AB1140: Bill Text

AB1140,15,10 (j) The limited dental care specified in sub. (4).

AB1140,15,13 (k) Other preventive services or procedures, as determined by the corporation, for which there is scientific evidence that exemption from cost sharing is likely to reduce health care costs or avoid health risks.

AB1140,15,17 (3) Pharmacy benefit. (a) Except as provided in par. (b), the corporation shall assume the risk for, and pay for, prescription drugs provided to eligible residents. For this purpose, the corporation shall retain the portion of the amount credited under s. 260.10 (1) (a) that is actuarially allocated for prescription drug coverage.

AB1140,15,22 (b) If the corporation determines that the method of providing prescription drug coverage under par. (a) is not cost-effective, the corporation may require the health care plans to provide prescription drug coverage to eligible residents and shall pay the portion of the amount credited under s. 260.10 (1) (a) that is actuarially allocated for prescription drug coverage to the eligible residents' health care plans.

AB1140,16,2 (4) Dental benefit. Every health care plan shall provide coverage of dental examinations and the application of varnishes and sealants, as determined by the corporation, for eligible residents who are at least 2 years of age but not more than 16 years of age.

AB1140,16,7 (5) Benefit and health savings account deposit reductions. (a) If the corporation determines, based on information and recommendations received from its actuaries, that the cash balance in the health insurance purchasing trust fund is likely to be insufficient for providing the health care benefits under subs. (1) to (4), the corporation shall inform the governor and the legislature of all of the following:

AB1140,16,8 1. That expenses will exceed revenues for one or more specified years.

AB1140,16,11 2. What increase in revenues would be required to maintain the current health savings account and benefit levels and bring revenues and expenses into balance for the year or years specified in subd. 1.

AB1140,16,15 3. Alternative reductions in the amount deposited into health savings accounts under s. 260.10 (1) (b) 2. or in the benefits under this section that would be appropriate to bring revenues and expenses into balance for the year or years specified in subd. 1.

AB1140,16,19 4. The revenue increase, health savings account deposit reduction, or benefit reductions, or the combination of increase and reductions, that the corporation recommends to bring revenues and expenses into balance for the year or years specified in subd. 1.

AB1140,16,24 5. The health savings account deposit reduction or benefit reductions that the corporation prefers to bring revenues and expenses into balance for the year or years specified in subd. 1. if legislation that increases revenues, reduces the health savings account deposit under s. 260.10 (1) (b) 2., or reduces benefits provided under this section is not enacted before the beginning of the first year specified in subd. 1.

AB1140,17,4 (b) If legislation to bring revenues and expenses into balance for the year or years specified in par. (a) 1. is not enacted before the beginning of the first year specified, the corporation shall implement the health savings account deposit reduction or benefit reductions specified in par. (a) 5.

AB1140,17,8 260.25 Cost sharing. (1) Premiums. (a) An eligible resident who selects or is assigned to coverage under a Tier 1 health care plan shall pay no premium in addition to the amount paid by the corporation under s. 260.10 (1) (a) to the eligible resident's health care plan.

AB1140,17,12 (b) An eligible resident who selects coverage under a Tier 2 or Tier 3 health care plan shall be required to pay to the selected Tier 2 or Tier 3 health care plan, as a condition of enrollment, the out-of-pocket monthly premium determined by the corporation under s. 260.15 (2) (b).

AB1140,17,14 (2) Deductibles. Except as provided in s. 260.20 (2) and subject to sub. (4), in a year, an eligible resident shall pay the following annual deductible amount:

AB1140,17,16 (a) For an eligible resident who is 18 years of age or older on January 1 of that year, $1,200.

AB1140,17,18 (b) For an eligible resident who is under 18 years of age on January 1 of that year, $100.

AB1140,17,21 (3) Coinsurance and copayments. Except as provided in s. 260.20 (2) and subject to sub. (4), in a year, after the deductible under sub. (2) has been satisfied, an eligible resident shall pay all of the following:

AB1140,17,24 (a) Coinsurance that is equal to at least 10 percent but not more than 20 percent of medical, hospital, related health care services, and prescription drug costs, as determined by the corporation.

AB1140,18,5 (b) For each prescription of a brand-name drug that is on the preferred list determined by the corporation under s. 260.20 (3) (a) or by the eligible resident's health care plan under s. 260.20 (3) (b), in addition to the coinsurance required under par. (a), either coinsurance of at least 10 percent but not more than 20 percent or a copayment, as determined by the corporation.

AB1140,18,10 (c) For each prescription of a brand-name drug that is not on the preferred list determined by the corporation under s. 260.20 (3) (a) or by the eligible resident's health care plan under s. 260.20 (3) (b), in addition to the coinsurance required under par. (a), either coinsurance of at least 20 percent but not more than 40 percent or a copayment, as determined by the corporation.

AB1140,18,13 (4) Maximum amounts. (a) Subject to par. (c), an eligible resident under sub. (2) (a) may not be required to pay more than $2,000 per year in total cost sharing under subs. (2) and (3).

AB1140,18,15 (b) Subject to par. (c), an eligible resident under sub. (2) (b) may not be required to pay more than $500 per year in total cost sharing under subs. (2) and (3).

AB1140,18,17 (c) A family consisting of 2 or more eligible residents may not be required to pay more than $3,000 per year in total cost sharing under subs. (2) and (3).

AB1140,18,23 (5) Adjustments. (a) Notwithstanding subs. (2) to (4), the corporation shall reduce the deductible, coinsurance, copayment, or maximum cost-sharing amounts, or any combination of those amounts, for low-income eligible residents, as determined by the corporation, to ensure that the cost sharing required does not deter low-income eligible residents from seeking and using appropriate health care services.

AB1140,19,3 (b) Notwithstanding subs. (2) to (4), beginning in 2010, the corporation annually shall adjust the deductible and maximum cost-sharing amounts to reflect the annual percentage change in the U.S. consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor, for the 12-month period ending on December 31 of the preceding year.

AB1140,19,9 260.30 Preexisting condition exclusion. (1) To whom applicable. Subject to sub. (2), a health care plan may not provide coverage for any preexisting condition, as defined by the corporation, of an eligible resident who, at any time during the 18-month period before becoming an eligible resident, resided outside of Wisconsin and did not have health insurance coverage that was substantially similar to the coverage provided under this chapter, as determined by the corporation.

AB1140,19,12 (2) Length of exclusion. A preexisting condition exclusion under sub. (1) may not extend beyond the date on which the eligible resident has been continuously covered under this chapter for a total of 18 months.

AB1140,19,21 260.40 Health care advisory committee; health care policies. (1) Establishment of committee. (a) The corporation shall establish a health care advisory committee to advise it on all matters related to promoting healthier lifestyles; promoting health care quality; increasing the transparency of health care cost and quality information; preventive care; disease management; the appropriate use of primary care, medical specialists, prescription drugs, and hospital emergency rooms; confidentiality of medical information; the appropriate use of technology; benefit design; the availability of physicians, hospitals, and other providers; and reducing health care costs.

AB1140,19,22 (b) The committee shall consist of the following:

AB1140,19,23 1. Three members designated by the Wisconsin Medical Society.

AB1140,19,24 2. Three members designated by the Wisconsin Hospital Association.

AB1140,20,2 3. One member designated by the dean of the University of Wisconsin School of Medicine and Public Health.

AB1140,20,4 4. One member designated by the president of the Medical College of Wisconsin.

AB1140,20,5 5. One member designated by the Wisconsin Nurses Association.

AB1140,20,7 6. One member designated by the Wisconsin Federation of Nurses and Health Professionals.

AB1140,20,8 7. One member designated by the Wisconsin Chiropractic Association.

AB1140,20,9 8. One member designated by the Wisconsin Dental Association.

AB1140,20,16 (c) The committee members shall elect a chairperson from among the members. The chairperson, or his or her designee, shall attend every meeting of the board to communicate to the corporation the advice and recommendations of the committee. The chairperson, or his or her designee, shall communicate to the committee any questions on which the corporation is seeking the committee's advice or recommendations. The corporation shall vote on each recommendation submitted to it by the committee as to whether the recommendation should be implemented.

AB1140,20,21 (d) Annually, on or before September 1, the committee shall submit to the corporation a summary of all of its recommendations during the previous 12 months for improving the health insurance purchasing arrangement under this chapter. The corporation shall include those recommendations and the votes taken by the corporation on them in its annual report under s. 260.05 (2) (f).

AB1140,20,23 (2) Adoption of health care policies. The corporation shall do all of the following:

AB1140,21,3 (a) In consultation with the health care advisory committee and experts on creating effective incentives for individuals and employers relating to healthier lifestyles, adopt evidence-based policies that create incentives for eligible residents to adopt healthier lifestyles and for employers to institute work-based programs that have been shown to improve the health status of employees and their families.

AB1140,21,12 (b) In consultation with the health care advisory committee and experts on increasing the transparency of health care cost and quality information, and in collaboration with the health care advisory committee and health care plans and health care providers, adopt policies that provide eligible residents with current, comprehensive, easily accessible, and easily understandable information about the cost and quality of the care provided by Wisconsin health care providers and by any physicians, clinics, or hospitals outside of Wisconsin that are included in a network of a health care plan offered under the health insurance purchasing arrangement under this chapter.

AB1140,21,16 (c) In consultation with the health care advisory committee, the Wisconsin Health Information Organization, the Wisconsin Collaborative for Health Care Quality, and other medical and nonmedical experts on health care quality, promote evidence-based improvements in the quality of health care delivery in Wisconsin.

AB1140,21,24 260.60 Including certain residents who are eligible for Medical Assistance. (1) Plan. The corporation and the department of health and family services shall jointly develop a plan for providing health care coverage under the health insurance purchasing arrangement established under this chapter to individuals who satisfy the criteria under s. 260.01 (3) (a) 1. to 4. and who are eligible for Medical Assistance under subch. IV of ch. 49 in the low-income families category, as determined under 2005 Wisconsin Act .... (this act), section 14 (1 ) (b), or for health care coverage under the Badger Care health care program under s. 49.665.

AB1140,22,5 (2) Waiver request. The department of health and family services shall, no later than July 1, 2010, submit to the legislature under s. 13.172 (2) the plan developed under sub. (1), together with its recommendations concerning the desirability of requesting waivers from the secretary of the federal department of health and human services for all of the following purposes:

AB1140,22,6 (a) To implement the plan developed under sub. (1).

AB1140,22,9 (b) To allow the use of federal financial participation to fund, to the maximum extent possible, health care coverage under the arrangement established under this chapter for individuals specified in sub. (1).

AB1140,22,14 (3) Proposed legislation. If the legislature authorizes or requires the department of health and family services to request the waivers specified in sub. (2) and if the waivers are granted, the department of health and family services shall submit to the appropriate standing committees under s. 13.172 (3) proposed legislation that will implement the provisions approved under the waivers.

AB1140, s. 12 Section 12. 632.755 (1g) (a) of the statutes is amended to read:

AB1140,22,19 632.755 (1g) (a) A Except as provided under ch. 260, a disability insurance policy may not exclude a person or a person's dependent from coverage because the person or the dependent is eligible for assistance under ch. 49 or because the dependent is eligible for early intervention services under s. 51.44.

AB1140, s. 13 Section 13. 632.755 (1g) (b) of the statutes is amended to read:

AB1140,22,24 632.755 (1g) (b) A Except as provided under ch. 260, a disability insurance policy may not terminate its coverage of a person or a person's dependent because the person or the dependent is eligible for assistance under ch. 49 or because the dependent is eligible for early intervention services under s. 51.44.

AB1140, s. 14 Section 14 . Nonstatutory provisions.

AB1140,23,2 (1) Proposed legislation on eligibility of and appropriations for Medical Assistance and Badger Care recipients.

AB1140,23,4 (a) Definition. In this subsection, "department" means the department of health and family services.

AB1140,23,5 (b) Eligibility categories for Medical Assistance.

AB1140,23,8 1. The department shall review the statutes and determine which statutory provisions specify eligibility criteria for Medical Assistance by each of the following categories of persons:

AB1140,23,9 a. Low-income families.

AB1140,23,10 b. Elderly or disabled persons.

AB1140,23,19 2. No later than April 1, 2008, the department shall submit the findings of its review under subdivision 1. to the appropriate standing committees of the legislature in the manner provided under section 13.172 (3) of the statutes. If the department determines that one or more statutory provisions provide eligibility criteria that apply to both categories of persons under subdivision 1., along with its findings the department shall submit proposed legislation specifying eligibility criteria for Medical Assistance that clearly separates the 2 categories of persons under subdivision 1. so that any single statutory unit applies to only one of the 2 categories.

AB1140,23,20 (c) Appropriations for Medical Assistance and Badger Care.

AB1140,24,2 1. The department and the legislative fiscal bureau shall review the following Medical Assistance and Badger Care health care program appropriations to determine what amount of each of the total amounts appropriated under each of the appropriations is attributable to benefits provided to, or the administrative costs of providing benefits to, Medical Assistance recipients in the category under paragraph (b) 1 . a. or Badger Care health care program recipients:

AB1140,24,3 a. Section 20.435 (2) (gk) of the statutes.

AB1140,24,5 b. Section 20.435 (4) (a), (b), (bc), (bm), (bn), (gp), (iL), (im), (in), (kt), (L), (vt), (w), (wm), (wp), and (x) of the statutes.

AB1140,24,6 c. Section 20.435 (6) (ga) and (k) of the statutes.

AB1140,24,7 d. Section 20.435 (7) (b) of the statutes.

AB1140,24,11 2. No later than April 1, 2008, the department and the legislative fiscal bureau shall submit the findings of the review under subdivision 1. to the appropriate standing committees of the legislature in the manner provided under section 13.172 (3) of the statutes, along with proposed legislation that does all of the following:

AB1140,24,16 a. Creates, effective January 1, 2009, separate Medical Assistance appropriations for the state's share of benefits and administrative costs for the category of persons under paragraph (b ) 1. a ., along with the appropriate amounts in the schedule, and funds those appropriations from the health insurance purchasing trust fund.

AB1140,24,20 b. Creates, effective January 1, 2009, separate appropriations for the state's share of benefits and administrative costs for the Badger Care health care program, along with the appropriate amounts in the schedule, and funds those appropriations from the health insurance purchasing trust fund.

AB1140,25,2 c. Modifies, effective January 1, 2009, the Medical Assistance and Badger Care health care program appropriations in current law that are affected by the creation of the appropriations under subdivision 2 . a. and b., along with the amounts in the schedule, to account for the creation of the appropriations under subdivision 2. a. and b., and funds the modified appropriations in the same manner as those appropriations are funded under current law.

AB1140, s. 15 Section 15. Initial applicability.

AB1140,25,6 (1) Health savings accounts. The treatment of sections 71.83 (1) (ce) and subchapter XVI of chapter 71 of the statutes first applies to taxable years beginning on January 1, 2008.

AB1140,25,7 (End)