AB100-engrossed,1553,220
146.55
(4) (a) From the appropriation under s. 20.435
(1) (rm) (5) (ch), the
21department shall annually distribute funds for ambulance service vehicles or vehicle
22equipment, emergency medical services supplies or equipment or emergency
23medical training for personnel to an ambulance service provider that is a public
24agency, a volunteer fire department or a nonprofit corporation, under a funding
25formula consisting of an identical base amount for each ambulance service provider
1plus a supplemental amount based on the population of the ambulance service
2provider's primary service or contract area, as established under s. 146.50 (5).
AB100-engrossed,1553,114
146.55
(5) Emergency medical technician training and examination aid. From
5the appropriation under s. 20.435
(1) (rm) (5) (ch), the department shall annually
6distribute funds to entities, including technical college districts, whose courses or
7instructional programs are approved by the department under s. 146.50 (9), to assist
8the entities in providing the training required for licensure and renewal of licensure
9as an emergency medical technician—basic under s. 146.50 (6), and to fund each
10examination administered by the entity for licensure or renewal of licensure as an
11emergency medical technician—basic under s. 146.50 (6) (a) 3. and (b) 1.
AB100-engrossed,1553,1913
146.57
(3) (a) The department shall implement a statewide poison control
14program. From the appropriation under s. 20.435
(1)
(5) (ds), the department shall,
15if the requirement under par. (b) is met, distribute total funding of not more than
16$187,500 $375,000 in each fiscal year to supplement the operation of the program
17and to provide for the statewide collection and reporting of poison control data. The
18department may, but need not, distribute all of the funds in each fiscal year to a single
19poison control center.
AB100-engrossed,1553,2221
146.58
(8) Review the annual budget prepared by the department for the
22expenditures under s. 20.435
(1) (rm) (5) (ch).
AB100-engrossed,1554,3
1146.81
(1) (hm) A speech-language pathologist or audiologist licensed under
2subch. II of ch. 459 or a speech and language pathologist licensed by the department
3of
education public instruction.
AB100-engrossed, s. 3009m
4Section 3009m. 146.89 (2) (a) 1. of the statutes is renumbered 146.89 (2) (a)
5and amended to read:
AB100-engrossed,1554,106
146.89
(2) (a) A volunteer health care provider may participate under this
7section only if he or she submits a joint application with a nonprofit agency
in a
8county that is specified under sub. (3) (a) 1. to the department of administration and
9that department approves the application. The department of administration shall
10provide application forms for use under this
subdivision paragraph.
AB100-engrossed, s. 3009qs
13Section 3009qs. 146.89 (3) (a) 2. of the statutes is renumbered 146.89 (3) (a)
14and amended to read:
AB100-engrossed,1554,1815
146.89
(3) (a) The volunteer health care provider shall provide services under
16par. (b) without charge
in any county, other than those counties specified in subd. 1., 17at the nonprofit agency, if the
joint application of the volunteer health care provider
18and the nonprofit agency
in that county has received approval under sub. (2) (a)
2.
AB100-engrossed,1554,20
20146.92 Primary health care grant program. (1) In this section:
AB100-engrossed,1554,2421
(a) "Community-based nonprofit corporation" means a nonprofit corporation
22that is governed by a community-based board of directors and that is organized
23primarily to provide primary health care services in a geographic area, or to a
24population, that the department designates as medically underserved.
AB100-engrossed,1555,2
1(b) "Nonprofit corporation" means a nonstock, nonprofit corporation organized
2under ch. 181.
AB100-engrossed,1555,5
3(2) Prior to implementing the grant program under this section, the
4department shall consult with representatives of statewide organizations that
5represent primary health care providers.
AB100-engrossed,1555,8
6(3) From the appropriation under s. 20.435 (5) (gp), the department shall
7award $1,500,000 in grants in each fiscal year to community-based nonprofit
8corporations under a competitive process established by the department.
AB100-engrossed,1555,10
9(4) A community-based nonprofit corporation that receives a grant under this
10section shall do all of the following:
AB100-engrossed,1555,1211
(a) Provide comprehensive primary health care services to any person
12regardless of insurance status or ability to pay.
AB100-engrossed,1555,1313
(b) Establish a sliding fee scale for uninsured, low-income persons.
AB100-engrossed,1555,15
15146.93 (title)
Primary Supplemental primary health care program.
AB100-engrossed,1555,2017
146.93
(1) (a) From the appropriation under s. 20.435
(1) (gp) (5) (kp), the
18department shall maintain a program for the provision of primary health care
19services based on the primary health care program in existence on June 30, 1987.
20The department may promulgate rules necessary to implement the program.
AB100-engrossed,1555,2422
146.93
(4) (d) The individual received health care services under this section
23on the effective date of this paragraph .... [revisor inserts date], and cannot be served
24by an entity that receives a grant under s. 146.92.
AB100-engrossed,1556,8
1146.99 Assessments. The department shall, within 90 days after the
2commencement of each fiscal year, estimate the total amount of expenditures and the
3department shall assess the estimated total amount under s. 20.435
(1) (5) (gp) to
4hospitals, as defined in s. 50.33 (2), in proportion to each hospital's respective gross
5private-pay patient revenues during the hospital's most recently concluded entire
6fiscal year. Each hospital shall pay its assessment on or before December 1 for the
7fiscal year. All payments of assessments shall be deposited in the appropriation
8under s. 20.435
(1) (5) (gp).
AB100-engrossed,1556,1211
Mandatory health insurance
12
risk-sharing plan
AB100-engrossed,1556,1414
149.10
(2f) "Commissioner" means the commissioner of insurance.
AB100-engrossed,1556,1716
149.10
(2m) "Department" means the department of health and family
17services.
AB100-engrossed,1556,2019
149.10
(4c) "Health maintenance organization" has the meaning given in s.
20609.01 (2).
AB100-engrossed,1556,2222
149.10
(4p) (a) "Insurance" includes any of the following:
AB100-engrossed,1556,2523
1. Risk distributing arrangements providing for compensation of damages or
24loss through the provision of services or benefits in kind rather than indemnity in
25money.
AB100-engrossed,1557,2
12. Contracts of guaranty or suretyship entered into by the guarantor or surety
2as a business and not as merely incidental to a business transaction.
AB100-engrossed,1557,33
3. Plans established and operated under ss. 185.981 to 185.985.
AB100-engrossed,1557,54
(b) "Insurance" does not include a continuing care contract, as defined in s.
5647.01 (2).
AB100-engrossed,1557,87
149.10
(5m) "Limited service health organization" has the meaning given in
8s. 609.01 (3).
AB100-engrossed,1557,1110
149.10
(8b) "Plan administrator" means the fiscal agent specified in s. 149.16
11(1).
AB100-engrossed,1557,1513
149.10
(8c) "Policy" means any document other than a group certificate used
14to prescribe in writing the terms of an insurance contract, including endorsements
15and riders and service contracts issued by motor clubs.
AB100-engrossed,1557,2117
149.10
(8j) "Preexisting condition exclusion" means, with respect to coverage,
18a limitation or exclusion of benefits relating to a condition of an individual that
19existed before the individual's date of enrollment for coverage, whether or not the
20individual received any medical advice or recommendation, diagnosis, care or
21treatment related to the condition before that date.
AB100-engrossed,1557,2323
149.10
(8m) "Preferred provider plan" has the meaning given in s. 609.01 (4).
AB100-engrossed,1558,3
1149.10
(8p) "Premium" means any consideration for an insurance policy, and
2includes assessments, membership fees or other required contributions or
3consideration, however designated.
AB100-engrossed,1558,55
149.10
(10) "Secretary" means the secretary of health and family services.
AB100-engrossed,1558,87
149.10
(11) "State" means the same as in s. 990.01 (40) except that it also
8includes the Panama Canal Zone.
AB100-engrossed,1558,1110
149.12
(2) (f) No person who is eligible for medical assistance is eligible for
11coverage under the plan.
AB100-engrossed,1558,1813
149.14
(4m) Payment is payment in full. Except for copayments, coinsurance
14or deductibles required or authorized under the plan, a provider of a covered service
15or article shall accept as payment in full for the covered service or article the payment
16rate determined under ss. 149.143, 149.144 and 149.15 (3) (e) and may not bill an
17eligible person who receives the service or article for any amount by which the charge
18for the service or article is reduced under s. 149.143, 149.144 or 149.15 (3) (e).
AB100-engrossed,1558,21
20149.143 Payment of plan costs. (1) The department shall pay or recover the
21operating and administrative costs of the plan as follows:
AB100-engrossed,1558,2222
(a) First from the appropriation under s. 20.435 (5) (af).
AB100-engrossed,1558,2323
(b) The remainder of the costs as follows:
AB100-engrossed,1558,2424
1. A total of 60% from the following sources, calculated as follows:
AB100-engrossed,1559,6
1a. First, from premiums from eligible persons with coverage under s. 149.14 set
2at 150% of the rate that a standard risk would be charged under an individual policy
3providing substantially the same coverage and deductibles as are provided under the
4plan, including amounts received for premium and deductible subsidies under ss.
520.435 (5) (ah) and 149.144, and from premiums collected from eligible persons with
6coverage under s. 149.146 set in accordance with s. 149.146 (2) (b).
AB100-engrossed,1559,87
b. Second, from the appropriation under s. 20.435 (5) (gh), to the extent that
8the amounts under subd. 1. a. are insufficient to pay 60% of plan costs.
AB100-engrossed,1559,169
c. Third, by increasing premiums from eligible persons with coverage under s.
10149.14 to more than 150% but not more than 200% of the rate that a standard risk
11would be charged under an individual policy providing substantially the same
12coverage and deductibles as are provided under the plan, including amounts received
13for premium and deductible subsidies under ss. 20.435 (5) (ah) and 149.144, and by
14increasing premiums from eligible persons with coverage under s. 149.146 in
15accordance with s. 149.146 (2) (b), to the extent that the amounts under subd. 1. a.
16and b. are insufficient to pay 60% of plan costs.
AB100-engrossed,1559,2117
d. Fourth, notwithstanding subd. 2., by increasing insurer assessments,
18excluding assessments under s. 149.144, and adjusting provider payment rates,
19excluding adjustments to those rates under ss. 149.144 and 149.15 (3) (e), in equal
20proportions and to the extent that the amounts under subd. 1. a. to c. are insufficient
21to pay 60% of plan costs.
AB100-engrossed,1559,2222
2. A total of 40% as follows:
AB100-engrossed,1559,2423
a. Fifty percent from insurer assessments, excluding assessments under s.
24149.144.
AB100-engrossed,1560,2
1b. Fifty percent from adjustments to provider payment rates, excluding
2adjustments to those rates under ss. 149.144 and 149.15 (3) (e).
AB100-engrossed,1560,6
3(2) (a) Prior to each plan year, the department shall estimate the operating and
4administrative costs of the plan and the costs of the premium reductions under s.
5149.165 and the deductible reductions under s. 149.14 (5) (a) for the new plan year
6and do all of the following:
AB100-engrossed,1560,137
1. a. Estimate the amount of enrollee premiums that would be received in the
8new plan year if the enrollee premiums were set at a level sufficient, when including
9amounts received for premium and deductible subsidies under ss. 20.435 (5) (ah) and
10149.144 and from premiums collected from eligible persons with coverage under s.
11149.146 set in accordance with s. 149.146 (2) (b), to cover 60% of the estimated plan
12costs for the new plan year, after deducting from the estimated plan costs the amount
13available in the appropriation under s. 20.435 (5) (af) for that plan year.
AB100-engrossed,1560,1514
b. Estimate the amount of enrollee premiums that will be received under sub.
15(1) (b) 1. a.
AB100-engrossed,1560,2116
c. If the amount estimated to be received under subd. 1. a. is less than the
17amount estimated to be received under subd. 1. b., direct the plan administrator to
18provide to the department, prior to the beginning of the plan year and according to
19procedures specified by the department, the amount of the difference. The
20department shall deposit all amounts received under this subd. 1. c. in the
21appropriation account under s. 20.435 (5) (gh).
AB100-engrossed,1561,222
2. After making the determinations under subd. 1., by rule set premium rates
23for the new plan year, including the rates under s. 149.146 (2) (b), in the manner
24specified in sub. (1) (b) 1. a. and c. and such that a rate for coverage under s. 149.14
25is not less than 150% nor more than 200% of the rate that a standard risk would be
1charged under an individual policy providing substantially the same coverage and
2deductibles as are provided under the plan.
AB100-engrossed,1561,63
3. By rule set the total insurer assessments under s. 149.13 for the new plan
4year by estimating and setting the assessments at the amount necessary to equal the
5amounts specified in sub. (1) (b) 1. d. and 2. a. and notify the commissioner of the
6amount.
AB100-engrossed,1561,97
4. By the same rule as under subd. 3. adjust the provider payment rate for the
8new plan year by estimating and setting the rate at the level necessary to equal the
9amounts specified in sub. (1) (b) 1. d. and 2. b. and as provided in s. 149.145.
AB100-engrossed,1561,1510
(b) In setting the premium rates under par. (a) 2., the insurer assessment
11amount under par. (a) 3. and the provider payment rate under par. (a) 4. for the new
12plan year, the department shall include any increase or decrease necessary to reflect
13the amount, if any, by which the rates and amount set under par. (a) for the current
14plan year differed from the rates and amount which would have equaled the amounts
15specified in sub. (1) (b) in the current plan year.
AB100-engrossed,1561,25
16(3) (a) If, during a plan year, the department determines that the amounts
17estimated to be received as a result of the rates and amount set under sub. (2) (a) 2.
18to 4. and any adjustments in insurer assessments and the provider payment rate
19under s. 149.144 will not be sufficient to cover plan costs, the department may by rule
20increase the premium rates set under sub. (2) (a) 2. for the remainder of the plan year,
21subject to s. 149.146 (2) (b) and the maximum specified in sub. (2) (a) 2., by rule
22increase the assessments set under sub. (2) (a) 3. for the remainder of the plan year,
23subject to sub. (1) (b) 2. a., and by the same rule under which assessments are
24increased adjust the provider payment rate set under sub. (2) (a) 4. for the remainder
25of the plan year, subject to sub. (1) (b) 2. b.
AB100-engrossed,1562,6
1(b) If, after increasing premium rates and insurer assessments and adjusting
2the provider payment rate under par. (a), the department determines that there will
3still be a deficit and that premium rates have been increased to the maximum extent
4allowable under par. (a), the department shall further adjust, in equal proportions,
5assessments set under sub. (2) (a) 3. and the provider payment rate set under sub.
6(2) (a) 4., without regard to sub. (1) (b) 2.