146.40 (4r) (d) If the nurse's assistant or home health aide person specified in the report received under par. (b) (a) or (am) timely notifies the department division of hearings and appeals created under s. 15.103 (1) that he or she contests the listings in the registry under par. (b), the department division of hearings and appeals shall hold a hearing under the requirements of ch. 227. If after presentation of evidence a hearing officer finds that there is no reasonable cause to believe that the nurse's assistant or home health aide person specified in the report received under par. (a) or (am) performed an action alleged under par. (a) or (am), the hearing officer shall dismiss the proceeding. If after presentation of evidence a hearing officer finds that there is reasonable cause to believe that the nurse's assistant or home health aide
person specified in the report received under par. (a) or (am) performed an action alleged under par. (a) or (am), the hearing officer shall so find and shall cause the name of the nurse's assistant or home health aide person specified in the report received under par. (a) or (am) to be entered under sub. (4g) (a) 2. and the hearing officer's findings about the nurse's assistant or home health aide person specified in the report received under par. (a) or (am) to be entered under sub. (4g) (a) 3.
27,2986un
Section 2986un. 146.40 (4r) (em) and (er) of the statutes are created to read:
146.40 (4r) (em) If the department of health and family services receives a report under par. (a) or (am) and determines that a person who is the subject of the report holds a credential that is related to the person's employment at, or contract with, the entity, the department of health and family services shall refer the report to the department of regulation and licensing.
(er) The department may contract with private field investigators to conduct investigations of reports received by the department under par. (a) or (am).
27,3004
Section 3004
. 146.55 (4) (a) of the statutes is amended to read:
146.55 (4) (a) From the appropriation under s. 20.435 (1) (rm) (5) (ch), the department shall annually distribute funds for ambulance service vehicles or vehicle equipment, emergency medical services supplies or equipment or emergency medical training for personnel to an ambulance service provider that is a public agency, a volunteer fire department or a nonprofit corporation, under a funding formula consisting of an identical base amount for each ambulance service provider plus a supplemental amount based on the population of the ambulance service provider's primary service or contract area, as established under s. 146.50 (5).
27,3005
Section 3005
. 146.55 (5) of the statutes is amended to read:
146.55 (5) Emergency medical technician training and examination aid. From the appropriation under s. 20.435 (1) (rm) (5) (ch), the department shall annually distribute funds to entities, including technical college districts, whose courses or instructional programs are approved by the department under s. 146.50 (9), to assist the entities in providing the training required for licensure and renewal of licensure as an emergency medical technician—basic under s. 146.50 (6), and to fund each examination administered by the entity for licensure or renewal of licensure as an emergency medical technician—basic under s. 146.50 (6) (a) 3. and (b) 1.
27,3006
Section 3006
. 146.57 (3) (a) of the statutes is amended to read:
146.57 (3) (a) The department shall implement a statewide poison control program. From the appropriation under s. 20.435 (1) (5) (ds), the department shall, if the requirement under par. (b) is met, distribute total funding of not more than $187,500 $375,000 in each fiscal year to supplement the operation of the program and to provide for the statewide collection and reporting of poison control data. The department may, but need not, distribute all of the funds in each fiscal year to a single poison control center.
27,3007
Section 3007
. 146.58 (8) of the statutes is amended to read:
146.58 (8) Review the annual budget prepared by the department for the expenditures under s. 20.435 (1) (rm) (5) (ch).
27,3009
Section 3009
. 146.81 (1) (hm) of the statutes is amended to read:
146.81 (1) (hm) A speech-language pathologist or audiologist licensed under subch. II of ch. 459 or a speech and language pathologist licensed by the department of education public instruction.
27,3009m
Section 3009m. 146.89 (2) (a) 1. of the statutes is renumbered 146.89 (2) (a) and amended to read:
146.89 (2) (a) A volunteer health care provider may participate under this section only if he or she submits a joint application with a nonprofit agency in a county that is specified under sub. (3) (a) 1. to the department of administration and that department approves the application. The department of administration shall provide application forms for use under this subdivision
paragraph.
27,3009n
Section 3009n. 146.89 (2) (a) 2. of the statutes is repealed.
27,3009p
Section 3009p. 146.89 (3) (a) 1. of the statutes is repealed.
27,3009qs
Section 3009qs. 146.89 (3) (a) 2. of the statutes is renumbered 146.89 (3) (a) and amended to read:
146.89 (3) (a) The volunteer health care provider shall provide services under par. (b) without charge in any county, other than those counties specified in subd. 1., at the nonprofit agency, if the joint application of the volunteer health care provider and the nonprofit agency in that county has received approval under sub. (2) (a) 2.
27,3010m
Section 3010m. 146.92 of the statutes is created to read:
146.92 Primary health care grant program. (1) In this section:
(a) “Community-based nonprofit corporation" means a nonprofit corporation that is governed by a community-based board of directors and that is organized primarily to provide primary health care services in a geographic area, or to a population, that the department designates as medically underserved.
(b) “Nonprofit corporation" means a nonstock, nonprofit corporation organized under ch. 181.
(2) Prior to implementing the grant program under this section, the department shall consult with representatives of statewide organizations that represent primary health care providers.
(3) From the appropriation under s. 20.435 (5) (gp), the department shall award $1,500,000 in grants in each
fiscal year to community-based nonprofit corporations under a competitive process established by the department.
(4) A community-based nonprofit corporation that receives a grant under this section shall do all of the following:
(a) Provide comprehensive primary health care services to any person regardless of insurance status or ability to pay.
(b) Establish a sliding fee scale for uninsured, low-income persons.
27,3010p
Section 3010p. 146.93 (title) of the statutes is amended to read:
146.93 (title) Primary Supplemental primary health care program.
27,3011
Section
3011. 146.93 (1) (a) of the statutes is amended to read:
146.93 (1) (a) From the appropriation under s. 20.435 (1) (gp) (5) (kp), the department shall maintain a program for the provision of primary health care services based on the primary health care program in existence on June 30, 1987. The department may promulgate rules necessary to implement the program.
27,3011m
Section 3011m. 146.93 (4) (d) of the statutes is created to read:
146.93 (4) (d) The individual received health care services under this section on the effective date of this paragraph .... [revisor inserts date], and cannot be served by an entity that receives a grant under s. 146.92.
27,3012
Section
3012. 146.99 of the statutes is amended to read:
146.99 Assessments. The department shall, within 90 days after the commencement of each fiscal year, estimate the total amount of expenditures and the department shall assess the estimated total amount under s. 20.435 (1) (5) (gp) to hospitals, as defined in s. 50.33 (2), in proportion to each hospital's respective gross private-pay patient revenues during the hospital's most recently concluded entire fiscal year. Each hospital shall pay its assessment on or before December 1 for the fiscal year. All payments of assessments shall be deposited in the appropriation under s. 20.435 (1) (5) (gp).
27,3013
Section 3013
. Chapter 149 (title) of the statutes is created to read:
Chapter 149
Mandatory health insurance
risk-sharing plan
27,3014
Section 3014
. 149.10 (2f) of the statutes is created to read:
149.10 (2f) “Commissioner" means the commissioner of insurance.
27,3015
Section 3015
. 149.10 (2m) of the statutes is created to read:
149.10 (2m) “Department" means the department of health and family services.
27,3016
Section 3016
. 149.10 (4c) of the statutes is created to read:
149.10 (4c) “Health maintenance organization" has the meaning given in s. 609.01 (2).
27,3017
Section 3017
. 149.10 (4p) of the statutes is created to read:
149.10 (4p) (a) “Insurance" includes any of the following:
1. Risk distributing arrangements providing for compensation of damages or loss through the provision of services or benefits in kind rather than indemnity in money.
2. Contracts of guaranty or suretyship entered into by the guarantor or surety as a business and not as merely incidental to a business transaction.
3. Plans established and operated under ss. 185.981 to 185.985.
(b) “Insurance" does not include a continuing care contract, as defined in s. 647.01 (2).
27,3018
Section 3018
. 149.10 (5m) of the statutes is created to read:
149.10 (5m) “Limited service health organization" has the meaning given in s. 609.01 (3).
27,3019c
Section 3019c. 149.10 (8b) of the statutes is created to read:
149.10 (8b) “Plan administrator" means the fiscal agent specified in s. 149.16 (1).
27,3020
Section 3020
. 149.10 (8c) of the statutes is created to read:
149.10 (8c) “Policy" means any document other than a group certificate used to prescribe in writing the terms of an insurance contract, including endorsements and riders and service contracts issued by motor clubs.
27,3020p
Section 3020p. 149.10 (8j) of the statutes is created to read:
149.10 (8j) “Preexisting condition exclusion" means, with respect to coverage, a limitation or exclusion of benefits relating to a condition of an individual that existed before the individual's date of enrollment for coverage, whether or not the individual received any medical advice or recommendation, diagnosis, care or treatment related to the condition before that date.
27,3021
Section 3021
. 149.10 (8m) of the statutes is created to read:
149.10 (8m) “Preferred provider plan" has the meaning given in s. 609.01 (4).
27,3022
Section 3022
. 149.10 (8p) of the statutes is created to read:
149.10 (8p) “Premium" means any consideration for an insurance policy, and includes assessments, membership fees or other required contributions or consideration, however designated.
27,3023
Section 3023
. 149.10 (10) of the statutes is created to read:
149.10 (10) “Secretary" means the secretary of health and family services.
27,3024
Section 3024
. 149.10 (11) of the statutes is created to read:
149.10 (11) “State" means the same as in s. 990.01 (40) except that it also includes the Panama Canal Zone.
27,3025f
Section 3025f. 149.12 (2) (f) of the statutes is created to read:
149.12 (2) (f) No person who is eligible for medical assistance is eligible for coverage under the plan.
27,3026c
Section 3026c. 149.14 (4m) of the statutes is created to read:
149.14 (4m) Payment is payment in full. Except for copayments, coinsurance or deductibles required or authorized under the plan, a provider of a covered service or article shall accept as payment in full for the covered service or article the payment rate determined under ss. 149.143, 149.144 and 149.15 (3) (e) and may not bill an eligible person who receives the service or article for any amount by which the charge for the service or article is reduced under s. 149.143, 149.144 or 149.15 (3) (e).
27,3026f
Section 3026f. 149.143 of the statutes is created to read:
149.143 Payment of plan costs.
(1) The department shall pay or recover the operating and administrative costs of the plan as follows:
(a) First from the appropriation under s. 20.435 (5) (af).
(b) The remainder of the costs as follows:
1. A total of 60% from the following sources, calculated as follows:
a. First, from premiums from eligible persons with coverage under s. 149.14 set at 150% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan, including amounts received for premium and deductible subsidies under ss. 20.435 (5) (ah) and 149.144, and from premiums collected from eligible persons with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b).
b. Second, from the appropriation under s. 20.435 (5) (gh), to the extent that the amounts under subd. 1. a. are insufficient to pay 60% of plan costs.
c. Third, by increasing premiums from eligible persons with coverage under s. 149.14 to more than 150% but not more than 200% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan, including amounts received for premium and deductible subsidies under ss. 20.435 (5) (ah) and 149.144, and by increasing premiums from eligible persons with coverage under s. 149.146 in accordance with s. 149.146 (2) (b), to the extent that the amounts under subd. 1. a. and b. are insufficient to pay 60% of plan costs.
d. Fourth, notwithstanding subd. 2., by increasing insurer assessments, excluding assessments under s. 149.144, and adjusting provider payment rates, excluding adjustments to those rates under ss. 149.144 and 149.15 (3) (e), in equal proportions and to the extent that the amounts under subd. 1. a. to c. are insufficient to pay 60% of plan costs.
2. A total of 40% as follows:
a. Fifty percent from insurer assessments, excluding assessments under s. 149.144.
b. Fifty percent from adjustments to provider payment rates, excluding adjustments to those rates under ss. 149.144 and 149.15 (3) (e).
(2) (a) Prior to each plan year, the department shall estimate the operating and administrative costs of the plan and the costs of the premium reductions under s. 149.165 and the deductible reductions under s. 149.14 (5) (a) for the new plan year and do all of the following:
1. a. Estimate the amount of enrollee premiums that would be received in the new plan year if the enrollee premiums were set at a level sufficient, when including amounts received for premium and deductible subsidies under ss. 20.435 (5) (ah) and 149.144 and from premiums collected from eligible persons with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b), to cover 60% of the estimated plan costs for the new plan year, after deducting from the estimated plan costs the amount available in the appropriation under s. 20.435 (5) (af) for that plan year.
b. Estimate the amount of enrollee premiums that will be received under sub. (1) (b) 1. a.
c. If the amount estimated to be received under subd. 1. a. is less than the amount estimated to be received under subd. 1. b., direct the plan administrator to provide to the department, prior to the beginning of the plan year and according to procedures specified by the department, the amount of the difference. The department shall deposit all amounts received under this subd. 1. c. in the appropriation account under s. 20.435 (5) (gh).
2. After making the determinations under subd. 1., by rule set premium rates for the new plan year, including the rates under s. 149.146 (2) (b), in the manner specified in sub. (1) (b) 1. a. and c. and such that a rate for coverage under s. 149.14 is not less than 150% nor more than 200% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan.
