Wisconsin 2023-2024 Regular Session

Wisconsin Assembly Bill AB1087 Compare Versions

Only one version of the bill is available at this time.

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3	3	2023 - 2024 LEGISLATURE
4	4	2023 ASSEMBLY BILL 1087
5	5	February 13, 2024 - Introduced by Representatives SNYDER, ROZAR, KURTZ and
6	6	SUMMERFIELD, cosponsored by Senator CABRAL-GUEVARA. Referred to
7	7	Committee on Family Law.
8	8	*AUTHORS SUBJECT TO CHANGE*
9	9	AN ACT to create 49.45 (3n) and 49.45 (6r) of the statutes; relating to:
10	10	supplemental payments to hospitals with avoidable patient days and an
11	11	enhanced rate to nursing homes for bariatric and extensive wound care under
12	12	the Medical Assistance program.
13	13	Analysis by the Legislative Reference Bureau
14	14	This bill requires the Department of Health Services, at the beginning of each
15	15	quarter starting with the quarter that begins on July 1, 2024, and ending with the
16	16	quarter that begins on April 1, 2025, to provide a supplemental payment under the
17	17	Medical Assistance program to hospitals that have qualifying avoidable patient
18	18	days. Under the bill, a qualifying avoidable patient day means any day following the
19	19	seventh consecutive day on which a high-acuity patient was eligible for discharge
20	20	from a hospital, as reasonably identified by the hospital, and the hospital was not
21	21	able to identify a setting to which the patient could be safely discharged. The Medical
22	22	Assistance program is a joint federal and state program that provides health services
23	23	to individuals who have limited financial resources.
24	24	Under the bill, in each quarter during the period described in the bill, DHS
25	25	must distribute a total of $5,000,000 plus any matching federal funds to hospitals
26	26	that have qualifying avoidable patient days. The bill provides that DHS must pay
27	27	to each of these hospitals a percentage of the total distribution that equals the
28	28	hospital's percentage of the total number of qualifying avoidable patient days
29	29	reported by all hospitals for the applicable quarterly reporting period. The bill
30	30	requires that DHS limit the maximum amount of funding to any hospital under the
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36	36	ASSEMBLY BILL 1087
37	37	bill in accordance with any federal rules concerning hospital-specific funding limits.
38	38	The bill provides that in order to receive a portion of the quarterly supplemental
39	39	funding that DHS distributes each quarter, a hospital must submit, by a specific
40	40	deadline, the total number of qualifying avoidable patient days at the hospital for the
41	41	relevant period.
42	42	The bill requires DHS to submit any necessary request to the federal
43	43	Department of Health and Human Services for a state plan amendment or waiver
44	44	of federal Medicaid law to receive federal matching funds for the supplemental
45	45	payments to hospitals under the bill. The bill also provides that DHS must
46	46	implement the supplemental payments regardless of whether federal approval is
47	47	received.
48	48	The bill also requires DHS, during the 2023-25 fiscal biennium, to develop an
49	49	enhanced rate for reimbursement under the Medical Assistance program for
50	50	bariatric and extensive wound care needs for nursing home residents who are
51	51	admitted on or after July 1, 2024. Under the bill, the calculated cost of the enhanced
52	52	rate developed by the department may not exceed $10,000,000. The bill provides that
53	53	once DHS has developed an enhanced rate, DHS must implement that rate. Under
54	54	the bill, in seeking reimbursement under any enhanced rate implemented, a nursing
55	55	home may claim only one enhanced rate type for a resident and may not claim both
56	56	a bariatric care needs enhanced reimbursement rate and an extensive wound care
57	57	enhanced reimbursement rate for the same resident at the same time.
58	58	The bill requires that DHS apply certain standards with respect to the
59	59	enhanced rates developed. For the bariatric care needs enhanced rate, a nursing
60	60	home must identify bariatric care needs by a minimum data set assessment at
61	61	admission indicating a body mass index equal to or greater than 40 and total or
62	62	extensive assistance with activities of daily living. The bariatric care needs
63	63	enhanced rate applicable for a resident must be available for the duration of the
64	64	resident's stay at the nursing home. Under the bill, an enhanced rate for bariatric
65	65	care needs may be used to provide reimbursement for specialized mattresses, diets,
66	66	medical supplies, extra staff for transfers, as well as more expensive or specialized
67	67	transportation services. Finally, the enhanced rate for bariatric care needs may only
68	68	be applicable if the resident is admitted to the nursing home directly from a hospital;
69	69	the resident is non-ambulatory; and the person needs at least a two-person assist
70	70	with a lift.
71	71	With regard to an extensive wound care needs enhanced rate developed under
72	72	the bill, a nursing home must identify extensive wound care needs by a prior
73	73	authorization process that includes consideration of the number and stage of
74	74	wounds, the cost and frequency of necessary interventions and supplies, including
75	75	including vacuum-assisted closure of wounds, nutritional supplements, specialized
76	76	mattresses, and wheelchair cushions. The bill provides that the enhanced rate for
77	77	extensive wound care needs may only be applicable if the resident is admitted to the
78	78	nursing home directly from a hospital and the resident did not acquire the wound or
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82	82	ASSEMBLY BILL 1087
83	83	For further information see the state fiscal estimate, which will be printed as
84	84	an appendix to this bill.
85	85	The people of the state of Wisconsin, represented in senate and assembly, do
86	86	enact as follows:
87	87	SECTION 1. 49.45 (3n) of the statutes is created to read:
88	88	49.45 (3n) SUPPLEMENTAL PAYMENTS TO HOSPITALS. (a) In this subsection:
89	89	1. “High-acuity patient” means any of the following:
90	90	a. A hospital patient with bariatric care needs, identified by a minimum data
91	91	set assessment indicating a body mass index equal to or greater than 40 and a need
92	92	for total or extensive assistance with activities of daily living, who is non- or
93	93	semi-ambulatory, and needs at least a two-person assist with a lift.
94	94	b. A hospital patient who has a disability, has a need for extensive wound care,
95	95	has a mental illness, has high behavior needs, has a substance use disorder, is
96	96	receiving intravenous fluid or intravenous medication, or requires dialysis.
97	97	2. “Qualifying avoidable patient day” means any day following the 7th
98	98	consecutive day on which a high-acuity patient was eligible for discharge from a
99	99	hospital, as reasonably identified by the hospital, and the hospital was not able to
100	100	identify a setting to which the patient could be safely discharged.
101	101	(b) 1. At the beginning of each quarter starting with the quarter that begins on
102	102	July 1, 2024, and ending with the quarter that begins on April 1, 2025, the
103	103	department shall pay to hospitals that have qualifying avoidable patient days a
104	104	payment as calculated under this paragraph.
105	105	2. Each quarter during the period described under subd. 1., the department
106	106	shall distribute $5,000,000 plus any matching federal funds to the hospitals
107	107	described under subd. 1.
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130	130	SECTION 1 ASSEMBLY BILL 1087
131	131	3. Subject to subd. 4., the department shall pay to each hospital described
132	132	under subd. 1. a percentage of the distribution under subd. 2. that equals the
133	133	hospital's percentage of the total number of qualifying avoidable patient days
134	134	reported by all hospitals for the applicable quarterly reporting period.
135	135	4. The department shall limit the maximum amount of funding to any hospital
136	136	under this paragraph in accordance with any federal rules concerning
137	137	hospital-specific funding limits.
138	138	(c) 1. To receive a portion of the quarterly supplemental funding the
139	139	department distributes on July 1, 2024, a hospital seeking a payment under this
140	140	subsection shall submit to the department by May 1, 2024, the total number of
141	141	qualifying avoidable patient days at the hospital between January 1, 2024, and
142	142	March 31, 2024.
143	143	2. To receive a portion of the quarterly supplemental funding the department
144	144	distributes on October 1, 2024, a hospital seeking a payment under this subsection
145	145	shall submit to the department by August 1, 2024, the total number of qualifying
146	146	avoidable patient days at the hospital between April 1, 2024, and June 30, 2024.
147	147	3. To receive a portion of the quarterly supplemental funding the department
148	148	distributes on January 1, 2025, a hospital seeking a payment under this subsection
149	149	shall submit to the department by November 1, 2024, the total number of qualifying
150	150	avoidable patient days at the hospital between July 1, 2024, and September 30, 2024.
151	151	4. To receive a portion of the quarterly supplemental funding the department
152	152	distributes on April 1, 2025, a hospital seeking a payment under this subsection shall
153	153	submit to the department by February 1, 2025, the total number of qualifying
154	154	avoidable patient days at the hospital between October 1, 2024, and December 31,
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183	183	SECTION 1
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185	185	(d) The department shall submit any necessary request to the federal
186	186	department of health and human services for a state plan amendment or waiver of
187	187	federal Medicaid law to receive federal matching funds for the supplemental
188	188	payments to hospitals under this subsection. The department shall implement this
189	189	subsection regardless of whether the federal approval of any necessary state plan
190	190	amendment or waiver of federal Medicaid law, as specified in this paragraph, is
191	191	received.
192	192	SECTION 2. 49.45 (6r) of the statutes is created to read:
193	193	49.45 (6r) NURSING HOME RATES FOR BARIATRIC AND EXTENSIVE WOUND CARE NEEDS.
194	194	(a) During the 2023-25 fiscal biennium, the department shall develop an enhanced
195	195	rate for reimbursement under the Medical Assistance program under this
196	196	subchapter for bariatric and extensive wound care needs for nursing home residents
197	197	who are admitted on or after July 1, 2024. The calculated cost of the enhanced rate
198	198	developed by the department under this subsection may not exceed $10,000,000.
199	199	Once the department has developed a rate under this subsection, the department
200	200	shall implement the enhanced rate.
201	201	(b) In seeking reimbursement under the enhanced rate implemented under
202	202	this subsection, a nursing home may claim only one enhanced rate type for a resident
203	203	and may not claim both an enhanced bariatric care reimbursement rate and an
204	204	enhanced extensive wound care reimbursement rate for the same resident at the
205	205	same time.
206	206	(c) With respect to a bariatric care needs enhanced rate developed under this
207	207	subsection, the department shall apply all of the following standards:
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232	232	SECTION 2 ASSEMBLY BILL 1087
233	233	1. A nursing home shall identify bariatric care needs by a minimum data set
234	234	assessment at admission indicating a body mass index equal to or greater than 40
235	235	and total or extensive assistance with activities of daily living.
236	236	2. A bariatric care needs rate applicable for a resident under this subsection
237	237	shall be available for the duration of the resident's stay at the nursing home.
238	238	3. An enhanced rate for bariatric care needs may be used to provide
239	239	reimbursement for specialized mattresses, diets, medical supplies, extra staff for
240	240	transfers, as well as more expensive or specialized transportation services.
241	241	4. The enhanced rate for bariatric care needs shall only be applicable if all of
242	242	the following apply:
243	243	a. The resident is admitted to the nursing home directly from a hospital.
244	244	b. The resident is non- or semi-ambulatory.
245	245	c. The resident needs at least a two-person assist with a lift.
246	246	(d) With respect to an extensive wound care needs enhanced rate developed
247	247	under this subsection, the department shall apply all of the following standards:
248	248	1. A nursing home shall identify extensive wound care needs by a prior
249	249	authorization process that includes consideration of the number and stage of
250	250	wounds, the cost and frequency of necessary interventions and supplies, including
251	251	including vacuum-assisted closure of wounds, nutritional supplements, specialized
252	252	mattresses, and wheelchair cushions.
253	253	2. The enhanced rate for extensive wound care needs may only be applicable
254	254	if all of the following are true:
255	255	a. The resident is admitted to the nursing home directly from a hospital.
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281	281	SECTION 2
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283	283	b. The resident did not acquire the wound or wounds while a resident of the
284	284	nursing home.
285	285	(END)
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