Wisconsin 2023-2024 Regular Session

Wisconsin Assembly Bill AB1088 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 1088
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 renumber and amend 50.06 (1); to amend 50.06 (2) (b), 50.06 (2) (c),
10	10	50.06 (5) (a) (intro.), 50.06 (5) (b), 50.06 (6) and 50.06 (7); and to create 50.06
11	11	(1) (b), 50.06 (5) (am) and 50.06 (8) of the statutes; relating to: consent to
12	12	admissions to certain health care facilities by patient representatives,
13	13	allocation of nursing beds for patients with certain complex needs, and a
14	14	complex patient pilot program.
15	15	Analysis by the Legislative Reference Bureau
16	16	The bill allows a patient's representative to consent to an admission of an
17	17	incapacitated individual from a hospital to a nursing home or community-based
18	18	residential facility without a petition for guardianship or protective placement and
19	19	allows a patient's representative to make health care decisions and authorize
20	20	expenditures related to health care on behalf of an incapacitated individual without
21	21	certain time limitations that are imposed under current law if certain conditions are
22	22	met. Under current law, an individual who is either related to an incapacitated
23	23	individual as provided under current law or is an adult close friend of an
24	24	incapacitated individual may consent to admission, directly from a hospital to a
25	25	nursing home or community-based residential facility, of the incapacitated
26	26	individual who does not have a valid power of attorney for health care and who has
27	27	not been adjudicated incompetent in this state if certain conditions apply, including
28	28	that the individual for whom admission is sought is not diagnosed as
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37	37	developmentally disabled or as having a mental illness at the time of the proposed
38	38	admission, that the incapacitated individual does not verbally object to or otherwise
39	39	actively protest the admission, and that petitions for guardianship for the individual
40	40	and for protective placement of the individual are filed prior to the proposed
41	41	admission. An individual who consents to admission of an incapacitated individual
42	42	may make health care decisions to the same extent as a guardian of the person and
43	43	authorize expenditures related to health care to the same extent as a guardian of the
44	44	estate until 60 days after the admission to the facility, discharge of the incapacitated
45	45	individual from the facility, or appointment of a guardian for the incapacitated
46	46	individual, whichever occurs first. The bill allows a patient's representative to
47	47	consent to an admission of an incapacitated individual from a hospital to a nursing
48	48	home or community-based residential facility as provided under current law
49	49	without petitions for guardianship or protective placement of the incapacitated
50	50	individual being filed if certain conditions apply, including that the patient's
51	51	representative promptly notifies all of the incapacitated individual's family
52	52	members that can be readily contacted that the patient's representative may make
53	53	decisions or authorize expenditures on the incapacitated individual's behalf, that the
54	54	patient's representative provides a written statement to the discharging hospital
55	55	that contains certain information, and that the facility to which the incapacitated
56	56	individual is admitted notifies a representative of the Board on Aging and Long Term
57	57	Care of the admission. Further, the bill allows a patient's representative to make
58	58	health care decisions and authorize expenditures related to health care without the
59	59	time limitations that apply to other direct admissions under current law if the
60	60	patient's representative satisfies the conditions for admission provided under the
61	61	bill. The authority of a patient's representative to make health care decisions and
62	62	authorize expenditures related to health care under the bill ends if a court appoints
63	63	a guardian to make such decisions.
64	64	The bill allocates 250 nursing home beds to be awarded to applicants who agree
65	65	to prioritize admissions of patients with complex needs and to prioritize admissions
66	66	of patients who have been unable to find appropriate placement at another facility.
67	67	Under current law, the maximum number of licensed nursing home beds that are
68	68	available in the state is limited in order to enable the state to budget accurately and
69	69	to allocate fiscal resources appropriately. At least once each year, the Department
70	70	of Health Services is required to publish a notice concerning the number of nursing
71	71	home beds that are available in each of its health planning areas. DHS is required
72	72	to accept applications for available nursing home beds and review the applications
73	73	based on criteria provided under current law, including cost containment, a need for
74	74	additional beds in the health planning area where the beds are requested, and
75	75	whether health care personnel, capital, and operating funds and other resources
76	76	needed to provide proposed services are available. This bill directs DHS to allocate
77	77	250 nursing home beds to be awarded to applicants as provided in the bill. An
78	78	applicant for nursing home beds allocated under the bill must apply to DHS on a form
79	79	provided DHS and include a plan for the applicant to become licensed for the nursing
80	80	home beds that the applicant requested, to become certified as a provider under the
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85	85	sufficient resources to provide 24-hour nursing services within 18 months of DHS
86	86	approval. The bill requires that within 30 days of receipt of an application, DHS
87	87	must review applications received and approve applications that contain reasonable
88	88	plans to satisfy the above criteria within 18 months. The bill requires DHS to make
89	89	determinations on applications in the order that they are received. If DHS approves
90	90	an application, the bill requires DHS to award the beds requested in the application.
91	91	If not enough beds remain under the program to award all of the beds requested in
92	92	an application, DHS must contact the applicant and determine whether the
93	93	applicant will accept some or all of the remaining beds instead of the beds requested
94	94	in the application. If the applicant is willing to accept some or all of the remaining
95	95	beds, DHS must award those beds. DHS must continue to request and approve
96	96	applications until DHS awards all 250 nursing home beds allocated under the bill.
97	97	The bill requires DHS to select, using a competitive grant selection process,
98	98	partnership groups to be designated as participating sites for a complex patient pilot
99	99	program and then award grants to the partnership groups selected. The bill provides
100	100	that a partnership group is one or more hospitals in partnership with one or more
101	101	post-acute facilities. The bill provides that DHS must solicit feedback regarding the
102	102	pilot program from representatives of healthcare system organizations, long-term
103	103	care provider organizations, long-term care operator organizations, patient
104	104	advocate groups, insurers, and any other organization determined to be relevant by
105	105	the secretary of health services. Under the bill, DHS must require each partnership
106	106	group that applies to be designated as a site for the pilot program to address certain
107	107	issues in its application, including: 1) the number of complex patient care beds that
108	108	will be set aside in a post-acute facility or through implementation of another
109	109	innovative model of patient care in a post-acute facility to which participating
110	110	hospitals agree; 2) defined goals and measurable outcomes of the partnership both
111	111	during and after the pilot program; 3) the types of complex patients for whom care
112	112	will be provided; 4) an operating budget for the proposed site; and 5) the participant
113	113	group's expertise to successfully implement the proposal.
114	114	The bill requires DHS to reserve 10 percent of the pilot program funding for
115	115	reconciliation to help address unanticipated costs. Under the bill, DHS must also
116	116	develop a methodology to evaluate the pilot program and contract with an
117	117	independent organization to complete the evaluation. Under the bill, DHS may pay
118	118	the organization's fee from the funding appropriated for the pilot program. Under
119	119	the bill, DHS must give additional weight to partnership groups that would ensure
120	120	geographic diversity.
121	121	For further information see the state fiscal estimate, which will be printed as
122	122	an appendix to this bill.
123	123	The people of the state of Wisconsin, represented in senate and assembly, do
124	124	enact as follows: - 4 -2023 - 2024 Legislature LRB-5507/1
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126	126	SECTION 1 ASSEMBLY BILL 1088
127	127	SECTION 1. 50.06 (1) of the statutes is renumbered 50.06 (1) (intro.) and
128	128	amended to read:
129	129	50.06 (1) (intro.) In this section, “incapacitated":
130	130	(a) “Incapacitated” means unable to receive and evaluate information
131	131	effectively or to communicate decisions to such an extent that the individual lacks
132	132	the capacity to manage his or her health care decisions, including decisions about his
133	133	or her post-hospital care.
134	134	SECTION 2. 50.06 (1) (b) of the statutes is created to read:
135	135	50.06 (1) (b) “Patient's representative” means the individual described under
136	136	sub. (3) who may consent to an admission of an incapacitated individual under sub.
137	137	(2).
138	138	SECTION 3. 50.06 (2) (b) of the statutes is amended to read:
139	139	50.06 (2) (b) The individual for whom admission is sought is not diagnosed as
140	140	developmentally disabled or as having a mental illness, as defined in s. 51.01 (13) (a),
141	141	at the time of the proposed admission.
142	142	SECTION 4. 50.06 (2) (c) of the statutes is amended to read:
143	143	50.06 (2) (c) A Unless the incapacitated individual is admitted to a facility
144	144	under sub. (8), a petition for guardianship for the individual under s. 54.34 and a
145	145	petition under s. 55.075 for protective placement of the individual are filed prior to
146	146	the proposed admission.
147	147	SECTION 5. 50.06 (5) (a) (intro.) of the statutes is amended to read:
148	148	50.06 (5) (a) (intro.) Except as otherwise provided in par. pars. (am) and (b), an
149	149	individual who consents to an admission under this section a patient's
150	150	representative may, for the incapacitated individual, make health care decisions to
151	151	the same extent as a guardian of the person may and authorize expenditures related
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181	181	to health care to the same extent as a guardian of the estate may, until the earliest
182	182	of the following:
183	183	SECTION 6. 50.06 (5) (am) of the statutes is created to read:
184	184	50.06 (5) (am) Except as otherwise provided in par. (b), a patient's
185	185	representative may, for the incapacitated individual, make health care decisions to
186	186	the same extent as a guardian of the person may and authorize expenditures related
187	187	to health care to the same extent as a guardian of the estate may if the patient's
188	188	representative consents to admission for the incapacitated individual in the manner
189	189	provided in sub. (8). The authority of a patient's representative to make health care
190	190	decisions or authorize expenditures under this paragraph ends if a court appoints a
191	191	guardian to make such decisions for the incapacitated individual.
192	192	SECTION 7. 50.06 (5) (b) of the statutes is amended to read:
193	193	50.06 (5) (b) An individual who consents to an admission under this section A
194	194	patient's representative may not authorize expenditures related to health care if the
195	195	incapacitated individual has an agent under a durable power of attorney, as defined
196	196	in s. 244.02 (3), who may authorize expenditures related to health care.
197	197	SECTION 8. 50.06 (6) of the statutes is amended to read:
198	198	50.06 (6) If Unless the incapacitated individual was admitted to a facility under
199	199	sub. (8), if the incapacitated individual is in the facility after 60 days after admission
200	200	and a guardian has not been appointed, the authority of the person who consented
201	201	to the admission patient's representative to make decisions and, if sub. (5) (a) applies,
202	202	to authorize expenditures is extended for 30 days for the purpose of allowing the
203	203	facility to initiate discharge planning for the incapacitated individual.
204	204	SECTION 9. 50.06 (7) of the statutes is amended to read:
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230	230	SECTION 9 ASSEMBLY BILL 1088
231	231	50.06 (7) An individual who consents to an admission under this section A
232	232	patient's representative may request a functional screening and a financial and
233	233	cost-sharing screening to determine eligibility for the family care benefit under s.
234	234	46.286 (1). If admission is sought on behalf of the incapacitated individual or if the
235	235	incapacitated individual is about to be admitted on a private pay basis, the individual
236	236	who consents to the admission patient's representative may waive the requirement
237	237	for a financial and cost-sharing screening under s. 46.283 (4) (g), unless the
238	238	incapacitated individual is expected to become eligible for medical assistance within
239	239	6 months.
240	240	SECTION 10. 50.06 (8) of the statutes is created to read:
241	241	50.06 (8) (a) A patient's representative may consent to an admission of an
242	242	incapacitated individual under sub. (2) without a petition for guardianship or
243	243	protective placement of the incapacitated individual being filed if all of the following
244	244	apply:
245	245	1. The patient's representative acknowledges in writing that he or she agrees
246	246	to make health care decisions on the incapacitated individual's behalf under this
247	247	subsection and provides the acknowledgment to the discharging hospital and the
248	248	accepting facility.
249	249	2. The patient's representative promptly notifies all of the incapacitated
250	250	individual's family members that can be readily contacted that the patient's
251	251	representative may make decisions or authorize expenditures under sub. (5) (am).
252	252	3. The patient's representative provides a written statement to the discharging
253	253	hospital and the accepting facility that states all of the following:
254	254	a. To the best knowledge of the patient's representative, a family member in a
255	255	higher priority class under sub. (3) does not exist or no family member in a higher
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285	285	priority class is willing to make health care decisions on the incapacitated
286	286	individual's behalf under this subsection.
287	287	b. To the best knowledge of the patient's representative, the incapacitated
288	288	individual does not have a health care agent, as defined in s. 155.01 (4), or guardian
289	289	of the person, as defined in s. 54.01 (12).
290	290	c. The incapacitated individual's family members who have received notice as
291	291	provided under subd. 2.
292	292	4. The facility to which the incapacitated individual is admitted under this
293	293	subsection notifies a representative of the board on aging and long-term care of the
294	294	admission no later than 72 hours after the admission.
295	295	(b) A hospital discharging an incapacitated patient to a facility under this
296	296	subsection shall be in compliance with 42 CFR 482.13 (b) (3) or 42 CFR 485.608 (a)
297	297	regarding the implementation of the patient's rights to formulate advance directives.
298	298	A nursing home admitting the incapacitated individual shall be in compliance with
299	299	the requirements under 42 CFR 483.10 (b) (3) to (6) that a resident be afforded the
300	300	right to designate a representative, including the requirement that if the nursing
301	301	home has reason to believe that a resident representative is making decisions or
302	302	taking actions that are not in the best interests of the resident then the nursing home
303	303	shall report such concerns as required by state law.
304	304	(c) Nothing in this subsection may be construed to preclude the administration
305	305	of health care treatment in accordance with accepted standards of medical practice
306	306	and as otherwise provided by law.
307	307	(d) The discharging hospital and the accepting facility shall include a copy of
308	308	the written acknowledgment under par. (a) 1. and a copy of the written statement
309	309	under par. (a) 3. in the incapacitated individual's health care record.
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337	337	(e) Any interested party may petition the court to review whether the patient's
338	338	representative is acting in accordance with the known wishes or in the best interest
339	339	of the incapacitated individual and is exercising the degree of care, diligence, and
340	340	good faith when acting on behalf of the incapacitated individual that an ordinarily
341	341	prudent person exercises in his or her own affairs. The court may issue orders that
342	342	the court determines necessary to protect the incapacitated individual, including
343	343	any of the following:
344	344	1. Directing the patient's representative to act in the best interest of the
345	345	incapacitated individual.
346	346	2. Requiring the patient's representative to report to the court periodically on
347	347	the incapacitated individual's status. The court may require that the report include
348	348	a financial accounting of expenditures made under sub. (5) (am) within 72 hours of
349	349	the court's order.
350	350	3. Directing the patient's representative not to make certain decisions or
351	351	authorize certain expenditures under sub. (5) (am).
352	352	SECTION 11.0Nonstatutory provisions.
353	353	(1) ALLOCATION OF NURSING HOME BEDS.
354	354	(a) Definitions. In this subsection, “department” means the department of
355	355	health services.
356	356	(b) Applicability. Beginning on July 1, 2024, the department shall allocate 250
357	357	nursing home beds as provided under this subsection.
358	358	(c) Applications. The department shall request applications for nursing home
359	359	beds allocated under this subsection. An applicant for nursing home beds allocated
360	360	under this subsection shall submit an application to the department on a form
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389	389	provided by the department. The application shall include a plan for the applicant
390	390	to satisfy all of the following criteria within 18 months of department approval:
391	391	1. Become licensed under subch. I of ch. 50 for the nursing home beds that the
392	392	applicant requested in the application.
393	393	2. Become certified as a provider under the medical assistance program under
394	394	subch. IV of ch. 49.
395	395	3. Hire sufficient health care personnel and expend sufficient resources to
396	396	provide 24-hour nursing services.
397	397	(d) Approval.
398	398	1. Within 30 days of receipt of an application under this subsection, the
399	399	department shall review the application and, if it contains reasonable plans to satisfy
400	400	the criteria under par. (c) within 18 months of approval, approve the application. The
401	401	department shall review and approve applications in the order that the applications
402	402	are received. If the department approves an application under this paragraph, the
403	403	department shall award the applicant the number of nursing home beds requested
404	404	in the application, subject to subd. 2.
405	405	2. If there is not a sufficient number of beds remaining under this subsection
406	406	to award an applicant the number of nursing home beds requested in the application,
407	407	the department shall contact the applicant and determine whether the applicant will
408	408	accept some or all of the remaining beds under this subsection instead of the beds
409	409	requested in the application. If the applicant is willing to accept some or all of the
410	410	remaining beds under this subsection instead of the beds requested in the
411	411	application, the department shall award those beds. If the applicant is not willing
412	412	to accept some or all of the remaining beds under this subsection, the department
413	413	shall discard the application.
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441	441	3. The department shall continue to request applications for nursing home beds
442	442	and approve applications as provided under this paragraph until the department
443	443	awards all nursing home beds allocated under this subsection.
444	444	(e) Conditions of approval. As a condition of being awarded nursing home beds
445	445	under this subsection, an applicant shall agree to do all of the following:
446	446	1. Prioritize admissions of patients with complex needs and conditions, such
447	447	as patients with mental health and behavioral needs, serious wound care needs,
448	448	bariatrics, substance use disorder, nonambulatory disability, intravenous therapy
449	449	needs, or dialysis needs.
450	450	2. Prioritize admissions of patients who have been unable to find appropriate
451	451	placement at another facility.
452	452	(f) Compliance. Each person awarded nursing home beds under this subsection
453	453	shall biennially or upon request from the department report to the department
454	454	whether the person has satisfied the criteria under par. (c) and the conditions under
455	455	par. (e), including all of the following information:
456	456	1. The number of patients served utilizing the nursing home beds awarded
457	457	under this subsection.
458	458	2. The complex conditions that were served utilizing the nursing home beds
459	459	awarded under this subsection.
460	460	3. The number of patients served and the number of patient days for each of
461	461	those complex conditions under subd. 2.
462	462	4. Any other information required by the department.
463	463	(g) Miscellaneous.
464	464	1. No application under this subsection may be for more than 50 nursing home
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495	495	2. If an applicant that is awarded nursing home beds under par. (d) fails to
496	496	satisfy any of the criteria under par. (c) within 24 months following department
497	497	approval under par. (d), the applicant shall reapply for the awarded nursing home
498	498	beds by submitting an application to the department as provided under par. (c) or
499	499	surrender the awarded nursing home beds.
500	500	3. If any nursing home beds awarded under this subsection are surrendered,
501	501	the department shall request applications for the surrendered nursing home beds as
502	502	provided under par. (c).
503	503	(h) Reporting. By September 1, 2025, and biennially thereafter, the
504	504	department shall submit to the chief clerk of each house of the legislature, for
505	505	distribution to the appropriate standing committees in the manner required under
506	506	s. 13.172 (3), a report on the performance of the program under this subsection,
507	507	including the total number of patients served, the complex conditions addressed, the
508	508	number of patients served and the number of patient days for each complex
509	509	condition, and any cost savings associated with the program.
510	510	(2) COMPLEX PATIENT PILOT PROGRAM.
511	511	(a) In this subsection:
512	512	1. “Department” means the department of health services.
513	513	2. “Partnership group” means one or more hospitals in partnership with one
514	514	or more post-acute facilities.
515	515	(b) The department shall use a competitive grant selection process to select
516	516	partnership groups to be designated as participating sites for a complex patient pilot
517	517	program under this subsection and, from the appropriation under s. 20.435 (7) (d),
518	518	award grants to the groups selected.
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544	544	SECTION 11 ASSEMBLY BILL 1088
545	545	(c) The department shall solicit feedback regarding the complex patient pilot
546	546	program from representatives of healthcare system organizations, long-term care
547	547	provider organizations, long-term care operator organizations, patient advocate
548	548	groups, insurers, and any other organization determined to be relevant by the
549	549	secretary of health services.
550	550	(d) The department shall require that each partnership group that applies to
551	551	the department to be designated as a site for the complex patient pilot program shall
552	552	address all of the following issues in its application:
553	553	1. The number of complex patient care beds that will be set aside in a
554	554	post-acute facility or through implementation of an innovative model of patient care
555	555	in a post-acute facility to which participating hospitals agree, such as dedicated
556	556	staffing for dementia or a behavioral health unit.
557	557	2. Defined goals and measurable outcomes of the partnership group during the
558	558	pilot program and after the pilot program.
559	559	3. The types of complex patients for whom care will be provided, which may
560	560	include patients needing total care for multiple conditions or comorbidities such as
561	561	cardiac and respiratory diseases, obesity, mental health, substance use, or dementia.
562	562	4. An operating budget for the proposed site that details how fiscal
563	563	responsibility will be shared among members of the partnership group and includes
564	564	all of the following:
565	565	a. Estimated patient revenues from other sources, including the Medical
566	566	Assistance program under subch. IV of ch. 49, and estimated total costs.
567	567	b. A margin to account for reserved beds.
568	568	5. The partnership group's expertise to successfully implement the proposal,
569	569	which may include a discussion of the following issues:
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597	597	SECTION 11
598	598	ASSEMBLY BILL 1088
599	599	a. Documented experience of the partners working together to serve complex
600	600	patients.
601	601	b. The implementation timeline and the plan for post-acute facilities to accept
602	602	admissions and transfer patients within 72 hours of a request submitted by a
603	603	hospital.
604	604	c. The plan for an interdisciplinary team that will staff the unit in the
605	605	post-acute facility, including the availability of staff with appropriate expertise that
606	606	includes physicians, nurses, advance practice health professionals, pharmacists,
607	607	physical therapists, occupational therapists, and social workers.
608	608	d. Ability to electronically exchange health information.
609	609	e. Resources to conduct patient intake and discharge planning from the
610	610	post-acute facility, including case managers and social workers.
611	611	f. Ability to conduct monthly case management reviews with the
612	612	interdisciplinary team for every complex care patient that cover care plan progress
613	613	and any readmissions to an acute care hospital.
614	614	g. Ability to conduct monthly quality assurance reviews.
615	615	h. Ability of the treatment model to be replicated by other healthcare systems.
616	616	i. Plans to document decreases in lengths of stay for complex patients in
617	617	hospitals and avoided hospital days.
618	618	j. Documentation of stable finances among partnership group members to
619	619	support the proposal, including matching funds that could be dedicated to the pilot
620	620	program under this subsection. No applicant may be required to provide matching
621	621	funds or a contribution, but the department may take into consideration the
622	622	availability of matching funds or a contribution in evaluating an application.
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648	648	SECTION 11 ASSEMBLY BILL 1088
649	649	k. Description of anticipated impediments to successful implementation and
650	650	how the partnership group intends to overcome the anticipated impediments.
651	651	(e) In implementing this subsection, the department shall do all of the
652	652	following:
653	653	1. Reserve 10 percent of the funding appropriated under s. 20.435 (7) (d) for the
654	654	complex patient pilot program for reconciliation to help address unanticipated costs.
655	655	2. Develop a methodology to evaluate the complex patient pilot program and
656	656	contract with an independent organization to complete the evaluation. The
657	657	department may pay the fee of the organization selected from the appropriation
658	658	under s. 20.435 (7) (d).
659	659	3. Give additional weight to partnership groups that would ensure geographic
660	660	diversity.
661	661	(END)
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