SECTION 79. 20.866 (intro.) of the statutes is amended to read:
20.866 Public debt. (intro.) There are irrevocably appropriated to the bond security and redemption fund and to the capital improvement fund, as a first charge upon all revenues of this state, sums sufficient for payment of principal, interest and, premium due, if any, on and payment due, if any, under an agreement or ancillary arrangement entered into under s. 18.06 (8) (a) with respect to any public debt contracted under subchs. I and IV of ch. 18.
SECTION 80. 20.867 (1) (a) of the statutes is amended to read:
20.867 (1) (a) Principal repayment and interest; housing of state agencies. A sum sufficient to reimburse s. 20.866 (1) (u) for the payment of principal and interest costs incurred in financing the housing of state agencies and to make payments under an agreement or ancillary arrangement entered into under s. 18.06 (8) (a).
SECTION 81. 20.867 (1) (b) of the statutes is amended to read:
20.867 (1) (b) Principal repayment and interest; capitol and executive residence. A sum sufficient to reimburse s. 20.866 (1) (u) for the payment of principal and interest costs incurred in financing building projects at the capitol and executive residence and to make payments under an agreement or ancillary arrangement entered into under s. 18.06 (8) (a).
SECTION 82. 20.867 (3) (a) of the statutes is amended to read:
20.867 (3) (a) Principal repayment and interest. A sum sufficient to pay all principal repayment and interest costs on tax-supported borrowing which is not initially allocable to the respective programs and to make payments under an agreement or ancillary arrangement entered into under s. 18.06 (8) (a).
SECTION 83. 20.867 (3) (b) of the statutes is amended to read:
20.867 (3) (b) Principal repayment and interest. A sum sufficient to reimburse s. 20.866 (1) (u) for the payment of principal and interest costs incurred in financing capital improvements for other public purposes authorized by law but not otherwise specified in this chapter and to make payments under an agreement or ancillary arrangement entered into under s. 18.06 (8) (a).
SECTION 84. 20.867 (3) (bm) of the statutes is amended to read:
20.867 (3) (bm) Principal repayment, interest, and rebates; HR Academy, Inc. A sum sufficient to reimburse s. 20.866 (1) (u) for the payment of principal and interest costs incurred in financing the construction of a youth and family center for HR Academy, Inc., in the city of Milwaukee, and to make the payments determined by the building commission under s. 13.488 (1) (m) that are attributable to the proceeds of obligations incurred in financing the construction of a youth and family center for the HR Academy, Inc., and to make payments under an agreement or ancillary arrangement entered into under s. 18.06 (8) (a).
SECTION 85. 20.867 (3) (bp) of the statutes is amended to read:
20.867 (3) (bp) Principal repayment, interest and rebates. A sum sufficient to reimburse s. 20.866 (1) (u) for the payment of principal and interest costs incurred in financing the construction of a Swiss cultural center in the village of New Glarus, and to make the payments determined by the building commission under s. 13.488 (1) (m) that are attributable to the proceeds of obligations incurred in financing the construction of a Swiss cultural center in the village of New Glarus, and to make payments under an agreement or ancillary arrangement entered into under s. 18.06 (8) (a).
SECTION 86. 20.867 (3) (br) of the statutes is amended to read:
20.867 (3) (br) Principal repayment, interest and rebates. A sum sufficient to reimburse s. 20.866 (1) (u) for the payment of principal and interest costs incurred in financing the construction of the youth activities center specified in s. 13.48 (34), and to make the payments determined by the building commission under s. 13.488 (1) (m) that are attributable to the proceeds of obligations incurred in financing the construction of that the youth activities center, and to make payments under an agreement or ancillary arrangement entered into under s. 18.06 (8) (a).
SECTION 87. 20.867 (3) (bt) of the statutes is amended to read:
20.867 (3) (bt) Principal repayment, interest, and rebates; Discovery Place museum. A sum sufficient to reimburse s. 20.866 (1) (u) for the payment of principal and interest costs incurred in financing the construction grant under s. 13.48 (32r), and to make the payments determined by the building commission under s. 13.488 (1) (m) that are attributable to the proceeds of obligations incurred in financing the construction grant under s. 13.48 (32r), and to make payments under an agreement or ancillary arrangement entered into under s. 18.06 (8) (a).
