2021 - 2022 LEGISLATURE
February 24, 2021 - Introduced by Senators Bewley, Agard,
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 to hospitals for nursing
Analysis by the Legislative Reference Bureau
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 June 30, 2021, 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.
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 hospitals for nursing facility care.
(a) In this subsection, “public health emergency period” means the period 4
ending on June 30, 2021, or the termination of any public health emergency declared 5
under 42 USC 247d
by the secretary of the federal department of health and human 6
services in response to the 2019 novel coronavirus, whichever is earlier.
(b) During the public health emergency period, subject to par. (c), the 8
department of health services shall provide, under the Medical Assistance program, 9
reimbursement at the statewide average per-diem rate paid to nursing facilities or 10
a supplemental payment to hospitals for providing nursing-facility-level care when 11
all of the following criteria apply:
1. The individual for whom the hospital provided nursing-facility-level care 13
is enrolled in the Medical Assistance program, has been admitted on an inpatient 14
basis to the hospital, is eligible for discharge after receiving care in the hospital, 15
requires nursing-facility-level care upon discharge, and due to the hospital being 16
unable to locate a nursing facility that accepts the individual for admission, is unable 17
to be transferred to a nursing facility.
2. The services provided to the individual described under subd. 1
. are custodial 19
care for which federal financial participation is approved.
3. The hospital notifies the department of health services that it is 21
participating as a swing bed hospital under the Medical Assistance program.
(c) The department of health services shall use the same standards and criteria 2
for determining whether a hospital is eligible for reimbursement or a supplemental 3
payment under par. (b) as are used by the federal Medicare program under 42 USC
et seq. for the payment for use of swing beds or, for any hospital that is not a 5
critical access hospital, under the terms of a federal waiver approved under section 6
1135 of the federal social security act. The department shall seek any approval from 7
the federal government necessary to implement the reimbursement under this 8