SB578: Bill Text

2025 - 2026 LEGISLATURE

LRB-4936/1

JPC&SWB:emw/amn/cjs

2025 SENATE BILL 578

October 24, 2025 - Introduced by Senators Wimberger, Cabral-Guevara, Feyen, James and Quinn, cosponsored by Representatives Snyder, Subeck, Dittrich, Donovan, Doyle, Goodwin, Gundrum, Hurd, Johnson, Knodl, Kreibich, Kurtz, McCarville, Melotik, Mursau, Novak, O'Connor, Palmeri, Penterman, Piwowarczyk, Prado, Rivera-Wagner, Rodriguez, Roe, Sheehan, Sinicki, Stroud, Stubbs, Swearingen and Wittke. Referred to Committee on Health.

SB578,1,7 An Act to renumber and amend 50.06 (1) and 50.06 (4); to amend 50.06 (2) (b), 50.06 (2) (c), 50.06 (5) (a) (intro.), 50.06 (5) (b), 50.06 (6), 50.06 (7), 50.08 (1) (b) and 154.225 (1) (c); to create 50.06 (1) (a), 50.06 (1) (b), 50.06 (1) (d), 50.06 (4) (b), 50.06 (4) (c), 50.06 (5) (am), 50.06 (5) (ar), 50.06 (8), 54.36 (1m), 54.50 (3) (cm), 59.42 (4) and 146.82 (2) (a) 7m. of the statutes; relating to: consent to admissions to certain health care facilities by patient representatives without requiring a petition for guardianship or protective placement.

Analysis by the Legislative Reference Bureau

This bill allows a patient’s representative to consent to an admission of an incapacitated individual from a hospital to a nursing home or community-based residential facility without a petition for guardianship or protective placement and allows a patient’s representative to make health care decisions, enroll the patient in the Medical Assistance program, and authorize expenditures related to health care on behalf of an incapacitated individual without certain time limitations that are imposed under current law if certain conditions are met.

Under current law, an individual who is either related to an incapacitated individual as provided under current law or is an adult close friend of an incapacitated individual may consent to admission, directly from a hospital to a nursing home or community-based residential facility, of the incapacitated individual who does not have a valid power of attorney for health care and who has not been adjudicated incompetent in this state if certain conditions apply, including that the individual for whom admission is sought is not diagnosed as developmentally disabled or as having a mental illness at the time of the proposed admission, that the incapacitated individual does not verbally object to or otherwise actively protest the admission, and that petitions for guardianship for the individual and for protective placement of the individual are filed prior to the proposed admission. A determination that an individual is incapacitated must be made by two physicians or one physician and one psychologist who personally examine the individual. An individual who consents to admission of an incapacitated individual may make health care decisions to the same extent as a guardian of the person and authorize expenditures related to health care to the same extent as a guardian of the estate until 60 days after the admission to the facility, discharge of the incapacitated individual from the facility, or appointment of a guardian for the incapacitated individual, whichever occurs first.

The bill allows a patient’s representative to consent to an admission of an incapacitated individual from a hospital to a nursing home or community-based residential facility as provided under current law without petitions for guardianship or protective placement of the incapacitated individual being filed if 1) the incapacitated individual is admitted directly from a hospital inpatient unit, 2) the facility to which the incapacitated individual is admitted notifies the corporation counsel for the county in which the incapacitated patient resides of the admission within 72 hours of admission, and 3) the patient’s representative signs, subject to penalty of false swearing, a declaration that contains certain information including a written acknowledgment that the patient’s representative may make decisions or authorize expenditures as provided under the bill and promptly provides the signed declaration to all of the incapacitated individual’s family members that can be reasonably contacted, the discharging hospital and the accepting facility, the corporation counsel for the county in which the incapacitated individual resides, and the adult-at-risk agency for the county in which the incapacitated individual resides. Further, the bill allows a patient’s representative to make health care decisions, enroll the incapacitated individual in the Medical Assistance program, and authorize expenditures related to health care without the time limitations that apply to other direct admissions under current law if the patient’s representative satisfies the conditions for admission provided under the bill. The authority of a patient’s representative to make health care decisions and authorize expenditures related to health care under the bill ends if a court appoints a guardian to make such decisions, the incapacitated individual is discharged to a setting that is not a facility, a health care power of attorney that was not identified at the time that the patient’s representative was established is identified, or the individual is determined to no longer be incapacitated.

The bill provides that a determination that an individual is incapacitated for the purposes of admitting the individual directly from a hospital to a facility may be made by two physicians or by one physician and one advanced practice clinician, which is defined to mean either a psychologist, a registered nurse who is currently certified as a nurse practitioner, or a physician assistant who a physician responsible for overseeing the physician assistant’s practice affirms is competent to conduct evaluations of the capacity of patients to manage health care decisions. Any physician or advanced practice clinician who determines that an individual is incapacitated for the purposes of admitting the individual directly from a hospital to a facility must, if the individual is admitted to a facility as provided under the bill, prepare a written statement on a form prescribed by the DHS stating that the physician or advanced practice clinician personally examined the incapacitated individual, the date and location that the physician or advanced practice clinician determined the individual is incapacitated, the medical conditions of the individual, if any, that led the physician or advanced practice clinician to conclude that the individual is incapacitated, the physician’s or advanced practice clinician’s office address and contact information, and any other information identified by DHS. A copy of the written statement must be included in the incapacitated individual’s patient health care records and must be sent, within 72 hours of the incapacitated individual’s admission to a facility, to the corporation counsel for the county in which the incapacitated individual resides and the adult-at-risk agency for the county in which the incapacitated individual resides. The bill provides that any physician or psychologist who examines an individual who is a proposed ward pursuant to a petition for guardianship must request and review any written statements prepared for the proposed ward and received by an adult-at-risk agency as provided under the bill.

The bill provides that a petitioner for temporary guardianship of a proposed ward admitted to a facility under the alternative procedure set forth in the bill must, as soon as practicable after filing the petition, request a copy of any written statement held by the corporation counsel for the county in which the proposed ward resided prior to admission to the facility. The corporation counsel must provide a copy of any written statement relating to the proposed ward upon the request of a petitioner who has filed a petition in a court of competent jurisdiction for a temporary guardianship of the proposed ward. The petitioner must submit to the court either a copy, under seal, of any written statement received for in camera inspection by the court or a statement that the petitioner requested any relevant written statement but no such document was located. Under the bill, the court must inspect, in camera, any submitted written statement, and unless the court determines that a written statement in which a physician or advanced practice clinician determined the proposed ward is no longer incapacitated has been submitted to the court and indicates that the proposed ward’s circumstances have changed from those described in the written statement submitted to the court in which a physician or advanced practice clinician determined the individual is incapacitated, the submitted written statement containing the determination that the individual is incapacitated constitutes a prima facie showing, for purposes of temporary guardianship proceedings, that the proposed ward’s particular situation requires immediate appointment of a temporary guardian of the person or estate, notwithstanding that the document may be uncorroborated hearsay. The submitted written statement is self authenticating and does not require foundational or other testimony for its admissibility. However, the prima facie evidence may be rebutted by presenting information that affirmatively indicates a lack of trustworthiness in the document or information that the proposed ward’s circumstances have changed. The privilege between health care providers and patients does not apply to these written statements.

The bill provides that no patient’s representative may consent to admission for an incapacitated individual in the manner established in the bill after three years following the effective date of the bill.

Finally, the bill provides that an individual who consents to admission of an incapacitated individual as set forth under current law may enroll the incapacitated individual in the Medical Assistance program in addition to the authority provided under current law to make health care decisions to the same extent as a guardian of the person and authorize expenditures related to health care to the same extent as a guardian of the estate.

For further information see the state and local 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:

SB578,1 Section 1. 50.06 (1) of the statutes is renumbered 50.06 (1) (intro.) and amended to read:

SB578,2,3 50.06 (1) (intro.) In this section, “incapacitated”:

SB578,2,7 (c) “Incapacitated” means unable to receive and evaluate information effectively or to communicate decisions to such an extent that the individual lacks the capacity to manage his or her health care decisions, including decisions about his or her post-hospital care.

SB578,2 Section 2. 50.06 (1) (a) of the statutes is created to read:

SB578,2,9 50.06 (1) (a) “Adult-at-risk agency” has the meaning given in s. 55.01 (1f).

SB578,3 Section 3. 50.06 (1) (b) of the statutes is created to read:

SB578,3,2 50.06 (1) (b) “Advanced practice clinician” has the meaning given in s. 155.01 (1g).

SB578,4 Section 4. 50.06 (1) (d) of the statutes is created to read:

SB578,3,6 50.06 (1) (d) “Patient’s representative” means the individual described under sub. (3) who may consent to an admission of an incapacitated individual under sub. (2).

SB578,5 Section 5. 50.06 (2) (b) of the statutes is amended to read:

SB578,3,10 50.06 (2) (b) The individual for whom admission is sought is not diagnosed as developmentally disabled or as having a mental illness, as defined in s. 51.01 (13) (a), at the time of the proposed admission.

SB578,6 Section 6. 50.06 (2) (c) of the statutes is amended to read:

SB578,3,15 50.06 (2) (c) A Unless the incapacitated individual is admitted to a facility under sub. (8), a petition for guardianship for the individual under s. 54.34 and a petition under s. 55.075 for protective placement of the individual are filed prior to the proposed admission.

SB578,7 Section 7. 50.06 (4) of the statutes is renumbered 50.06 (4) (a) and amended to read:

SB578,4,4 50.06 (4) (a) A determination that an individual is incapacitated for purposes of sub. (2) shall be made by 2 physicians, as defined in s. 448.01 (5), or by one physician and one psychologist advanced practice clinician, who personally examine the individual and sign a statement specifying that the individual is incapacitated. Mere old age, eccentricity, or physical disability, either singly or together, are insufficient to make a finding that an individual is incapacitated. Neither of the individuals who make a finding that an individual is incapacitated may be a relative, as defined in s. 242.01 (11), of the individual or have knowledge that he or she is entitled to or has a claim on any portion of the individual’s estate. A copy of the statement shall be included in the individual’s records in the facility to which he or she is admitted.

SB578,8 Section 8. 50.06 (4) (b) of the statutes is created to read:

SB578,4,20 50.06 (4) (b) A physician or advanced practice clinician who has determined that an individual is incapacitated for purposes of sub. (2) shall, if the individual is admitted to a facility under sub. (8), prepare a written statement on a form prescribed by the department stating that they personally examined the incapacitated individual, the date and location that the physician or advanced practice clinician determined the individual is incapacitated for purposes of sub. (2), the medical conditions of the individual, if any, that led the physician or advanced practice clinician to conclude that the individual is incapacitated, the physician’s or advanced practice clinician’s office address and contact information, and any other information identified by the department. A copy of the written statement shall be included in the incapacitated individual’s patient health care records and shall, within 72 hours following admission of the incapacitated individual to a facility under sub. (8), be sent to the corporation counsel for the county in which the incapacitated individual resides and the adult-at-risk agency for the county in which the incapacitated individual resides.

SB578,9 Section 9. 50.06 (4) (c) of the statutes is created to read:

SB578,5,11 50.06 (4) (c) A physician or advanced practice clinician who determines that an individual is no longer incapacitated for purposes of sub. (8) (f) shall, if the individual was admitted as an incapacitated individual to a facility under sub. (8), prepare a written statement that they personally examined the individual, the date and location that the physician or advanced practice clinician determined the individual is no longer incapacitated for purposes of sub. (8) (f), the medical conditions of the individual, if any, that led the physician or advanced practice clinician to conclude that the individual is no longer incapacitated, the physician’s or advanced practice clinician’s office address and contact information, and any other information identified by the department. A copy of the written statement shall be included in the individual’s patient health care records and shall, within 72 hours of a determination made under this paragraph, be sent to the corporation counsel for the county in which the individual resides and the adult-at-risk agency for the county in which the individual resides.

SB578,10 Section 10. 50.06 (5) (a) (intro.) of the statutes is amended to read:

SB578,5,20 50.06 (5) (a) (intro.) Except as otherwise provided in par. pars. (am) and (b), an individual who consents to an admission under this section a patient’s representative may, for the incapacitated individual, make health care decisions to the same extent as a guardian of the person may, enroll the incapacitated individual in the Medical Assistance program under subch. IV of ch. 49 to the same extent as a guardian of the estate may, and authorize expenditures related to health care to the same extent as a guardian of the estate may, until the earliest of the following:

SB578,11 Section 11. 50.06 (5) (am) of the statutes is created to read:

SB578,6,6 50.06 (5) (am) Except as otherwise provided in pars. (ar) and (b), a patient’s representative may, for the incapacitated individual, make health care decisions to the same extent as a guardian of the person may, enroll the incapacitated individual in the Medical Assistance program under subch. IV of ch. 49 to the same extent as a guardian of the estate may, and authorize expenditures related to health care to the same extent as a guardian of the estate may if the patient’s representative consents to admission for the incapacitated individual in the manner provided in sub. (8). Any authority of a patient’s representative under this paragraph ends if any of the following occurs:

SB578,6,8 1. A court appoints a guardian to make such decisions for the incapacitated individual.

SB578,6,9 2. The incapacitated individual is discharged to a setting that is not a facility.

SB578,6,11 3. A health care power of attorney that was not identified at the time that the patient’s representative was established is identified.

SB578,6,13 4. The incapacitated individual is determined to no longer be incapacitated as provided in sub. (8) (f).

SB578,12 Section 12. 50.06 (5) (ar) of the statutes is created to read:

SB578,6,17 50.06 (5) (ar) No patient’s representative may consent to admission for an incapacitated individual in the manner provided in sub. (8) after the date that is 3 years after the effective date of this paragraph .... [LRB inserts date].

SB578,13 Section 13. 50.06 (5) (b) of the statutes is amended to read:

SB578,6,22 50.06 (5) (b) An individual who consents to an admission under this section A patient’s representative may not authorize expenditures related to health care if the incapacitated individual has an agent under a durable power of attorney, as defined in s. 244.02 (3), who may authorize expenditures related to health care.

SB578,14 Section 14. 50.06 (6) of the statutes is amended to read:

SB578,7,6 50.06 (6) If Unless the incapacitated individual was admitted to a facility under sub. (8), if the incapacitated individual is in the facility after 60 days after admission and a guardian has not been appointed, the authority of the person who consented to the admission patient’s representative to make decisions and, if sub. (5) (a) applies, to authorize expenditures is extended for 30 days for the purpose of allowing the facility to initiate discharge planning for the incapacitated individual.

SB578,15 Section 15. 50.06 (7) of the statutes is amended to read:

SB578,7,16 50.06 (7) An individual who consents to an admission under this section A patient’s representative may request a functional screening and a financial and cost-sharing screening to determine eligibility for the family care benefit under s. 46.286 (1). If admission is sought on behalf of the incapacitated individual or if the incapacitated individual is about to be admitted on a private pay basis, the individual who consents to the admission patient’s representative may waive the requirement for a financial and cost-sharing screening under s. 46.283 (4) (g), unless the incapacitated individual is expected to become eligible for medical assistance within 6 months.

SB578,16 Section 16. 50.06 (8) of the statutes is created to read:

SB578,7,21 50.06 (8) (a) A patient’s representative may consent to an admission of an incapacitated individual under sub. (2) without a petition for guardianship or protective placement of the incapacitated individual being filed if all of the following apply:

SB578,7,23 1. The incapacitated individual is admitted directly from a hospital inpatient unit.

SB578,8,9 2. The patient’s representative signs a declaration under oath and promptly submits the signed declaration to the discharging hospital and the accepting facility, to the corporation counsel for the county in which the incapacitated individual resides, to the adult-at-risk agency for the county in which the incapacitated individual resides, and to all of the incapacitated individual’s family members that can be reasonably contacted following admission of the incapacitated individual to a facility under this subsection. The department shall prescribe a form declaration for use by a patient’s representative under this subdivision. A declaration submitted under this subdivision shall include all of the following: