49.45(23b)(b)
(b) Beginning as soon as practicable after October 31, 2018, and ending no sooner than December 31, 2023, the department shall do all of the following with regard to the childless adults demonstration project under sub.
(23):
49.45(23b)(b)1.
1. Require in each month persons, except exempt individuals, who are eligible to receive Medical Assistance under sub.
(23) and who are at least 19 years of age but have not attained the age of 50 to participate in, document, and report 80 hours per calendar month of community engagement activities. The department, after finding good cause, may grant a temporary exemption from the requirement under this subdivision upon request of a Medical Assistance recipient.
49.45(23b)(b)2.
2. Require persons with incomes of at least 50 percent of the poverty line to pay premiums in accordance with par.
(c) as a condition of eligibility for Medical Assistance under sub.
(23).
49.45(23b)(b)3.
3. Require as a condition of eligibility for Medical Assistance under sub.
(23) completion of a health risk assessment.
49.45(23b)(b)5.
5. Disenroll from Medical Assistance under sub.
(23) for 6 months any individual who does not pay a required premium under subd.
2. and any individual who is required under subd.
1. to participate in a community engagement activity but who does not participate for 48 aggregate months in the community engagement activity.
49.45(23b)(c)1.1. Persons who are eligible for the demonstration project under sub.
(23) and who have monthly household income that exceeds 50 percent of the poverty line shall pay a monthly premium amount of $8 per household. A person who is eligible to receive an item or service furnished by an Indian health care provider is exempt from the premium requirement under this subdivision.
49.45(23b)(c)2.
2. The department may disenroll under par.
(b) 5. a person for nonpayment of a required monthly premium only at annual eligibility redetermination after providing notice and reasonable opportunity for the person to pay. If a person who is disenrolled for nonpayment of premiums pays all owed premiums or becomes exempt from payment of premiums, he or she may reenroll in Medical Assistance under sub.
(23).
49.45(23b)(c)3.
3. The department shall reduce the amount of the required household premium by up to half for a recipient of Medical Assistance under sub.
(23) who does not engage in certain behaviors that increase health risks or who attests to actively managing certain unhealthy behaviors.
49.45(23b)(d)
(d) The department shall comply with any other requirements not specified elsewhere in this subsection that are imposed by the federal department of health and human services in its approval effective October 31, 2018.
49.45(23b)(e)
(e) Before December 31, 2023, the demonstration project requirements under this subsection may not be withdrawn and the department may not request from the federal government withdrawal, suspension, or termination of the demonstration project requirements under this subsection unless legislation has been enacted specifically allowing for the withdrawal, suspension, or termination.
49.45(23b)(f)
(f) The department shall comply with all applicable timing in and requirements of s.
20.940.
49.45(24)
(24)
Primary care provider pilot. The department may request a waiver from the secretary of the federal department of health and human services under
42 USC 1396n (b) (1) to permit the establishment of a primary care provider pilot project. If the waiver is granted, the department may establish a primary care provider pilot project under which primary care providers act as case managers for medical assistance beneficiaries. If the department establishes a primary care provider pilot project, it shall reimburse a case manager for the allowable charges for case management services provided to a beneficiary participating in the pilot project.
49.45(24g)
(24g)
Physician practice payment pilot. 49.45(24g)(a)
(a) The department shall develop a proposal to increase medical assistance reimbursement to providers to which at least one of the following applies:
49.45(24g)(a)1.
1. The provider is recognized by the National Committee on Quality Assurance as a Patient-Centered Medical Home.
49.45(24g)(a)2.
2. The secretary determines that the provider performs well with respect to all of the following aspects of care:
49.45(24g)(a)2.a.
a. Adoption of written standards for patient access and patient communication.
49.45(24g)(a)2.b.
b. Use of data to show that standards for patient access and patient communication are satisfied.
49.45(24g)(a)2.c.
c. Use of paper or electronic charting tools to organize clinical information.
49.45(24g)(a)2.d.
d. Use of data to identify diagnoses and conditions among the provider's patients that have a lasting detrimental effect on health.
49.45(24g)(a)2.e.
e. Adoption and implementation of guidelines that are based on evidence for treatment and management of at least 3 chronic conditions.
49.45(24g)(a)2.g.
g. Systematic tracking of patient test results and systematic identification of abnormal patient test results.
49.45(24g)(a)2.h.
h. Systematic tracking of referrals using a paper or electronic system.
49.45(24g)(a)2.i.
i. Measuring the quality of the performance of the physician practice and of individual physicians within the practice, including with respect to provision of clinical services, patient outcomes, and patient safety.
49.45(24g)(a)2.j.
j. Reporting to members of the physician practice and to other persons on the quality of the performance of the physician practice and of individual physicians.
49.45(24g)(c)
(c) The department's proposal under par.
(a) shall specify increases in reimbursement rates for providers that satisfy the conditions under par.
(a) 1. or
2., and shall provide for payment of a monthly per-patient care coordination fee to those providers. The department shall set the increases in reimbursement rates and the monthly per-patient care coordination fee so that together they provide sufficient incentive for providers to satisfy a condition under par.
(a) 1. or
2. The proposal shall specify effective dates for the increases in reimbursement rates and the monthly per-patient care coordination fee that are no sooner than July 1, 2011.