25,2045m
Section 2045m. 149.14 (3) (a) to (r) of the statutes are repealed.
25,2046c
Section 2046c. 149.14 (4) of the statutes is repealed and recreated to read:
149.14 (4) Benefit design. Except as provided in subs. (2) (a) and (6), the board shall determine the benefit design of the plan, including the covered expenses, expenses excluded from coverage, deductibles, copayments, coinsurance, out-of-pocket limits, and coverage limitations. The board may establish more than one benefit design under the plan. All benefit designs shall be comparable to typical individual health insurance policies offered in the private sector market in this state.
25,2046m
Section 2046m. 149.14 (4c) of the statutes is repealed.
25,2047c
Section 2047c. 149.14 (4m) of the statutes is renumbered 149.142 (2m) and amended to read:
149.142 (2m) Payment is payment in full. Except for copayments, coinsurance, or deductibles required or authorized under the plan, a provider of a covered service or article shall accept as payment in full for the covered service or article the payment rate determined under ss. 149.142, 149.143 and 149.144 sub. (1) and may not bill an eligible person who receives the service or article for any amount by which the charge for the service or article is reduced under s. 149.142, 149.143 or 149.144 sub. (1).
25,2047m
Section 2047m. 149.14 (5) of the statutes is repealed.
25,2048c
Section 2048c. 149.14 (5m) of the statutes is repealed.
25,2048m
Section 2048m. 149.14 (6) (a) of the statutes is repealed.
25,2049c
Section 2049c. 149.14 (6) (b) of the statutes is renumbered 149.14 (6).
25,2049m
Section 2049m. 149.14 (7) (b) of the statutes is amended to read:
149.14 (7) (b) The department organization has a cause of action against an eligible participant for the recovery of the amount of benefits paid which are not for covered expenses under the plan. Benefits under the plan may be reduced or refused as a setoff against any amount recoverable under this paragraph.
25,2050c
Section 2050c. 149.14 (7) (c) of the statutes is amended to read:
149.14 (7) (c) The department organization is subrogated to the rights of an eligible person to recover special damages for illness or injury to the person caused by the act of a 3rd person to the extent that benefits are provided under the plan. Section 814.03 (3) applies to the department organization under this paragraph.
25,2050m
Section 2050m. 149.14 (8) of the statutes is repealed and recreated to read:
149.14 (8) Subsidies. The board shall provide for subsidies for premiums, deductibles, and copayments for eligible persons with household incomes below a level established by the board.
25,2051c
Section 2051c. 149.141 of the statutes is created to read:
149.141 Premiums. The board shall set premiums for coverage under the plan at a level that is sufficient to cover 60 percent of plan costs, as provided in s. 149.143 (1), except that in no event may plan rates exceed 200 percent of rates applicable to individual standard risks.
25,2051m
Section 2051m. 149.142 (1) (a) of the statutes is renumbered 149.142 (1) and amended to read:
149.142 (1) Establishment of rates.
Except as provided in par. (b), the department The board shall establish provider payment rates for covered expenses that consist of the allowable charges paid under s. 49.46 (2) for the services and articles provided plus an enhancement determined by the department board. The rates shall be based on the allowable charges paid under s. 49.46 (2), projected plan costs, and trend factors. Using the same methodology that applies to medical assistance under subch. IV of ch. 49, the department board shall establish hospital outpatient per visit reimbursement rates and hospital inpatient reimbursement rates that are specific to diagnostically related groups of eligible persons. The adjustments to the usual and customary rates shall be sufficient to cover 20 percent of plan costs, as provided in s. 149.143 (3).
25,2052c
Section 2052c. 149.142 (1) (b) of the statutes is repealed.
25,2052m
Section 2052m. 149.142 (2) of the statutes is repealed.
25,2053c
Section 2053c. 149.143 of the statutes is repealed and recreated to read:
149.143 Payment of plan costs. The board shall pay plan costs, including any premium, deductible, and copayment subsidies, as follows:
(1) Sixty percent from premiums paid by eligible persons.
