AB878: Bill Text

AB878,4,23 2. Counsel individuals, or members of a family, who are under 60 years of age regarding consumer rights and grievance procedures relating to health care benefits.

AB878,4,25 3. Refer individuals, or members of a family, who are under 60 years of age for legal assistance in obtaining and maintaining health care benefits.

AB878,5,3 4. Coordinate health care benefits available to an individual, or members of a family, who are under 60 years of age to maximize health care benefits for the individual or family members.

AB878,5,6 5. Assist individuals, or members of a family, who are under 60 years of age in obtaining coverage of expenses for drugs or medical equipment that has been prescribed for them.

AB878,5,9 6. Monitor and track whether individuals and family members to whom the entity provides services under this paragraph maintain health care benefits between encounters with the entity.

AB878,5,12 7. Refer individuals to information regarding, or programs that promote, preventive health care, chronic disease management, responsible utilization of health care services, and healthy lifestyle.

AB878,5,15 8. Assist individuals, or members of a family, who are under 60 years of age who require transportation, interpreter services, or other services to access health care benefits in obtaining those services.

AB878,5,20 9. Coordinate provision of services under this paragraph with any aging unit that provides benefit specialist services for older individuals under s. 46.81, any resource center under s. 46.283, or any agency under contract with the department to administer the children with special health care needs program under s. 253.02 that operates in the same geographic areas as the entity.

AB878,6,2 10. Bring together persons who work in the fields of public health, health care, elementary or secondary education, and other relevant fields for the purpose of educating them regarding activities under subds. 1. to 9. and for the purposes of sharing strategies for, and coordinating efforts to, assist individuals, and members of a family, who are under 60 years of age in obtaining and maintaining health care benefits.

AB878,6,6 (b) The oversight organization shall obtain approval of a request for proposals under par. (a) from the department and the office of the commissioner of insurance before issuing the request, and shall obtain approval for allocations of funding under par. (a) before finalizing the allocations.

AB878,6,10 (c) The oversight organization may allocate moneys under this subsection only to a governmental unit, an institution of higher education, or an organization described in section 501 (c) of the Internal Revenue Code that is exempt from federal income tax under section 501 (a) of the Internal Revenue Code.

AB878,6,13 (d) As a condition of receiving funding under this subsection, an entity shall ensure that individuals who provide services under par. (a) have knowledge of all of the following:

AB878,6,16 1. Health care benefits, and eligibility criteria and appeal procedures for health care benefits, under the federal Social Security Act for which an individual under 60 years of age may be eligible.

AB878,6,20 2. Health care benefits, eligibility criteria and appeal procedures for health care benefits, including procedures for appeals relating to disability determinations, under the Medical Assistance program subch. IV of ch. 49 and under Medical Assistance waiver programs under 42 USC 1396n.

AB878,6,22 3. Health care benefits, eligibility criteria, and appeal procedures under the Health Insurance Risk-Sharing Plan under subch. II of ch. 149.

AB878,6,24 4. Health care plans and group health plans, including appeal and grievance procedures under health care plans and group health plans.

AB878,6,25 5. Federal law governing health care plans and group health plans.

AB878,7,2 6. Coordination between health care plans or group health plans and public health care benefits programs.

AB878,7,3 7. Provision of services in a family-centered and culturally competent manner.

AB878,7,6 (e) As a condition of receiving moneys under this subsection, an entity shall provide funding, from a source other than an allocation under this subsection, to support at least 25 percent of the cost of providing services under par. (a).

AB878,7,8 (f) An entity or an individual that the entity employs or contracts with to provide services under par. (a) may not do any of the following:

AB878,7,10 1. Be directly involved in licensing or accrediting a hospital, as defined in s. 50.33 (2), or a nursing home, as defined in s. 50.01 (3).

AB878,7,11 2. Be directly involved in granting a certificate of authority to a health insurer.

AB878,7,13 3. Have a direct ownership or investment interest in a health insurer or an administrator of a group health plan.

AB878,7,15 4. Be employed by or manage a health insurer or an administrator of a group health plan.

AB878,7,17 5. Receive remuneration from a health insurer or an administrator of a group health plan.

AB878,7,22 (4) As condition of receiving grant funding under sub. (2), the oversight organization shall in the 12 months beginning on the date that is 3 months after the effective date of this subsection .... [LRB inserts date], provide a total of $150,000, from sources other than the grant under sub. (2), to support the cost of performing the duties under sub. (2).

AB878,7,25 (5) The department shall submit the report and plan received from the oversight organization under sub. (2) (e) to the chief clerk of each house of the legislature for distribution under s. 13.172 (2).

AB878,8,3 (6) The department shall expend for the grant under sub. (2) any moneys received as federal financial participation under the federal Medicaid program for expenditures under s. 20.435 (4) (kr).

AB878, s. 5 Section 5. Nonstatutory provisions.

AB878,8,7 (1) The department of health services shall apply for any federal moneys that are available to states for providing services described under section 46.79 (3) (a) of the statutes, as created by this act.

AB878, s. 6 Section 6. Fiscal changes.

AB878,8,14 (1) In the schedule under section 20.005 (3) of the statutes for the appropriation to the office of the commissioner of insurance under section 20.145 (1) (g) of the statutes, as affected by the acts of 2009, the dollar amount is increased by $250,000 for the second fiscal year of the fiscal biennium in which this subsection takes effect to provide funding for the program under section 46.79 of the statutes, as created by this act.

AB878, s. 7 Section 7. Effective dates. This act takes effect on the day after publication, except as follows:

AB878,8,18 (1) The treatment of sections 20.145 (1) (g) (intro.) and 20.435 (4) (kr) and (kv) of the statutes takes effect on July 1, 2010.

AB878,8,19 (End)