Amendment AA6-SB306

ASSEMBLY AMENDMENT 6, TO 2011 SENATE BILL 306

March 13, 2012 - Offered by Representatives Mason, C. Taylor, E. Coggs, Roys, Hulsey, Zamarripa, Pope-Roberts, Sinicki, Milroy, Vruwink, Danou, Billings, Pasch, Bernard Schaber, Barca, Molepske Jr and Pocan.

SB306-AA6,1,1 At the locations indicated, amend the bill as follows:

SB306-AA6,1,2 1. Page 1, line 4: delete "abortion," and substitute "abortion;".

SB306-AA6,1,3 2. Page 1, line 5: delete "services," and substitute "services;".

SB306-AA6,1,4 3. Page 1, line 5: delete "drug," and substitute "drug;".

SB306-AA6,2,7 4. Page 1, line 7: delete that line and substitute "procedures; expanding eligibility for the earned income tax credit; hospital best practices for postpartum patients and newborns; hospital staff privileges and written agreements required for nurse-midwives and allowing nurse-midwives to elect to be covered under the injured patients and families compensation fund; a report on information related to hospital neonatal intensive care units; an electronic application and information systems to determine eligibility and register for public assistance programs; directing the Department of Health Services to request a Medical Assistance waiver; evidence-based home visitation program services for persons who are at risk of poor birth outcomes or of abusing or neglecting their children; designating race and ethnicity on birth certificates; requiring informed consent for performance of certain elective procedures prior to the full gestational term of a fetus; cultural competency training for medical students and students enrolled in programs in a health care occupation in the University of Wisconsin-System and certain technical college students; granting rule-making authority; requiring the exercise of rule-making authority; and providing a penalty.".

SB306-AA6,2,8 5. Page 3, line 1: before that line insert:

SB306-AA6,2,9 " Section 1am. 36.25 (49g) of the statutes is created to read:

SB306-AA6,2,18 36.25 (49g) Cultural competency training. The board shall ensure that all students enrolled in the University of Wisconsin-Madison School of Medicine and Public Health, or in any program providing instruction for a health care or social work occupation, receive training in cultural competency to improve patient-centered care, which shall include evidence-based training related to implicit bias and emerging evidence related to cultural humility, in order to increase the students' cultural awareness and to improve the students' ability to communicate with, and effectively deliver health care to, patients from different racial and ethnic backgrounds.

SB306-AA6, s. 1b Section 1b. 38.04 (32) of the statutes is created to read:

SB306-AA6,3,2 38.04 (32) Cultural competency training. The board shall ensure that technical college students enrolled in health care occupation programs receive training in cultural competency to improve patient-centered care, which shall include evidence-based training related to implicit bias and emerging evidence related to cultural humility, in order to increase the students' cultural awareness and to improve the students' ability to communicate with, and effectively deliver health care to, patients from different racial and ethnic backgrounds.

SB306-AA6, s. 1c Section 1c. 48.983 (4) (a) 4m. of the statutes is amended to read:

SB306-AA6,3,9 48.983 (4) (a) 4m. To reimburse a case management provider under s. 49.45 (25) (b) for the amount of the allowable charges under the Medical Assistance program that is not provided by the federal government for case management services provided to a Medical Assistance beneficiary described in s. 49.45 (25) (am) 9. who is a child and who is a member of a family that receives evidence-based home visitation program services under par. (b) 1.

SB306-AA6, s. 1d Section 1d. 48.983 (4) (b) of the statutes is amended to read:

