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5. In the southeastern region, a total of 12 members, consisting of 2 members
24from each county in that region. The county board of supervisors of each county in
25that region shall appoint 2 persons from that county.
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16. In the area within Milwaukee County, a total of 12 members, consisting of
26 persons who are residents of the city of Milwaukee and are appointed by the mayor
3of the city of Milwaukee as provided under s. 62.09 (8) (cm), and 6 persons who are
4residents of Milwaukee County but are not residents of the city of Milwaukee and are
5appointed by the county executive of Milwaukee County.
AB229, s. 8
6Section
8. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
7the following amounts for the purposes indicated:
-
See PDF for table ![PDF](https://docs.legis.wisconsin.gov/assets/image/file_acrobat.gif)
AB229, s. 9
8Section
9. 20.430 of the statutes is created to read:
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920.430 Health planning and finance, department of. There is
10appropriated to the department of health planning and finance for the following
11program:
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12(1) Health planning and finance. (a)
General program operations. The
13amounts in the schedule for the general program operations of the department of
14health planning and finance.
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(b)
Universal health plan services and benefits. The amounts in the schedule
16for health care services and benefits provided under s. 152.10 (4).
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(i)
Gifts and grants. All moneys received from gifts, grants, bequests, and
18devises to carry out the purposes for which made.
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1(m)
Federal funds; state operations. All moneys received from the federal
2government, as authorized by the governor under s. 16.54, for the purposes for which
3made and received.
AB229, s. 10
4Section
10. 59.17 (2) (c) of the statutes is amended to read:
AB229,7,95
59.17
(2) (c) Appoint the members of all boards
and, commissions
, and councils 6where appointments are required and where the statutes provide that the
7appointments are made by the county board
or, by the chairperson of the county
8board
, or by the county executive. All appointments to boards
and, commissions
, and
9councils by the county executive are subject to confirmation by the county board.
AB229, s. 11
10Section
11. 59.53 (24) of the statutes is created to read:
AB229,7,1211
59.53
(24) Regional health council. The board shall appoint members of a
12regional health council, as specified in s. 15.207 (1) (b) 1. to 5.
AB229, s. 12
13Section
12. 62.09 (8) (cm) of the statutes is created to read:
AB229,7,1614
62.09
(8) (cm) The mayor of the city of Milwaukee shall, with the advice and
15consent of the common council of that city, appoint 6 members of a regional health
16council, as specified under s. 15.207 (1) (b) 6.
AB229, s. 13
17Section
13. Chapter 152 of the statutes is created to read:
AB229,7,1918
Chapter 152
19
Universal health plan
AB229,7,20
20152.01 Definitions. In this chapter:
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21(1) "Block grant" has the meaning given in s. 16.54 (2) (a) 3.
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22(2) "Board" means the health policy board.
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23(3) "Department" means the department of health planning and finance.
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24(4) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
AB229,8,9
1(5) "Health care facility" means a facility, as defined in s. 647.01 (4), or any
2hospital, nursing home, community-based residential facility, county home, county
3infirmary, county hospital, county mental health center, community health center,
4primary health center, tuberculosis sanatorium, adult family home, assisted living
5facility, rural medical center, hospice, or other place licensed, certified, or approved
6by the department of health and family services under s. 49.70, 49.71, 49.72, 50.02,
750.03, 50.032, 50.033, 50.034, 50.35, 50.52, 50.92 (2), 51.08, or 51.09 or a facility
8under s. 45.365, 51.05, 51.06, or 252.10 or ch. 233, or licensed or certified by a county
9department under s. 50.032 or 50.033.
AB229,8,11
10(6) "Health care provider" means a provider of health care services or other
11benefits in this state that are specified under s. 152.10 (4).
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12(7) "Medicare" means coverage under part A or part B of Title XVIII of the
13federal Social Security Act,
42 USC 1395 to
1395ddd.
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14(8) "Reimbursement" means payment for the provision of services and other
15benefits that are specified under s. 152.10 (4).
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16(9) "Secretary" means the secretary of health planning and finance.
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17(10) "Veteran" has the meaning given in
38 USC 101 (2).
AB229,8,25
18152.10 Universal health plan. (1) There is created a universal health plan
19in this state, under which, beginning on July 1, 2006, each eligible person shall
20receive reasonable medical service necessary to maintain health, enable diagnosis,
21or provide treatment or rehabilitation for an injury, condition, disability, or disease,
22for which reimbursement shall be made by the department, except that no coverage
23is provided for orthodontia or for the performance of reconstructive or cosmetic
24surgery that is not determined to be medically necessary under criteria that are
25promulgated as rules by the department.
