Wisconsin 2023-2024 Regular Session

Wisconsin Senate Bill SB462 Compare Versions

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3	3	2023 - 2024 LEGISLATURE
4	4	2023 SENATE BILL 462
5	5	September 29, 2023 - Introduced by Senators M ARKLEIN, JAMES, BALLWEG,
6	6	CABRAL-GUEVARA, FELZKOWSKI, SPREITZER, TESTIN, TOMCZYK and QUINN,
7	7	cosponsored by Representatives M OSES, SUMMERFIELD, CALLAHAN, C.
8	8	ANDERSON, BROOKS, DITTRICH, DONOVAN, EDMING, GREEN, GUNDRUM, JACOBSON,
9	9	KITCHENS, KRUG, MAXEY, MURPHY, MURSAU, NOVAK, O'CONNOR, PETRYK, ROZAR,
10	10	SAPIK, SHANKLAND, SPIROS, TRANEL, ZIMMERMAN and WICHGERS. Referred to
11	11	Committee on Mental Health, Substance Abuse Prevention, Children and
12	12	Families.
13	13	*AUTHORS SUBJECT TO CHANGE*
14	14	AN ACT to renumber and amend 49.45 (41) (a); to amend 49.45 (41) (b), 49.45
15	15	(41) (c) (intro.) and 51.15 (2) (d); and to create 49.45 (41) (a) 1., 49.45 (41) (d)
16	16	and 51.036 of the statutes; relating to: crisis urgent care and observation
17	17	facilities and granting rule-making authority.
18	18	Analysis by the Legislative Reference Bureau
19	19	This bill requires the Department of Health Services to establish a certification
20	20	process for crisis urgent care and observation facilities and a grant program to award
21	21	grants to develop and support these facilities. Under the bill, a crisis urgent care and
22	22	observation facility is a treatment facility that admits an individual to prevent,
23	23	de-escalate, or treat the individual's mental health or substance use disorder and
24	24	includes the necessary structure and staff to support the individual's needs relating
25	25	to the mental health or substance use disorder. The bill provides that no person may
26	26	operate a crisis urgent care and observation facility without a certification from
27	27	DHS. Under the bill, a certified crisis urgent care and observation facility is not
28	28	regulated as a hospital, except to the extent the facility is otherwise required due to
29	29	the facility's licensure or certification for other services or purposes. The bill provides
30	30	that the provisions of the bill may not be construed to prohibit, limit, or otherwise
31	31	interfere with services provided by a county or a hospital or other facility that are
32	32	provided consistent with the facility's existing licensure or certification, whether the
33	33	facility is publicly or privately funded.
34	34	The bill provides that DHS may certify crisis urgent care and observation
35	35	facilities that demonstrate the ability to do certain things, including 1) accept
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41	41	SENATE BILL 462
42	42	referrals for crisis services for adults, and, if applicable, for youth, including
43	43	involuntary patients under emergency detention, walk-ins, and individuals brought
44	44	by law enforcement, emergency medical responders or emergency medical services
45	45	practitioners, or county crisis personnel; 2) abstain from having a requirement for
46	46	medical clearance before admission assessment; 3) provide assessments for physical
47	47	health, substance use disorder, and mental health; 4) provide screening for suicide
48	48	and violence risk; 5) provide medication management and therapeutic counseling;
49	49	6) provide coordination of services for basic needs; 7) provide for the safety and
50	50	security of both the staff and the patients; 8) have adequate staffing 24 hours a day,
51	51	7 days a week, including through use of telehealth, with a multidisciplinary team,
52	52	including, as needed, psychiatrists or psychiatric nurse practitioners, nurses,
53	53	licensed clinicians capable of completing assessments, peers with lived experience,
54	54	and other appropriate staff; 9) allow for voluntary and involuntary treatment of
55	55	individuals in crisis as a means to avoid unnecessary placement of those individuals
56	56	in hospital inpatient beds and allow for an effective conversion to voluntary
57	57	stabilization when warranted in the same setting; and 10) contribute, from one or
58	58	more nonstate, federal, or third-party sources, an amount, as determined by DHS,
59	59	in addition to any grant awarded by DHS under the bill. The bill requires that DHS
60	60	must provide the Joint Committee on Finance with certain information and obtain
61	61	approval of that committee before granting certification to a crisis urgent care and
62	62	observation facility. The bill also requires DHS to provide an annual report to the
63	63	Joint Committee on Finance regarding the facilities.
64	64	Under the bill, a certified crisis urgent care and observation facility must accept
65	65	adult individuals for emergency detention, and may accept youths for emergency
66	66	detention. The bill provides that a certified crisis urgent care and observation facility
67	67	may accept individuals for services including voluntary stabilization; observation
68	68	and treatment, including for assessments for mental health or substance use
69	69	disorder; screening for suicide and violence risk; and medication management and
70	70	therapeutic counseling.
71	71	The bill provides that a certified crisis urgent care and observation facility must
72	72	coordinate to the fullest extent possible with any facility established or operated with
73	73	funding received from settlement proceeds from the opiate litigation, which under
74	74	current law refers to the litigation in In re: National Prescription Opiate Litigation,
75	75	Case No.: MDL 2804 or any proceeding filed in a circuit court in this state containing
76	76	allegations and seeking relief that is substantially similar to allegations contained
77	77	and relief sought in that matter. The bill also requires that DHS promulgate rules
78	78	establishing policies that encourage awareness of and communication and
79	79	coordination between certified crisis urgent care and observation facilities and other
80	80	facilities that provide similar services.
81	81	The bill requires DHS, in accordance with existing requirements to obtain
82	82	approval from the Joint Committee on Finance, to request any necessary federal
83	83	approval by seeking either a waiver, specifically, what is known as a 1115 waiver, or
84	84	a Medical Assistance state plan amendment to add services provided by a crisis
85	85	urgent care and observation facility as a type of crisis intervention service
86	86	reimbursable under the Medical Assistance program. If DHS determines a state - 3 -2023 - 2024 Legislature
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90	90	plan amendment is appropriate, DHS must follow the procedures for review by the
91	91	Joint Committee on Finance, regardless of whether the amendment is expected to
92	92	have a fiscal effect of $7,500,000 or more. Under the bill, if federal approval is either
93	93	unnecessary or is necessary and is granted, DHS may provide reimbursement for
94	94	these services.
95	95	For further information see the state and local fiscal estimate, which will be
96	96	printed as an appendix to this bill.
97	97	The people of the state of Wisconsin, represented in senate and assembly, do
98	98	enact as follows:
99	99	SECTION 1. 49.45 (41) (a) of the statutes is renumbered 49.45 (41) (a) (intro.)
100	100	and amended to read:
101	101	49.45 (41) (a) (intro.) In this subsection, “crisis intervention services" means
102	102	crisis intervention services for the treatment of mental illness, intellectual disability,
103	103	substance abuse, and dementia that are provided by a any of the following:
104	104	2. A crisis intervention program operated by, or under contract with, a county,
105	105	if the county is certified as a medical assistance provider.
106	106	SECTION 2. 49.45 (41) (a) 1. of the statutes is created to read:
107	107	49.45 (41) (a) 1. A crisis urgent care and observation facility certified under s.
108	108	51.036.
109	109	SECTION 3. 49.45 (41) (b) of the statutes is amended to read:
110	110	49.45 (41) (b) If a county elects to become certified as a provider of crisis
111	111	intervention services under par. (a) 2., the county may provide crisis intervention
112	112	services under this subsection in the county to medical assistance recipients through
113	113	the medical assistance program. A county that elects to provide the services shall
114	114	pay the amount of the allowable charges for the services under the medical
115	115	assistance program that is not provided by the federal government. The department
116	116	shall reimburse the county under this subsection only for the amount of the allowable
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136	136	SECTION 3 SENATE BILL 462
137	137	charges for those services under the medical assistance program that is provided by
138	138	the federal government.
139	139	SECTION 4. 49.45 (41) (c) (intro.) of the statutes is amended to read:
140	140	49.45 (41) (c) (intro.) Notwithstanding par. (b), if a county elects, pursuant to
141	141	par. (a) 2., to deliver crisis intervention services under the Medical Assistance
142	142	program on a regional basis according to criteria established by the department, all
143	143	of the following apply:
144	144	SECTION 5. 49.45 (41) (d) of the statutes is created to read:
145	145	49.45 (41) (d) The department shall, in accordance with all procedures set forth
146	146	under s. 20.940, request a waiver under 42 USC 1315 or submit a Medical Assistance
147	147	state plan amendment to the federal department of health and human services to
148	148	obtain any necessary federal approval required to provide reimbursement to crisis
149	149	urgent care and observation facilities certified under s. 51.036 for crisis intervention
150	150	services under this subsection. If the department determines submission of a state
151	151	plan amendment is appropriate, the department shall, notwithstanding whether the
152	152	expected fiscal effect of the amendment is $7,500,000 or more, submit the
153	153	amendment to the joint committee on finance for review in accordance with the
154	154	procedures under s. 49.45 (2t). If federal approval is granted or no federal approval
155	155	is required, the department shall provide reimbursement under s. 49.46 (2) (b) 15.
156	156	If federal approval is necessary but is not granted, the department may not provide
157	157	reimbursement for crisis intervention services provided by crisis urgent care and
158	158	observation facilities.
159	159	SECTION 6. 51.036 of the statutes is created to read:
160	160	51.036 Crisis urgent care and observation facilities. (1) DEFINITIONS. In
161	161	this section:
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189	189	SECTION 6
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191	191	(a) “Crisis” means a situation caused by an individual's apparent mental or
192	192	substance use disorder that results in a high level of stress or anxiety for the
193	193	individual, persons providing care for the individual, or the public and that is not
194	194	resolved by the available coping methods of the individual or by the efforts of those
195	195	providing ordinary care or support for the individual.
196	196	(b) “Crisis urgent care and observation facility” means a treatment facility that
197	197	admits an individual to prevent, de-escalate, or treat the individual's mental health
198	198	or substance use disorder and includes the necessary structure and staff to support
199	199	the individual's needs relating to the mental health or substance use disorder.
200	200	(2) CERTIFICATION REQUIRED; EXEMPTION; GRANTS. (a) The department shall
201	201	establish a certification process for crisis urgent care and observation facilities and
202	202	a grant program to award grants to develop and support crisis urgent care and
203	203	observation facilities. No person may operate a crisis urgent care and observation
204	204	facility without a certification under this section. The department may limit the
205	205	number of certifications it grants to operate crisis urgent care and observation
206	206	facilities. The department shall, using the department's division of the state into
207	207	regions by county, include statewide geographic consideration in its evaluation of
208	208	applications for certification under this section to ensure geographic diversity among
209	209	the regions in the location of crisis urgent care and observation facilities certified
210	210	under this section.
211	211	(b) 1. A crisis urgent care and observation facility certified under this section
212	212	is not subject to facility regulation under ch. 50, unless otherwise required due to the
213	213	facility's licensure or certification for other services or purposes. A crisis urgent care
214	214	and observation facility is not a hospital subject to approval under ss. 50.32 to 50.39
215	215	and nothing in this subsection limits services a hospital may provide under ch. 50.
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242	242	SECTION 6 SENATE BILL 462
243	243	2. Notwithstanding par. (d), the department shall promote certification and
244	244	encourage any facility that is licensed as a hospital under ch. 50 and provides
245	245	services consistent with those described in par. (c) 1. to 9. to apply for certification
246	246	under this section. The requirements under this section may not be construed to
247	247	prohibit, limit, or otherwise interfere with services provided by a county or a hospital
248	248	or other facility that are provided consistent with the facility's existing licensure or
249	249	certification, whether the facility is publicly or privately funded.
250	250	3. Notwithstanding s. 150.93, any hospital that expands psychiatric bed
251	251	capacity to accommodate admissions under this section may increase its approved
252	252	bed capacity by the number of psychiatric beds added under this subdivision.
253	253	4. The department shall take into account the geography of hospital facilities
254	254	granted certification under subd. 2. when considering certification applications for
255	255	other crisis urgent care and observations facilities.
256	256	(c) Subject to par. (d), the department may grant a certification to a crisis urgent
257	257	care and observation facility that specifies in an application the level of care the
258	258	facility can provide to patients and demonstrates in the application its ability to do
259	259	all of the following:
260	260	1. Accept referrals for crisis services for adults and, if applicable, for youth,
261	261	including involuntary patients under emergency detention, walk-ins, and
262	262	individuals brought by law enforcement, emergency medical responders or
263	263	emergency medical services practitioners, or county crisis personnel.
264	264	2. Abstain from having a requirement for medical clearance before admission
265	265	assessment.
266	266	3. Provide assessments for physical health, substance use disorder, and mental
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297	297	4. Provide screening for suicide and violence risk.
298	298	5. Provide medication management and therapeutic counseling.
299	299	6. Provide coordination of services for basic needs.
300	300	7. Provide for the safety and security of both the staff and the patients.
301	301	8. Have adequate staffing 24 hours a day, 7 days a week, including through use
302	302	of telehealth, as described under s. 49.45 (61), with a multidisciplinary team that
303	303	includes, as needed, psychiatrists or psychiatric nurse practitioners, nurses,
304	304	licensed clinicians capable of completing assessments, peers with lived experience,
305	305	and other appropriate staff.
306	306	9. Allow for voluntary and involuntary treatment of individuals in crisis as a
307	307	means to avoid unnecessary placement of those individuals in hospital inpatient
308	308	beds and allow for an effective conversion to voluntary stabilization when warranted
309	309	in the same setting.
310	310	10. Contribute, from at least one nonstate, federal, or 3rd-party revenue
311	311	source, an amount, as determined by the department, in addition to any grant
312	312	awarded by the department under this section.
313	313	(d) Before the department may grant certification to a facility under this
314	314	section, the department shall submit the proposal for certification to the joint
315	315	committee on finance for approval. If the cochairpersons of the joint committee on
316	316	finance do not notify the department within 14 working days after the date of the
317	317	submittal under this paragraph that the committee has scheduled a meeting for the
318	318	purpose of reviewing the proposal, the department may grant certification of that
319	319	facility as described in the proposal. If, within 14 working days after the date of the
320	320	submittal under this paragraph, the cochairpersons of the committee notify the
321	321	department that the committee has scheduled a meeting for the purpose of reviewing
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348	348	SECTION 6 SENATE BILL 462
349	349	the proposal, the department may grant certification of that facility only upon
350	350	approval by the committee. When submitting a proposal regarding certification of
351	351	a facility under this paragraph, the department shall provide the joint committee on
352	352	finance with all of the following information about the facility proposed for
353	353	certification:
354	354	1. The department's rationale for selecting the facility.
355	355	2. Where the facility is to be located.
356	356	3. A specific description of the entity that will be awarded certification.
357	357	4. A description of how the funding for the facility will work.
358	358	5. The timeline of the facility for accepting patients.
359	359	6. The distance from the facility to the nearest hospital.
360	360	7. A description of the facility's plan for staffing, including staff on call.
361	361	8. The number of beds in the facility.
362	362	9. A description of the facility's admission, hold, and discharge policies.
363	363	10. Security considerations for patients and staff at the facility.
364	364	11. The estimated population to be served.
365	365	12. The estimated number of diversions from the Winnebago Mental Health
366	366	Institute had the facility been operating the past 5 years.
367	367	13. Policies that ensure the facility has the capacity to assess physical health
368	368	needs and deliver care for most minor physical health challenges, while also having
369	369	an identified process in order to transfer an individual to a facility with more
370	370	medically staffed services if needed.
371	371	(e) No later than June 30 of each year, beginning by June 30, 2025, the
372	372	department shall submit to the joint committee on finance a report regarding crisis
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399	399	SECTION 6
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401	401	urgent care and observation facilities under this section, including information
402	402	relating to all of the following:
403	403	1. Applications for certification received by the department.
404	404	2. The number of admissions, including both voluntary and involuntary
405	405	admissions.
406	406	3. Data regarding how patients are arriving for admission, including through
407	407	transport by law enforcement, family, emergency medical responders or emergency
408	408	medical services practitioners, or county crisis personnel.
409	409	4. Average wait times.
410	410	5. The length of patient stays.
411	411	6. The time of day patients are admitted.
412	412	7. The source of payments for patient care, including private payment sources
413	413	or payment under the Medical Assistance program under subch. IV of ch. 49.
414	414	8. Data regarding the county of residence for each patient in counties for which
415	415	the county's data is equal to or greater than 20 patients.
416	416	9. The estimated number of diversions from the Winnebago Mental Health
417	417	Institute.
418	418	10. A description of the number and type of employees providing staffing during
419	419	the various times of day.
420	420	11. A description of rules and procedures for determining where to take an
421	421	individual in need of crisis services if a crisis urgent care and observation facility
422	422	does not have capacity or otherwise does not accept an individual.
423	423	(3) ADMISSIONS. (a) A crisis urgent care and observation facility certified under
424	424	this section may accept individuals for any of the following services:
425	425	1. Voluntary stabilization.
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453	453	2. Observation and treatment, including for assessments for mental health or
454	454	substance use disorder.
455	455	3. Screening for suicide and violence risk.
456	456	4. Medication management and therapeutic counseling.
457	457	(b) A crisis urgent care and observation facility certified under this section shall
458	458	accept an adult individual for emergency detention under s. 51.15 and may accept
459	459	a youth for emergency detention under s. 51.15. If the facility does not have capacity
460	460	to accept an adult individual for purposes of emergency detention or if the facility
461	461	does not accept a youth for purposes of emergency detention, that individual shall
462	462	be transported to another appropriate facility in accordance with rules established
463	463	by the department under sub. (4). A county crisis assessment under s. 51.15 (2) (c)
464	464	is required prior to admission to a crisis urgent care and observation facility for
465	465	purposes of emergency detention, but the medical clearance requirement under s.
466	466	51.15 (2) (b) does not apply to crisis urgent care and observation facility admissions
467	467	for purposes of emergency detention.
468	468	(c) The department shall encourage each crisis urgent care and observation
469	469	facility certified under this section to operate with the intent to admit individuals for
470	470	no longer than 5 days, except in exceptional circumstances.
471	471	(4) RULES. The department shall promulgate rules to implement this section,
472	472	including all of the following:
473	473	(a) Establishment of the grant program described under sub. (2), including
474	474	procedures for administration and establishment of criteria for awarding grants.
475	475	(b) Establishment of requirements for crisis urgent care and observation
476	476	facilities to match a portion of any grant awarded by the department under this
477	477	section, as set forth under sub. (2) (c) 10., and for determining what types of
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505	505	SECTION 6
506	506	SENATE BILL 462
507	507	contributions may count toward the matching requirement. The matching
508	508	requirement established by the department under this paragraph may be fulfilled
509	509	through in-kind contributions.
510	510	(c) Requirements for admitting, holding, and discharging individuals for
511	511	purposes of emergency detention.
512	512	(d) Minimum security requirements for crisis urgent care and observation
513	513	facilities certified under this section.
514	514	(e) Establishment of a target range for the number of beds in a crisis urgent care
515	515	and observation facility certified under this section.
516	516	(f) Establishment of policies and criteria to ensure that law enforcement and
517	517	other persons authorized to transport or cause transportation of an individual for
518	518	purposes of emergency detention have clear standards and procedures regarding all
519	519	of the following:
520	520	1. The circumstances under which law enforcement and other persons may
521	521	bring an individual to a crisis urgent care and observation facility certified under this
522	522	section.
523	523	2. The determination as to which facility law enforcement and other persons
524	524	authorized to transport or cause transportation of an individual for purposes of
525	525	emergency detention may take an individual.
526	526	(g) Establishment of policies relating to interfacility transfers, including how
527	527	such transfers should occur and who should be involved in such transfers. Barring
528	528	exigent circumstances that necessitate law enforcement involvement, law
529	529	enforcement may not transport an individual for purposes of an interfacility transfer
530	530	from a crisis urgent care and observation facility.
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556	556	SECTION 6 SENATE BILL 462
557	557	(h) Establishment of procedures to coordinate communication regarding bed
558	558	availability before the arrival of a patient and establishment of a process for
559	559	determining where to take an individual in need of crisis services if a crisis urgent
560	560	care and observation facility does not have capacity or otherwise does not accept an
561	561	individual.
562	562	(i) Establishment of policies for coordination between crisis urgent care and
563	563	observation facilities certified under this section and any facility established or
564	564	operated with funding received under s. 165.12 from settlement proceeds from the
565	565	opiate litigation, as defined in s. 165.12 (1), as well as policies to encourage
566	566	awareness of and communication and coordination with other facilities that provide
567	567	services similar to those provided by crisis urgent care and observation facilities.
568	568	(j) Establishment of procedures to require a crisis urgent care and observation
569	569	facility to coordinate continuity of care with, when appropriate, a hub-and-spoke
570	570	health home pilot program for any patient treated at a crisis urgent care and
571	571	observation facility for a period of 5 or fewer days. The department shall establish
572	572	procedures for follow-up with other transition facilities in the event that a
573	573	hub-and-spoke health home pilot program is appropriate but not available.
574	574	(k) Establishment of policies and procedures for crisis urgent care and
575	575	observation facilities that intend to accept both youths and adults, including
576	576	requirements that youths be treated in a separate part of the facility from adults,
577	577	policies to address youth-related treatment issues, including parental input, and
578	578	staff training for youth-specific issues.
579	579	(L) Establishment of appropriate staffing level requirements.
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605	605	SECTION 6
606	606	SENATE BILL 462
607	607	(m) Establishment of requirements to define the population to be served at a
608	608	given crisis urgent care and observation facility, including establishment of any
609	609	minimum age requirements.
610	610	(5) COORDINATION. In accordance with rules established by the department
611	611	under sub. (4) (i), a crisis urgent care and observation facility certified under this
612	612	section shall coordinate to the fullest extent possible with any facility established or
613	613	operated with funding received under s. 165.12 from settlement proceeds from the
614	614	opiate litigation, as defined in s. 165.12 (1), as well as with other facilities that
615	615	provide services similar to those provided by crisis urgent care and observation
616	616	facilities.
617	617	SECTION 7. 51.15 (2) (d) of the statutes is amended to read:
618	618	51.15 (2) (d) Detention under this section may only be in a treatment facility
619	619	approved by the department or the county department, if the facility agrees to detain
620	620	the individual, or a state treatment facility. The department shall approve for
621	621	purposes of this subsection any facility certified under s. 51.036.
622	622	SECTION 8.0Nonstatutory provisions.
623	623	(1) When considering the initial certifications of crisis urgent care and
624	624	observation facilities under s. 51.036, the department of health services shall, to the
625	625	fullest extent possible, prioritize certification of a crisis urgent care and observation
626	626	facility to be located at least 100 miles from the Winnebago Mental Health Institute
627	627	and in the region of the state defined as the western region according to the
628	628	department's division of the state into five regions by county as of January 5, 2023,
629	629	for purposes of data analysis and communication.
630	630	(END)
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