SECTION 88. 20.867 (3) (g) of the statutes is amended to read:
20.867 (3) (g) Principal repayment, interest and rebates; program revenues. From the appropriate program revenue accounts, a sum sufficient to pay all principal and interest costs on self-amortizing borrowing issued under s. 20.866 (2) which are not initially allocable to the respective programs and, to make any payments determined by the building commission under s. 13.488 (1) (m) on the proceeds of such borrowing, and to make payments under an agreement or ancillary arrangement entered into under s. 18.06 (8) (a).
SECTION 89. 20.867 (3) (h) of the statutes is amended to read:
20.867 (3) (h) Principal repayment, interest, and rebates. A sum sufficient to guarantee full payment of principal and interest costs for self-amortizing or partially self-amortizing facilities enumerated under ss. 20.190 (1) (j), 20.245 (1) (j), 20.285 (1) (ih), (je), (jq), (kd), (km), and (ko), 20.370 (7) (eq) and 20.485 (1) (go) if moneys available in those appropriations are insufficient to make full payment, and to make full payment of the amounts determined by the building commission under s. 13.488 (1) (m) if the appropriation under s. 20.190 (1) (j), 20.245 (1) (j), 20.285 (1) (ih), (je), (jq), (kd), (km), or (ko), or 20.485 (1) (go) is insufficient to make full payment of those amounts, and to make payments under an agreement or ancillary arrangement entered into under s. 18.06 (8) (a). All amounts advanced under the authority of this paragraph shall be repaid to the general fund whenever the balance of the appropriation for which the advance was made is sufficient to meet any portion of the amount advanced. The department of administration may take whatever action is deemed necessary including the making of transfers from program revenue appropriations and corresponding appropriations from program receipts in segregated funds and including actions to enforce contractual obligations that will result in additional program revenue for the state, to ensure recovery of the amounts advanced.
SECTION 90. 20.867 (3) (i) of the statutes is amended to read:
20.867 (3) (i) Principal repayment, interest and rebates; capital equipment. A sum sufficient to pay principal and interest on public debt contracted under s. 20.866 (2) (ym) and, to make the payments determined by the building commission under s. 13.488 (1) (m) that are attributable to the proceeds of obligations contracted under s. 20.866 (2) (ym) for programs financed from program revenue or program revenue-service appropriations, and to make payments under an agreement or ancillary arrangement entered into under s. 18.06 (8) (a). All payments under this paragraph shall be repaid to the general fund from the revenues of state agencies for which capital equipment is financed under s. 20.866 (2) (ym).
SECTION 91. 20.867 (3) (q) of the statutes is amended to read:
20.867 (3) (q) Principal repayment and interest; segregated revenues. From the appropriate segregated funds, a sum sufficient to pay all principal and interest costs on self-amortizing borrowing issued under s. 20.866 (2) which are not initially allocable to the respective programs and to make payments under an agreement or ancillary arrangement entered into under s. 18.06 (8) (a).
(End)
LRB-0578LRB-0578/P6
CMH&PJK:jld:rs
2005 - 2006 LEGISLATURE
DOA:......Jablonsky, BB0041 - HIRSP pharmacy reform
For 2005-07 Budget -- Not Ready For Introduction
2005 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
Health and human services
Other health and human services
The Health Insurance Risk-Sharing Plan (HIRSP) under current law provides major medical health insurance coverage for persons who are covered under Medicare because they are disabled, persons who have tested positive for human immunodeficiency virus (HIV), and persons who have been refused coverage, or coverage at an affordable price, in the private health insurance market because of their mental or physical health condition. Also eligible for coverage are persons who do not currently have health insurance coverage, but who were covered under certain types of health insurance coverage for at least 18 months in the past. DHFS and a board of governors (board) administer HIRSP.
Under current law, HIRSP payment rates for prescription drugs are the same as payment rates under the Medical Assistance (MA) program. This bill allows DHFS, with the approval of the board, to set HIRSP prescription drug payment rates.
Under current law, DHFS is allowed by rule to establish for prescription drug coverage copayment amounts, coinsurance rates, and copayment and coinsurance out-of-pocket limits over which HIRSP will pay 100 percent of the covered costs incurred by the covered person during the remainder of the calendar year. This bill allows DHFS to establish a three-tiered copayment structure for prescription drug benefits. This bill allows DHFS to establish the out-of-pocket limit for prescription drug coverage at $300 for persons who are also covered under Medicare and at $300 or $400 for other covered persons, depending on coverage selected. This bill allows DHFS to establish that only certain copayment amounts count toward the out-of-pocket limit. This bill also allows DHFS to change the out-of-pocket limit by administrative rule.
Under current law, DHFS must promulgate administrative rules to set or adjust HIRSP premium rates, insurer assessments, and provider payment rate. This bill eliminates the requirement that DHFS set or adjust these amounts by administrative rules.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 149.14 (5) (e) of the statutes is amended to read:
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 establish a 3-tiered copayment structure for prescription drugs. The copayment and coinsurance out-of-pocket limits limit for prescription drug coverage under sub. (3) (d) over which the plan will pay 100% of covered costs under sub. (3) (d) may be $300. The department may establish that only certain copayment amounts count toward the out-of-pocket limit. 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 Subject to sub. (8) (b), the department may change, by rule under s. 149.17 (4), the out-of-pocket limit. Using the procedure under s. 227.24, the department may promulgate rules under this paragraph for the period before the effective date of any permanent rules promulgated under this paragraph, but not to exceed the period authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) (a), (2) (b), and (3), the department is not required to provide evidence that promulgating a rule under this paragraph as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to make a finding of emergency for promulgating a rule under this paragraph as an emergency rule. 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).
SECTION 2. 149.142 (1) (b) of the statutes is amended to read:
149.142 (1) (b) The payment rate for a prescription drug shall be the allowable charge paid under s. 49.46 (2) (b) 6. h. for the prescription drug. Notwithstanding s. 149.17 (4), the department may not reduce the payment rate for prescription drugs below the rate specified in this paragraph, and the rate may not be adjusted under s. 149.143 or 149.144 set by the department, subject to the approval of the board.
SECTION 3. 149.142 (2) of the statutes is amended to read:
149.142 (2) Except as provided in sub. (1) (b), the The rates established under this section are subject to adjustment under ss. 149.143 and 149.144.
SECTION 4. 149.143 (1) (am) 4. of the statutes is amended to read:
149.143 (1) (am) 4. Fourth, notwithstanding 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 subds. 1. to 3. are insufficient to pay 60% of plan costs.
SECTION 5. 149.143 (1) (bm) 2. of the statutes is amended to read:
149.143 (1) (bm) 2. Fifty percent from adjustments to provider payment rates, subject to s. 149.142 (1) (b) and excluding adjustments to those rates under s. 149.144.
SECTION 6. 149.143 (2) (a) 2. of the statutes is amended to read:
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) (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.
SECTION 7. 149.143 (2) (a) 3. of the statutes is amended to read:
149.143 (2) (a) 3. By rule set 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) (am) 4. and (bm) 1. and notify the commissioner of the amount.
SECTION 8. 149.143 (2) (a) 4. of the statutes is amended to read:
149.143 (2) (a) 4. By the same rule as under subd. 3. adjust 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) (am) 4. and (bm) 2. and as provided in s. 149.145.
SECTION 9. 149.143 (2) (a) 4. of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:
149.143 (2) (a) 4. 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) (am) 4. and (bm) 2. and as provided in s. 149.145.
****NOTE: This is reconciled s. 149.143 (2) (a) 4. This SECTION has been affected by drafts with the following LRB numbers: -0268 and -0578.
SECTION 10. 149.143 (3) (a) of the statutes is amended to read:
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) (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) (bm) 2. and s. 149.142 (1) (b).
SECTION 11. 149.143 (3) (a) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:
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 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., increase the assessments set under sub. (2) (a) 3. for the remainder of the plan year, subject to sub. (1) (bm) 1., and adjust the provider payment rate set under sub. (2) (a) 4. for the remainder of the plan year, subject to sub. (1) (bm) 2. and s. 149.142 (1) (b).
****NOTE: This is reconciled s. 149.143 (3) (a). This SECTION has been affected by drafts with the following LRB numbers: -0268 and -0578.
SECTION 12. 149.143 (3) (b) of the statutes is amended to read:
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) (bm) but subject to s. 149.142 (1) (b).
SECTION 13. 149.143 (4) of the statutes is repealed.
SECTION 14. 149.143 (5) (a) of the statutes is amended to read:
149.143 (5) (a) Annually, no later than April 30, the department shall perform a reconciliation with respect to plan costs, premiums, insurer assessments, and provider payment rate adjustments based on data from the previous calendar year. On the basis of the reconciliation, the department shall make any necessary adjustments in premiums, insurer assessments, or provider payment rates, subject to s. 149.142 (1) (b), for the fiscal year beginning on the first July 1 after the reconciliation, as provided in sub. (2) (b).
SECTION 15. 149.143 (5) (b) of the statutes is amended to read:
149.143 (5) (b) Except as provided in sub. (3) and s. 149.144, the department shall adjust the provider payment rates to meet the providers' specified portion of the plan costs no more than once annually, subject to s. 149.142 (1) (b). The department may not determine the adjustment on an individual provider basis or on the basis of provider type, but shall determine the adjustment for all providers in the aggregate, subject to s. 149.142 (1) (b).
SECTION 16. 149.144 of the statutes is amended to read:
149.144 Adjustments to insurer assessments and provider payment rates for premium, deductible, and prescription drug copayment reductions. The department 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) (am), sufficient to reimburse the plan for premium reductions under s. 149.165, deductible reductions under s. 149.14 (5) (a), 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.
SECTION 17. 149.144 of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:
149.144 Adjustments to insurer assessments and provider payment rates for premium, deductible, and prescription drug copayment reductions. The department shall 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 s. 149.143 (1) (am), sufficient to reimburse the plan for premium reductions under s. 149.165, deductible reductions under s. 149.14 (5) (a), 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.
****NOTE: This is reconciled s. 149.144. This SECTION has been affected by drafts with the following LRB numbers: -0268 and -0578.
SECTION 18. 149.145 of the statutes is amended to read:
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 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.
SECTION 19. 149.146 (2) (am) 5. of the statutes is amended to read:
149.146 (2) (am) 5. Subject to s. 149.14 (8) (b), the department may, by rule under s. 149.17 (4), establish for prescription drug coverage under this section copayment amounts, coinsurance rates, and establish a 3-tiered copayment structure for prescription drugs. The copayment and coinsurance out-of-pocket limits limit for prescription drug coverage under this section over which the plan will pay 100% of covered costs for prescription drugs. Any copayment amount, coinsurance rate, or out-of-pocket limit established under this subdivision is subject to the approval of the board under this section may be $400. The department may establish that only certain copayment amounts count toward the out-of-pocket limit. Subject to s. 149.14 (8) (b), the department may change, by rule under s. 149.17 (4), the out-of-pocket limit. Using the procedure under s. 227.24, the department may promulgate rules under this subdivision for the period before the effective date of any permanent rules promulgated under this subdivision, but not to exceed the period authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) (a), (2) (b), and (3), the department is not required to provide evidence that promulgating a rule under this subdivision as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to make a finding of emergency for promulgating a rule under this subdivision as an emergency rule. Copayments and coinsurance paid by an eligible person under this subdivision are separate from and do not count toward the deductible and covered costs not paid by the plan under subds. 1. to 3.
SECTION 20. 149.146 (2) (b) (intro.) of the statutes is amended to read:
149.146 (2) (b) (intro.) The schedule of premiums for coverage under this section shall be promulgated by rule set by the department, as provided in s. 149.143. The rates for coverage under this section shall be set such that they differ from the rates for coverage under s. 149.14 (2) (a) by the same percentage as the percentage difference between the following:
SECTION 21. 227.01 (13) (nm) of the statutes is created to read:
227.01 (13) (nm) Sets or adjusts premium rates, insurer assessments, or provider payment rates under ch. 149.
SECTION 9321. Initial applicability; health and family services.
(1) HEALTH INSURANCE RISK-SHARING PLAN PRESCRIPTION DRUG COPAYS AND OUT-OF-POCKET LIMITS. The treatment of sections 149.14 (5) (e) and 149.146 (2) (am) 5. of the statutes first applies to prescription drug coverage on July 1, 2006.
SECTION 9421. Effective dates; health and family services.
(1) HEALTH INSURANCE RISK-SHARING PLAN PAYMENT RATE FOR PRESCRIPTION DRUGS. The treatment of sections 149.142 (1) (b) and (2), 149.143 (1) (am) 4. and (bm) 2., (2) (a) 4. (by SECTION 9), (3) (a) (by SECTION 11) and (b), and (5) (a) and (b), 149.144 (by SECTION 17), and 149.145 of the statutes takes effect on October 1, 2005.
(End)
LRB-0598LRB-0598/1
JTK:kjf:pg
2005 - 2006 LEGISLATURE
DOA:......Caucutt, BB0214 - Elections Board gifts and grants
For 2005-07 Budget -- Not Ready For Introduction
