Wisconsin 2023-2024 Regular Session

Wisconsin Assembly Bill AB467 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 467
5	5	October 5, 2023 - Introduced by Representatives MOSES, SUMMERFIELD, CALLAHAN,
6	6	C. ANDERSON, BROOKS, DITTRICH, DONOVAN, EDMING, GREEN, GUNDRUM,
7	7	JACOBSON, KITCHENS, KRUG, MAXEY, MURPHY, MURSAU, NOVAK, O'CONNOR,
8	8	PETRYK, ROZAR, SHANKLAND, SPIROS, TRANEL, ZIMMERMAN and SAPIK,
9	9	cosponsored by Senators MARKLEIN, JAMES, BALLWEG, CABRAL-GUEVARA,
10	10	FELZKOWSKI, SPREITZER, TESTIN, TOMCZYK and QUINN. Referred to Committee
11	11	on Mental Health and Substance Abuse Prevention.
12	12	*AUTHORS SUBJECT TO CHANGE*
13	13	AN ACT to renumber and amend 49.45 (41) (a); to amend 49.45 (41) (b), 49.45
14	14	(41) (c) (intro.) and 51.15 (2) (d); and to create 49.45 (41) (a) 1., 49.45 (41) (d)
15	15	and 51.036 of the statutes; relating to: crisis urgent care and observation
16	16	facilities and granting rule-making authority.
17	17	Analysis by the Legislative Reference Bureau
18	18	This bill requires the Department of Health Services to establish a certification
19	19	process for crisis urgent care and observation facilities and a grant program to award
20	20	grants to develop and support these facilities. Under the bill, a crisis urgent care and
21	21	observation facility is a treatment facility that admits an individual to prevent,
22	22	de-escalate, or treat the individual's mental health or substance use disorder and
23	23	includes the necessary structure and staff to support the individual's needs relating
24	24	to the mental health or substance use disorder. The bill provides that no person may
25	25	operate a crisis urgent care and observation facility without a certification from
26	26	DHS. Under the bill, a certified crisis urgent care and observation facility is not
27	27	regulated as a hospital, except to the extent the facility is otherwise required due to
28	28	the facility's licensure or certification for other services or purposes. The bill provides
29	29	that the provisions of the bill may not be construed to prohibit, limit, or otherwise
30	30	interfere with services provided by a county or a hospital or other facility that are
31	31	provided consistent with the facility's existing licensure or certification, whether the
32	32	facility is publicly or privately funded.
33	33	The bill provides that DHS may certify crisis urgent care and observation
34	34	facilities that demonstrate the ability to do certain things, including 1) accept
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41	41	referrals for crisis services for adults, and, if applicable, for youth, including
42	42	involuntary patients under emergency detention, walk-ins, and individuals brought
43	43	by law enforcement, emergency medical responders or emergency medical services
44	44	practitioners, or county crisis personnel; 2) abstain from having a requirement for
45	45	medical clearance before admission assessment; 3) provide assessments for physical
46	46	health, substance use disorder, and mental health; 4) provide screening for suicide
47	47	and violence risk; 5) provide medication management and therapeutic counseling;
48	48	6) provide coordination of services for basic needs; 7) provide for the safety and
49	49	security of both the staff and the patients; 8) have adequate staffing 24 hours a day,
50	50	7 days a week, including through use of telehealth, with a multidisciplinary team,
51	51	including, as needed, psychiatrists or psychiatric nurse practitioners, nurses,
52	52	licensed clinicians capable of completing assessments, peers with lived experience,
53	53	and other appropriate staff; 9) allow for voluntary and involuntary treatment of
54	54	individuals in crisis as a means to avoid unnecessary placement of those individuals
55	55	in hospital inpatient beds and allow for an effective conversion to voluntary
56	56	stabilization when warranted in the same setting; and 10) contribute, from one or
57	57	more nonstate, federal, or third-party sources, an amount, as determined by DHS,
58	58	in addition to any grant awarded by DHS under the bill. The bill requires that DHS
59	59	must provide the Joint Committee on Finance with certain information and obtain
60	60	approval of that committee before granting certification to a crisis urgent care and
61	61	observation facility. The bill also requires DHS to provide an annual report to the
62	62	Joint Committee on Finance regarding the facilities.
63	63	Under the bill, a certified crisis urgent care and observation facility must accept
64	64	adult individuals for emergency detention, and may accept youths for emergency
65	65	detention. The bill provides that a certified crisis urgent care and observation facility
66	66	may accept individuals for services including voluntary stabilization; observation
67	67	and treatment, including for assessments for mental health or substance use
68	68	disorder; screening for suicide and violence risk; and medication management and
69	69	therapeutic counseling.
70	70	The bill provides that a certified crisis urgent care and observation facility must
71	71	coordinate to the fullest extent possible with any facility established or operated with
72	72	funding received from settlement proceeds from the opiate litigation, which under
73	73	current law refers to the litigation in In re: National Prescription Opiate Litigation,
74	74	Case No.: MDL 2804 or any proceeding filed in a circuit court in this state containing
75	75	allegations and seeking relief that is substantially similar to allegations contained
76	76	and relief sought in that matter. The bill also requires that DHS promulgate rules
77	77	establishing policies that encourage awareness of and communication and
78	78	coordination between certified crisis urgent care and observation facilities and other
79	79	facilities that provide similar services.
80	80	The bill requires DHS, in accordance with existing requirements to obtain
81	81	approval from the Joint Committee on Finance, to request any necessary federal
82	82	approval by seeking either a waiver, specifically, what is known as a 1115 waiver, or
83	83	a Medical Assistance state plan amendment to add services provided by a crisis
84	84	urgent care and observation facility as a type of crisis intervention service
85	85	reimbursable under the Medical Assistance program. If DHS determines a state - 3 -2023 - 2024 Legislature
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89	89	plan amendment is appropriate, DHS must follow the procedures for review by the
90	90	Joint Committee on Finance, regardless of whether the amendment is expected to
91	91	have a fiscal effect of $7,500,000 or more. Under the bill, if federal approval is either
92	92	unnecessary or is necessary and is granted, DHS may provide reimbursement for
93	93	these services.
94	94	For further information see the state and local fiscal estimate, which will be
95	95	printed as an appendix to this bill.
96	96	The people of the state of Wisconsin, represented in senate and assembly, do
97	97	enact as follows:
98	98	SECTION 1. 49.45 (41) (a) of the statutes is renumbered 49.45 (41) (a) (intro.)
99	99	and amended to read:
100	100	49.45 (41) (a) (intro.) In this subsection, “crisis intervention services" means
101	101	crisis intervention services for the treatment of mental illness, intellectual disability,
102	102	substance abuse, and dementia that are provided by a any of the following:
103	103	2. A crisis intervention program operated by, or under contract with, a county,
104	104	if the county is certified as a medical assistance provider.
105	105	SECTION 2. 49.45 (41) (a) 1. of the statutes is created to read:
106	106	49.45 (41) (a) 1. A crisis urgent care and observation facility certified under s.
107	107	51.036.
108	108	SECTION 3. 49.45 (41) (b) of the statutes is amended to read:
109	109	49.45 (41) (b) If a county elects to become certified as a provider of crisis
110	110	intervention services under par. (a) 2., the county may provide crisis intervention
111	111	services under this subsection in the county to medical assistance recipients through
112	112	the medical assistance program. A county that elects to provide the services shall
113	113	pay the amount of the allowable charges for the services under the medical
114	114	assistance program that is not provided by the federal government. The department
115	115	shall reimburse the county under this subsection only for the amount of the allowable
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136	136	charges for those services under the medical assistance program that is provided by
137	137	the federal government.
138	138	SECTION 4. 49.45 (41) (c) (intro.) of the statutes is amended to read:
139	139	49.45 (41) (c) (intro.) Notwithstanding par. (b), if a county elects, pursuant to
140	140	par. (a) 2., to deliver crisis intervention services under the Medical Assistance
141	141	program on a regional basis according to criteria established by the department, all
142	142	of the following apply:
143	143	SECTION 5. 49.45 (41) (d) of the statutes is created to read:
144	144	49.45 (41) (d) The department shall, in accordance with all procedures set forth
145	145	under s. 20.940, request a waiver under 42 USC 1315 or submit a Medical Assistance
146	146	state plan amendment to the federal department of health and human services to
147	147	obtain any necessary federal approval required to provide reimbursement to crisis
148	148	urgent care and observation facilities certified under s. 51.036 for crisis intervention
149	149	services under this subsection. If the department determines submission of a state
150	150	plan amendment is appropriate, the department shall, notwithstanding whether the
151	151	expected fiscal effect of the amendment is $7,500,000 or more, submit the
152	152	amendment to the joint committee on finance for review in accordance with the
153	153	procedures under s. 49.45 (2t). If federal approval is granted or no federal approval
154	154	is required, the department shall provide reimbursement under s. 49.46 (2) (b) 15.
155	155	If federal approval is necessary but is not granted, the department may not provide
156	156	reimbursement for crisis intervention services provided by crisis urgent care and
157	157	observation facilities.
158	158	SECTION 6. 51.036 of the statutes is created to read:
159	159	51.036 Crisis urgent care and observation facilities. (1) DEFINITIONS. In
160	160	this section:
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190	190	(a) “Crisis” means a situation caused by an individual's apparent mental or
191	191	substance use disorder that results in a high level of stress or anxiety for the
192	192	individual, persons providing care for the individual, or the public and that is not
193	193	resolved by the available coping methods of the individual or by the efforts of those
194	194	providing ordinary care or support for the individual.
195	195	(b) “Crisis urgent care and observation facility” means a treatment facility that
196	196	admits an individual to prevent, de-escalate, or treat the individual's mental health
197	197	or substance use disorder and includes the necessary structure and staff to support
198	198	the individual's needs relating to the mental health or substance use disorder.
199	199	(2) CERTIFICATION REQUIRED; EXEMPTION; GRANTS. (a) The department shall
200	200	establish a certification process for crisis urgent care and observation facilities and
201	201	a grant program to award grants to develop and support crisis urgent care and
202	202	observation facilities. No person may operate a crisis urgent care and observation
203	203	facility without a certification under this section. The department may limit the
204	204	number of certifications it grants to operate crisis urgent care and observation
205	205	facilities. The department shall, using the department's division of the state into
206	206	regions by county, include statewide geographic consideration in its evaluation of
207	207	applications for certification under this section to ensure geographic diversity among
208	208	the regions in the location of crisis urgent care and observation facilities certified
209	209	under this section.
210	210	(b) 1. A crisis urgent care and observation facility certified under this section
211	211	is not subject to facility regulation under ch. 50, unless otherwise required due to the
212	212	facility's licensure or certification for other services or purposes. A crisis urgent care
213	213	and observation facility is not a hospital subject to approval under ss. 50.32 to 50.39
214	214	and nothing in this subsection limits services a hospital may provide under ch. 50.
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242	242	2. Notwithstanding par. (d), the department shall promote certification and
243	243	encourage any facility that is licensed as a hospital under ch. 50 and provides
244	244	services consistent with those described in par. (c) 1. to 9. to apply for certification
245	245	under this section. The requirements under this section may not be construed to
246	246	prohibit, limit, or otherwise interfere with services provided by a county or a hospital
247	247	or other facility that are provided consistent with the facility's existing licensure or
248	248	certification, whether the facility is publicly or privately funded.
249	249	3. Notwithstanding s. 150.93, any hospital that expands psychiatric bed
250	250	capacity to accommodate admissions under this section may increase its approved
251	251	bed capacity by the number of psychiatric beds added under this subdivision.
252	252	4. The department shall take into account the geography of hospital facilities
253	253	granted certification under subd. 2. when considering certification applications for
254	254	other crisis urgent care and observations facilities.
255	255	(c) Subject to par. (d), the department may grant a certification to a crisis urgent
256	256	care and observation facility that specifies in an application the level of care the
257	257	facility can provide to patients and demonstrates in the application its ability to do
258	258	all of the following:
259	259	1. Accept referrals for crisis services for adults and, if applicable, for youth,
260	260	including involuntary patients under emergency detention, walk-ins, and
261	261	individuals brought by law enforcement, emergency medical responders or
262	262	emergency medical services practitioners, or county crisis personnel.
263	263	2. Abstain from having a requirement for medical clearance before admission
264	264	assessment.
265	265	3. Provide assessments for physical health, substance use disorder, and mental
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296	296	4. Provide screening for suicide and violence risk.
297	297	5. Provide medication management and therapeutic counseling.
298	298	6. Provide coordination of services for basic needs.
299	299	7. Provide for the safety and security of both the staff and the patients.
300	300	8. Have adequate staffing 24 hours a day, 7 days a week, including through use
301	301	of telehealth, as described under s. 49.45 (61), with a multidisciplinary team that
302	302	includes, as needed, psychiatrists or psychiatric nurse practitioners, nurses,
303	303	licensed clinicians capable of completing assessments, peers with lived experience,
304	304	and other appropriate staff.
305	305	9. Allow for voluntary and involuntary treatment of individuals in crisis as a
306	306	means to avoid unnecessary placement of those individuals in hospital inpatient
307	307	beds and allow for an effective conversion to voluntary stabilization when warranted
308	308	in the same setting.
309	309	10. Contribute, from at least one nonstate, federal, or 3rd-party revenue
310	310	source, an amount, as determined by the department, in addition to any grant
311	311	awarded by the department under this section.
312	312	(d) Before the department may grant certification to a facility under this
313	313	section, the department shall submit the proposal for certification to the joint
314	314	committee on finance for approval. If the cochairpersons of the joint committee on
315	315	finance do not notify the department within 14 working days after the date of the
316	316	submittal under this paragraph that the committee has scheduled a meeting for the
317	317	purpose of reviewing the proposal, the department may grant certification of that
318	318	facility as described in the proposal. If, within 14 working days after the date of the
319	319	submittal under this paragraph, the cochairpersons of the committee notify the
320	320	department that the committee has scheduled a meeting for the purpose of reviewing
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348	348	the proposal, the department may grant certification of that facility only upon
349	349	approval by the committee. When submitting a proposal regarding certification of
350	350	a facility under this paragraph, the department shall provide the joint committee on
351	351	finance with all of the following information about the facility proposed for
352	352	certification:
353	353	1. The department's rationale for selecting the facility.
354	354	2. Where the facility is to be located.
355	355	3. A specific description of the entity that will be awarded certification.
356	356	4. A description of how the funding for the facility will work.
357	357	5. The timeline of the facility for accepting patients.
358	358	6. The distance from the facility to the nearest hospital.
359	359	7. A description of the facility's plan for staffing, including staff on call.
360	360	8. The number of beds in the facility.
361	361	9. A description of the facility's admission, hold, and discharge policies.
362	362	10. Security considerations for patients and staff at the facility.
363	363	11. The estimated population to be served.
364	364	12. The estimated number of diversions from the Winnebago Mental Health
365	365	Institute had the facility been operating the past 5 years.
366	366	13. Policies that ensure the facility has the capacity to assess physical health
367	367	needs and deliver care for most minor physical health challenges, while also having
368	368	an identified process in order to transfer an individual to a facility with more
369	369	medically staffed services if needed.
370	370	(e) No later than June 30 of each year, beginning by June 30, 2025, the
371	371	department shall submit to the joint committee on finance a report regarding crisis
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400	400	urgent care and observation facilities under this section, including information
401	401	relating to all of the following:
402	402	1. Applications for certification received by the department.
403	403	2. The number of admissions, including both voluntary and involuntary
404	404	admissions.
405	405	3. Data regarding how patients are arriving for admission, including through
406	406	transport by law enforcement, family, emergency medical responders or emergency
407	407	medical services practitioners, or county crisis personnel.
408	408	4. Average wait times.
409	409	5. The length of patient stays.
410	410	6. The time of day patients are admitted.
411	411	7. The source of payments for patient care, including private payment sources
412	412	or payment under the Medical Assistance program under subch. IV of ch. 49.
413	413	8. Data regarding the county of residence for each patient in counties for which
414	414	the county's data is equal to or greater than 20 patients.
415	415	9. The estimated number of diversions from the Winnebago Mental Health
416	416	Institute.
417	417	10. A description of the number and type of employees providing staffing during
418	418	the various times of day.
419	419	11. A description of rules and procedures for determining where to take an
420	420	individual in need of crisis services if a crisis urgent care and observation facility
421	421	does not have capacity or otherwise does not accept an individual.
422	422	(3) ADMISSIONS. (a) A crisis urgent care and observation facility certified under
423	423	this section may accept individuals for any of the following services:
424	424	1. Voluntary stabilization.
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452	452	2. Observation and treatment, including for assessments for mental health or
453	453	substance use disorder.
454	454	3. Screening for suicide and violence risk.
455	455	4. Medication management and therapeutic counseling.
456	456	(b) A crisis urgent care and observation facility certified under this section shall
457	457	accept an adult individual for emergency detention under s. 51.15 and may accept
458	458	a youth for emergency detention under s. 51.15. If the facility does not have capacity
459	459	to accept an adult individual for purposes of emergency detention or if the facility
460	460	does not accept a youth for purposes of emergency detention, that individual shall
461	461	be transported to another appropriate facility in accordance with rules established
462	462	by the department under sub. (4). A county crisis assessment under s. 51.15 (2) (c)
463	463	is required prior to admission to a crisis urgent care and observation facility for
464	464	purposes of emergency detention, but the medical clearance requirement under s.
465	465	51.15 (2) (b) does not apply to crisis urgent care and observation facility admissions
466	466	for purposes of emergency detention.
467	467	(c) The department shall encourage each crisis urgent care and observation
468	468	facility certified under this section to operate with the intent to admit individuals for
469	469	no longer than 5 days, except in exceptional circumstances.
470	470	(4) RULES. The department shall promulgate rules to implement this section,
471	471	including all of the following:
472	472	(a) Establishment of the grant program described under sub. (2), including
473	473	procedures for administration and establishment of criteria for awarding grants.
474	474	(b) Establishment of requirements for crisis urgent care and observation
475	475	facilities to match a portion of any grant awarded by the department under this
476	476	section, as set forth under sub. (2) (c) 10., and for determining what types of
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506	506	contributions may count toward the matching requirement. The matching
507	507	requirement established by the department under this paragraph may be fulfilled
508	508	through in-kind contributions.
509	509	(c) Requirements for admitting, holding, and discharging individuals for
510	510	purposes of emergency detention.
511	511	(d) Minimum security requirements for crisis urgent care and observation
512	512	facilities certified under this section.
513	513	(e) Establishment of a target range for the number of beds in a crisis urgent care
514	514	and observation facility certified under this section.
515	515	(f) Establishment of policies and criteria to ensure that law enforcement and
516	516	other persons authorized to transport or cause transportation of an individual for
517	517	purposes of emergency detention have clear standards and procedures regarding all
518	518	of the following:
519	519	1. The circumstances under which law enforcement and other persons may
520	520	bring an individual to a crisis urgent care and observation facility certified under this
521	521	section.
522	522	2. The determination as to which facility law enforcement and other persons
523	523	authorized to transport or cause transportation of an individual for purposes of
524	524	emergency detention may take an individual.
525	525	(g) Establishment of policies relating to interfacility transfers, including how
526	526	such transfers should occur and who should be involved in such transfers. Barring
527	527	exigent circumstances that necessitate law enforcement involvement, law
528	528	enforcement may not transport an individual for purposes of an interfacility transfer
529	529	from a crisis urgent care and observation facility.
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556	556	(h) Establishment of procedures to coordinate communication regarding bed
557	557	availability before the arrival of a patient and establishment of a process for
558	558	determining where to take an individual in need of crisis services if a crisis urgent
559	559	care and observation facility does not have capacity or otherwise does not accept an
560	560	individual.
561	561	(i) Establishment of policies for coordination between crisis urgent care and
562	562	observation facilities certified under this section and any facility established or
563	563	operated with funding received under s. 165.12 from settlement proceeds from the
564	564	opiate litigation, as defined in s. 165.12 (1), as well as policies to encourage
565	565	awareness of and communication and coordination with other facilities that provide
566	566	services similar to those provided by crisis urgent care and observation facilities.
567	567	(j) Establishment of procedures to require a crisis urgent care and observation
568	568	facility to coordinate continuity of care with, when appropriate, a hub-and-spoke
569	569	health home pilot program for any patient treated at a crisis urgent care and
570	570	observation facility for a period of 5 or fewer days. The department shall establish
571	571	procedures for follow-up with other transition facilities in the event that a
572	572	hub-and-spoke health home pilot program is appropriate but not available.
573	573	(k) Establishment of policies and procedures for crisis urgent care and
574	574	observation facilities that intend to accept both youths and adults, including
575	575	requirements that youths be treated in a separate part of the facility from adults,
576	576	policies to address youth-related treatment issues, including parental input, and
577	577	staff training for youth-specific issues.
578	578	(L) Establishment of appropriate staffing level requirements.
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602	602	LRB-4322/1
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604	604	SECTION 6
605	605	ASSEMBLY BILL 467
606	606	(m) Establishment of requirements to define the population to be served at a
607	607	given crisis urgent care and observation facility, including establishment of any
608	608	minimum age requirements.
609	609	(5) COORDINATION. In accordance with rules established by the department
610	610	under sub. (4) (i), a crisis urgent care and observation facility certified under this
611	611	section shall coordinate to the fullest extent possible with any facility established or
612	612	operated with funding received under s. 165.12 from settlement proceeds from the
613	613	opiate litigation, as defined in s. 165.12 (1), as well as with other facilities that
614	614	provide services similar to those provided by crisis urgent care and observation
615	615	facilities.
616	616	SECTION 7. 51.15 (2) (d) of the statutes is amended to read:
617	617	51.15 (2) (d) Detention under this section may only be in a treatment facility
618	618	approved by the department or the county department, if the facility agrees to detain
619	619	the individual, or a state treatment facility. The department shall approve for
620	620	purposes of this subsection any facility certified under s. 51.036.
621	621	SECTION 8.0Nonstatutory provisions.
622	622	(1) When considering the initial certifications of crisis urgent care and
623	623	observation facilities under s. 51.036, the department of health services shall, to the
624	624	fullest extent possible, prioritize certification of a crisis urgent care and observation
625	625	facility to be located at least 100 miles from the Winnebago Mental Health Institute
626	626	and in the region of the state defined as the western region according to the
627	627	department's division of the state into five regions by county as of January 5, 2023,
628	628	for purposes of data analysis and communication.
629	629	(END)
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