2023 - 2024 LEGISLATURE
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2023 SENATE BILL 462
September 29, 2023 - Introduced by Senators MARKLEIN, JAMES, BALLWEG,
CABRAL-GUEVARA, FELZKOWSKI, SPREITZER, TESTIN, TOMCZYK and QUINN,
cosponsored by Representatives MOSES, SUMMERFIELD, CALLAHAN, C.
ANDERSON, BROOKS, DITTRICH, DONOVAN, EDMING, GREEN, GUNDRUM, JACOBSON,
KITCHENS, KRUG, MAXEY, MURPHY, MURSAU, NOVAK, O'CONNOR, PETRYK, ROZAR,
SAPIK, SHANKLAND, SPIROS, TRANEL, ZIMMERMAN and WICHGERS. Referred to
Committee on Mental Health, Substance Abuse Prevention, Children and
Families.
1 AN ACT to renumber and amend 49.45 (41) (a); to amend 49.45 (41) (b), 49.45
2 (41) (c) (intro.) and 51.15 (2) (d); and to create 49.45 (41) (a) 1., 49.45 (41) (d)
3 and 51.036 of the statutes; relating to: crisis urgent care and observation
4 facilities and granting rule-making authority.
Analysis by the Legislative Reference Bureau
This bill requires the Department of Health Services to establish a certification
process for crisis urgent care and observation facilities and a grant program to award
grants to develop and support these facilities. Under the bill, a crisis urgent care and
observation facility is a treatment facility that admits an individual to prevent,
de-escalate, or treat the individual's mental health or substance use disorder and
includes the necessary structure and staff to support the individual's needs relating
to the mental health or substance use disorder. The bill provides that no person may
operate a crisis urgent care and observation facility without a certification from
DHS. Under the bill, a certified crisis urgent care and observation facility is not
regulated as a hospital, except to the extent the facility is otherwise required due to
the facility's licensure or certification for other services or purposes. The bill provides
that the provisions of the bill may not be construed to prohibit, limit, or otherwise
interfere with services provided by a county or a hospital or other facility that are
provided consistent with the facility's existing licensure or certification, whether the
facility is publicly or privately funded.
The bill provides that DHS may certify crisis urgent care and observation
facilities that demonstrate the ability to do certain things, including 1) accept
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SENATE BILL 462
referrals for crisis services for adults, and, if applicable, for youth, including
involuntary patients under emergency detention, walk-ins, and individuals brought
by law enforcement, emergency medical responders or emergency medical services
practitioners, or county crisis personnel; 2) abstain from having a requirement for
medical clearance before admission assessment; 3) provide assessments for physical
health, substance use disorder, and mental health; 4) provide screening for suicide
and violence risk; 5) provide medication management and therapeutic counseling;
6) provide coordination of services for basic needs; 7) provide for the safety and
security of both the staff and the patients; 8) have adequate staffing 24 hours a day,
7 days a week, including through use of telehealth, with a multidisciplinary team,
including, as needed, psychiatrists or psychiatric nurse practitioners, nurses,
licensed clinicians capable of completing assessments, peers with lived experience,
and other appropriate staff; 9) allow for voluntary and involuntary treatment of
individuals in crisis as a means to avoid unnecessary placement of those individuals
in hospital inpatient beds and allow for an effective conversion to voluntary
stabilization when warranted in the same setting; and 10) contribute, from one or
more nonstate, federal, or third-party sources, an amount, as determined by DHS,
in addition to any grant awarded by DHS under the bill. The bill requires that DHS
must provide the Joint Committee on Finance with certain information and obtain
approval of that committee before granting certification to a crisis urgent care and
observation facility. The bill also requires DHS to provide an annual report to the
Joint Committee on Finance regarding the facilities.
Under the bill, a certified crisis urgent care and observation facility must accept
adult individuals for emergency detention, and may accept youths for emergency
detention. The bill provides that a certified crisis urgent care and observation facility
may accept individuals for services including voluntary stabilization; observation
and treatment, including for assessments for mental health or substance use
disorder; screening for suicide and violence risk; and medication management and
therapeutic counseling.
The bill provides that a certified crisis urgent care and observation facility must
coordinate to the fullest extent possible with any facility established or operated with
funding received from settlement proceeds from the opiate litigation, which under
current law refers to the litigation in In re: National Prescription Opiate Litigation,
Case No.: MDL 2804 or any proceeding filed in a circuit court in this state containing
allegations and seeking relief that is substantially similar to allegations contained
and relief sought in that matter. The bill also requires that DHS promulgate rules
establishing policies that encourage awareness of and communication and
coordination between certified crisis urgent care and observation facilities and other
facilities that provide similar services.
The bill requires DHS, in accordance with existing requirements to obtain
approval from the Joint Committee on Finance, to request any necessary federal
approval by seeking either a waiver, specifically, what is known as a 1115 waiver, or
a Medical Assistance state plan amendment to add services provided by a crisis
urgent care and observation facility as a type of crisis intervention service
reimbursable under the Medical Assistance program. If DHS determines a state
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SENATE BILL 462
plan amendment is appropriate, DHS must follow the procedures for review by the
Joint Committee on Finance, regardless of whether the amendment is expected to
have a fiscal effect of $7,500,000 or more. Under the bill, if federal approval is either
unnecessary or is necessary and is granted, DHS may provide reimbursement for
these services.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
1 SECTION 1. 49.45 (41) (a) of the statutes is renumbered 49.45 (41) (a) (intro.)
2 and amended to read:
3 49.45 (41) (a) (intro.) In this subsection, “crisis intervention services" means
4 crisis intervention services for the treatment of mental illness, intellectual disability,
5 substance abuse, and dementia that are provided by a any of the following:
6 2. A crisis intervention program operated by, or under contract with, a county,
7 if the county is certified as a medical assistance provider.
8 SECTION 2. 49.45 (41) (a) 1. of the statutes is created to read:
9 49.45 (41) (a) 1. A crisis urgent care and observation facility certified under s.
10 51.036.
11 SECTION 3. 49.45 (41) (b) of the statutes is amended to read:
12 49.45 (41) (b) If a county elects to become certified as a provider of crisis
13 intervention services under par. (a) 2., the county may provide crisis intervention
14 services under this subsection in the county to medical assistance recipients through
15 the medical assistance program. A county that elects to provide the services shall
16 pay the amount of the allowable charges for the services under the medical
17 assistance program that is not provided by the federal government. The department
18 shall reimburse the county under this subsection only for the amount of the allowable
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SENATE BILL 462 SECTION 3
1 charges for those services under the medical assistance program that is provided by
2 the federal government.
3 SECTION 4. 49.45 (41) (c) (intro.) of the statutes is amended to read:
4 49.45 (41) (c) (intro.) Notwithstanding par. (b), if a county elects, pursuant to
5 par. (a) 2., to deliver crisis intervention services under the Medical Assistance
6 program on a regional basis according to criteria established by the department, all
7 of the following apply:
8 SECTION 5. 49.45 (41) (d) of the statutes is created to read:
9 49.45 (41) (d) The department shall, in accordance with all procedures set forth
10 under s. 20.940, request a waiver under 42 USC 1315 or submit a Medical Assistance
11 state plan amendment to the federal department of health and human services to
12 obtain any necessary federal approval required to provide reimbursement to crisis
13 urgent care and observation facilities certified under s. 51.036 for crisis intervention
14 services under this subsection. If the department determines submission of a state
15 plan amendment is appropriate, the department shall, notwithstanding whether the
16 expected fiscal effect of the amendment is $7,500,000 or more, submit the
17 amendment to the joint committee on finance for review in accordance with the
18 procedures under s. 49.45 (2t). If federal approval is granted or no federal approval
19 is required, the department shall provide reimbursement under s. 49.46 (2) (b) 15.
20 If federal approval is necessary but is not granted, the department may not provide
21 reimbursement for crisis intervention services provided by crisis urgent care and
22 observation facilities.
23 SECTION 6. 51.036 of the statutes is created to read:
24 51.036 Crisis urgent care and observation facilities. (1) DEFINITIONS. In
25 this section:
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1 (a) “Crisis” means a situation caused by an individual's apparent mental or
2 substance use disorder that results in a high level of stress or anxiety for the
3 individual, persons providing care for the individual, or the public and that is not
4 resolved by the available coping methods of the individual or by the efforts of those
5 providing ordinary care or support for the individual.
6 (b) “Crisis urgent care and observation facility” means a treatment facility that
7 admits an individual to prevent, de-escalate, or treat the individual's mental health
8 or substance use disorder and includes the necessary structure and staff to support
9 the individual's needs relating to the mental health or substance use disorder.
10 (2) CERTIFICATION REQUIRED; EXEMPTION; GRANTS. (a) The department shall
11 establish a certification process for crisis urgent care and observation facilities and
12 a grant program to award grants to develop and support crisis urgent care and
13 observation facilities. No person may operate a crisis urgent care and observation
14 facility without a certification under this section. The department may limit the
15 number of certifications it grants to operate crisis urgent care and observation
16 facilities. The department shall, using the department's division of the state into
17 regions by county, include statewide geographic consideration in its evaluation of
18 applications for certification under this section to ensure geographic diversity among
19 the regions in the location of crisis urgent care and observation facilities certified
20 under this section.
21 (b) 1. A crisis urgent care and observation facility certified under this section
22 is not subject to facility regulation under ch. 50, unless otherwise required due to the
23 facility's licensure or certification for other services or purposes. A crisis urgent care
24 and observation facility is not a hospital subject to approval under ss. 50.32 to 50.39
25 and nothing in this subsection limits services a hospital may provide under ch. 50.
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1 2. Notwithstanding par. (d), the department shall promote certification and
2 encourage any facility that is licensed as a hospital under ch. 50 and provides
3 services consistent with those described in par. (c) 1. to 9. to apply for certification
4 under this section. The requirements under this section may not be construed to
5 prohibit, limit, or otherwise interfere with services provided by a county or a hospital
6 or other facility that are provided consistent with the facility's existing licensure or
7 certification, whether the facility is publicly or privately funded.
8 3. Notwithstanding s. 150.93, any hospital that expands psychiatric bed
9 capacity to accommodate admissions under this section may increase its approved
10 bed capacity by the number of psychiatric beds added under this subdivision.
11 4. The department shall take into account the geography of hospital facilities
12 granted certification under subd. 2. when considering certification applications for
13 other crisis urgent care and observations facilities.
14 (c) Subject to par. (d), the department may grant a certification to a crisis urgent
15 care and observation facility that specifies in an application the level of care the
16 facility can provide to patients and demonstrates in the application its ability to do
17 all of the following:
18 1. Accept referrals for crisis services for adults and, if applicable, for youth,
19 including involuntary patients under emergency detention, walk-ins, and
20 individuals brought by law enforcement, emergency medical responders or
21 emergency medical services practitioners, or county crisis personnel.
22 2. Abstain from having a requirement for medical clearance before admission
23 assessment.
24 3. Provide assessments for physical health, substance use disorder, and mental
25 health.
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1 4. Provide screening for suicide and violence risk.
2 5. Provide medication management and therapeutic counseling.
3 6. Provide coordination of services for basic needs.
4 7. Provide for the safety and security of both the staff and the patients.
5 8. Have adequate staffing 24 hours a day, 7 days a week, including through use
6 of telehealth, as described under s. 49.45 (61), with a multidisciplinary team that
7 includes, as needed, psychiatrists or psychiatric nurse practitioners, nurses,
8 licensed clinicians capable of completing assessments, peers with lived experience,
9 and other appropriate staff.
10 9. Allow for voluntary and involuntary treatment of individuals in crisis as a
11 means to avoid unnecessary placement of those individuals in hospital inpatient
12 beds and allow for an effective conversion to voluntary stabilization when warranted
13 in the same setting.
14 10. Contribute, from at least one nonstate, federal, or 3rd-party revenue
15 source, an amount, as determined by the department, in addition to any grant
16 awarded by the department under this section.
17 (d) Before the department may grant certification to a facility under this
18 section, the department shall submit the proposal for certification to the joint
19 committee on finance for approval. If the cochairpersons of the joint committee on
20 finance do not notify the department within 14 working days after the date of the
21 submittal under this paragraph that the committee has scheduled a meeting for the
22 purpose of reviewing the proposal, the department may grant certification of that
23 facility as described in the proposal. If, within 14 working days after the date of the
24 submittal under this paragraph, the cochairpersons of the committee notify the
25 department that the committee has scheduled a meeting for the purpose of reviewing
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1 the proposal, the department may grant certification of that facility only upon
2 approval by the committee. When submitting a proposal regarding certification of
3 a facility under this paragraph, the department shall provide the joint committee on
4 finance with all of the following information about the facility proposed for
5 certification:
6 1. The department's rationale for selecting the facility.
7 2. Where the facility is to be located.
8 3. A specific description of the entity that will be awarded certification.