AB100,954,65 6. Health care coverage under the Badger Care health care program under s.
649.665.
AB100, s. 2036 7Section 2036. 149.14 (5) (b) of the statutes is amended to read:
AB100,954,158 149.14 (5) (b) Except as provided in pars. (c) and (e), if the covered costs
9incurred in a calendar year by the an eligible person who is not eligible for Medicare
10exceed the deductible for major medical expense coverage in a calendar year, the plan
11shall pay at least 80% of any additional covered costs incurred by the person during
12the calendar year, and if the covered costs incurred in a calendar year by an eligible
13person who is eligible for Medicare exceed the deductible for major medical expense
14coverage or $2,000, whichever is less, the plan shall pay 100% of any additional
15covered costs incurred by the person during the calendar year
.
AB100, s. 2037 16Section 2037. 149.14 (5) (c) of the statutes is amended to read:
AB100,954,2317 149.14 (5) (c) Except as provided in par. (e), if the aggregate of the covered costs
18not paid by the plan under par. (b) and the deductible exceeds $500 for an eligible
19person receiving medicare,
$2,000 for any other in a calendar year for an eligible
20person during a calendar year who is not eligible for Medicare, or $4,000 in a calendar
21year
for all eligible persons in a family, the plan shall pay 100% of all covered costs
22incurred by the eligible person or the eligible persons in the family during the
23calendar year after the payment ceilings under this paragraph are exceeded.
AB100, s. 2038 24Section 2038. 149.14 (5) (e) of the statutes is amended to read:
AB100,955,22
1149.14 (5) (e) Subject to sub. (8) (b), the department may, by rule under s. 149.17
2(4), establish for prescription drug coverage under sub. (3) (d) copayment amounts,
3coinsurance rates, and
establish a 3-tiered copayment structure for prescription
4drugs. The
copayment and coinsurance out-of-pocket limits limit for prescription
5drug coverage under sub. (3) (d)
over which the plan will pay 100% of covered costs
6under sub. (3) (d) may be $300. The department may establish that only certain
7copayment amounts count toward the out-of-pocket limit
. The department may
8provide subsidies for prescription drug copayment amounts paid by eligible persons
9under s. 149.165 (2) (a) 1. to 5. Any copayment amount, coinsurance rate, or
10out-of-pocket limit established under this paragraph is subject to the approval of the
11board
Subject to sub. (8) (b), the department may change, by rule under s. 149.17 (4),
12the out-of-pocket limit. Using the procedure under s. 227.24, the department may
13promulgate rules under this paragraph for the period before the effective date of any
14permanent rules promulgated under this paragraph, but not to exceed the period
15authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) (a), (2) (b),
16and (3), the department is not required to provide evidence that promulgating a rule
17under this paragraph as an emergency rule is necessary for the preservation of the
18public peace, health, safety, or welfare and is not required to make a finding of
19emergency for promulgating a rule under this paragraph as an emergency rule
.
20Copayments and coinsurance paid by an eligible person under this paragraph are
21separate from and do not count toward the deductible and covered costs not paid by
22the plan under pars. (a) to (c).
AB100, s. 2039 23Section 2039. 149.142 (1) (b) of the statutes is amended to read:
AB100,956,324 149.142 (1) (b) The payment rate for a prescription drug shall be the allowable
25charge paid under s. 49.46 (2) (b) 6. h. for the prescription drug. Notwithstanding

1s. 149.17 (4), the department may not reduce the payment rate for prescription drugs
2below the rate specified in this paragraph, and the rate may not be adjusted under
3s. 149.143 or 149.144
set by the department, subject to the approval of the board.
AB100, s. 2040 4Section 2040. 149.142 (2) of the statutes is amended to read:
AB100,956,65 149.142 (2) Except as provided in sub. (1) (b), the The rates established under
6this section are subject to adjustment under ss. 149.143 and 149.144.
AB100, s. 2041 7Section 2041. 149.143 (1) (intro.) of the statutes is amended to read:
AB100,956,158 149.143 (1) (intro.) The department shall pay or recover the operating costs of
9the plan from the appropriation under s. 20.435 (4) (v) and administrative costs of
10the plan from the appropriation under s. 20.435 (4) (u). For purposes of determining
11premiums, insurer assessments and provider payment rate adjustments, the
12department shall apportion and prioritize responsibility for payment or recovery of
13plan costs, excluding deductible reductions under s. 149.14 (5) (a) and prescription
14drug copayment reductions under s. 149.14 (5) (e),
from among the moneys
15constituting the fund as follows:
AB100, s. 2042 16Section 2042. 149.143 (1) (am) 1. of the statutes is amended to read:
AB100,956,2417 149.143 (1) (am) 1. First, from premiums from eligible persons with coverage
18under s. 149.14 (2) (a) set at a rate that is 140% to 150% of the rate that a standard
19risk would be charged under an individual policy providing substantially the same
20coverage and deductibles as are provided under the plan and from eligible persons
21with coverage under s. 149.14 (2) (b) set in accordance with s. 149.14 (5m), including
22amounts received for premium, deductible, and prescription drug copayment
23subsidies under s. 149.144, and from premiums collected from eligible persons with
24coverage under s. 149.146 set in accordance with s. 149.146 (2) (b).
AB100, s. 2043 25Section 2043. 149.143 (1) (am) 3. of the statutes is amended to read:
AB100,957,11
1149.143 (1) (am) 3. Third, by increasing premiums from eligible persons with
2coverage under s. 149.14 (2) (a) to more than the rate at which premiums were set
3under subd. 1. but not more than 200% of the rate that a standard risk would be
4charged under an individual policy providing substantially the same coverage and
5deductibles as are provided under the plan and from eligible persons with coverage
6under s. 149.14 (2) (b) by a comparable amount in accordance with s. 149.14 (5m),
7including amounts received for premium, deductible, and prescription drug
8copayment
subsidies under s. 149.144, and by increasing premiums from eligible
9persons with coverage under s. 149.146 in accordance with s. 149.146 (2) (b), to the
10extent that the amounts under subds. 1. and 2. are insufficient to pay 60% of plan
11costs.
AB100, s. 2044 12Section 2044. 149.143 (1) (am) 4. of the statutes is amended to read:
AB100,957,1713 149.143 (1) (am) 4. Fourth, notwithstanding par. (bm), by increasing insurer
14assessments, excluding assessments under s. 149.144, and adjusting provider
15payment rates, subject to s. 149.142 (1) (b) and excluding adjustments to those rates
16under s. 149.144, in equal proportions and to the extent that the amounts under
17subds. 1. to 3. are insufficient to pay 60% of plan costs.
AB100, s. 2045 18Section 2045. 149.143 (1) (bm) 2. of the statutes is amended to read:
AB100,957,2119 149.143 (1) (bm) 2. Fifty percent from adjustments to provider payment rates,
20subject to s. 149.142 (1) (b) and excluding adjustments to those rates under s.
21149.144.
AB100, s. 2046 22Section 2046. 149.143 (2) (a) (intro.) of the statutes is amended to read:
AB100,958,223 149.143 (2) (a) (intro.) Prior to each plan year, the department shall estimate
24the operating and administrative costs of the plan and the costs of the premium
25reductions under s. 149.165, the deductible reductions under s. 149.14 (5) (a), and

1any prescription drug copayment reductions under s. 149.14 (5) (e)
for the new plan
2year and do all of the following:
AB100, s. 2047 3Section 2047. 149.143 (2) (a) 1. a. of the statutes is amended to read:
AB100,958,94 149.143 (2) (a) 1. a. Estimate the amount of enrollee premiums that would be
5received in the new plan year if the enrollee premiums were set at a level sufficient,
6when including amounts received for premium, deductible, and prescription drug
7copayment
subsidies under s. 149.144 and from premiums collected from eligible
8persons with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b), to
9cover 60% of the estimated plan costs for the new plan year.
AB100, s. 2048 10Section 2048. 149.143 (2) (a) 2. of the statutes is amended to read:
AB100,958,1711 149.143 (2) (a) 2. After making the determinations under subd. 1., by rule set
12premium rates for the new plan year, including the rates under s. 149.146 (2) (b), in
13the manner specified in sub. (1) (am) 1. and 3. and such that a rate for coverage under
14s. 149.14 (2) (a) is approved by the board and is not less than 140% nor more than
15200% of the rate that a standard risk would be charged under an individual policy
16providing substantially the same coverage and deductibles as are provided under the
17plan.
AB100, s. 2049 18Section 2049. 149.143 (2) (a) 3. of the statutes is amended to read:
AB100,958,2219 149.143 (2) (a) 3. By rule set Set the total insurer assessments under s. 149.13
20for the new plan year by estimating and setting the assessments at the amount
21necessary to equal the amounts specified in sub. (1) (am) 4. and (bm) 1. and notify
22the commissioner of the amount.
AB100, s. 2050 23Section 2050. 149.143 (2) (a) 4. of the statutes is amended to read:
AB100,959,224 149.143 (2) (a) 4. By the same rule as under subd. 3. adjust Adjust the provider
25payment rate for the new plan year, subject to s. 149.142 (1) (b), by estimating and

1setting the rate at the level necessary to equal the amounts specified in sub. (1) (am)
24. and (bm) 2. and as provided in s. 149.145.
AB100, s. 2051 3Section 2051 . 149.143 (2) (a) 4. of the statutes, as affected by 2005 Wisconsin
4Act .... (this act), is amended to read:
AB100,959,85 149.143 (2) (a) 4. Adjust the provider payment rate for the new plan year,
6subject to s. 149.142 (1) (b),
by estimating and setting the rate at the level necessary
7to equal the amounts specified in sub. (1) (am) 4. and (bm) 2. and as provided in s.
8149.145.
AB100, s. 2052 9Section 2052. 149.143 (2m) (a) 1. of the statutes is amended to read:
AB100,959,1210 149.143 (2m) (a) 1. The amount of premiums received in a plan year from all
11eligible persons, including amounts received for premium, deductible, and
12prescription drug copayment
subsidies.
AB100, s. 2053 13Section 2053. 149.143 (2m) (a) 2. of the statutes is amended to read:
AB100,959,1614 149.143 (2m) (a) 2. The amount of premiums, including amounts received for
15premium, deductible, and prescription drug copayment subsidies, necessary to cover
1660% of the plan costs for the plan year.
AB100, s. 2054 17Section 2054. 149.143 (3) (a) of the statutes is amended to read:
AB100,960,218 149.143 (3) (a) If, during a plan year, the department determines that the
19amounts estimated to be received as a result of the rates and amount set under sub.
20(2) (a) 2. to 4. and any adjustments in insurer assessments and the provider payment
21rate under s. 149.144 will not be sufficient to cover plan costs, the department may
22by rule increase the premium rates set under sub. (2) (a) 2. for the remainder of the
23plan year, subject to s. 149.146 (2) (b) and the maximum specified in sub. (2) (a) 2.,
24by rule increase the assessments set under sub. (2) (a) 3. for the remainder of the plan
25year, subject to sub. (1) (bm) 1., and by the same rule under which assessments are

1increased
adjust the provider payment rate set under sub. (2) (a) 4. for the remainder
2of the plan year, subject to sub. (1) (bm) 2. and s. 149.142 (1) (b).
AB100, s. 2055 3Section 2055 . 149.143 (3) (a) of the statutes, as affected by 2005 Wisconsin Act
4.... (this act), is amended to read:
AB100,960,135 149.143 (3) (a) If, during a plan year, the department determines that the
6amounts estimated to be received as a result of the rates and amount set under sub.
7(2) (a) 2. to 4. and any adjustments in insurer assessments and the provider payment
8rate under s. 149.144 will not be sufficient to cover plan costs, the department may
9increase the premium rates set under sub. (2) (a) 2. for the remainder of the plan year,
10subject to s. 149.146 (2) (b) and the maximum specified in sub. (2) (a) 2., increase the
11assessments set under sub. (2) (a) 3. for the remainder of the plan year, subject to sub.
12(1) (bm) 1., and adjust the provider payment rate set under sub. (2) (a) 4. for the
13remainder of the plan year, subject to sub. (1) (bm) 2. and s. 149.142 (1) (b).
AB100, s. 2056 14Section 2056. 149.143 (3) (b) of the statutes is amended to read:
AB100,960,2115 149.143 (3) (b) If the department increases premium rates and insurer
16assessments and adjusts the provider payment rate under par. (a) and determines
17that there will still be a deficit and that premium rates have been increased to the
18maximum extent allowable under par. (a), the department may further adjust, in
19equal proportions, assessments set under sub. (2) (a) 3. and the provider payment
20rate set under sub. (2) (a) 4., without regard to sub. (1) (bm) but subject to s. 149.142
21(1) (b)
.
AB100, s. 2057 22Section 2057. 149.143 (4) of the statutes is repealed.
AB100, s. 2058 23Section 2058. 149.143 (5) (a) of the statutes is amended to read:
AB100,961,524 149.143 (5) (a) Annually, no later than April 30, the department shall perform
25a reconciliation with respect to plan costs, premiums, insurer assessments, and

1provider payment rate adjustments based on data from the previous calendar year.
2On the basis of the reconciliation, the department shall make any necessary
3adjustments in premiums, insurer assessments, or provider payment rates, subject
4to s. 149.142 (1) (b),
for the fiscal year beginning on the first July 1 after the
5reconciliation, as provided in sub. (2) (b).
AB100, s. 2059 6Section 2059. 149.143 (5) (b) of the statutes is amended to read:
AB100,961,127 149.143 (5) (b) Except as provided in sub. (3) and s. 149.144, the department
8shall adjust the provider payment rates to meet the providers' specified portion of the
9plan costs no more than once annually, subject to s. 149.142 (1) (b). The department
10may not determine the adjustment on an individual provider basis or on the basis
11of provider type, but shall determine the adjustment for all providers in the
12aggregate, subject to s. 149.142 (1) (b).
AB100, s. 2060 13Section 2060. 149.144 of the statutes is amended to read:
AB100,961,22 14149.144 Adjustments to insurer assessments and provider payment
15rates for premium, deductible, and prescription drug copayment
16reductions.
The department shall, by rule, adjust in equal proportions the amount
17of the assessment set under s. 149.143 (2) (a) 3. and the provider payment rate set
18under s. 149.143 (2) (a) 4., subject to ss. 149.142 (1) (b) and 149.143 (1) (am), sufficient
19to reimburse the plan for premium reductions under s. 149.165, deductible
20reductions under s. 149.14 (5) (a), and any prescription drug copayment reductions
21under s. 149.14 (5) (e). The department shall notify the commissioner so that the
22commissioner may levy any increase in insurer assessments.
AB100, s. 2061 23Section 2061 . 149.144 of the statutes, as affected by 2005 Wisconsin Act ....
24(this act), is amended to read:
AB100,962,9
1149.144 Adjustments to insurer assessments and provider payment
2rates for premium, deductible, and prescription drug copayment
3reductions.
The department shall adjust in equal proportions the amount of the
4assessment set under s. 149.143 (2) (a) 3. and the provider payment rate set under
5s. 149.143 (2) (a) 4., subject to ss. 149.142 (1) (b) and s. 149.143 (1) (am), sufficient
6to reimburse the plan for premium reductions under s. 149.165, deductible
7reductions under s. 149.14 (5) (a), and any prescription drug copayment reductions
8under s. 149.14 (5) (e). The department shall notify the commissioner so that the
9commissioner may levy any increase in insurer assessments.
AB100, s. 2062 10Section 2062. 149.145 of the statutes is amended to read:
AB100,962,22 11149.145 Program budget. The department, in consultation with the board,
12shall establish a program budget for each plan year. The program budget shall be
13based on the provider payment rates specified in s. 149.142 and in the most recent
14provider contracts that are in effect and on the funding sources specified in ss.
15149.143 (1) and 149.144, including the methodologies specified in ss. 149.143,
16149.144, and 149.146 for determining premium rates, insurer assessments, and
17provider payment rates. Except as otherwise provided in s. 149.143 (3) (a) and (b)
18and subject to s. 149.142 (1) (b), from the program budget the department shall derive
19the actual provider payment rate for a plan year that reflects the providers'
20proportional share of the plan costs, consistent with ss. 149.143 and 149.144. The
21department may not implement a program budget established under this section
22unless it is approved by the board.
AB100, s. 2063 23Section 2063. 149.146 (2) (am) 5. of the statutes is amended to read:
AB100,963,1924 149.146 (2) (am) 5. Subject to s. 149.14 (8) (b), the department may, by rule
25under s. 149.17 (4), establish for prescription drug coverage under this section

1copayment amounts, coinsurance rates, and
establish a 3-tiered copayment
2structure for prescription drugs. The
copayment and coinsurance out-of-pocket
3limits limit for prescription drug coverage under this section over which the plan will
4pay 100% of covered costs for prescription drugs. Any copayment amount,
5coinsurance rate, or out-of-pocket limit established under this subdivision is subject
6to the approval of the board
under this section may be $400. The department may
7establish that only certain copayment amounts count toward the out-of-pocket
8limit. Subject to s. 149.14 (8) (b), the department may change, by rule under s. 149.17
9(4), the out-of-pocket limit. Using the procedure under s. 227.24, the department
10may promulgate rules under this subdivision for the period before the effective date
11of any permanent rules promulgated under this subdivision, but not to exceed the
12period authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) (a),
13(2) (b), and (3), the department is not required to provide evidence that promulgating
14a rule under this subdivision as an emergency rule is necessary for the preservation
15of the public peace, health, safety, or welfare and is not required to make a finding
16of emergency for promulgating a rule under this subdivision as an emergency rule
.
17Copayments and coinsurance paid by an eligible person under this subdivision are
18separate from and do not count toward the deductible and covered costs not paid by
19the plan under subds. 1. to 3.
AB100, s. 2064 20Section 2064. 149.146 (2) (b) (intro.) of the statutes is amended to read:
AB100,963,2521 149.146 (2) (b) (intro.) The schedule of premiums for coverage under this
22section shall be promulgated by rule set by the department, as provided in s. 149.143.
23The rates for coverage under this section shall be set such that they differ from the
24rates for coverage under s. 149.14 (2) (a) by the same percentage as the percentage
25difference between the following:
AB100, s. 2065
1Section 2065. 149.25 of the statutes is repealed.
AB100, s. 2066 2Section 2066. 153.01 (2) of the statutes is amended to read:
AB100,964,43 153.01 (2) "Board" means the health care quality and patient safety board on
4health care information
.
AB100, s. 2067 5Section 2067. 153.05 (6m) of the statutes is amended to read:
AB100,964,116 153.05 (6m) The department may contract with the group insurance board for
7the provision of data collection and analysis services related to health maintenance
8organizations and insurance companies that provide health insurance for state
9employees. The department shall establish contract fees for the provision of the
10services. All moneys collected under this subsection shall be credited to the
11appropriation under s. 20.435 (4) (1) (hg).
AB100, s. 2068 12Section 2068. 153.07 (5) of the statutes is created to read:
AB100,964,1513 153.07 (5) By January 1, 2006, and at least annually thereafter, the board shall
14report to the governor on the plans, activities, accomplishments, and
15recommendations of the board.
AB100, s. 2069 16Section 2069. 153.07 (6) of the statutes is created to read:
AB100,964,1917 153.07 (6) The board shall annually assess the extent to which automated
18information and decision support systems are used by health care providers in this
19state.
AB100, s. 2070 20Section 2070. 153.07 (7) of the statutes is created to read:
AB100,964,2321 153.07 (7) The board shall annually assess options and develop a plan and
22specific strategies to achieve automation of all health care systems in the state by
232010 or as soon as practicable.
AB100, s. 2071 24Section 2071. 153.07 (8) of the statutes is created to read:
AB100,965,2
1153.07 (8) The board shall administer the health care quality improvement
2fund.
AB100, s. 2072 3Section 2072. 153.07 (9) of the statutes is created to read:
AB100,965,54 153.07 (9) The board may accept gifts, grants, bequests, and devises to be used
5in the execution of its functions.
AB100, s. 2073 6Section 2073. 153.076 of the statutes is created to read:
AB100,965,7 7153.076 Grants and loans. (1) In this section:
AB100,965,108 (a) "Clinic" means a place, other than a residence, that is used primarily for the
9provision of nursing, medical, podiatric, dental, chiropractic, or optometric care and
10treatment.
AB100,965,1111 (b) "Health maintenance organization" has the meaning given in s. 609.01 (2).
AB100,965,1212 (c) "Hospital" has the meaning given in s. 50.33 (2).
AB100,965,1313 (d) "Physician" has the meaning given in s. 448.01 (5).
AB100,965,17 14(2) (a) From the appropriation under s. 20.505 (4) (qb), the board may make
15grants or loans, under procedures and criteria determined by the board, to clinics,
16health maintenance organizations, or other health care systems, hospitals, or
17physicians for any of the following projects:
AB100,965,2018 1. Installation of computer-assisted physician order entry, electronic medical
19records, or other information system infrastructure, including clinical decision
20support systems, to improve the quality, safety, and efficiency of patient care.
AB100,965,2421 2. Development of health information exchanges, integrated health care data
22repositories, and interoperable systems to facilitate the reporting of quality, safety,
23and efficiency information for purposes of health care system improvement or
24related purposes by informing consumers and health care purchasers.
AB100,966,2
13. Demonstration, through pilot projects, of rapid cycle improvement in quality,
2safety, and efficiency of care.
AB100,966,43 4. Facilitation of group purchases of medical technology systems by assisting
4health care providers in forming collaborative agreements for technology.
AB100,966,65 (b) Repayment of any loans made under par. (a) shall be deposited into the
6health care quality improvement fund.
AB100, s. 2074 7Section 2074. 153.60 (1) of the statutes is amended to read:
Loading...
Loading...