AB100,1266,1714
146.93
(1) (a) From the appropriation under s. 20.435
(1) (5) (gp), the
15department shall maintain a program for the provision of primary health care
16services based on the primary health care program in existence on June 30, 1987.
17The department may promulgate rules necessary to implement the program.
AB100, s. 3012
18Section
3012. 146.99 of the statutes is amended to read:
AB100,1267,2
19146.99 Assessments. The department shall, within 90 days after the
20commencement of each fiscal year, estimate the total amount of expenditures and the
21department shall assess the estimated total amount under s. 20.435
(1) (5) (gp) to
22hospitals, as defined in s. 50.33 (2), in proportion to each hospital's respective gross
23private-pay patient revenues during the hospital's most recently concluded entire
24fiscal year. Each hospital shall pay its assessment on or before December 1 for the
1fiscal year. All payments of assessments shall be deposited in the appropriation
2under s. 20.435
(1) (5) (gp).
AB100, s. 3013
3Section
3013. Chapter 149 (title) of the statutes is created to read:
AB100,1267,44
Chapter 149
AB100,1267,65
Mandatory health insurance
6
risk-sharing plan
AB100, s. 3014
7Section
3014. 149.10 (2c) of the statutes is created to read:
AB100,1267,88
149.10
(2c) "Commissioner" means the commissioner of insurance.
AB100, s. 3015
9Section
3015. 149.10 (2m) of the statutes is created to read:
AB100,1267,1110
149.10
(2m) "Department" means the department of health and family
11services.
AB100, s. 3016
12Section
3016. 149.10 (4c) of the statutes is created to read:
AB100,1267,1413
149.10
(4c) "Health maintenance organization" has the meaning given in s.
14609.01 (2).
AB100, s. 3017
15Section
3017. 149.10 (4p) of the statutes is created to read:
AB100,1267,1616
149.10
(4p) (a) "Insurance" includes any of the following:
AB100,1267,1917
1. Risk distributing arrangements providing for compensation of damages or
18loss through the provision of services or benefits in kind rather than indemnity in
19money.
AB100,1267,2120
2. Contracts of guaranty or suretyship entered into by the guarantor or surety
21as a business and not as merely incidental to a business transaction.
AB100,1267,2222
3. Plans established and operated under ss. 185.981 to 185.985.
AB100,1267,2423
(b) "Insurance" does not include a continuing care contract, as defined in s.
24647.01 (2).
AB100, s. 3018
25Section
3018. 149.10 (5m) of the statutes is created to read:
AB100,1268,2
1149.10
(5m) "Limited service health organization" has the meaning given in
2s. 609.01 (3).
AB100, s. 3019
3Section
3019. 149.10 (8b) of the statutes is created to read:
AB100,1268,54
149.10
(8b) "Plan administrator" means the fiscal agent specified under s.
5149.16.
AB100, s. 3020
6Section
3020. 149.10 (8c) of the statutes is created to read:
AB100,1268,97
149.10
(8c) "Policy" means any document other than a group certificate used
8to prescribe in writing the terms of an insurance contract, including endorsements
9and riders and service contracts issued by motor clubs.
AB100, s. 3021
10Section
3021. 149.10 (8m) of the statutes is created to read:
AB100,1268,1111
149.10
(8m) "Preferred provider plan" has the meaning given in s. 609.01 (4).
AB100, s. 3022
12Section
3022. 149.10 (8p) of the statutes is created to read:
AB100,1268,1513
149.10
(8p) "Premium" means any consideration for an insurance policy, and
14includes assessments, membership fees or other required contributions or
15consideration, however designated.
AB100, s. 3023
16Section
3023. 149.10 (10) of the statutes is created to read:
AB100,1268,1717
149.10
(10) "Secretary" means the secretary of health and family services.
AB100, s. 3024
18Section
3024. 149.10 (11) of the statutes is created to read:
AB100,1268,2019
149.10
(11) "State" means the same as in s. 990.01 (40) except that it also
20includes the Panama Canal Zone.
AB100, s. 3025
21Section
3025. 149.12 (1c) of the statutes is created to read:
AB100,1268,2422
149.12
(1c) For purposes of s. 149.135, the department shall notify the
23commissioner whenever a person is certified as eligible and obtains coverage under
24the plan as a result of receiving a notice under sub. (1) (am), (b) or (c).
AB100, s. 3026
25Section
3026. 149.14 (4m) of the statutes is created to read:
AB100,1269,6
1149.14
(4m) Allowable charge is payment in full. The provider of a covered
2service or article under sub. (3) shall accept as payment in full for the covered service
3or article the allowable charge paid under the medical assistance program under ss.
449.45 to 49.47 and may not impose a charge or receive payment from an eligible
5person for the covered service or article in excess of the allowable charge paid under
6the medical assistance program under ss. 49.45 to 49.47.
AB100, s. 3027
7Section
3027. 149.14 (4s) of the statutes is created to read:
AB100,1269,138
149.14
(4s) Additional coverage by rule. The plan shall provide coverage for
9any services specified in s. 619.14 (3) (c) 1., 1995 stats., that are not specified in sub.
10(3) (c) 1. The department shall, by rule, define the coverage required under this
11subsection and develop a methodology for providing the coverage consistent with the
12methodology used for payment of allowable charges under the medical assistance
13program under ss. 49.45 to 49.47.
AB100, s. 3028
14Section
3028. 149.14 (6) of the statutes is created to read:
AB100,1269,1815
149.14
(6) Timely payment. The department shall ensure timely payment of
16benefits under the plan according to the procedures established by the department
17for the payment of allowable charges under the medical assistance program under
18ss. 49.45 to 49.47.
AB100, s. 3029
19Section
3029. 149.15 (3) (e) of the statutes is created to read:
AB100,1269,2120
149.15
(3) (e) Under the direction of the department and in consultation with
21the office of the commissioner, develop an alternative plan for eligible persons.
AB100, s. 3030
22Section
3030. 149.16 (title) of the statutes is created to read:
AB100,1269,23
23149.16 (title)
Plan administrator.
AB100, s. 3031
24Section
3031. 149.16 (1) of the statutes is created to read:
AB100,1269,2525
149.16
(1) The fiscal agent under s. 49.45 (2) (b) 2. shall administer the plan.
AB100, s. 3032
1Section
3032. 149.168 of the statutes is created to read:
AB100,1270,8
2149.168 Recovery of subsidies from estates. (1) (a) Unless already
3recovered by the department, the department shall file a claim against the estate of
4an eligible person who had coverage under the plan or against the estate of the
5surviving spouse of an eligible person who had coverage under the plan for the
6amount of any subsidies paid from the appropriation account under s. 20.435 (5) (ah)
7on behalf of the eligible person to reduce a deductible under s. 149.14 (5) (a), or to
8reduce a premium under s. 149.165.
AB100,1270,119
(b) The court shall reduce the amount of a claim under par. (a) by up to $3,000
10if necessary to allow the eligible person's heirs or the beneficiaries of the eligible
11person's will to retain the following personal property:
AB100,1270,1212
1. The decedent's wearing apparel and jewelry held for personal use.
AB100,1270,1313
2. Household furniture, furnishings and appliances.
AB100,1270,1514
3. Other tangible personal property not used in trade, agriculture or other
15business, not to exceed $1,000 in value.
AB100,1270,17
16(2) A claim under par. (a) is not allowable if the decedent has a surviving child
17who is under 21 years of age or disabled or a surviving spouse.
AB100,1270,20
18(3) The department may file a claim and recover amounts under this section
19only for subsidies paid on or after January 1, 1998, with respect to an eligible person
20who dies after March 15, 1998.
AB100,1270,23
21(4) The department may waive the application of this section in a particular
22case if the department determines, according to standards established by rule, that
23the application of this section would work an undue hardship in that particular case.
AB100,1270,25
24(5) The department shall deposit all moneys recovered under this section in the
25appropriation account under s. 20.435 (5) (g).
AB100, s. 3033
1Section
3033. 150.21 (1) of the statutes is amended to read:
AB100,1271,22
150.21
(1) The construction
or total replacement of a
new nursing home.
AB100, s. 3034
3Section
3034. 150.21 (3) of the statutes is amended to read:
AB100,1271,54
150.21
(3) A capital expenditure
, other than a renovation or replacement, that
5exceeds $1,000,000 by or on behalf of a nursing home.
AB100, s. 3035
6Section
3035. 150.21 (4) of the statutes is amended to read:
AB100,1271,87
150.21
(4) An expenditure
, other than a renovation or replacement, that
8exceeds $600,000 for clinical equipment by or on behalf of a nursing home.
AB100, s. 3036
9Section
3036. 150.31 (5t) of the statutes is created to read:
AB100,1271,1210
150.31
(5t) The department shall decrease the statewide bed limits specified
11in sub. (1) to account for any reduction in the licensed bed capacity of a nursing home
12that has relinquished use of a bed, as specified in s. 49.45 (6m) (ap) 4.
AB100, s. 3037
13Section
3037. 150.35 (3m) (a) 3. of the statutes is amended to read:
AB100,1271,1714
150.35
(3m) (a) 3. All applications for activities that are specified in s. 150.21
15(3)
, that are renovations with capital expenditures which do not exceed $1,500,000
16and that do not include additions, the replacement of a nursing home or an increase
17in the bed capacity of a nursing home.
AB100, s. 3038
18Section
3038. 150.39 (2) of the statutes is amended to read:
AB100,1271,2219
150.39
(2) The cost of
renovating or providing an equal number of nursing home
20beds or of an equal expansion would be consistent with the cost at similar nursing
21homes, and the applicant's per diem rates would be consistent with those of similar
22nursing homes.
AB100, s. 3039
23Section
3039. Subchapter VI of chapter 150 [precedes 150.93] of the statutes
24is repealed.
AB100, s. 3040
1Section
3040. Subchapter VII of chapter 150 [precedes 150.94] of the statutes
2is repealed.
AB100, s. 3041
3Section
3041. 153.01 (4) of the statutes is created to read:
AB100,1272,44
153.01
(4) "Department" means the department of health and family services.
AB100, s. 3042
5Section
3042. 153.01 (4m) of the statutes is repealed.
AB100, s. 3044
7Section
3044. 153.05 (1) (c) 1. of the statutes is amended to read:
AB100,1272,128
153.05
(1) (c) 1. Identification of charges in each hospital's most recent entire
9fiscal year for up to 100 charge elements, as selected by the
office department, and
10identification of the increase or decrease in charges for each of these charge elements
11from amounts charged during the hospital's entire fiscal year that is nearest in time
12to the hospital's most recent entire fiscal year.
AB100, s. 3045
13Section
3045. 153.05 (1) (e) of the statutes is amended to read:
AB100,1272,1714
153.05
(1) (e) Final audited financial statements of hospitals that include, for
15a hospital's most recent entire fiscal year, as dollar amounts, the amounts of revenue
16and expenditures for the hospital, in categories specified in rules promulgated by the
17commissioner department.
AB100, s. 3046
18Section
3046. 153.05 (2) of the statutes is amended to read:
AB100,1272,2519
153.05
(2) The
office department shall provide copies of reports published
20under ss. 153.10 to 153.35 at no charge to hospitals assessed under s. 153.60 (1) and,
21if assessed, at no charge to ambulatory surgery centers assessed under s. 153.60 (2).
22The
office department shall provide copies of the reports to any person, upon the
23person's request, and the board shall advise the
office department as to whether the
24copies shall be provided at no charge or at a charge not to exceed the cost of printing,
25copying and mailing the report to the person.
AB100, s. 3047
1Section
3047. 153.05 (3) of the statutes is amended to read:
AB100,1273,42
153.05
(3) Upon request of the
office
department, state agencies shall provide
3health care information to the
office department for use in preparing reports under
4ss. 153.10 to 153.35.
AB100, s. 3048
5Section
3048. 153.05 (4) of the statutes is amended to read:
AB100,1273,126
153.05
(4) (a) The
office department, under rules promulgated by the
7commissioner department, shall require hospitals to use, and private-pay patients
8and payers who are insurers to accept, uniform patient billing forms, shall require
9hospitals to submit to the
office department the information provided on the billing
10forms, including, for an injury, the external cause of the event, and may require
11payers who are insurers to use a standard set of definitions for base data reporting
12under a uniform patient billing form.
AB100,1273,1813
(b) The
office department, under rules promulgated by the
commissioner 14department, may require ambulatory surgery centers to use uniform patient billing
15forms and other information, and, if so requiring, shall require ambulatory surgery
16centers to submit to the
office department the information provided on the billing
17forms, including, for an injury, the external cause of the event, using a standard set
18of definitions for base data reporting.
AB100, s. 3049
19Section
3049. 153.05 (5) of the statutes is amended to read:
AB100,1273,2020
153.05
(5) The
office department:
AB100,1273,2321
(a) Shall require hospitals to submit information regarding medical
22malpractice, staffing levels and patient case-mix, and expenditures related to labor
23relations consultants, as specified by the
office
department.
AB100,1274,324
(b) May require hospitals to submit to the
office
department information from
25sources identified under sub. (1) (a) to (e) that the
office department deems necessary
1for the preparation of reports, plans and recommendations under ss. 153.10 to 153.35
2and any other reports required of the
office department in the form specified by the
3office department.