Amendment SSA1-SB21

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.

SB21-SSA1,561,3 5. If feasible, the impact of the pilot project on oral health outcomes, such as Medical Assistance recipients' self-reported assessment of oral health and barriers to obtaining dental care.

SB21-SSA1,561,7 (d) The department may not distribute the reimbursement rate increases under par. (a) for pediatric dental care and adult emergency dental services provided after the first day of the 37th month beginning after the effective date of the waiver or plan amendment described in par. (b).

SB21-SSA1,1799 Section 1799. 49.45 (30x) of the statutes is created to read:

SB21-SSA1,561,13 49.45 (30x) Licensed midwife services. (a) Provider reimbursement. Beginning January 1, 2016, services under s. 49.46 (2) (b) 12t. provided to an individual are reimbursable under the Medical Assistance program if an amendment to the state medical assistance plan approved by the federal department of health and human services permits reimbursement under s. 49.46 (2) (b) 12t.

SB21-SSA1,561,18 (b) Plan amendment. The department shall submit to the federal department of health and human services an amendment to the state medical assistance plan to permit the application of par. (a). The department may not pay reimbursement under par. (a) unless the amendment to the state plan allowing reimbursement under s. 49.46 (2) (b) 12t. is approved and in effect.

SB21-SSA1,1800 Section 1800. 49.45 (39) (bm) of the statutes is created to read:

SB21-SSA1,561,23 49.45 (39) (bm) Excess state share. Any portion of the state share under this subsection in excess of $42,200,000 in fiscal year 2015-16 and in excess of $41,700,000 in fiscal year 2016-17 and each fiscal year thereafter shall be deposited in the Medical Assistance trust fund.

SB21-SSA1,1801 Section 1801. 49.45 (39m) of the statutes is created to read:

SB21-SSA1,562,10 49.45 (39m) State plan amendment for pharmacist reimbursement. The department shall submit to the federal department of health and human services an amendment to the state Medical Assistance plan to permit Medical Assistance reimbursement to pharmacists who meet the training requirements specified by the department to administer vaccines, as determined by the department, to a person 6 to 18 years of age. The department shall provide Medical Assistance reimbursement under this subsection if the federal department of health and human services approves the amendment to the state Medical Assistance plan. A pharmacist or pharmacy shall enroll in the federal Vaccines for Children Program under 42 USC 1396s to be eligible for Medical Assistance reimbursement under this subsection.

SB21-SSA1,1802 Section 1802. 49.45 (41) (b) of the statutes is amended to read:

SB21-SSA1,562,21 49.45 (41) (b) If a county elects to become certified as a provider of mental health crisis intervention services, the county may provide mental health crisis intervention services under this subsection in the county to medical assistance recipients through the medical assistance program. A county that elects to provide the services shall pay the amount of the allowable charges for the services under the medical assistance program that is not provided by the federal government. From the appropriation account under s. 20.435 (5) (bL), the The department shall reimburse the county under this subsection only for the amount of the allowable charges for those services under the medical assistance program that is provided by the federal government.

SB21-SSA1,1803 Section 1803. 49.452 of the statutes is created to read:

SB21-SSA1,563,2 49.452 Counting promissory notes as assets for certain Medical Assistance programs. (1) In this section, "promissory note" means a written, unconditional agreement, given in return for goods, money loaned, or services rendered, under which one party promises to pay another party a specified sum of money at a specified time or on demand.

SB21-SSA1,563,5 (2) If an individual's assets are counted when determining or redetermining the individual's financial eligibility for Medical Assistance, the department shall include a promissory note as a countable asset if all of the following apply:

SB21-SSA1,563,8 (a) The individual applying for or receiving benefits under Medical Assistance or his or her spouse provided the goods, money loaned, or services rendered for the promissory note.

SB21-SSA1,563,10 (b) The promissory note was entered into or purchased on or after the effective date of this paragraph .... [LRB inserts date].

SB21-SSA1,563,12 (c) The promissory note is negotiable, assignable, and enforceable and does not contain any terms making it unmarketable.

SB21-SSA1,563,18 (3) A promissory note is presumed to be negotiable and its asset value is the outstanding principal balance at the time the individual applies for Medical Assistance or at the time the individual's eligibility for Medical Assistance is redetermined, unless the individual shows by credible evidence from a knowledgeable source that the note is nonnegotiable or has a different current market value, which will then be considered the asset value.

SB21-SSA1,1804 Section 1804. 49.453 (4c) (am) of the statutes is created to read:

SB21-SSA1,563,23 49.453 (4c) (am) Notwithstanding par. (a), for purposes of sub. (2), the purchase of or entering into a promissory note by an individual or his or her spouse on or after the effective date of this paragraph .... [LRB inserts date], is a transfer of assets for less than fair market value unless all of the following apply:

SB21-SSA1,563,24 1. The promissory note satisfies the requirements under par. (a) 1. to 3.

SB21-SSA1,564,2 2. The promissory note is negotiable, assignable, and enforceable and does not contain any terms making it unmarketable.

SB21-SSA1,1805 Section 1805. 49.453 (4c) (b) of the statutes is renumbered 49.453 (4c) (b) 1. and amended to read:

SB21-SSA1,564,9 49.453 (4c) (b) 1. The value of a promissory note , purchased before the effective date of this subdivision .... [LRB inserts date], a loan, or a mortgage that does not satisfy the requirements under par. (a) 1. to 3. is the outstanding balance due on the date that the individual applies for medical assistance for nursing facility services or other long-term care services described in sub. (2).

SB21-SSA1,1806 Section 1806. 49.453 (4c) (b) 2. of the statutes is created to read:

SB21-SSA1,564,17 49.453 (4c) (b) 2. The value of a promissory note purchased or entered into on or after the effective date of this subdivision .... [LRB inserts date], that does not satisfy the requirements under par. (am) 1. and 2. is the outstanding balance due on the date that the individual applies for Medical Assistance for nursing facility services or other long-term care services described in sub. (2) or on the date that the individual's eligibility for Medical Assistance for nursing facility services or other long-term care services described in sub. (2) is redetermined.

SB21-SSA1,1807 Section 1807. 49.46 (2) (b) 12t. of the statutes is created to read:

SB21-SSA1,564,21 49.46 (2) (b) 12t. Subject to the limitations under s. 49.45 (30x), licensed midwife services provided by a certified professional midwife licensed under s. 440.982.

SB21-SSA1,1808 Section 1808. 49.46 (2) (b) 14m. of the statutes is created to read:

SB21-SSA1,564,25 49.46 (2) (b) 14m. Subject to par. (bt), substance abuse treatment services provided by a medically monitored treatment service or a transitional residential treatment service.

SB21-SSA1,1809 Section 1809. 49.46 (2) (bt) of the statutes is created to read:

SB21-SSA1,565,6 49.46 (2) (bt) 1. For the purposes of par. (b) 14m., a "medically monitored treatment service" is a 24-hour, community-based service providing observation, monitoring, and treatment by a multidisciplinary team under supervision of a physician, with a minimum of 12 hours of counseling provided per week for each patient.

SB21-SSA1,565,10 2. For the purposes of par. (b) 14m., a "transitional residential treatment service" is a clinically supervised, peer-supported, therapeutic environment with clinical involvement providing substance abuse treatment in the form of counseling for 3 to 11 hours provided per week for each patient.

SB21-SSA1,565,14 3. If approval by the federal department of health and human services of a state plan amendment or waiver request is necessary for federal reimbursement of the services under par. (b) 14m., the department is not required to pay for services described in par. (b) 14m. if the department does not receive the necessary approval.

SB21-SSA1,565,17 4. The department may not provide reimbursement for services under par. (b) 14m. that are provided before July 1, 2016, or before the date of approval of the state plan amendment or waiver request described under subd. 3., whichever is later.

SB21-SSA1,1810 Section 1810. 49.471 (8) (d) 1. a. of the statutes is amended to read:

SB21-SSA1,565,20 49.471 (8) (d) 1. a. A pregnant woman, except as provided in pars. par. (cr) 1. c. and (fm) 4.

SB21-SSA1,1811 Section 1811. 49.471 (8) (f) of the statutes is repealed.

SB21-SSA1,1812 Section 1812. 49.471 (8) (fm) of the statutes is repealed.

SB21-SSA1,1813 Section 1813. 49.471 (8) (g) of the statutes is repealed.

SB21-SSA1,1814 Section 1814. 49.472 (5) of the statutes is amended to read:

SB21-SSA1,566,4 49.472 (5) Community options participants. From the appropriation under s. 20.435 (7) (4) (bd), the department may pay all or a portion of the monthly premium calculated under sub. (4) (a) for an individual who is a participant in the community options program under s. 46.27 (11).

SB21-SSA1,1817 Section 1817. 49.682 (title) of the statutes is amended to read:

SB21-SSA1,566,6 49.682 (title) Recovery from estates ; disease aids and funeral expenses.

SB21-SSA1,1818 Section 1818. 49.682 (1) (a) of the statutes is amended to read:

SB21-SSA1,566,10 49.682 (1) (a) "Client" means a person who receives or received aid under s. 49.68, 49.683, or 49.685 or a person on whose behalf funeral, burial, or cemetery expenses aid was provided under s. 49.785.

SB21-SSA1,1819b Section 1819b. 49.682 (1) (d) of the statutes is renumbered 49.682 (1) (d) (intro.) and amended to read:

SB21-SSA1,566,13 49.682 (1) (d) (intro.) "Nonclient surviving spouse" means any of the following: