SB111,1011 10Section 1011. 49.45 (3m) (a) (intro.) of the statutes is amended to read:
SB111,746,1711 49.45 (3m) (a) (intro.) Subject to par. (c) (d) and notwithstanding sub. (3) (e),
12from the appropriations under s. 20.435 (4) (b) and (o), in each fiscal year, the
13department shall pay to hospitals that serve a disproportionate share of low-income
14patients an amount equal to the sum of $27,500,000, as the state share of payments,
15and the matching federal share of payments. The department may make a payment
16to a hospital under this subsection under the calculation method described in par. (b)
17if the hospital meets all of the following criteria:
SB111,1012 18Section 1012. 49.45 (3m) (cm) of the statutes is created to read:
SB111,746,2519 49.45 (3m) (cm) Notwithstanding the total amount of state share paid to
20hospitals under par. (a) and the limit paid to a single hospital under par. (b) 3. a., if
21the department has expanded eligibility under section 2001 (a) (1) (C) of the Patient
22Protection and Affordable Care Act, P.L. 111-148, for the Medical Assistance
23program under this subchapter, the department shall pay as the state share to
24hospitals $47,500,000 under par. (a) and pay no single hospital more than $7,950,000
25under par. (b) 3. a.
SB111,1013
1Section 1013. 49.45 (5g) of the statutes is created to read:
SB111,747,112 49.45 (5g) Payments to tribes. (a) Tribal care coordination agreements. A
3tribal health care provider's care coordination agreement with a nontribal health
4care provider shall meet federal requirements, including that a service provided by
5the nontribal health care provider be at the request of the tribal health care provider
6on behalf of a tribal member who remains in the tribal health care provider's care
7according to the care coordination agreement; that both the tribal health care
8provider and nontribal health care provider are providers, as defined in s. 49.43 (10);
9that an established relationship exists between the tribal health care provider and
10the tribal member; and that the care be provided pursuant to a written care
11coordination agreement.
SB111,747,2112 (b) Amount and distribution of payments. 1. From the appropriation account
13under s. 20.435 (4) (b), the department shall make payments to eligible governing
14bodies of federally recognized American Indian tribes or bands or tribal health care
15providers in an amount and manner determined by the department. The
16department shall determine payment amounts on the basis of the difference between
17the state share of medical assistance payments paid for services rendered to tribal
18members for whom a care coordination agreement with nontribal health care
19providers is in place and the state share of medical assistance payments that would
20have been paid for those services absent a care coordination agreement with
21nontribal partners.
SB111,747,2422 2. The department shall withhold from the payments under subd. 1. the state
23share of administrative costs associated with carrying out this subsection, not to
24exceed 10 percent of the amounts calculated in subd. 1.
SB111,748,3
13. Federally recognized American Indian tribes or bands may use funds paid
2under this subsection for health-related purposes. The department shall consult
3biennially with tribes to determine the timing and distribution of payments.
SB111,1014 4Section 1014. 49.45 (6m) (a) 6. of the statutes is repealed.
SB111,1015 5Section 1015. 49.45 (6m) (ag) 3p. a. to c. of the statutes are amended to read:
SB111,748,86 49.45 (6m) (ag) 3p. a. The system may incorporate acuity measurements under
7the most recent Resource Utilization Groupings methodology
to determine factors
8for case-mix adjustment.
SB111,748,129 b. Four times annually, for For each facility resident who is a Medical
10Assistance recipient on March 31, June 30, September 30, or December 31, as
11applicable, the system shall determine the average case-mix index by use of the
12factors specified under subd. 3p. a.
SB111,748,1413 c. The system shall may incorporate payment adjustments for dementia,
14behavioral needs, or other complex medical conditions.
SB111,1016 15Section 1016. 49.45 (6xm) of the statutes is created to read:
SB111,748,1916 49.45 (6xm) Pediatric inpatient supplement. (a) From the appropriations
17under s. 20.435 (4) (b), (o), and (w), the department shall, using a method determined
18by the department, distribute a total sum of $2,000,000 each state fiscal year to
19hospitals that meet all of the following criteria:
SB111,748,2020 1. The hospital is an acute care hospital located in this state.
SB111,748,2521 2. During the hospital's fiscal year, the inpatient days in the hospital's acute
22care pediatric units and intensive care pediatric units totaled more than 12,000 days,
23not including neonatal intensive care units. For purposes of this subsection, the
24hospital's fiscal year is the hospital's fiscal year that ended in the 2nd calendar year
25preceding the beginning of the state fiscal year.
SB111,749,8
1(b) Notwithstanding par. (a), from the appropriations under s. 20.435 (4) (b),
2(o), and (w), if the department has expanded eligibility under section 2001 (a) (1) (C)
3of the Patient Protection and Affordable Care Act, P.L. 111-148, for the Medical
4Assistance program under this subchapter, then the department may, using a
5method determined by the department, distribute an additional total sum of
6$7,500,000 in each state fiscal year to hospitals that are free-standing pediatric
7teaching hospitals located in Wisconsin that have a percentage calculated under s.
849.45 (3m) (b) 1. a. greater than 45 percent.
SB111,1017 9Section 1017. 49.45 (18) (ac) of the statutes is amended to read:
SB111,749,2110 49.45 (18) (ac) Except as provided in pars. (am) to (d), and subject to par. (ag)
11(c), any person eligible for medical assistance under s. 49.46, 49.468, or 49.47, or for
12the benefits under s. 49.46 (2) (a) and (b) under s. 49.471 shall pay up to the maximum
13amounts allowable under 42 CFR 447.53 to 447.58 for purchases of services provided
14under s. 49.46 (2). The service provider shall collect the specified or allowable
15copayment, coinsurance, or deductible, unless the service provider determines that
16the cost of collecting the copayment, coinsurance, or deductible exceeds the amount
17to be collected. The department shall reduce payments to each provider by the
18amount of the specified or allowable copayment, coinsurance, or deductible. No
19provider may deny care or services because the recipient is unable to share costs, but
20an inability to share costs specified in this subsection does not relieve the recipient
21of liability for these costs.
SB111,1018 22Section 1018. 49.45 (18) (ag) of the statutes is repealed.
SB111,1019 23Section 1019. 49.45 (18) (b) 8. of the statutes is created to read:
SB111,749,2424 49.45 (18) (b) 8. Prescription drugs.
SB111,1020 25Section 1020. 49.45 (18) (d) of the statutes is repealed.
SB111,1021
1Section 1021. 49.45 (23) of the statutes is repealed.
SB111,1022 2Section 1022 . 49.45 (23b) of the statutes is repealed.
SB111,1023 3Section 1023 . 49.45 (24L) of the statutes is created to read:
SB111,750,74 49.45 (24L) Critical access reimbursement payments to dental providers. (a)
5Based on the criteria in pars. (b) and (c), the department shall increase
6reimbursements to dental providers that meet quality of care standards, as
7established by the department.
SB111,750,98 (b) In order to be eligible for enhanced reimbursement under this subsection,
9the provider must meet one of the following qualifications:
SB111,750,1210 1. For a nonprofit or public provider, 50 percent or more of the individuals
11served by the provider are individuals who are without dental insurance or are
12enrolled in the Medical Assistance program.
SB111,750,1413 2. For a for-profit provider, 5 percent or more of the individuals served by the
14provider are enrolled in the Medical Assistance program.
SB111,750,2515 (c) For dental services rendered on or after January 1, 2022, by a qualified
16nonprofit or public dental provider, the department shall increase reimbursement by
1750 percent above the reimbursement rate that would otherwise be paid to that
18provider. For dental services rendered on or after January 1, 2022, by a qualified
19for-profit dental provider, the department shall increase reimbursement by 30
20percent above the reimbursement rate that would otherwise be paid to that provider.
21For dental providers rendering services to individuals in managed care under the
22Medical Assistance program, for services rendered on or after January 1, 2022, the
23department shall increase reimbursement to pay an additional amount on the basis
24of the rate that would have been paid to the dental provider had the individual not
25been enrolled in managed care.
SB111,751,3
1(d) If a provider has more than one service location, the thresholds described
2under par. (b) apply to each location, and the department will determine the payment
3for each separate service location.
SB111,751,54 (e) Any provider that receives reimbursement through the pilot project under
5sub. (24k) is not eligible for reimbursement under this subsection.
SB111,1024 6Section 1024 . 49.45 (25) (bj) of the statutes is amended to read:
SB111,751,147 49.45 (25) (bj) The department of corrections may elect to provide case
8management services under this subsection to persons who are under the
9supervision of that department under s. 938.183, 938.34 (4h), (4m), or (4n), or
10938.357 (3) or (4), who are Medical Assistance beneficiaries, and who meet one or
11more of the conditions specified in par. (am). The amount of the allowable charges
12for those services under the Medical Assistance program that is not provided by the
13federal government shall be paid from the appropriation account under s. 20.410 (3)
14(hm), (ho), or (hr).
SB111,1025 15Section 1025 . 49.45 (25) (bj) of the statutes, as affected by 2019 Wisconsin Act
168
and 2021 Wisconsin Act .... (this act), is repealed and recreated to read:
SB111,751,2317 49.45 (25) (bj) The department of corrections may elect to provide case
18management services under this subsection to persons who are under the
19supervision of that department under s. 938.183, 938.34 (4m), or 938.357 (3) or (4),
20who are Medical Assistance beneficiaries, and who meet one or more of the conditions
21specified in par. (am). The amount of the allowable charges for those services under
22the Medical Assistance program that is not provided by the federal government shall
23be paid from the appropriation account under s. 20.410 (3) (hm), (ho), or (hr).
SB111,1026 24Section 1026. 49.45 (25r) of the statutes is created to read:
SB111,751,2525 49.45 (25r) Community health worker services. (a) In this subsection:
SB111,752,2
11. “Community health services” means services provided by a community
2health worker.
SB111,752,103 2. “Community health worker” means a frontline public health worker who is
4a trusted member of or has a close understanding of the community served, enabling
5the worker to serve as a liaison, link, or intermediary between health and social
6services and the community to facilitate access to services and improve the quality
7and cultural competence of service delivery, and who builds individual and
8community capacity by increasing health knowledge and self-sufficiency through a
9range of activities such as outreach, community education, informal counseling,
10social support, and advocacy.
SB111,752,1811 (b) The department shall request any necessary waiver from, or submit any
12necessary amendments to the state Medical Assistance plan to, the secretary of the
13federal department of health and human services to provide community health
14services to eligible Medical Assistance recipients. If the waiver or state plan
15amendment is granted, the department shall reimburse certified providers for those
16community health services approved by the federal department of health and human
17services for Medical Assistance coverage and as provided to Medical Assistance
18recipients under s. 49.46 (2) (b) 9m.
SB111,1027 19Section 1027. 49.45 (30e) (a) 2. of the statutes is repealed.
SB111,1028 20Section 1028. 49.45 (30e) (b) 3. of the statutes is amended to read:
SB111,752,2321 49.45 (30e) (b) 3. Requirements for certification of community-based
22psychosocial service programs. The department may certify county-based providers
23and providers that are not county-based providers.
SB111,1029 24Section 1029. 49.45 (30e) (c) of the statutes is renumbered 49.45 (30e) (c) 1.
25and amended to read:
SB111,753,7
149.45 (30e) (c) 1. A The department shall reimburse a county that elects to
2make the provide services under s. 49.46 (2) (b) 6. Lm. available shall reimburse a
3provider of the services
for the amount of the allowable charges for those services
4under the medical assistance Medical Assistance program that is not provided by the
5federal government. The department shall reimburse the provider only for and the
6amount of the allowable charges for those services under the medical assistance
7Medical Assistance program that is provided by the federal government.
SB111,1030 8Section 1030. 49.45 (30e) (c) 2. of the statutes is created to read:
SB111,753,119 49.45 (30e) (c) 2. The department shall reimburse to a provider that is not a
10county-based provider for services under s. 49.46 (2) (b) 6. Lm. for both the federal
11and nonfederal share of a fee schedule that is determined by the department.
SB111,1031 12Section 1031. 49.45 (30e) (d) of the statutes is amended to read:
SB111,753,2013 49.45 (30e) (d) Provision of services on regional basis. Notwithstanding par.
14(c) 1. and subject to par. (e), in counties that elect to deliver provide the services under
15s. 49.46 (2) (b) 6. Lm. through the Medical Assistance program on a regional basis
16according to criteria established by the department, the department shall reimburse
17a provider of the services for the amount of the allowable charges for those services
18under the Medical Assistance program that is provided by the federal government
19and for the amount of the allowable charges that is not provided by the federal
20government.
SB111,1032 21Section 1032. 49.45 (30t) of the statutes is created to read:
SB111,753,2222 49.45 (30t) Doula services. (a) In this subsection:
SB111,753,2423 1. “Certified doula” means an individual who has received certification from a
24doula certifying organization recognized by the department.
SB111,754,3
12. “Doula services” means childbirth education and support services, including
2emotional and physical support provided during pregnancy, labor, birth, and the
3postpartum period.
SB111,754,94 (b) The department shall request from the secretary of the federal department
5of health and human services any required waiver or any required amendment to the
6state plan for Medical Assistance to allow reimbursement for doula services provided
7by a certified doula. If the waiver or state plan amendment is granted, the
8department shall reimburse a certified doula under s. 49.46 (2) (b) 12p. for the
9allowable charges for doula services provided to Medical Assistance recipients.
SB111,1033 10Section 1033. 49.46 (1) (a) 1m. of the statutes is amended to read:
SB111,754,1411 49.46 (1) (a) 1m. Any pregnant woman whose income does not exceed the
12standard of need under s. 49.19 (11) and whose pregnancy is medically verified.
13Eligibility continues to the last day of the month in which the 60th 365th day after
14the last day of the pregnancy falls.
SB111,1034 15Section 1034. 49.46 (1) (j) of the statutes is amended to read:
SB111,754,1916 49.46 (1) (j) An individual determined to be eligible for benefits under par. (a)
179. remains eligible for benefits under par. (a) 9. for the balance of the pregnancy and
18to the last day of the month in which the 60th 365th day after the last day of the
19pregnancy falls without regard to any change in the individual's family income.
SB111,1035 20Section 1035. 49.46 (2) (b) 8m. of the statutes is created to read:
SB111,754,2221 49.46 (2) (b) 8m. Room and board for residential substance use disorder
22treatment.
SB111,1036 23Section 1036. 49.46 (2) (b) 9m. of the statutes is created to read:
SB111,754,2424 49.46 (2) (b) 9m. Community health services, as specified under s. 49.45 (25r).
SB111,1037 25Section 1037 . 49.46 (2) (b) 11m. of the statutes is created to read:
SB111,755,2
149.46 (2) (b) 11m. Subject to par. (bx), acupuncture provided by an
2acupuncturist who holds a certificate under ch. 451.
SB111,1038 3Section 1038. 49.46 (2) (b) 12p. of the statutes is created to read:
SB111,755,54 49.46 (2) (b) 12p. Doula services provided by a certified doula, as specified
5under s. 49.45 (30t).
SB111,1039 6Section 1039. 49.46 (2) (b) 24. of the statutes is created to read:
SB111,755,87 49.46 (2) (b) 24. Subject to par. (bv), nonmedical services that contribute to the
8determinants of health.
SB111,1040 9Section 1040. 49.46 (2) (bv) of the statutes is created to read:
SB111,755,1610 49.46 (2) (bv) The department shall determine those services under par. (b) 24.
11that contribute to the determinants of health. The department shall seek any
12necessary state plan amendment or request any waiver of federal Medicaid law to
13implement this paragraph. The department is not required to provide the services
14under this paragraph as a benefit under the Medical Assistance program if the
15federal department of health and human services does not provide federal financial
16participation for the services under this paragraph.
SB111,1041 17Section 1041 . 49.46 (2) (bx) of the statutes is created to read:
SB111,755,2418 49.46 (2) (bx) The department shall submit to the federal department of health
19and human services any request for a state plan amendment, waiver, or other federal
20approval necessary to provide reimbursement for the benefit under par. (b) 11m. If
21the federal department approves the request or if no federal approval is necessary,
22the department shall provide the benefit and reimbursement under par. (b) 11m. If
23the federal department disapproves the request, the department may not provide the
24benefit or reimbursement for the benefit described under par. (b) 11m.
SB111,1042 25Section 1042. 49.47 (4) (ag) 2. of the statutes is amended to read:
SB111,756,3
149.47 (4) (ag) 2. Pregnant and the woman's pregnancy is medically verified
2Eligibility continues to the last day of the month in which the 60th 365th day after
3the last day of the pregnancy falls.
SB111,1043 4Section 1043 . 49.471 (1) (b) 2. of the statutes is amended to read:
SB111,756,55 49.471 (1) (b) 2. A stepfather, stepmother stepparent, stepbrother, or stepsister.
SB111,1044 6Section 1044 . 49.471 (1) (cr) of the statutes is created to read:
SB111,756,87 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
8federal medical assistance percentage described under 42 USC 1396d (y) or (z).
SB111,1045 9Section 1045 . 49.471 (4) (a) 4. b. of the statutes is amended to read:
SB111,756,1210 49.471 (4) (a) 4. b. The individual's family income does not exceed 100 133
11percent of the poverty line before application of the 5 percent income disregard under
1242 CFR 435.603 (d)
.
SB111,1046 13Section 1046 . 49.471 (4) (a) 8. of the statutes is created to read:
SB111,756,1414 49.471 (4) (a) 8. An individual who meets all of the following criteria:
SB111,756,1515 a. The individual is an adult under the age of 65.
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