Analysis by the Legislative Reference Bureau
Under current law, payment for medical services that residents of this state
receive is made from a combination of federal moneys (such as under the Medicare,
Medical Assistance (commonly referred to as "Medicaid"), and various block grant
programs); general purpose revenues (such as the "state share" of the joint
federal-state Medical Assistance Program, the Badger Care Program, state
contributions to relief block grants for health care services, and moneys appropriated
for specific medical purposes, such as cancer control grants); local moneys, such as
funding for medical relief health care services and county nursing homes and
hospitals; private health insurance coverage that individuals purchase or that is
provided, in part, as employee benefits; and out-of-pocket payments that are made
by health care consumers.

This bill establishes a health plan for Wisconsin, under which, beginning July
1, 2008, each state resident, with certain specified exceptions, shall receive
reasonable medical services necessary to maintain health, enable diagnosis, and
provide treatment or rehabilitation for an injury, disability, or disease. Specified
persons who are excepted from the July 1, 2008, beginning date are phased in for
eligibility that begins July 1, 2009.
To administer the health plan, the bill creates a Department of Health Planning
and Finance (DHPF), with six regional offices, that is directed and supervised by an
11-member Health Policy Board that is also created in the bill. The Health Policy
Board appoints the secretary of health planning and finance and is required to
review that appointment after 36 months. The Health Policy Board also may appoint
two advisory committees, which are advisory to the secretary of health planning and
finance. The bill also creates six regional consumer health councils that are attached
to DHPF and that report at least twice a year to the Health Policy Board on the health
care needs, problems, and concerns of the region. Each regional consumer health
council may create a regional advisory committee. The bill requires appropriation
of general purpose revenues to DHPF for operation of the Health Policy Board for the
2005-07 fiscal biennium and requires that the Health Policy Board consider
numerous specified issues related to the formation of a health plan in this state.
Under the bill, by July 1, 2007, DHPF must begin implementation of processes,
in light of policies determined by the Health Policy Board, to effect numerous
health-related matters, including specifying the amounts and sources of funds to
finance payment to providers under the health plan, applying for waivers to federal
Medicaid statutes and rules, and establishing a listing of approved medicinal
substances and formulae. The secretary of health planning and finance and the
secretary of administration must, until September 1, 2009, meet at least
semimonthly to formulate decisions on issues concerning the health plan and DHPF
and how the scope and functions of DHPF affect the scope and functions of the
Department of Health and Family Services, the Office of the Commissioner of
Insurance, the Board on Aging and Long-Term Care, and the duties or powers of any
other state agency. The Health Policy Board must convey the decisions to the
Legislative Reference Bureau for drafting of necessary proposed legislation for
introduction in the legislature in 2008. The Legislative Reference Bureau must
prepare, in proper form for introduction, the proposed legislation that relates to the
decisions.
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:
AB807, s. 1 1Section 1. 15.01 (3) of the statutes is amended to read:
AB807,3,6
115.01 (3) "Committee" Except as provided in ss. 152.20 (5) and 152.30 (2m),
2"committee"
means a part-time body appointed to study a specific problem and to
3recommend a solution or policy alternative with respect to that problem, and
4intended to terminate on the completion of its assignment. Because of their
5temporary nature, committees shall, except as provided in ss. 152.20 (5) and 152.30
6(2m),
be created by session law rather than by statute.
AB807, s. 2 7Section 2. 15.01 (4) of the statutes, as affected by 2005 Wisconsin Act 25, is
8amended to read:
AB807,3,169 15.01 (4) "Council" means a part-time body appointed to function on a
10continuing basis for the study, and recommendation of solutions and policy
11alternatives, of the problems arising in a specified functional area of state
12government, except the Milwaukee River revitalization council has the powers and
13duties specified in s. 23.18, the council on physical disabilities has the powers and
14duties specified in s. 46.29 (1) and (2), and the state council on alcohol and other drug
15abuse has the powers and duties specified in s. 14.24, and the regional consumer
16health councils have the powers and duties specified in s. 152.30 (1)
.
AB807, s. 3 17Section 3. 15.07 (1) (a) 7. of the statutes is created to read:
AB807,3,1918 15.07 (1) (a) 7. Members of the health policy board elected under s. 15.20 (1)
19shall be elected as provided in that subsection.
AB807, s. 4 20Section 4. 15.07 (2) (n) of the statutes is created to read:
AB807,3,2221 15.07 (2) (n) The chairperson of the health policy board shall serve for a period
22of 3 years and may be reelected for 2 additional successive terms.
AB807, s. 5 23Section 5. 15.07 (5) (m) of the statutes is created to read:
AB807,3,2424 15.07 (5) (m) Members of the health policy board, $50 per day.
AB807, s. 6 25Section 6. 15.07 (5m) (c) of the statutes is created to read:
AB807,4,4
115.07 (5m) (c) Health policy board. Members of the health policy board may
2be reimbursed for lost wages if required by their employers to use leave without pay
3in order to attend meetings of the health policy board, and they may be reimbursed
4for actual and necessary child care expenses without proof of financial hardship.
AB807, s. 7 5Section 7. 15.20 of the statutes is created to read:
AB807,4,12 615.20 Department of health planning and finance. There is created a
7department of health planning and finance under the direction and supervision of
8the health policy board. The health policy board shall consist of the following
9members, each of whom is to serve for a 6-year term and, if reelected or reappointed,
10for an additional 6-year term and none of whom may be a health care provider, as
11defined in s. 152.01 (6), an administrator or owner of a health care facility or
12organization, or an elected public official:
AB807,4,14 13(1) One member elected by and from the current membership of each of the 6
14regional consumer health councils specified under s. 15.207 (1) (b).
AB807,4,18 15(2) Five members, nominated by the governor and with the advice and consent
16of the senate appointed, who reflect as much as possible a balance of gender, race,
17age, sexual orientation, ethnicity, religion, geographic area, and the interests of
18management, labor, and individuals with disabilities.
AB807, s. 8 19Section 8. 15.207 of the statutes is created to read:
AB807,4,23 2015.207 Same; councils. (1) Regional consumer health councils. (a) There
21are created 6 regional consumer health councils that are attached to the department
22of health planning and finance under s. 15.03, one of which is established in each of
23the following areas of this state:
AB807,5,3
11. The northern region, consisting of Ashland, Bayfield, Douglas, Florence,
2Forest, Iron, Langlade, Lincoln, Marathon, Oneida, Portage, Price, Sawyer, Taylor,
3Vilas, and Wood counties.
AB807,5,64 2. The southern region, consisting of Adams, Columbia, Crawford, Dane,
5Dodge, Grant, Green, Iowa, Jefferson, Juneau, Lafayette, Richland, Rock, Sauk, and
6Vernon counties.
AB807,5,97 3. The western region, consisting of Barron, Burnett, Buffalo, Chippewa,
8Clark, Dunn, Eau Claire, Jackson, La Crosse, Monroe, Pepin, Pierce, Polk, Rusk, St.
9Croix, Trempealeau, and Washburn counties.
AB807,5,1210 4. The northeastern region, consisting of Brown, Calumet, Door, Fond du Lac,
11Green Lake, Kewaunee, Manitowoc, Marinette, Marquette, Menominee, Oconto,
12Outagamie, Shawano, Sheboygan, Waupaca, Waushara, and Winnebago counties.
AB807,5,1413 5. The southeastern region, consisting of Kenosha, Ozaukee, Walworth,
14Washington, Waukesha, and Racine counties.
AB807,5,1515 6. The area within Milwaukee County.
AB807,5,1916 (b) Each regional consumer health council shall consist of the following
17members, none of whom may be a health care provider, as defined in s. 152.01 (6),
18an administrator or owner of a health care facility or organization, or an elected
19public official, to serve for no more than 3 3-year terms:
AB807,5,2220 1. In the northern region, a total of 16 members, consisting of one member from
21each county in that region. The county board of supervisors of each county in that
22region shall appoint one person from that county.
AB807,5,2523 2. In the southern region, a total of 15 members, consisting of one member from
24each county in that region. The county board of supervisors of each county in that
25region shall appoint one person from that county.
AB807,6,3
13. In the western region, a total of 17 members, consisting of one member from
2each county in that region. The county board of supervisors of each county in that
3region shall appoint one person from that county.
AB807,6,64 4. In the northeastern region, a total of 17 members, consisting of one member
5from each county in that region. The county board of supervisors of each county in
6that region shall appoint one person from that county.
AB807,6,97 5. In the southeastern region, a total of 12 members, consisting of 2 members
8from each county in that region. The county board of supervisors of each county in
9that region shall appoint 2 persons from that county.
AB807,6,1410 6. In the area within Milwaukee County, a total of 12 members, consisting of
116 persons who are residents of the city of Milwaukee and are appointed by the mayor
12of the city of Milwaukee as provided under s. 62.09 (8) (cm), and 6 persons who are
13residents of Milwaukee County but are not residents of the city of Milwaukee and are
14appointed by the county executive of Milwaukee County.
AB807, s. 9 15Section 9. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
16the following amounts for the purposes indicated: - See PDF for table PDF
AB807, s. 10 17Section 10. 20.430 of the statutes is created to read:
AB807,7,3
120.430 Health planning and finance, department of. There is
2appropriated to the department of health planning and finance for the following
3program:
AB807,7,6 4(1) Health planning and finance. (a) General program operations. The
5amounts in the schedule for the general program operations of the department of
6health planning and finance.
AB807,7,87 (b) Health plan services and benefits. The amounts in the schedule for health
8care services and benefits provided under s. 152.10 (4).
AB807,7,109 (c) Job retraining and placement. The amounts in the schedule for job
10retraining and placement services under s. 152.40 (6).
AB807,7,1211 (i) Gifts and grants. All moneys received from gifts, grants, bequests, and
12devises to carry out the purposes for which made.
AB807,7,1513 (m) Federal funds; state operations. All moneys received from the federal
14government, as authorized by the governor under s. 16.54, for the purposes for which
15made and received.
AB807, s. 11 16Section 11. 59.17 (2) (c) of the statutes is amended to read:
AB807,7,2117 59.17 (2) (c) Appoint the members of all boards and, commissions, and councils
18where appointments are required and where the statutes provide that the
19appointments are made by the county board or by the, chairperson of the county
20board, or county executive. All appointments to boards and, commissions, and
21councils
by the county executive are subject to confirmation by the county board.
AB807, s. 12 22Section 12. 59.53 (25) of the statutes is created to read:
AB807,7,2523 59.53 (25) Regional consumer health council. The board shall appoint
24members of a regional consumer health council, as specified in s. 15.207 (1) (b) 1. to
255.
AB807, s. 13
1Section 13. 62.09 (8) (cm) of the statutes is created to read:
AB807,8,42 62.09 (8) (cm) The mayor of the city of Milwaukee shall, with the advice and
3consent of the common council of that city, appoint 6 members of a regional consumer
4health council, as specified under s. 15.207 (1) (b) 6.
AB807, s. 14 5Section 14. Chapter 152 of the statutes is created to read:
AB807,8,76 Chapter 152
7 health plan
AB807,8,8 8152.01 Definitions. In this chapter:
AB807,8,9 9(1) "Block grant" has the meaning given in s. 16.54 (2) (a) 3.
AB807,8,10 10(2) "Board" means the health policy board.
AB807,8,11 11(3) "Department" means the department of health planning and finance.
AB807,8,12 12(4) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
AB807,8,21 13(5) "Health care facility" means a facility, as defined in s. 647.01 (4), or any
14hospital, nursing home, community-based residential facility, county home, county
15infirmary, county hospital, county mental health center, community health center,
16primary health center, tuberculosis sanatorium, adult family home, assisted living
17facility, rural medical center, hospice, or other place licensed, certified, or approved
18by the department of health and family services under s. 49.70, 49.71, 49.72, 50.02,
1950.03, 50.032, 50.033, 50.034, 50.35, 50.52, 50.92 (2), 51.08, or 51.09 or a facility
20under s. 45.365, 51.05, 51.06, or 252.10 or ch. 233, or licensed or certified by a county
21department under s. 50.032 or 50.033.
AB807,8,23 22(6) "Health care provider" means a provider of health care services or other
23benefits in this state that are specified under s. 152.10 (4).
AB807,8,25 24(7) "Medicare" means coverage under part A or part B of Title XVIII of the
25federal Social Security Act, 42 USC 1395 to 1395ddd.
AB807,9,2
1(8) "Reimbursement" means payment for the provision of services and other
2benefits that are specified under s. 152.10 (4).
AB807,9,3 3(9) "Secretary" means the secretary of health planning and finance.
AB807,9,4 4(10) "Veteran" has the meaning given in 38 USC 101 (2).
AB807,9,12 5152.10 Health plan. (1) There is created a health plan in this state, under
6which, beginning on July 1, 2008, each eligible person, regardless of any preexisting
7condition, shall receive reasonable medical service necessary to maintain health,
8enable diagnosis, or provide treatment or rehabilitation for an injury, condition,
9disability, or disease, for which reimbursement shall be made by the department.
10Coverage is provided under the health plan for orthodontia or for the performance
11of reconstructive or cosmetic surgery that is determined to be necessary under
12criteria that are promulgated as rules by the department.
AB807,9,16 13(2) Each individual in this state who is not excluded from residency, as specified
14in sub. (3) (c), is eligible for coverage under the health plan, except as provided in sub.
15(5), and except that all of the following may be phased in for eligibility under this
16subsection, beginning no later than July 1, 2009:
AB807,9,1817 (a) Individuals, other than those specified in par. (b), who have no coverage
18under disability insurance policies.
AB807,9,2219 (b) Individuals who have no coverage under disability insurance policies and
20who receive health care, treatment for nervous or mental disorders, or treatment or
21prevention services for alcohol and other drug abuse that are funded by state or local
22funding.
AB807,9,2423 (c) Individuals who are employees of the state or any county, city, village, or
24town, and who, as a benefit of the employment, have coverage for themselves and

1family members under provisions of group disability insurance policies or under
2self-insured health plans.
AB807,10,53 (d) Individuals, other than those specified in par. (c) or (h), who, by reason of
4their employment or as family members of individuals who are employed, have
5coverage under group disability insurance policies.
AB807,10,76 (e) Individuals who have coverage under individual disability insurance
7policies.
AB807,10,98 (f) Individuals who have coverage under the health insurance risk-sharing
9plan under ch. 149.
AB807,10,1110 (g) Individuals who are eligible for benefits or services under s. 49.46, 49.468,
1149.47, or 49.665, Medicare, or block grants that provide health care services.
AB807,10,1412 (h) Individuals who are employees of self-insured employers, other than those
13specified in par. (c), and who receive health care benefits for themselves and family
14members under self-insured health plans.
AB807,10,1515 (i) Individuals who receive medical benefits under worker's compensation.
AB807,10,1816(j) Veterans who receive medical benefits under s. 45.351 (1j) or 38 USC 1701
17to 1774, or both, and the children of veterans who receive medical benefits under 38
18USC 1801
to 1806.
AB807,10,2019 (k) Members of federally-recognized American Indian tribes or bands who
20receive health and other services under 25 USC 1651 to 1683.
AB807,10,25 21(3) (a) Any individual who is eligible under sub. (2) may receive services that
22are available under the health plan from any participating health care provider in
23this state. Services that correspond to those that are available under the health plan
24and that are provided to the individual in another state are reimbursable at rates
25under the health plan that are current at the time of service provision.
AB807,11,3
1(b) No individual who is eligible under sub. (2) may under this section be
2required to pay an amount as a deductible or copayment as a condition for receipt of
3services under this section from a health care facility or health care provider.
AB807,11,74 (c) An individual who has a fixed habitation outside the state but not inside the
5state is not a resident for purposes of this chapter. Any reimbursement paid under
6the health plan for health care services rendered to an individual who is determined
7not to be a resident is a liability of the individual.
AB807,11,9 8(4) Health care services and other benefits provided under the health plan shall
9include all of the following:
AB807,11,1110 (a) Services of all persons licensed, certified, registered, or permitted to treat
11the sick under chs. 441, 446, 447, 448, 449, 450, 451, 455, 457, and 459.
AB807,11,1312 (b) Health care services that are provided by health care facilities and the
13offices and clinics of persons under par. (a).
AB807,11,1514 (c) Preventive health care services and health promotional programs, including
15well-child care, immunizations, screening, outreach, and education.
AB807,11,1816 (d) Medical or surgical supplies and durable medical or surgical equipment,
17supplies and appliances, including valves, pacemakers, prostheses, eyeglasses, and
18hearing aids.
AB807,11,2119 (e) Prescription drugs specified in the listing of approved medicinal substances
20and formulae under s. 152.40 (5) (m) and any other drugs specified by the department
21by rule.
AB807,11,2222 (f) Blood and blood products.
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