SB44: Bill Text

SB44,834,6 146.946 Pharmacy benefits purchasing pool for governmental units. (1) In this section:

SB44,834,7 (a) "Brand name" has the meaning given in s. 450.12 (1) (a).

SB44,834,8 (b) "Generic name" has the meaning given in s. 450.12 (1) (b).

SB44,834,15 (c) "Governmental unit" means the state, including any body in state government created or authorized to be created by the constitution or any law; an instrumentality of the state or any corporation or other body created by the state; a political subdivision of the state; a special purpose district in this state; an instrumentality, corporation, or other body of a political subdivision or special purpose district; and any combination or subunit of any of the foregoing or of an instrumentality of the state and any of the foregoing.

SB44,834,16 (d) "Prescription drug" has the meaning given in s. 450.01 (20).

SB44,835,3 (2) Beginning on January 1, 2005, each governmental unit that offers or is required to provide health insurance coverage to any of its employees shall, together with every other such governmental unit, develop a common purchasing pool for pharmacy benefits that uses a preferred list of covered prescription drugs. The governmental units shall seek to develop the preferred list of covered prescription drugs under an evidence-based analysis that first identifies the relative effectiveness of prescription drugs within therapeutic classes for particular diseases and conditions and next identifies the least costly prescription drugs, including prescription drugs with generic names that are alternatives to prescription drugs with brand names, among those found to be equally effective. After the purchasing pool is developed, the pool shall be available to an employer to whom all of the following apply:

SB44,835,4 (a) The employer is not a governmental unit.

SB44,835,6 (b) The employer provides health insurance coverage to any of the employer's employees.

SB44,835,7 (c) The governor requests the employer's participation in the pool.

SB44, s. 2064 Section 2064. 146.997 (4) (a) of the statutes is amended to read:

SB44,835,14 146.997 (4) (a) Subject to par. (b), any Any employee of a health care facility or health care provider who is subjected to disciplinary action, or who is threatened with disciplinary action, in violation of sub. (3) may file a complaint with the department under s. 106.54 (6). If the department finds that a violation of sub. (3) has been committed, the department may take such action under s. 111.39 as will effectuate the purpose of this section.

SB44, s. 2065 Section 2065. 146.997 (4) (b) of the statutes is repealed.

SB44, s. 2066 Section 2066. 146.997 (4) (c) of the statutes is amended to read:

SB44,835,18 146.997 (4) (c) Section 111.322 (2m) applies to a disciplinary action arising in connection with any proceeding under par. (a) or (b).

SB44, s. 2067 Section 2067. 149.10 (8b) of the statutes is repealed.

SB44, s. 2068 Section 2068. 149.14 (5) (e) of the statutes is amended to read:

SB44,836,5 149.14 (5) (e) Subject to sub. (8) (b), the department may, by rule under s. 149.17 (4), establish for prescription drug coverage under sub. (3) (d) copayment amounts, coinsurance rates, and copayment and coinsurance out-of-pocket limits over which the plan will pay 100% of covered costs under sub. (3) (d). The department may provide subsidies for prescription drug copayment amounts paid by eligible persons under s. 149.165 (2) (a) 1. to 5. Any copayment amount, coinsurance rate, or out-of-pocket limit established under this paragraph is subject to the approval of the board. Copayments and coinsurance paid by an eligible person under this paragraph are separate from and do not count toward the deductible and covered costs not paid by the plan under pars. (a) to (c).

SB44, s. 2069 Section 2069. 149.143 (1) (a) of the statutes is repealed.

SB44, s. 2070 Section 2070. 149.143 (1) (b) (intro.) of the statutes is repealed.

SB44, s. 2071 Section 2071. 149.143 (1) (b) 1. of the statutes is renumbered 149.143 (1) (am) and amended to read:

SB44,836,11 149.143 (1) (am) A total of 60% 58% from the following sources, calculated as follows:

SB44,836,20 1. First, from premiums from eligible persons with coverage under s. 149.14 (2) (a) set at a rate that is 140% to 150% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan and from eligible persons with coverage under s. 149.14 (2) (b) set in accordance with s. 149.14 (5m), including amounts received for premium and, deductible , and prescription drug copayment subsidies under s. 149.144 and under the transfer to the fund from the appropriation account under s. 20.435 (4) (ah), and from premiums collected from eligible persons with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b).

