LRB-4529/1
RLR:jld:rs
2009 - 2010 LEGISLATURE
March 19, 2010 - Introduced by Representatives Seidel, Dexter, Hraychuck,
Pasch, Turner and
Vruwink, cosponsored by Senators Miller, Coggs,
Erpenbach, Vinehout and Risser. Referred to Committee on Health and
Healthcare Reform.
AB878,1,4
1An Act to amend 20.145 (1) (g) (intro.) and 20.435 (4) (kv); and
to create 20.435
2(4) (kr) and 46.79 of the statutes;
relating to: a grant for providing assistance
3to individuals to obtain and maintain health care benefits and making an
4appropriation.
Analysis by the Legislative Reference Bureau
This bill requires the Department of Health Services (DHS) to award funding
to an organization to oversee a program to assist people in obtaining and maintaining
health care services and coverage of health care expenses (health care benefits). The
organization in turn must allocate funding to other entities to directly provide people
assistance in obtaining and maintaining health care benefits. In addition, the
oversight organization must provide training and technical assistance to the entities
and provide legal services to aid low-income people in obtaining and maintaining
health care benefits.
The services for which funding is authorized under the bill include assisting
people in applying for health insurance or government health care programs;
appealing denials of eligibility or denials of coverage for health care services;
coordinating health care benefits for people who have more than one source of health
care coverage; referring people to information and programs regarding preventive
health care, chronic disease management, responsible utilization of health care
services, and healthy lifestyle; coordinating efforts of community members who are
involved in assisting people in obtaining and maintaining health care benefits; and
educating people about the services provided under the grant program. The bill
provides that the oversight organization may award funding for these services to
nonprofit entities, governmental units, or institutions of higher education. The bill
establishes minimum knowledge requirements for people employed by the entities
to provide the services. The bill also prohibits an entity that receives funding, or its
employees, from having a financial interest in a health insurance company or health
insurance plan or from being directly involved in accrediting a hospital or nursing
home.
The bill requires the oversight organization to provide matching funds for the
grant in the first year that DHS awards the grant and requires each entity that
receives funding from the oversight organization to provide matching funds on an
ongoing basis. Finally, the bill requires DHS to apply for any federal funds available
for assisting people in obtaining and maintaining health care benefits.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB878,2,93
20.145
(1) (g)
General program operations. (intro.) The amounts in the
4schedule for general program operations, including organizational support services
5and oversight of care management organizations,
and for transferring to the
6appropriation account under s. 20.435 (4) (kv) the amount allocated by the
7commissioner of insurance
, and for transferring $250,000 each fiscal year to the
8appropriation account under s. 20.435 (4) (kr). All of the following shall be credited
9to this appropriation account:
AB878, s. 2
10Section
2. 20.435 (4) (kr) of the statutes is created to read:
AB878,2,1311
20.435
(4) (kr)
Health benefits counseling grant. All moneys transferred from
12the appropriation account under s. 20.145 (1) (g) to the appropriation account under
13this paragraph for the program under s. 46.79.
AB878,3,73
20.435
(4) (kv)
Care management organization; oversight. All moneys
4transferred from the appropriation account under s. 20.145 (1) (g)
to the
5appropriation account under this paragraph, for expenses related to financial
6certification, monitoring, and assessment of care management organizations that
7are subject to ch. 648.
AB878, s. 4
8Section
4. 46.79 of the statutes is created to read:
AB878,3,9
946.79 Health care benefits counseling.
(1) In this section:
AB878,3,1010
(a) "Administrator" has the meaning given in s. 633.01 (1).
AB878,3,1111
(b) "Group health plan" has the meaning given in s. 632.745 (10).
AB878,3,1312
(c) "Health care benefits" means health care services, coverage of expenses for
13health care services, or both.
AB878,3,1414
(d) "Health care plan" has the meaning given in s. 628.36 (2) (a) 1.
AB878,3,1715
(e) "Health insurer" means an insurer, as defined in s. 600.03 (27), that is
16authorized to do business in this state in one or more lines of insurance that includes
17health insurance and that offers a health care plan.
AB878,3,1818
(f) "Oversight organization" means the recipient of the grant under sub. (2).
AB878,3,2219
(g) "Public health care benefits program" means a program to provide health
20care benefits that is administered by a governmental entity or the Health Insurance
21Risk-Sharing Plan Authority, other than health care benefits that the governmental
22entity or the authority provides to its employees as a benefit of employment.
AB878,3,24
23(2) Subject to sub. (4), the department shall award a grant to an organization
24to do all of the following:
AB878,4,2
1(a) Allocate funding to entities to provide services under sub. (3) (a) and oversee
2provision of those services by the entities.
AB878,4,33
(b) Provide training for individuals who provide services under sub. (3) (a).
AB878,4,44
(c) Provide technical assistance to entities that receive funding under sub. (3).
AB878,4,75
(d) Provide legal services to low-income individuals, and members of a family,
6who are under 60 years of age to assist them in obtaining and maintaining health
7care benefits.
AB878,4,128
(e) By the date that is 16 months after the effective date of this paragraph ....
9[LRB inserts date], report to the department and the office of the commissioner of
10insurance regarding services provided by entities under sub. (3) (a) during the first
1112 months that the entities received funding under sub. (3) and submit a plan to the
12department and office for providing services under sub. (3) (a) in additional counties.
AB878,4,14
13(3) (a) Subject to pars. (b) to (f), the oversight organization shall allocate
14moneys to entities to do any of the following:
AB878,4,2115
1. Assist individuals, or members of a family, who are under 60 years of age in
16obtaining and maintaining health care benefits, including providing information
17regarding eligibility for health care benefits; providing advice and assistance in
18applying for health care benefits; providing information regarding health care
19services and expenses covered under a health care plan, group health plan, or public
20health care benefits program; and advocating on behalf of individuals and families
21to obtain those services and coverage of those expenses.
AB878,4,2322
2. Counsel individuals, or members of a family, who are under 60 years of age
23regarding consumer rights and grievance procedures relating to health care benefits.
AB878,4,2524
3. Refer individuals, or members of a family, who are under 60 years of age for
25legal assistance in obtaining and maintaining health care benefits.
AB878,5,3
14. Coordinate health care benefits available to an individual, or members of a
2family, who are under 60 years of age to maximize health care benefits for the
3individual or family members.
AB878,5,64
5. Assist individuals, or members of a family, who are under 60 years of age in
5obtaining coverage of expenses for drugs or medical equipment that has been
6prescribed for them.
AB878,5,97
6. Monitor and track whether individuals and family members to whom the
8entity provides services under this paragraph maintain health care benefits between
9encounters with the entity.
AB878,5,1210
7. Refer individuals to information regarding, or programs that promote,
11preventive health care, chronic disease management, responsible utilization of
12health care services, and healthy lifestyle.
AB878,5,1513
8. Assist individuals, or members of a family, who are under 60 years of age who
14require transportation, interpreter services, or other services to access health care
15benefits in obtaining those services.
AB878,5,2016
9. Coordinate provision of services under this paragraph with any aging unit
17that provides benefit specialist services for older individuals under s. 46.81, any
18resource center under s. 46.283, or any agency under contract with the department
19to administer the children with special health care needs program under s. 253.02
20that operates in the same geographic areas as the entity.
AB878,6,221
10. Bring together persons who work in the fields of public health, health care,
22elementary or secondary education, and other relevant fields for the purpose of
23educating them regarding activities under subds. 1. to 9. and for the purposes of
24sharing strategies for, and coordinating efforts to, assist individuals, and members
1of a family, who are under 60 years of age in obtaining and maintaining health care
2benefits.
AB878,6,63
(b) The oversight organization shall obtain approval of a request for proposals
4under par. (a) from the department and the office of the commissioner of insurance
5before issuing the request, and shall obtain approval for allocations of funding under
6par. (a) before finalizing the allocations.
AB878,6,107
(c) The oversight organization may allocate moneys under this subsection only
8to a governmental unit, an institution of higher education, or an organization
9described in section
501 (c) of the Internal Revenue Code that is exempt from federal
10income tax under section
501 (a) of the Internal Revenue Code.
AB878,6,1311
(d) As a condition of receiving funding under this subsection, an entity shall
12ensure that individuals who provide services under par. (a) have knowledge of all of
13the following:
AB878,6,1614
1. Health care benefits, and eligibility criteria and appeal procedures for health
15care benefits, under the federal Social Security Act for which an individual under 60
16years of age may be eligible.
AB878,6,2017
2. Health care benefits, eligibility criteria and appeal procedures for health
18care benefits, including procedures for appeals relating to disability determinations,
19under the Medical Assistance program subch. IV of ch. 49 and under Medical
20Assistance waiver programs under
42 USC 1396n.
AB878,6,2221
3. Health care benefits, eligibility criteria, and appeal procedures under the
22Health Insurance Risk-Sharing Plan under subch. II of ch. 149.
AB878,6,2423
4. Health care plans and group health plans, including appeal and grievance
24procedures under health care plans and group health plans.
AB878,6,2525
5. Federal law governing health care plans and group health plans.
AB878,7,2
16. Coordination between health care plans or group health plans and public
2health care benefits programs.
AB878,7,33
7. Provision of services in a family-centered and culturally competent manner.
AB878,7,64
(e) As a condition of receiving moneys under this subsection, an entity shall
5provide funding, from a source other than an allocation under this subsection, to
6support at least 25 percent of the cost of providing services under par. (a).
AB878,7,87
(f) An entity or an individual that the entity employs or contracts with to
8provide services under par. (a) may not do any of the following:
AB878,7,109
1. Be directly involved in licensing or accrediting a hospital, as defined in s.
1050.33 (2), or a nursing home, as defined in s. 50.01 (3).
AB878,7,1111
2. Be directly involved in granting a certificate of authority to a health insurer.
AB878,7,1312
3. Have a direct ownership or investment interest in a health insurer or an
13administrator of a group health plan.
AB878,7,1514
4. Be employed by or manage a health insurer or an administrator of a group
15health plan.
AB878,7,1716
5. Receive remuneration from a health insurer or an administrator of a group
17health plan.
AB878,7,22
18(4) As condition of receiving grant funding under sub. (2), the oversight
19organization shall in the 12 months beginning on the date that is 3 months after the
20effective date of this subsection .... [LRB inserts date], provide a total of $150,000,
21from sources other than the grant under sub. (2), to support the cost of performing
22the duties under sub. (2).
AB878,7,25
23(5) The department shall submit the report and plan received from the
24oversight organization under sub. (2) (e) to the chief clerk of each house of the
25legislature for distribution under s. 13.172 (2).
AB878,8,3
1(6) The department shall expend for the grant under sub. (2) any moneys
2received as federal financial participation under the federal Medicaid program for
3expenditures under s. 20.435 (4) (kr).
AB878,8,75
(1)
The department of health services shall apply for any federal moneys that
6are available to states for providing services described under section 46.79 (3) (a) of
7the statutes, as created by this act.
AB878,8,149
(1)
In the schedule under section 20.005 (3) of the statutes for the appropriation
10to the office of the commissioner of insurance under section 20.145 (1) (g) of the
11statutes, as affected by the acts of 2009, the dollar amount is increased by $250,000
12for the second fiscal year of the fiscal biennium in which this subsection takes effect
13to provide funding for the program under section 46.79 of the statutes, as created by
14this act.
AB878, s. 7
15Section
7.
Effective dates. This act takes effect on the day after publication,
16except as follows: