Amendment SSA1-SB21

SB21-SSA1,543,17 49.34 (5m) (a) 1j. "Control" means the possession of the power, directly or indirectly, to direct or cause the direction of the management and policies of a provider through the ownership of more than 50 percent of the voting rights of the provider, by contract, or otherwise.

SB21-SSA1,1777fh Section 1777fh. 49.34 (5m) (a) 2. of the statutes is amended to read:

SB21-SSA1,543,25 49.34 (5m) (a) 2. "Rate-based service" means a service or a group of similar services, as determined by the department, provided under one or more contracts between a provider and the purchaser of those services that is reimbursed through a prospectively set rate and that is distinguishable from other services or groups of similar services by the purpose for which funds are provided for that service or group of similar services and by the source of funding for that service or group of similar services.

SB21-SSA1,1777fj Section 1777fj. 49.34 (5m) (a) 3. of the statutes is created to read:

SB21-SSA1,544,3 49.34 (5m) (a) 3. "Rate-regulated service" means a rate-based service that is reimbursed through a rate established under s. 49.343.

SB21-SSA1,1777fk Section 1777fk. 49.34 (5m) (b) 1. and 2. of the statutes are consolidated, renumbered 49.34 (5m) (b) and amended to read:

SB21-SSA1,545,20 49.34 (5m) (b) Subject to subds. 2. and 3. and par. pars. (d), (e), and (em), if revenue under a contract for the provision of a rate-based service exceeds allowable costs incurred in the contract period, the provider may shall be permitted to retain from the any surplus generated by that rate-based service up to 5% of the contract amount. A provider that retains a surplus under this subdivision shall as provided in this paragraph and to use that retained surplus to cover a deficit between revenue and allowable costs incurred in any preceding or future contract period for the same rate-based service that generated the surplus or to address the programmatic needs of clients served by the same rate-based service that generated the surplus. This subdivision does not apply to a child welfare agency that is authorized under s. 48.61 (7) to license foster homes, a group home, as defined in s. 48.02 (7), or a residential care center for children and youth, as defined in s. 48.02 (15d). 2. amount, in the sole discretion of the provider, to cover any allowable costs specified in 2 CFR part 200 or in any other applicable federal law or regulation. If on December 31 of any year the amount accumulated by a provider from all contract periods ending during that year for a rate-based service exceeds 5 percent of the total revenue received from all of those contract periods, the provider shall provide written notice of that excess to all purchasers of the rate-based service and, upon the written request of such a purchaser received no later than 6 months after the date of the notice, shall return to the purchaser the purchaser's proportional share of that excess. Subject to subd. 3. and par. pars. (d), (e), and (em), a provider may accumulate funds from more than one contract period under this paragraph, except that, if at the end of a contract period the amount accumulated from all contract periods for a rate-based service exceeds 10% of the amount of all current contracts for that rate-based service, the provider shall, at the request of a purchaser, return to that purchaser the purchaser's proportional share of that excess and use any of that excess that is not returned to a purchaser to reduce the provider's unit rate per client for that rate-based service in the next contract period. If a provider has held for 4 consecutive contract periods an accumulated reserve for a rate-based service that is equal to or exceeds 10% of the amount of all current contracts for that rate-based service, the provider shall apply 50% of that accumulated amount to reducing its unit rate per client for that rate-based service in the next contract period. The department may grant an exception to this subdivision upon request of a provider that is a child welfare agency that is authorized under s. 48.61 (7) to license foster homes, a group home, as defined in s. 48.02 (7), or a residential care center for children and youth, as defined in s. 48.02 (15d). A contract for a rate-based service may not limit the provider to retaining from any surplus generated by that service an amount that is less than 5 percent of the revenue received under the contract. Nothing in this paragraph shall be construed to guarantee the generation of a surplus by the provider of a rate-based service.

SB21-SSA1,1777fn Section 1777fn. 49.34 (5m) (b) 3. of the statutes is repealed.

SB21-SSA1,1777fp Section 1777fp. 49.34 (5m) (d) of the statutes is created to read:

SB21-SSA1,546,17 49.34 (5m) (d) 1. Subject to subd. 2. and par. (e), if on December 31 of any year the combined revenues from all contract periods ending during that year for all rate-regulated services exceed the allowable costs related to the provision of those rate-regulated services in that year, the provider shall be permitted to retain any surplus generated by those rate-regulated services as provided in this subdivision and to use that retained amount, in the sole discretion of the provider, to cover any allowable costs specified in 2 CFR Part 200 or in any other applicable federal law or regulation. If on December 31 of any year the amount accumulated by a provider from all contract periods ending during that year for a rate-regulated service provided under those contracts in that year exceeds 5 percent of the total revenue received from all of those contract periods, the provider shall provide written notice of that excess to all purchasers of that rate-regulated service and, upon the written request of such a purchaser received no later than 6 months after the date of the notice, shall return to the purchaser the purchaser's proportional share of that excess. The department may grant an exception to this subdivision upon the request of a provider of a rate-regulated service. A contract for a rate-regulated service may not limit the provider to retaining from any surplus generated by that service an amount that is less than 5 percent of the revenue received under the contract. Nothing in this subdivision shall be construed to guarantee the generation of a surplus by the provider of a rate-regulated service.

SB21-SSA1,547,2 2. In calculating under subd. 1. the surplus generated by 2 or more affiliated providers, any surplus of combined revenues over allowable costs generated by one or more of those affiliated providers shall be reduced, but not below zero, by any deficit between combined revenues and allowable costs generated by any one or more of those affiliated providers. If after that reduction there remains any net surplus, that net surplus shall be allocated among the affiliated providers that generated a surplus in proportion to the amount of surplus generated by each such affiliated provider and subd. 1. shall apply to each such affiliated provider's proportionate share of that surplus.

SB21-SSA1,1777fq Section 1777fq. 49.34 (5m) (e) of the statutes is created to read:

SB21-SSA1,547,10 49.34 (5m) (e) In making the calculations under pars. (b) and (d), if 2 or more providers engage in a merger, acquisition, consolidation, reorganization, sale, or other transfer resulting in a single successor provider, all surpluses generated by a rate-based service or a rate-regulated service provided by a preexisting provider shall be offset against all deficits generated by that service provided by a preexisting provider and those net surpluses or deficits shall be the surpluses or deficits of the successor provider.

SB21-SSA1,1777fr Section 1777fr. 49.34 (5m) (em) of the statutes is amended to read:

SB21-SSA1,547,18 49.34 (5m) (em) Notwithstanding par. (b) 1. and 2., a county department under s. 46.215, 51.42, or 51.437 providing client services in a county having a population of 500,000 or more or a nonstock, nonprofit corporation providing client services in such a county may not retain a surplus generated by a rate-based service or accumulate funds from more than one contract period for a rate-based service from revenues that are used to meet the maintenance-of-effort requirement under the federal temporary assistance for needy families program under 42 USC 601 to 619.

SB21-SSA1,1778 Section 1778. 49.345 (1) of the statutes is amended to read:

SB21-SSA1,547,24 49.345 (1) Liability and the collection and enforcement of such liability for the care, maintenance, services, and supplies specified in this section are governed exclusively by this section, except in cases of child support ordered by a court under s. 48.355 (2) (b) 4., 48.357 (5m) (a), or 48.363 (2), 938.183 (4), 938.355 (2) (b) 4., 938.357 (5m) (a), or 938.363 (2) or ch. 767.

SB21-SSA1,1779 Section 1779. 49.345 (2) of the statutes is amended to read:

SB21-SSA1,548,21 49.345 (2) Except as provided in sub. (14) (b) and (c), any person, including but not limited to a person placed under s. 48.345 (3) or , 48.357 (1) or (2m), 938.183, 938.34 (3) or (4d), or 938.357 (1), (2m), (4), or (5) (e), receiving care, maintenance, services, and supplies provided by any institution in this state, in which the state is chargeable with all or part of the person's care, maintenance, services, and supplies, and the person's property and estate, including the homestead, and the spouse of the person, and the spouse's property and estate, including the homestead, and, in the case of a minor child, the parents of the person, and their property and estates, including their homestead, and, in the case of a foreign child described in s. 48.839 (1) who became dependent on public funds for his or her primary support before an order granting his or her adoption, the resident of this state appointed guardian of the child by a foreign court who brought the child into this state for the purpose of adoption, and his or her property and estate, including his or her homestead, shall be liable for the cost of the care, maintenance, services, and supplies in accordance with the fee schedule established by the department under s. 49.32 (1). If a spouse, widow, or minor, or an incapacitated person may be lawfully dependent upon the property for his or her support, the court shall release all or such part of the property and estate from the charges that may be necessary to provide for the person. The department shall make every reasonable effort to notify the liable persons as soon as possible after the beginning of the maintenance, but the notice or the receipt thereof of the notice is not a condition of liability.

SB21-SSA1,1780 Section 1780. 49.345 (8) (g) of the statutes is amended to read:

SB21-SSA1,548,25 49.345 (8) (g) Pay quarterly from the appropriation under s. 20.437 (1) (gg) the collection moneys due county departments under ss. 46.215, 46.22, and 46.23. Payments shall be made as soon after the close of each quarter as is practicable.

SB21-SSA1,1781 Section 1781. 49.345 (14) (b) of the statutes is amended to read:

SB21-SSA1,549,9 49.345 (14) (b) Except as provided in par. (c), and subject to par. (cm), liability of a parent specified in sub. (2) or s. 49.32 (1) for the care and maintenance of the parent's minor child who has been placed by a court order under s. 48.355 or, 48.357, 938.183, 938.355, or 938.357 in a residential, nonmedical facility such as a group home, foster home, subsidized guardianship home, or residential care center for children and youth shall be determined by the court by using the percentage standard established by the department under s. 49.22 (9) and by applying the percentage standard in the manner established by the department under par. (g).

SB21-SSA1,1782 Section 1782. 49.345 (14) (e) 1. of the statutes is amended to read:

SB21-SSA1,549,19 49.345 (14) (e) 1. An order issued under s. 48.355 (2) (b) 4., 48.357 (5m) (a), or 48.363 (2) for support determined under this subsection constitutes an assignment of all commissions, earnings, salaries, wages, pension benefits, income continuation insurance benefits under s. 40.62, duty disability benefits under s. 40.65, benefits under ch. 102 or 108, and other money due or to be due in the future to the county department under s. 46.22 or 46.23 in the county where the order was entered or to the department, depending upon the placement of the child as specified by rules promulgated under subd. 5. The assignment shall be for an amount sufficient to ensure payment under the order.

SB21-SSA1,1783 Section 1783 . 49.345 (14) (e) 1. of the statutes, as affected by 2015 Wisconsin Act .... (this act), is amended to read:

SB21-SSA1,550,6 49.345 (14) (e) 1. An order issued under s. 48.355 (2) (b) 4., 48.357 (5m) (a), or 48.363 (2), 938.183 (4), 938.355 (2) (b) 4., 938.357 (5m) (a), or 938.363 (2) for support determined under this subsection constitutes an assignment of all commissions, earnings, salaries, wages, pension benefits, income continuation insurance benefits under s. 40.62, duty disability benefits under s. 40.65, benefits under ch. 102 or 108, and other money due or to be due in the future to the county department under s. 46.215, 46.22, or 46.23 in the county where the order was entered or to the department, depending upon the placement of the child as specified by rules promulgated under subd. 5. The assignment shall be for an amount sufficient to ensure payment under the order.

SB21-SSA1,1784 Section 1784. 49.345 (14) (g) of the statutes is amended to read:

SB21-SSA1,550,14 49.345 (14) (g) For purposes of determining child support under par. (b), the department shall promulgate rules related to the application of the standard established by the department under s. 49.22 (9) to a child support obligation for the care and maintenance of a child who is placed by a court order under s. 48.355 or, 48.357, 938.183, 938.355, or 938.357 in a residential, nonmedical facility. The rules shall take into account the needs of any person, including dependent children other than the child, whom either parent is legally obligated to support.

SB21-SSA1,1785 Section 1785. 49.345 (16) of the statutes is amended to read:

SB21-SSA1,550,24 49.345 (16) The department shall delegate to county departments under ss. 46.215, 46.22, and 46.23 or the local providers of care and services meeting the standards established by the department under s. 49.34 the responsibilities vested in the department under this section for collection of fees for services other than those provided at state facilities, if the county departments or providers meet the conditions that the department determines are appropriate. The department may delegate to county departments under ss. 46.215, 46.22, and 46.23 the responsibilities vested in the department under this section for collection of fees for services provided at the state facilities if the necessary conditions are met.

SB21-SSA1,1785m Section 1785m. 49.348 of the statutes is created to read:

SB21-SSA1,551,12 49.348 Recidivism reduction program. (1) The department may request proposals for a program that reduces the rate of recidivism of persons in the city of Milwaukee who have previously been incarcerated following a criminal conviction. The department shall specify that the program will be conducted under a contract with a 5-year term and that no payment will be made under the contract until the organization selected to conduct the program demonstrates, after the 5-year term, that the program met a certain minimum level of success, as determined under subs. (2) and (4). The selected organization may serve as an intermediary for obtaining funding to perform the contract by raising capital from private donors or investors and for subcontracting with direct providers to achieve the specified performance outcomes. In evaluating proposals, the department shall give a preference to those that incorporate reuniting parents with their children.

SB21-SSA1,551,15 (2) The legislative audit bureau shall assist the department and the selected organization in identifying benchmarks by which to measure the organization's performance under the contract.

SB21-SSA1,552,5 (3) After selecting a proposal, the department shall submit a written plan for the program and the contract under which it will be performed to the joint committee on finance. The department shall include in the plan information on the selected proposal and organization, the methods by which the organization will finance startup and ongoing costs of the program during the 5-year term of the contract, the benchmarks identified under sub. (2), the methods by which performance will be monitored and measured, the levels of payment for different degrees of success, and any service providers that the selected organization intends to engage in order to deliver services under the contract. If the cochairpersons of the joint committee on finance do not notify the department within 14 working days after the date of the submittal of the plan that the committee has scheduled a meeting to review the plan, the plan may be implemented by the department. If, within 14 days after the date of the submittal of the plan, the cochairpersons of the committee notify the department that the committee has scheduled a meeting to review the plan, the department may only implement the plan as approved by the committee.

SB21-SSA1,552,8 (4) After completion of the 5-year contract term, the legislative audit bureau shall conduct an audit of the program to determine whether the benchmarks identified under sub. (2) have been met.

SB21-SSA1,1786 Section 1786. 49.35 (1) (a) of the statutes is amended to read:

SB21-SSA1,552,17 49.35 (1) (a) The department shall supervise the administration of programs under this subchapter and ch. 48 and of community-based juvenile delinquency-related programs under ch. 938. The department shall submit to the federal authorities state plans for the administration of programs under this subchapter and ch. 48 and of community-based juvenile delinquency-related programs under ch. 938 in such form and containing such information as the federal authorities require, and shall comply with all requirements prescribed to ensure their correctness.

SB21-SSA1,1787 Section 1787. 49.35 (1) (b) of the statutes is amended to read:

SB21-SSA1,553,2 49.35 (1) (b) All records of the department and all county records relating to programs under this subchapter and ch. 48, community-based juvenile delinquency-related programs under ch. 938, and aid under s. 49.18, 1971 stats., s. 49.20, 1971 stats., and s. 49.61, 1971 stats., as affected by chapter 90, laws of 1973, shall be open to inspection at all reasonable hours by authorized representatives of the federal government. Notwithstanding ss. 48.396 (2) and 938.396 (2), all county records relating to the administration of the services and public assistance specified in this paragraph shall be open to inspection at all reasonable hours by authorized representatives of the department.

SB21-SSA1,1788 Section 1788. 49.35 (2) of the statutes is amended to read:

SB21-SSA1,553,7 49.35 (2) The county administration of all laws relating to programs under this subchapter and ch. 48 and to community-based juvenile delinquency-related programs under ch. 938 shall be vested in the officers and agencies designated in the statutes.

SB21-SSA1,1789 Section 1789. 49.36 (3) (a) of the statutes is amended to read:

SB21-SSA1,553,11 49.36 (3) (a) Except as provided in par. (f) and subject to sub. (3m), a person ordered to register under s. 767.55 (2) (am) shall participate in a work experience program if services are available.

SB21-SSA1,1790 Section 1790. 49.36 (3m) of the statutes is created to read:

SB21-SSA1,553,15 49.36 (3m) A person is not eligible to participate in a program under this section unless the person satisfies all of the requirements related to substance abuse screening, testing, and treatment under s. 49.162 that apply to the individual.

SB21-SSA1,1791p Section 1791p. 49.45 (3g) of the statutes is created to read:

SB21-SSA1,553,21 49.45 (3g) Payments to federally qualified health centers. (a) For services provided by a federally qualified health center before July 1, 2016, to a recipient of the Medical Assistance program under this subchapter, the department shall reimburse the federally qualified health center under a payment methodology in effect on January 1, 2015, and in accordance with 42 USC 1396a (bb) (6).

SB21-SSA1,554,5 (b) For services provided by a federally qualified health center on or after July 1, 2016, to a recipient of the Medical Assistance program under this subchapter, the department shall reimburse the federally qualified health centers using a payment methodology based on the Medicaid prospective payment system under 42 USC 1396a (bb) (1) to (3). The department shall consult with federally qualified health centers in developing the payment methodology under this paragraph. The department shall phase-in over fiscal years 2016-17, 2017-18, and 2018-19 payment of new rates under the payment methodology developed under this paragraph.

SB21-SSA1,1791r Section 1791r. 49.45 (3m) of the statutes is created to read:

SB21-SSA1,554,14 49.45 (3m) Disproportionate share hospital payments. (a ) Subject to par. (c) and notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b) and (o), in each fiscal year, the department shall pay to hospitals that serve a disproportionate share of low-income patients an amount equal to the sum of $15,000,000, as the state share of payments, and the matching federal share of payments. The department may make a payment to a hospital under this subsection under the calculation method described in par. (b ) if the hospital meets all of the following criteria:

SB21-SSA1,554,15 1. The hospital is located in this state.

SB21-SSA1,554,17 2. The hospital provides a wide array of services, including services provided through an emergency department.

SB21-SSA1,554,20 3. The inpatient days for Medical Assistance recipients at the hospital were at least 6 percent of the total inpatient days at that hospital during the most recent year for which such information is available.

SB21-SSA1,554,23 4. The hospital meets applicable, minimum requirements to be a disproportionate share hospital under 42 USC 1396r-4 and any other applicable federal law.

SB21-SSA1,554,25 (b) The department shall comply with all of the following when making payments to hospitals described in par. (a ):

SB21-SSA1,555,3 1. The department shall distribute the total amount of moneys described under par. (a) to be paid to hospitals with a disproportionate share of low-income patients by doing all of the following:

SB21-SSA1,555,6 a. Dividing the number of Medical Assistance recipient inpatient days at a hospital by the number of total inpatient days at the hospital to obtain the percentage of Medical Assistance recipient inpatient days at that hospital.

SB21-SSA1,555,11 b. Subject to subds. 2. and 3 ., providing an increase to the inpatient fee-for-service base rate for each hospital that qualifies for a disproportionate share hospital payment such that the hospital's overall fee-for-service add-on percentage under this subsection increases as the hospital's percentage of Medical Assistance recipient inpatient days increases.

SB21-SSA1,555,14 2. The department shall ensure that the total amount of moneys available to pay hospitals with a disproportionate share of low-income patients is distributed in each fiscal year.

SB21-SSA1,555,17 3. The department shall limit the maximum payment to hospitals such that all of the following are true for disproportionate share hospital payments under this subsection in a fiscal year:

SB21-SSA1,555,18 a. No single hospital receives more than $2,500,000.

SB21-SSA1,555,20 b. The amount of payment is in accordance with federal rules concerning the hospital specific limit.

SB21-SSA1,555,25 (c) If the department needs data to calculate the payments under this subsection other than the data available from the Medicaid Management Information System, the fiscal survey data, or the federal centers for Medicare and Medicaid services public records, the department shall collect the necessary data from hospitals.

SB21-SSA1,556,19 (d) The department shall seek any necessary approval from the federal department of health and human services to implement the hospital payment methodology described under pars. (a ) and (b). If approval is necessary and approval from the federal department of health and human services is received, the department shall implement the payment methodology described under pars. (a) and (b). If approval is necessary and the department and the federal department of health and human services negotiate a methodology for making payments to hospitals with a disproportionate share of low-income patients that is different from the methodology described under pars. (a ) and (b), the department, before implementing the negotiated payment methodology, shall submit to the joint committee on finance the negotiated payment methodology. If the cochairpersons of the committee do not notify the department within 14 working days after the date of the submittal by the department that the committee has scheduled a meeting for the purpose of reviewing the negotiated payment methodology, the department may implement the negotiated payment methodology. If, within 14 working days after the date of the submittal by the department, the cochairpersons of the committee notify the department that the committee has scheduled a meeting for the purpose of reviewing the negotiated payment methodology, the negotiated payment methodology may be implemented only on approval of the committee.

SB21-SSA1,1792 Section 1792. 49.45 (6m) (br) 1. of the statutes is amended to read:

SB21-SSA1,557,4 49.45 (6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435 or (7) (b) or 20.437 (1) (cj) or (2) (dz), the department shall reduce allocations of funds to counties in the amount of the disallowance from the appropriation account under s. 20.435 (7) (b), or the department shall direct the department of children and families to reduce allocations of funds to counties or Wisconsin Works agencies in the amount of the disallowance from the appropriation account under s. 20.437 (1) (cj) or (2) (dz) or direct the department of corrections to reduce allocations of funds to counties in the amount of the disallowance from the appropriation account under s. 20.410 (3) (cd), in accordance with s. 16.544 to the extent applicable.

SB21-SSA1,1793 Section 1793. 49.45 (6v) of the statutes, as affected by 2015 Wisconsin Act .... (this act), is repealed.

SB21-SSA1,1794 Section 1794. 49.45 (6v) (c) of the statutes is amended to read:

SB21-SSA1,557,18 49.45 (6v) (c) If the report specified in par. (b) indicates that utilization of beds by recipients of medical assistance in facilities is less than estimates for that utilization reflected in the intentions of the joint committee on finance, legislature and governor, as expressed by them in the budget determinations, the department shall include a proposal to transfer moneys from the appropriation under s. 20.435 (4) (b) to the appropriation under s. 20.435 (7) (4) (bd) for the purpose of increasing funding for the community options program under s. 46.27. The amount proposed for transfer may not reduce the balance in the appropriation account under s. 20.435 (4) (b) below an amount necessary to ensure that that appropriation account will end the current fiscal year or the current fiscal biennium with a positive balance. The secretary shall transfer the amount identified under the proposal.

SB21-SSA1,1796 Section 1796. 49.45 (23) (c) of the statutes is repealed.

SB21-SSA1,1797 Section 1797. 49.45 (23) (g) of the statutes is created to read:

SB21-SSA1,557,25 49.45 (23) (g) 1. Subject to subd. 3., the department shall submit to the secretary of the federal department of health and human services an amendment to the waiver requested under par. (a) that authorizes the department to do all of the following with respect to the childless adults demonstration project under this subsection:

SB21-SSA1,558,1 a. Impose monthly premiums as determined by the department.

SB21-SSA1,558,3 b. Impose higher premiums for enrollees who engage in behaviors that increase their health risks, as determined by the department.

SB21-SSA1,558,4 c. Require a health risk assessment for all enrollees.

SB21-SSA1,558,7 d. Limit an enrollee's eligibility under the demonstration project to no more than 48 months. The department shall specify the eligibility formula in the waiver amendment.

SB21-SSA1,558,10 e. Require, as a condition of eligibility, that an applicant or enrollee submit to a drug screening assessment and, if indicated, a drug test, as specified by the department in the waiver amendment.

SB21-SSA1,558,15 2. Subject to subd. 3., if the secretary of the federal department of health and human services approves the amendment to the waiver under par. (a), in whole or in part, the department shall implement the changes to the demonstration project under this subsection specified in subd. 1. a. to e. that are approved by the secretary, consistent with the approval.

SB21-SSA1,558,24 3. Prior to submitting to the secretary of the federal department of health and human services the amendment described in subd. 1., the department shall submit to the joint committee on finance a report that summarizes the provisions, and provides an estimate of the fiscal effect, of the proposed amendment to the waiver. If the secretary of the federal department of health and human services approves the amendment described in subd. 1., in whole or in part, before implementing the changes approved by the secretary, the department shall submit a report to the joint committee on finance that summarizes the provisions, and provides an estimate of the fiscal effect, of the amendment approved by the secretary.

SB21-SSA1,1798 Section 1798. 49.45 (24k) of the statutes is created to read:

SB21-SSA1,559,14 49.45 (24k) Dental reimbursement pilot project. (a) 1. Subject to approval of the federal department of health and human services under par. (b), the department, as a pilot project, shall distribute moneys in each fiscal year to increase the reimbursement rate under Medical Assistance for pediatric dental care and adult emergency dental services, as defined by the department, that are provided in Brown, Marathon, Polk, and Racine counties. The reimbursement rate for these services shall equal 80 percent of the median fee for each service as reported in the most recent fee survey for the east north central region conducted by the American Dental Association or shall equal the provider's usual and customary charge, whichever is less. If a median fee is not reported for a service, the department shall establish a fee for the service that approximates 80 percent of the median usual and customary charge for that service for dentists practicing in the state but the reimbursement received by a provider may not exceed the provider's usual and customary charge for that service.

SB21-SSA1,560,2 2. For dental services provided on a fee-for-service basis as of July 1, 2015, the reimbursement rate increase specified in subd. 1. shall be distributed on a fee-for-service basis. For dental services provided as of July 1, 2015, by a health maintenance organization that contracts with the department to provide Medical Assistance services at a capitated rate, the department shall distribute the reimbursement rate increase under subd. 1. to the health maintenance organization. The department shall include in a contract with a health maintenance organization that provides dental services described in subd. 1. in the counties specified in subd. 1. a requirement that the health maintenance organization reimburse providers of services in accordance with the reimbursement rate increase pilot project under subd. 1. The department may not distribute the reimbursement rate increase under subd. 1. to federally qualified health centers that receive a grant under 42 USC 254b.

SB21-SSA1,560,8 (b) The department shall request any waiver from and submit any amendments to the state Medical Assistance plan to the federal department of health and human services necessary for the reimbursement rate increase pilot project under par. (a). If any necessary waiver request or state plan amendment request is approved, the department shall implement par. (a) beginning on the effective date of the waiver or plan amendment.

SB21-SSA1,560,16 (c) If the reimbursement rate increase pilot project under par. (a) is implemented, before the first day of the 4th month beginning after the effective date of the waiver or plan amendment described in par. (b) and quarterly thereafter, the department shall collaborate with the Health Policy Institute of the American Dental Association to evaluate the pilot project under par. (a) and shall submit a report to the joint committee on finance that includes data on all of the following key outcomes of interest from the pilot counties specified in par. (a) and from counties that are not pilot counties:

SB21-SSA1,560,18 1. Dental care utilization among children and adults in dental clinics and in emergency rooms.

SB21-SSA1,560,19 2. Participation by dentists in the Medical Assistance program.

SB21-SSA1,560,21 3. The fiscal impact of the pilot project under par. (a), including costs and savings.

SB21-SSA1,560,23 4. If feasible, a comparison of the pilot project as administered under a fee-for-service system and under a health maintenance organization system.