Amendment ASA1-AB100

AB100-ASA1, s. 2244 Section 2244. 149.10 (5m) of the statutes is created to read:

AB100-ASA1,1355,6 149.10 (5m) "Limited service health organization" has the meaning given in s. 609.01 (3).

AB100-ASA1, s. 2245 Section 2245. 149.10 (8c) of the statutes is created to read:

AB100-ASA1,1355,10 149.10 (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.

AB100-ASA1, s. 3020p Section 3020p. 149.10 (8j) of the statutes is created to read:

AB100-ASA1,1355,16 149.10 (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.

AB100-ASA1, s. 2246 Section 2246. 149.10 (8m) of the statutes is created to read:

AB100-ASA1,1355,18 149.10 (8m) "Preferred provider plan" has the meaning given in s. 609.01 (4).

AB100-ASA1, s. 2247 Section 2247. 149.10 (8p) of the statutes is created to read:

AB100-ASA1,1355,22 149.10 (8p) "Premium" means any consideration for an insurance policy, and includes assessments, membership fees or other required contributions or consideration, however designated.

AB100-ASA1, s. 2248 Section 2248. 149.10 (10) of the statutes is created to read:

AB100-ASA1,1355,24 149.10 (10) "Secretary" means the secretary of health and family services.

AB100-ASA1, s. 2249 Section 2249. 149.10 (11) of the statutes is created to read:

AB100-ASA1,1356,2 149.10 (11) "State" means the same as in s. 990.01 (40) except that it also includes the Panama Canal Zone.

AB100-ASA1, s. 3025f Section 3025f. 149.12 (2) (f) of the statutes is created to read:

AB100-ASA1,1356,5 149.12 (2) (f) No person who is eligible for medical assistance is eligible for coverage under the plan.

AB100-ASA1, s. 3026c Section 3026c. 149.14 (4m) of the statutes is created to read:

AB100-ASA1,1356,12 149.14 (4m) Discounted payment is payment in full. A provider of a covered service or article shall accept as payment in full for the covered service or article the discounted reimbursement rate determined under ss. 149.143 (2) (a) 3. and (3), 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 (2) (a) 3. or (3), 149.144 or 149.15 (3) (e).

AB100-ASA1, s. 3026f Section 3026f. 149.143 of the statutes is created to read:

AB100-ASA1,1356,15 149.143 Payment of plan costs. (1) The department shall pay or recover the operating, administrative and subsidy costs of the plan as follows:

AB100-ASA1,1356,16 (a) First from the appropriation under s. 20.435 (5) (af).

AB100-ASA1,1356,17 (b) The remainder of the costs as follows:

AB100-ASA1,1356,18 1. A total of 60% from all of the following:

AB100-ASA1,1356,19 a. The appropriation under s. 20.435 (5) (ah).

AB100-ASA1,1356,21 b. Insurer assessments and provider reimbursement discounts under s. 149.144.

AB100-ASA1,1356,23 c. Subject to sub. (2) (a) 1. and s. 149.146 (2) (b), premiums collected from eligible persons.

AB100-ASA1,1356,24 2. A total of 40% as follows:

AB100-ASA1,1357,2 a. Fifty percent from insurer assessments, excluding assessments under s. 149.144.

AB100-ASA1,1357,4 b. Fifty percent from discounts to provider reimbursement rates, excluding discounts under ss. 149.144 and 149.15 (3) (e).

AB100-ASA1,1357,8 (2) (a) Prior to each plan year, the department shall estimate the operating, administrative and subsidy costs of the plan for the new plan year and, taking into consideration the funds expected to be available under s. 20.435 (5) (af) and (ah), do all of the following:

AB100-ASA1,1357,14 1. By rule set premium rates for the new plan year, including the rates under s. 149.146 (2) (b), by estimating the rates necessary to equal the amount specified in sub. (1) (b) 1. c., except that a rate for coverage under s. 149.14 may not be 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.

AB100-ASA1,1357,17 2. By rule set the total insurer assessments under s. 149.13 for the new plan year by estimating the amount necessary to equal the amount specified in sub. (1) (b) 2. a. and notify the commissioner of the amount.

AB100-ASA1,1357,20 3. By the same rule set the rate at which provider charges shall be discounted for the new plan year by estimating the rate necessary to equal the amount specified in sub. (1) (b) 2. b.

AB100-ASA1,1357,25 (b) In setting the rates under par. (a) 1. and 3. and the amount under par. (a) 2. for the new plan year, the department shall include any increase or decrease necessary to reflect the amount, if any, by which the rates and amount set under par. (a) for the current plan year differed from the rates and amount which would have equaled the amounts specified in sub. (1) in the current plan year.

AB100-ASA1,1358,9 (3) (a) If, during a plan year, the department determines that the moneys under s. 20.435 (5) (af) and (ah), the amounts set under sub. (2) (a) and any increases in insurer assessments and provider discounts under s. 149.144 are not sufficient to cover plan costs, the department may by rule increase the premium rates set under sub. (2) (a) 1. for the remainder of the plan year, subject to subs. (1) (b) 1. and (2) (a) 1. and s. 149.146 (2) (b), increase the assessments set under sub. (2) (a) 2. for the remainder of the plan year, subject to sub. (1) (b) 2. a., and increase the discount rate set under sub. (2) (a) 3. for the remainder of the plan year, subject to sub. (1) (b) 2. b.

AB100-ASA1,1358,17 (b) If, after increasing premium rates, assessments and discount rates under par. (a), the department determines that there will still be a deficit and that premium rates have been increased to the maximum extent allowable under par. (a), the department shall further increase, in equal proportions, assessments set under sub. (2) (a) 2. and discount rates set under sub. (2) (a) 3., without regard to sub. (1) (b) 2. Insurers and providers affected by this paragraph may recover the assessment increase and the discount rate increase in the normal course of their respective businesses without time limitation, subject to s. 149.14 (4m).

AB100-ASA1,1358,22 (4) Using the procedure under s. 227.24, the department may promulgate rules under sub. (2) or (3) for the period before the effective date of any permanent rules promulgated under sub. (2) or (3), but not to exceed the period authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) and (3), the department is not required to make a finding of emergency.

AB100-ASA1,1359,2 (5) Notwithstanding sub. (2) (a) (intro.), the department shall set premium rates, insurer assessments and provider discount rates for the period beginning on January 1, 1998, and ending on June 30, 1998, in the manner provided in subs. (1), (2) (a), (3) and (4). This subsection applies to policies in effect on January 1, 1998, as well as to policies issued or renewed on or after January 1, 1998.

AB100-ASA1, s. 3027m Section 3027m. 149.15 (2m) of the statutes is created to read:

AB100-ASA1,1359,6 149.15 (2m) Annually, beginning in 1999, the board shall submit a report on or before June 30 to the legislature under s. 13.172 (2) and to the governor on the operation of the plan, including any recommendations for changes to the plan.

AB100-ASA1, s. 2250 Section 2250. 149.16 (title) of the statutes is created to read:

AB100-ASA1,1359,8 149.16 (title) Plan administrator.

AB100-ASA1, s. 2251 Section 2251. 149.16 (1) of the statutes is created to read:

AB100-ASA1,1359,11 149.16 (1) The department shall contract with an organization or other person to administer the plan.

AB100-ASA1, s. 2252 Section 2252. 150.21 (1) of the statutes is amended to read:

AB100-ASA1,1359,13 150.21 (1) The construction or total replacement of a new nursing home.

AB100-ASA1, s. 2253 Section 2253. 150.21 (3) of the statutes is amended to read:

AB100-ASA1,1359,16 150.21 (3) A capital expenditure, other than a renovation or replacement, that exceeds $1,000,000 by or on behalf of a nursing home.

AB100-ASA1, s. 2254 Section 2254. 150.21 (4) of the statutes is amended to read:

AB100-ASA1,1359,19 150.21 (4) An expenditure, other than a renovation or replacement, that exceeds $600,000 for clinical equipment by or on behalf of a nursing home.

AB100-ASA1, s. 3035v Section 3035v. 150.31 (4) of the statutes is amended to read:

AB100-ASA1,1359,24 150.31 (4) The department may decrease the statewide bed limit in facilities primarily serving the developmentally disabled in order to account for any decreased use of beds at the a state centers center for the developmentally disabled due to the community integration program under s. 46.275.

AB100-ASA1, s. 2255 Section 2255. 150.31 (5t) of the statutes is created to read:

AB100-ASA1,1360,3 150.31 (5t) The department shall decrease the statewide bed limits specified in sub. (1) to account for any reduction in the licensed bed capacity of a nursing home that has relinquished use of a bed, as specified in s. 49.45 (6m) (ap) 4.

AB100-ASA1, s. 2256 Section 2256. 150.35 (3m) (a) 3. of the statutes is amended to read:

AB100-ASA1,1360,8 150.35 (3m) (a) 3. All applications for activities that are specified in s. 150.21 (3), that are renovations with capital expenditures which do not exceed $1,500,000 and that do not include additions, the replacement of a nursing home or an increase in the bed capacity of a nursing home.

AB100-ASA1, s. 2257 Section 2257. 150.39 (2) of the statutes is amended to read:

AB100-ASA1,1360,13 150.39 (2) The cost of renovating or providing an equal number of nursing home beds or of an equal expansion would be consistent with the cost at similar nursing homes, and the applicant's per diem rates would be consistent with those of similar nursing homes.

AB100-ASA1, s. 2258 Section 2258. 153.01 (4) of the statutes is created to read:

AB100-ASA1,1360,15 153.01 (4) "Department" means the department of health and family services.

AB100-ASA1, s. 2259 Section 2259. 153.01 (4m) of the statutes is repealed.

AB100-ASA1, s. 2260 Section 2260. 153.01 (6) of the statutes is repealed.

AB100-ASA1, s. 2261 Section 2261. 153.05 (1) (c) 1. of the statutes is amended to read:

AB100-ASA1,1360,23 153.05 (1) (c) 1. Identification of charges in each hospital's most recent entire fiscal year for up to 100 charge elements, as selected by the office department, and identification of the increase or decrease in charges for each of these charge elements from amounts charged during the hospital's entire fiscal year that is nearest in time to the hospital's most recent entire fiscal year.

AB100-ASA1, s. 2262 Section 2262. 153.05 (1) (e) of the statutes is amended to read:

AB100-ASA1,1361,4 153.05 (1) (e) Final audited financial statements of hospitals that include, for a hospital's most recent entire fiscal year, as dollar amounts, the amounts of revenue and expenditures for the hospital, in categories specified in rules promulgated by the commissioner department.

AB100-ASA1, s. 2263 Section 2263. 153.05 (2) of the statutes is amended to read:

AB100-ASA1,1361,12 153.05 (2) The office department shall provide copies of reports published under ss. 153.10 to 153.35 at no charge to hospitals assessed under s. 153.60 (1) and, if assessed, at no charge to ambulatory surgery centers assessed under s. 153.60 (2). The office department shall provide copies of the reports to any person, upon the person's request, and the board shall advise the office department as to whether the copies shall be provided at no charge or at a charge not to exceed the cost of printing, copying and mailing the report to the person.

AB100-ASA1, s. 2264 Section 2264. 153.05 (3) of the statutes is amended to read:

AB100-ASA1,1361,16 153.05 (3) Upon request of the office department, state agencies shall provide health care information to the office department for use in preparing reports under ss. 153.10 to 153.35.

AB100-ASA1, s. 2265 Section 2265. 153.05 (4) of the statutes is amended to read:

AB100-ASA1,1361,24 153.05 (4) (a) The office department, under rules promulgated by the commissioner department, shall require hospitals to use, and private-pay patients and payers who are insurers to accept, uniform patient billing forms, shall require hospitals to submit to the office department the information provided on the billing forms, including, for an injury, the external cause of the event, and may require payers who are insurers to use a standard set of definitions for base data reporting under a uniform patient billing form.

AB100-ASA1,1362,6 (b) The office department, under rules promulgated by the commissioner department, may require ambulatory surgery centers to use uniform patient billing forms and other information, and, if so requiring, shall require ambulatory surgery centers to submit to the office department the information provided on the billing forms, including, for an injury, the external cause of the event, using a standard set of definitions for base data reporting.

AB100-ASA1, s. 2266 Section 2266. 153.05 (5) of the statutes is amended to read:

AB100-ASA1,1362,8 153.05 (5) The office department:

AB100-ASA1,1362,11 (a) Shall require hospitals to submit information regarding medical malpractice, staffing levels and patient case-mix, and expenditures related to labor relations consultants, as specified by the office department.

AB100-ASA1,1362,16 (b) May require hospitals to submit to the office department information from sources identified under sub. (1) (a) to (e) that the office department deems necessary for the preparation of reports, plans and recommendations under ss. 153.10 to 153.35 and any other reports required of the office department in the form specified by the office department.

AB100-ASA1,1362,20 (bm) Shall require a hospital to submit to the office department information from sources identified under sub. (1) (e) by the date that is 4 months following the close of the hospital's fiscal year unless the office department grants an extension of time to file the information.

AB100-ASA1, s. 2267 Section 2267. 153.05 (6) of the statutes is amended to read:

AB100-ASA1,1363,2 153.05 (6) If the requirements of s. 153.07 (2) are first met, the office department may contract with a public or private entity that is not a major purchaser, payer or provider of health care services in this state for the provision of data processing services for the collection, analysis and dissemination of health care information under sub. (1) or the department of health and family services shall provide the services under s. 153.07 (2).

AB100-ASA1, s. 2268 Section 2268. 153.05 (6m) of the statutes is amended to read:

AB100-ASA1,1363,11 153.05 (6m) If the requirements of s. 153.07 (2) are first met, the office department may contract with the group insurance board for the provision of data collection and analysis services related to health maintenance organizations and insurance companies that provide health insurance for state employes or the commissioner department shall provide the services under s. 153.07 (2). The office department shall establish contract fees for the provision of the services. All moneys collected under this subsection shall be credited to the appropriation under s. 20.145 (8) 20.435 (1) (kx).

AB100-ASA1, s. 2269 Section 2269. 153.05 (7) of the statutes is amended to read:

AB100-ASA1,1363,16 153.05 (7) The office department may require each insurer authorized to write disability insurance to submit to the office department information obtained on uniform patient billing forms regarding reported claims for health care services which insureds who are residents of this state obtain in another state.

AB100-ASA1, s. 2270 Section 2270. 153.05 (8) of the statutes is amended to read:

AB100-ASA1,1364,2 153.05 (8) Beginning April 1, 1992, the office department shall collect, analyze and disseminate, in language that is understandable to lay persons, health care information under the provisions of this chapter, as determined by rules promulgated by the commissioner department, from health care providers, as defined by rules promulgated by the commissioner department, other than hospitals and ambulatory surgery centers. Data from physicians shall be obtained through sampling techniques in lieu of collection of data on all patient encounters and data collection procedures shall minimize unnecessary duplication and administrative burdens.

AB100-ASA1, s. 2271 Section 2271. 153.05 (9) of the statutes is amended to read:

AB100-ASA1,1364,7 153.05 (9) The office department shall provide orientation and training to physicians, hospital personnel and other health care providers to explain the process of data collection and analysis and the procedures for data verification, interpretation and release.

AB100-ASA1, s. 2272 Section 2272. 153.05 (11) of the statutes is amended to read: