Wisconsin Legislature: 20,9118

(a) Before the group insurance board offers state employees the option of receiving health care coverage through a program that consists of a high-deductible health plan and the establishment of a health savings account under section 40.515 of the statutes, as created by this act, the group insurance board and the director of the office of state employment relations shall design a proposed program that specifies key actuarial parameters of the program, including proposed required deductible amounts, out-of-pocket maximum limits, premium rates, employer contributions to health savings accounts, and any other relevant factors.

(b) The group insurance board shall submit the proposed program for an actuarial analysis under section 40.03 (5) (a) of the statutes to determine the fiscal effect of the proposed program on state employee health care costs. If the actuary determines that short-term or long-term state employee health care costs will increase under the proposed program, the actuary shall make recommendations to make the program more cost-effective.

(c) The group insurance board and the director of the office of state employment relations shall consider the actuary's recommendations, if any, in designing a program that consists of a high-deductible health plan and the establishment of a health savings account under section 40.515 of the statutes, as created by this act.

(4m) Study of health savings accounts and health reimbursement accounts. The secretary of employee trust funds and the director of the office of state employment relations shall study the feasibility and cost-effectiveness of providing health reimbursement accounts instead of health savings accounts to state employees under section 40.515 of the statutes, as created by this act. No later than January 31, 2014, the secretary of employee trust funds and the director of the office of state employment relations shall report their findings and recommendations to the governor and the joint committee on finance.

20,9114 Section 9114. Nonstatutory provisions; Financial Institutions.

(1) Notice in dissolution and revocation proceedings. In addition to posting the notices described in sections 180.1421 (2m) (b), 180.1531 (2m) (b), 181.1421 (2) (b), 181.1531 (2g) (b), 183.09025 (2) (d), and 183.1021 (2g) (b) of the statutes, as affected by this act, the department of financial institutions shall, for 6 months after the effective date of this subsection, publish a monthly class 1 notice under chapter 985 of the statutes in the official state newspaper informing the public that notices described in sections 180.1421 (2m) (b), 180.1531 (2m) (b), 181.1421 (2) (b), 181.1531 (2g) (b), 183.09025 (2) (d), and 183.1021 (2g) (b) of the statutes, as affected by this act, are posted on the department's Internet site.

20,9115 Section 9115. Nonstatutory provisions; Government Accountability Board.

(1d) Government accountability board audit. The joint legislative audit committee is requested to direct the legislative audit bureau to perform a performance evaluation audit of the government accountability board, which shall include an evaluation of the board's election day processes and practices; a review of complaints that the board receives concerning voting irregularities and an assessment of the board's procedures for investigating and resolving the complaints; a complete review of the statewide voter registration system, including system processes and the accuracy of the data included in the system; and a review of the instruction and training the board provides to local election officials. If the committee directs the legislative audit bureau to perform an audit, the bureau shall file its report as described under section 13.94 (1) (b) of the statutes.

20,9118 Section 9118. Nonstatutory provisions; Health Services.

(1e) Supplemental appropriations for Sheboygan tuberculosis response funding.

(a) Of the moneys appropriated to the joint committee on finance under section 20.865 (4) (a) of the statutes for the 2013-15 fiscal biennium, $2,508,900 in fiscal year 2013-14 and $2,159,000 in fiscal year 2014-15 are allocated for supplementations under paragraphs (b) and (c).

(b) At any time during fiscal year 2013-14, the department of health services may submit one or more requests to the joint committee on finance to supplement the appropriations under section 20.435 (1) (a) and (e) and (4) (b) of the statutes for fiscal year 2013-14 from the appropriation under section 20.865 (4) (a) of the statutes for the purpose of funding state and local costs to respond to a tuberculosis incident in Sheboygan County. The department of health services shall include in any request submitted under this paragraph a proposal for allocating the requested funds among the appropriations under section 20.435 (1) (a) and (e) and (4) (b) of the statutes. The department of health services may not submit requests under this paragraph for supplementations totaling more than $2,508,900 in general purpose revenue for fiscal year 2013-14. If the cochairpersons of the committee do not notify the department of health services within 14 working days after the date a request is submitted that the committee has scheduled a meeting for the purpose of reviewing the request, notwithstanding section 13.101 (1) and (3) of the statutes, the supplementation shall be made as proposed in the request. If, within 14 working days after the date the request is submitted, the cochairpersons of the committee notify the department of health services that the committee has scheduled a meeting for the purpose of reviewing the request, the supplementation may be made only upon approval of the committee, in an amount specified by the committee. Notwithstanding section 13.101 (3) of the statutes, the joint committee on finance is not required to find that an emergency exists prior to making a supplementation under this paragraph.

(c) At any time during the 2013-15 fiscal biennium, the department of health services may submit one or more requests to the joint committee on finance under section 13.10 of the statutes to supplement the appropriations under section 20.435 (1) (a) and (e) and (4) (b) of the statutes for fiscal year 2014-15 from the appropriation account under section 20.865 (4) (a) of the statutes for the purpose of funding state and local costs to respond to a tuberculosis incident in Sheboygan County. The department of health services shall include in any request submitted under this paragraph a proposal for allocating the requested funds among the appropriations under section 20.435 (1) (a) and (e) and (4) (b) of the statutes. The department of health services may not submit requests under this paragraph for supplementations totaling more than $2,159,000 in general purpose revenue for fiscal year 2014-15. Notwithstanding section 13.101 (3) of the statutes, the joint committee on finance is not required to find that an emergency exists prior to making a supplementation under this paragraph.

(d) The department of health services may provide funding to Sheboygan County from supplementations under paragraph (b) or (c) for the purpose of reimbursing Sheboygan County for costs incurred by the county responding to a tuberculosis incident in the county, including costs for drug treatment. Before requesting any funding provided under this paragraph, the county shall submit to the department of health services documentation for its actual costs for which it seeks reimbursement. The department of health services may not provide any funding under this paragraph in the absence of documentation by the county as provided in this paragraph.

(2c) Supplement to Older Americans Act funding. From the appropriation account under section 20.435 (7) (dh) of the statutes, the department of health services shall pay moneys to counties and American Indian tribes that have reductions in the amount of federal moneys received from grants under title III of the Older Americans Act in calendar year 2013 as compared to the amount received in calendar year 2012. In the 2013-14 fiscal year, the department of health services shall pay to each county and tribe that had a reduction an amount equal to one-half of the amount the federal moneys are reduced between calendar years 2012 and 2013 to be used for the same purposes as federal moneys provided under title III of the Older Americans Act.

(3q) Community-based long-term care expansion. Before December 14, 2013, the department of health services shall do all of the following:

(a) Develop a comprehensive projection of the expected future change in the need for publicly funded community-based long-term care.

(b) Include all of the following in the projection described in paragraph (a):

1. The projected future growth trends in populations likely to access services.

2. The potential or projected shifts in the use of alternatives that are allowed under the federal Medicaid program for the populations identified in subdivision 1.

3. The comparative cost efficiency of service options allowed under the federal Medicaid program to meet the needs of the populations identified under subdivision 1.

4. Strategies to control the growth in long-term care costs in the Medical Assistance program.

5. Strategies to promote keeping individuals in their own homes to reduce or delay entry into publicly funded long-term care programs.

(c) Submit a report summarizing the results of the projection described under paragraphs (a) and (b) to the joint committee on finance.

(4c) Disproportionate share hospital payments.

(a) Subject to paragraph (c) and notwithstanding section 49.45 (3) (e) of the statutes, from the appropriation accounts in section 20.435 (4) (b) and (o) of the statutes, the department of health services shall pay to hospitals that serve a disproportionate share of low-income patients a total of $36,792,000 in fiscal year 2013-14 and $36,728,700 in fiscal year 2014-15. The department of health services may make a payment to a hospital under this subsection under the calculation method described in paragraph (b) if the hospital meets all of the following criteria:

1. The hospital is located in this state.

2. The hospital provides a wide array of services, including services provided through an emergency department.

3. The inpatient days for Medical Assistance recipients at the hospital was at least 6 percent of the total inpatient days at that hospital during the most recent year for which such information is available.

4. The hospital meets applicable, minimum requirements to be a disproportionate share hospital under 42 USC 1396r-4 and any other applicable federal law.

(b) The department of health services shall comply with all of the following when making payments to hospitals described in paragraph (a):

1. The department of health services shall distribute the total amount of moneys described under paragraph (a) to be paid to hospitals with a disproportionate share of low-income patients by doing all of the following:

a. Dividing the number of Medical Assistance recipient inpatient days at a hospital by the number of total inpatient days at the hospital to obtain the percentage of Medical Assistance recipient inpatient days at that hospital.

b. Subject to subdivisions 2. and 3., providing an increase to the inpatient fee-for-service base rate for each hospital that qualifies for a disproportionate share hospital payment under this subsection.

c. Subject to subdivisions 2. and 3., providing an additional increase to the increase under subdivision 1. b. using a slope factor of 0.75 such that a hospital's overall fee-for-service add-on percentage under this subsection increases as the hospital's percentage of Medical Assistance recipient inpatient days increases.

2. The department of health services shall set the addition to the base rate at a level that ensures the total amount of moneys available to pay hospitals with a disproportionate share of low-income patients is distributed in each fiscal year.

3. The department of health services shall limit the maximum payment to hospitals such that no single hospital receives more than $2,500,000 in disproportionate share hospital payments under this subsection in a fiscal year.

(c) The department of health services shall seek any necessary approval from the federal department of health and human services to implement the hospital payment methodology described under paragraphs (a) and (b). If approval is necessary and approval from the federal department of health and human services is received, the department of health services shall implement the payment methodology described under paragraphs (a) and (b). If approval is necessary and the department of health services and the federal department of health and human services negotiate a methodology for making payments to hospitals with a disproportionate share of low-income patients that is different from the methodology described under paragraphs (a) and (b), the department of health services, before implementing the negotiated payment methodology, shall submit to the joint committee on finance the negotiated payment methodology. If the cochairpersons of the committee do not notify the department of health services within 14 working days after the date of the submittal by the department of health services that the committee has scheduled a meeting for the purpose of reviewing the negotiated payment methodology, the department of health services may implement the negotiated payment methodology. If, within 14 working days after the date of the submittal by the department of health services, the cochairpersons of the committee notify the department of health services that the committee has scheduled a meeting for the purpose of reviewing the negotiated payment methodology, the negotiated payment methodology may be implemented only on approval of the committee.

(5e) Funding of Family Care enrollees admitted to mental health institutes.

(a) In this subsection:

1. "Department" means the department of health services.

2. "Family Care program" means the benefit program under section 46.286 of the statutes.

3. "Mental health institute" has the meaning given in section 51.01 (12) of the statutes.

(b) Before September 1, 2013, the department shall submit to the joint committee on finance a report that identifies issues relating to cost liability for counties with residents who were formerly enrolled in the Family Care program and who are admitted to a mental health institute.

(c) After submitting the report under paragraph (b) and during the 2013-15 fiscal biennium, the department shall submit one or more requests to the joint committee on finance under section 13.10 of the statutes to supplement the appropriation under section 20.435 (2) (bj) of the statutes from the appropriation under section 20.865 (4) (a) of the statutes for the purpose of paying a portion of the additional costs counties incur to support services provided by the mental health institutes to certain enrollees in the Family Care program. If the joint committee on finance releases the moneys, the department may reimburse the county for all of the following for a stay of an enrollee of the Family Care program at a mental health institute subject to paragraph (d):

1. For any portion of a stay longer than 30 days but not longer than 60 days at a mental health institute, 50 percent of the state share of the cost of care incurred by the county for that portion of the stay.

2. For any portion of a stay longer than 60 days but not longer than 90 days, 75 percent of the state share of the cost of care incurred by the county for that portion of the stay.

3. For any portion of a stay longer than 90 days, all of the state share of the cost of care incurred by the county for that portion of the stay.

(d) The department may provide reimbursement to counties for Family Care program enrollees admitted to mental health institutes on or after the effective date of this paragraph and, if the Family Care program enrollee is still at the mental health institute on the effective date of this paragraph, before the effective date of this paragraph. For a Family Care program enrollee admitted to a mental health institute before the effective date of this paragraph, the department shall base the reimbursement on the Family Care program enrollee's total length of stay since admission to the mental health institute using the calculations under paragraph (c) 1. to 3.

(e) The financial liability of the state to pay reimbursements for services at a mental health institute for Family Care program enrollees under this subsection is limited to services provided at a mental health institute before July 1, 2015.

(6i) Estate recovery and divestment provision approval. By no later than June 30, 2015, the department of health services shall submit one or more proposals to the joint committee on finance requesting approval of the implementation of the estate recovery and divestment provisions of this act. Notwithstanding Sections 9318 (3), (4), (5), (6), (7), and (8) and 9418 (2) of this act, the department of health services may not implement any of the following estate recovery or divestment provisions of this act without the approval of the joint committee on finance:

(a) The treatment of sections 20.435 (4) (im) and (in) and (7) (im), 46.27 (7g) (a) 1m., 4., and 5., (c) 1., 2m., 3. (intro.), 5. a. and b., 6. (intro.), and 6m., and (g), 46.286 (7), 46.287 (2) (a) 1. k., 49.453 (2) (a) (intro.) and (b) (intro.), (3) (a) (intro.) and (ag), (4c) (c), and (8) (a) 1., 49.455 (5) (title), (d), and (e), 49.47 (4) (b) 2w., 49.496 (1) (a), (af), (bk), (bw), and (cm), (3) (a) (intro.) and 2. a., am., b., and c., (ad), (aj), (am) (intro.), (c) 1. and 2., (d) (intro.), and (dm), and (6m), 49.4962, 49.682 (1) (am), (d), and (e), (2) (a), (bm), (c) (intro.), (e) 1. and 2., (f) (intro.), and (fm), (3), and (5), 49.848, 49.849, 49.85 (title), (2) (a) (intro.) and 4., and (3) (a) 1., 59.43 (1) (w), 224.42 (1) (a), 632.697, 700.24, 701.065 (1) (b) 1. and (5), 705.04 (2g), 766.55 (2) (bm), 859.02 (2) (a), 859.07 (2) (a) 3., 867.01 (3) (am) 4. and (d), 867.02 (2) (am) 6., 867.03 (1g) (c) and (1m) (a) and (b), 867.035 (title), (1) (a) (intro.), 1., 2., 3., and 4., and (bm), (2), (2m) (a) and (b), (3), (4), (4m), and (5), and 893.33 (4r) of the statutes.

(b) The renumbering and amendment of sections 49.45 (4m) (a) 3., 49.455 (8) (d), and 867.03 (2g) of the statutes.

20,9122 Section 9122. Nonstatutory provisions; Insurance.

(1L) Dissolution of the Health Insurance Risk-Sharing Plan and Authority.

(a) Definitions. In this subsection:

1. "Authority" means the Health Insurance Risk-Sharing Plan Authority under subchapter III of chapter 149 of the statutes.

2. "Board" means the board of directors of the authority.

3. "Commissioner" means the commissioner of insurance.

4. "Covered person" means a person who has coverage under the plan.

5. "Office" means the office of the commissioner of insurance.

6. "Plan" means the Health Insurance Risk-Sharing Plan under subchapter II of chapter 149 of the statutes.

(b) Dissolution of the plan and authority. Notwithstanding any statute, administrative rule, or provision of a policy or contract or of the plan to the contrary, the plan and the authority shall be dissolved in accordance with the following:

1. `Coverage provisions.'

a. New coverage under the plan may not be issued to any person after December 31, 2013, except that new coverage under the plan that is funded under a contract with the federal department of health and human services may not be issued to any person after December 1, 2013.

b. Coverage under the policies issued under the plan terminates on January 1, 2014, or on the date that any health insurance coverage that is accessed through an American health benefit exchange, as described in 42 USC 18031, in this state is effective, if later than January 1, 2014. At least 60 days before coverage terminates, the authority shall provide notice of the date on which coverage terminates to all covered persons, all insurers and providers that are affected by the termination of the coverage, the office, the legislative audit bureau, and the insurers described in subsection (1m) (b) 1.

c. If coverage under the policies issued under the plan terminates on a date that is later than January 1, 2014, because no health insurance coverage that is accessed through an American health benefit exchange, as described in 42 USC 18031, in this state is effective on January 1, 2014, the authority may allow covered persons whose coverage under the plan is funded under a contract with the federal department of health and human services to elect to be covered, until coverage under the plan terminates, under the same coverage provided under the plan to covered persons whose coverage under the plan is not funded under a contract with the federal department of health and human services.

2. `Provider claims.' Providers of medical services and devices and prescription drugs to covered persons must file claims for payment no later than 90 days after the date coverage terminates under subdivision 1. b. Any claim filed after that date is not payable and may not be charged to the covered person who received the service, device, or drug. Except for copayments, coinsurance, or deductibles required under the plan, during the 90 days after the date coverage terminates under subdivision 1. b., consistent with section 149.14 (3) of the statutes and section 149.142 (2m) of the statutes, a provider may not bill a covered person who receives a covered service or article and shall accept as payment in full the payment rate determined under section 149.142 (1) of the statutes.

3. `Grievances and review.'

a. Except for a grievance related to a prior authorization denial, a covered person must submit any grievance, in writing, no later than 180 days after the date coverage terminates under subdivision 1. b. or be barred from submitting the grievance.

b. A covered person must submit any grievance related to a prior authorization denial no later than 45 days before the date on which coverage terminates under subdivision 1. b. or be barred from submitting the grievance, except that a grievance related to a prior authorization denial that meets the requirements for an expedited grievance must be submitted no later than the date on which coverage terminates under subdivision 1. b. or be barred.

c. A covered person who submits a grievance after the date coverage terminates under subdivision 1. b. must request an independent review, if any, with respect to the grievance no later than 60 days after he or she receives notice of the disposition of the grievance or be barred from requesting an independent review with respect to the grievance.

4. `Payment of plan costs.' The authority shall pay plan costs incurred in 2013 and all other costs associated with dissolving the plan that are incurred before administrative responsibility for the dissolution of the plan is transferred to the office under subdivision 8. The authority and the office shall make every effort to pay plan costs in accordance with, or as closely as possible to, the manner provided in section 149.143 of the statutes.

5. `Contracts.' The authority may extend any administrative contracts that are in effect into 2014, regardless of a contract's expiration date and without having to comply with the requirements under section 149.47 of the statutes for the extension.

6. `Report to legislature.' The authority shall submit a final report on plan operation to the legislature under section 13.172 of the statutes no later than September 30, 2013.

7. `Board responsibilities.' The board shall do all of the following:

a. Develop a proposal , which shall be followed by the office, for the dispensation of the plan's cash assets after all financial obligations of the plan and authority are satisfied. To the extent feasible and practical, the proposal shall provide for the return of any remaining equity to the source from which derived, including insurers, providers, and covered persons. The proposal shall provide for alternative dispensations in the event that returning any remaining equity is not feasible or practical, such as using remaining cash assets in support of activities providing an indirect benefit to the insurers, providers, and covered persons.

b. Dispose of the noncash assets of the authority as soon as possible after the administrative offices of the authority are closed.

c. Make any other decisions and take any other actions necessary to effectively wind up the operations and affairs of the authority and plan and transfer responsibility to the office. All actions taken by the board must be consistent with the purpose of, and may not endanger the solvency of, the plan.

8. `Transfer to the office.' On the date that is 60 days after the date coverage under the plan terminates under subdivision 1. b., all of the following shall occur:

a. Administrative responsibility for the dissolution of the plan is transferred to the office. The commissioner shall take any action necessary or advisable to wind up the affairs of the plan in accordance with the proposal developed by the board under subdivision 7. a. and shall notify the legislative audit bureau when the windup is completed and provide to the legislative audit bureau the final financial statements of the plan. For purposes of chapter 177 of the statutes, as affected by this act, the dissolution, and winding up of the affairs, of the plan shall be considered a dissolution of an insurer in accordance with section 645.44 of the statutes, except that a court order of dissolution is not required to effect the dissolution of the plan.

b. All remaining cash assets of the plan, including the balance in the Health Insurance Risk-Sharing Plan fund, are transferred to the appropriation account under section 20.145 (5) (g) of the statutes, as created by this act.

c. All tangible personal property, including records, of the authority not already disposed of by the board is transferred to the office.

d. All contracts and agreements entered into by the board that are in effect are transferred to the office. The office shall carry out any contractual obligations under such a contract or agreement until the contract or agreement terminates or is modified or rescinded by the office to the extent allowed under the contract or agreement. The office may enter into such other contracts as are necessary to carry out the dissolution of the plan.

e. Any matters pending with the authority or plan, including grievances and independent reviews, payment claims, subrogation claims, drug rebate claims, and legal actions or causes of action, are transferred to the office and all materials submitted to and actions taken by the office with respect to a pending matter are considered as having been submitted to or taken by the authority or plan.

9. `Health Insurance Risk-Sharing Plan advisory committee.'

a. There is created, 60 days after the date coverage under the plan terminates under subdivision 1. b., a Health Insurance Risk-Sharing Plan advisory committee consisting of the commissioner, or his or her designee, and the other 13 members of the board holding office on the date the advisory committee is created.

b. If a vacancy occurs on the Health Insurance Risk-Sharing Plan advisory committee, the governor shall appoint a successor, who must meet the same qualifications and criteria as the member who is being replaced.