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. 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:
AB100,967,48
153.60
(1) The department shall, by the first October 1 after the
9commencement of each fiscal year, estimate the total amount of expenditures under
10this chapter for the department and the board for that fiscal year for data collection,
11database development and maintenance, generation of data files and standard
12reports, orientation and training provided under s. 153.05 (9) (a) and maintaining
13the board. The department shall assess the estimated total amount for that fiscal
14year
, less the estimated total amount to be received for purposes of administration
15of this chapter under s. 20.435
(4) (1) (hi) during the fiscal year
, and the
16unencumbered balance of the amount received for purposes of administration of this
17chapter under s. 20.435
(4) (1) (hi) from the prior fiscal year
and the amount in the
18appropriation account under s. 20.435 (1) (dg), 1997 stats., for the fiscal year, to
19health care providers, other than hospitals and ambulatory surgery centers, who are
20in a class of health care providers from whom the department collects data under this
21chapter in a manner specified by the department by rule. The department shall
22obtain approval from the board for the amounts of assessments for health care
23providers other than hospitals and ambulatory surgery centers. The department
24shall work together with the department of regulation and licensing to develop a
25mechanism for collecting assessments from health care providers other than
1hospitals and ambulatory surgery centers. No health care provider that is not a
2facility may be assessed under this subsection an amount that exceeds $75 per fiscal
3year. All payments of assessments shall be credited to the appropriation under s.
420.435
(4) (1) (hg).
AB100, s. 2075
5Section
2075. 153.60 (3) of the statutes is amended to read:
AB100,967,166
153.60
(3) The department shall, by the first October 1 after the
7commencement of each fiscal year, estimate the total amount of expenditures
8required for the collection, database development and maintenance and generation
9of public data files and standard reports for health care plans that voluntarily agree
10to supply health care data under s. 153.05 (6r). The department shall assess the
11estimated total amount for that fiscal year to health care plans in a manner specified
12by the department by rule and may enter into an agreement with the office of the
13commissioner of insurance for collection of the assessments. Each health plan that
14voluntarily agrees to supply this information shall pay the assessments on or before
15December 1. All payments of assessments shall be deposited in the appropriation
16under s. 20.435
(4) (1) (hg) and may be used solely for the purposes of s. 153.05 (6r).
AB100, s. 2076
17Section
2076. 153.65 (1) of the statutes is amended to read: