AB807: Bill Text

AB807,16,19 (a) Guidelines for cost containment under the health plan, including the purchasing and distribution of major diagnostic, medical, and surgical equipment.

AB807,16,23 (b) Criteria, as recommended by the medical advisory committee appointed by the secretary under sub. (7), for determining necessity for orthodontia and for the performance of reconstructive or cosmetic surgery for coverage under the health plan.

AB807,16,25 (4) The department shall biennially evaluate and recommend to the board cost control measures for the health plan.

AB807,17,3 (5) The department shall, by July 1, 2007, begin implementation of processes, in light of policies formulated or revised under s. 152.20 (3), to effect all of the following:

AB807,17,7 (a) Specification of the amounts and sources of revenues to finance payment to providers under the health plan, which may not include any premiums, copayments, deductibles, and other forms of direct payment by patients, and which shall include all of the following:

AB807,17,13 1. Use of federal, state, and local moneys that fund, as of July 1, 2008, health care services, including medicare, medical assistance, health care services funded by a relief block grant under s. 49.02 or 49.025, health care services under s. 49.665, veterans medical benefits, services specified in s. 152.10 (2) (k), services provided under federal block grants, alcohol and other drug abuse services, and services provided by local health departments.

AB807,17,18 2. Use of revenues from a tax on employers, based on the amount of wages that they pay, that generates, in the aggregate, revenues that are at least equal to amounts that employers contribute, as of the effective date of this subdivision .... [revisor inserts date], for employee health care benefit costs, including the costs of worker's compensation attributable to health care for injured employees.

AB807,17,22 3. Use of revenues from a graduated income tax on individuals that generates, in the aggregate, revenues that are not greater than expenditures that individuals make, as of July 1, 2008, for health care costs for which coverage under disability insurance policies is not obtained.

AB807,17,25 4. An indexing of the sources of revenues under this paragraph that provides for revenue growth that is equivalent to the anticipated growth of health care costs under the health plan.

AB807,18,3 (b) Application for waivers to 42 USC 1396 to 1396v or consideration of the feasibility of statutory changes to 42 USC 1396 to 1396v in order to effect all of the following:

AB807,18,5 1. Administration of the Medical Assistance program in this state by the department, rather than by the department of health and family services.

AB807,18,7 2. Use of federal financial participation to fund a portion of the administrative costs, after June 30, 2008, of the department.

AB807,18,12 3. Use of federal financial participation, after June 30, 2008, to fund, under the health plan, the health care services received by a percentage of the residents that corresponds to the percentage of the residents, as determined by the board, that is eligible to receive health care services under the Medical Assistance program on July 1, 2008.

AB807,18,14 4. The formulation of criteria and procedures for payment of out-of-state health care costs incurred by residents specified in subd. 3.

AB807,18,16 5. Use of federal financial participation to fund the scope, or a portion of the scope, of medical services to be provided under the health plan.

AB807,18,18 (c) Application for waivers to Medicare or consideration of the feasibility of statutory changes to 42 USC 1395 to 1395ddd in order to effect all of the following:

AB807,18,20 1. Administration of the Medicare program in this state by the department, rather than by private insurers.

AB807,18,22 2. Use of federal Medicare funds to fund a portion of the administrative costs, after June 30, 2008, of the department.

AB807,18,25 3. Use of federal Medicare funds to fund, under the health plan, the health care services received by residents who are eligible to receive services under Medicare beginning on July 1, 2008.

AB807,19,2 4. The formulation of criteria and procedures for payment of out-of-state health care costs incurred by residents specified in subd. 3.

AB807,19,4 5. Use of federal Medicare funds to fund the scope, or a portion of the scope, of medical services to be provided under the health plan.

AB807,19,6 6. The assignment to the state, as represented by the department, of rights of an individual to payment for medical care from any 3rd party.

AB807,19,10 (d) Application for waivers or consideration of the feasibility of statutory changes to federal laws, other than those specified in pars. (b) and (c), in order to use moneys available under those federal laws for payment of health care services under the health plan or in order to provide services to all residents under the health plan.

AB807,19,13 (e) The establishment and maintenance, with reserves of no less than 5 percent of the total annual amount appropriated under s. 20.430 (1) (b), of a health trust fund in the department, for receipt of revenues specified in par. (a).

AB807,19,21 (f) The formulation of criteria for determining payment and the formulation of procedures for determining payment and negotiating applicable rates to be used for payment for health care providers, including health care facilities, under the health plan. The criteria and procedures for determining payment shall include periodic overall budgeting, including separately budgeting for operational costs; for health care facilities and services; for negotiations with professional groups or associations of practitioners; for consideration of inflation costs and increased patient populations; and for research and teaching.

AB807,19,25 (g) The development and implementation of a system to provide an electronic or other identification card, bearing a unique number that is not a social security number, to each health plan participant, for receipt of benefits under the plan, and to each health care provider, for receipt of reimbursement.

AB807,20,4 (h) The formulation of criteria and procedures to review and to provide funding for capital expenditures, from an account separate from that from which health care services are paid, for the establishment, maintenance, or expansion of health care facilities.

AB807,20,6 (i) The formulation of criteria and procedures for recovery of overpayments made to health care providers under the health plan.

AB807,20,8 (j) The determination and use of factors requisite to establishing an annual state health budget for the provision of services under the health plan.

AB807,20,11 (k) Application for waivers of 29 USC 1144 (a) or consideration of the feasibility of statutory change to 29 USC 1144 (a) or the means by which operation of the health plan may avoid conflict with 29 USC 1144 (a).

AB807,20,14 (L) Investigation of the feasibility of providing the state with subrogation rights to payments for injury or disease to residents that are provided under motor vehicle or other liability insurance policies or plans.

AB807,20,16 (m) Formulation of criteria and procedures for payment under the health plan of out-of-state health care costs incurred by residents.

AB807,20,18 (n) Establishment of a listing of approved medicinal substances and formulae, including all of the following:

AB807,20,22 1. Negotiation with pharmaceutical manufacturers or distributors to obtain the lowest possible cost for each medicinal substance. The negotiation shall include as parties on behalf of the health plan the secretary of the department and the chairperson of the board.

AB807,20,24 2. Establishment of a single statewide price, under the health plan, for each medicinal substance.

AB807,21,2 3. Monitoring the listing to oversee its currency and revising the listing by January 1 and July 1 annually.

AB807,21,4 4. Negotiating a statewide uniform dispensing fee with representatives of pharmacists or pharmacies.

AB807,21,5 (p) Exemption of operation of the health plan from ch. 133, if necessary.

AB807,21,6 (q) Other issues relevant to the health plan, as determined by the board.

AB807,21,15 (6) From the appropriation under s. 20.430 (1) (c), the department shall, in cooperation with the department of workforce development and any other applicable state agency, as defined in s. 20.001 (1), provide job retraining or job placement services to individuals employed by insurers, as defined in s. 600.03 (27) and by health care providers whose employment is or will be terminated because of implementation of the health plan under this chapter. The department may award moneys as grants to applying organizations, under the department's request-for-proposal procedures, for the provision of job retraining or placement services under this subsection.

AB807,21,17 (7) The secretary shall create a medical advisory committee and appoint members of the committee, to recommend criteria under sub. (3) (b).

AB807, s. 15 Section 15. Nonstatutory provisions; health planning and finance.

AB807,21,23 (1) Health policy board; appointment of members. Notwithstanding the length of terms specified for the members of the health policy board under section 15.20 (intro.) of the statutes, as created by this act, the initial members of the health policy board shall be appointed or elected by the first day of the 4th month beginning after the effective date of this subsection for the following terms:

AB807,22,3 (a) Two members specified under section 15.20 (1) of the statutes, as created by this act, one of whom is elected from the northern regional consumer health council and one of whom is elected from the southeastern regional health council, and 2 members specified under section 15.20 (2) of the statutes, as created by this act, for terms expiring on May 1, 2009.

AB807,22,8 (b) Two members specified under section 15.20 (1) of the statutes, as created by this act, one of whom is elected from the northeastern regional consumer health council and one of whom is elected from the regional consumer health council for the area within Milwaukee County, and 2 members specified under section 15.20 (2) of the statutes, as created by this act, for terms expiring on May 1, 2011.

AB807,22,13 (c) Two members specified under section 15.20 (1) of the statutes, as created by this act, one of whom is elected from the southern regional consumer health council and one of whom is elected from the western regional consumer health council, and one member specified under section 15.20 (2) of the statutes, as created by this act, for terms expiring on May 1, 2013.

AB807,22,19 (2) Regional consumer health councils; appointment of members. Notwithstanding the length of terms specified for the members of regional consumer health councils under section 15.207 (1) (b) of the statutes, as created by this act, the initial members of the regional consumer health councils shall be appointed by the first day of the 3rd month beginning after the effective date of this subsection for the following terms:

AB807,22,21 (a) For the regional consumer health council under section 15.207 (1) (b) 1. of the statutes, as created by this act:

AB807,22,22 1. Five members, for terms expiring on July 1, 2010.

AB807,22,23 2. Five members, for terms expiring on July 1, 2011.

AB807,22,24 3. Six members, for terms expiring on July 1, 2012.

AB807,23,2 (b) For the regional consumer health council under section 15.207 (1) (b) 2. of the statutes, as created by this act:

AB807,23,3 1. Five members, for terms expiring on July 1, 2010.

AB807,23,4 2. Five members, for terms expiring on July 1, 2011.

AB807,23,5 3. Five members, for terms expiring on July 1, 2012.

AB807,23,7 (c) For each regional consumer health council under section 15.207 (1) (b) 3. or 4. of the statutes, as created by this act:

AB807,23,8 1. Five members, for terms expiring on July 1, 2010.

AB807,23,9 2. Five members, for terms expiring on July 1, 2011.

AB807,23,10 3. Seven members, for terms expiring on July 1, 2012.

AB807,23,12 (d) For each regional consumer health council under section 15.207 (1) (b) 5. or 6. of the statutes, as created by this act:

AB807,23,13 1. Four members, for terms expiring on July 1, 2010.

AB807,23,14 2. Four members, for terms expiring on July 1, 2011.

AB807,23,15 3. Four members, for terms expiring on July 1, 2012.

AB807,23,16 (3) Proposed implementation.

AB807,23,21 (a) The department of administration shall expedite the creation of regional consumer health councils in accord with section 15.207 (1) (b) of the statutes, as created by this act, by initiating and making follow-up contacts with boards of supervisors in counties other than Milwaukee County and with the county executive of Milwaukee County and the mayor of the city of Milwaukee.

AB807,23,25 (b) The department of administration shall provide staff assistance to complete all activities required to create the 6 regional consumer health councils and enable each regional consumer health council to elect one member of the health policy board as required under section 15.20 (1) of the statutes, as created by this act.

AB807,24,3 (c) The health policy board shall appoint the secretary of health planning and finance within 6 months after the first meeting at which all appointed and at least 3 elected board members assemble.

AB807,24,16 (d) The secretary of health planning and finance and the secretary of administration shall, until September 1, 2009, meet at least semimonthly to formulate decisions on issues concerning the health plan and the department of health planning and finance, as specified in chapter 152 of the statutes, as created by this act, and how the scope and functions of the department of health planning and finance affect the scope and functions of the department of health and family services, the office of the commissioner of insurance, and the board on aging and long-term care and the duties or powers of any other state agency. Following approval by the health policy board, the department of health planning and finance shall convey these decisions to, and cooperate with, the legislative reference bureau in the drafting of proposed legislation that is necessary to implement those decisions, for introduction in the legislature in 2008 by the appropriate committee of the legislature.

AB807,24,23 (e) Within 2 months after the first day of the 36th month after the appointment of the first secretary of health planning and finance under paragraph (c), the health policy board shall evaluate, in writing, the performance of the secretary, shall decide whether or not to continue the appointment, and shall provide a copy of the evaluation to the governor. If the health policy board decides to discontinue the appointment, the board shall, within 6 months, implement the decision and appoint a successor.

AB807, s. 16 Section 16. Nonstatutory provisions; legislative reference bureau.

AB807,25,6 (1) Drafting proposed legislation to implement the health plan. The legislative reference bureau shall, after meeting with and receiving the decisions of the department of health planning and finance with respect to the health plan, as specified in chapter 152 of the statutes, as created by this act, prepare in proper form proposed legislation that shall relate to those decisions, for introduction in the legislature in 2008 by the appropriate committee of the legislature.

AB807, s. 17 Section 17. Effective dates. This act takes effect on the day after publication, except as follows:

AB807,25,10 (1) The treatment of sections 20.430 (1) (b) and 152.10 of the statutes takes effect on July 1, 2008.

AB807,25,11 (End)