SB44-SSA1, s. 2081 5Section 2081. 149.143 (2m) (a) 2. of the statutes is amended to read:
SB44-SSA1,816,96 149.143 (2m) (a) 2. The amount of premiums, including amounts received for
7premium and, deductible, and prescription drug copayment subsidies, necessary to
8cover 60% of the plan costs for the plan year, after deducting the amount transferred
9to the fund from the appropriation account under s. 20.435 (4) (af)
.
SB44-SSA1, s. 2082 10Section 2082. 149.143 (2m) (b) 1. of the statutes is amended to read:
SB44-SSA1,816,1511 149.143 (2m) (b) 1. To reduce premiums in succeeding plan years as provided
12in sub. (1) (b) 1. b. (am) 2. For eligible persons with coverage under s. 149.14 (2) (a),
13premiums may not be reduced below 140% of the rate that a standard risk would be
14charged under an individual policy providing substantially the same coverage and
15deductibles as are provided under the plan.
SB44-SSA1, s. 2083 16Section 2083. 149.143 (3) (a) of the statutes is amended to read:
SB44-SSA1,817,217 149.143 (3) (a) If, during a plan year, the department determines that the
18amounts estimated to be received as a result of the rates and amount set under sub.
19(2) (a) 2. to 4. and any adjustments in insurer assessments and the provider payment
20rate under s. 149.144 will not be sufficient to cover plan costs, the department may
21by rule increase the premium rates set under sub. (2) (a) 2. for the remainder of the
22plan year, subject to s. 149.146 (2) (b) and the maximum specified in sub. (2) (a) 2.,
23by rule increase the assessments set under sub. (2) (a) 3. for the remainder of the plan
24year, subject to sub. (1) (b) 2. a. (bm) 1., and by the same rule under which
25assessments are increased adjust the provider payment rate set under sub. (2) (a) 4.

1for the remainder of the plan year, subject to sub. (1) (b) 2. b. (bm) 2. and s. 149.142
2(1) (b).
SB44-SSA1, s. 2084 3Section 2084. 149.143 (3) (b) of the statutes is amended to read:
SB44-SSA1,817,104 149.143 (3) (b) If the department increases premium rates and insurer
5assessments and adjusts the provider payment rate under par. (a) and determines
6that there will still be a deficit and that premium rates have been increased to the
7maximum extent allowable under par. (a), the department may further adjust, in
8equal proportions, assessments set under sub. (2) (a) 3. and the provider payment
9rate set under sub. (2) (a) 4., without regard to sub. (1) (b) 2. (bm) but subject to s.
10149.142 (1) (b).
SB44-SSA1, s. 2085 11Section 2085. 149.144 of the statutes is amended to read:
SB44-SSA1,818,2 12149.144 Adjustments to insurer assessments and provider payment
13rates for premium
and, deductible , and prescription drug copayment
14reductions.
If the moneys transferred to the fund under the appropriation under
15s. 20.435 (4) (ah) are insufficient to reimburse the plan for premium reductions under
16s. 149.165 and deductible reductions under s. 149.14 (5) (a), or the department
17determines that the moneys transferred or to be transferred to the fund under the
18appropriation under s. 20.435 (4) (ah) will be insufficient to reimburse the plan for
19premium reductions under s. 149.165 and deductible reductions under s. 149.14 (5)
20(a), the
The department may shall, by rule, adjust in equal proportions the amount
21of the assessment set under s. 149.143 (2) (a) 3. and the provider payment rate set
22under s. 149.143 (2) (a) 4., subject to ss. 149.142 (1) (b) and 149.143 (1) (b) 1. (am),
23sufficient to reimburse the plan for premium reductions under s. 149.165 and,
24deductible reductions under s. 149.14 (5) (a). If the department makes the
25adjustment under this section, the
, and any prescription drug copayment reductions

1under s. 149.14 (5) (e). The
department shall notify the commissioner so that the
2commissioner may levy any increase in insurer assessments.
SB44-SSA1, s. 2086 3Section 2086. 149.145 of the statutes is amended to read:
SB44-SSA1,818,15 4149.145 Program budget. The department, in consultation with the board,
5shall establish a program budget for each plan year. The program budget shall be
6based on the provider payment rates specified in s. 149.142 and in the most recent
7provider contracts that are in effect and on the funding sources specified in s. ss.
8149.143 (1) and 149.144, including the methodologies specified in ss. 149.143,
9149.144, and 149.146 for determining premium rates, insurer assessments, and
10provider payment rates. Except as otherwise provided in s. 149.143 (3) (a) and (b)
11and subject to s. 149.142 (1) (b), from the program budget the department shall derive
12the actual provider payment rate for a plan year that reflects the providers'
13proportional share of the plan costs, consistent with ss. 149.143 and 149.144. The
14department may not implement a program budget established under this section
15unless it is approved by the board.
SB44-SSA1, s. 2087 16Section 2087. 149.146 (2) (a) of the statutes is amended to read:
SB44-SSA1,818,2117 149.146 (2) (a) Except as specified by the department, the terms of coverage
18under s. 149.14, including deductible reductions under s. 149.14 (5) (a) and
19prescription drug copayment reductions under s. 149.14 (5) (e)
, do not apply to the
20coverage offered under this section. Premium reductions under s. 149.165 do not
21apply to the coverage offered under this section.
SB44-SSA1, s. 2088 22Section 2088. 149.16 (1) of the statutes is repealed.
SB44-SSA1, s. 2089 23Section 2089. 149.16 (1m) of the statutes is created to read:
SB44-SSA1,818,2524 149.16 (1m) The plan administrator may be selected by the department in a
25competitive bidding process.
SB44-SSA1, s. 2090
1Section 2090. 149.16 (4) of the statutes is amended to read:
SB44-SSA1,819,42 149.16 (4) The If the plan administrator is the fiscal agent under s. 49.45 (2)
3(b) 2., the
plan administrator shall account for costs related to the plan separately
4from costs related to medical assistance under subch. IV of ch. 49.
SB44-SSA1, s. 2091 5Section 2091. 149.165 (4) of the statutes is amended to read:
SB44-SSA1,819,96 149.165 (4) The department shall reimburse the plan for premium reductions
7under sub. (2) and, deductible reductions under s. 149.14 (5) (a) with moneys
8transferred to the fund
, and prescription drug copayment reductions under s. 149.14
9(5) (e)
from the appropriation account under s. 20.435 (4) (ah) (v).
SB44-SSA1, s. 2092 10Section 2092. 150.963 (3) (e) of the statutes is amended to read:
SB44-SSA1,819,1411 150.963 (3) (e) Accept on behalf of the state and deposit with the state treasurer
12secretary of administration any grant, gift, or contribution made to assist in meeting
13the cost of carrying out the purposes of this subchapter, and expend those funds for
14the purposes of this subchapter.
SB44-SSA1, s. 2092c 15Section 2092c. 153.01 (4j) of the statutes is created to read:
SB44-SSA1,819,1916 153.01 (4j) "Entity" means a nonstock corporation organized under ch. 181 that
17is described in section 501 (c) (6) of the Internal Revenue Code and is exempt from
18federal income tax under section 501 (a) of the Internal Revenue Code, and that does
19all of the following:
SB44-SSA1,819,2020 (a) Represents at least 70% of the hospitals in Wisconsin.
SB44-SSA1,819,2221 (b) Receives oversight with respect to services performed by the entity under
22this chapter from a group that is composed of all of the following:
SB44-SSA1,819,2423 1. The secretary of health and family services, who shall serve as chairperson
24and nonvoting member of the group.
SB44-SSA1,819,2525 2. Two members designated by Wisconsin Manufacturers and Commerce, Inc.
SB44-SSA1,820,1
13. Two members designated by the Wisconsin Association of Health Plans, Inc.
SB44-SSA1,820,22 4. One member designated by the Wisconsin State AFL-CIO.
SB44-SSA1,820,33 5. Two members designated by the Wisconsin Hospital Association, Inc.
SB44-SSA1,820,44 6. One member designated by the speaker of the assembly.
SB44-SSA1,820,55 7. One member designated by the senate majority leader.
SB44-SSA1, s. 2092d 6Section 2092d. 153.05 (1) of the statutes is amended to read:
SB44-SSA1,820,107 153.05 (1) In order to provide to hospitals, health care providers, insurers,
8consumers, governmental agencies and others information concerning health care
9providers and uncompensated health care services, and in order to provide
10information to assist in peer review for the purpose of quality assurance, the:
SB44-SSA1,820,14 11(a) The department shall collect from health care providers other than
12hospitals and ambulatory surgery centers
, analyze, and disseminate health care
13information, as adjusted for case mix and severity, in language that is
14understandable to lay persons laypersons.
SB44-SSA1, s. 2092e 15Section 2092e. 153.05 (1) (b) of the statutes is created to read:
SB44-SSA1,820,2416 153.05 (1) (b) The entity under contract under sub. (2m) (a) shall collect from
17hospitals and ambulatory surgery centers the health care information required of
18hospitals and ambulatory surgery centers by the department under ch. 153, 2001
19stats., and the rules promulgated under ch. 153, 2001 stats., including, by the date
20that is 18 months after the date of the contract under sub. (2m) (a), all outpatient
21hospital-based services. The entity shall analyze and disseminate that health care
22information, as adjusted for case mix and severity, in the manner required under this
23chapter, under ch. 153, 2001 stats., and under the rules promulgated under ch. 153,
242001 stats., and in language that is understandable to laypersons.
SB44-SSA1, s. 2092f 25Section 2092f. 153.05 (2m) of the statutes is created to read:
SB44-SSA1,821,11
1153.05 (2m) (a) Notwithstanding s. 16.75 (1), (2), and (3m), by the date that is
2the first day of the 2nd month after the effective date of this paragraph .... [revisor
3inserts date], the department of administration shall, from the appropriation under
4s. 20.505 (1) (im), contract with an entity to perform services under this chapter that
5are specified for the entity with respect to the collection, analysis, and dissemination
6of health care information of hospitals and ambulatory surgery centers. The
7department of administration may not, by this contract, require from the entity any
8collection, analysis, or dissemination of health care information of hospitals and
9ambulatory surgery centers that is in addition to that required under this chapter,
10and may include in the contract only terms standard to contracts with the
11department of administration under subch. IV of ch. 16.
SB44-SSA1,821,2112 (b) Biennially, the group specified under s. 153.01 (4j) (b) shall review the
13entity's performance, including the timeliness and quality of the reports generated
14by the entity. If the group is dissatisfied with the entity's performance, the group may
15recommend to the department of administration that that department use a
16competitive request-for-proposal process to solicit offers from other organizations
17for performance of the services. If no organization responds to the request for
18proposal, the department of health and family services shall perform the services
19specified for the entity with respect to the collection, analysis, and dissemination of
20health care information of hospitals and ambulatory surgery centers under this
21chapter.
SB44-SSA1,822,222 (c) By April 1, 2004, and annually thereafter, the secretary of health and family
23services, as chairperson of the group specified under s. 153.01 (4j) (b), shall submit
24to the chief clerk of each house of the legislature for distribution to the legislature
25under s. 13.172 (2), a report concerning the content and number of reports and

1currency of information and reports generated in the previous calendar year by the
2entity under contract under s. 153.05 (2m).
SB44-SSA1, s. 2092g 3Section 2092g. 153.05 (3) of the statutes is renumbered 153.05 (3) (a) and
4amended to read:
SB44-SSA1,822,85 153.05 (3) (a) Upon request of the department for health care information
6relating to health care providers other than hospitals and ambulatory surgery
7centers
, state agencies shall provide that health care information to the department
8for use in preparing reports under this chapter.
SB44-SSA1, s. 2092h 9Section 2092h. 153.05 (3) (b) of the statutes is created to read:
SB44-SSA1,822,1310 153.05 (3) (b) Upon request of the entity under contract under sub. (2m) (a) for
11health care information relating to hospitals and ambulatory surgery centers, state
12agencies shall provide that health care information to the entity for use in preparing
13reports under this chapter.
SB44-SSA1, s. 2092i 14Section 2092i. 153.05 (5) of the statutes is renumbered 153.05 (5) (a) and
15amended to read:
SB44-SSA1,822,2016 153.05 (5) (a) Unless sub. (13) (a) applies, the department may require health
17care providers other than hospitals and ambulatory surgery centers to submit to the
18department information specified by rule under s. 153.75 (1) (n) for the preparation
19of reports, plans, and recommendations in the form specified by the department by
20rule.
SB44-SSA1, s. 2092j 21Section 2092j. 153.05 (5) (b) of the statutes is created to read:
SB44-SSA1,822,2522 153.05 (5) (b) Unless sub. (13) (b) applies, the entity under contract under sub.
23(2m) (a) may require hospitals and ambulatory surgery centers to submit to the
24entity information for the preparation of reports, plans, and recommendations in the
25form specified by the entity.
SB44-SSA1, s. 2092k
1Section 2092k. 153.05 (6) of the statutes is amended to read:
SB44-SSA1,823,52 153.05 (6) The department may contract with a public or private entity
3organization that is not a major purchaser, payer or provider of health care services
4in this state for the provision of data processing services for the collection, analysis
5and dissemination of health care information under sub. (1) (a).
SB44-SSA1, s. 2092L 6Section 2092L. 153.05 (6r) of the statutes is amended to read:
SB44-SSA1,823,197 153.05 (6r) The department shall study and, based on the results of the study,
8may develop and implement a voluntary system of health care plan reporting that
9enables purchasers and consumers to assess the performance of health care plans
10and the health care providers, other than hospitals and ambulatory surgery centers,
11that are employed or reimbursed by the health care plans. The department shall
12undertake the study and any development and implementation in cooperation with
13private health care purchasers, the board, the department of employee trust funds,
14the office of the commissioner of insurance, the interagency coordinating council
15created under s. 15.107 (7), major associations of health care providers, health care
16plans and consumers. If implemented, the department shall operate the system in
17a manner so as to enable purchasers, consumers, the public, the governor and
18legislators to assess the performance of health care plans and health care providers
19other than hospitals and ambulatory surgery centers
.
SB44-SSA1, s. 2093bg 20Section 2093bg. 153.05 (8) of the statutes is renumbered 153.05 (8) (a) and
21amended to read:
SB44-SSA1,824,922 153.05 (8) (a) Unless sub. (13) (a) applies, the department shall collect, analyze
23and disseminate, in language that is understandable to lay persons laypersons,
24claims information and other health care information, as adjusted for case mix and
25severity, under the provisions of this chapter, as determined by rules promulgated

1by the department, from health care providers, other than hospitals and ambulatory
2surgery centers,
specified by rules promulgated by the department. Data from those
3health care providers may be obtained through sampling techniques in lieu of
4collection of data on all patient encounters and data collection procedures shall
5minimize unnecessary duplication and administrative burdens. If the department
6collects health care provider-specific data from health care plans data that is specific
7to health care providers other than hospitals and ambulatory surgery centers
, the
8department shall attempt to avoid collecting the same data from those health care
9providers.
SB44-SSA1, s. 2093bh 10Section 2093bh. 153.05 (8) (b) of the statutes is created to read:
SB44-SSA1,824,1811 153.05 (8) (b) Unless sub. (13) (b) applies, the entity under contract under sub.
12(2m) (a) shall collect, analyze, and disseminate, in language that is understandable
13to laypersons, claims information and other health care information, as adjusted for
14case mix and severity, under the provisions of this chapter, from hospitals and
15ambulatory surgery centers. Data from hospitals and ambulatory surgery centers
16may be obtained through sampling techniques in lieu of collection of data on all
17patient encounters, and data collection procedures shall minimize unnecessary
18duplication and administrative burdens.
SB44-SSA1, s. 2093c 19Section 2093c. 153.05 (9) of the statutes is renumbered 153.05 (9) (a) and
20amended to read:
SB44-SSA1,824,2421 153.05 (9) (a) The department shall provide orientation and training to health
22care providers, other than hospitals and ambulatory surgery centers, who submit
23data under this chapter, to explain the process of data collection and analysis and the
24procedures for data verification, comment, interpretation, and release.
SB44-SSA1, s. 2093d 25Section 2093d. 153.05 (9) (b) of the statutes is created to read:
SB44-SSA1,825,4
1153.05 (9) (b) The entity under contract under sub. (2m) (a) shall provide
2orientation and training to hospitals and ambulatory surgery centers that submit
3data under this chapter, to explain the process of data collection and analysis and the
4procedures for data verification, comment, interpretation, and release.
SB44-SSA1, s. 2093e 5Section 2093e. 153.05 (12) of the statutes is renumbered 153.05 (12) (a).
SB44-SSA1, s. 2093f 6Section 2093f. 153.05 (12) (b) of the statutes is created to read:
SB44-SSA1,825,97 153.05 (12) (b) The entity under contract under sub. (2m) (a) shall, to the extent
8possible and upon request, assist members of the public in interpreting data in
9health care information disseminated by the entity.
SB44-SSA1, s. 2094c 10Section 2094c. 153.05 (13) of the statutes is renumbered 153.05 (13) (a) and
11amended to read:
SB44-SSA1,825,1812 153.05 (13) (a) The department may waive the requirement under sub. (1) (a),
13(5) (a), or (8) (a) for a health care provider, other than a hospital or ambulatory
14surgery center
, who requests the waiver and presents evidence to the department
15that the requirement under sub. (1) (a), (5) (a), or (8) (a) is burdensome, under
16standards established by the department by rule. The department shall develop a
17form for use by a the health care provider in submitting a request under this
18subsection paragraph.
SB44-SSA1, s. 2094d 19Section 2094d. 153.05 (13) (b) of the statutes is created to read:
SB44-SSA1,825,2520 153.05 (13) (b) The entity under contract under sub. (2m) (a) may waive the
21requirement under sub. (1) (b), (5) (b), or (8) (b) for a hospital or ambulatory surgery
22center that requests the waiver and presents evidence to the entity that the
23requirement under sub. (1) (b), (5) (b), or (8) (b) is burdensome. The entity shall
24develop a form for use by the hospital or ambulatory surgery center in submitting a
25request under this paragraph.
SB44-SSA1, s. 2094e
1Section 2094e. 153.07 (1) of the statutes is amended to read:
SB44-SSA1,826,42 153.07 (1) The board shall advise the department with regard to the collection,
3analysis and dissemination of health care information required of the department
4by this chapter.
SB44-SSA1, s. 2094f 5Section 2094f. 153.07 (4) (b) of the statutes is amended to read:
SB44-SSA1,826,86 153.07 (4) (b) Provide oversight on the standard reports required of the
7department
under this chapter, including the reports report under ss. 153.20 and s.
8153.21 (1).
SB44-SSA1, s. 2094g 9Section 2094g. 153.07 (4) (c) of the statutes is amended to read:
SB44-SSA1,826,1110 153.07 (4) (c) Develop the overall strategy and direction for implementation of
11the department's duties and powers under this chapter.
SB44-SSA1, s. 2094h 12Section 2094h. 153.08 (5) of the statutes is created to read:
SB44-SSA1,826,1413 153.08 (5) The entity under contract under s. 153.05 (2m) (a) shall annually
14publish a hospital rate increase report that contains all of the following information:
SB44-SSA1,826,1515 (a) For each hospital that publishes a notice under sub. (4), all of the following:
SB44-SSA1,826,1716 1. The name of the hospital and the city, village, or town in which the hospital
17is located.
SB44-SSA1,826,1818 2. The date the rate increase is to take effect.
SB44-SSA1,826,1919 3. The annualized percentage rate increase that will result.
SB44-SSA1,826,2020 4. The geographic area of analysis in which the hospital is located.
SB44-SSA1,826,2121 (b) A list of hospitals that have closed since 1993.
SB44-SSA1, s. 2094i 22Section 2094i. 153.10 of the statutes is renumbered 153.10 (1) and amended
23to read:
SB44-SSA1,827,324 153.10 (1) The department shall prepare, and submit to the governor and the
25chief clerk of each house of the legislature for distribution to the legislature under

1s. 13.172 (2), standard reports concerning health care providers other than hospitals
2and ambulatory surgery centers
that the department prepares and shall collect
3information necessary for preparation of those reports.
SB44-SSA1, s. 2094j 4Section 2094j. 153.10 (2) of the statutes is created to read:
SB44-SSA1,827,95 153.10 (2) The entity under contract under s. 153.05 (2m) (a) shall prepare, and
6submit to the governor and the chief clerk of each house of the legislature for
7distribution to the legislature under s. 13.172 (2), standard reports concerning
8hospitals and ambulatory surgery centers that the entity prepares and shall collect
9information necessary for preparation of those reports.
SB44-SSA1, s. 2094k 10Section 2094k. 153.20 of the statutes is amended to read:
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