SB306-AA6,4,14 48.983 (4) (b) Home Evidence-based home visitation program services. 1. A county, private agency, or Indian tribe that is selected to participate in the program under this section shall offer all pregnant women in the county, the area in which that private agency is providing services, or the reservation of the tribe who are eligible for Medical Assistance under subch. IV of ch. 49 an opportunity to undergo an assessment through use of a risk assessment instrument to determine whether the person assessed presents risk factors for poor birth outcomes or for perpetrating child abuse or neglect. Persons who agree to be assessed shall be assessed during the prenatal period. The risk assessment instrument shall be developed by the department and shall be based on risk assessment instruments developed by the department for similar programs that are in operation. The department need not promulgate as rules under ch. 227 the risk assessment instrument developed under this subdivision. A person who is assessed to be at risk of poor birth outcomes or of abusing or neglecting his or her child shall be offered evidence-based home visitation program services that shall be commenced during the prenatal period. Home Evidence-based home visitation program services may be provided to a family with a child identified as being at risk of child abuse or neglect until the identified child reaches 3 years of age. If a family has been receiving evidence-based home visitation program services continuously for not less than 12 months, those services may continue to be provided to the family until the identified child reaches 3 years of age, regardless of whether the child continues to be eligible for Medical Assistance under subch. IV of ch. 49. If risk factors for child abuse or neglect with respect to the identified child continue to be present when the child reaches 3 years of age, evidence-based home visitation program services may be provided until the identified child reaches 5 years of age. Home Evidence-based home visitation program services may not be provided to a person unless the person gives his or her written informed consent to receiving those services or, if the person is a child, unless the child's parent, guardian, or legal custodian gives his or her written informed consent for the child to receive those services.

SB306-AA6,4,18 1m. No person who is required or permitted to report suspected or threatened abuse or neglect under s. 48.981 (2) may make or threaten to make such a report based on a refusal of a person to receive or to continue receiving evidence-based home visitation program services under subd. 1.

SB306-AA6,4,22 3. A county, private agency, or Indian tribe that is providing evidence-based home visitation program services under subd. 1. shall provide to a person receiving those services the information relating to shaken baby syndrome and impacted babies required under s. 253.15 (6).

SB306-AA6, s. 1e Section 1e. 48.983 (6) (a) (intro.) of the statutes is amended to read:

SB306-AA6,5,3 48.983 (6) (a) (intro.) The part of an application, other than a renewal application, submitted by a county, private agency, or Indian tribe that relates to evidence-based home visitation programs shall include all of the following:

SB306-AA6, s. 1f Section 1f. 48.983 (6) (a) 1. of the statutes is amended to read:

SB306-AA6,5,11 48.983 (6) (a) 1. Information on how the applicant's home visitation program is evidence-based, comprehensive, incorporates practice standards that have been developed for home visitation programs by entities concerned with the prevention of poor birth outcomes and child abuse and neglect and that are acceptable to the department, and incorporates practice standards and critical elements that have been developed for successful home visitation programs by a nationally recognized home visitation program model and that are acceptable to the department.

SB306-AA6, s. 1g Section 1g. 48.983 (6) (a) 2. of the statutes is amended to read:

SB306-AA6,5,18 48.983 (6) (a) 2. Documentation that the application was developed through collaboration among public and private organizations that provide services to children and families, especially children who are at risk of child abuse or neglect and families that are at risk of poor birth outcomes, or that are otherwise interested in child welfare and a description of how that collaboration effort will support a comprehensive, evidence-based home visitation program.

SB306-AA6, s. 1h Section 1h. 48.983 (6) (a) 3. of the statutes is amended to read:

SB306-AA6,5,24 48.983 (6) (a) 3. An identification of existing poor birth outcome and child abuse and neglect prevention services that are available to residents of the county, the area in which the private agency is providing services, or the reservation of the Indian tribe and a description of how those services and any additional needed services will support a comprehensive, evidence-based home visitation program.

SB306-AA6, s. 1i Section 1i. 48.983 (6) (a) 4. of the statutes is amended to read:

SB306-AA6,6,4 48.983 (6) (a) 4. An explanation of how the evidence-based home visitation program will build on existing poor birth outcome and child abuse and neglect prevention programs, including programs that provide support to families, and how the evidence-based home visitation program will coordinate with those programs.

SB306-AA6, s. 1j Section 1j. 48.983 (6) (a) 4m. of the statutes is amended to read:

SB306-AA6,6,8 48.983 (6) (a) 4m. An explanation of how the applicant will encourage private organizations to provide services under the applicant's evidence-based home visitation program.

SB306-AA6, s. 1k Section 1k. 48.983 (6) (a) 6. of the statutes is amended to read:

SB306-AA6,6,14 48.983 (6) (a) 6. An identification of how the evidence-based home visitation program is comprehensive and incorporates the practice standards and critical elements for successful home visitation programs referred to in subd. 1., including how services will vary in intensity levels depending on the needs and strengths of the participating family.

SB306-AA6,6,15 Section 1L 48.983 (6) (a) 6m. of the statutes is amended to read:

SB306-AA6,6,18 48.983 (6) (a) 6m. An explanation of how the services to be provided under the evidence-based home visitation program, including the risk assessment under sub. (4) (b) 1., will be provided in a culturally competent manner.

SB306-AA6, s. 1m Section 1m. 48.983 (6) (b) 1. of the statutes is amended to read:

SB306-AA6,7,5 48.983 (6) (b) 1. `Flexible fund for evidence-based home visitation programs.' The applicant demonstrates in the application that the applicant has established, or has plans to establish, if selected, a fund from which payments totaling not less than $250 per calendar year may be made for appropriate expenses of each family that is participating in the evidence-based home visitation program under sub. (4) (b) 1. or that is receiving home visitation services under s. 49.45 (44). The payments shall be authorized by an individual designated by the applicant. If an applicant makes a payment to or on behalf of a family under this subdivision, one-half of the payment shall be from grant moneys received under this section and one-half of the payment shall be from moneys provided by the applicant from sources other than grant moneys received under this section.

SB306-AA6, s. 1n Section 1n. 48.983 (6) (c) of the statutes is amended to read:

SB306-AA6,7,12 48.983 (6) (c) Case management benefit. The applicant states in the grant application that it has elected, or, if selected, that it will elect, under s. 49.45 (25) (b), to make the case management benefit under s. 49.45 (25) available to the category of beneficiaries under s. 49.45 (25) (am) 9. who are children and who are members of families receiving evidence-based home visitation program services under sub. (4) (b) 1.

SB306-AA6, s. 1p Section 1p. 48.983 (6g) (a) and (b) of the statutes are amended to read:

SB306-AA6,7,23 48.983 (6g) (a) Except as permitted or required under s. 48.981 (2), no person may use or disclose any information concerning any individual who is selected for an assessment under sub. (4) (b), including an individual who declines to undergo the assessment, or concerning any individual who is offered services under a an evidence-based home visitation program funded under this section, including an individual who declines to receive those services, unless the use or disclosure is connected with the administration of the evidence-based home visitation program or the administration of the Medical Assistance program under ss. 49.43 to 49.497 or unless the individual has given his or her written informed consent to the use or disclosure.

SB306-AA6,8,4 (b) A county, private agency, or Indian tribe that is selected to participate in the program under this section shall provide or shall designate an individual or entity to provide an explanation of the confidentiality requirements under par. (a) to each individual who is offered an assessment under sub. (4) (b) or who is offered services under the evidence-based home visitation program of the county, private agency, or Indian tribe.

SB306-AA6, s. 1q Section 1q. 48.983 (6m) of the statutes is amended to read:

SB306-AA6,8,14 48.983 (6m) Notification of parent prior to making abuse or neglect report. If a person who is providing services under a an evidence-based home visitation program under sub. (4) (b) 1. determines that he or she is required or permitted to make a report under s. 48.981 (2) about a child in a family to which the person is providing those services, the person shall, prior to making the report under s. 48.981 (2), make a reasonable effort to notify the child's parent that a report under s. 48.981 (2) will be made and to encourage the parent to contact a county department to request assistance. The notification requirements under this subsection do not affect the reporting requirements under s. 48.981 (2).

SB306-AA6, s. 1r Section 1r. 48.983 (6r) of the statutes is amended to read:

SB306-AA6,8,20 48.983 (6r) Home Evidence-based home visitation program informational materials. Any informational materials about a an evidence-based home visitation program under sub. (4) (b) 1. that are distributed to a person who is offered or who is receiving home visitation program services under that program shall state the sources of funding for the program.

SB306-AA6, s. 1s Section 1s. 48.983 (7) (title) and (a) (intro.) of the statutes are amended to read:

SB306-AA6,9,2 48.983 (7) (title) Home Evidence-based home visitation program evaluation. (a) (intro.) The department shall conduct or shall select an evaluator to conduct an evaluation of the evidence-based home visitation program. The evaluation shall measure all of the following criteria in families that have participated in the home visitation that program and that are selected for evaluation:

SB306-AA6, s. 1t Section 1t. 48.983 (7) (ag) of the statutes is amended to read:

SB306-AA6,9,8 48.983 (7) (ag) The department shall evaluate the availability of evidence-based home visitation programs in the state and determine whether there are gaps in home visitation services in the state. The department shall cooperate with counties, private agencies, and Indian tribes providing evidence-based home visitation programs to address any gaps in services identified.

SB306-AA6, s. 1u Section 1u. 48.983 (7) (ar) of the statutes is amended to read:

SB306-AA6,9,14 48.983 (7) (ar) Each county, private agency, and Indian tribe providing a an evidence-based home visitation program shall collect and report data to the department, as required by the department. The department shall require each county, private agency, and Indian tribe providing a an evidence-based home visitation program to collect data using forms prescribed by the department.

SB306-AA6, s. 1v Section 1v. 48.983 (7) (b) of the statutes is amended to read:

SB306-AA6,9,18 48.983 (7) (b) In the evaluation, the department shall determine the number of families who remained in the evidence-based home visitation program for the time recommended in the family's case plan.

SB306-AA6, s. 1w Section 1w. 48.983 (7) (c) of the statutes is amended to read:

SB306-AA6,9,25 48.983 (7) (c) Each county, private agency, and Indian tribe providing a an evidence-based home visitation program shall develop a plan for evaluating the effectiveness of its program for approval by the department. The plan shall demonstrate how the county, private agency, or Indian tribe will use the evaluation of its program to improve the quality and outcomes of the program and to ensure continued compliance with the home visitation program criteria under sub. (6) (a). The plan shall demonstrate how the outcomes will be tracked and measured. Under the plan, the extent to which all of the following outcomes are achieved shall be tracked and measured:

SB306-AA6,10,6 1. Parents receiving evidence-based home visitation services acquiring knowledge of early learning and child development and interacting with their children in ways that enhance the children's development and early learning.

SB306-AA6,10,7 2. Children receiving evidence-based home visitation services being healthy.

SB306-AA6,10,9 3. Children receiving evidence-based home visitation services living in a safe environment.

SB306-AA6,10,11 4. Families receiving evidence-based home visitation services accessing formal and informal support networks.

SB306-AA6,10,13 5. Children receiving evidence-based home visitation services achieving milestones in development and early learning.

SB306-AA6,10,15 6. Children receiving evidence-based home visitation services who have developmental delays receiving appropriate intervention services.

SB306-AA6, s. 1x Section 1x. 48.983 (8) of the statutes is amended to read:

SB306-AA6,10,24 48.983 (8) Technical assistance and training. The department shall provide technical assistance and training to counties, private agencies, and Indian tribes that are selected to participate in the program under this section. The training may not be limited to a particular evidence-based home visitation model. The training shall include training in best practices regarding basic skills, uniform administration of screening and assessment tools, the issues and challenges that families face, and supervision and personnel skills for program managers. The training may also include training on data collection and reporting.

SB306-AA6, s. 1y Section 1y. 48.983 (9) of the statutes is created to read:

SB306-AA6,11,4 48.983 (9) Memorandum of understanding. The department shall enter into a memorandum of understanding with the department of health services that provides for collaboration between those departments in carrying out evidence-based home visiting programs under sub. (4) (b) 1.

SB306-AA6, s. 1z Section 1z. 49.45 (24w) of the statutes is created to read:

SB306-AA6,11,18 49.45 (24w) Services for pregnant women. (a) The department shall request a wavier of federal Medicaid law from the secretary of the federal department of health and human services to permit the department to provide services and support under medical assistance for pregnant women who face an increased risk of having a low-birth weight baby, a preterm birth, or other negative birth outcome because of medical or nonmedical factors, such as psychosocial, behavioral, environmental, educational, or nutritional factors. The department shall implement the programs and services authorized by this waiver in Milwaukee, Racine, Kenosha, Rock, and Dane counties, and in a rural multicounty region identified by the department in collaboration with the Great Lakes Intertribal Council. The multicounty region shall include counties experiencing the largest disparities in birth outcomes between Caucasian and Native American populations and shall be of sufficient size to enable meaningful implementation and evaluation of the programs and services.

SB306-AA6,11,20 (b) The department shall consider including all of the following as covered services or programs in the waiver request under par. (a):

SB306-AA6,11,23 1. Evidence-based social marketing of programs designed to reduce fetal and infant mortality, improve birth outcomes, and address needs of infants and their families.

SB306-AA6,11,25 2. Evidence-based social-support programs, including fatherhood initiatives designed to reduce fetal and infant mortality and improve birth outcomes.

SB306-AA6,12,4 3. Transportation services for persons who accompany a pregnant woman to prenatal appointments and transportation for the pregnant woman and her children to other destinations including social services' offices and locations where child care is provided for her children.

SB306-AA6,12,8 4. Data collection, including the pregnancy risk assessment and monitoring system, fetal and infant mortality review, vital statistics information, information from medical assistance data and chart reviews, and an assessment of nonmedical factors that may contribute to poor birth outcomes.

SB306-AA6,12,10 5. Full reimbursement for evidence-based group prenatal care, such as the Centering Pregnancy program.

SB306-AA6,12,11 6. Mental health services.

SB306-AA6,12,12 7. Smoking cessation services.

SB306-AA6,12,15 8. Initiatives to increase the utilization of public health and other health care providers with similar racial and socioeconomic backgrounds as the pregnant women and families served by the health care provider.

SB306-AA6,12,20 9. Coordinators to create social care plans for medical assistance recipients, to provide information and assistance regarding all programs that may impact low-income pregnant women, including programs regarding rental assistance, the earned income tax credit, available child care services for a pregnant woman's other children, and to provide breastfeeding support.

SB306-AA6,12,23 10. Demonstration projects developed by the department, to evaluate the effectiveness of evidence-based programs designed to serve under-served populations.

SB306-AA6,13,3 11. One or more initiatives, developed by the department, to increase the utilization of nurse-midwives licensed under s. 441.15 (3) and doulas in the delivery of care to underserved populations and to evaluate the outcomes of that care.

SB306-AA6,13,4 12. The establishment of freestanding birth centers.

SB306-AA6,13,8 13. Extension of the prenatal care coordination services that are available as a medical assistance benefit from the beginning of pregnancy to the first day of the 13th month after delivery and specifying that prenatal care coordination services are available to recipients' babies during that time period.

SB306-AA6,13,10 14. Expansion and full reimbursement of evidence-based, home-based prenatal care coordination services.

SB306-AA6,13,15 15. Full reimbursement for home visits made by registered nurses who are public health nurses or who meet the qualifications of a public health nurse as specified in s. 250.06 (1), by social workers as defined in s. 252.15 (1) (er), nurse-midwives licensed under s. 441.15 (3), and by persons who receive the training established under s. 38.04 (32).

SB306-AA6,13,17 16. Reimbursement of care provided through telemedicine visits on the same basis that reimbursement is provided for in-person visits.

SB306-AA6,13,19 17. Reimbursement of the costs of providing banked human donor milk to newborns when medically indicated.

SB306-AA6,13,22 (c) The department shall evaluate the programs and services implemented under the waiver and develop a plan to implement the programs and services statewide.

SB306-AA6,13,25 (d) The department shall consider prohibiting reimbursement for elective induction of labor or cesarean sections if either procedure is performed before 39 weeks gestation, unless medically indicated.