AB100: Bill Text

AB100,1267,4 Chapter 149

AB100,1267,6 Mandatory health insurance risk-sharing plan

AB100, s. 3014 Section 3014. 149.10 (2c) of the statutes is created to read:

AB100,1267,8 149.10 (2c) "Commissioner" means the commissioner of insurance.

AB100, s. 3015 Section 3015. 149.10 (2m) of the statutes is created to read:

AB100,1267,11 149.10 (2m) "Department" means the department of health and family services.

AB100, s. 3016 Section 3016. 149.10 (4c) of the statutes is created to read:

AB100,1267,14 149.10 (4c) "Health maintenance organization" has the meaning given in s. 609.01 (2).

AB100, s. 3017 Section 3017. 149.10 (4p) of the statutes is created to read:

AB100,1267,16 149.10 (4p) (a) "Insurance" includes any of the following:

AB100,1267,19 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.

AB100,1267,21 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.

AB100,1267,22 3. Plans established and operated under ss. 185.981 to 185.985.

AB100,1267,24 (b) "Insurance" does not include a continuing care contract, as defined in s. 647.01 (2).

AB100, s. 3018 Section 3018. 149.10 (5m) of the statutes is created to read:

AB100,1268,2 149.10 (5m) "Limited service health organization" has the meaning given in s. 609.01 (3).

AB100, s. 3019 Section 3019. 149.10 (8b) of the statutes is created to read:

AB100,1268,5 149.10 (8b) "Plan administrator" means the fiscal agent specified under s. 149.16.

AB100, s. 3020 Section 3020. 149.10 (8c) of the statutes is created to read:

AB100,1268,9 149.10 (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, s. 3021 Section 3021. 149.10 (8m) of the statutes is created to read:

AB100,1268,11 149.10 (8m) "Preferred provider plan" has the meaning given in s. 609.01 (4).

AB100, s. 3022 Section 3022. 149.10 (8p) of the statutes is created to read:

AB100,1268,15 149.10 (8p) "Premium" means any consideration for an insurance policy, and includes assessments, membership fees or other required contributions or consideration, however designated.

AB100, s. 3023 Section 3023. 149.10 (10) of the statutes is created to read:

AB100,1268,17 149.10 (10) "Secretary" means the secretary of health and family services.

AB100, s. 3024 Section 3024. 149.10 (11) of the statutes is created to read:

AB100,1268,20 149.10 (11) "State" means the same as in s. 990.01 (40) except that it also includes the Panama Canal Zone.

AB100, s. 3025 Section 3025. 149.12 (1c) of the statutes is created to read:

AB100,1268,24 149.12 (1c) For purposes of s. 149.135, the department shall notify the commissioner whenever a person is certified as eligible and obtains coverage under the plan as a result of receiving a notice under sub. (1) (am), (b) or (c).

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

AB100,1269,6 149.14 (4m) Allowable charge is payment in full. The provider of a covered service or article under sub. (3) shall accept as payment in full for the covered service or article the allowable charge paid under the medical assistance program under ss. 49.45 to 49.47 and may not impose a charge or receive payment from an eligible person for the covered service or article in excess of the allowable charge paid under the medical assistance program under ss. 49.45 to 49.47.

AB100, s. 3027 Section 3027. 149.14 (4s) of the statutes is created to read:

AB100,1269,13 149.14 (4s) Additional coverage by rule. The plan shall provide coverage for any services specified in s. 619.14 (3) (c) 1., 1995 stats., that are not specified in sub. (3) (c) 1. The department shall, by rule, define the coverage required under this subsection and develop a methodology for providing the coverage consistent with the methodology used for payment of allowable charges under the medical assistance program under ss. 49.45 to 49.47.

AB100, s. 3028 Section 3028. 149.14 (6) of the statutes is created to read:

AB100,1269,18 149.14 (6) Timely payment. The department shall ensure timely payment of benefits under the plan according to the procedures established by the department for the payment of allowable charges under the medical assistance program under ss. 49.45 to 49.47.

AB100, s. 3029 Section 3029. 149.15 (3) (e) of the statutes is created to read:

AB100,1269,21 149.15 (3) (e) Under the direction of the department and in consultation with the office of the commissioner, develop an alternative plan for eligible persons.

AB100, s. 3030 Section 3030. 149.16 (title) of the statutes is created to read:

AB100,1269,23 149.16 (title) Plan administrator.

AB100, s. 3031 Section 3031. 149.16 (1) of the statutes is created to read:

AB100,1269,25 149.16 (1) The fiscal agent under s. 49.45 (2) (b) 2. shall administer the plan.

AB100, s. 3032 Section 3032. 149.168 of the statutes is created to read:

AB100,1270,8 149.168 Recovery of subsidies from estates. (1) (a) Unless already recovered by the department, the department shall file a claim against the estate of an eligible person who had coverage under the plan or against the estate of the surviving spouse of an eligible person who had coverage under the plan for the amount of any subsidies paid from the appropriation account under s. 20.435 (5) (ah) on behalf of the eligible person to reduce a deductible under s. 149.14 (5) (a), or to reduce a premium under s. 149.165.

AB100,1270,11 (b) The court shall reduce the amount of a claim under par. (a) by up to $3,000 if necessary to allow the eligible person's heirs or the beneficiaries of the eligible person's will to retain the following personal property:

AB100,1270,12 1. The decedent's wearing apparel and jewelry held for personal use.

AB100,1270,13 2. Household furniture, furnishings and appliances.

AB100,1270,15 3. Other tangible personal property not used in trade, agriculture or other business, not to exceed $1,000 in value.

AB100,1270,17 (2) A claim under par. (a) is not allowable if the decedent has a surviving child who is under 21 years of age or disabled or a surviving spouse.

AB100,1270,20 (3) The department may file a claim and recover amounts under this section only for subsidies paid on or after January 1, 1998, with respect to an eligible person who dies after March 15, 1998.

AB100,1270,23 (4) The department may waive the application of this section in a particular case if the department determines, according to standards established by rule, that the application of this section would work an undue hardship in that particular case.

AB100,1270,25 (5) The department shall deposit all moneys recovered under this section in the appropriation account under s. 20.435 (5) (g).

AB100, s. 3033 Section 3033. 150.21 (1) of the statutes is amended to read:

AB100,1271,2 150.21 (1) The construction or total replacement of a new nursing home.

AB100, s. 3034 Section 3034. 150.21 (3) of the statutes is amended to read:

AB100,1271,5 150.21 (3) A capital expenditure, other than a renovation or replacement, that exceeds $1,000,000 by or on behalf of a nursing home.

AB100, s. 3035 Section 3035. 150.21 (4) of the statutes is amended to read:

AB100,1271,8 150.21 (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, s. 3036 Section 3036. 150.31 (5t) of the statutes is created to read:

AB100,1271,12 150.31 (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, s. 3037 Section 3037. 150.35 (3m) (a) 3. of the statutes is amended to read:

AB100,1271,17 150.35 (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, s. 3038 Section 3038. 150.39 (2) of the statutes is amended to read:

AB100,1271,22 150.39 (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, s. 3039 Section 3039. Subchapter VI of chapter 150 [precedes 150.93] of the statutes is repealed.

AB100, s. 3040 Section 3040. Subchapter VII of chapter 150 [precedes 150.94] of the statutes is repealed.

AB100, s. 3041 Section 3041. 153.01 (4) of the statutes is created to read:

AB100,1272,4 153.01 (4) "Department" means the department of health and family services.

AB100, s. 3042 Section 3042. 153.01 (4m) of the statutes is repealed.

AB100, s. 3043 Section 3043. 153.01 (6) of the statutes is repealed.

AB100, s. 3044 Section 3044. 153.05 (1) (c) 1. of the statutes is amended to read:

AB100,1272,12 153.05 (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, s. 3045 Section 3045. 153.05 (1) (e) of the statutes is amended to read:

AB100,1272,17 153.05 (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, s. 3046 Section 3046. 153.05 (2) of the statutes is amended to read:

AB100,1272,25 153.05 (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, s. 3047 Section 3047. 153.05 (3) of the statutes is amended to read:

AB100,1273,4 153.05 (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, s. 3048 Section 3048. 153.05 (4) of the statutes is amended to read:

AB100,1273,12 153.05 (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.

AB100,1273,18 (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, s. 3049 Section 3049. 153.05 (5) of the statutes is amended to read:

AB100,1273,20 153.05 (5) The office department:

AB100,1273,23 (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.

AB100,1274,3 (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.

AB100,1274,7 (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, s. 3050 Section 3050. 153.05 (6) of the statutes is amended to read:

AB100,1274,14 153.05 (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, s. 3051 Section 3051. 153.05 (6m) of the statutes is amended to read: