SB562: Bill Text

SB562, s. 39 Section 39. 40.05 (4g) (d) of the statutes is created to read:

SB562,22,3 40.05 (4g) (d) This subsection shall not apply to an eligible employee who is receiving health care coverage under the Healthy Wisconsin Plan under ch. 260 while on active duty in the U.S. armed forces.

SB562, s. 40 Section 40. 40.51 (1) of the statutes is amended to read:

SB562,22,10 40.51 (1) The procedures and provisions pertaining to enrollment, premium transmitted and coverage of eligible employees for health care benefits shall be established by contract or rule except as otherwise specifically provided by this chapter. Notwithstanding subs. (6) and (7), an eligible employee who is covered under the Healthy Wisconsin Plan under ch. 260 may not receive coverage under this subchapter for any coverage provided the employee under ch. 260.

SB562, s. 41 Section 41. 40.51 (2) of the statutes is amended to read:

SB562,23,2 40.51 (2) Except as provided in subs. (10), (10m), (11) and (16), any eligible employee may become covered by group health insurance benefits under this subchapter by electing coverage within 30 days of being hired, to be effective as of the first day of the month which begins on or after the date the application is received by the employer, or by electing coverage prior to becoming eligible for any employer contribution towards the premium cost as provided in s. 40.05 (4) (a) to be effective upon becoming eligible for employer contributions. An eligible employee who is not insured, but who is eligible for an employer contribution under s. 40.05 (4) (ag) 1., may elect coverage prior to becoming eligible for an employer contribution under s. 40.05 (4) (ag) 2., with the coverage to be effective upon becoming eligible for the increase in the employer contribution. Any employee who does not so elect at one of these times, or who subsequently cancels the insurance, shall not thereafter become insured unless the employee furnishes evidence of insurability satisfactory to the insurer, at the employee's own expense or obtains coverage subject to contractual waiting periods. The method to be used shall be specified in the health insurance contract.

SB562, s. 42 Section 42. 40.51 (6) of the statutes is renumbered 40.51 (6) (a) and amended to read:

SB562,23,13 40.51 (6) (a) This state shall offer to all of its eligible employees described in subs. (10), (10m), and (16) at least 2 insured or uninsured health care coverage plans providing substantially equivalent hospital and medical benefits, including a health maintenance organization or a preferred provider plan, if those health care plans are determined by the group insurance board to be available in the area of the place of employment and are approved by the group insurance board. The group insurance board shall place each of the plans into one of 3 tiers established in accordance with standards adopted by the group insurance board. The tiers shall be separated according to the employee's share of premium costs.

SB562, s. 43 Section 43. 40.51 (6) (b) of the statutes is created to read:

SB562,23,17 40.51 (6) (b) The state may offer to its employees coverage for health care benefits not provided to the employees under the Healthy Wisconsin Plan under ch. 260.

SB562, s. 44 Section 44. 40.51 (7) of the statutes is amended to read:

SB562,24,2 40.51 (7) Any employer, other than the state, may offer to all of its employees a health care coverage plan coverage for health care benefits not provided to the employees under the Healthy Wisconsin Plan under ch. 260 through a program offered by the group insurance board. Notwithstanding sub. (2) and ss. 40.05 (4) and 40.52 (1), the department may by rule establish different eligibility standards or contribution requirements for such employees and employers and may by rule limit the categories of employers, other than the state, which may be included as participating employers under this subchapter.

SB562, s. 45 Section 45. 40.51 (8) of the statutes, as affected by 2007 Wisconsin Act 36, is amended to read:

SB562,24,8 40.51 (8) Every health care coverage plan offered by the state under sub. (6) (a) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8) and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to (5) (6), 632.895 (5m) and (8) to (15), and 632.896.

SB562, s. 46 Section 46. 40.51 (8m) of the statutes, as affected by 2007 Wisconsin Act 36, is amended to read:

SB562,24,14 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. subs. (6) (b) and (7) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8) and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, and 632.895 (11) to (15) 632.87 (3) to (6).

SB562, s. 47 Section 47. 40.52 (1) (intro.) of the statutes is amended to read:

SB562,24,19 40.52 (1) (intro.) The group insurance board shall establish by contract a standard health insurance plan in which all insured employees shall participate except as otherwise provided in this chapter. The Except as provided in sub. (1m), the standard plan shall provide:

SB562, s. 48 Section 48. 40.52 (1m) of the statutes is created to read:

SB562,24,23 40.52 (1m) The standard health insurance plan described under sub. (1) shall not provide employees any health care coverage that the employees receive under the Healthy Wisconsin Plan under ch. 260.

SB562, s. 49 Section 49. 40.52 (2) of the statutes is amended to read:

SB562,25,15 40.52 (2) Health insurance benefits under this subchapter shall be integrated, with exceptions determined appropriate by the group insurance board, with benefits under federal plans for hospital and health care for the aged and disabled and with benefits provided under the Healthy Wisconsin Plan under ch. 260. Exclusions and limitations with respect to benefits and different rates may be established for persons eligible under federal plans for hospital and health care for the aged and disabled in recognition of the utilization by persons within the age limits eligible under the federal program and for employees who receive benefits under the Healthy Wisconsin Plan under ch. 260. The plan may include special provisions for spouses and other dependents covered under a plan established under this subchapter where one spouse is eligible under federal plans for hospital and health care for the aged or under the Healthy Wisconsin Plan under ch. 260 but the others are not eligible because of age or other reasons. As part of the integration, the department may, out of premiums collected under s. 40.05 (4), pay premiums for the federal health insurance.

SB562, s. 50 Section 50. 40.98 (2) (a) 1. of the statutes is amended to read:

SB562,26,2 40.98 (2) (a) 1. The department shall design an actuarially sound health care coverage program for employers that includes more than one group health care coverage plan and that provides coverage beginning not later than January 1, 2001. The health care coverage program shall be known as the "Private Employer Health Care Purchasing Alliance". In designing the health care coverage program, the department shall consult with the office of the commissioner of insurance and may consult with the departments of commerce and health and family services. The health care coverage program may not be implemented until it is approved by the board. The health care coverage program shall not provide employees any health care coverage that the employees receive under the Healthy Wisconsin Plan under ch. 260.

SB562, s. 51 Section 51. 49.45 (54) of the statutes is created to read:

SB562,26,6 49.45 (54) Eligibility for Healthy Wisconsin. (a) In this subsection, "program" means any Medical Assistance program administered under this subchapter.

SB562,26,12 (b) Notwithstanding any other statute to the contrary, if a program, or the provision of health care benefits for any eligibility category of persons under a program, is not eligible for, or supported by, federal matching funds, persons who are eligible for health care benefits under the program, or under the eligibility category under the program, are not eligible for those health care benefits but are instead eligible for coverage under the Healthy Wisconsin Plan under ch. 260.

SB562, s. 52 Section 52. 49.473 (2) (c) of the statutes is amended to read:

SB562,26,17 49.473 (2) (c) The woman is not covered under the Healthy Wisconsin Plan under ch. 260 and is not eligible for any other health care coverage that qualifies as creditable coverage in 42 USC 300gg (c), excluding the coverage specified in 42 USC 300gg (c) (1) (F).

SB562, s. 53 Section 53. 49.68 (3) (d) 1. of the statutes is amended to read:

SB562,27,8 49.68 (3) (d) 1. No aid may be granted under this subsection unless if the recipient has no other form of aid available from the federal medicare Medicare program, from private health, accident, sickness, medical, and or hospital insurance coverage, or from other health care coverage specified by rule under s. 49.687 (1m), excluding the Healthy Wisconsin Plan under ch. 260. If insufficient aid is available from other sources and if the recipient has paid an amount equal to the annual medicare Medicare deductible amount specified in subd. 2., the state shall pay the difference in cost to a qualified recipient. If at any time sufficient federal or private insurance aid or other health care coverage becomes available during the treatment period, state aid under this subsection shall be terminated or appropriately reduced. Any patient who is eligible for the federal medicare Medicare program shall register and pay the premium for medicare Medicare medical insurance coverage where permitted, and shall pay an amount equal to the annual medicare Medicare deductible amounts required under 42 USC 1395e and 1395L (b), prior to becoming eligible for state aid under this subsection.

SB562, s. 54 Section 54. 49.683 (3) of the statutes is amended to read:

SB562,27,14 49.683 (3) No payment shall be made under this section for any portion of medical care costs that are payable under any state, federal, or other health care coverage program, including a health care coverage program specified by rule under s. 49.687 (1m), or under any grant, contract, or other contractual arrangement, but excluding the Healthy Wisconsin Plan under ch. 260.

SB562, s. 55 Section 55. 49.685 (6) (b) of the statutes is amended to read:

SB562,27,24 49.685 (6) (b) Reimbursement shall not be made under this section for any blood products or supplies that are not purchased from or provided by a comprehensive hemophilia treatment center, or a source approved by the treatment center. Reimbursement shall not be made under this section for any portion of the costs of blood products or supplies that are payable under any other state, federal, or other health care coverage program under which the person is covered, including a health care coverage program specified by rule under s. 49.687 (1m), or under any grant, contract, or other contractual arrangement, but excluding the Healthy Wisconsin Plan under ch. 260.

SB562, s. 56 Section 56. 49.687 (1m) (d) of the statutes is created to read:

SB562,28,4 49.687 (1m) (d) Notwithstanding the health care programs for which a person must apply that are specified by the department by rule under pars. (a) and (b), a person is not ineligible to receive benefits under s. 49.68, 49.683, or 49.685 by reason of being eligible for or covered under the Healthy Wisconsin Plan under ch. 260.

SB562, s. 57 Section 57. 59.52 (11) (c) of the statutes is amended to read:

SB562,28,18 59.52 (11) (c) Employee insurance. Provide for individual or group hospital, surgical and life insurance for county officers and employees and for payment of premiums for county officers and employees. A county may elect to provide health care benefits not provided under the Healthy Wisconsin Plan under ch. 260 to its officers and employees and a county with at least 100 employees may elect to provide health care benefits not provided under the Healthy Wisconsin Plan under ch. 260 on a self-insured basis to its officers and employees. A county and one or more cities, villages, towns, or other counties that together have at least 100 employees may jointly provide health care benefits not provided under the Healthy Wisconsin Plan under ch. 260 to their officers and employees on a self-insured basis. Counties that elect to provide health care benefits not provided under the Healthy Wisconsin Plan under ch. 260 on a self-insured basis to their officers and employees shall be subject to the requirements set forth under s. 120.13 (2) (c) to (e) and (g).

SB562, s. 58 Section 58. 60.23 (25) of the statutes is amended to read:

SB562,28,22 60.23 (25) Self-insured health plans. Provide health care benefits not provided under the Healthy Wisconsin Plan under ch. 260 to its officers and employees on a self-insured basis, subject to s. 66.0137 (4).

SB562, s. 59 Section 59. 62.61 of the statutes is renumbered 62.61 (1) (intro.) and amended to read:

SB562,29,2 62.61 (1) (intro.) The common council of a 1st class city may, by ordinance or resolution, provide do any of the following:

SB562,29,6 (a) Provide for, including the payment of premiums of, general hospital, surgical and group insurance for both active and retired city officers and city employees and their respective dependents in private companies, or may, by ordinance or resolution, elect.

SB562,29,10 (c) Elect to offer to all of its employees a health care coverage plan through a program offered by the group insurance board under ch. 40. Municipalities which that elect to participate under s. 40.51 (7) are subject to the applicable sections of ch. 40 instead of this section.

SB562,29,18 (2) Contracts for insurance under this section may be entered into for active officers and employees separately from contracts for retired officers and employees. Appropriations may be made for the purpose of financing insurance under this section. Moneys accruing to a fund to finance insurance under this section, by investment or otherwise, may not be diverted for any other purpose than those for which the fund was set up or to defray management expenses of the fund or to partially pay premiums to reduce costs to the city or to persons covered by the insurance, or both.

SB562, s. 60 Section 60. 62.61 (1) (b) of the statutes is created to read:

SB562,29,22 62.61 (1) (b) Subject to s. 260.37, provide for, including the payment of premiums of, group health insurance for active city officers and city employees and their respective dependents.

SB562, s. 61 Section 61. 66.0137 (4) of the statutes, as affected by 2007 Wisconsin Act 36, is amended to read:

SB562,30,8 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits not provided under the Healthy Wisconsin Plan under ch. 260 under its home rule power, or if a town provides health care benefits not provided under the Healthy Wisconsin Plan under ch. 260, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4) and (5), 632.895 (9) to (15), 632.896, and 767.25 (4m) (d) 767.513 (4).

SB562, s. 62 Section 62. 66.0137 (4m) (b) of the statutes is amended to read:

SB562,30,13 66.0137 (4m) (b) A political subdivision and one or more other political subdivisions, that together have at least 100 employees, may jointly provide health care benefits not provided under the Healthy Wisconsin Plan under ch. 260 to their officers and employees on a self insured self-insured basis.

SB562, s. 63 Section 63. 66.0137 (5) of the statutes is amended to read:

SB562,30,24 66.0137 (5) Hospital, accident, and life insurance. The Subject to s. 260.37, the state or a local governmental unit may provide for the payment of premiums for hospital, surgical and other health and accident insurance and life insurance for employees and officers and their spouses and dependent children. A local governmental unit may also provide for the payment of premiums for hospital and surgical care for its retired employees. In addition, a local governmental unit may, by ordinance or resolution, elect to offer to all of its employees a health care coverage plan through a program offered by the group insurance board under ch. 40. A local governmental unit that elects to participate under s. 40.51 (7) is subject to the applicable sections of ch. 40 instead of this subsection.

SB562, s. 64 Section 64. 70.11 (41p) of the statutes is created to read:

SB562,31,3 70.11 (41p) Healthy Wisconsin Authority. All property owned by the Healthy Wisconsin Authority, provided that use of the property is primarily related to the purposes of the authority.

SB562, s. 65 Section 65. 71.26 (1) (be) of the statutes is amended to read:

SB562,31,8 71.26 (1) (be) Certain authorities. Income of the University of Wisconsin Hospitals and Clinics Authority, of the Health Insurance Risk-Sharing Plan Authority, and of the Healthy Wisconsin Authority, of the Fox River Navigational System Authority, and of the Wisconsin Aerospace Authority.

SB562, s. 66 Section 66. 77.54 (9a) (a) of the statutes is amended to read:

SB562,31,13 77.54 (9a) (a) This state or any agency thereof, the University of Wisconsin Hospitals and Clinics Authority, the Wisconsin Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority, the Healthy Wisconsin Authority, and the Fox River Navigational System Authority.

SB562, s. 67 Section 67. 100.45 (1) (dm) of the statutes is amended to read:

SB562,31,23 100.45 (1) (dm) "State agency" means any office, department, agency, institution of higher education, association, society or other body in state government created or authorized to be created by the constitution or any law which is entitled to expend moneys appropriated by law, including the legislature and the courts, the Wisconsin Housing and Economic Development Authority, the Bradley Center Sports and Entertainment Corporation, the University of Wisconsin Hospitals and Clinics Authority, the Wisconsin Health and Educational Facilities Authority, the Wisconsin Aerospace Authority, and the Fox River Navigational System Authority, and the Healthy Wisconsin Authority.

SB562, s. 68 Section 68. 109.075 (9) of the statutes is created to read:

SB562,32,3 109.075 (9) This section does not apply to an employer that ceases providing health care benefits to its employees because the employees are covered under the Healthy Wisconsin Plan under ch. 260.

SB562, s. 69 Section 69. 111.70 (1) (dm) of the statutes is amended to read:

SB562,32,18 111.70 (1) (dm) "Economic issue" means salaries, overtime pay, sick leave, payments in lieu of sick leave usage, vacations, clothing allowances in excess of the actual cost of clothing, length-of-service credit, continuing education credit, shift premium pay, longevity pay, extra duty pay, performance bonuses, health insurance coverage of benefits not provided under the Healthy Wisconsin Plan under ch. 260, life insurance, dental insurance, disability insurance, vision insurance, long-term care insurance, worker's compensation and unemployment insurance, social security benefits, vacation pay, holiday pay, lead worker pay, temporary assignment pay, retirement contributions, supplemental retirement benefits, severance or other separation pay, hazardous duty pay, certification or license payment, limitations on layoffs that create a new or increased financial liability on the employer and contracting or subcontracting of work that would otherwise be performed by municipal employees in the collective bargaining unit with which there is a labor dispute.

SB562, s. 70 Section 70. 111.70 (4) (cm) 8s. of the statutes is amended to read:

SB562,34,2 111.70 (4) (cm) 8s. `Forms for determining costs.' The commission shall prescribe forms for calculating the total increased cost to the municipal employer of compensation and fringe benefits provided to school district professional employees. The cost shall be determined based upon the total cost of compensation and fringe benefits provided to school district professional employees who are represented by a labor organization on the 90th day before expiration of any previous collective bargaining agreement between the parties, or who were so represented if the effective date is retroactive, or the 90th day prior to commencement of negotiations if there is no previous collective bargaining agreement between the parties, without regard to any change in the number, rank or qualifications of the school district professional employees. For purposes of such determinations, any cost increase that is incurred on any day other than the beginning of the 12-month period commencing with the effective date of the agreement or any succeeding 12-month period commencing on the anniversary of that effective date shall be calculated as if the cost increase were incurred as of the beginning of the 12-month period beginning on the effective date or anniversary of the effective date in which the cost increase is incurred. For the purpose of determining if a municipal employer has maintained current fringe benefits under sub. (1) (nc) 1. a., the commission shall consider the municipal employer to have maintained its health care coverage benefit if the municipal employer provides health care coverage to its school district professional employees through the Healthy Wisconsin Plan under ch. 260 and supplements that coverage, if necessary, to produce a health care coverage benefit that is actuarially equivalent to the health care coverage benefit in place before the school district professional employees become covered under the Healthy Wisconsin Plan under ch. 260. If a dispute arises concerning the municipal employer's determination of actuarial equivalence or what supplemental benefits are sufficient to achieve actuarial equivalence, the dispute shall be resolved by a neutral person who is designated by the commission. In each collective bargaining unit to which subd. 5s. applies, the municipal employer shall transmit to the commission and the labor organization a completed form for calculating the total increased cost to the municipal employer of compensation and fringe benefits provided to the school district professional employees covered by the agreement as soon as possible after the effective date of the agreement.

SB562, s. 71 Section 71. 111.91 (2) (pt) of the statutes is created to read:

SB562,34,5 111.91 (2) (pt) Health care coverage of employees under the Healthy Wisconsin Plan under ch. 260.

SB562, s. 72 Section 72. 120.13 (2) (b) of the statutes is amended to read:

SB562,34,12 120.13 (2) (b) Provide health care benefits not provided under the Healthy Wisconsin Plan under ch. 260 on a self-insured basis to the employees of the school district if the school district has at least 100 employees. In addition, any 2 or more school districts which together have at least 100 employees may jointly provide health care benefits not provided under the Healthy Wisconsin Plan under ch. 260 on a self-insured basis to employees of the school districts.

SB562, s. 73 Section 73. 120.13 (2) (g) of the statutes, as affected by 2007 Wisconsin Act 36, is amended to read:

SB562,34,18 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4) and (5), 632.895 (9) to (15), 632.896, and 767.25 (4m) (d) 767.513 (4).

SB562, s. 74 Section 74. 149.12 (2) (em) of the statutes is created to read:

SB562,34,22 149.12 (2) (em) No person who is eligible for coverage under the Healthy Wisconsin Plan under ch. 260 is eligible for coverage under the plan under this chapter.

SB562, s. 75 Section 75. 230.03 (3) of the statutes, as affected by 2007 Wisconsin Act 20, is amended to read:

SB562,35,10 230.03 (3) "Agency" means any board, commission, committee, council, or department in state government or a unit thereof created by the constitution or statutes if such board, commission, committee, council, department, unit, or the head thereof, is authorized to appoint subordinate staff by the constitution or statute, except a legislative or judicial board, commission, committee, council, department, or unit thereof or an authority created under subch. II of ch. 114 or subch. III of ch. 149 or under ch. 231, 232, 233, 234, 235, 237, 260, or 279. "Agency" does not mean any local unit of government or body within one or more local units of government that is created by law or by action of one or more local units of government.

SB562, s. 76 Section 76. Chapter 260 of the statutes is created to read:

SB562,35,12 Chapter 260

SB562,35,13 Healthy Wisconsin Plan

SB562,35,14 260.01 Definitions. In this chapter, except as otherwise provided:

SB562,35,15 (1) "Authority" means the Healthy Wisconsin Authority.

SB562,35,16 (2) "Board" means the board of trustees of the authority.

SB562,35,21 (3) "Health care network" means a provider-driven, coordinated group of health care providers comprised of primary care physicians, medical specialists, physician assistants, nurses, clinics, one or more hospitals, and other health care providers and facilities, including providers and facilities that specialize in mental health services and alcohol or other drug abuse treatment.

SB562,35,25 (4) "Medical inflation" means changes in the consumer price index for all consumers, U.S. city average, for the medical care group, including medical care commodities and medical care services, as determined by the U.S. department of labor.

SB562,36,1 (5) "Plan" means the Healthy Wisconsin Plan.

SB562,36,10 (6) "Primary care provider" means a health care provider who is identified as the key professional responsible for coordinating all medical care for a given participant, including referral to a specialist. "Primary care provider" includes general practice physicians, family practitioners, internists, pediatricians, obstetricians and gynecologists, advanced practice nurses, certified nurse midwives, and physician assistants. "Primary care provider" may also include a specialist who is treating a person with a chronic medical condition or special health care needs for which regular treatment by a specialist is medically necessary or a specialist who is treating a disabled person.

SB562,36,20 260.05 Creation and organization of authority. (1) Creation and membership of board. There is created a public body corporate and politic to be known as the "Healthy Wisconsin Authority." The nonvoting members of the board shall consist of the secretary of employee trust funds and 4 representatives from the advisory committee under s. 260.49 who are health care personnel and administrators, selected by the advisory committee. The secretary of employee trust funds shall serve as the initial chairperson of the board until such time as the board elects a chairperson from its voting membership. The board shall also consist of the following voting members, nominated by the governor and with the advice and consent of the senate appointed, for staggered 6-year terms: