AB100-ASA1,809,63
149.14
(7) (b) The
department organization has a cause of action against an
4eligible participant for the recovery of the amount of benefits paid which are not for
5covered expenses under the plan. Benefits under the plan may be reduced or refused
6as a setoff against any amount recoverable under this paragraph.
AB100-ASA1,809,118
149.14
(7) (c) The
department organization is subrogated to the rights of an
9eligible person to recover special damages for illness or injury to the person caused
10by the act of a 3rd person to the extent that benefits are provided under the plan.
11Section 814.03 (3) applies to the
department organization under this paragraph.
AB100-ASA1,809,1513
149.14
(8) Subsidies. The board shall provide for subsidies for premiums,
14deductibles, and copayments for eligible persons with household incomes below a
15level established by the board.
AB100-ASA1,809,19
17149.141 Premiums. The board shall set premiums for coverage under the
18plan at a level that is sufficient to cover 60 percent of plan costs, as provided in s.
19149.143 (1).
AB100-ASA1, s. 2051m
20Section 2051m. 149.142 (1) (a) of the statutes is renumbered 149.142 (1) and
21amended to read:
AB100-ASA1,810,722
149.142
(1) Establishment of rates.
Except as provided in par. (b), the
23department The board shall establish
provider payment rates for covered expenses
24that consist of the allowable charges paid under s. 49.46 (2) for the services and
25articles provided plus an enhancement determined by the
department board. The
1rates shall be based on the allowable charges paid under s. 49.46 (2), projected plan
2costs
, and trend factors. Using the same methodology that applies to medical
3assistance under subch. IV of ch. 49, the
department
board shall establish hospital
4outpatient per visit reimbursement rates and hospital inpatient reimbursement
5rates that are specific to diagnostically related groups of eligible persons.
The
6adjustments to the usual and customary rates shall be sufficient to cover 20 percent
7of plan costs, as provided in s. 149.143 (3).
AB100-ASA1,810,12
11149.143 Payment of plan costs. The board shall pay plan costs, including
12any premium, deductible, and copayment subsidies, as follows:
AB100-ASA1,810,13
13(1) Sixty percent from premiums paid by eligible persons.
AB100-ASA1,810,14
14(2) Twenty percent from insurer assessments under s. 149.13.
AB100-ASA1,810,16
15(3) Twenty percent from adjustments to provider payment rates under s.
16149.142.
AB100-ASA1, s. 2054m
19Section 2054m. 149.146 (1) (a) and (b) of the statutes are consolidated,
20renumbered 149.14 (2) (c) and amended to read:
AB100-ASA1,811,921
149.14
(2) (c)
Beginning on January 1, 1998, in In addition to the coverage
22required under
s. 149.14 pars. (a) and (b), the plan shall offer to all eligible persons
23who are not eligible for
medicare Medicare a choice of coverage, as described in
24section 2744 (a) (1) (C), P.L.
104-191. Any such choice of coverage shall be major
25medical expense coverage.
(b) An eligible person
under par. (a) who is not eligible
1for Medicare may elect once each year, at the time and according to procedures
2established by the
department board, among the coverages offered under this
section
3and s. 149.14. If an eligible person elects new coverage, any preexisting condition
4exclusion imposed under the new coverage is met to the extent that the eligible
5person has been previously and continuously covered under this chapter. No
6preexisting condition exclusion may be imposed on an eligible person who elects new
7coverage if the person was an eligible individual when first covered under this
8chapter and the person remained continuously covered under this chapter up to the
9time of electing the new coverage paragraph and par. (a).
AB100-ASA1,811,13
13149.155 Additional duties of board. The board shall do all of the following:
AB100-ASA1,811,15
14(1) Adopt policies for the administration of this chapter, including delegation
15of any part of its powers and its own procedures.
AB100-ASA1,811,17
16(5) Seek to qualify the plan as a state pharmacy assistance program, as defined
17in
42 CFR 423.464.
AB100-ASA1,811,19
18(6) Annually submit a report to the legislature under s. 13.172 (2) and to the
19governor on the operation of the plan.
AB100-ASA1, s. 2057m
22Section 2057m. 149.16 (3) (a) of the statutes is renumbered 149.155 (2) and
23amended to read:
AB100-ASA1,811,2524
149.155
(2) The plan administrator shall perform Perform all eligibility and
25administrative claims payment functions relating to the plan.
AB100-ASA1, s. 2058c
1Section 2058c. 149.16 (3) (b) of the statutes is renumbered 149.155 (3) and
2amended to read:
AB100-ASA1,812,53
149.155
(3) The plan administrator shall establish Establish a premium billing
4procedure for collection of premiums from insured persons. Billings shall be made
5on a periodic basis as determined by the
department
board.
AB100-ASA1, s. 2058m
6Section 2058m. 149.16 (3) (c) of the statutes is renumbered 149.155 (4), and
7149.155 (4) (intro.), as renumbered, is amended to read:
AB100-ASA1,812,108
149.155
(4) (intro.)
The plan administrator shall perform Perform all necessary
9functions to assure timely payment of benefits to covered persons under the plan,
10including:
AB100-ASA1,812,1716
149.17
(1) Subject to
ss. 149.14 (5m),
s. 149.143
and 149.146 (2) (b), a rating
17plan calculated in accordance with generally accepted actuarial principles.
AB100-ASA1,813,424
153.05
(6m) The department may contract with the group insurance board for
25the provision of data collection and analysis services related to health maintenance
1organizations and insurance companies that provide health insurance for state
2employees. The department shall establish contract fees for the provision of the
3services. All moneys collected under this subsection shall be credited to the
4appropriation under s. 20.435
(4) (1) (hg).
AB100-ASA1,813,86
153.05
(14) With respect to health care information required to be collected
7under this section from health care providers that are not hospitals or ambulatory
8surgery centers, the department shall do all of the following:
AB100-ASA1,813,119
(a) Develop procedures to ensure that data are submitted consistently and
10accurately, including clarifying the place-of-service codes and types of ancillary
11services that are required to be reported.
AB100-ASA1,813,1312
(b) Work directly with individual physician practice groups to identify and
13correct data submission errors.
AB100-ASA1,813,1514
(c) Develop and publish standard reports under s. 153.45 (1) (a) that are
15understandable by individuals other than medical professionals.
AB100-ASA1,813,1616
(d) Make program data available in a timely fashion.
AB100-ASA1,813,1917
(e) Enter into a memorandum of understanding with the department of
18regulation and licensing to improve the timeliness of updating physician information
19and to improve the assessment process under s. 153.60 (1).
AB100-ASA1,814,1721
153.60
(1) The department shall, by the first October 1 after the
22commencement of each fiscal year, estimate the total amount of expenditures under
23this chapter for the department and the board for that fiscal year for data collection,
24database development and maintenance, generation of data files and standard
25reports, orientation and training provided under s. 153.05 (9) (a) and maintaining
1the board. The department shall assess the estimated total amount for that fiscal
2year
, less the estimated total amount to be received for purposes of administration
3of this chapter under s. 20.435
(4) (1) (hi) during the fiscal year
, and the
4unencumbered balance of the amount received for purposes of administration of this
5chapter under s. 20.435
(4) (1) (hi) from the prior fiscal year
and the amount in the
6appropriation account under s. 20.435 (1) (dg), 1997 stats., for the fiscal year, to
7health care providers, other than hospitals and ambulatory surgery centers, who are
8in a class of health care providers from whom the department collects data under this
9chapter in a manner specified by the department by rule. The department shall
10obtain approval from the board for the amounts of assessments for health care
11providers other than hospitals and ambulatory surgery centers. The department
12shall work together with the department of regulation and licensing to develop a
13mechanism for collecting assessments from health care providers other than
14hospitals and ambulatory surgery centers. No health care provider that is not a
15facility may be assessed under this subsection an amount that exceeds $75 per fiscal
16year. All payments of assessments shall be credited to the appropriation under s.
1720.435
(4) (1) (hg).
AB100-ASA1,815,419
153.60
(3) The department shall, by the first October 1 after the
20commencement of each fiscal year, estimate the total amount of expenditures
21required for the collection, database development and maintenance and generation
22of public data files and standard reports for health care plans that voluntarily agree
23to supply health care data under s. 153.05 (6r). The department shall assess the
24estimated total amount for that fiscal year to health care plans in a manner specified
25by the department by rule and may enter into an agreement with the office of the
1commissioner of insurance for collection of the assessments. Each health plan that
2voluntarily agrees to supply this information shall pay the assessments on or before
3December 1. All payments of assessments shall be deposited in the appropriation
4under s. 20.435
(4) (1) (hg) and may be used solely for the purposes of s. 153.05 (6r).
AB100-ASA1,815,126
153.65
(1) The department may, but is not required to, provide, upon request
7from a person, a data compilation or a special report based on the information
8collected by the department. The department shall establish user fees for the
9provision of these compilations or reports, payable by the requester, which shall be
10sufficient to fund the actual necessary and direct cost of the compilation or report.
11All moneys collected under this subsection shall be credited to the appropriation
12under s. 20.435
(4) (1) (hi).
AB100-ASA1,815,1414
157.061
(2g) "Cemetery board" means the board created in s. 15.405 (3m).
AB100-ASA1,816,916
157.08
(2) (b) Before a cemetery authority sells or encumbers any cemetery
17land, except for a sale described in par. (a), the cemetery authority shall notify the
18department cemetery board in writing of the proposed sale or encumbrance. If
19within 60 days after the
department cemetery board is notified of the proposed sale
20or encumbrance the
department cemetery board notifies the cemetery authority in
21writing that the
department cemetery board objects to the sale or encumbrance the
22cemetery authority may not sell or encumber the cemetery land unless the
23department cemetery board subsequently notifies the cemetery authority in writing
24that the objection is withdrawn. The
department
cemetery board may object to a sale
25or encumbrance only if it determines that the cemetery authority will not be
1financially solvent or that the rights and interests of owners of cemetery lots and
2mausoleum spaces will not be adequately protected if the sale or encumbrance
3occurs. The
department cemetery board may, before the expiration of the 60-day
4period, notify the cemetery authority in writing that the
department cemetery board 5approves of the sale or encumbrance. Upon receipt of the
department's cemetery
6board's written approval, the cemetery authority may sell or encumber the cemetery
7land and is released of any liability under this paragraph. The
department cemetery
8board shall make every effort to make determinations under this paragraph in an
9expeditious manner.
AB100-ASA1,816,1411
157.08
(5) Subsections (1) and (2) (b) do not apply to a religious society
12organized under ch. 187, and sub. (2) (b) does not apply to a cemetery authority that
13is not required to be
registered licensed under s. 440.91 (1) and that is not organized
14or conducted for pecuniary profit.
AB100-ASA1,816,1816
157.11
(11) Exemption for certain nonprofit cemeteries. Subsection (9g) does
17not apply to a cemetery authority that is not required to be
registered licensed under
18s. 440.91 (1) and that is not organized or conducted for pecuniary profit.
AB100-ASA1,816,2220
157.128
(3) (b) A cemetery consisting of less than 20 contiguous acres may be
21dedicated by a cemetery authority that is not required to be
registered licensed under
22s. 440.91 (1) and that is not organized or conducted for pecuniary profit.
AB100-ASA1,817,524
157.19
(5) (a) This section does not apply to care funds under s. 157.11 (9g) that
25are deposited with a city or county as provided under s. 157.11 (9g) (a), to care funds
1of a cemetery for which a certification under s. 157.63 is effective, to preneed trust
2funds of a cemetery for which a certification under s. 440.92 (9) is effective, or to care
3funds or preneed trust funds of a cemetery authority that is not required to be
4registered licensed under s. 440.91 (1) and that is not organized or conducted for
5pecuniary profit.
AB100-ASA1,817,97
157.625
(3) Section 157.62 does not apply to a cemetery authority that is not
8required to be
registered licensed under s. 440.91 (1) and that is not organized or
9conducted for pecuniary profit.
AB100-ASA1,817,2111
157.65
(2) The department of justice or any district attorney, upon informing
12the department of justice, may commence an action in circuit court in the name of
13the state to restrain by temporary or permanent injunction any violation of this
14subchapter. The court may, prior to entry of final judgment, make such orders or
15judgments as may be necessary to restore to any person any pecuniary loss suffered
16because of the acts or practices involved in the action, if proof of such loss is submitted
17to the satisfaction of the court. The department of justice may subpoena persons and
18require the production of books and other documents, and may request the
19department of regulation and licensing board described in s. 15.405 (3m) or the
20department of commerce to exercise its authority under sub. (1) to aid in the
21investigation of alleged violations of this subchapter.
AB100-ASA1,818,223
165.755
(1) (a) Except as provided in par. (b), a court shall impose under ch. 814
24a crime laboratories and drug law enforcement surcharge of
$7 $8 if the court
1imposes a sentence, places a person on probation, or imposes a forfeiture for a
2violation of state law or for a violation of a municipal or county ordinance.
AB100-ASA1,818,4
4165.89 (title)
Grants to certain counties for law enforcement programs.
AB100-ASA1,818,8
5(4) Notwithstanding subs. (1) and (2) and any criteria and procedures
6developed under sub. (3), the department shall allocate $300,000 to Forest County
7each fiscal year from the appropriation account under s. 20.455 (2) (kq) to fund law
8enforcement services.
AB100-ASA1,818,10
10165.91 (title)
Grants to tribes for law enforcement programs.
