SWB:skw
2023 - 2024 LEGISLATURE
September 29, 2023 - Introduced by Senators Marklein, James, Ballweg,
Cabral-Guevara, Felzkowski, Spreitzer, Testin, Tomczyk and Quinn,
cosponsored by Representatives Moses, Summerfield, Callahan, C.
Anderson
, Brooks, Dittrich, Donovan, Edming, Green, Gundrum, Jacobson,
Kitchens, Krug, Maxey, Murphy, Mursau, Novak, O'Connor, Petryk, Rozar,
Sapik, Shankland, Spiros, Tranel, Zimmerman and Wichgers. Referred to
Committee on Mental Health, Substance Abuse Prevention, Children and
Families.
SB462,1,4 1An Act to renumber and amend 49.45 (41) (a); to amend 49.45 (41) (b), 49.45
2(41) (c) (intro.) and 51.15 (2) (d); and to create 49.45 (41) (a) 1., 49.45 (41) (d)
3and 51.036 of the statutes; relating to: crisis urgent care and observation
4facilities and granting rule-making authority.
Analysis by the Legislative Reference Bureau
This bill requires the Department of Health Services to establish a certification
process for crisis urgent care and observation facilities and a grant program to award
grants to develop and support these facilities. Under the bill, a crisis urgent care and
observation facility is a treatment facility that admits an individual to prevent,
de-escalate, or treat the individual's mental health or substance use disorder and
includes the necessary structure and staff to support the individual's needs relating
to the mental health or substance use disorder. The bill provides that no person may
operate a crisis urgent care and observation facility without a certification from
DHS. Under the bill, a certified crisis urgent care and observation facility is not
regulated as a hospital, except to the extent the facility is otherwise required due to
the facility's licensure or certification for other services or purposes. The bill provides
that the provisions of the bill may not be construed to prohibit, limit, or otherwise
interfere with services provided by a county or a hospital or other facility that are
provided consistent with the facility's existing licensure or certification, whether the
facility is publicly or privately funded.
The bill provides that DHS may certify crisis urgent care and observation
facilities that demonstrate the ability to do certain things, including 1) accept

referrals for crisis services for adults, and, if applicable, for youth, including
involuntary patients under emergency detention, walk-ins, and individuals brought
by law enforcement, emergency medical responders or emergency medical services
practitioners, or county crisis personnel; 2) abstain from having a requirement for
medical clearance before admission assessment; 3) provide assessments for physical
health, substance use disorder, and mental health; 4) provide screening for suicide
and violence risk; 5) provide medication management and therapeutic counseling;
6) provide coordination of services for basic needs; 7) provide for the safety and
security of both the staff and the patients; 8) have adequate staffing 24 hours a day,
7 days a week, including through use of telehealth, with a multidisciplinary team,
including, as needed, psychiatrists or psychiatric nurse practitioners, nurses,
licensed clinicians capable of completing assessments, peers with lived experience,
and other appropriate staff; 9) allow for voluntary and involuntary treatment of
individuals in crisis as a means to avoid unnecessary placement of those individuals
in hospital inpatient beds and allow for an effective conversion to voluntary
stabilization when warranted in the same setting; and 10) contribute, from one or
more nonstate, federal, or third-party sources, an amount, as determined by DHS,
in addition to any grant awarded by DHS under the bill. The bill requires that DHS
must provide the Joint Committee on Finance with certain information and obtain
approval of that committee before granting certification to a crisis urgent care and
observation facility. The bill also requires DHS to provide an annual report to the
Joint Committee on Finance regarding the facilities.
Under the bill, a certified crisis urgent care and observation facility must accept
adult individuals for emergency detention, and may accept youths for emergency
detention. The bill provides that a certified crisis urgent care and observation facility
may accept individuals for services including voluntary stabilization; observation
and treatment, including for assessments for mental health or substance use
disorder; screening for suicide and violence risk; and medication management and
therapeutic counseling.
The bill provides that a certified crisis urgent care and observation facility must
coordinate to the fullest extent possible with any facility established or operated with
funding received from settlement proceeds from the opiate litigation, which under
current law refers to the litigation in In re: National Prescription Opiate Litigation,
Case No.: MDL 2804 or any proceeding filed in a circuit court in this state containing
allegations and seeking relief that is substantially similar to allegations contained
and relief sought in that matter. The bill also requires that DHS promulgate rules
establishing policies that encourage awareness of and communication and
coordination between certified crisis urgent care and observation facilities and other
facilities that provide similar services.
The bill requires DHS, in accordance with existing requirements to obtain
approval from the Joint Committee on Finance, to request any necessary federal
approval by seeking either a waiver, specifically, what is known as a 1115 waiver, or
a Medical Assistance state plan amendment to add services provided by a crisis
urgent care and observation facility as a type of crisis intervention service
reimbursable under the Medical Assistance program. If DHS determines a state

plan amendment is appropriate, DHS must follow the procedures for review by the
Joint Committee on Finance, regardless of whether the amendment is expected to
have a fiscal effect of $7,500,000 or more. Under the bill, if federal approval is either
unnecessary or is necessary and is granted, DHS may provide reimbursement for
these services.
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:
SB462,1 1Section 1 . 49.45 (41) (a) of the statutes is renumbered 49.45 (41) (a) (intro.)
2and amended to read:
SB462,3,53 49.45 (41) (a) (intro.) In this subsection, “crisis intervention services" means
4crisis intervention services for the treatment of mental illness, intellectual disability,
5substance abuse, and dementia that are provided by a any of the following:
SB462,3,7 62. A crisis intervention program operated by, or under contract with, a county,
7if the county is certified as a medical assistance provider.
SB462,2 8Section 2 . 49.45 (41) (a) 1. of the statutes is created to read:
SB462,3,109 49.45 (41) (a) 1. A crisis urgent care and observation facility certified under s.
1051.036.
SB462,3 11Section 3 . 49.45 (41) (b) of the statutes is amended to read:
SB462,4,212 49.45 (41) (b) If a county elects to become certified as a provider of crisis
13intervention services under par. (a) 2., the county may provide crisis intervention
14services under this subsection in the county to medical assistance recipients through
15the medical assistance program. A county that elects to provide the services shall
16pay the amount of the allowable charges for the services under the medical
17assistance program that is not provided by the federal government. The department
18shall reimburse the county under this subsection only for the amount of the allowable

1charges for those services under the medical assistance program that is provided by
2the federal government.
SB462,4 3Section 4 . 49.45 (41) (c) (intro.) of the statutes is amended to read:
SB462,4,74 49.45 (41) (c) (intro.) Notwithstanding par. (b), if a county elects, pursuant to
5par. (a) 2.,
to deliver crisis intervention services under the Medical Assistance
6program on a regional basis according to criteria established by the department, all
7of the following apply:
SB462,5 8Section 5 . 49.45 (41) (d) of the statutes is created to read:
SB462,4,229 49.45 (41) (d) The department shall, in accordance with all procedures set forth
10under s. 20.940, request a waiver under 42 USC 1315 or submit a Medical Assistance
11state plan amendment to the federal department of health and human services to
12obtain any necessary federal approval required to provide reimbursement to crisis
13urgent care and observation facilities certified under s. 51.036 for crisis intervention
14services under this subsection. If the department determines submission of a state
15plan amendment is appropriate, the department shall, notwithstanding whether the
16expected fiscal effect of the amendment is $7,500,000 or more, submit the
17amendment to the joint committee on finance for review in accordance with the
18procedures under s. 49.45 (2t). If federal approval is granted or no federal approval
19is required, the department shall provide reimbursement under s. 49.46 (2) (b) 15.
20If federal approval is necessary but is not granted, the department may not provide
21reimbursement for crisis intervention services provided by crisis urgent care and
22observation facilities.
SB462,6 23Section 6 . 51.036 of the statutes is created to read:
SB462,4,25 2451.036 Crisis urgent care and observation facilities. (1) Definitions. In
25this section:
SB462,5,5
1(a) “Crisis” means a situation caused by an individual's apparent mental or
2substance use disorder that results in a high level of stress or anxiety for the
3individual, persons providing care for the individual, or the public and that is not
4resolved by the available coping methods of the individual or by the efforts of those
5providing ordinary care or support for the individual.
SB462,5,96 (b) “Crisis urgent care and observation facility” means a treatment facility that
7admits an individual to prevent, de-escalate, or treat the individual's mental health
8or substance use disorder and includes the necessary structure and staff to support
9the individual's needs relating to the mental health or substance use disorder.
SB462,5,20 10(2) Certification required; exemption; grants. (a) The department shall
11establish a certification process for crisis urgent care and observation facilities and
12a grant program to award grants to develop and support crisis urgent care and
13observation facilities. No person may operate a crisis urgent care and observation
14facility without a certification under this section. The department may limit the
15number of certifications it grants to operate crisis urgent care and observation
16facilities. The department shall, using the department's division of the state into
17regions by county, include statewide geographic consideration in its evaluation of
18applications for certification under this section to ensure geographic diversity among
19the regions in the location of crisis urgent care and observation facilities certified
20under this section.
SB462,5,2521 (b) 1. A crisis urgent care and observation facility certified under this section
22is not subject to facility regulation under ch. 50, unless otherwise required due to the
23facility's licensure or certification for other services or purposes. A crisis urgent care
24and observation facility is not a hospital subject to approval under ss. 50.32 to 50.39
25and nothing in this subsection limits services a hospital may provide under ch. 50.
SB462,6,7
12. Notwithstanding par. (d), the department shall promote certification and
2encourage any facility that is licensed as a hospital under ch. 50 and provides
3services consistent with those described in par. (c) 1. to 9. to apply for certification
4under this section. The requirements under this section may not be construed to
5prohibit, limit, or otherwise interfere with services provided by a county or a hospital
6or other facility that are provided consistent with the facility's existing licensure or
7certification, whether the facility is publicly or privately funded.
SB462,6,108 3. Notwithstanding s. 150.93, any hospital that expands psychiatric bed
9capacity to accommodate admissions under this section may increase its approved
10bed capacity by the number of psychiatric beds added under this subdivision.
SB462,6,1311 4. The department shall take into account the geography of hospital facilities
12granted certification under subd. 2. when considering certification applications for
13other crisis urgent care and observations facilities.
SB462,6,1714 (c) Subject to par. (d), the department may grant a certification to a crisis urgent
15care and observation facility that specifies in an application the level of care the
16facility can provide to patients and demonstrates in the application its ability to do
17all of the following:
SB462,6,2118 1. Accept referrals for crisis services for adults and, if applicable, for youth,
19including involuntary patients under emergency detention, walk-ins, and
20individuals brought by law enforcement, emergency medical responders or
21emergency medical services practitioners, or county crisis personnel.
SB462,6,2322 2. Abstain from having a requirement for medical clearance before admission
23assessment.
SB462,6,2524 3. Provide assessments for physical health, substance use disorder, and mental
25health.
SB462,7,1
14. Provide screening for suicide and violence risk.
SB462,7,22 5. Provide medication management and therapeutic counseling.
SB462,7,33 6. Provide coordination of services for basic needs.
SB462,7,44 7. Provide for the safety and security of both the staff and the patients.
SB462,7,95 8. Have adequate staffing 24 hours a day, 7 days a week, including through use
6of telehealth, as described under s. 49.45 (61), with a multidisciplinary team that
7includes, as needed, psychiatrists or psychiatric nurse practitioners, nurses,
8licensed clinicians capable of completing assessments, peers with lived experience,
9and other appropriate staff.
SB462,7,1310 9. Allow for voluntary and involuntary treatment of individuals in crisis as a
11means to avoid unnecessary placement of those individuals in hospital inpatient
12beds and allow for an effective conversion to voluntary stabilization when warranted
13in the same setting.
SB462,7,1614 10. Contribute, from at least one nonstate, federal, or 3rd-party revenue
15source, an amount, as determined by the department, in addition to any grant
16awarded by the department under this section.
SB462,8,517 (d) Before the department may grant certification to a facility under this
18section, the department shall submit the proposal for certification to the joint
19committee on finance for approval. If the cochairpersons of the joint committee on
20finance do not notify the department within 14 working days after the date of the
21submittal under this paragraph that the committee has scheduled a meeting for the
22purpose of reviewing the proposal, the department may grant certification of that
23facility as described in the proposal. If, within 14 working days after the date of the
24submittal under this paragraph, the cochairpersons of the committee notify the
25department that the committee has scheduled a meeting for the purpose of reviewing

1the proposal, the department may grant certification of that facility only upon
2approval by the committee. When submitting a proposal regarding certification of
3a facility under this paragraph, the department shall provide the joint committee on
4finance with all of the following information about the facility proposed for
5certification:
SB462,8,66 1. The department's rationale for selecting the facility.
SB462,8,77 2. Where the facility is to be located.
SB462,8,88 3. A specific description of the entity that will be awarded certification.
SB462,8,99 4. A description of how the funding for the facility will work.
SB462,8,1010 5. The timeline of the facility for accepting patients.
SB462,8,1111 6. The distance from the facility to the nearest hospital.
SB462,8,1212 7. A description of the facility's plan for staffing, including staff on call.
SB462,8,1313 8. The number of beds in the facility.
SB462,8,1414 9. A description of the facility's admission, hold, and discharge policies.
SB462,8,1515 10. Security considerations for patients and staff at the facility.
SB462,8,1616 11. The estimated population to be served.
SB462,8,1817 12. The estimated number of diversions from the Winnebago Mental Health
18Institute had the facility been operating the past 5 years.
SB462,8,2219 13. Policies that ensure the facility has the capacity to assess physical health
20needs and deliver care for most minor physical health challenges, while also having
21an identified process in order to transfer an individual to a facility with more
22medically staffed services if needed.
SB462,9,223 (e) No later than June 30 of each year, beginning by June 30, 2025, the
24department shall submit to the joint committee on finance a report regarding crisis

1urgent care and observation facilities under this section, including information
2relating to all of the following:
SB462,9,33 1. Applications for certification received by the department.
SB462,9,54 2. The number of admissions, including both voluntary and involuntary
5admissions.
SB462,9,86 3. Data regarding how patients are arriving for admission, including through
7transport by law enforcement, family, emergency medical responders or emergency
8medical services practitioners, or county crisis personnel.
SB462,9,99 4. Average wait times.
SB462,9,1010 5. The length of patient stays.
SB462,9,1111 6. The time of day patients are admitted.
SB462,9,1312 7. The source of payments for patient care, including private payment sources
13or payment under the Medical Assistance program under subch. IV of ch. 49.
SB462,9,1514 8. Data regarding the county of residence for each patient in counties for which
15the county's data is equal to or greater than 20 patients.
SB462,9,1716 9. The estimated number of diversions from the Winnebago Mental Health
17Institute.
SB462,9,1918 10. A description of the number and type of employees providing staffing during
19the various times of day.
SB462,9,2220 11. A description of rules and procedures for determining where to take an
21individual in need of crisis services if a crisis urgent care and observation facility
22does not have capacity or otherwise does not accept an individual.
SB462,9,24 23(3) Admissions. (a) A crisis urgent care and observation facility certified under
24this section may accept individuals for any of the following services:
SB462,9,2525 1. Voluntary stabilization.
SB462,10,2
12. Observation and treatment, including for assessments for mental health or
2substance use disorder.
SB462,10,33 3. Screening for suicide and violence risk.
SB462,10,44 4. Medication management and therapeutic counseling.
SB462,10,155 (b) A crisis urgent care and observation facility certified under this section shall
6accept an adult individual for emergency detention under s. 51.15 and may accept
7a youth for emergency detention under s. 51.15. If the facility does not have capacity
8to accept an adult individual for purposes of emergency detention or if the facility
9does not accept a youth for purposes of emergency detention, that individual shall
10be transported to another appropriate facility in accordance with rules established
11by the department under sub. (4). A county crisis assessment under s. 51.15 (2) (c)
12is required prior to admission to a crisis urgent care and observation facility for
13purposes of emergency detention, but the medical clearance requirement under s.
1451.15 (2) (b) does not apply to crisis urgent care and observation facility admissions
15for purposes of emergency detention.
SB462,10,1816 (c) The department shall encourage each crisis urgent care and observation
17facility certified under this section to operate with the intent to admit individuals for
18no longer than 5 days, except in exceptional circumstances.
SB462,10,20 19(4) Rules. The department shall promulgate rules to implement this section,
20including all of the following:
SB462,10,2221 (a) Establishment of the grant program described under sub. (2), including
22procedures for administration and establishment of criteria for awarding grants.
SB462,11,323 (b) Establishment of requirements for crisis urgent care and observation
24facilities to match a portion of any grant awarded by the department under this
25section, as set forth under sub. (2) (c) 10., and for determining what types of

1contributions may count toward the matching requirement. The matching
2requirement established by the department under this paragraph may be fulfilled
3through in-kind contributions.
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