SB21-SSA1,554,522 (b) For services provided by a federally qualified health center on or after July
231, 2016, to a recipient of the Medical Assistance program under this subchapter, the
24department shall reimburse the federally qualified health centers using a payment
25methodology based on the Medicaid prospective payment system under 42 USC

11396a (bb) (1) to (3). The department shall consult with federally qualified health
2centers in developing the payment methodology under this paragraph. The
3department shall phase-in over fiscal years 2016-17, 2017-18, and 2018-19
4payment of new rates under the payment methodology developed under this
5paragraph.
SB21-SSA1,1791r 6Section 1791r. 49.45 (3m) of the statutes is created to read:
SB21-SSA1,554,147 49.45 (3m) Disproportionate share hospital payments. (a ) Subject to par. (c)
8and notwithstanding sub. (3) (e), from the appropriations under s. 20.435 (4) (b) and
9(o), in each fiscal year, the department shall pay to hospitals that serve a
10disproportionate share of low-income patients an amount equal to the sum of
11$15,000,000, as the state share of payments, and the matching federal share of
12payments. The department may make a payment to a hospital under this subsection
13under the calculation method described in par. (b ) if the hospital meets all of the
14following criteria:
SB21-SSA1,554,15 151. The hospital is located in this state.
SB21-SSA1,554,17 162. The hospital provides a wide array of services, including services provided
17through an emergency department.
SB21-SSA1,554,20 183. The inpatient days for Medical Assistance recipients at the hospital were at
19least 6 percent of the total inpatient days at that hospital during the most recent year
20for which such information is available.
SB21-SSA1,554,23 214. The hospital meets applicable, minimum requirements to be a
22disproportionate share hospital under 42 USC 1396r-4 and any other applicable
23federal law.
SB21-SSA1,554,2524 (b) The department shall comply with all of the following when making
25payments to hospitals described in par. (a ):
SB21-SSA1,555,3
11. The department shall distribute the total amount of moneys described under
2par. (a) to be paid to hospitals with a disproportionate share of low-income patients
3by doing all of the following:
SB21-SSA1,555,6 4a. Dividing the number of Medical Assistance recipient inpatient days at a
5hospital by the number of total inpatient days at the hospital to obtain the
6percentage of Medical Assistance recipient inpatient days at that hospital.
SB21-SSA1,555,11 7b. Subject to subds. 2. and 3 ., providing an increase to the inpatient
8fee-for-service base rate for each hospital that qualifies for a disproportionate share
9hospital payment such that the hospital's overall fee-for-service add-on percentage
10under this subsection increases as the hospital's percentage of Medical Assistance
11recipient inpatient days increases.
SB21-SSA1,555,14 122. The department shall ensure that the total amount of moneys available to
13pay hospitals with a disproportionate share of low-income patients is distributed in
14each fiscal year.
SB21-SSA1,555,17 153. The department shall limit the maximum payment to hospitals such that all
16of the following are true for disproportionate share hospital payments under this
17subsection in a fiscal year:
SB21-SSA1,555,18 18a. No single hospital receives more than $2,500,000.
SB21-SSA1,555,20 19b. The amount of payment is in accordance with federal rules concerning the
20hospital specific limit.
SB21-SSA1,555,2521 (c) If the department needs data to calculate the payments under this
22subsection other than the data available from the Medicaid Management
23Information System, the fiscal survey data, or the federal centers for Medicare and
24Medicaid services public records, the department shall collect the necessary data
25from hospitals.
SB21-SSA1,556,19
1(d) The department shall seek any necessary approval from the federal
2department of health and human services to implement the hospital payment
3methodology described under pars. (a ) and (b). If approval is necessary and approval
4from the federal department of health and human services is received, the
5department shall implement the payment methodology described under pars. (a)
6and (b). If approval is necessary and the department and the federal department of
7health and human services negotiate a methodology for making payments to
8hospitals with a disproportionate share of low-income patients that is different from
9the methodology described under pars. (a ) and (b), the department, before
10implementing the negotiated payment methodology, shall submit to the joint
11committee on finance the negotiated payment methodology. If the cochairpersons of
12the committee do not notify the department within 14 working days after the date
13of the submittal by the department that the committee has scheduled a meeting for
14the purpose of reviewing the negotiated payment methodology, the department may
15implement the negotiated payment methodology. If, within 14 working days after
16the date of the submittal by the department, the cochairpersons of the committee
17notify the department that the committee has scheduled a meeting for the purpose
18of reviewing the negotiated payment methodology, the negotiated payment
19methodology may be implemented only on approval of the committee.
SB21-SSA1,1792 20Section 1792. 49.45 (6m) (br) 1. of the statutes is amended to read:
SB21-SSA1,557,421 49.45 (6m) (br) 1. Notwithstanding s. 20.410 (3) (cd), 20.435 or (7) (b) or 20.437
22(1) (cj) or (2) (dz), the department shall reduce allocations of funds to counties in the
23amount of the disallowance from the appropriation account under s. 20.435 (7) (b),
24or the department shall direct the department of children and families to reduce
25allocations of funds to counties or Wisconsin Works agencies in the amount of the

1disallowance from the appropriation account under s. 20.437 (1) (cj) or (2) (dz) or
2direct the department of corrections to reduce allocations of funds to counties in the
3amount of the disallowance from the appropriation account under s. 20.410 (3) (cd)
,
4in accordance with s. 16.544 to the extent applicable.
SB21-SSA1,1793 5Section 1793. 49.45 (6v) of the statutes, as affected by 2015 Wisconsin Act ....
6(this act), is repealed.
SB21-SSA1,1794 7Section 1794. 49.45 (6v) (c) of the statutes is amended to read:
SB21-SSA1,557,188 49.45 (6v) (c) If the report specified in par. (b) indicates that utilization of beds
9by recipients of medical assistance in facilities is less than estimates for that
10utilization reflected in the intentions of the joint committee on finance, legislature
11and governor, as expressed by them in the budget determinations, the department
12shall include a proposal to transfer moneys from the appropriation under s. 20.435
13(4) (b) to the appropriation under s. 20.435 (7) (4) (bd) for the purpose of increasing
14funding for the community options program under s. 46.27. The amount proposed
15for transfer may not reduce the balance in the appropriation account under s. 20.435
16(4) (b) below an amount necessary to ensure that that appropriation account will end
17the current fiscal year or the current fiscal biennium with a positive balance. The
18secretary shall transfer the amount identified under the proposal.
SB21-SSA1,1796 19Section 1796. 49.45 (23) (c) of the statutes is repealed.
SB21-SSA1,1797 20Section 1797. 49.45 (23) (g) of the statutes is created to read:
SB21-SSA1,557,2521 49.45 (23) (g) 1. Subject to subd. 3., the department shall submit to the
22secretary of the federal department of health and human services an amendment to
23the waiver requested under par. (a) that authorizes the department to do all of the
24following with respect to the childless adults demonstration project under this
25subsection:
SB21-SSA1,558,1
1a. Impose monthly premiums as determined by the department.
SB21-SSA1,558,32 b. Impose higher premiums for enrollees who engage in behaviors that increase
3their health risks, as determined by the department.
SB21-SSA1,558,44 c. Require a health risk assessment for all enrollees.
SB21-SSA1,558,75 d. Limit an enrollee's eligibility under the demonstration project to no more
6than 48 months. The department shall specify the eligibility formula in the waiver
7amendment.
SB21-SSA1,558,108 e. Require, as a condition of eligibility, that an applicant or enrollee submit to
9a drug screening assessment and, if indicated, a drug test, as specified by the
10department in the waiver amendment.
SB21-SSA1,558,1511 2. Subject to subd. 3., if the secretary of the federal department of health and
12human services approves the amendment to the waiver under par. (a), in whole or
13in part, the department shall implement the changes to the demonstration project
14under this subsection specified in subd. 1. a. to e. that are approved by the secretary,
15consistent with the approval.
SB21-SSA1,558,2416 3. Prior to submitting to the secretary of the federal department of health and
17human services the amendment described in subd. 1., the department shall submit
18to the joint committee on finance a report that summarizes the provisions, and
19provides an estimate of the fiscal effect, of the proposed amendment to the waiver.
20If the secretary of the federal department of health and human services approves the
21amendment described in subd. 1., in whole or in part, before implementing the
22changes approved by the secretary, the department shall submit a report to the joint
23committee on finance that summarizes the provisions, and provides an estimate of
24the fiscal effect, of the amendment approved by the secretary.
SB21-SSA1,1798 25Section 1798. 49.45 (24k) of the statutes is created to read:
SB21-SSA1,559,14
149.45 (24k) Dental reimbursement pilot project. (a) 1. Subject to approval
2of the federal department of health and human services under par. (b), the
3department, as a pilot project, shall distribute moneys in each fiscal year to increase
4the reimbursement rate under Medical Assistance for pediatric dental care and adult
5emergency dental services, as defined by the department, that are provided in
6Brown, Marathon, Polk, and Racine counties. The reimbursement rate for these
7services shall equal 80 percent of the median fee for each service as reported in the
8most recent fee survey for the east north central region conducted by the American
9Dental Association or shall equal the provider's usual and customary charge,
10whichever is less. If a median fee is not reported for a service, the department shall
11establish a fee for the service that approximates 80 percent of the median usual and
12customary charge for that service for dentists practicing in the state but the
13reimbursement received by a provider may not exceed the provider's usual and
14customary charge for that service.
SB21-SSA1,560,215 2. For dental services provided on a fee-for-service basis as of July 1, 2015, the
16reimbursement rate increase specified in subd. 1. shall be distributed on a
17fee-for-service basis. For dental services provided as of July 1, 2015, by a health
18maintenance organization that contracts with the department to provide Medical
19Assistance services at a capitated rate, the department shall distribute the
20reimbursement rate increase under subd. 1. to the health maintenance organization.
21The department shall include in a contract with a health maintenance organization
22that provides dental services described in subd. 1. in the counties specified in subd.
231. a requirement that the health maintenance organization reimburse providers of
24services in accordance with the reimbursement rate increase pilot project under

1subd. 1. The department may not distribute the reimbursement rate increase under
2subd. 1. to federally qualified health centers that receive a grant under 42 USC 254b.
SB21-SSA1,560,83 (b) The department shall request any waiver from and submit any
4amendments to the state Medical Assistance plan to the federal department of health
5and human services necessary for the reimbursement rate increase pilot project
6under par. (a). If any necessary waiver request or state plan amendment request is
7approved, the department shall implement par. (a) beginning on the effective date
8of the waiver or plan amendment.
SB21-SSA1,560,169 (c) If the reimbursement rate increase pilot project under par. (a) is
10implemented, before the first day of the 4th month beginning after the effective date
11of the waiver or plan amendment described in par. (b) and quarterly thereafter, the
12department shall collaborate with the Health Policy Institute of the American
13Dental Association to evaluate the pilot project under par. (a) and shall submit a
14report to the joint committee on finance that includes data on all of the following key
15outcomes of interest from the pilot counties specified in par. (a) and from counties
16that are not pilot counties:
SB21-SSA1,560,1817 1. Dental care utilization among children and adults in dental clinics and in
18emergency rooms.
SB21-SSA1,560,1919 2. Participation by dentists in the Medical Assistance program.
SB21-SSA1,560,2120 3. The fiscal impact of the pilot project under par. (a), including costs and
21savings.
SB21-SSA1,560,2322 4. If feasible, a comparison of the pilot project as administered under a
23fee-for-service system and under a health maintenance organization system.
SB21-SSA1,561,3
15. If feasible, the impact of the pilot project on oral health outcomes, such as
2Medical Assistance recipients' self-reported assessment of oral health and barriers
3to obtaining dental care.
SB21-SSA1,561,74 (d) The department may not distribute the reimbursement rate increases
5under par. (a) for pediatric dental care and adult emergency dental services provided
6after the first day of the 37th month beginning after the effective date of the waiver
7or plan amendment described in par. (b).
SB21-SSA1,1799 8Section 1799. 49.45 (30x) of the statutes is created to read:
SB21-SSA1,561,139 49.45 (30x) Licensed midwife services. (a) Provider reimbursement.
10Beginning January 1, 2016, services under s. 49.46 (2) (b) 12t. provided to an
11individual are reimbursable under the Medical Assistance program if an
12amendment to the state medical assistance plan approved by the federal department
13of health and human services permits reimbursement under s. 49.46 (2) (b) 12t.
SB21-SSA1,561,1814 (b) Plan amendment. The department shall submit to the federal department
15of health and human services an amendment to the state medical assistance plan to
16permit the application of par. (a). The department may not pay reimbursement
17under par. (a) unless the amendment to the state plan allowing reimbursement
18under s. 49.46 (2) (b) 12t. is approved and in effect.
SB21-SSA1,1800 19Section 1800. 49.45 (39) (bm) of the statutes is created to read:
SB21-SSA1,561,2320 49.45 (39) (bm) Excess state share. Any portion of the state share under this
21subsection in excess of $42,200,000 in fiscal year 2015-16 and in excess of
22$41,700,000 in fiscal year 2016-17 and each fiscal year thereafter shall be deposited
23in the Medical Assistance trust fund.
SB21-SSA1,1801 24Section 1801. 49.45 (39m) of the statutes is created to read:
SB21-SSA1,562,10
149.45 (39m) State plan amendment for pharmacist reimbursement. The
2department shall submit to the federal department of health and human services an
3amendment to the state Medical Assistance plan to permit Medical Assistance
4reimbursement to pharmacists who meet the training requirements specified by the
5department to administer vaccines, as determined by the department, to a person 6
6to 18 years of age. The department shall provide Medical Assistance reimbursement
7under this subsection if the federal department of health and human services
8approves the amendment to the state Medical Assistance plan. A pharmacist or
9pharmacy shall enroll in the federal Vaccines for Children Program under 42 USC
101396s
to be eligible for Medical Assistance reimbursement under this subsection.
SB21-SSA1,1802 11Section 1802. 49.45 (41) (b) of the statutes is amended to read:
SB21-SSA1,562,2112 49.45 (41) (b) If a county elects to become certified as a provider of mental
13health crisis intervention services, the county may provide mental health crisis
14intervention services under this subsection in the county to medical assistance
15recipients through the medical assistance program. A county that elects to provide
16the services shall pay the amount of the allowable charges for the services under the
17medical assistance program that is not provided by the federal government. From
18the appropriation account under s. 20.435 (5) (bL), the
The department shall
19reimburse the county under this subsection only for the amount of the allowable
20charges for those services under the medical assistance program that is provided by
21the federal government.
SB21-SSA1,1803 22Section 1803. 49.452 of the statutes is created to read:
SB21-SSA1,563,2 2349.452 Counting promissory notes as assets for certain Medical
24Assistance programs.
(1) In this section, "promissory note" means a written,
25unconditional agreement, given in return for goods, money loaned, or services

1rendered, under which one party promises to pay another party a specified sum of
2money at a specified time or on demand.
SB21-SSA1,563,5 3(2) If an individual's assets are counted when determining or redetermining
4the individual's financial eligibility for Medical Assistance, the department shall
5include a promissory note as a countable asset if all of the following apply:
SB21-SSA1,563,86 (a) The individual applying for or receiving benefits under Medical Assistance
7or his or her spouse provided the goods, money loaned, or services rendered for the
8promissory note.
SB21-SSA1,563,109 (b) The promissory note was entered into or purchased on or after the effective
10date of this paragraph .... [LRB inserts date].
SB21-SSA1,563,1211 (c) The promissory note is negotiable, assignable, and enforceable and does not
12contain any terms making it unmarketable.
SB21-SSA1,563,18 13(3) A promissory note is presumed to be negotiable and its asset value is the
14outstanding principal balance at the time the individual applies for Medical
15Assistance or at the time the individual's eligibility for Medical Assistance is
16redetermined, unless the individual shows by credible evidence from a
17knowledgeable source that the note is nonnegotiable or has a different current
18market value, which will then be considered the asset value.
SB21-SSA1,1804 19Section 1804. 49.453 (4c) (am) of the statutes is created to read:
SB21-SSA1,563,2320 49.453 (4c) (am) Notwithstanding par. (a), for purposes of sub. (2), the purchase
21of or entering into a promissory note by an individual or his or her spouse on or after
22the effective date of this paragraph .... [LRB inserts date], is a transfer of assets for
23less than fair market value unless all of the following apply:
SB21-SSA1,563,2424 1. The promissory note satisfies the requirements under par. (a) 1. to 3.
SB21-SSA1,564,2
12. The promissory note is negotiable, assignable, and enforceable and does not
2contain any terms making it unmarketable.
SB21-SSA1,1805 3Section 1805. 49.453 (4c) (b) of the statutes is renumbered 49.453 (4c) (b) 1.
4and amended to read:
SB21-SSA1,564,95 49.453 (4c) (b) 1. The value of a promissory note , purchased before the effective
6date of this subdivision .... [LRB inserts date], a
loan, or a mortgage that does not
7satisfy the requirements under par. (a) 1. to 3. is the outstanding balance due on the
8date that the individual applies for medical assistance for nursing facility services
9or other long-term care services described in sub. (2).
SB21-SSA1,1806 10Section 1806. 49.453 (4c) (b) 2. of the statutes is created to read:
SB21-SSA1,564,1711 49.453 (4c) (b) 2. The value of a promissory note purchased or entered into on
12or after the effective date of this subdivision .... [LRB inserts date], that does not
13satisfy the requirements under par. (am) 1. and 2. is the outstanding balance due on
14the date that the individual applies for Medical Assistance for nursing facility
15services or other long-term care services described in sub. (2) or on the date that the
16individual's eligibility for Medical Assistance for nursing facility services or other
17long-term care services described in sub. (2) is redetermined.
SB21-SSA1,1807 18Section 1807. 49.46 (2) (b) 12t. of the statutes is created to read:
SB21-SSA1,564,2119 49.46 (2) (b) 12t. Subject to the limitations under s. 49.45 (30x), licensed
20midwife services provided by a certified professional midwife licensed under s.
21440.982.
SB21-SSA1,1808 22Section 1808. 49.46 (2) (b) 14m. of the statutes is created to read:
SB21-SSA1,564,2523 49.46 (2) (b) 14m. Subject to par. (bt), substance abuse treatment services
24provided by a medically monitored treatment service or a transitional residential
25treatment service.
SB21-SSA1,1809
1Section 1809. 49.46 (2) (bt) of the statutes is created to read:
SB21-SSA1,565,62 49.46 (2) (bt) 1. For the purposes of par. (b) 14m., a "medically monitored
3treatment service" is a 24-hour, community-based service providing observation,
4monitoring, and treatment by a multidisciplinary team under supervision of a
5physician, with a minimum of 12 hours of counseling provided per week for each
6patient.
SB21-SSA1,565,107 2. For the purposes of par. (b) 14m., a "transitional residential treatment
8service" is a clinically supervised, peer-supported, therapeutic environment with
9clinical involvement providing substance abuse treatment in the form of counseling
10for 3 to 11 hours provided per week for each patient.
SB21-SSA1,565,1411 3. If approval by the federal department of health and human services of a state
12plan amendment or waiver request is necessary for federal reimbursement of the
13services under par. (b) 14m., the department is not required to pay for services
14described in par. (b) 14m. if the department does not receive the necessary approval.
SB21-SSA1,565,1715 4. The department may not provide reimbursement for services under par. (b)
1614m. that are provided before July 1, 2016, or before the date of approval of the state
17plan amendment or waiver request described under subd. 3., whichever is later.
SB21-SSA1,1810 18Section 1810. 49.471 (8) (d) 1. a. of the statutes is amended to read:
SB21-SSA1,565,2019 49.471 (8) (d) 1. a. A pregnant woman, except as provided in pars. par. (cr) 1.
20c. and (fm) 4.
SB21-SSA1,1811 21Section 1811. 49.471 (8) (f) of the statutes is repealed.
SB21-SSA1,1812 22Section 1812. 49.471 (8) (fm) of the statutes is repealed.
SB21-SSA1,1813 23Section 1813. 49.471 (8) (g) of the statutes is repealed.
SB21-SSA1,1814 24Section 1814. 49.472 (5) of the statutes is amended to read:
SB21-SSA1,566,4
149.472 (5) Community options participants. From the appropriation under s.
220.435 (7) (4) (bd), the department may pay all or a portion of the monthly premium
3calculated under sub. (4) (a) for an individual who is a participant in the community
4options program under s. 46.27 (11).
SB21-SSA1,1817 5Section 1817. 49.682 (title) of the statutes is amended to read:
SB21-SSA1,566,6 649.682 (title) Recovery from estates ; disease aids and funeral expenses.
SB21-SSA1,1818 7Section 1818. 49.682 (1) (a) of the statutes is amended to read:
SB21-SSA1,566,108 49.682 (1) (a) "Client" means a person who receives or received aid under s.
949.68, 49.683, or 49.685 or a person on whose behalf funeral, burial, or cemetery
10expenses aid was provided under s. 49.785
.
SB21-SSA1,1819b 11Section 1819b. 49.682 (1) (d) of the statutes is renumbered 49.682 (1) (d)
12(intro.) and amended to read:
SB21-SSA1,566,1313 49.682 (1) (d) (intro.) "Nonclient surviving spouse" means any of the following:
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