AB64-ASA1,522,7 a. A description of each component of the waiver amendment that is approved and any pertinent information on the department's plan for implementation.

AB64-ASA1,522,11 b. An estimate of the effect of implementation of the approved portions of the waiver amendment on enrollment in and the budget of the Medical Assistance program in the fiscal biennium in which approval occurs and in future fiscal bienniums.

AB64-ASA1,522,24 4. The department may not implement any approved portion of the waiver amendment requested under subd. 1. unless the joint committee on finance meets under s. 13.10 and approves the implementation of that portion of the waiver amendment. In a meeting under s. 13.10 to review the report submitted under subd. 3., the joint committee on finance may approve or disapprove of the waiver amendment portions that are approved by the federal department of health and human services or may modify the waiver amendment only by removing one or more components of the waiver amendment. The department may implement the waiver amendment only as approved by the joint committee on finance, including any modifications. The department shall, if necessary to implement the waiver amendment as modified by the joint committee on finance, submit a subsequent waiver amendment request to the federal department of health and human services that is consistent with the committee's actions.

AB64-ASA1,928f Section 928f. 49.45 (24n) of the statutes is created to read:

AB64-ASA1,523,9 49.45 (24n) Reimbursement for dental services by facilities serving individuals with disabilities. (a) Subject to approval of the federal department of health and human services under par. (b), the department shall distribute moneys in each fiscal year to increase the Medical Assistance reimbursement rates for all eligible dental services rendered by facilities that provide at least 90 percent of their dental services to individuals with cognitive and physical disabilities, as determined by the department. Under this subsection, the enhanced reimbursement rates for dental services would equal 200 percent of the Medical Assistance reimbursement rates that would otherwise be paid for these dental services.

AB64-ASA1,523,15 (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 Medical Assistance reimbursement rate increase 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.

AB64-ASA1,928g Section 928g. 49.45 (26g) of the statutes is created to read:

AB64-ASA1,523,21 49.45 (26g) Intensive care coordination program. (a) Subject to par. (h), the department shall create and implement a program to reimburse hospitals and health care systems for intensive care coordination services provided to recipients of Medical Assistance under this subchapter who are not enrolled in coverage under Medicare, 42 USC 1395 et seq.

AB64-ASA1,523,24 (b) The department shall select hospitals and health care systems to receive reimbursement under this subsection that submit to the department a description of their intensive care coordination program that includes all of the following:

AB64-ASA1,524,4 1. A statement that the hospital or health care system will use emergency department utilization data to identify recipients of Medical Assistance to receive intensive care coordination to reduce use of the emergency department by those Medical Assistance recipients.

AB64-ASA1,524,10 2. The method the hospital or health care system uses to identify for intensive care coordination a Medical Assistance recipient who uses the emergency department frequently. The hospital or health care system shall specify how it defines frequent emergency department use and may use criteria such as whether a recipient of Medical Assistance visits the emergency room 3 or more times within 30 days, 6 or more times within 90 days, or 7 or more times within 12 months.

AB64-ASA1,524,14 3. A description of the hospital's or health care system's intensive care coordination team consisting of health care providers other than solely physicians, such as nurses; social workers, case managers, or care coordinators ; behavioral health specialists; and schedulers.

AB64-ASA1,524,17 4. That the hospital or health care system provides to a Medical Assistance recipient enrolled in intensive care coordination through the hospital or health care system all of the following, as appropriate to his or her care:

AB64-ASA1,524,18 a. Discharge instructions and contacts for following up on care and treatment.

AB64-ASA1,524,19 b. Referral information.

AB64-ASA1,524,20 c. Appointment scheduling.

AB64-ASA1,524,21 d. Medication instructions.

AB64-ASA1,524,24 e. Intensive care coordination by a social worker, case manager, or care coordinator to connect the Medical Assistance recipient to a primary care provider or to a managed care organization.

AB64-ASA1,525,2 f. Information about other health and social resources, such as transportation and housing.

AB64-ASA1,525,8 5. The outcomes intended to result from intensive care coordination by the hospital or health care system. Outcomes for a Medical Assistance recipient during a 6-month or 12-month period may include successful connection to primary care or the managed care organization as evidenced by 2 or 3 primary care appointments, successful connection to behavioral health resources and alcohol and other drug abuse resources, as needed, or a decrease in use of the emergency room.

AB64-ASA1,525,9 (c) The department shall do all of the following:

AB64-ASA1,525,12 1. Respond to the hospital or health care system indicating if additional information is required to determine eligibility for the reimbursement program under this subsection.

AB64-ASA1,525,15 2. If the hospital or health care system is eligible for the reimbursement program under this subsection, provide a description of the process for enrolling Medical Assistance recipients in intensive care coordination for reimbursement.

AB64-ASA1,525,25 (d) The department shall provide as reimbursement for intensive care coordination to eligible hospitals and health care systems participating in the program under this subsection $500 for each Medical Assistance recipient who is not enrolled in coverage under Medicare, 42 USC 1395 et seq., the hospital or health care system enrolls in intensive care coordination. The initial enrollment for each recipient lasts for 6 months, and the health care provider may enroll the Medical Assistance recipient in one additional 6-month period for an additional $500 reimbursement payment. The department shall pay no more than $1,500,000 cumulatively in each fiscal year from all funding sources for reimbursements under this paragraph.

AB64-ASA1,526,3 (e) Annually, each hospital and health care system that is eligible for the reimbursement program under this subsection shall submit a report to the department containing all of the following:

AB64-ASA1,526,5 1. The number of Medical Assistance recipients served by intensive care coordination.

AB64-ASA1,526,10 2. For each Medical Assistance recipient who is not enrolled in coverage under Medicare, 42 USC 1395 et seq., the number of emergency department visits for a period before enrollment of that recipient in intensive care coordination and the number of emergency department visits for the same recipient during the same period after enrollment in intensive care coordination.

AB64-ASA1,526,12 3. Any demonstrated outcomes, such as those described in par. (b) 5., for Medical Assistance recipients.

AB64-ASA1,526,20 (f) For each hospital or health care system eligible for the reimbursement program under this subsection, the department shall calculate the costs saved to the Medical Assistance program by avoiding emergency department visits by subtracting the sum of reimbursements made under par. (d) to the hospital or health care system from the sum of costs of visits to the emergency department as reported under par. (e) 2. that were expected to occur without intensive care coordination. If the result of the calculation is positive, the department shall distribute half of the amount saved to the hospital or health care system subject to par. (h).