Currently, under Senior Care, DHFS reimburses pharmacists and pharmacies
for providing prescription drugs to elderly persons at reduced rates. DHFS provides
payments from general purpose revenues, rebate payments made by prescription
drug manufacturers, and federal funds.
This bill establishes the health care quality fund, consisting of moneys obtained
from an increase in cigarette and other tobacco products taxes and certain other
moneys and used as another source of Senior Care funding.
Under current law, a person who applies for benefits under Wisconsin Works,
MA, or the food stamp program must provide, as a condition of eligibility, a
declaration of citizenship or satisfactory immigration status. Federal law provides
that no federal moneys will be provided to a state for MA expenditures made on
behalf of a person who declares that he or she is a citizen or national of the United
States unless the person presents satisfactory documentary evidence of citizenship
or nationality. Federal law specifies the documentary evidence that is satisfactory
and certain exemptions to the requirement. This bill conforms state law to federal
law.
Under the Chronic Disease Program, DHFS currently provides financial
assistance for the cost of medical care to persons with chronic kidney disease, cystic
fibrosis, and hemophilia.
This bill requires health insurers, self-insured plans, service benefits plans,
and pharmacy benefits managers (third parties) to provide to DHFS information
from their records to identify persons receiving benefits under the Chronic Disease
Program and under Senior Care who are eligible, or would be eligible as dependents,
for third-party health care coverage and imposes other requirements on third
parties that are similar to those by which third-party liability is determined and
enforced under MA.
Under current law, DHFS provides benefits under the federal Food Stamp
Program and contracts with DWD for administration of an employment and training
program for Food Stamp Program recipients. This bill transfers, administration of
the employment and training program for food stamp recipients to DHFS, which may
contract with county departments of social services and human services and with
tribal governing bodies to administer the program.
Under current law, an individual is ineligible for food stamps in any month in
which the individual is not in compliance with various child support enforcement
requirements, such as refusing to cooperate with efforts to establish paternity with
respect to a child or being delinquent in the payment of child support. This bill
removes noncompliance with the child support enforcement requirements as a basis
for ineligibility for food stamps.
Wisconsin Works
Currently the Wisconsin Works (W-2) program provides work experience and
benefits for low-income custodial parents who are at least 18 years old; job search
assistance to noncustodial parents who are required to pay child support, to minor
custodial parents, and to pregnant women who are not custodial parents; and child
care subsidies for certain parents who need child care services to participate in
various educational or work activities. W-2 is administered by DWD, which
contracts with W-2 agencies to administer W-2 on the local level.
The work components under W-2, called employment positions, consist of three
categories: trial jobs, community service jobs, and transitional placements. A
participant in an employment position must search for unsubsidized employment
the entire time that he or she is participating in the W-2 employment position.
Under current law, DWD is directed to continue the creation and implementation of
a subsidized work program.
This bill eliminates the latter directive and requires DWD to conduct and
evaluate, from January 1, 2008, to December 31, 2009, a real work, real pay pilot
project, limited to 500 participants and conducted in at least one of the areas of the
state established for administering the W-2 program that is located in Milwaukee
County and in at least two areas that are not in Milwaukee County. Under the
project, a W-2 agency pays a wage subsidy, which may not exceed the federal
minimum wage for no more than 30 hours of work per week, to an employer that
employs a project participant. The employer is also reimbursed for up to 100 percent
of federal social security taxes, state and federal unemployment contributions, and
worker's compensation insurance premiums paid on behalf of a participant. An
employer that employs a participant and receives a wage subsidy must agree to make
a good faith effort to retain the participant as an unsubsidized employee after the
wage subsidy ends if the participant successfully completes participation in the pilot
project.
Under current law, a person who is eligible for W-2 and who is the custodial
parent of a child who is 12 weeks old or less may receive a monthly grant of $673 and
may not be required to work in a W-2 employment position. This bill provides that
the custodial parent of a child who is 26 weeks old or less may receive the monthly
grant and may not be required to work in a W-2 employment position. In addition,
the bill provides that an unmarried woman who would be eligible for W-2 except that
she is not a custodial parent may also receive a monthly grant of $673 and may not
be required to work in a W-2 employment position if she is in the third trimester of
a medically verified pregnancy that is at risk and that renders the woman unable to
participate in the workforce.
Under W-2, an individual who is the parent of a child under the age of 13 or,
if the child is disabled, under the age of 19, is eligible for a child care subsidy if the
individual needs child care services to participate in various educational or work
activities and satisfies other eligibility criteria, one of which is that the individual's
family income may not exceed 185 percent of the poverty line. If an individual is
already receiving a child care subsidy, however, family income may be as high as 200
percent of the poverty line. This bill changes these maximum family income levels
to 175 percent of the poverty line for an individual who is first applying for a child
care subsidy and to 190 percent of the poverty line for an individual who is already
receiving a subsidy.
Health
Under current law, DHFS administers a program under which individuals with
a human immunodeficiency virus (HIV) infection may be reimbursed for the cost of
the drug azidothymidine (AZT) or other cost-effective alternatives. DHFS also
administers a program under which individuals with an HIV infection may have
their health insurance premiums subsidized if they are on unpaid medical leave, or
have had to discontinue their employment or reduce their hours, because of a medical
condition arising from or related to the HIV infection.
This bill requires DHFS to conduct a three-year pilot program under which
DHFS may pay premiums and copayments for drugs that are eligible for
reimbursement under the AZT-reimbursement program, for individuals under the
Health Insurance Risk-Sharing Plan (HIRSP), which is the health insurance
program that provides major medical health insurance coverage for disabled persons
covered under Medicare, persons with HIV, and persons who have been refused
coverage in the private health insurance market. The pilot program is limited to 100
individuals at any given time who: 1) are eligible for the AZT-reimbursement
program; 2) do not have health insurance coverage; and 3) are not eligible for the
health insurance premium subsidy program.
Currently, DHFS administers the Well-Woman Program, under which certain
medical services related to breast cancer, cervical cancer, and multiple sclerosis and
certain general medical services are provided to underinsured and uninsured women
of low income.
This bill requires health insurers, self-insured plans, service benefits plans,
and pharmacy benefits managers (third parties) to provide information to DHFS to
identify persons receiving benefits under the Well-Woman Program who are eligible,
or would be eligible as dependents, for third-party health care coverage and imposes
other requirements on third parties that are similar to those by which third-party
liability is determined and enforced under MA.
This bill does all of following:
1. Provides that the HIRSP Authority is to be treated as a state agency for all
purposes under the Wisconsin Retirement System, including the purpose of
providing fringe benefits, such as participation in the pension plan and health
insurance coverage, to its employees.
2. Requires the Investment Board, if requested by the HIRSP Authority, to
invest funds of the HIRSP Authority in the state investment fund and permits the
HIRSP Authority to participate in the local government pooled-investment fund.
3. Allows prescription drugs to be provided under HIRSP by a network of
pharmacists and pharmacies that are approved by the HIRSP Authority Board of
Directors.
4. Requires payments to providers under HIRSP to consist of usual and
customary payment rates instead of the allowable charges for services and articles
under MA.
5. Expands eligibility for premium and deductible subsidies to all persons with
coverage under HIRSP with incomes below a specified level.
Under current law, DHFS annually assesses hospitals a statewide total of
$1,500,000, in proportion to each hospital's respective gross private-pay patient
revenues during the hospital's most recent fiscal year. Moneys from the assessments
pay for a portion of MA benefits, certain long-term care pilot projects under COP, and
services under Family Care. This bill eliminates the current hospital assessments
and instead authorizes DHFS to collect an annual assessment on hospitals based on
claims. Under the bill, the assessments are based on a rate not to exceed 1 percent
of a hospital's gross revenues, as adjusted by DHFS. The assessments are deposited
into the health care quality fund, as created in the bill.
Currently, DHFS subsidizes the premium costs for health insurance coverage,
except for Medicare premiums, of low-income persons who are unable to continue
employment or must reduce employment hours because of illnesses or medical
conditions arising from HIV infections. Medicare has separate programs of coverage
for hospital care, physicians' services, and prescription drugs. This bill authorizes
DHFS to subsidize the premium costs for Medicare prescription drug coverage for
these persons.
This bill requires DHFS to award a grant of at least $167,000 in each fiscal year
to an organization for services to consumers and providers of supportive home care
and personal care.
Long-term care
Under current law, DHFS administers a variety of long-term care programs for
people who are aged or have a disability. Under the Community Options Program
(COP), Community Options Waiver Program (COP Waiver), and the Community
Integration Program for people who are relocated or diverted from nursing homes
(CIP II), counties provide community-based long-term care services to persons who
are aged or have a physical or developmental disability and qualify for MA. A
number of counties have implemented the Family Care program to provide
long-term care services for a capitated payment rate and information and referrals
related to long-term care options. Finally, in several counties, organizations
administer the Wisconsin Partnership Program or the Program for All-Inclusive
Care for the Elderly (PACE), capitated payment rate programs to provide both
long-term care and acute health care services to elderly people or people with
physical disabilities who are eligible for nursing home care.
Current law requires that DHFS obtain approval from JCF before expanding
use of capitated rate payment programs to provide long-term care services. This bill
eliminates this requirement.
Under the Family Care Program, DHFS contracts with resource centers to
provide information to interested individuals regarding long-term care services and
to determine eligibility for the family care benefit. DHFS contracts with care
management organizations (CMOs) to provide the family care benefit to eligible
people for a capitated monthly rate. CMOs must provide a variety of services under
the family care benefit including supportive living, personal care, supported
employment, and home health services, as well as nursing home and other
institutional care.
To be eligible for the family care benefit, a person must be at least 18 years of
age; have a physical or developmental disability or a degenerative brain disorder (a
qualifying condition); have a long-term or irreversible condition and be in need of
ongoing care or require care in order to maintain independence or functional capacity
(functional eligibility); and either be eligible for MA or have projected care costs that
exceed a specified portion of income and assets (financial eligibility).
Currently, five counties have both a resource center and a CMO, and an
additional four counties have only a resource center. Before DHFS contracts with an
entity to operate a resource center or a CMO in a county or for a tribe, the county or
tribe must appoint a local long-term care council and the council must develop a plan
concerning whether and how to implement Family Care. A single entity may not
operate both a resource center and a CMO. A county, alone or with other counties,
may create a special purpose district called a family care district that is independent
of the county to operate either a resource center or a CMO, and a tribe may establish
a corporation that is separate from the tribe to operate a resource center or a CMO.
The bill makes the following changes to Family Care:
1. The bill eliminates the requirement that DHFS obtain approval from JCF
before entering into a new contract for a resource center or a CMO, and before
entering into a contract with a private entity to operate a CMO.
2. The bill eliminates the current requirement that DHFS only make the family
care benefit available in areas of the state in which, in the aggregate, not more than
50 percent of the population that is eligible for the family care benefit resides.
3. Currently, only people who are eligible for both the family care benefit and
MA are entitled to the family care benefit. By January 1, 2008, DHFS must extend
entitlement for the benefit to certain persons who are not MA eligible. The bill
requires that a person be eligible for MA to receive the benefit, and thus eliminates
the requirement that DHFS extend, by January 1, 2008, entitlement for the benefit
to people who are not eligible for MA. The bill provides, however, that people who
are not eligible for MA but are receiving the benefit on the date this bill is enacted
continue to be eligible for, but not entitled to, the family care benefit.
4. The bill renames a family care district a long-term care district and provides
for tribes (acting alone or in conjunction with counties or tribes). The bill allows a
long-term care district to operate the Wisconsin Partnership Program or PACE, as
long as the district does not also operate a resource center. The bill also modifies
membership of long-term care district boards; modifies compensation and benefit
provisions for former county employees hired by a long-term care district; specifies
that counties are not responsible for providing or paying for services that a long-term
care district is required by statute or contract to provide or pay for; and provides for
a county or tribe to withdraw or be removed from a long-term care district.
5. Currently, the local long-term care council for a county or tribe is required
to review the performance of CMOs, identify gaps in services provided by the CMOs,
develop strategies for increasing availability of needed long-term care services,
advise the CMOs, monitor coordination between the resource center and CMOs, and
perform long-range planning for the long-term care system. The councils must
report to DHFS annually on achievements and problems of the local long term-care
system. This bill eliminates the councils and assigns some of their duties to the
governing boards of resource centers and some to regional long-term care advisory
committees, which are created in the bill.
The bill requires governing boards of resource centers to assess the availability
and adequacy of long-term care services, review coordination between the resource
center and CMOs, monitor complaints and appeals regarding the local long-term
care system, and develop strategies for increasing the availability for long-term care
services. The governing boards must report their findings to the appropriate
regional long-term care committee.
The bill requires DHFS to establish regions for regional long-term care
advisory committees. The governing body of each resource center must appoint a
number of members specified by DHFS to serve on the appropriate regional
long-term care committee. The duties of the committees include evaluating the
performance of CMOs and resource centers, monitoring grievances and appeals
regarding CMOs, reviewing the utilization of long-term care services, identifying
gaps in the availability of long-term care services, and performing long range
planning for the regional long-term care system.
6. The bill eliminates degenerative brain disorder as a qualifying condition for
the family care benefit, and instead provides that a person has a qualifying condition
if he or she is a "frail elder" (a person who is 65 years of age or older with a physical
disability or irreversible dementia that restricts the individual's ability to perform
daily tasks or that threatens the capacity to live independently).
7. Currently, a person may be functionally eligible for the family care benefit
at one of two levels, comprehensive or intermediate. This bill changes the two levels
to nursing home level of care and non-nursing home level of care.
8. The bill allows DHFS to determine by agreement with a county that has a
CMO the portion of the county's basic community aids allocation that is used to fund
the county's resource center and CMO.
9. The bill provides that counties in which the family care benefit is available
or in which the Wisconsin Partnership Program or PACE is operated may use their
COP funding to provide mental health or substance abuse services or to provide
services under the Family Support Program. Under the Family Support Program,
counties provide services to families of children who are disabled to assist the
families in caring for the children at home.
Under current law, community-based residential facilities (CBRFs) must
assess the financial condition of privately paying clients prior to admission and
provide them a statement that includes the estimated date on which the client would
deplete his or her financial resources by paying for care in the facility. If that date
is less that two years from the date of the statement, the CBRF must refer the client
to the county department responsible for administering long-term care programs to
assess the person's functional abilities, disabilities, and service needs and review
alternatives to institutional care. Counties generally may not use COP, COP Waiver,
or CIP II funds to pay for care in a CBRF unless the program recipient underwent
such an assessment before he or she entered the CBRF, regardless of whether the
recipient entered the CBRF as a privately paying client.
This bill repeals the requirement that CBRFs assess the financial condition of
privately paying clients prior to admission and the restriction on using COP, COP
Waiver, or CIP II funds to pay for care in a CBRF for a program recipient who did not
undergo an assessment of his or her abilities, disabilities, and services needs and a
review of alternatives to institutional care before entering the CBRF.
The bill repeals the requirements that adult family homes provide information
to prospective residents regarding Family Care resource centers and the family care
benefit and refer prospective residents to the resource centers. The bill also repeals
the requirement that hospitals refer patients to resource centers before discharging
them. Under the bill, CBRFs and residential care apartment complexes must
provide information regarding resource centers and the family care benefit to
prospective residents and, if a referral is required, refer prospective residents to
resource centers when the CBRFs or RCACs first provide the prospective residents
written material regarding their facilities. (A residential care apartment complex
consists of independent apartments, each of which has in individual lockable
entrance and exit, a kitchen with a stove, and individual bathroom, sleeping, and
living areas, and provides to a resident not more than 28 hours per week of
supportive, personal, and nursing services.) Also, in counties that do not have
resource centers, CBRFs must refer certain prospective residents who are aged or
have a physical or developmental disability to the county department responsible for
administering long-term care programs, and the county department must offer the
prospective resident counseling concerning public and private long-term care
benefit programs.
Under current law, intermediate care facilities for the mentally retarded
(ICF-MRs) must pay the state an assessment of $445 per month for each licensed
bed. Federal law provides for a reduction in federal funding for MA if the state
collects an amount in ICF-MR bed assessments that exceeds a specified portion of
the aggregate revenues of all ICF-MRs in the state.
This bill directs DHFS annually to set the monthly per bed assessment amount
at 5.5 percent of the projected aggregate annual revenues for ICF-MRs in the state
divided by the number of licensed ICF-MR beds and by 12 months. DHFS may
reduce the assessment amount during any fiscal year to avoid collecting an amount
during that year that exceeds 5.5 percent of ICF-MR aggregate revenues.
Under current law, nursing homes must pay the state an assessment on each
licensed bed that may not exceed $75. This bill raises that maximum amount for the
nursing home bed assessment to $127.
Under current law, the maximum number of licensed nursing home beds
statewide is 51,795. A nursing home may transfer a licensed bed to another nursing
home only under certain conditions. This bill reduces the statewide licensed nursing
home bed cap to 42,000 beds and provides that when a licensed bed is transferred,
the receiving nursing home must be in the same bed allocation area, as determined
by DHFS, or in an adjoining area.
Under current law, DHFS may approve a temporary reduction in the number
of beds licensed for a nursing home if the nursing home's occupancy rate falls below
the minimum per patient day occupancy standard established by DHFS. If the
nursing home does not resume licensure of the affected beds, DHFS must
incrementally revoke the license for the beds. This bill repeals the authority of DHFS
to reduce temporarily a nursing home's number of licensed beds.
This bill requires health insurers, self-insured plans, service benefits plans,
and pharmacy benefits managers (third parties) to provide to DHFS information
from their records to enable DHFS to identify persons receiving benefits under
Family Care who are eligible, or would be eligible as dependents, for third-party
health care coverage and imposes other requirements on third parties that are
similar to those by which third-party liability is determined and enforced under MA.
This bill requires DHFS to seek any waivers from federal MA laws that are
necessary to implement, in at least three pilot sites, an MA Program under managed
care for the long-term care of children with disabilities. The bill also requires DHFS
to award moneys in both years of the fiscal biennium for technical assistance and
planning services in support of family-centered managed care for children with
long-term support needs.
Under current law, the long-term care ombudsman may enter, without notice,
and have access to clients and residents of a nursing home, a CBRF, a place in which
care is provided under a continuing care contract, a swing bed in an acute care or
extended care facility, or an adult family home (a long-term care facility). The
ombudsman may communicate in private with a client or resident, review records
with consent of the client or resident or his or her legal counsel, and have access to
records of the long-term care facility or of DHFS concerning regulation of the
long-term care facility. Current law specifies the rights of residents of nursing
homes and CBRFs, including the rights to have private and unrestricted
communication with others, to present grievances without justifiable fear of reprisal,
and to be fully informed of all services, charges for services, and changes in service.
Current law authorizes the Board on Aging and Long-Term Care to contract to
provide advocacy services to potential or actual recipients of the Family Care
Program, or their families or guardians.
This bill expands the definition of a long-term care facility, for purposes of
activities by the long-term care ombudsman, to include residential care apartment
complexes. The bill provides that residents of residential care apartment complexes
are entitled to the same rights as residents of nursing homes and CBRFs. The bill
authorizes the Board on Aging and Long-Term Care to employ staff within the
classified service to provide advocacy services to Family Care recipients or potential
recipients, their families, and guardians.
Other health and human services
Currently, DHFS awards grants to prevent, reduce, or cease tobacco use. This
bill establishes the health care quality fund. The fund consists of moneys derived
from the increase in cigarette and other tobacco products taxes, moneys transferred
from the permanent endowment fund, and moneys from certain other sources.
Under the bill, moneys in the health care quality fund are used to fund, in part,
tobacco use control programs and for health care quality and patient safety
information.
Under current law, DHFS may recover incorrect payments made for health care
services under MA that resulted from certain action or inaction by an applicant or
recipient. If DHFS provides medical assistance to a person as a result of, for example,
an injury that was caused by a third party, DHFS may recover from the third party
the amount of the medical assistance provided. Also under current law, if an
individual who is obligated to pay support (court-ordered child or family support or
maintenance) has an overdue support obligation because of a failure to pay, his or her
name, social security number, and amount of overdue support is posted on a
statewide support lien docket.
This bill requires every insurer authorized to do business in this state, before
paying a claim of $500 or more, to verify with DHFS that the individual to whom the
claim is to be paid does not have a medical assistance liability (an amount of medical
assistance paid incorrectly under MA or that DHFS may recover from a third party)
and to check the statewide support lien docket to ensure that the individual does not
have an overdue support obligation. If the individual has an overdue support
obligation or a medical assistance liability, the insurer must pay the claim proceeds,
up to the amount of the overdue obligation or liability, to DWD or DHFS before
paying the individual any claim proceeds that remain.
This bill increases the fees that the state registrar or a local registrar must
charge for issuing a copy of a certificate of birth, death, divorce or annulment, or
marriage (vital record); for verifying information about the event without issuing a
copy; for issuing an additional copy of the same vital record at the same time, for
expedited service; and for searching vital records under certain circumstances. Of
the fees charged for certain birth certificates and copies, a portion is used by the Child
Abuse and Neglect Prevention Board (CANPB) for expenses, for certain statewide
projects, for the Family Resource Center Grant Program, and for technical
assistance to organizations. This bill increases the portion used by CANPB.
The bill requires local registrars to forward to the secretary of administration
60 percent of all revenue generated by fee increases for the issuance of copies of vital
records, other than divorce records. From these moneys, DHFS must distribute
$950,000 in each fiscal year for domestic abuse services, $250,000 in each fiscal year
to Milwaukee County for gender-responsive alcohol and other drug abuse services
and other services to drug dependent women with children, $50,000 in each fiscal
year to Milwaukee County for services to aid youth in transferring from foster care
to independent living, and $500,000 in each fiscal year for comprehensive early
childhood initiatives in Dane County for low-income families.
The bill also increases fees the state registrar must charge for making
amendments to birth records without a court order; making court-ordered
corrections to birth certificates; making any change in a birth certificate, such as
acknowledgment of paternity; making court-ordered name changes; and for
registering certain new or corrected vital records, and late registration of birth
certificates.
This bill creates a health care quality and patient safety council, attached to
DHFS, to consider the most cost-effective means of implementing a statewide
integrated or interoperable health care information system.
Under current law, WHEFA provides financial assistance to health facilities
and participating health institutions. This bill prohibits WHEFA from providing
such assistance unless the health facility or institution demonstrates progress in
improving medical information systems technology.
This bill increases from $35 to $65 the annual fee that a person who is obligated
to pay child or family support must pay to DWD for receiving and disbursing the child
support funds. This bill also requires DWD to collect an annual fee of $25 from a
person who receives child or family support.
Under current law, DHFS distributes community aids to counties to provide
social, mental health, developmental disabilities, and alcohol and other drug abuse
services. This bill eliminates the current requirement that each county, before
December 1 of each year, submit to DHFS a proposed budget for the expenditure of
the community aids allocated to that county.
Currently, the Council on Developmental Disabilities, attached to DHFS,
performs numerous duties, including developing, approving, and continuing
modification of the statewide plan for delivery of services to individuals with
developmental disabilities. The council is funded, in part, by a federal grant. This
bill transfers the council to DOA and requires DHFS to ensure that the matching
funds requirement under the federal grant is met.
Currently, DHFS makes loans to nonprofit organizations to establish housing
programs for individuals who are recovering from alcohol or other drug abuse. This
bill eliminates these loans.
Insurance
This bill creates the Healthy Wisconsin Authority (HWA), which is a public
body corporate and politic with a board of directors that is created by state law but
that is not a state agency. The board of directors consists of the commissioner of
insurance, or the commissioner's designee, and 13 other members who serve
four-year terms. HWA is treated like a state agency with respect to the open records
and open meetings laws; the law regulating lobbying; state purchasing
requirements; exemption from income tax, sales and use tax, and property taxes; the
Code of Ethics for Public Officials and Employees; all purposes under the Wisconsin
Retirement System; and auditing by the Legislative Audit Bureau. HWA is unlike
a state agency in that it may approve its own budget; its employees are not state
employees; and it is not subject to statutory rule-making procedures.
The bill directs HWA to study options and develop recommendations for
providing reinsurance to groups and individuals for catastrophic claims under
health insurance policies. HWA must develop and administer any reinsurance
program for which legislation is enacted that authorizes or requires HWA to do so
and may explore other ways to lower health care costs, including considering options
for comprehensive health care reform.
Under current law, a group health insurance policy that covers any inpatient
hospital treatment must cover at least 30 days or, generally, $7,000 of inpatient
hospital treatment of nervous and mental disorders and alcoholism and other drug
abuse problems. If a group health insurance policy covers any outpatient treatment,
it must cover at least, generally, $2,000 of outpatient treatment of nervous and
mental disorders and alcoholism and other drug abuse problems. If a group health
insurance policy covers any inpatient hospital or outpatient treatment, it must cover
at least, generally, $3,000 of transitional treatment (services, specified by the
commissioner of insurance, that are provided in a less restrictive manner than
inpatient services but in a more intensive manner than outpatient services) of
nervous and mental disorders and alcoholism and other drug abuse problems. If a
group health insurance policy covers both inpatient and outpatient hospital services,
the total coverage for all types of treatment for nervous and mental disorders and
alcoholism and other drug abuse problems need not exceed, generally, $7,000 in a
policy year.
This bill increases the minimum amounts of coverage that must be provided for
the treatment of nervous and mental disorders and alcoholism and other drug abuse
problems on the basis of the change in the consumer price index for medical services
since the current coverage amounts were enacted in 1985 and 1992.
Excluding limited-scope benefit plans, medicare replacement or supplement
policies, long-term care policies, and policies covering only certain specified
diseases, this bill requires health insurance policies and self-insured governmental
and school district health plans to cover up to four hours per month of treatment for
autism, Asperger's syndrome, and pervasive developmental disorder not otherwise
specified if the treatment is provided by a psychiatrist, a psychologist, or a social
worker who is certified or licensed to practice psychotherapy. The coverage
requirement applies to both individual and group health insurance policies and may
be subject to any limitations or exclusions or cost-sharing provisions that apply
generally under the policy or plan.
Under current law, an insurer may not restrict or terminate coverage for
chiropractic treatment under a health insurance policy that covers chiropractic
treatment except on the basis of an independent evaluation. If the insurer restricts
or terminates a patient's coverage for chiropractic treatment and the patient then
becomes liable for payment of the treatment, the insurer must provide to the patient
and the treating chiropractor a written statement that includes a reasonable
explanation of the factual basis for the restriction or termination of coverage.
Under this bill, the written statement must provide a detailed, rather than
merely reasonable, explanation of the clinical rationale, rather than the factual
basis, for the restriction or termination of coverage. Also, if an insurer restricts or
terminates an insured's coverage for treatment, not limited to chiropractic
treatment, and as a result the insured becomes liable for all of the cost of the
treatment, the insurer must provide on the explanation of benefits form a detailed
explanation of the clinical rationale and the basis in the policy or applicable law for
the restriction or termination of coverage.
Current law does not regulate the use of current procedural terminology codes
(numbers on a health insurance claim form that indicate the services that a health
care provider performed). This bill requires an insurer who changes the current
procedural terminology code that the health care provider put on the health
insurance claim form to include on the explanation of benefits form the reason for the
change and to cite the source for the change.
Under current law, certain health care providers are required to carry health
care liability insurance with liability limits of at least $1,000,000 for each occurrence
and at least $3,000,000 for all occurrences in a policy year. Any portion of a medical
malpractice claim against a health care provider subject to the health care liability
insurance requirements that exceeds the policy limits of the health care provider's
health care liability insurance is paid from the injured patients and families
compensation fund. Moneys in the fund come from annual assessments paid by the
health care providers who are subject to the health care liability insurance
requirements. This bill transfers $175,000,000 in fiscal year 2007-08 from the
injured patients and families compensation fund to the health care quality fund
created in the bill.
justice
This bill authorizes DOJ to bring an action for injunctive or other equitable
relief against a person who interferes with the exercise or enjoyment by an individual
of a right secured by the constitution or laws of this state or of the United States.
Currently, under the Crime Victim Compensation Program, DOJ must
compensate victims of certain crimes for expenses that result from the victim's injury
or death. DOJ may not compensate a victim who has not cooperated with appropriate
law enforcement agencies. Any compensation that DOJ provides must be reduced
by any insurance payments received as a result of the crime.
This bill creates the Sexual Assault Forensic Examination Program, under
which a health care provider who examines a victim of a sex offense is compensated
by DOJ for the costs of the examination, any procedure that tests for or prevents a
sexually transmitted disease, and any medication to prevent or treat a sexually
transmitted disease (examination costs). If the victim does not authorize the health
care provider to seek payment from insurance or another program, DOJ must
compensate the health care provider for the examination costs, regardless of whether
the victim cooperates with a law enforcement agency. If the victim does authorize
the health care provider to seek payment from insurance or another program, DOJ
must compensate the health care provider for the examination costs, reduced by any
payment from insurance or another program, only if the victim refuses to cooperate
with a law enforcement agency.
Under current law, most people who are ordered by a state or municipal court
to pay a fine or forfeiture must also pay a penalty surcharge equal to 26 percent of
the fine or forfeiture. The penalty surcharges are used by DOJ to fund a variety of
activities, services, and equipment, including training for law enforcement and
correctional officers, enforcement of drug laws, services for crime victims, and
information systems for law enforcement. This bill increases the penalty surcharge
to 27 percent of fines or forfeitures.
Under current law, a firearms dealer must request that DOJ perform a firearms
restrictions record search on a handgun purchaser before the dealer may complete
a sale of a handgun to the purchaser. DOJ charges firearms dealers $8 for each record
search and uses the fees for the administrative costs of conducting records searches.
This bill increases the firearms restrictions record search fee to $30 and provides
that, in addition to using the fees for record search administrative costs, DOJ may
use the fees to fund the same activities, services, and equipment that are funded with
penalty surcharges.
Local government
Until January 1, 2007, the law prohibited a political subdivision (any city,
village, town, or county) from increasing its levy by a percentage that exceeded its
valuation factor, which was the percentage change in the political subdivision's
equalized value due to new construction, less improvements removed, but not less
than 2 percent. In addition, the calculation of a political subdivision's levy did not
include any tax increment generated by a tax incremental district.
The law contained a number of exceptions to the levy limit, such as for the
transfer of the provision of services, for cities or villages that annexed town territory,
and for certain debt service payments.
