(1) CIGARETTE AND TOBACCO PRODUCTS TAX RATES. The treatment of sections 139.31 (1) (a) and (b), 139.315 (1), 139.32 (5), 139.455, 139.76 (1), 139.78 (1), and 139.865 of the statutes takes effect on September 1, 2007, or on the first day of the 3rd month beginning after publication, whichever is later.
(End)
LRB-0904LRB-0904/2
DAK:jld:rs
2007 - 2008 LEGISLATURE
DOA:......Johnston, BB0187 - Health Care Quality and Patient Safety Council
For 2007-09 Budget -- Not Ready For Introduction
2007 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
health and human services
Other health and human services
This bill creates a health care quality and patient safety council, attached to DHFS, which must, among other things, consider the most cost-effective means of implementing a statewide integrated or interoperable health care information system.
Under current law, the Wisconsin Health and Educational Facilities Authority (WHEFA) provides financial assistance to health facilities and participating health institutions. This bill prohibits WHEFA from providing such financial assistance unless the health facility or participating health institution seeking assistance demonstrates to the secretary of health and family services progress in improving medical information systems technology. In making a determination as to whether the progress is demonstrated, the secretary of health and family services must consider advice of the health care quality and patient safety council.
For further information see the state 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) (k) of the statutes is created to read:
15.07 (2) (k) The secretary of health and family services, or his or her designee, shall serve as chairperson of the health care quality and patient safety council and shall appoint chairpersons for subcommittees on patient care, consumer interest and privacy, public health, and statewide health information exchange and interoperability.
SECTION 2. 15.197 (6) of the statutes is created to read:
15.197 (6) HEALTH CARE QUALITY AND PATIENT SAFETY COUNCIL. There is created a health care quality and patient safety council, attached to the department of health and family services under s. 15.03. The health care quality and patient safety council shall consist of the following members that, except for the members specified in pars. (a) to (c), are appointed by the governor for 2-year terms:
(a) The secretary of administration or his or her designee.
(b) The secretary of health and family services or his or her designee.
(c) The secretary of employee trust funds or his or her designee.
(d) An employer who purchases health care for employees.
(e) A representative of the Wisconsin Health and Hospital Association.
(f) A physician, as defined in s. 448.01 (5).
(g) A representative of the health insurance industry.
(h) A representative of a major health care provider system.
(i) A health care consumer advocate.
SECTION 3. 146.75 of the statutes is created to read:
146.75 Health care quality and patient safety council. (1) In this section:
(a) "American Health Information Community" means a panel that is advisory on information technology to the federal department of health and human services.
(b) "Council" means the health care quality and patient safety council.
(2) Acting in an advisory capacity, the council shall lead implementation efforts for an action plan for health care quality and patient safety by doing all of the following:
(a) Identifying strategies and actions necessary to do all of the following:
1. Attempt to achieve goals established by the Institute of Medicine of the National Academy of Sciences for health care that is safe, effective, patient-centered, timely, efficient, and equitable.
2. Extend health care information systems statewide so as to optimize the improvement of health care quality, safety, and efficiency within a reasonable period of time and with reasonable financial investment.
(b) Considering the most cost-effective means of implementing a statewide integrated or interoperable health care information system, including all of the following:
1. Assessing the benefits of an integrated or interoperable system for supporting rapid deployment of health care providers.
2. Promoting accurate and appropriate shared information about individual patients among health care providers.
3. Creating points of reference for performance indicators among health care provider organizations for organizational performance improvement.
4. Reporting to the public on health care quality, safety, and efficiency data for consumer and purchaser decision making.
(3) The council shall advise the secretary on all of the following:
(a) A communication and marketing plan.
(b) Annually, on recommendations to improve the committee organizational structure of the council.
(c) The distribution of funding to entities to promote the health information technology agenda of the governor.
(d) Whether a health facility, as defined in s. 231.01 (5), or a participating health institution, as defined in s. 231.01 (6), that seeks financial assistance from the Wisconsin Health and Educational Facilities Authority under s. 231.03 demonstrates progress in improving medical information systems technology.
(4) By January 1, 2008, and at least annually thereafter, the council shall report to the legislature under s. 13.172 (3) and to the governor on the council's plans, activities, accomplishments, and recommendations.
(5) Any subcommittee of the council shall align its work with recommendations of the American Health Information Community.
SECTION 4. 146.76 of the statutes is created to read:
146.76 Approval of certain financial assistance. The secretary shall determine whether a health facility, as defined in s. 231.01 (5), or a participating health institution, as defined in s. 231.01 (6), that seeks financial assistance from the Wisconsin Health and Educational Facilities Authority under s. 231.03 demonstrates progress in improving medical information systems technology and shall inform the Wisconsin Health and Educational Facilities Authority of his or her determination. In making a determination under this section, the secretary shall consider as a factor the advice of the health care quality and patient safety council, as provided under s. 146.75 (3) (d).
SECTION 5. 231.03 (intro.) of the statutes is amended to read:
231.03 Powers. (intro.) The authority has all the powers necessary or convenient to carry out and effectuate the purposes and provisions of this chapter. In addition to all other powers granted by this chapter, subject to s. 231.035, the authority may:
SECTION 6. 231.035 of the statutes is created to read:
231.035 Approval by secretary of health and family services. Beginning on the effective date of this section .... [revisor inserts date], the authority shall inform the secretary of health and family services of any health facility or participating health institution that seeks financial assistance under s. 231.03. The authority may not provide any financial assistance to such a health facility or participating health institution unless the secretary of health and family services determines, under s. 146.76, that the health facility or participating health institution demonstrates progress in improving medical information systems technology.
SECTION 9101. Nonstatutory provisions; Administration.
(1) HEALTH CARE QUALITY AND PATIENT SAFETY COUNCIL MEMBERSHIP. Notwithstanding the length of terms specified in section 15.197 (6) (intro.) of the statutes, as created by this act, the initial terms of the members specified in section 15.197 (6) (d) to (f) of the statutes, as created by this act, shall expire on July 1, 2009, and the initial terms of the members specified in section 15.197 (6) (g) to (i) of the statutes, as created by this act, shall expire on July 1, 2011.
SECTION 9321. Initial applicability; Health and Family Services.
(1) APPROVAL OF FINANCIAL ASSISTANCE. The treatment of sections 146.75 (3) (d), 146.76, 231.03 (intro.), and 231.035 of the statutes first applies to applications for financial assistance made by a health facility or participating health institution under section 231.03 of the statutes, as affected by this act, on the effective date of this subsection.
(End)
LRB-0905LRB-0905/4
PJK:jld:rs
2007 - 2008 LEGISLATURE
DOA:......Pink, BB0185 - BadgerCare Plus
For 2007-09 Budget -- Not Ready For Introduction
2007 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
HEALTH AND HUMAN SERVICES
Medical Assistance
Under current law, DHFS administers the Medical Assistance (MA) program and the Badger Care health care program (BadgerCare), both of which provide health care benefits for eligible individuals. Individuals who may be eligible for MA, generally, are pregnant women, certain children, and elderly or disabled individuals, all of whom must meet specific low-income requirements. Families, children who do not reside with their parents, and unborn children whose mothers are not eligible for MA or BadgerCare may be eligible for BadgerCare if their incomes do not exceed 185 percent of the federal poverty line and they meet certain nonfinancial criteria, such as not having access to employer-subsidized health care coverage.
Waiver to implement BadgerCare Plus
Under this bill, DHFS must request a waiver from, and submit amendments to the state MA plan to, the secretary of the federal department of health and human services to allow DHFS to implement an MA health care program called BadgerCare Plus (BC+). BC+ would be financed as are other MA programs, partly with federal funds and partly with state funds. BC+ would replace all of BadgerCare and part of MA. Thus, individuals who satisfy eligibility criteria under both BC+ and BadgerCare would receive benefits under BC+. Individuals who satisfy eligibility criteria under both BC+ and MA would receive benefits under either BC+ or MA, depending on the basis for their eligibility for MA. For example, an individual who is eligible for MA because he or she receives supplemental security income would continue to receive benefits as usual under MA rather than under BC+.
Benefits and general eligibility
BC+ would provide health care benefits to recipients under two different plans, depending on the basis for the recipient's eligibility. The first plan provides the same benefits that are provided under regular MA. Individuals eligible for BC+ benefits under that plan (regular MA plan) include: a pregnant woman whose family income does not exceed 200 percent of the poverty level (poverty); a child under one year of age whose mother, on the day on which the child was born, was eligible for and receiving benefits under MA or BC+ under the regular MA plan; any child whose family income does not exceed 200 percent of poverty; an individual whose family income does not exceed 200 percent of poverty and who is the parent or caretaker relative of a child who is, generally, living in the home of the parent or caretaker relative; certain migrant workers and their dependents; and an individual between 19 and 21 years of age who was in foster care on his or her 18th birthday.
The second plan, called the Benchmark Plan, provides specified benefits, including, but not limited to, coverage for prescription drugs; physicians' services; inpatient and outpatient hospital services; home health services; physical, occupational, and speech therapy; treatment for nervous and mental disorders and alcoholism and other drug abuse problems; durable medical equipment; and transportation to obtain emergency medical care. Individuals eligible for BC+ benefits under the Benchmark Plan include: a pregnant woman whose family income exceeds 200 percent, but does not exceed 300 percent, of poverty; a child under one year of age whose mother, on the day on which the child was born, was eligible for and receiving BC+ benefits under the Benchmark Plan; any child whose family income exceeds 200 percent, but does not exceed 300 percent, of poverty; and an individual whose family income exceeds 200 percent, but does not exceed 300 percent, of poverty and who is the parent or caretaker relative of a child who is, generally, living in the home of the parent or caretaker relative. In addition, any child whose family income exceeds 300 percent of poverty may purchase coverage under the Benchmark Plan at the full per member per month cost of the coverage.
For coverage under both the regular MA plan and the Benchmark Plan, a child is defined to include an unborn child whose mother is not eligible for MA or BC+ but satisfies all other eligibility criteria except that she is not a U.S. citizen or qualifying alien or is an inmate of a public institution. If the mother's family income does not exceed 200 percent of poverty, the unborn child is eligible for BC+ benefits, limited to prenatal care, under the regular MA plan; if the mother's family income exceeds 200 percent, but does not exceed 300 percent, of poverty, the unborn child is eligible for BC+ benefits, limited to prenatal care, under the Benchmark Plan.
Various other eligibility provisions apply under BC+. For example, regardless of any increase in income, a pregnant woman who is eligible for regular MA benefits remains eligible for those benefits until the last day of the month in which the 60th day after the last day of the pregnancy falls. A child who is receiving inpatient services under the regular MA plan on the day before his or her 19th birthday remains eligible for those services until the end of the stay for which the services are being provided. A pregnant woman, a child, or a parent or caretaker relative whose family income is less than 150 percent of poverty is eligible for benefits for any of the three months before he or she applied for coverage if he or she was otherwise eligible and his or her family income was less than 150 percent of poverty.
Health insurance-related provisions
Various health insurance qualifications and limitations apply under BC+. As a condition of eligibility for BC+, an individual who is eligible for enrollment in a group health plan must apply for enrollment in that plan if DHFS determines that it is cost-effective. With exceptions for pregnant women, individuals in foster care on their 18th birthday, and certain children, no individual whose family income exceeds 150 percent of poverty is eligible for BC+ if the individual has health care coverage under the state employee health plan or coverage that is provided by an employer and for which the employer pays at least 80 percent of the premium. Regardless of family income, however, an unborn child is not eligible for BC+ if the unborn child or its mother has any type of health insurance coverage. Unless there is a good cause reason for not enrolling in the coverage, if an individual whose family income exceeds 150 percent of poverty or an unborn child or its mother had access in the 12 months before applying for BC+ to health care coverage under the state employee health plan or coverage that is provided by an employer and for which the employer pays at least 80 percent of the premium, the individual or unborn child is not eligible for BC+. A pregnant woman whose family income exceeds 200 percent of poverty and who has health insurance coverage must maintain that coverage as a condition of eligibility for BC+. If an individual whose family income exceeds 150 percent of poverty had coverage under the state employee health plan or employer-provided coverage but no longer has the coverage, if an unborn child or its mother had health insurance coverage but no longer has the coverage, or if a pregnant woman whose family income exceeds 200 percent of poverty did not maintain coverage that she had, the individual, unborn child, or pregnant woman is not eligible for BC+ for three calendar months following the month in which the coverage ended, unless there was a good cause reason for the termination of the coverage.
Under the bill, with certain exceptions, for an individual whose family income exceeds 150 percent of poverty, DHFS must verify directly with the employer, if any, whether the individual has or had insurance coverage or access. An employer that receives a request from DHFS for that information must supply the information within a certain time or pay a penalty equal to the full per member per month cost of coverage under BC+ for each month the individual is covered under BC+ until the employer provides the information. Penalties are limited to no more than $1,000 in any six-month period for an employer with fewer than 250 employees, and to no more than $15,000 in any six-month period for other employers.
Cost sharing
Generally, the same copayment requirements that apply under MA apply to BC+ recipients with benefits under the regular MA plan. BC+ recipients with benefits under the Benchmark Plan are subject to the copayment and coinsurance requirements specified in the bill for that plan. A BC+ recipient who is an adult and who is not a pregnant woman must pay a premium for BC+ coverage if the recipient's family income is at least 150 percent of poverty. The premium may not exceed 5 percent of the recipient's family income. A BC+ recipient who is a child must pay a premium for BC+ coverage if the recipient's family income is at least 200 percent of poverty. The premium may not exceed the full per member per month cost of coverage for a child with a family income equal to 300 percent of poverty. A BC+ recipient who is an unborn child or a pregnant woman must pay a premium if the recipient's family income exceeds 200 percent of poverty. The premium may not exceed the full per member per month cost of coverage for an adult with a family income equal to 300 percent of poverty. If a recipient who is required to pay a premium does not pay it when it is due, the recipient's coverage terminates and the recipient may not be eligible for BC+ again for six months.
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. 20.435 (4) (b) of the statutes, as affected by 2007 Wisconsin Act .... (this act), is amended to read:
20.435 (4) (b) Medical Assistance program benefits. Biennially, the amounts in the schedule to provide a portion of the state share of Medical Assistance program benefits administered under s. 49.45 subch. IV of ch. 49, for a portion of the Badger Care health care program under s. 49.665, to provide a portion of the Medical Assistance program benefits administered under s. 49.45 subch. IV of ch. 49 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, for services under the family care benefit under s. 46.284 (5), for assisting victims of diseases, as provided in ss. 49.68, 49.683, and 49.685, and for reduction of any operating deficits as specified in 2005 Wisconsin Act 15, section 3. Notwithstanding s. 20.002 (1), the department may transfer from this appropriation account to the appropriation account under sub. (7) (kb) funds in the amount of and for the purposes specified in s. 46.485. Notwithstanding ss. 20.001 (3) (b) and 20.002 (1), the department may credit or deposit into this appropriation account and may transfer between fiscal years funds that it transfers from the appropriation account under sub. (7) (kb) for the purposes specified in s. 46.485 (3r). Notwithstanding s. 20.002 (1), the department may transfer from this appropriation account to the appropriation account under sub. (7) (bd) funds in the amount and for the purposes specified in s. 49.45 (6v).
****NOTE: This is reconciled s. 20.435 (4) (b). This SECTION has been affected by drafts with the following LRB numbers: LRB-0892, LRB-0905, and LRB-1521.
SECTION 2. 20.435 (4) (bm) of the statutes, as affected by 2007 Wisconsin Act .... (this act), is amended to read:
20.435 (4) (bm) Medical Assistance, food stamps, and Badger Care administration; contract costs, reports, and resource centers. Biennially, the amounts in the schedule to provide a portion of the state share of administrative contract costs for the Medical Assistance program under s. 49.45 subch. IV of ch. 49 and the Badger Care health care program under s. 49.665 and to provide the state share of administrative costs for the food stamp program under s. 49.79, other than payments to counties and tribal governing bodies under s. 49.78 (8), to develop and implement a registry of recipient immunizations, to reimburse 3rd parties for their costs under s. 49.475, for costs associated with outreach activities, and for services of resource centers under s. 46.283. No state positions may be funded in the department of health and family services from this appropriation, except positions for the performance of duties under a contract in effect before January 1, 1987, related to the administration of the Medical Assistance program between the subunit of the department primarily responsible for administering the Medical Assistance program and another subunit of the department. Total administrative funding authorized for the program under s. 49.665 may not exceed 10% of the amounts budgeted under pars. (bc), (p), and (x).
****NOTE: This is reconciled s. 20.435 (4) (bm). This SECTION has been affected by drafts with the following LRB numbers: LRB-0905, LRB-0248, and LRB-0892.
SECTION 3. 20.435 (4) (bn) of the statutes, as affected by 2007 Wisconsin Act .... (this act), is amended to read:
20.435 (4) (bn) Income maintenance. Biennially, the amounts in the schedule for funeral expenses under s. 49.785, for administration of the food stamp employment and training program under s. 49.79 (9), and for payments under s. 49.78 (8) relating to the administration of the Medical Assistance program under subch. IV of ch. 49, the Badger Care health care program under s. 49.665, the food stamp program, and the cemetery, funeral, and burial expenses program under s. 49.785.
****NOTE: This is reconciled s. 20.435 (4) (bn). This SECTION has been affected by drafts with the following LRB numbers: LRB-0905 and LRB-1313.
SECTION 4. 20.435 (4) (jw) of the statutes is created to read:
20.435 (4) (jw) BadgerCare Plus administrative costs. Biennially, the amounts in the schedule to provide a portion of the state share of administrative costs for the BadgerCare Plus Medical Assistance program under s. 49.471. Ten percent of all moneys received from penalty assessments under s. 49.471 (9) (c) shall be credited to this appropriation account.
****NOTE: This SECTION involves a change in an appropriation that must be reflected in the revised schedule in s. 20.005, stats.