SB44,836,22 2. Second, from moneys specified under sub. (2m), to the extent that the amounts under subd. 1. a. are insufficient to pay 60% 58% of plan costs.

SB44,837,9 3. Third, by increasing premiums from eligible persons with coverage under s. 149.14 (2) (a) to more than the rate at which premiums were set under subd. 1. a. but not more than 200% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan and from eligible persons with coverage under s. 149.14 (2) (b) by a comparable amount in accordance with s. 149.14 (5m), including amounts received for premium and, deductible , and prescription drug copayment subsidies under s. 149.144 and under the transfer to the fund from the appropriation account under s. 20.435 (4) (ah), and by increasing premiums from eligible persons with coverage under s. 149.146 in accordance with s. 149.146 (2) (b), to the extent that the amounts under subd. 1. a. subds. 1. and b. 2. are insufficient to pay 60% 58% of plan costs.

SB44,837,14 4. Fourth, notwithstanding subd. 2. par. (bm), by increasing insurer assessments, excluding assessments under s. 149.144, and adjusting provider payment rates, subject to s. 149.142 (1) (b) and excluding adjustments to those rates under s. 149.144, in equal proportions and to the extent that the amounts under subd. 1. a. to c. subds. 1. to 3. are insufficient to pay 60% 58% of plan costs.

SB44, s. 2072 Section 2072. 149.143 (1) (b) 2. of the statutes is renumbered 149.143 (1) (bm), and 149.143 (1) (bm) (intro.), as renumbered, is amended to read:

SB44,837,17 149.143 (1) (bm) (intro.) A total of 40% 42% as follows:

SB44, s. 2073 Section 2073. 149.143 (2) (a) (intro.) of the statutes is amended to read:

SB44,837,23 149.143 (2) (a) (intro.) Prior to each plan year, the department shall estimate the operating and administrative costs of the plan and the costs of the premium reductions under s. 149.165 and, the deductible reductions under s. 149.14 (5) (a), and any prescription drug copayment reductions under s. 149.14 (5) (e) for the new plan year and do all of the following:

SB44, s. 2074 Section 2074. 149.143 (2) (a) 1. a. of the statutes is amended to read:

SB44,838,9 149.143 (2) (a) 1. a. Estimate the amount of enrollee premiums that would be received in the new plan year if the enrollee premiums were set at a level sufficient, when including amounts received for premium and, deductible, and prescription drug copayment subsidies under s. 149.144 and under the transfer to the fund from the appropriation account under s. 20.435 (4) (ah) and from premiums collected from eligible persons with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b), to cover 60% 58% of the estimated plan costs for the new plan year, after deducting from the estimated plan costs the amount available for transfer to the fund from the appropriation account under s. 20.435 (4) (af) for that plan year.

SB44, s. 2075 Section 2075. 149.143 (2) (a) 1. b. of the statutes is amended to read:

SB44,838,12 149.143 (2) (a) 1. b. Estimate the amount of enrollee premiums that will be received under sub. (1) (b) 1. a. (am) 1.

SB44, s. 2076 Section 2076. 149.143 (2) (a) 2. of the statutes is amended to read:

SB44,838,20 149.143 (2) (a) 2. After making the determinations under subd. 1., by rule set premium rates for the new plan year, including the rates under s. 149.146 (2) (b), in the manner specified in sub. (1) (b) 1. a. and c. (am) 1. and 3. and such that a rate for coverage under s. 149.14 (2) (a) is approved by the board and is not less than 140% nor more than 200% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan.

SB44, s. 2077 Section 2077. 149.143 (2) (a) 3. of the statutes is amended to read:

SB44,838,25 149.143 (2) (a) 3. By rule set the total insurer assessments under s. 149.13 for the new plan year by estimating and setting the assessments at the amount necessary to equal the amounts specified in sub. (1) (b) 1. d. and 2. a. (am) 4. and (bm) 1. and notify the commissioner of the amount.

SB44, s. 2078 Section 2078. 149.143 (2) (a) 4. of the statutes is amended to read:

SB44,839,5 149.143 (2) (a) 4. By the same rule as under subd. 3. adjust the provider payment rate for the new plan year, subject to s. 149.142 (1) (b), by estimating and setting the rate at the level necessary to equal the amounts specified in sub. (1) (b) 1. d. and 2. b. (am) 4. and (bm) 2. and as provided in s. 149.145.

SB44, s. 2079 Section 2079. 149.143 (2) (b) of the statutes is amended to read:

SB44,839,12 149.143 (2) (b) In setting the premium rates under par. (a) 2., the insurer assessment amount under par. (a) 3. and the provider payment rate under par. (a) 4. for the new plan year, the department shall include any increase or decrease necessary to reflect the amount, if any, by which the rates and amount set under par. (a) for the current plan year differed from the rates and amount which would have equaled the amounts specified in sub. (1) (b) (am) and (bm) in the current plan year.

SB44, s. 2080 Section 2080. 149.143 (2m) (a) 1. of the statutes is amended to read:

SB44,839,16 149.143 (2m) (a) 1. The amount of premiums received in a plan year from all eligible persons, including amounts received for premium and, deductible, and prescription drug copayment subsidies.

SB44, s. 2081 Section 2081. 149.143 (2m) (a) 2. of the statutes is amended to read:

SB44,839,21 149.143 (2m) (a) 2. The amount of premiums, including amounts received for premium and, deductible, and prescription drug copayment subsidies, necessary to cover 60% 58% of the plan costs for the plan year, after deducting the amount transferred to the fund from the appropriation account under s. 20.435 (4) (af).

SB44, s. 2082 Section 2082. 149.143 (2m) (b) 1. of the statutes is amended to read:

SB44,840,2 149.143 (2m) (b) 1. To reduce premiums in succeeding plan years as provided in sub. (1) (b) 1. b. (am) 2. For eligible persons with coverage under s. 149.14 (2) (a), premiums may not be reduced below 140% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan.

SB44, s. 2083 Section 2083. 149.143 (3) (a) of the statutes is amended to read:

SB44,840,14 149.143 (3) (a) If, during a plan year, the department determines that the amounts estimated to be received as a result of the rates and amount set under sub. (2) (a) 2. to 4. and any adjustments in insurer assessments and the provider payment rate under s. 149.144 will not be sufficient to cover plan costs, the department may by rule increase the premium rates set under sub. (2) (a) 2. for the remainder of the plan year, subject to s. 149.146 (2) (b) and the maximum specified in sub. (2) (a) 2., by rule increase the assessments set under sub. (2) (a) 3. for the remainder of the plan year, subject to sub. (1) (b) 2. a. (bm) 1., and by the same rule under which assessments are increased adjust the provider payment rate set under sub. (2) (a) 4. for the remainder of the plan year, subject to sub. (1) (b) 2. b. (bm) 2. and s. 149.142 (1) (b).

SB44, s. 2084 Section 2084. 149.143 (3) (b) of the statutes is amended to read:

SB44,840,22 149.143 (3) (b) If the department increases premium rates and insurer assessments and adjusts the provider payment rate under par. (a) and determines that there will still be a deficit and that premium rates have been increased to the maximum extent allowable under par. (a), the department may further adjust, in equal proportions, assessments set under sub. (2) (a) 3. and the provider payment rate set under sub. (2) (a) 4., without regard to sub. (1) (b) 2. (bm) but subject to s. 149.142 (1) (b).

SB44, s. 2085 Section 2085. 149.144 of the statutes is amended to read:

SB44,841,14 149.144 Adjustments to insurer assessments and provider payment rates for premium and, deductible , and prescription drug copayment reductions. If the moneys transferred to the fund under the appropriation under s. 20.435 (4) (ah) are insufficient to reimburse the plan for premium reductions under s. 149.165 and deductible reductions under s. 149.14 (5) (a), or the department determines that the moneys transferred or to be transferred to the fund under the appropriation under s. 20.435 (4) (ah) will be insufficient to reimburse the plan for premium reductions under s. 149.165 and deductible reductions under s. 149.14 (5) (a), the The department may shall, by rule, adjust in equal proportions the amount of the assessment set under s. 149.143 (2) (a) 3. and the provider payment rate set under s. 149.143 (2) (a) 4., subject to ss. 149.142 (1) (b) and 149.143 (1) (b) 1. (am), sufficient to reimburse the plan for premium reductions under s. 149.165 and, deductible reductions under s. 149.14 (5) (a). If the department makes the adjustment under this section, the, and any prescription drug copayment reductions under s. 149.14 (5) (e). The department shall notify the commissioner so that the commissioner may levy any increase in insurer assessments.

SB44, s. 2086 Section 2086. 149.145 of the statutes is amended to read:

SB44,842,2 149.145 Program budget. The department, in consultation with the board, shall establish a program budget for each plan year. The program budget shall be based on the provider payment rates specified in s. 149.142 and in the most recent provider contracts that are in effect and on the funding sources specified in s. ss. 149.143 (1) and 149.144, including the methodologies specified in ss. 149.143, 149.144, and 149.146 for determining premium rates, insurer assessments, and provider payment rates. Except as otherwise provided in s. 149.143 (3) (a) and (b) and subject to s. 149.142 (1) (b), from the program budget the department shall derive the actual provider payment rate for a plan year that reflects the providers' proportional share of the plan costs, consistent with ss. 149.143 and 149.144. The department may not implement a program budget established under this section unless it is approved by the board.

SB44, s. 2087 Section 2087. 149.146 (2) (a) of the statutes is amended to read:

SB44,842,8 149.146 (2) (a) Except as specified by the department, the terms of coverage under s. 149.14, including deductible reductions under s. 149.14 (5) (a) and prescription drug copayment reductions under s. 149.14 (5) (e), do not apply to the coverage offered under this section. Premium reductions under s. 149.165 do not apply to the coverage offered under this section.

SB44, s. 2088 Section 2088. 149.16 (1) of the statutes is repealed.

SB44, s. 2089 Section 2089. 149.16 (1m) of the statutes is created to read:

SB44,842,12 149.16 (1m) The plan administrator may be selected by the department in a competitive bidding process.

SB44, s. 2090 Section 2090. 149.16 (4) of the statutes is amended to read:

SB44,842,16 149.16 (4) The If the plan administrator is the fiscal agent under s. 49.45 (2) (b) 2., the plan administrator shall account for costs related to the plan separately from costs related to medical assistance under subch. IV of ch. 49.

SB44, s. 2091 Section 2091. 149.165 (4) of the statutes is amended to read:

SB44,842,21 149.165 (4) The department shall reimburse the plan for premium reductions under sub. (2) and, deductible reductions under s. 149.14 (5) (a) with moneys transferred to the fund, and prescription drug copayment reductions under s. 149.14 (5) (e) from the appropriation account under s. 20.435 (4) (ah) (v).

SB44, s. 2092 Section 2092. 150.963 (3) (e) of the statutes is amended to read:

SB44,843,2 150.963 (3) (e) Accept on behalf of the state and deposit with the state treasurer secretary of administration any grant, gift, or contribution made to assist in meeting the cost of carrying out the purposes of this subchapter, and expend those funds for the purposes of this subchapter.

SB44, s. 2093 Section 2093. 153.05 (8) of the statutes is repealed.

SB44, s. 2094 Section 2094. 153.05 (13) of the statutes is amended to read:

SB44,843,10 153.05 (13) The department may waive the requirement under sub. (1), (5) or (8) or (5) for a health care provider, who requests the waiver and presents evidence to the department that the requirement under sub. (1), (5) or (8) or (5) is burdensome, under standards established by the department by rule. The department shall develop a form for use by a health care provider in submitting a request under this subsection.

SB44, s. 2095 Section 2095. 153.75 (1) (t) of the statutes is amended to read:

SB44,843,14 153.75 (1) (t) Establishing standards for determining under s. 153.05 (13) if a requirement under s. 153.05 (1), (5) or (8) or (5) is burdensome for a health care provider.

SB44, s. 2096 Section 2096. 165.065 (2) of the statutes is amended to read:

SB44,843,23 165.065 (2) The assistant attorney general in charge of antitrust investigations and prosecutions is to cooperate actively with the antitrust division of the U.S. department of justice in everything that concerns monopolistic practices in Wisconsin, and also to cooperate actively with the department of agriculture, trade and consumer protection in the work which this agency is carrying on under s. 100.20 of the marketing law with regard to monopolistic practices in the field of agriculture and with the federal trade commission on matters arising in or affecting Wisconsin which pertain to its jurisdiction.

SB44, s. 2097 Section 2097. 165.25 (4) (ar) of the statutes is amended to read:

SB44,844,9 165.25 (4) (ar) The department of justice shall furnish all legal services required by represent the department of agriculture, trade and consumer protection in any court action relating to the enforcement of ss. 100.171, 100.173, 100.174, 100.175, 100.177, 100.18, 100.182, 100.20, 100.205, 100.207, 100.209, 100.21, 100.28, 100.37, 100.42, 100.50 and 100.51 and chs. 126, 136, 344, 704, 707, and 779 ch. 126 and ss. 100.01 to 100.025, 100.05, 100.07, 100.14, 100.183 to 100.19, 100.201, 100.22, 100.235, 100.27, 100.285 to 100.297, 100.33 to 100.36, 100.45, 100.47, and 100.48, together with any other services as are necessarily connected to the legal services.

SB44, s. 2098 Section 2098. 165.252 of the statutes is created to read:

SB44,844,15 165.252 Consumer protection matters. The department of justice shall administer ss. 100.15 to 100.182, 100.20, 100.205, 100.207 to 100.2095, 100.28, 100.31, 100.37 to 100.44, 100.46, 100.50, and 100.52 and may promulgate rules to aid in the administration and enforcement of these sections. The department of justice may appear for the state in any court action relating to these sections.

SB44, s. 2099 Section 2099. 165.30 (3) of the statutes is amended to read:

SB44,844,19 165.30 (3) Collection proceeds. (a) All obligations collected by the department of justice under this section shall be paid to the state treasurer secretary of administration and deposited in the appropriate fund.

SB44,844,24 (b) From the amount of obligations collected by the department of justice under this section, the treasurer secretary of administration shall credit an amount equal to the reasonable and necessary expenses incurred by the department of justice related to collecting those obligations to the appropriation account under s. 20.455 (1) (gs).

SB44, s. 2100 Section 2100. 165.755 (1) (a) of the statutes is amended to read:

SB44,845,4 165.755 (1) (a) Except as provided in par. (b), a court shall impose a crime laboratories and drug law enforcement assessment of $5 $7 if the court imposes a sentence, places a person on probation or imposes a forfeiture for a violation of state law or for a violation of a municipal or county ordinance.

SB44, s. 2101 Section 2101. 165.755 (3) of the statutes is amended to read:

SB44,845,10 165.755 (3) Except as provided in sub. (4), after the court determines the amount due under sub. (1) (a), the clerk of the court shall collect and transmit the amount to the county treasurer under s. 59.40 (2) (m). The county treasurer shall then make payment to the state treasurer secretary of administration under s. 59.25 (3) (f) 2.

SB44, s. 2102 Section 2102. 165.755 (4) of the statutes is amended to read:

SB44,845,15 165.755 (4) If a municipal court imposes a forfeiture, after determining the amount due under sub. (1) (a) the court shall collect and transmit such amount to the treasurer of the county, city, town, or village, and that treasurer shall make payment to the state treasurer secretary of administration as provided in s. 66.0114 (1) (bm).

SB44, s. 2103 Section 2103. 165.755 (5) of the statutes is amended to read:

SB44,845,22 165.755 (5) If any deposit of bail is made for a noncriminal offense to which sub. (1) (a) applies, the person making the deposit shall also deposit a sufficient amount to include the assessment prescribed in sub. (1) (a) for forfeited bail. If bail is forfeited, the amount of the assessment under sub. (1) (a) shall be transmitted monthly to the state treasurer secretary of administration under this section. If bail is returned, the assessment shall also be returned.

SB44, s. 2104 Section 2104. 165.755 (6) of the statutes is amended to read: