Under current law, a physician who treats a patient must inform the patient
about the availability of all alternate, viable medical modes of treatment and about
the benefits and risks of those treatments. A physician who violates this
requirement is guilty of unprofessional conduct and may be subject to discipline by
the Medical Examining Board (MEB), which may warn or reprimand the physician,
or limit, suspend, or revoke his or her license to practice medicine and surgery.
Current law requires the MEB to promulgate rules implementing these informed
consent requirements.
The bill specifically prohibits a physician from performing an elective
caesarean section on a pregnant woman, and prohibits a physician or a
nurse-midwife from performing an elective procedure intended to induce labor in a
pregnant woman, before the completion of a gestational period of 39 weeks unless the
physician has first obtained the informed consent of the woman. The bill provides
that a woman's consent is informed only if she receives timely information orally and
in person from the physician or nurse-midwife regarding potential negative effects
to the fetus of early delivery, including long-term learning and behavioral problems.
Under the bill, a physician who violates the prohibition in the bill is guilty of
unprofessional conduct and may be subject to the same disciplinary consequences as
violations of the informed consent provisions under current law. The Board of
Nursing may similarly revoke, limit, suspend, or deny renewal of the license of a
nurse-midwife who violates the prohibition. The bill directs the MEB to promulgate
rules implementing the provisions of the newly created prohibition and directs both
the MEB and the Board of Nursing to promulgate rules defining "elective" for
purposes of the prohibition in the bill.
Evidence-based home visitation services
Under current law, the Department of Children and Families (DCF)
administers the Child Abuse and Neglect Prevention Program under which DCF
awards grants to counties, private agencies, and Indian tribes that offer voluntary
home visitation services to parents who are eligible for MA and who are at risk of poor
birth outcomes or of perpetrating child abuse or neglect. Current law requires a
grant applicant to provide information on how the applicant's home visitation
program incorporates: 1) 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 2) practice standards and critical elements that
have been developed for successful home visitation programs by a nationally
recognized home visitation program model.
This bill specifies that home visitation program services provided by a county,
private agency, or Indian tribe under a child abuse and neglect prevention grant from
DCF must be evidence-based. The bill also requires DCF to enter into a
memorandum of understanding with DHS that provides for collaboration between
DCF and DHS in carrying out those evidence-based home visitation program
services.

Neonatal intensive care unit reports
The bill requires DHS to collect all of the following information from a hospital
that has a neonatal intensive care unit: 1) the daily census of the neonatal intensive
care unit; and 2) the criteria for admission to the neonatal intensive care unit. DHS
must annually prepare a report that includes all of the information collected from
hospitals from the previous calendar year. DHS must make the reports available to
the public and post the report on its Internet site.
Best practices for postpartum patients and newborns at hospitals
The bill requires DHS to promulgate rules requiring hospitals to ensure that
best practices for postpartum patients and newborns are supported in the hospital,
including rules that: 1) require hospitals to develop, for each postpartum patient, an
appropriate discharge plan that ensures that, to the extent practicable, an
appointment with a health care provider has been scheduled for the newborn within
an appropriate time after discharge and that the postpartum patient is consulted
and provided with assistance regarding health care resources and safe
transportation for the newborn; 2) require, prior to discharge from the hospital, that
education be provided, orally and in person, to each postpartum patient on certain
topics; and 3) require that health care providers, including physicians, recommend
and actively support breastfeeding for all newborns for whom breastfeeding is not
medically contraindicated; provide parents with complete, up-to-date information
to ensure that feeding decisions are fully informed; and provide, upon a parent's
request, referrals to lactation specialists or public health nurses for home visits.
Cultural competency training for students at higher educational
institutions
The bill directs the University of Wisconsin System Board of Regents and the
Technical College System Board to ensure that students enrolled in health care or
social work programs receive training in cultural competency to improve
patient-centered care.
Indication of race on birth certificates
The bill requires a birth certificate to include the race and ethnicity of the child,
as reported by the mother of the registrant, and requires DHS to promulgate rules
establishing designations of race and ethnicity to be used for reporting race and
ethnicity. The bill provides that the designations must be sufficiently detailed to
enable compilation and analysis of data related to births and birth outcomes among
all significant racial and ethnic populations in the state and to assist in the design
and evaluation of programs and policies designed to improve birth outcomes. In
addition, the rules must establish procedures to ensure that the racial and ethnic
designations included on each certificate of birth accurately reflect the race and
ethnicity of the registrant as directly reported by the child's mother.
Fetal and infant mortality and birth outcome report
The bill requires DHS to annually prepare a report relating to fetal and infant
mortality and birth outcomes in this state. The report must include data related to
births and birth outcomes in this state in the previous calendar year and an analysis
of that data. DHS must collaborate with local health departments, tribes, and other

interested parties about the data and the report. DHS must ensure that the report,
to the greatest extent possible, includes data and analysis that are necessary and
useful for the development and evaluation of programs to address disparities in birth
outcomes among racial and ethnic groups in this state and must periodically consult
with interested parties to review and update the data and analysis to be included in
the report as needed to ensure that this goal continues to be met.
DHS must include certain specified information about infant births and deaths
in the annual report and must, in collaboration with the aforementioned persons and
entities, consider including in the report data related to the type of prenatal care, if
any, received by the mother of each infant whose birth data is included in the report.
DHS must annually submit the report to the appropriate standing committees
of the legislature; post the report on its Internet site; and post, on its Internet site,
the raw data used for the report in a manner that does not disclose or enable the
identification of any individual infant, mother, or birth attendant.
Finally, DHS must explore whether any of the costs of collecting the data and
creating the annual report may be funded by the MA program.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB754,1 1Section 1. 36.25 (54) of the statutes is created to read:
AB754,7,102 36.25 (54) Cultural competency training. The board shall ensure that all
3students enrolled in the University of Wisconsin-Madison School of Medicine and
4Public Health, or in any program providing instruction for a health care or social
5work occupation, receive training in cultural competency to improve
6patient-centered care, which shall include evidence-based training related to
7implicit bias and emerging evidence related to cultural humility, in order to increase
8the students' cultural awareness and to improve the students' ability to
9communicate with, and effectively deliver health care to, patients from different
10racial and ethnic backgrounds.
AB754,2 11Section 2. 38.04 (33) of the statutes is created to read:
AB754,8,7
138.04 (33) Cultural competency training. The board shall ensure that
2technical college students enrolled in health care occupation programs receive
3training in cultural competency to improve patient-centered care, which shall
4include evidence-based training related to implicit bias and emerging evidence
5related to cultural humility, in order to increase the students' cultural awareness and
6to improve the students' ability to communicate with, and effectively deliver health
7care to, patients from different racial and ethnic backgrounds.
AB754,3 8Section 3. 48.983 (4) (a) 4m. of the statutes is amended to read:
AB754,8,149 48.983 (4) (a) 4m. To reimburse a case management provider under s. 49.45 (25)
10(b) for the amount of the allowable charges under the Medical Assistance program
11that is not provided by the federal government for case management services
12provided to a Medical Assistance beneficiary described in s. 49.45 (25) (am) 9. who
13is a child and who is a member of a family that receives evidence-based home
14visitation program services under par. (b) 1.
AB754,4 15Section 4. 48.983 (4) (b) of the statutes is amended to read:
AB754,9,1916 48.983 (4) (b) Home Evidence-based home visitation program services. 1. A
17county, private agency, or Indian tribe that is selected to participate in the program
18under this section shall offer all pregnant women in the county, the area in which
19that private agency is providing services, or the reservation of the tribe who are
20eligible for Medical Assistance under subch. IV of ch. 49 an opportunity to undergo
21an assessment through use of a risk assessment instrument to determine whether
22the person assessed presents risk factors for poor birth outcomes or for perpetrating
23child abuse or neglect. Persons who agree to be assessed shall be assessed during
24the prenatal period. The risk assessment instrument shall be developed by the
25department and shall be based on risk assessment instruments developed by the

1department for similar programs that are in operation. The department need not
2promulgate as rules under ch. 227 the risk assessment instrument developed under
3this subdivision. A person who is assessed to be at risk of poor birth outcomes or of
4abusing or neglecting his or her child shall be offered evidence-based home visitation
5program services that shall be commenced during the prenatal period. Home
6Evidence-based home visitation program services may be provided to a family with
7a child identified as being at risk of child abuse or neglect until the identified child
8reaches 3 years of age. If a family has been receiving evidence-based home visitation
9program services continuously for not less than 12 months, those services may
10continue to be provided to the family until the identified child reaches 3 years of age,
11regardless of whether the child continues to be eligible for Medical Assistance under
12subch. IV of ch. 49. If risk factors for child abuse or neglect with respect to the
13identified child continue to be present when the child reaches 3 years of age,
14evidence-based home visitation program services may be provided until the
15identified child reaches 5 years of age. Home Evidence-based home visitation
16program services may not be provided to a person unless the person gives his or her
17written informed consent to receiving those services or, if the person is a child, unless
18the child's parent, guardian, or legal custodian gives his or her written informed
19consent for the child to receive those services.
AB754,9,2320 1m. No person who is required or permitted to report suspected or threatened
21abuse or neglect under s. 48.981 (2) may make or threaten to make such a report
22based on a refusal of a person to receive or to continue receiving evidence-based
23home visitation program services under subd. 1.
AB754,9,2524 3. A county, private agency, or Indian tribe that is providing evidence-based
25home visitation program services under subd. 1. shall provide to a person receiving

1those services the information relating to shaken baby syndrome and impacted
2babies required under s. 253.15 (6).
AB754,5 3Section 5. 48.983 (6) (a) (intro.) of the statutes is amended to read:
AB754,10,64 48.983 (6) (a) (intro.) The part of an application, other than a renewal
5application, submitted by a county, private agency, or Indian tribe that relates to
6evidence-based home visitation programs shall include all of the following:
AB754,6 7Section 6. 48.983 (6) (a) 1. of the statutes is amended to read:
AB754,10,148 48.983 (6) (a) 1. Information on how the applicant's home visitation program
9is evidence-based, comprehensive, incorporates practice standards that have been
10developed for home visitation programs by entities concerned with the prevention of
11poor birth outcomes and child abuse and neglect and that are acceptable to the
12department, and incorporates practice standards and critical elements that have
13been developed for successful home visitation programs by a nationally recognized
14home visitation program model and that are acceptable to the department.
AB754,7 15Section 7. 48.983 (6) (a) 2. of the statutes is amended to read:
AB754,10,2116 48.983 (6) (a) 2. Documentation that the application was developed through
17collaboration among public and private organizations that provide services to
18children and families, especially children who are at risk of child abuse or neglect and
19families that are at risk of poor birth outcomes, or that are otherwise interested in
20child welfare and a description of how that collaboration effort will support a
21comprehensive, evidence-based home visitation program.
AB754,8 22Section 8. 48.983 (6) (a) 3. of the statutes is amended to read:
AB754,11,223 48.983 (6) (a) 3. An identification of existing poor birth outcome and child abuse
24and neglect prevention services that are available to residents of the county, the area
25in which the private agency is providing services, or the reservation of the Indian

1tribe and a description of how those services and any additional needed services will
2support a comprehensive, evidence-based home visitation program.
AB754,9 3Section 9. 48.983 (6) (a) 4. of the statutes is amended to read:
AB754,11,74 48.983 (6) (a) 4. An explanation of how the evidence-based home visitation
5program will build on existing poor birth outcome and child abuse and neglect
6prevention programs, including programs that provide support to families, and how
7the evidence-based home visitation program will coordinate with those programs.
AB754,10 8Section 10. 48.983 (6) (a) 4m. of the statutes is amended to read:
AB754,11,119 48.983 (6) (a) 4m. An explanation of how the applicant will encourage private
10organizations to provide services under the applicant's evidence-based home
11visitation program.
AB754,11 12Section 11. 48.983 (6) (a) 6. of the statutes is amended to read:
AB754,11,1713 48.983 (6) (a) 6. An identification of how the evidence-based home visitation
14program is comprehensive and incorporates the practice standards and critical
15elements for successful home visitation programs referred to in subd. 1., including
16how services will vary in intensity levels depending on the needs and strengths of the
17participating family.
AB754,12 18Section 12. 48.983 (6) (a) 6m. of the statutes is amended to read:
AB754,11,2119 48.983 (6) (a) 6m. An explanation of how the services to be provided under the
20evidence-based home visitation program, including the risk assessment under sub.
21(4) (b) 1., will be provided in a culturally competent manner.
AB754,13 22Section 13. 48.983 (6) (b) 1. of the statutes is amended to read:
AB754,12,823 48.983 (6) (b) 1. `Flexible fund for evidence-based home visitation programs.'
24The applicant demonstrates in the application that the applicant has established, or
25has plans to establish, if selected, a fund from which payments totaling not less than

1$250 per calendar year may be made for appropriate expenses of each family that is
2participating in the evidence-based home visitation program under sub. (4) (b) 1. or
3that is receiving home visitation services under s. 49.45 (44). The payments shall be
4authorized by an individual designated by the applicant. If an applicant makes a
5payment to or on behalf of a family under this subdivision, one-half of the payment
6shall be from grant moneys received under this section and one-half of the payment
7shall be from moneys provided by the applicant from sources other than grant
8moneys received under this section.
AB754,14 9Section 14. 48.983 (6) (c) of the statutes is amended to read:
AB754,12,1510 48.983 (6) (c) Case management benefit. The applicant states in the grant
11application that it has elected, or, if selected, that it will elect, under s. 49.45 (25) (b),
12to make the case management benefit under s. 49.45 (25) available to the category
13of beneficiaries under s. 49.45 (25) (am) 9. who are children and who are members
14of families receiving evidence-based home visitation program services under sub. (4)
15(b) 1.
AB754,15 16Section 15. 48.983 (6g) (a) and (b) of the statutes are amended to read:
AB754,13,217 48.983 (6g) (a) Except as permitted or required under s. 48.981 (2), no person
18may use or disclose any information concerning any individual who is selected for an
19assessment under sub. (4) (b), including an individual who declines to undergo the
20assessment, or concerning any individual who is offered services under a an
21evidence-based
home visitation program funded under this section, including an
22individual who declines to receive those services, unless the use or disclosure is
23connected with the administration of the evidence-based home visitation program
24or the administration of the Medical Assistance program under ss. 49.43 to 49.497

1or unless the individual has given his or her written informed consent to the use or
2disclosure.
AB754,13,83 (b) A county, private agency, or Indian tribe that is selected to participate in the
4program under this section shall provide or shall designate an individual or entity
5to provide an explanation of the confidentiality requirements under par. (a) to each
6individual who is offered an assessment under sub. (4) (b) or who is offered services
7under the evidence-based home visitation program of the county, private agency, or
8Indian tribe.
AB754,16 9Section 16. 48.983 (6m) of the statutes is amended to read:
AB754,13,1810 48.983 (6m) Notification of parent prior to making abuse or neglect report.
11If a person who is providing services under a an evidence-based home visitation
12program under sub. (4) (b) 1. determines that he or she is required or permitted to
13make a report under s. 48.981 (2) about a child in a family to which the person is
14providing those services, the person shall, prior to making the report under s. 48.981
15(2), make a reasonable effort to notify the child's parent that a report under s. 48.981
16(2) will be made and to encourage the parent to contact a county department to
17request assistance. The notification requirements under this subsection do not affect
18the reporting requirements under s. 48.981 (2).
AB754,17 19Section 17. 48.983 (6r) of the statutes is amended to read:
AB754,13,2420 48.983 (6r) Home Evidence-based home visitation program informational
21materials.
Any informational materials about a an evidence-based home visitation
22program under sub. (4) (b) 1. that are distributed to a person who is offered or who
23is receiving home visitation program services under that program shall state the
24sources of funding for the program.
AB754,18
1Section 18. 48.983 (7) (title) and (a) (intro.) of the statutes are amended to
2read:
AB754,14,73 48.983 (7) (title) Home Evidence-based home visitation program evaluation.
4(a) (intro.) The department shall conduct or shall select an evaluator to conduct an
5evaluation of the evidence-based home visitation program. The evaluation shall
6measure all of the following criteria in families that have participated in the home
7visitation
that program and that are selected for evaluation:
AB754,19 8Section 19. 48.983 (7) (ag) of the statutes is amended to read:
AB754,14,139 48.983 (7) (ag) The department shall evaluate the availability of
10evidence-based home visitation programs in the state and determine whether there
11are gaps in evidence-based home visitation services in the state. The department
12shall cooperate with counties, private agencies, and Indian tribes providing
13evidence-based home visitation programs to address any gaps in services identified.
AB754,20 14Section 20. 48.983 (7) (ar) of the statutes is amended to read:
AB754,14,1915 48.983 (7) (ar) Each county, private agency, and Indian tribe providing a an
16evidence-based
home visitation program shall collect and report data to the
17department, as required by the department. The department shall require each
18county, private agency, and Indian tribe providing a an evidence-based home
19visitation program to collect data using forms prescribed by the department.
AB754,21 20Section 21. 48.983 (7) (b) of the statutes is amended to read:
AB754,14,2321 48.983 (7) (b) In the evaluation, the department shall determine the number
22of families who remained in the evidence-based home visitation program for the time
23recommended in the family's case plan.
AB754,22 24Section 22. 48.983 (7) (c) of the statutes is amended to read:
AB754,15,9
148.983 (7) (c) Each county, private agency, and Indian tribe providing a an
2evidence-based
home visitation program shall develop a plan for evaluating the
3effectiveness of its program for approval by the department. The plan shall
4demonstrate how the county, private agency, or Indian tribe will use the evaluation
5of its program to improve the quality and outcomes of the program and to ensure
6continued compliance with the home visitation program criteria under sub. (6) (a).
7The plan shall demonstrate how the outcomes will be tracked and measured. Under
8the plan, the extent to which all of the following outcomes are achieved shall be
9tracked and measured:
AB754,15,1210 1. Parents receiving evidence-based home visitation services acquiring
11knowledge of early learning and child development and interacting with their
12children in ways that enhance the children's development and early learning.
AB754,15,1313 2. Children receiving evidence-based home visitation services being healthy.
AB754,15,1514 3. Children receiving evidence-based home visitation services living in a safe
15environment.
AB754,15,1716 4. Families receiving evidence-based home visitation services accessing formal
17and informal support networks.
AB754,15,1918 5. Children receiving evidence-based home visitation services achieving
19milestones in development and early learning.
AB754,15,2120 6. Children receiving evidence-based home visitation services who have
21developmental delays receiving appropriate intervention services.
AB754,23 22Section 23. 48.983 (8) of the statutes is amended to read:
AB754,16,523 48.983 (8) Technical assistance and training. The department shall provide
24technical assistance and training to counties, private agencies, and Indian tribes
25that are selected to participate in the program under this section. The training may

1not be limited to a particular evidence-based home visitation model. The training
2shall include training in best practices regarding basic skills, uniform
3administration of screening and assessment tools, the issues and challenges that
4families face, and supervision and personnel skills for program managers. The
5training may also include training on data collection and reporting.
AB754,24 6Section 24. 48.983 (9) of the statutes is created to read:
AB754,16,107 48.983 (9) Memorandum of understanding. The department shall enter into
8a memorandum of understanding with the department of health services that
9provides for collaboration between those departments in carrying out
10evidence-based home visiting programs under sub. (4) (b) 1.
AB754,25 11Section 25. 49.45 (24w) of the statutes is created to read:
AB754,16,2412 49.45 (24w) Services for pregnant women. (a) The department shall request
13a waiver of federal Medicaid law from the secretary of the federal department of
14health and human services to permit the department to provide services and support
15under Medical Assistance for pregnant women who face an increased risk of having
16a low birth weight baby, a preterm birth, or other negative birth outcome because of
17medical or nonmedical factors, such as psychosocial, behavioral, environmental,
18educational, or nutritional factors. The department shall implement the programs
19and services authorized by this waiver in Milwaukee, Racine, Kenosha, Rock, and
20Dane counties, and in a rural multicounty region identified by the department in
21collaboration with the Great Lakes Intertribal Council. The multicounty region
22shall include counties experiencing the largest disparities in birth outcomes between
23Caucasian and Native American populations and shall be of sufficient size to enable
24meaningful implementation and evaluation of the programs and services.
AB754,17,2
1(b) The department shall consider including all of the following as covered
2services or programs in the waiver request under par. (a):
AB754,17,53 1. Evidence-based social marketing of programs designed to reduce fetal and
4infant mortality, improve birth outcomes, and address needs of infants and their
5families.
AB754,17,76 2. Evidence-based social-support programs, including fatherhood initiatives
7designed to reduce fetal and infant mortality and improve birth outcomes.
AB754,17,118 3. Transportation services for persons who accompany a pregnant woman to
9prenatal appointments and transportation for the pregnant woman and her children
10to other destinations including social services offices and locations where child care
11is provided for her children.
AB754,17,1512 4. Data collection, including the pregnancy risk assessment and monitoring
13system, fetal and infant mortality review, vital statistics information, information
14from Medical Assistance data and chart reviews, and an assessment of nonmedical
15factors that may contribute to poor birth outcomes.
AB754,17,1816 5. Full reimbursement for evidence-based group prenatal care, such as a
17multifaceted model of care that integrates health assessment, education, and
18support into a unified program within a group setting.
AB754,17,1919 6. Mental health services.
AB754,17,2020 7. Smoking cessation services.
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