1. By March 1, 2006, study and make recommendations concerning the feasibility of creating a centralized physician information database.
2. By October 1, 2006, study and make recommendations concerning rules required and authorized to be promulgated by DHFS concerning the collection, analysis, and dissemination of health care information; promote the collection and availability of certain health care information; and foster the evolution of certain partnerships and agreements and transparency of health care information.
3. By January 1, 2007, develop a plan and specific strategies to deploy health care information systems technology for health care quality, safety, and efficiency.
4. Annually report on its plans, activities, accomplishments, and recommendations.
5. Annually assess the extent to which automated information and decision support systems are used by health care providers in Wisconsin.
6. Annually assess options and develop a plan to achieve automation of all health care systems in Wisconsin by 2010.
7. Make grants or loans to clinics, health maintenance organizations, hospitals, or physicians for various projects.
The bill prohibits DHFS from enforcing rules promulgated before the effective date of this bill as an act that relate to the collection, from physicians, of workforce and practice information, health care plan affiliations, and hospital privileges and, from dentists, chiropractors, and podiatrists, of workforce and practice information. Beginning July 1, 2007, the bill also prohibits DHFS from enforcing rules promulgated before that date that relate to physician claims data. DHFS may only promulgate rules that relate to the collection and dissemination of health care information that are first approved by HCQPSB.
The bill creates the health care quality improvement fund, a segregated fund that consists of moneys transferred from the injured patients and families compensation fund, the net proceeds of certain revenue obligations, a portion of the annual assessments levied on health care providers other than hospitals and ambulatory surgery centers, the repayment of any loans made by the HCQPSB, and any moneys transferred by the secretary of administration. Funds of the health care quality improvement fund are, under the bill, appropriated for general program operations of the HCQPSB, for grants or loans made by the HCQPSB, and for benefits under the Medical Assistance (MA) program, including payments for direct graduate medical education, a major managed care supplement, a pediatric services supplement, rural hospital supplements, and an essential access city hospital.
Under the bill, before July 1, 2007, DHFS may promulgate only those rules relating to the collection, analysis, and dissemination of health care information that are first approved by the HCQPSB.
Other health and human services
Under current law, the Wisconsin Health and Educational Facilities Authority (WHEFA) provides financial assistance to private and public health facilities and hospitals. This bill prohibits WHEFA from providing such financial assistance unless the health facility or hospital demonstrates to the Health Care Quality and Patient Safety Board (HCQPSB) that the health facility or hospital is making progress to improve medical information systems technology.
insurance
Under current law, certain health care providers are required to carry health care liability insurance with liability limits of at least $1,000,000 for each occurrence and at least $3,000,000 for all occurrences in a policy year. Any portion of a medical malpractice claim against a health care provider subject to the health care liability insurance requirements that exceeds the policy limits of the health care provider's health care liability insurance is paid by the injured patients and families compensation fund. Moneys for the fund come from annual assessments paid by the health care providers who are subject to the health care liability insurance requirements. Current law provides that the fund is established to curb the rising costs of health care by financing part of the liability incurred by health care providers as a result of medical malpractice claims and that the fund is held in irrevocable trust for the sole benefit of providers and proper claimants and may not be used for any other purpose of the state.
This bill transfers $169,703,400 in fiscal year 2005-06 and $9,714,000 in fiscal year 2006-07 from the injured patients and families compensation fund to the health care quality improvement fund, as created in the bill. The bill also adds to the stated purposes of the injured patients and families compensation fund the purposes of ensuring the availability of health care providers in Wisconsin and of enabling the deployment of health care information systems technology for health care quality, safety, and efficiency, by the Health Care Quality and Patient Safety Board (HCQPSB), as created in the bill.
state government
State finance
This bill creates a program to issue revenue obligations to fund costs of the Medical Assistance program. Under the bill, funds for the program may not exceed $130,000,000. The bill provides that the principal and interest costs on the revenue obligations are to be paid from excise taxes that are currently imposed on the sale of liquor, fermented malt beverages, cigarettes, and tobacco products. These taxes are to be deposited into the excise tax fund, a fund under current law that can be used for any revenue obligations issued to pay the state's unfunded prior service liability under the Wisconsin Retirement System (WRS). To dedicate moneys in the excise tax fund for the payment of these grants, the bill eliminates the state's authority to issue revenue obligations secured by tax revenues derived from the sale of liquor, fermented malt beverages, cigarettes, and tobacco products for the payment of the state's unfunded prior liability under the WRS. Obligations for this purpose have already been issued under other current law authority.
For further information see the state and local 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. 15.07 (2) (b) of the statutes is repealed.
SECTION 2. 15.07 (2) (n) of the statutes is created to read:
15.07 (2) (n) The chairperson of the health care quality and patient safety board shall be designated biennially by the governor.
SECTION 3. 15.07 (3) (bm) 1. of the statutes is repealed.
SECTION 4. 15.105 (13) of the statutes is created to read:
15.105 (13) HEALTH CARE QUALITY AND PATIENT SAFETY BOARD. (a) Creation; membership. There is created a health care quality and patient safety board, attached to the department of administration under s. 15.03, consisting of the following members:
1. The secretary of health and family services, the secretary of employee trust funds, and the secretary of administration or their designees.
2. One physician, as defined in s. 448.01 (5).
3. One representative of hospitals.
4. One employer purchaser of health care.
5. One representative of the insurance industry.
6. One representative of health maintenance organizations, as defined in s. 609.01 (2).
7. One member who shall represent the public interest.
(b) Terms. The board members specified in par. (a) 2. to 7. shall be appointed for 4-year terms.
SECTION 5. 15.195 (6) of the statutes is repealed.
SECTION 6. 16.03 (3) of the statutes is amended to read:
16.03 (3) REPORT. The interagency coordinating council shall report at least twice annually to the health care quality and patient safety board on health care information in the department of health and family services administration, concerning the council's activities under this section.
SECTION 7. 16.526 (title) of the statutes is repealed and recreated to read:
16.526 (title) Revenue obligation program to fund costs of the Medical Assistance program.
SECTION 8. 16.526 (1) of the statutes is amended to read:
16.526 (1) For purposes of subch. II of ch. 18, the purposes of obtaining proceeds to pay the state's anticipated unfunded prior service liability under s. 40.05 (2) (b) and of paying the state's unfunded prior service liability under s. 40.05 (2) (b) and the state's unfunded liability under s. 40.05 (4) (b), (bc), and (bw) and subch. IX of ch. 40 fund costs of the Medical Assistance program is a special fund program, and the excise tax fund is a special fund. The legislature finds and determines that the excise tax fund is a segregated fund consisting of fees, penalties, or excise taxes and that financing the special Medical Assistance program to pay the state's unfunded prior service liability under s. 40.05 (2) (b) and the state's unfunded liability under s. 40.05 (4) (b), (bc), and (bw) and subch. IX of ch. 40 fund costs from the net proceeds of revenue obligations issued under this section is appropriate and will serve a public purpose by improving the quality of, and access of citizens of this state to, health care services.
SECTION 9. 16.526 (2) of the statutes is amended to read:
16.526 (2) The net proceeds of revenue obligations issued under subch. II of ch. 18, as authorized under this section, shall be deposited in a fund in the state treasury, or an account maintained by a trustee, created under s. 18.57 (1). The moneys shall be applied for ancillary payments and for the provision of reserves, as determined by the building commission, and for the payment of part or all of the state's unfunded prior service liability under s. 40.05 (2) (b) and the state's unfunded liability under s. 40.05 (4) (b), (bc), and (bw) and subch. IX of ch. 40, as determined by the department, costs of the Medical Assistance program, and any remainder shall be paid into a retirement liability an excise tax revenue obligation redemption fund created under 18.562 (3).
SECTION 10. 16.526 (5) (b) of the statutes is amended to read:
16.526 (5) (b) Except as otherwise provided in this paragraph, the secretary shall determine the requirements for funds to be obtained from revenue obligations issued under this section to pay the state's anticipated unfunded prior service liability under s. 40.05 (2) (b) and funds used for the payment of the state's unfunded prior service liability under s. 40.05 (2) (b) and the state's unfunded liability under s. 40.05 (4) (b), (bc), and (bw) and subch. IX of ch. 40, that are to be paid from revenue obligations issued under this section, shall be determined by the secretary costs of the Medical Assistance program. The sum amount of expenditures to be paid from revenue obligations issued under this section and appropriation obligations issued under s. 16.527, if any, excluding any appropriation revenue obligations that have been defeased under a cash optimization program administered by the building commission and any appropriation obligations issued pursuant to s. 16.527 (3) (b) 3., shall not exceed $1,500,000,000 $130,000,000.
SECTION 11. 16.526 (5) (c) of the statutes is created to read:
16.526 (5) (c) For the purpose of s. 18.58 (4), the department is carrying out program responsibilities for which the revenue obligations are authorized under this section.
SECTION 12. 16.527 (3) (b) 2. of the statutes is amended to read:
16.527 (3) (b) 2. The sum of appropriation obligations issued under this section, excluding any obligations that have been defeased under a cash optimization program administered by the building commission and any obligations issued pursuant to subd. 3., and revenue obligations issued under s. 16.526, if any, may not exceed $1,500,000,000.
SECTION 13. 18.55 (5) of the statutes is amended to read:
18.55 (5) EXERCISE OF AUTHORITY. Money may be borrowed and evidences of revenue obligation issued therefor pursuant to one or more authorizing resolutions, unless otherwise provided in the resolution or in this subchapter, at any time and from time to time, for any combination of purposes, in any specific amounts, at any rates of interest, for any term, payable at any intervals, at any place, in any manner and having any other terms or conditions deemed necessary or useful. Revenue obligation bonds may bear interest at variable or fixed rates, bear no interest or bear interest payable only at maturity or upon redemption prior to maturity. Unless sooner exercised or unless a shorter different period is provided in the resolution, every authorizing resolution, except as provided in s. 18.59 (1), shall expire one year after the date of its adoption.
SECTION 14. 18.61 (5) of the statutes is amended to read:
18.61 (5) The legislature may provide, with respect to any specific issue of revenue obligations, prior to their issuance, that if the special fund income or the enterprise or program income pledged to the payment of the principal and interest of the issue is insufficient for that purpose, or is insufficient to replenish a reserve fund, if applicable, it will consider supplying the deficiency by appropriation of funds, from time to time, out of the treasury. If the legislature so provides, the commission may make the necessary provisions therefor in the authorizing resolution and other proceedings of the issue. Thereafter, if the contingency occurs, recognizing its moral obligation to do so, the legislature hereby expresses its expectation and aspiration that it shall make such appropriation.
SECTION 15. 20.435 (4) (hg) of the statutes is renumbered 20.435 (1) (hg) and amended to read:
20.435 (1) (hg) General program operations; health care information. The amounts in the schedule to fund the activities of the department of health and family services and the board on health care information under ch. 153. The contract fees paid under s. 153.05 (6m) and assessments paid under s. 153.60, less $250,000 in assessments paid in each fiscal year, shall be credited to this appropriation account.
****NOTE: This is reconciled s. 20.435 (4) (hg). This SECTION has been affected by drafts with the following LRB numbers: LRB-0316/2 and LRB-1649/3.
SECTION 16. 20.435 (4) (r) of the statutes is created to read:
20.435 (4) (r) Health care quality improvement fund; Medical Assistance. From the health care quality improvement fund, as a continuing appropriation, the amounts in the schedule to provide a portion of the state share of Medical Assistance program benefits administered under s. 49.45, to provide a portion of the Medical Assistance program benefits administered under s. 49.45 that are not also provided under par. (o), to fund the pilot project under s. 46.27 (9) and (10), to provide a portion of the facility payments under 1999 Wisconsin Act 9, section 9123 (9m), to fund services provided by resource centers under s. 46.283, and for services under the family care benefit under s. 46.284 (5).
****NOTE: This SECTION involves a change in an appropriation that must be reflected in the revised schedule in s. 20.005, stats.
SECTION 17. 20.435 (4) (rg) of the statutes is created to read:
20.435 (4) (rg) Health care quality improvement fund; Medical Assistance payments. From the health care quality improvement fund, a sum sufficient equal to the amounts transferred under s. 16.518 (4), to provide a portion of the state share of Medical Assistance program benefits administered under s. 49.45, to provide a portion of the Medical Assistance program benefits administered under s. 49.45 that are not also provided under par. (o), to fund the pilot project under s. 46.27 (9) and (10), to provide a portion of the facility payments under 1999 Wisconsin Act 9, section 9123 (9m), to fund services provided by resource centers under s. 46.283, and for services under the family care benefit under s. 46.284 (5).
****NOTE: This SECTION involves a change in an appropriation that must be reflected in the revised schedule in s. 20.005, stats.
SECTION 18. 20.435 (4) (rg) of the statutes, as created by 2005 Wisconsin Act .... (this act), is repealed.
SECTION 19. 20.435 (4) (rm) of the statutes is created to read:
20.435 (4) (rm) Health care quality improvement fund; hospital supplemental payments. From the health care quality improvement fund, the amounts in the schedule to provide payments for direct graduate medical education, a major managed care supplement, a pediatric services supplement, rural hospital supplements under s. 49.45 (5m) (am), and an essential access city hospital under s. 49.45 (6x) (a).
****NOTE: This SECTION involves a change in an appropriation that must be reflected in the revised schedule in s. 20.005, stats.
SECTION 20. 20.505 (1) (sd) of the statutes is amended to read:
20.505 (1) (sd) Revenue obligation proceeds to pay the state's unfunded liability under the Wisconsin Retirement System fund costs of the Medical Assistance program. As a continuing appropriation, all proceeds from revenue obligations that are issued under subch. II of ch. 18, as authorized under s. 16.526, and deposited in a fund in the state treasury, or in an account maintained by a trustee, created under s. 18.57 (1), as authorized under s. 16.526 (2), to pay part or all of the state's unfunded prior service liability under s. 40.05 (2) (b) and the state's unfunded liability under s. 40.05 (4) (b), (bc), and (bw) and subch. IX of ch. 40, as determined by the department of administration be transferred to the health care quality improvement fund, and to provide for reserves and to make ancillary payments, as determined by the building commission, and the remainder to be transferred to a retirement liability an excise tax revenue obligation redemption fund created under s. 18.562 (3). Estimated disbursements under this paragraph shall not be included in the schedule under s. 20.005.
****NOTE: This SECTION involves a change in an appropriation that must be reflected in the revised schedule in s. 20.005, stats.
SECTION 21. 20.505 (1) (sh) of the statutes is amended to read:
20.505 (1) (sh) Excise tax fund -- revenue obligation repayment. From the excise tax fund, a sum sufficient to pay a retirement liability an excise tax revenue obligation redemption fund created under s. 18.562 (3) the amount needed to pay the principal of and premium, if any, and interest on revenue obligations issued under subch. II of ch. 18, as authorized under s. 16.526, and to make ancillary payments authorized by the authorizing resolution for the revenue obligations. Estimated disbursements under this paragraph shall not be included in the schedule under s. 20.005.
SECTION 22. 20.505 (1) (sm) of the statutes is amended to read:
20.505 (1) (sm) Excise tax fund -- provision of reserves and payment of ancillary costs relating to revenue obligations. From the excise tax fund, a sum sufficient to provide for reserves and for ancillary payments relating to revenue obligations issued under subch. II of ch. 18, as authorized under s. 16.526 and the resolution authorizing the revenue obligations. Estimated disbursements under this paragraph shall not be included in the schedule under s. 20.005.
SECTION 23. 20.505 (1) (sp) of the statutes is amended to read:
20.505 (1) (sp) Revenue obligation debt service. From a retirement liability an excise tax revenue obligation redemption fund created under s. 18.562 (3), all moneys received by the fund for the payment of principal of and premium, if any, and interest on revenue obligations issued under subch. II of ch. 18, as authorized under s. 16.526, and for ancillary payments authorized by the authorizing resolution for the revenue obligations. All moneys received by the fund are irrevocably appropriated in accordance with subch. II of ch. 18 and further established in resolutions authorizing the issuance of the revenue obligations under. s. 16.526 and setting forth the distribution of funds to be received thereafter. Estimated disbursements under this paragraph shall not be included in the schedule under s. 20.005.
SECTION 24. 20.505 (4) (i) of the statutes is created to read:
20.505 (4) (i) Health care quality and patient safety board; gifts and grants. All money received from gifts, grants, bequests, and devises to the health care quality and patient safety board, for the purposes for which made.
****NOTE: This SECTION involves a change in an appropriation that must be reflected in the revised schedule in s. 20.005, stats.
SECTION 25. 20.505 (4) (q) of the statutes is created to read:
20.505 (4) (q) Health care quality and patient safety board; general program operations. Biennially, from the health care quality improvement fund, the amounts in the schedule for general program operations of the health care quality and patient safety board.
****NOTE: This SECTION involves a change in an appropriation that must be reflected in the revised schedule in s. 20.005, stats.
SECTION 26. 20.505 (4) (qb) of the statutes is created to read:
20.505 (4) (qb) Health care quality and patient safety board; grants or loans. As a continuing appropriation, from the health care quality improvement fund, the amounts in the schedule for grants or loans under s. 153.076.
****NOTE: This SECTION involves a change in an appropriation that must be reflected in the revised schedule in s. 20.005, stats.
SECTION 27. 25.17 (1) (gd) of the statutes is created to read:
25.17 (1) (gd) Health care quality improvement fund (s. 25.775);
SECTION 28. 25.775 of the statutes is created to read:
25.775 Health care quality improvement fund. There is created a separate nonlapsible trust fund designated as the health care quality improvement fund, consisting of all of the following:
(1) All moneys transferred under 2005 Wisconsin Act .... (this act), section 9225 (1).
(2) All moneys received from s. 20.505 (1) (sd).
(3) In each fiscal year, $250,000 of the assessments paid under s. 153.60.
(4) Repayment of any loans made under s. 153.076 (2).
(5) All moneys transferred under s. 16.518 (4).
SECTION 29. 25.775 (1) of the statutes, as created by 2005 Wisconsin Act .... (this act), is repealed.
SECTION 30. 25.775 (5) of the statutes, as created by 2005 Wisconsin Act .... (this act), is repealed.
SECTION 31. 46.27 (9) (a) of the statutes is amended to read:
46.27 (9) (a) The department may select up to 5 counties that volunteer to participate in a pilot project under which they will receive certain funds allocated for long-term care. The department shall allocate a level of funds to these counties equal to the amount that would otherwise be paid under s. 20.435 (4) (b), (gp), (r), (rg), or (w) to nursing homes for providing care because of increased utilization of nursing home services, as estimated by the department. In estimating these levels, the department shall exclude any increased utilization of services provided by state centers for the developmentally disabled. The department shall calculate these amounts on a calendar year basis under sub. (10).
