SB70-AA3,90,2525
(L) Any other factors as determined by the board by rule.
SB70-AA3,91,4
1(4) Upper payment limit. (a) If the board determines under sub. (3) that use
2of a prescription drug product has led or will lead to an affordability challenge, the
3board shall establish an upper payment limit for the prescription drug product after
4considering all of the following:
SB70-AA3,91,55
1. The cost of administering the drug.
SB70-AA3,91,66
2. The cost of delivering the drug to consumers.
SB70-AA3,91,77
3. Other relevant administrative costs related to the drug.
SB70-AA3,91,138
(b)
For a prescription drug product identified in sub. (1) (b) or (d) 2., the board
9shall solicit information from the manufacturer regarding the price increase. To the
10extent that the price increase is not a result of the need for increased manufacturing
11capacity or other effort to improve patient access during a public health emergency,
12the board shall establish an upper payment limit under par. (a) that is equal to the
13cost to consumers prior to the price increase.
SB70-AA3,91,1714
(c) 1. The upper payment limit established under this subsection shall apply
15to all purchases and payor reimbursements of the prescription drug product
16dispensed or administered to individuals in this state in person, by mail, or by other
17means.
SB70-AA3,92,318
2. Notwithstanding subd. 1., while state-sponsored and state-regulated
19health plans and health programs shall limit drug reimbursements and drug
20payment to no more than the upper payment limit established under this subsection,
21a plan subject to the Employee Retirement Income Security Act of 1974 or Part D of
22Medicare under
42 USC 1395w-101 et seq. may choose to reimburse more than the
23upper payment limit. A provider who dispenses and administers a prescription drug
24product in this state to an individual in this state may not bill a payor more than the
25upper payment limit to the patient regardless of whether a plan subject to the
1Employee Retirement Income Security Act of 1974 or Part D of Medicare under
42
2USC 1395w-101 et seq. chooses to reimburse the provider above the upper payment
3limit.
SB70-AA3,92,5
4(5) Public inspection. Information submitted to the board under this section
5shall be open to public inspection only as provided under ss. 19.31 to 19.39.
SB70-AA3,92,9
6(6) No prohibition on marketing. Nothing in this section may be construed to
7prevent a manufacturer from marketing a prescription drug product approved by the
8federal food and drug administration while the prescription drug product is under
9review by the board.
SB70-AA3,92,14
10(7) Appeals. A person aggrieved by a decision of the board may request an
11appeal of the decision no later than 30 days after the board makes the determination.
12The board shall hear the appeal and make a final decision no later than 60 days after
13the appeal is requested. A person aggrieved by a final decision of the board may
14petition for judicial review
in a court of competent jurisdiction.
SB70-AA3,9123
15Section 9123.
Nonstatutory provisions; Insurance.
SB70-AA3,92,2116
(1u)
Staggered terms for board. Notwithstanding the length of terms
17specified for the members of the board under s. 15.735 (1) (b) to (e), 2 of the initial
18members shall be appointed for terms expiring on May 1, 2025; 2 of the initial
19members shall be appointed for terms expiring on May 1, 2026; 2 of the initial
20members shall be appointed for terms expiring on May 1, 2027; and 2 of the initial
21members shall be appointed for terms expiring on May 1, 2028.
SB70-AA3,93,223
(1v)
Prescription drug affordability review board. The treatment of ss. 15.07
24(3) (bm) 7., 15.735, 601.78, 601.785, and 601.79 and subch. VI (title) of ch. 601 and
1Section 9123 (1u) of this act take effect on the first day of the 7th month beginning
2after publication.”.
SB70-AA3,93,5
4“
Section
84. 20.005 (3) (schedule) of the statutes: at the appropriate place,
5insert the following amounts for the purposes indicated:
-
See PDF for table ![PDF](https://docs.legis.wisconsin.gov/assets/image/file_acrobat.gif)
SB70-AA3,85
6Section
85. 20.435 (5) (ch) of the statutes is created to read:
SB70-AA3,93,87
20.435
(5) (ch)
Suicide and crisis lifeline grants. The amounts in the schedule
8for grants under s. 46.533.
SB70-AA3,86
9Section
86. 46.533 of the statutes is created to read:
SB70-AA3,93,12
1046.533 Suicide and crisis lifeline; grants. (1) In this section, “national
11crisis hotline” means the telephone or text access number “988,” or its successor, that
12is maintained under the federally administered program under
42 USC 290bb-36c.
SB70-AA3,93,16
13(2) From the appropriation under s. 20.435 (5) (ch), the department shall award
14grants to organizations that provide crisis intervention services and crisis care
15coordination to individuals who contact the national crisis hotline from anywhere
16within this state.”.
SB70-AA3,93,18
18“
Section
87. 49.79 (9) (f) of the statutes is repealed.”.
SB70-AA3,93,20
20“
Section
88. 46.48 (36) of the statutes is created to read:
SB70-AA3,94,7
146.48
(36) Amyotrophic lateral sclerosis. From the appropriation under s.
220.435 (1) (b), the department shall award $250,000 in each fiscal year as a grant to
3an organization that supports and provides services to individuals with amyotrophic
4lateral sclerosis for the purposes of assisting individuals diagnosed with
5amyotrophic lateral sclerosis and their families with the costs of respite care and
6costs associated with amyotrophic lateral sclerosis that are not covered by
7insurance.”.
SB70-AA3,94,9
9“
Section 9119.
Nonstatutory provisions; Health Services.
SB70-AA3,94,2310
(1)
Low-value care analysis grant. From the appropriation under s. 20.435 (1)
11(b), in the 2023-24 and 2024-25 fiscal years, the department of health services shall
12award a grant in an amount not to exceed $900,000 in each fiscal year to an
13organization for the purpose of conducting a data analysis of claims under the
14medical assistance program administered by the department of health services and
15claims under health care coverage plans offered by the state under s. 40.51 (6) to
16identify low-value care. The recipient of the grant under this subsection shall report
17the organization's findings, including any recommendations for providing effective
18and efficient care, to the department of health services and the department of
19employee trust funds. The department of health services and the department of
20employee trust funds shall distribute the findings reported under this subsection to
21health care providers that provide services covered by the medical assistance
22program or a health care coverage plan and to health maintenance organizations and
23insurance companies that provide health insurance to state employees.”.
SB70-AA3,90
3Section
90. 20.435 (1) (ex) of the statutes is created to read:
SB70-AA3,95,64
20.435
(1) (ex)
Maternal and infant mortality prevention and response. The
5amounts in the schedule for the prevention of and response to maternal and infant
6mortality under s. 253.143.
SB70-AA3,91
7Section
91. 253.143 of the statutes is created to read:
SB70-AA3,95,10
8253.143 Maternal and infant mortality prevention and response. From
9the appropriation under s. 20.435 (1) (ex), the department shall do all of the
10following:
SB70-AA3,95,12
11(1) Annually award grants to community organizations whose goal is the
12prevention of maternal and infant mortality.
SB70-AA3,95,16
13(2) Annually award grants to support the expansion of fetal and infant
14mortality review and maternal mortality review teams statewide and expand
15technical assistance and support for existing fetal and infant mortality review and
16child death review teams.
SB70-AA3,95,18
17(3) Provide funding and technical assistance to community-based
18organizations aimed at preventing infant morality.
SB70-AA3,96,2
1(4) Provide funding for grief and bereavement programming for those impacted
2by infant loss.
SB70-AA3,9119
3Section 9119.
Nonstatutory provisions; Health Services.
SB70-AA3,96,8
4(1) Maternal and infant mortality prevention and response. The authorized
5FTE positions for the department of health services are increased by 2.0 FTE
6positions, to be funded from the appropriation under s. 20.435 (1) (ex), for the purpose
7of administering the maternal and infant mortality prevention and response
8program.”.
SB70-AA3,96,10
10“
Section
92. 49.45 (7m) of the statutes is created to read:
SB70-AA3,96,1811
49.45
(7m) Pay-for-performance; health information exchange. The
12department shall develop and implement for non-hospital providers in the Medical
13Assistance program, including physicians, clinics, health departments, home health
14agencies, and post-acute care facilities, a payment system based on performance to
15incentivize participation in health information data sharing to facilitate better
16patient care, reduced costs, and easier access to patient information. The
17department shall establish performance metrics for the payment system under this
18subsection that satisfy all of the following:
SB70-AA3,96,2019
(a) The metric shall include participation by providers in a health information
20exchange at a minimum level of patient record access.
SB70-AA3,96,2221
(b) The payment under the payment system shall increase as the participation
22level in the health information exchange increases.
SB70-AA3,96,2323
(c) The payment system shall begin in the 2024 rate year.
SB70-AA3,97,2
1(d) For purposes of the payment system, the department shall seek any
2available federal moneys.”.
SB70-AA3,97,4
4“
Section
93. 49.45 (30p) of the statutes is created to read:
SB70-AA3,97,55
49.45
(30p) Detoxification and stabilization services. (a) In this subsection:
SB70-AA3,97,186
1. “Adult residential integrated behavioral health stabilization service” means
7a residential behavioral health treatment service, delivered under the oversight of
8a medical director, that provides withdrawal management and intoxication
9monitoring, as well as integrated behavioral health stabilization services, and
10includes nursing care on site for medical monitoring available on a 24-hour basis.
11“Adult residential integrated behavioral health stabilization service” may include
12the provision of services including screening, assessment, intake, evaluation and
13diagnosis, medical care, observation and monitoring, physical examination,
14determination of medical stability, medication management, nursing services, case
15management, drug testing, counseling, individual therapy, group therapy, family
16therapy, psychoeducation, peer support services, recovery coaching, recovery
17support services, and crisis intervention services, to ameliorate acute behavioral
18health symptoms and stabilize functioning.
SB70-AA3,97,2119
2. “Community-based withdrawal management” means a medically managed
20withdrawal management service delivered on an outpatient basis by a physician or
21other service personnel acting under the supervision of a physician.
SB70-AA3,97,2422
3. “Detoxification and stabilization services” means adult residential
23integrated behavioral health stabilization service, residential withdrawal
24management service, or residential intoxication monitoring service.
SB70-AA3,98,9
14. “Residential intoxication monitoring service” means a residential service
2that provides 24-hour observation to monitor the safe resolution of alcohol or
3sedative intoxication and to monitor for the development of alcohol withdrawal for
4intoxicated patients who are not in need of emergency medical or behavioral
5healthcare. “Residential intoxication monitoring service” may include the provision
6of services including screening, assessment, intake, evaluation and diagnosis,
7observation and monitoring, case management, drug testing, counseling, individual
8therapy, group therapy, family therapy, psychoeducation, peer support services,
9recovery coaching, and recovery support services.
SB70-AA3,98,2210
5. “Residential withdrawal management service” means a residential
11substance use treatment service that provides withdrawal management and
12intoxication monitoring, and includes medically managed 24-hour on-site nursing
13care, under the supervision of a physician. “Residential withdrawal management
14service” may include the provision of services, including screening, assessment,
15intake, evaluation and diagnosis, medical care, observation and monitoring,
16physical examination, medication management, nursing services, case
17management, drug testing, counseling, individual therapy, group therapy, family
18therapy, psychoeducation, peer support services, recovery coaching, and recovery
19support services, to ameliorate symptoms of acute intoxication and withdrawal and
20to stabilize functioning. “Residential withdrawal management service” may also
21include community-based withdrawal management and intoxication monitoring
22services.
SB70-AA3,99,223
(b) Subject to par. (c), the department shall provide reimbursement for
24detoxification and stabilization services under the Medical Assistance program
25under s. 49.46 (2) (b) 14r. The department shall certify providers under the Medical
1Assistance program to provide detoxification and stabilization services in
2accordance with this subsection.
SB70-AA3,99,103
(c) The department shall submit to the federal department of health and
4human services any request for a state plan amendment, waiver, or other federal
5approval necessary to provide reimbursement for detoxification and stabilization
6services as described in this subsection. If the federal department approves the
7request or if no federal approval is necessary, the department shall provide the
8reimbursement under par. 49.46 (2) (b) 14r. If the federal department disapproves
9the request, the department may not provide the reimbursement described in this
10subsection.
SB70-AA3,94
11Section
94. 49.46 (2) (b) 14r. of the statutes is created to read:
SB70-AA3,99,1312
49.46
(2) (b) 14r. Detoxification and stabilization services as specified under s.
1349.45 (30p).”.
SB70-AA3,99,15
15“
Section
95. 49.45 (6xm) of the statutes is created to read:
SB70-AA3,99,1916
49.45
(6xm) Pediatric inpatient supplement. (a) From the appropriations
17under s. 20.435 (4) (b), (o), and (w), the department shall, using a method determined
18by the department, distribute a total sum of $2,000,000 in each state fiscal year to
19hospitals that meet all of the following criteria:
SB70-AA3,99,2020
1. The hospital is an acute care hospital located in this state.
SB70-AA3,99,2321
2. During the hospital's fiscal year, the inpatient days in the hospital's acute
22care pediatric units and intensive care pediatric units totaled more than 12,000 days,
23not including neonatal intensive care units. For purposes of this subdivision, the
1hospital's fiscal year is the hospital's fiscal year that ended in the 2nd calendar year
2preceding the beginning of the state fiscal year.
SB70-AA3,100,73
(b) Notwithstanding par. (a), from the appropriations under s. 20.435 (4) (b),
4(o), and (w), the department may, using a method determined by the department,
5distribute an additional total sum of $10,000,000 in each state fiscal year to hospitals
6that are freestanding pediatric teaching hospitals located in Wisconsin that have a
7percentage calculated under s. 49.45 (3m) (b) 1. a. greater than 45 percent.”.
SB70-AA3,100,9
9“
Section
96. 49.45 (3) (e) 12. of the statutes is amended to read:
SB70-AA3,100,1710
49.45
(3) (e) 12. The department shall use a portion of the moneys collected
11under s. 50.38 (2) (b) to pay for services provided by critical access hospitals under
12the Medical Assistance Program under this subchapter, including services
13reimbursed on a fee-for-service basis and services provided under a managed care
14system. For each state fiscal year, total payments required under this subdivision,
15including both the federal and state share of Medical Assistance, shall equal the
16amount collected under s. 50.38 (2) (b) for the fiscal year divided by
61.68 44.21 17percent.”.
SB70-AA3,100,19
19“
Section
97. 49.45 (3) (e) 11. of the statutes is amended to read:
SB70-AA3,101,720
49.45
(3) (e) 11. The department shall use a portion of the moneys collected
21under s. 50.38 (2) (a) to pay for services provided by eligible hospitals, as defined in
22s. 50.38 (1), other than critical access hospitals, under the Medical Assistance
23Program under this subchapter, including services reimbursed on a fee-for-service
24basis and services provided under a managed care system. For state fiscal year
12008-09, total payments required under this subdivision, including both the federal
2and state share of Medical Assistance, shall equal the amount collected under s.
350.38 (2) (a) for fiscal year 2008-09 divided by 57.75 percent. For each state fiscal
4year after state fiscal year 2008-09, total payments required under this subdivision,
5including both the federal and state share of Medical Assistance, shall equal the
6amount collected under s. 50.38 (2) (a) for the fiscal year divided by
61.68 44.21 7percent.”.
SB70-AA3,101,9
9“
Section
98. 20.435 (4) (jw) of the statutes is amended to read:
SB70-AA3,101,1710
20.435
(4) (jw)
BadgerCare Plus and hospital assessment. All
moneys received
11from payment of enrollment fees under the program under s. 49.45 (23), all moneys
12transferred under s. 50.38 (9), all moneys transferred from the appropriation account
13under par. (jz), and 10 percent of all moneys received from penalty assessments
14under s. 49.471 (9) (c),
for administration of the program under s. 49.45 (23), to
15provide a portion of the state share of administrative costs for the BadgerCare Plus
16Medical Assistance program under s. 49.471
, and for administration of the hospital
17assessment under s. 50.38.
SB70-AA3,99
18Section
99. 49.45 (2p) of the statutes is repealed.
SB70-AA3,100
19Section
100. 49.45 (23) of the statutes is repealed.
SB70-AA3,101
20Section
101. 49.45 (23b) of the statutes is repealed.
SB70-AA3,102
21Section
102. 49.471 (1) (cr) of the statutes is created to read:
SB70-AA3,101,2322
49.471
(1) (cr) “Enhanced federal medical assistance percentage" means a
23federal medical assistance percentage described under
42 USC 1396d (y) or (z).
SB70-AA3,103
24Section
103. 49.471 (4) (a) 4. b. of the statutes is amended to read:
SB70-AA3,102,3
149.471
(4) (a) 4. b. The individual's family income does not exceed
100 133 2percent of the poverty line
before application of the 5 percent income disregard under
342 CFR 435.603 (d).
SB70-AA3,104
4Section
104. 49.471 (4) (a) 8. of the statutes is created to read:
SB70-AA3,102,55
49.471
(4) (a) 8. An individual who meets all of the following criteria:
SB70-AA3,102,66
a. The individual is an adult under the age of 65.
SB70-AA3,102,87
b. The adult has a family income that does not exceed 133 percent of the poverty
8line, except as provided in sub. (4g).
SB70-AA3,102,109
c. The adult is not otherwise eligible for the Medical Assistance program under
10this subchapter or the Medicare program under
42 USC 1395 et seq.
SB70-AA3,105
11Section
105. 49.471 (4g) of the statutes is created to read: