LRB-1099/P2
SWB:cdc
2023 - 2024 LEGISLATURE
DOA:......Bollhorst, BB0162 - Medicaid psychosocial rehabilitation benefit
For 2023-2025 Budget -- Not Ready For Introduction
An Act ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
health and human services
Medical Assistance
Community-based psychosocial services
Currently, community-based psychosocial services provided to Medical Assistance recipients are reimbursed only when the federal government agrees to provide its financial participation for the services, when the recipient's needs require more than outpatient level services but less than provided by a community support program, when the recipient's county has made the services available, when the provider is certified by DHS under its rules, and when any other requirements established by DHS by rule are met. This bill allows DHS to also provide community-based psychosocial services to Medical Assistance recipients and provide reimbursement for those services through providers other than those made available by a county. Reimbursement to providers that are not county-based will be both the federal and nonfederal share based on a fee schedule that is determined by DHS. Under the bill, for a county that elects to provide community-based psychosocial services to Medical Assistance recipients, DHS must reimburse the county only for the amount of the allowable charges for those services under the Medical Assistance program that is provided by the federal government. For a county that elects to provide the services through the Medical Assistance program on a regional basis according to requirements established by DHS, however, DHS must reimburse the county for the federal and nonfederal amount of allowable charges under the Medical Assistance program.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
Section
1. 49.45 (30e) (a) 2. of the statutes is repealed.
Section
2. 49.45 (30e) (b) 3. of the statutes is amended to read:
49.45 (30e) (b) 3. Requirements for certification of community-based psychosocial service programs. The department may certify county-based providers and providers that are not county-based providers.
Section
3. 49.45 (30e) (c) of the statutes is renumbered 49.45 (30e) (c) 1. and amended to read:
49.45 (30e) (c) 1. A For a county that elects to make provide the services under s. 49.46 (2) (b) 6. Lm. available shall reimburse a provider of the services for the amount of the allowable charges for those services under the medical assistance program that is not provided by the federal government. The, the department shall reimburse the provider county only for the amount of the allowable charges for those services under the medical assistance Medical Assistance program that is provided by the federal government.
Section
4. 49.45 (30e) (c) 2. of the statutes is created to read:
49.45 (30e) (c) 2. The department shall reimburse a provider that is not a county-based provider for services under s. 49.46 (2) (b) 6. Lm. for both the federal and nonfederal share of a fee schedule that is determined by the department.
Section
5. 49.45 (30e) (d) of the statutes is amended to read:
49.45 (30e) (d) Provision of services on regional basis. Notwithstanding par. (c) 1. and subject to par. (e), in counties that elect to deliver provide the services under s. 49.46 (2) (b) 6. Lm. through the Medical Assistance program on a regional basis according to criteria established by the department, the department shall reimburse a provider of the services for the amount of the allowable charges for those services under the Medical Assistance program that is provided by the federal government and for the amount of the allowable charges that is not provided by the federal government.
Section 9119.
Nonstatutory provisions; Health Services.
(1) Community-based psychosocial services. The department of health services may promulgate rules, including amending rules promulgated under s. 49.45 (30e) (b), update Medical Assistance program policies, and request any state plan amendment or waiver of federal Medicaid law from the federal government necessary to provide reimbursement to providers who are not county-based providers for psychosocial services provided to Medical Assistance recipients under s. 49.45 (30e).
(End)
