SB698: Bill Text

SB698,23,10 2. Copayments for prescription drugs may not exceed $15 per prescription for a generic drug or $20 per prescription for a brand name drug.

SB698,23,14 3. A covered individual shall pay a copayment of $15 each time the individual receives services from the individual's care coordinator under s. 634.10 (3) or any other health care provider to whom the individual has been referred by his or her care coordinator.

SB698,23,17 4. Subject to par. (c), a covered individual who receives health care services from a specialist provider without a referral from his or her care coordinator under s. 634.10 (3) shall be required to pay 25 percent of the cost of the services provided.

SB698,23,20 (c) The board shall establish guidelines for obtaining emergency treatment from a specialist provider without a referral and without the cost-sharing requirement under par. (b) 4.

SB698,23,24 (d) The board may modify the maximum cost-sharing amounts specified in par. (b) 1. and the copayment and coinsurance amounts specified in par. (b) 2. to 4. as long as any modification does not have a substantial effect on the total cost for covered individuals.

SB698,24,3 (e) After the first year of the plan's operation, the board annually may increase the maximum cost-sharing amounts and the copayment and coinsurance amounts under the plan by not more than a percentage equal to medical inflation.

SB698,24,9 (2) Employer assessment. (a) Subject to pars. (b), (c), and (d), each employer shall pay a monthly assessment at a flat rate for each of the employer's employees. The board shall determine the basis for calculating the assessments and, taking into consideration the reductions under par. (c), shall set the flat rate per employee at a level that is sufficient to cover the administrative and operating costs of the plan that are not covered by the cost sharing under sub. (1).

SB698,24,13 (b) An employer may pay, at the employer's discretion, the per employee assessment amount determined under par. (a) for an employee who leaves the employer's employment, for the period, or for any portion of the period, during which the former employee is not employed by another employer.

SB698,24,17 (c) If an employer has fewer than 10 employees and the average gross income of all of the employer's employees is not more than $20,000, the assessment amount that the employer would be required to pay under par. (a) or may pay under par. (b) shall be reduced by 50 percent.

SB698,24,20 (d) For an employee who is a member of a labor union, the employer assessments under pars. (a) to (c) may be paid through a Taft-Hartley Trust established by the labor union.

SB698,24,25 (3) Federal funds. The board shall seek to obtain federal funds for paying plan costs related to individuals covered under the plan who would otherwise be eligible for coverage under Medical Assistance, the Badger Care health care program, or any other health care program other than Medicare financed at least in part with federal funds.

SB698,25,7 634.30 Provider payment rates. (1) Establishment and increases. The board shall establish the provider payment rates for services and articles covered under the plan. The provider payment rates established shall be fair and adequate to ensure that this state is able to retain the highest quality of medical practitioners. The board shall limit increases in the provider payment rate for each service or article such that any increase in per person spending under the plan does not exceed medical inflation.

SB698,25,13 (2) Payment is payment in full. Except for deductibles, copayments, coinsurance, and any other cost sharing required or authorized under the plan, a provider of a covered service or article shall accept as payment in full for the covered service or article the payment rate determined under sub. (1) and may not bill a covered individual who receives the service or article for any amount by which the charge for the service or article is reduced under sub. (1).

SB698,25,16 634.35 Administration. The plan may be administered on either a statewide or a regional basis. The board shall select one or more administrators of the plan using a competitive bidding process.

SB698,25,20 634.40 Other employer-provided health care benefits. Nothing in this chapter prevents an employer, or a Taft-Hartly Trust on behalf of an employer, from paying all or part of any employee cost sharing under s. 634.25 (1) or from providing for the employer's employees any health care benefits not provided under the plan.

SB698, s. 57 Section 57 . Nonstatutory provisions.

SB698,25,25 (1) Terms of initial members of health plan board. Notwithstanding the length of terms specified for the members of the Wisconsin health plan board under section 15.735 (1) (c) of the statutes, as created by this act, the initial members of the Wisconsin health plan board shall be appointed for the following terms:

SB698,26,3 (a) Two members specified under section 15.735 (1) (a) 1. of the statutes, as created by this act, and one member specified under section 15.735 (1) (a) 2. of the statutes, as created by this act, for terms expiring on May 1, 2010.

SB698,26,6 (b) One member specified under section 15.735 (1) (a) 1. of the statutes, as created by this act, and 2 members specified under section 15.735 (1) (a) 2. of the statutes, as created by this act, for terms expiring on May 1, 2011.

SB698,26,9 (c) Two members specified under section 15.735 (1) (a) 1. of the statutes, as created by this act, and 2 members specified under section 15.735 (1) (a) 2. of the statutes, as created by this act, for terms expiring on May 1, 2012.

SB698,26,12 (2) Waivers. The office of the commissioner of insurance shall, no later than the first day of the 7th month beginning after the effective date of this subsection, do all of the following:

SB698,26,14 (a) Request waivers from the secretary of the federal department of health and human services for all of the following purposes:

SB698,26,19 1. To allow the use of federal financial participation to fund the benefits provided under the Wisconsin Health Care Plan to individuals who are eligible to receive health care services under Medical Assistance, the Badger Care health care program, or any other health care program other than Medicare financed at least in part with federal funds.

SB698,26,23 2. To allow individuals who are eligible for coverage under Medical Assistance, the Badger Care health care program, or any other health care program other than Medicare financed at least in part with federal funds to be covered under the Wisconsin Health Care Plan.

SB698,27,3 3. To allow individuals with coverage under Medical Assistance or the Badger Care health care program to purchase prescription drugs at discounted prices under agreements negotiated for Wisconsin Health Care Plan participants.

SB698,27,8 (b) Request a waiver of federal laws related to a program providing benefits comparable to state worker's compensation benefits to allow individuals paying for prescription drugs under the federal program to purchase prescription drugs at discounted prices under agreements negotiated for Wisconsin Health Care Plan participants.

SB698, s. 58 Section 58 . Initial applicability.

SB698,27,15 (1) If a comprehensive health insurance policy covering an employee is in effect on the effective date of this subsection and has a term that extends beyond the first day of the 13th month beginning after effective date of this subsection, this act first applies to that employee, with respect to coverage and cost sharing under the Wisconsin Health Care Plan, and to the employee's employer, with respect to paying an assessment for the employee, on the day on which the policy terminates.

SB698,27,22 (2) If compliance with the requirements of this act would impair any provision of a contract to which an employer is a party, that is related to providing health care benefits to the employer's employees on a self-insured basis, and that is in effect on the effective date of this subsection, this act first applies to that employer, with respect to paying assessments for the employer's employees, and to the employer's employees, with respect to coverage and cost sharing under the Wisconsin Health Care Plan, on the day on which the contract terminates.

SB698,28,3 (3) If an employer provides comprehensive health care coverage to its employees under a collective bargaining agreement that is in effect on the effective date of this subsection, this act first applies to that employer, with respect to paying assessments for the employer's employees, and to the employer's employees, with respect to coverage and cost sharing under the Wisconsin Health Care Plan, on the earlier of the following:

SB698,28,4 (a) The day on which the collective bargaining agreement expires.

SB698,28,6 (b) The day on which the collective bargaining agreement is extended, modified, or renewed.

SB698, s. 59 Section 59. Effective dates. This act takes effect on the first day of the 13th month beginning after the day after publication, except as follows:

SB698,28,11 (1) The treatment of sections 15.07 (2) (i), 15.735, 20.145 (6), and 227.01 (13) (nm) and chapter 634 of the statutes and Sections 57 and 58 of this act take effect on the day after publication.

SB698,28,12 (End)