when provided in the hospital's 14
inpatient facility but is not provided at the inpatient facility due to reasons 15
associated with the 2019 novel coronavirus pandemic.
3. The outpatient service is one for which federal financial participation is 17
(b) The department of health services may not include in a reimbursement 19
under par. (a) payments under s. 49.45 (3) (e) 11. or 12. or (59).
(c) The department of health services shall seek any approval from the federal 21
department of health and human services that is necessary to provide the 22
reimbursement or a supplemental payment in accordance with this subsection.