(2) Twenty percent from insurer assessments under s. 149.13.
(3) Twenty percent from adjustments to provider payment rates under s. 149.142.
25,2053m
Section 2053m. 149.144 of the statutes is repealed.
25,2054c
Section 2054c. 149.145 of the statutes is repealed.
25,2054m
Section 2054m. 149.146 (1) (a) and (b) of the statutes are consolidated, renumbered 149.14 (2) (c) and amended to read:
149.14
(2) (c)
Beginning on January 1, 1998, in In addition to the coverage
required under
s. 149.14 pars. (a) and (b), the plan shall offer to all eligible persons who are not eligible for
medicare Medicare a choice of coverage, as described in section 2744 (a) (1) (C), P.L.
104-191. Any such choice of coverage shall be major medical expense coverage.
(b) An eligible person
under par. (a) who is not eligible for Medicare may elect once each year, at the time and according to procedures established by the
department board, among the coverages offered under this
section and s. 149.14. If an eligible person elects new coverage, any preexisting condition exclusion imposed under the new coverage is met to the extent that the eligible person has been previously and continuously covered under this chapter. No preexisting condition exclusion may be imposed on an eligible person who elects new coverage if the person was an eligible individual when first covered under this chapter and the person remained continuously covered under this chapter up to the time of electing the new coverage paragraph and par. (a).
25,2055c
Section 2055c. 149.146 (2) of the statutes is repealed.
25,2055m
Section 2055m. 149.15 of the statutes is repealed.
25,2056c
Section 2056c. 149.155 of the statutes is created to read:
149.155 Additional duties of board. The board shall do all of the following:
(1) Adopt policies for the administration of this chapter, including delegation of any part of its powers and its own procedures.
(5) Seek to qualify the plan as a state pharmacy assistance program, as defined in
42 CFR 423.464.
(6) Annually submit a report to the legislature under s. 13.172 (2) and to the governor on the operation of the plan.
25,2056m
Section 2056m. 149.16 (title) of the statutes is repealed.
25,2057c
Section 2057c. 149.16 (1m) of the statutes is repealed.
25,2057m
Section 2057m. 149.16 (3) (a) of the statutes is renumbered 149.155 (2) and amended to read:
149.155 (2) The plan administrator shall perform Perform all eligibility and administrative claims payment functions relating to the plan.
25,2058c
Section 2058c. 149.16 (3) (b) of the statutes is renumbered 149.155 (3) and amended to read:
149.155 (3) The plan administrator shall establish Establish a premium billing procedure for collection of premiums from insured persons. Billings shall be made on a periodic basis as determined by the department board.
25,2058m
Section 2058m. 149.16 (3) (c) of the statutes is renumbered 149.155 (4), and 149.155 (4) (intro.), as renumbered, is amended to read:
149.155 (4) (intro.) The plan administrator shall perform Perform all necessary functions to assure timely payment of benefits to covered persons under the plan, including:
25,2059c
Section 2059c. 149.16 (3) (e) of the statutes is repealed.
25,2059m
Section 2059m. 149.16 (4) of the statutes is repealed.
25,2060c
Section 2060c. 149.16 (5) of the statutes is repealed.
25,2060m
Section 2060m. 149.165 of the statutes is repealed.
25,2061c
Section 2061c. 149.17 (1) of the statutes is amended to read:
149.17 (1) Subject to ss. 149.14 (5m),
s. 149.143 and 149.146 (2) (b), a rating plan calculated in accordance with generally accepted actuarial principles.
25,2061m
Section 2061m. 149.17 (2) of the statutes is repealed.
25,2062c
Section 2062c. 149.17 (4) of the statutes is repealed.
25,2062m
Section 2062m. 149.175 of the statutes is repealed.