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1(2) Each individual in this state who meets requirements of residency, under
2criteria promulgated as rules by the department, is eligible for coverage, except as
3provided in sub. (5), under the universal health plan, except that all of the following
4may be phased in for eligibility under this subsection, beginning no later than July
51, 2007:
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(a) Individuals, other than those specified in par. (b), who have no coverage
7under disability insurance policies.
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(b) Individuals who have no coverage under disability insurance policies and
9who receive health care, treatment for nervous or mental disorders, or treatment or
10prevention services for alcohol and other drug abuse that are funded by state or local
11funding.
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(c) Individuals who are employees of the state or any county, city, village, or
13town, and who, as a benefit of the employment, have coverage for themselves and
14family members under provisions of group disability insurance policies or under
15self-insured health plans.
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(d) Individuals, other than those specified in par. (c) or (h), who, by reason of
17their employment or as family members of individuals who are employed, have
18coverage under group disability insurance policies.
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(e) Individuals who have coverage under individual disability insurance
20policies.
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(f) Individuals who have coverage under the health insurance risk-sharing
22plan under ch. 149.
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(g) Individuals who are eligible for benefits or services under s. 49.46, 49.468,
2449.47, or 49.665, Medicare, or block grants that provide health care services.
AB229,10,3
1(h) Individuals who are employees of self-insured employers, other than those
2specified in par. (c), and who receive health care benefits for themselves and family
3members under self-insured health plans.
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(i) Individuals who receive medical benefits under worker's compensation.
AB229,10,75(j) Veterans who receive medical benefits under s. 45.351 (1j) or
38 USC 1701 6to
1774, or both, and the children of veterans who receive medical benefits under
38
7USC 1801 to
1806.
AB229,10,88(k) Indians who receive health and other services under
25 USC 1651 to
1683.
AB229,10,11
9(3) (a) Any individual who is eligible under sub. (2) may receive services that
10are available under the universal health plan from any participating health care
11provider in this state.
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(b) No individual who is eligible under sub. (2) may under this section be
13required to pay an amount as a deductible or copayment as a condition for receipt of
14services under this section from a health care facility or health care provider.
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(c) An individual's state residency is presumed unless rebutted by clear and
16convincing evidence. If the presumption is so rebutted, any reimbursement paid
17under the universal health plan for health care services rendered to the individual
18is a liability of the individual.
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19(4) Health care services and other benefits provided under the universal health
20plan shall include all of the following:
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(a) Services of all persons licensed, certified, registered, or permitted to treat
22the sick under chs. 441, 446, 447, 448, 449, 450, 451, 455, 457, and 459.
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(b) Health care services that are provided by health care facilities and the
24offices and clinics of persons under par. (a).
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1(c) Preventive health care services and health promotional programs, including
2well-child care, immunizations, screening, outreach, and education.
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(d) Medical or surgical supplies and durable medical or surgical equipment,
4supplies and appliances, including valves, pacemakers, prostheses, eyeglasses, and
5hearing aids.
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(e) Prescription drugs specified in the listing of approved medicinal substances
7and formulae under s. 152.40 (4) (m) and any other drugs specified by the department
8by rule.
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(f) Blood and blood products.
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(g) Long-term care services that are necessary for the physical health, mental
11and emotional well-being, and social and personal needs of individuals who have
12limited self-care capabilities, including services of health care facilities; home
13health care; hospice care; home-based and community-based services, including
14personal assistance and attendant care; and periodic needs assessments.
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(h) Mental health treatment and services, including substance abuse and brain
16injury treatment.
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(i) Dental services, as specified under s. 49.46 (2) (b) 1.
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18(5) The universal health plan is the payer of last resort, and coverage under
19the universal health plan is supplemental to any health care coverage in force that
20is held by an individual.
AB229,11,24
21(6) As a condition of participation by a health care provider in the universal
22health plan, the health care provider shall accept reimbursement only under the
23universal health plan for all services or other benefits that the health care provider
24provides under the universal health plan.
AB229,12,3
1152.20 Health policy board; powers and duties.
(1) The board shall
2approve and continually evaluate the listing of approved medicinal substances and
3formulae that is required under s. 152.40 (4) (m).
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4(2) The board shall biennially evaluate and oversee cost containment
5guidelines and policies, including the evaluation of mechanisms used to contain costs
6of providing services, and shall revise the guidelines and policies as necessary.
AB229,12,8
7(3) The board shall review all of the following issues and formulate or revise
8policies, as appropriate, with respect to the issues:
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(a) Duties of the department that require policy determinations.
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(b) The sources and amounts of revenues for the administration of the
11department and the board and for financing the payment of medical services that are
12provided to residents under the universal health plan.
AB229,12,1313
(c) Information provided by the regional health councils.
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(d) Development of a system for determination and periodic review of areas in
15this state, and specific populations within those areas, that are medically
16underserved; and development of plans for providing health care services to those
17areas and populations, including the establishment of community health centers.
AB229,12,2018
(e) Development of a system for periodic reviews and evaluations of all aspects
19of the operation of the universal health plan, including the adequacy, cost,
20effectiveness, and quality of health care services provided.
AB229,12,2321
(f) Development of a notice and hearing procedure for review of complaints of
22residents about the universal health plan, in accordance with the requirements of
23ch. 227.
AB229,12,2524
(g) Other issues that the board determines are relevant to the universal health
25plan.
AB229,13,1
1(h) State statutory changes that may be necessary to effect pars. (a) to (g).
AB229,13,5
2(4) By January 1, April 1, July 1, and October 1 of each year, the board shall
3report to the governor on the revenues and expenditures of the universal health plan
4for the calendar quarter immediately preceding the most recently completed
5calendar quarter.
AB229,13,8
6(5) The board shall establish provider payment rates, taking into consideration
7regional, rural, and urban differences, and conditions of payment for the provision
8of health care services under the universal health plan.
AB229,13,10
9152.30 Regional health councils. (1) Each regional health council shall do
10all of the following:
AB229,13,1511
(a) Elect one member of the regional health council to serve as a member of the
12board under s. 15.20 (1). If the term of the member who is so elected expires with
13respect to the regional health council or with respect to the board under s. 15.20 (1),
14the regional health council shall elect a current member of the council to serve as a
15member of the board in his or her stead.
AB229,13,1916
(b) Study and continuously monitor the delivery and quality of and access to
17health care services in the region of the regional health council and recommend to
18the board ways to improve the quality of and help ensure access to health care
19services.
AB229,13,2220
(c) Recommend to the board payment rates and conditions appropriate to
21specific regional needs and advise on regional health care policy issues and
22administrative policies and procedures.
AB229,13,2523
(d) Study and continuously monitor the unmet health care service needs in the
24region of the regional health council and recommend to the board ways by which the
25needs may be met.
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1(e) Report at least annually to the board with respect to the health care needs,
2problems, and concerns of the region, including any issues elicited at public hearings
3under par. (g), and provide to the board recommendations to alleviate these needs,
4problems, and concerns.
AB229,14,75
(f) Require reports from and advise the member of the staff of the appropriate
6regional office whose duties are specified under s. 152.40 (1), concerning issues that
7arise under pars. (b) to (e).
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(g) In at least 3 localities of the region, hold public hearings at least annually
9to elicit public opinion concerning the universal health plan. The council shall give
10notice of each hearing by publishing a class 1 notice, under ch. 985, at least 15 days
11before the hearing in a newspaper covering the affected area.
AB229,14,1212
(h) Perform other duties as required by the board.
AB229,14,15
13(2) Each regional health council may, for cause, recall the member elected
14under sub. (1) (a) and may elect another member to fulfill that term on the board if
15all of the following are done:
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(a) The elected member of the board for whom recall is sought receives notice
17of the recall at least 10 working days before the meeting at which recall is voted upon.
AB229,14,2018
(b) Notice of the vote to recall the elected member is made on the agenda of the
19meeting of the regional health council that is immediately prior to the meeting at
20which recall is voted upon.
AB229,14,23
21(3) The staff of the appropriate regional office shall provide services to each
22regional health council to deal with issues of health consumer advocacy and health
23ombudsman functions.
AB229,15,3
24152.40 Department of health planning and finance. (1) The department
25shall administer the universal health plan, including establishing a regional office
1in each of the regions specified under s. 15.207 (1) (a) 1. to 6. Each regional office shall
2have at least one staff member who acts in a full-time capacity as a regional
3consumer advocate and health care ombudsman.
AB229,15,5
4(2) The department shall, after review and approval by the board, promulgate
5as rules all of the following:
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(a) Guidelines for cost containment under the universal health plan, including
7the purchasing and distribution of major diagnostic, medical, and surgical
8equipment.
AB229,15,109
(b) Criteria for determining state residency for the purposes of eligibility under
10the universal health plan.
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(c) Criteria, as recommended by the medical advisory committee appointed by
12the secretary under sub. (5), for determining medical necessity for orthodontia and
13for the performance of reconstructive or cosmetic surgery for coverage under the
14universal health plan.
AB229,15,16
15(3) The department shall biennially evaluate and recommend to the board cost
16control measures for the universal health plan.
AB229,15,19
17(4) The department shall, by July 1, 2005, begin implementation of processes,
18in light of policies formulated or revised under s. 152.20 (3), to effect all of the
19following: