February 13, 2024 - Introduced by Representatives Snyder, Rozar, Kurtz and
Summerfield, cosponsored by Senator Cabral-Guevara. Referred to
Committee on Family Law.
AB1088,1,6 1An Act to renumber and amend 50.06 (1); to amend 50.06 (2) (b), 50.06 (2) (c),
250.06 (5) (a) (intro.), 50.06 (5) (b), 50.06 (6) and 50.06 (7); and to create 50.06
3(1) (b), 50.06 (5) (am) and 50.06 (8) of the statutes; relating to: consent to
4admissions to certain health care facilities by patient representatives,
5allocation of nursing beds for patients with certain complex needs, and a
6complex patient pilot program.
Analysis by the Legislative Reference Bureau
The bill allows a patient's representative to consent to an admission of an
incapacitated individual from a hospital to a nursing home or community-based
residential facility without a petition for guardianship or protective placement and
allows a patient's representative to make health care decisions and authorize
expenditures related to health care on behalf of an incapacitated individual without
certain time limitations that are imposed under current law if certain conditions are
met. Under current law, an individual who is either related to an incapacitated
individual as provided under current law or is an adult close friend of an
incapacitated individual may consent to admission, directly from a hospital to a
nursing home or community-based residential facility, of the incapacitated
individual who does not have a valid power of attorney for health care and who has
not been adjudicated incompetent in this state if certain conditions apply, including
that the individual for whom admission is sought is not diagnosed as

developmentally disabled or as having a mental illness at the time of the proposed
admission, that the incapacitated individual does not verbally object to or otherwise
actively protest the admission, and that petitions for guardianship for the individual
and for protective placement of the individual are filed prior to the proposed
admission. An individual who consents to admission of an incapacitated individual
may make health care decisions to the same extent as a guardian of the person and
authorize expenditures related to health care to the same extent as a guardian of the
estate until 60 days after the admission to the facility, discharge of the incapacitated
individual from the facility, or appointment of a guardian for the incapacitated
individual, whichever occurs first. The bill allows a patient's representative to
consent to an admission of an incapacitated individual from a hospital to a nursing
home or community-based residential facility as provided under current law
without petitions for guardianship or protective placement of the incapacitated
individual being filed if certain conditions apply, including that the patient's
representative promptly notifies all of the incapacitated individual's family
members that can be readily contacted that the patient's representative may make
decisions or authorize expenditures on the incapacitated individual's behalf, that the
patient's representative provides a written statement to the discharging hospital
that contains certain information, and that the facility to which the incapacitated
individual is admitted notifies a representative of the Board on Aging and Long Term
Care of the admission. Further, the bill allows a patient's representative to make
health care decisions and authorize expenditures related to health care without the
time limitations that apply to other direct admissions under current law if the
patient's representative satisfies the conditions for admission provided under the
bill. The authority of a patient's representative to make health care decisions and
authorize expenditures related to health care under the bill ends if a court appoints
a guardian to make such decisions.
The bill allocates 250 nursing home beds to be awarded to applicants who agree
to prioritize admissions of patients with complex needs and to prioritize admissions
of patients who have been unable to find appropriate placement at another facility.
Under current law, the maximum number of licensed nursing home beds that are
available in the state is limited in order to enable the state to budget accurately and
to allocate fiscal resources appropriately. At least once each year, the Department
of Health Services is required to publish a notice concerning the number of nursing
home beds that are available in each of its health planning areas. DHS is required
to accept applications for available nursing home beds and review the applications
based on criteria provided under current law, including cost containment, a need for
additional beds in the health planning area where the beds are requested, and
whether health care personnel, capital, and operating funds and other resources
needed to provide proposed services are available. This bill directs DHS to allocate
250 nursing home beds to be awarded to applicants as provided in the bill. An
applicant for nursing home beds allocated under the bill must apply to DHS on a form
provided DHS and include a plan for the applicant to become licensed for the nursing
home beds that the applicant requested, to become certified as a provider under the
Medical Assistance program, and to hire sufficient health care personnel and expend

sufficient resources to provide 24-hour nursing services within 18 months of DHS
approval. The bill requires that within 30 days of receipt of an application, DHS
must review applications received and approve applications that contain reasonable
plans to satisfy the above criteria within 18 months. The bill requires DHS to make
determinations on applications in the order that they are received. If DHS approves
an application, the bill requires DHS to award the beds requested in the application.
If not enough beds remain under the program to award all of the beds requested in
an application, DHS must contact the applicant and determine whether the
applicant will accept some or all of the remaining beds instead of the beds requested
in the application. If the applicant is willing to accept some or all of the remaining
beds, DHS must award those beds. DHS must continue to request and approve
applications until DHS awards all 250 nursing home beds allocated under the bill.
The bill requires DHS to select, using a competitive grant selection process,
partnership groups to be designated as participating sites for a complex patient pilot
program and then award grants to the partnership groups selected. The bill provides
that a partnership group is one or more hospitals in partnership with one or more
post-acute facilities. The bill provides that DHS must solicit feedback regarding the
pilot program from representatives of healthcare system organizations, long-term
care provider organizations, long-term care operator organizations, patient
advocate groups, insurers, and any other organization determined to be relevant by
the secretary of health services. Under the bill, DHS must require each partnership
group that applies to be designated as a site for the pilot program to address certain
issues in its application, including: 1) the number of complex patient care beds that
will be set aside in a post-acute facility or through implementation of another
innovative model of patient care in a post-acute facility to which participating
hospitals agree; 2) defined goals and measurable outcomes of the partnership both
during and after the pilot program; 3) the types of complex patients for whom care
will be provided; 4) an operating budget for the proposed site; and 5) the participant
group's expertise to successfully implement the proposal.
The bill requires DHS to reserve 10 percent of the pilot program funding for
reconciliation to help address unanticipated costs. Under the bill, DHS must also
develop a methodology to evaluate the pilot program and contract with an
independent organization to complete the evaluation. Under the bill, DHS may pay
the organization's fee from the funding appropriated for the pilot program. Under
the bill, DHS must give additional weight to partnership groups that would ensure
geographic diversity.
For further information see the state 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:
AB1088,1
1Section 1. 50.06 (1) of the statutes is renumbered 50.06 (1) (intro.) and
2amended to read:
AB1088,4,33 50.06 (1) (intro.) In this section, “incapacitated":
AB1088,4,7 4(a) “Incapacitated” means unable to receive and evaluate information
5effectively or to communicate decisions to such an extent that the individual lacks
6the capacity to manage his or her health care decisions, including decisions about his
7or her post-hospital care.
AB1088,2 8Section 2. 50.06 (1) (b) of the statutes is created to read:
AB1088,4,119 50.06 (1) (b) “Patient's representative” means the individual described under
10sub. (3) who may consent to an admission of an incapacitated individual under sub.
11(2).
AB1088,3 12Section 3. 50.06 (2) (b) of the statutes is amended to read:
AB1088,4,1513 50.06 (2) (b) The individual for whom admission is sought is not diagnosed as
14developmentally disabled or as having a mental illness, as defined in s. 51.01 (13) (a),
15at the time of the proposed admission.
AB1088,4 16Section 4. 50.06 (2) (c) of the statutes is amended to read:
AB1088,4,2017 50.06 (2) (c) A Unless the incapacitated individual is admitted to a facility
18under sub. (8), a
petition for guardianship for the individual under s. 54.34 and a
19petition under s. 55.075 for protective placement of the individual are filed prior to
20the proposed admission.
AB1088,5 21Section 5. 50.06 (5) (a) (intro.) of the statutes is amended to read:
AB1088,5,222 50.06 (5) (a) (intro.) Except as otherwise provided in par. pars. (am) and (b), an
23individual who consents to an admission under this section
a patient's
24representative
may, for the incapacitated individual, make health care decisions to
25the same extent as a guardian of the person may and authorize expenditures related

1to health care to the same extent as a guardian of the estate may, until the earliest
2of the following:
AB1088,6 3Section 6. 50.06 (5) (am) of the statutes is created to read:
AB1088,5,114 50.06 (5) (am) Except as otherwise provided in par. (b), a patient's
5representative may, for the incapacitated individual, make health care decisions to
6the same extent as a guardian of the person may and authorize expenditures related
7to health care to the same extent as a guardian of the estate may if the patient's
8representative consents to admission for the incapacitated individual in the manner
9provided in sub. (8). The authority of a patient's representative to make health care
10decisions or authorize expenditures under this paragraph ends if a court appoints a
11guardian to make such decisions for the incapacitated individual.
AB1088,7 12Section 7. 50.06 (5) (b) of the statutes is amended to read:
AB1088,5,1613 50.06 (5) (b) An individual who consents to an admission under this section A
14patient's representative
may not authorize expenditures related to health care if the
15incapacitated individual has an agent under a durable power of attorney, as defined
16in s. 244.02 (3), who may authorize expenditures related to health care.
AB1088,8 17Section 8. 50.06 (6) of the statutes is amended to read:
AB1088,5,2318 50.06 (6) If Unless the incapacitated individual was admitted to a facility under
19sub. (8), if
the incapacitated individual is in the facility after 60 days after admission
20and a guardian has not been appointed, the authority of the person who consented
21to the admission
patient's representative to make decisions and, if sub. (5) (a) applies,
22to authorize expenditures is extended for 30 days for the purpose of allowing the
23facility to initiate discharge planning for the incapacitated individual.
AB1088,9 24Section 9. 50.06 (7) of the statutes is amended to read:
AB1088,6,9
150.06 (7) An individual who consents to an admission under this section A
2patient's representative
may request a functional screening and a financial and
3cost-sharing screening to determine eligibility for the family care benefit under s.
446.286 (1). If admission is sought on behalf of the incapacitated individual or if the
5incapacitated individual is about to be admitted on a private pay basis, the individual
6who consents to the admission
patient's representative may waive the requirement
7for a financial and cost-sharing screening under s. 46.283 (4) (g), unless the
8incapacitated individual is expected to become eligible for medical assistance within
96 months.
AB1088,10 10Section 10. 50.06 (8) of the statutes is created to read:
AB1088,6,1411 50.06 (8) (a) A patient's representative may consent to an admission of an
12incapacitated individual under sub. (2) without a petition for guardianship or
13protective placement of the incapacitated individual being filed if all of the following
14apply:
AB1088,6,1815 1. The patient's representative acknowledges in writing that he or she agrees
16to make health care decisions on the incapacitated individual's behalf under this
17subsection and provides the acknowledgment to the discharging hospital and the
18accepting facility.
AB1088,6,2119 2. The patient's representative promptly notifies all of the incapacitated
20individual's family members that can be readily contacted that the patient's
21representative may make decisions or authorize expenditures under sub. (5) (am).
AB1088,6,2322 3. The patient's representative provides a written statement to the discharging
23hospital and the accepting facility that states all of the following:
AB1088,7,224 a. To the best knowledge of the patient's representative, a family member in a
25higher priority class under sub. (3) does not exist or no family member in a higher

1priority class is willing to make health care decisions on the incapacitated
2individual's behalf under this subsection.
AB1088,7,53 b. To the best knowledge of the patient's representative, the incapacitated
4individual does not have a health care agent, as defined in s. 155.01 (4), or guardian
5of the person, as defined in s. 54.01 (12).
AB1088,7,76 c. The incapacitated individual's family members who have received notice as
7provided under subd. 2.
AB1088,7,108 4. The facility to which the incapacitated individual is admitted under this
9subsection notifies a representative of the board on aging and long-term care of the
10admission no later than 72 hours after the admission.
AB1088,7,1911 (b) A hospital discharging an incapacitated patient to a facility under this
12subsection shall be in compliance with 42 CFR 482.13 (b) (3) or 42 CFR 485.608 (a)
13regarding the implementation of the patient's rights to formulate advance directives.
14A nursing home admitting the incapacitated individual shall be in compliance with
15the requirements under 42 CFR 483.10 (b) (3) to (6) that a resident be afforded the
16right to designate a representative, including the requirement that if the nursing
17home has reason to believe that a resident representative is making decisions or
18taking actions that are not in the best interests of the resident then the nursing home
19shall report such concerns as required by state law.
AB1088,7,2220 (c) Nothing in this subsection may be construed to preclude the administration
21of health care treatment in accordance with accepted standards of medical practice
22and as otherwise provided by law.
AB1088,7,2523 (d) The discharging hospital and the accepting facility shall include a copy of
24the written acknowledgment under par. (a) 1. and a copy of the written statement
25under par. (a) 3. in the incapacitated individual's health care record.
AB1088,8,7
1(e) Any interested party may petition the court to review whether the patient's
2representative is acting in accordance with the known wishes or in the best interest
3of the incapacitated individual and is exercising the degree of care, diligence, and
4good faith when acting on behalf of the incapacitated individual that an ordinarily
5prudent person exercises in his or her own affairs. The court may issue orders that
6the court determines necessary to protect the incapacitated individual, including
7any of the following:
AB1088,8,98 1. Directing the patient's representative to act in the best interest of the
9incapacitated individual.
AB1088,8,1310 2. Requiring the patient's representative to report to the court periodically on
11the incapacitated individual's status. The court may require that the report include
12a financial accounting of expenditures made under sub. (5) (am) within 72 hours of
13the court's order.
AB1088,8,1514 3. Directing the patient's representative not to make certain decisions or
15authorize certain expenditures under sub. (5) (am).
AB1088,11 16Section 11. Nonstatutory provisions.
AB1088,8,1717 (1) Allocation of nursing home beds.
AB1088,8,1918 (a) Definitions. In this subsection, “department” means the department of
19health services.
AB1088,8,2120 (b) Applicability. Beginning on July 1, 2024, the department shall allocate 250
21nursing home beds as provided under this subsection.
AB1088,9,222 (c) Applications. The department shall request applications for nursing home
23beds allocated under this subsection. An applicant for nursing home beds allocated
24under this subsection shall submit an application to the department on a form

1provided by the department. The application shall include a plan for the applicant
2to satisfy all of the following criteria within 18 months of department approval:
AB1088,9,4 31. Become licensed under subch. I of ch. 50 for the nursing home beds that the
4applicant requested in the application.
AB1088,9,6 52. Become certified as a provider under the medical assistance program under
6subch. IV of ch. 49.
AB1088,9,8 73. Hire sufficient health care personnel and expend sufficient resources to
8provide 24-hour nursing services.
AB1088,9,99 (d) Approval.
AB1088,9,16 101. Within 30 days of receipt of an application under this subsection, the
11department shall review the application and, if it contains reasonable plans to satisfy
12the criteria under par. (c) within 18 months of approval, approve the application. The
13department shall review and approve applications in the order that the applications
14are received. If the department approves an application under this paragraph, the
15department shall award the applicant the number of nursing home beds requested
16in the application, subject to subd. 2 .
AB1088,9,25 172. If there is not a sufficient number of beds remaining under this subsection
18to award an applicant the number of nursing home beds requested in the application,
19the department shall contact the applicant and determine whether the applicant will
20accept some or all of the remaining beds under this subsection instead of the beds
21requested in the application. If the applicant is willing to accept some or all of the
22remaining beds under this subsection instead of the beds requested in the
23application, the department shall award those beds. If the applicant is not willing
24to accept some or all of the remaining beds under this subsection, the department
25shall discard the application.
AB1088,10,3
13. The department shall continue to request applications for nursing home beds
2and approve applications as provided under this paragraph until the department
3awards all nursing home beds allocated under this subsection.
AB1088,10,54 (e) Conditions of approval. As a condition of being awarded nursing home beds
5under this subsection, an applicant shall agree to do all of the following:
AB1088,10,9 61. Prioritize admissions of patients with complex needs and conditions, such
7as patients with mental health and behavioral needs, serious wound care needs,
8bariatrics, substance use disorder, nonambulatory disability, intravenous therapy
9needs, or dialysis needs.
AB1088,10,11 102. Prioritize admissions of patients who have been unable to find appropriate
11placement at another facility.
AB1088,10,1512 (f) Compliance. Each person awarded nursing home beds under this subsection
13shall biennially or upon request from the department report to the department
14whether the person has satisfied the criteria under par. (c) and the conditions under
15par. (e), including all of the following information:
AB1088,10,17 161. The number of patients served utilizing the nursing home beds awarded
17under this subsection.
AB1088,10,19 182. The complex conditions that were served utilizing the nursing home beds
19awarded under this subsection.
AB1088,10,21 203. The number of patients served and the number of patient days for each of
21those complex conditions under subd. 2 .
AB1088,10,22 224. Any other information required by the department.
AB1088,10,2323 (g) Miscellaneous.
AB1088,10,25 241. No application under this subsection may be for more than 50 nursing home
25beds.
AB1088,11,5
12. If an applicant that is awarded nursing home beds under par. (d ) fails to
2satisfy any of the criteria under par. (c ) within 24 months following department
3approval under par. (d), the applicant shall reapply for the awarded nursing home
4beds by submitting an application to the department as provided under par. (c) or
5surrender the awarded nursing home beds.
AB1088,11,8 63. If any nursing home beds awarded under this subsection are surrendered,
7the department shall request applications for the surrendered nursing home beds as
8provided under par. (c).
AB1088,11,159 (h) Reporting. By September 1, 2025, and biennially thereafter, the
10department shall submit to the chief clerk of each house of the legislature, for
11distribution to the appropriate standing committees in the manner required under
12s. 13.172 (3), a report on the performance of the program under this subsection,
13including the total number of patients served, the complex conditions addressed, the
14number of patients served and the number of patient days for each complex
15condition, and any cost savings associated with the program.
AB1088,11,1616 (2) Complex patient pilot program.
AB1088,11,1717 (a) In this subsection:
AB1088,11,18 181. “Department” means the department of health services.
AB1088,11,20 192. “Partnership group” means one or more hospitals in partnership with one
20or more post-acute facilities.
AB1088,11,2421 (b) The department shall use a competitive grant selection process to select
22partnership groups to be designated as participating sites for a complex patient pilot
23program under this subsection and, from the appropriation under s. 20.435 (7) (d),
24award grants to the groups selected.
AB1088,12,5
1(c) The department shall solicit feedback regarding the complex patient pilot
2program from representatives of healthcare system organizations, long-term care
3provider organizations, long-term care operator organizations, patient advocate
4groups, insurers, and any other organization determined to be relevant by the
5secretary of health services.
AB1088,12,86 (d) The department shall require that each partnership group that applies to
7the department to be designated as a site for the complex patient pilot program shall
8address all of the following issues in its application:
AB1088,12,12 91. The number of complex patient care beds that will be set aside in a
10post-acute facility or through implementation of an innovative model of patient care
11in a post-acute facility to which participating hospitals agree, such as dedicated
12staffing for dementia or a behavioral health unit.
AB1088,12,14 132. Defined goals and measurable outcomes of the partnership group during the
14pilot program and after the pilot program.
AB1088,12,17 153. The types of complex patients for whom care will be provided, which may
16include patients needing total care for multiple conditions or comorbidities such as
17cardiac and respiratory diseases, obesity, mental health, substance use, or dementia.
AB1088,12,20 184. An operating budget for the proposed site that details how fiscal
19responsibility will be shared among members of the partnership group and includes
20all of the following:
AB1088,12,22 21a. Estimated patient revenues from other sources, including the Medical
22Assistance program under subch. IV of ch. 49, and estimated total costs.
AB1088,12,23 23b. A margin to account for reserved beds.
AB1088,12,25 245. The partnership group's expertise to successfully implement the proposal,
25which may include a discussion of the following issues:
AB1088,13,2
1a. Documented experience of the partners working together to serve complex
2patients.
AB1088,13,5 3b. The implementation timeline and the plan for post-acute facilities to accept
4admissions and transfer patients within 72 hours of a request submitted by a
5hospital.
AB1088,13,9 6c. The plan for an interdisciplinary team that will staff the unit in the
7post-acute facility, including the availability of staff with appropriate expertise that
8includes physicians, nurses, advance practice health professionals, pharmacists,
9physical therapists, occupational therapists, and social workers.
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