25,2063c
Section 2063c. 149.20 of the statutes is repealed.
25,2065
Section
2065. 149.25 of the statutes is repealed.
25,2067
Section
2067. 153.05 (6m) of the statutes is amended to read:
153.05 (6m) The department may contract with the group insurance board for the provision of data collection and analysis services related to health maintenance organizations and insurance companies that provide health insurance for state employees. The department shall establish contract fees for the provision of the services. All moneys collected under this subsection shall be credited to the appropriation under s. 20.435 (4) (1) (hg).
25,2067g
Section 2067g. 153.05 (14) of the statutes is created to read:
153.05 (14) With respect to health care information required to be collected under this section from health care providers that are not hospitals or ambulatory surgery centers, the department shall do all of the following:
(a) Develop procedures to ensure that data are submitted consistently and accurately, including clarifying the place-of-service codes and types of ancillary services that are required to be reported.
(b) Work directly with individual physician practice groups to identify and correct data submission errors.
(c) Develop and publish standard reports under s. 153.45 (1) (a) that are understandable by individuals other than medical professionals.
(d) Make program data available in a timely fashion.
(e) Enter into a memorandum of understanding with the department of regulation and licensing to improve the timeliness of updating physician information and to improve the assessment process under s. 153.60 (1).
25,2074
Section
2074. 153.60 (1) of the statutes is amended to read:
153.60 (1) The department shall, by the first October 1 after the commencement of each fiscal year, estimate the total amount of expenditures under this chapter for the department and the board for that fiscal year for data collection, database development and maintenance, generation of data files and standard reports, orientation and training provided under s. 153.05 (9) (a) and maintaining the board. The department shall assess the estimated total amount for that fiscal year, less the estimated total amount to be received for purposes of administration of this chapter under s. 20.435 (4) (1) (hi) during the fiscal year, and the unencumbered balance of the amount received for purposes of administration of this chapter under s. 20.435 (4) (1) (hi) from the prior fiscal year and the amount in the appropriation account under s. 20.435 (1) (dg), 1997 stats., for the fiscal year, to health care providers, other than hospitals and ambulatory surgery centers, who are in a class of health care providers from whom the department collects data under this chapter in a manner specified by the department by rule. The department shall obtain approval from the board for the amounts of assessments for health care providers other than hospitals and ambulatory surgery centers. The department shall work together with the department of regulation and licensing to develop a mechanism for collecting assessments from health care providers other than hospitals and ambulatory surgery centers. No health care provider that is not a facility may be assessed under this subsection an amount that exceeds $75 per fiscal year. All payments of assessments shall be credited to the appropriation under s. 20.435 (4) (1) (hg).
25,2075
Section
2075. 153.60 (3) of the statutes is amended to read:
153.60 (3) The department shall, by the first October 1 after the commencement of each fiscal year, estimate the total amount of expenditures required for the collection, database development and maintenance and generation of public data files and standard reports for health care plans that voluntarily agree to supply health care data under s. 153.05 (6r). The department shall assess the estimated total amount for that fiscal year to health care plans in a manner specified by the department by rule and may enter into an agreement with the office of the commissioner of insurance for collection of the assessments. Each health plan that voluntarily agrees to supply this information shall pay the assessments on or before December 1. All payments of assessments shall be deposited in the appropriation under s. 20.435 (4)
(1) (hg) and may be used solely for the purposes of s. 153.05 (6r).
25,2076
Section
2076. 153.65 (1) of the statutes is amended to read:
153.65 (1) The department may, but is not required to, provide, upon request from a person, a data compilation or a special report based on the information collected by the department. The department shall establish user fees for the provision of these compilations or reports, payable by the requester, which shall be sufficient to fund the actual necessary and direct cost of the compilation or report. All moneys collected under this subsection shall be credited to the appropriation under s. 20.435 (4)
(1) (hi).
25,2081na
Section 2081na. 157.061 (2g) of the statutes is created to read:
157.061 (2g) "Cemetery board" means the board created in s. 15.405 (3m).
25,2081nb
Section 2081nb. 157.08 (2) (b) of the statutes is amended to read:
157.08 (2) (b) Before a cemetery authority sells or encumbers any cemetery land, except for a sale described in par. (a), the cemetery authority shall notify the department cemetery board in writing of the proposed sale or encumbrance. If within 60 days after the department cemetery board is notified of the proposed sale or encumbrance the department cemetery board notifies the cemetery authority in writing that the department cemetery board objects to the sale or encumbrance the cemetery authority may not sell or encumber the cemetery land unless the department cemetery board subsequently notifies the cemetery authority in writing that the objection is withdrawn. The department cemetery board may object to a sale or encumbrance only if it determines that the cemetery authority will not be financially solvent or that the rights and interests of owners of cemetery lots and mausoleum spaces will not be adequately protected if the sale or encumbrance occurs. The department
cemetery board may, before the expiration of the 60-day period, notify the cemetery authority in writing that the department cemetery board approves of the sale or encumbrance. Upon receipt of the department's cemetery board's written approval, the cemetery authority may sell or encumber the cemetery land and is released of any liability under this paragraph. The department cemetery board shall make every effort to make determinations under this paragraph in an expeditious manner.
25,2081nc
Section 2081nc. 157.08 (5) of the statutes is amended to read:
157.08 (5) Subsections (1) and (2) (b) do not apply to a religious society organized under ch. 187, and sub. (2) (b) does not apply to a cemetery authority that is not required to be registered licensed under s. 440.91 (1) and that is not organized or conducted for pecuniary profit.
25,2081nd
Section 2081nd. 157.11 (11) of the statutes is amended to read:
157.11 (11) Exemption for certain nonprofit cemeteries. Subsection (9g) does not apply to a cemetery authority that is not required to be registered licensed under s. 440.91 (1) and that is not organized or conducted for pecuniary profit.
25,2081ne
Section 2081ne. 157.128 (3) (b) of the statutes is amended to read:
157.128 (3) (b) A cemetery consisting of less than 20 contiguous acres may be dedicated by a cemetery authority that is not required to be registered licensed under s. 440.91 (1) and that is not organized or conducted for pecuniary profit.
25,2081ng
Section 2081ng. 157.19 (5) (a) of the statutes is amended to read:
157.19 (5) (a) This section does not apply to care funds under s. 157.11 (9g) that are deposited with a city or county as provided under s. 157.11 (9g) (a), to care funds of a cemetery for which a certification under s. 157.63 is effective, to preneed trust funds of a cemetery for which a certification under s. 440.92 (9) is effective, or to care funds or preneed trust funds of a cemetery authority that is not required to be registered licensed under s. 440.91 (1) and that is not organized or conducted for pecuniary profit.
25,2081ni
Section 2081ni. 157.625 (3) of the statutes is amended to read:
157.625 (3) Section 157.62 does not apply to a cemetery authority that is not required to be registered
licensed under s. 440.91 (1) and that is not organized or conducted for pecuniary profit.
25,2081s
Section 2081s. 157.65 (2) of the statutes is amended to read:
157.65 (2) The department of justice or any district attorney, upon informing the department of justice, may commence an action in circuit court in the name of the state to restrain by temporary or permanent injunction any violation of this subchapter. The court may, prior to entry of final judgment, make such orders or judgments as may be necessary to restore to any person any pecuniary loss suffered because of the acts or practices involved in the action, if proof of such loss is submitted to the satisfaction of the court. The department of justice may subpoena persons and require the production of books and other documents, and may request the department of regulation and licensing board described in s. 15.405 (3m) or the department of commerce to exercise its authority under sub. (1) to aid in the investigation of alleged violations of this subchapter.
25,2086
Section
2086. 165.755 (1) (a) of the statutes is amended to read:
