SB562,59,2
24260.37 Employer-provided health care benefits. Nothing in this chapter
25prevents an employer, or a Taft-Hartley trust on behalf of an employer, from paying
1all or part of any cost sharing under s. 260.20 or 260.30, or from providing any health
2care benefits not provided under the plan, for any of the employer's employees.
SB562,59,4
3260.40 Assessments, individuals and businesses. (1) Definitions. In this
4section:
SB562,59,55
(a) "Department" means the department of revenue.
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(b) "Dependent" means a spouse, an unmarried child under the age of 19 years,
7an unmarried child who is a full-time student under the age of 21 years and who is
8financially dependent upon the parent, or an unmarried child of any age who is
9medically certified as disabled and who is dependent upon the parent.
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(c) "Eligible individual" means an individual who is eligible to participate in
11the plan, other than an employee or a self-employed individual.
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(d) "Employee" means an individual who has an employer.
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(e) "Employer" means a person who is required under the Internal Revenue
14Code to file form 941.
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(em) "Household" means an individual who is either an eligible individual, an
16employee, or a self-employed individual, and the individual's immediate family, as
17that term is defined by the board under s. 260.10 (7) (c).
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(f) "Medical inflation" means the percentage change between the U.S.
19consumer price index for all urban consumers, U.S. city average, for the medical care
20group only, including medical care commodities and medical care services, for the
21month of August of the previous year and the U.S. consumer price index for all urban
22consumers, U.S. city average, for the medical care group only, including medical care
23commodities and medical care services, for the month of August 2008, as determined
24by the U.S. department of labor.
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1(g) "Poverty line" means the federal poverty line, as defined under
42 USC 9902 2(2), for a family the size of the individual's family.
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(h) "Self-employed individual" means an individual who is required under the
4Internal Revenue Code to file schedule SE.
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(i) "Small employer" means an employer who has no more than 10 employees.
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(j) "Social security wages" means:
SB562,60,971. For purposes of sub. (2) (a), the amount of wages, as defined in section
3121 8(a) of the Internal Revenue Code, paid to an employee by an employer in a taxable
9year, up to a maximum amount that is equal to the social security wage base.
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2. For purposes of sub. (2) (b), the amount of net earnings from
11self-employment, as defined in section
1402 (a) of the Internal Revenue Code,
12received by an individual in a taxable year, up to a maximum amount that is equal
13to the social security wage base.
SB562,60,18143. For purposes of sub. (3), the amount of wages, as defined in section
3121 (a)
15of the Internal Revenue Code, paid by an employer in a taxable year with respect to
16employment, as defined in section
3121 (b) of the Internal Revenue Code, up to a
17maximum amount that is equal to the social security wage base multiplied by the
18number of the employer's employees.
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19(2) Individuals. Subject to sub. (4), the board shall calculate the following
20assessments, based on its anticipated revenue needs:
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(a) For an employee who is under the age of 65, a percent of social security
22wages that is at least 2 percent and not more than 4 percent, subject to the following:
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1. If the employee has social security wages that are 150 percent or less of the
24poverty line, the employee may not be assessed.
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12. If the employee has no dependents and his or her social security wages are
2more than 150 percent and 200 percent or less of the poverty line the assessment
3shall be in an amount, as determined by the board on a sliding scale based on the
4employee's social security wages, that is between zero percent and 4 percent of the
5employee's social security wages.
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3. If the employee has one or more dependents, or is a single individual who is
7pregnant, and the employee's social security wages are more than 150 percent and
8300 percent or less of the poverty line the assessment shall be in an amount, as
9determined by the board on a sliding scale based on the employee's social security
10wages, that is between zero percent and 4 percent of the employee's social security
11wages.
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(b) For a self-employed individual who is under the age of 65, a percent of social
13security wages that is at least 9 percent and not more than 10 percent.
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(c) For an eligible individual who has no social security wages under sub. (1)
15(j) 1. or 2. or, from an employer, under sub. (1) (j) 3., 10 percent of federal adjusted
16gross income, up to the maximum amount of income that is subject to social security
17tax.
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18(3) Employers. (a) Subject to pars. (b), (c), and (d) and sub. (4), the board shall
19calculate an assessment, based on its anticipated revenue needs, that is a percent of
20aggregate social security wages that is at least 9 percent and not more than 12
21percent.
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(b) Except as provided in par. (d), for taxable year beginning after December
2331, 2009, and before January 1, 2011, the assessment imposed on a small employer
24shall be 33 percent of the amount calculated for that employer under par. (a).
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1(c) Except as provided in par. (d), for taxable year beginning after December 31,
22010, and before January 1, 2012, the assessment imposed on a small employer shall
3be 67 percent of the amount calculated for that employer under par. (a).
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(d) If a small employer begins doing business in this state, as defined in s. 71.22
5(1r), during the period beginning on January 1, 2010, and ending on December 31,
62012, for the small employer's first taxable year the assessment imposed on the small
7employer shall be 33 percent of the amount calculated for that employer under par.
8(a) and for the small employer's 2nd taxable year the assessment imposed on the
9small employer shall be 67 percent of the amount calculated for that employer under
10par. (a).
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11(4) Collection and calculation of assessments. (a) For taxable years
12beginning after December 31, 2009, the department shall impose on, and collect
13from, individuals the assessment amounts that the board calculates under sub. (2),
14either through an assessment that is collected as part of the income tax under subch.
15I of ch. 71, or through another method devised by the department. For taxable years
16beginning after December 31, 2009, the department shall impose on, and collect
17from, employers the assessment amounts that the board calculates under sub. (3),
18either through an assessment that is collected as part of the tax under subch. IV of
19ch. 71, or through another method devised by the department. Section 71.80 (1) (c),
20as it applies to ch. 71, applies to the department's imposition and collection of
21assessments under this section.
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(b) The amounts that the department collects under par. (a) shall be deposited
23into the Healthy Wisconsin trust fund under s. 25.775.
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(c) The board may annually increase or decrease the amounts that may be
25assessed under subs. (2) and (3). No annual increase under this paragraph may
1exceed the percentage increase for medical inflation unless a greater increase is
2provided for by law.
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(d) The maximum amount of assessment that the department may impose on,
4and collect from, a household under par. (a) is 4 percent of the annual limit on the
5contribution and benefit base of the Old-Age, Survivors, and Disability Insurance
6program, as calculated annually by the U.S. social security administration.
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7260.49 Advisory committee. (1) Duties. The board shall establish a health
8care advisory committee to advise the board on all of the following:
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(a) Matters related to promoting healthier lifestyles.
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(b) Promoting health care quality.
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(c) Increasing the transparency of health care cost and quality information.
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(d) Preventive care.
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(e) Early identification of health disorders.
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(f) Disease management.
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(g) The appropriate use of primary care, medical specialists, prescription
16drugs, and hospital emergency rooms.
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(h) Confidentiality of medical information.
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(i) The appropriate use of technology.
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(j) Benefit design.
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(k) The availability of physicians, hospitals, and other providers.
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(L) Reducing health care costs.
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(m) Any other subject assigned to it by the board.
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(n) Any other subject determined appropriate by the committee.
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24(2) Membership. The board shall appoint as members of the committee all of
25the following individuals:
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1(a) At least one member designated by the Wisconsin Medical Society, Inc.
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(b) At least one member designated by the Wisconsin Academy of Family
3Physicians.
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(c) At least one member designated by the Wisconsin Hospital Association, Inc.
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(d) One member designated by the president of the Board of Regents of the
6University of Wisconsin System who is knowledgeable in the field of medicine and
7public health.
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(e) One member designated by the president of the Medical College of
9Wisconsin.
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(f) Two members designated by the Wisconsin Nurses Association, the
11Wisconsin Federation of Nurses and Health Professionals, and the Service
12Employees International Union.
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(g) One member designated by the Wisconsin Dental Association.
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(h) One member designated by statewide organizations interested in mental
15health issues.
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(i) One member representing health care administrators.
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(j) Other members representing health care professionals.
SB562, s. 77
18Section
77. 285.59 (1) (b) of the statutes is amended to read:
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285.59
(1) (b) "State agency" means any office, department, agency, institution
20of higher education, association, society
, or other body in state government created
21or authorized to be created by the constitution or any law
which that is entitled to
22expend moneys appropriated by law, including the legislature and the courts, the
23Wisconsin Housing and Economic Development Authority, the Bradley Center
24Sports and Entertainment Corporation, the University of Wisconsin Hospitals and
25Clinics Authority, the Fox River Navigational System Authority, the Wisconsin
1Aerospace Authority,
and the Wisconsin Health and Educational Facilities
2Authority
, and the Healthy Wisconsin Authority.
SB562, s. 78
3Section
78. 609.01 (7) of the statutes is repealed.
SB562, s. 79
4Section
79. 609.10 of the statutes is repealed.
SB562, s. 80
5Section
80. 609.20 (1m) (c) of the statutes is repealed.
SB562, s. 81
6Section
81. 609.20 (1m) (d) of the statutes is repealed.
SB562, s. 82
7Section
82. 628.36 (4) (a) (intro.) of the statutes is amended to read:
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628.36
(4) (a) (intro.) The commissioner shall provide information and
9assistance to
the department of employee trust funds, employers and their
10employees, providers of health care services
, and members of the public, as provided
11in par. (b), for the following purposes:
SB562, s. 83
12Section
83. 628.36 (4) (b) 1. of the statutes is repealed.
SB562, s. 84
13Section
84. 628.36 (4) (b) 2. of the statutes is repealed.
SB562, s. 85
14Section
85. 628.36 (4) (b) 3. of the statutes is repealed.
SB562, s. 86
15Section
86. 632.87 (5) of the statutes is amended to read:
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632.87
(5) No insurer
or self-insured school district, city or village may, under
17a policy, plan
, or contract covering gynecological services or procedures, exclude or
18refuse to provide coverage for Papanicolaou tests, pelvic examinations
, or associated
19laboratory fees when the test or examination is performed by a licensed nurse
20practitioner, as defined in s. 632.895 (8) (a) 3., within the scope of the nurse
21practitioner's professional license, if the policy, plan
, or contract includes coverage
22for Papanicolaou tests, pelvic examinations
, or associated laboratory fees when the
23test or examination is performed by a physician.
SB562, s. 87
24Section
87. 632.895 (8) (f) 4. of the statutes is created to read:
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1632.895
(8) (f) 4. A disability insurance policy providing only health care
2benefits not provided under the Healthy Wisconsin Plan under ch. 260.
SB562, s. 88
3Section
88. 632.895 (9) (d) 4. of the statutes is created to read:
SB562,66,54
632.895
(9) (d) 4. A disability insurance policy providing only health care
5benefits not provided under the Healthy Wisconsin Plan under ch. 260.
SB562, s. 89
6Section
89. 632.895 (10) (a) of the statutes is amended to read:
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632.895
(10) (a) Except as provided in par. (b), every disability insurance policy
8and every health care benefits plan provided on a self-insured basis by a county
9board under s. 59.52 (11), by a city or village under s. 66.0137 (4), by a political
10subdivision under s. 66.0137 (4m), by a town under s. 60.23 (25), or by a school district
11under s. 120.13 (2) shall provide coverage for blood lead tests for children under 6
12years of age, which shall be conducted in accordance with any recommended lead
13screening methods and intervals contained in any rules promulgated by the
14department of health and family services under s. 254.158.
SB562, s. 90
15Section
90. 632.895 (10) (b) 6. of the statutes is created to read:
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632.895
(10) (b) 6. A disability insurance policy providing only health care
17benefits not provided under the Healthy Wisconsin Plan under ch. 260.
SB562, s. 91
18Section
91. 632.895 (11) (a) (intro.) of the statutes is amended to read:
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632.895
(11) (a) (intro.) Except as provided in par. (e), every disability
20insurance policy
, and every self-insured health plan of the state or a county, city,
21village, town or school district, that provides coverage of any diagnostic or surgical
22procedure involving a bone, joint, muscle
, or tissue shall provide coverage for
23diagnostic procedures and medically necessary surgical or nonsurgical treatment for
24the correction of temporomandibular disorders if all of the following apply:
SB562, s. 92
25Section
92. 632.895 (11) (c) 1. of the statutes is amended to read:
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1632.895
(11) (c) 1. The coverage required under this subsection may be subject
2to any limitations, exclusions
, or cost-sharing provisions that apply generally under
3the disability insurance policy
or self-insured health plan.
SB562, s. 93
4Section
93. 632.895 (11) (d) of the statutes is amended to read:
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632.895
(11) (d) Notwithstanding par. (c) 1., an insurer
or a self-insured health
6plan of the state or a county, city, village, town or school district may require that an
7insured obtain prior authorization for any medically necessary surgical or
8nonsurgical treatment for the correction of temporomandibular disorders.
SB562, s. 94
9Section
94. 632.895 (11) (e) 3. of the statutes is created to read:
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632.895
(11) (e) 3. A disability insurance policy providing only health care
11benefits not provided under the Healthy Wisconsin Plan under ch. 260.
SB562, s. 95
12Section
95. 632.895 (12) (b) (intro.) of the statutes is amended to read:
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632.895
(12) (b) (intro.) Except as provided in par. (d), every disability
14insurance policy
, and every self-insured health plan of the state or a county, city,
15village, town or school district, shall cover hospital or ambulatory surgery center
16charges incurred, and anesthetics provided, in conjunction with dental care that is
17provided to a covered individual in a hospital or ambulatory surgery center, if any
18of the following applies:
SB562, s. 96
19Section
96. 632.895 (12) (c) of the statutes is amended to read: