Wisconsin Legislature: 16,2850c

16,2848r Section 2848r. 146.185 (3) of the statutes is amended to read:

146.185 (3) From the appropriation under s. 20.435 (5) (fh) (kb), the department shall in each fiscal year award up to $200,000 in grants for activities to improve the health status of economically disadvantaged minority group members. A person may apply, in the manner specified by the department, for a grant of up to $50,000 in each fiscal year to conduct these activities. A grant awarded An awardee of a grant under this subsection may not exceed 50% of the cost of the activities. An applicant's required contribution for a grant shall provide, for at least 50% of the grant amount, matching funds that may consist of funding or an in-kind contribution. An applicant that is not a federally qualified health center, as defined under 42 CFR 405.2401 (b) shall receive priority for grants awarded under this subsection.

16,2848s Section 2848s. 146.185 (4) of the statutes is amended to read:

146.185 (4) From the appropriation under s. 20.435 (5) (fh) (kb), the department shall award a grant of up to $100,000 $50,000 in each fiscal year to a private nonprofit corporation that applies, in the manner specified by the department, to conduct a public information campaign on minority health.

16,2850 Section 2850. 146.55 (2m) (a) of the statutes is repealed and recreated to read:

146.55 (2m) (a) The department shall contract with a physician to direct the state emergency medical services program. The department may expend from the funding under the federal preventive health services project grant program under 42 USC 2476 under the appropriation under s. 20.435 (1) (mc), $25,000 in each fiscal year for this purpose.

16,2850ag Section 2850ag. 146.56 (1) of the statutes is amended to read:

146.56 (1) Not later than July 1, 2002, the department shall develop and implement a statewide trauma care system. The department shall seek the advice of the statewide trauma advisory council under s. 15.197 (25) in developing and implementing the system , and, as part of the system, shall develop regional trauma advisory councils .

16,2850ah Section 2850ah. 146.56 (2) of the statutes is amended to read:

146.56 (2) The department shall promulgate rules to develop and implement the system. The rules shall include a method by which to classify all hospitals as to their respective emergency care capabilities. The classification rule shall be based on standards developed by the American College of Surgeons. Within 180 days after promulgation of the classification rule, and every 4 3 years thereafter, each hospital shall certify to the department the classification level of trauma care services that is provided by the hospital, based on the rule. The department may require a hospital to document the basis for its certification. The department may not direct a hospital to establish a certain level of certification. Confidential injury data that is collected under this subsection shall be used for confidential review relating to performance improvements in the trauma care system, and may be used for no other purpose.

16,2850bc Section 2850bc. 146.65 of the statutes is created to read:

146.65 Rural health dental clinics. (1) From the appropriation under s. 20.435 (5) (dm), the department shall distribute moneys as follows:

(a) In state fiscal year 2001-02, not more than $618,000 and in fiscal year 2002-03, not more than $232,000, to the rural health dental clinic located in Ladysmith that provides dental services to persons who are developmentally disabled or elderly or who have low income, in the counties of Rusk, Price, Taylor, Sawyer, and Chippewa.

(b) In fiscal year 2001-02, not more than $294,500 and in state fiscal year 2002-03, not more than $355,600, to the rural health dental clinic located in Menomonie that provides dental services to persons who are developmentally disabled or elderly or who have low income, in the counties of Barron, Chippewa, Dunn, Pepin, Pierce, Polk, and St. Croix.

(2) The department shall also seek federal funding to support the operations of the rural health dental clinics under sub. (1).

16,2850bg Section 2850bg. 146.83 (1) (b) of the statutes is amended to read:

146.83 (1) (b) Receive a copy of the patient's health care records upon payment of reasonable costs fees, as established by rule under sub. (3m).

16,2850bh Section 2850bh. 146.83 (1) (c) of the statutes is amended to read:

146.83 (1) (c) Receive a copy of the health care provider's X-ray reports or have the X-rays referred to another health care provider of the patient's choice upon payment of reasonable costs fees, as established by rule under sub. (3m).

16,2850bi Section 2850bi. 146.83 (3m) of the statutes is created to read:

146.83 (3m) (a) The department shall, by rule, prescribe fees that are based on an approximation of actual costs. The fees, plus applicable tax, are the maximum amount that a health care provider may charge under sub. (1) (b) for duplicate patient health care records and under sub. (1) (c) for duplicate X-ray reports or the referral of X-rays to another health care provider of the patient's choice. The rule shall also permit the health care provider to charge for actual postage or other actual delivery costs. In determining the approximation of actual costs for the purposes of this subsection, the department may consider all of the following factors:

1. Operating expenses, such as wages, rent, utilities, and duplication equipment and supplies.

2. The varying cost of retrieval of records, based on the different media on which the records are maintained.

3. The cost of separating requested patient health care records from those that are not requested.

4. The cost of duplicating requested patient health care records.

5. The impact on costs of advances in technology.

(b) By January 1, 2006, and every 3 years thereafter, the department shall revise the rules under par. (a) to account for increases or decreases in actual costs.

16,2850bm Section 2850bm. 148.19 (2) of the statutes is amended to read:

148.19 (2) Legal counsel, certified public accountants licensed or certified under ch. 442, or other persons as to matters the director or officer believes in good faith are within the person's professional or expert competence.

16,2850c Section 2850c. 149.115 of the statutes is amended to read:

149.115 Rules relating to creditable coverage. The commissioner, in consultation with the department, shall promulgate rules that specify how creditable coverage is to be aggregated for purposes of ss. s. 149.10 (2t) (a) and 149.14 (6) (b) 1. a. and that determine the creditable coverage to which ss. s. 149.10 (2t) (b) and (d) and 149.14 (6) (b) 1. b. and d. apply applies. The rules shall comply with section 2701 (c) of P.L. 104-191.

16,2850d Section 2850d. 149.13 (4) of the statutes is created to read:

149.13 (4) Notwithstanding subs. (1) to (3), the department, with the agreement of the commissioner, may perform various administrative functions related to the assessment of insurers participating in the cost of administering the plan.

16,2850dm Section 2850dm. 149.135 of the statutes is created to read:

149.135 Special small employer insurer assessment. (1) In this section:

(a) "Discontinued individual" means an individual who was covered under the health benefit plan subject to ch. 635 that was discontinued by the small employer insurer that provided the health benefit plan and who obtained coverage under the plan under this chapter after the coverage under the health benefit plan was discontinued.

(b) "Health benefit plan" has the meaning given in s. 632.745 (11).

(d) "Small employer insurer" has the meaning given in s. 635.02 (8).

(2) (a) Except as provided in sub. (3), a small employer insurer that discontinues coverage under a health benefit plan that is subject to ch. 635 shall pay a special assessment for each discontinued individual.

(b) The assessment under this subsection shall be determined by multiplying the small employer insurer's number of discontinued individuals by the average cost of an eligible person in the year in which the small employer insurer discontinued the coverage under the health benefit plan. The average cost of an eligible person in the year in which the health benefit plan was discontinued shall be determined by deducting from the total costs of the plan under this chapter in that year all premiums paid in that year by all persons with coverage under the plan under this chapter, and then by dividing that amount by the total number of persons with coverage under the plan under this chapter in that year.

(c) The assessment under this subsection shall also include all costs that are incurred by the small employer insurer's discontinued individuals during their first 6 months of coverage under the plan under this chapter and that are attributable to preexisting conditions.

(d) The board shall determine when a small employer insurer must pay the assessment under this section.

(3) The assessment under sub. (2) does not apply if the small employer insurer discontinued coverage under the health benefit plan subject to ch. 635 for any of the following reasons:

(a) The small employer failed to pay premiums or contributions in accordance with the terms of the health benefit plan or in a timely manner.

(b) The small employer performed an act or engaged in a practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage.

16,2850e Section 2850e. 149.14 (3) (nm) of the statutes is created to read:

149.14 (3) (nm) Hospice care provided by a hospice licensed under subch. IV of ch. 50.

16,2850f Section 2850f. 149.14 (5) (title) of the statutes is amended to read:

149.14 (5) (title) Deductibles, copayments and, coinsurance, and out-of-pocket limits.

16,2850g Section 2850g. 149.14 (5) (b) of the statutes is amended to read:

149.14 (5) (b) Except as provided in par. pars. (c) and (e), if the covered costs incurred by the eligible person exceed the deductible for major medical expense coverage in a calendar year, the plan shall pay at least 80% of any additional covered costs incurred by the person during the calendar year.

16,2850h Section 2850h. 149.14 (5) (c) of the statutes is amended to read:

149.14 (5) (c) If Except as provided in par. (e), if the aggregate of the covered costs not paid by the plan under par. (b) and the deductible exceeds $500 for an eligible person receiving medicare, $2,000 for any other eligible person during a calendar year or $4,000 for all eligible persons in a family, the plan shall pay 100% of all covered costs incurred by the eligible person during the calendar year after the payment ceilings under this paragraph are exceeded.

16,2850i Section 2850i. 149.14 (5) (e) of the statutes is amended to read:

149.14 (5) (e) Subject to sub. (8) (b), the department may, by rule under s. 149.17 (4), establish copayments for prescription drug coverage under sub. (3) (d) copayment amounts, coinsurance rates, and copayment and coinsurance out-of-pocket limits over which the plan will pay 100% of covered costs under sub. (3) (d). Any copayment amounts or rates amount, coinsurance rate, or out-of-pocket limit established are under this paragraph is subject to the approval of the board. Copayments and coinsurance paid by an eligible person under this paragraph shall are separate from and do not count toward the deductible and covered costs not paid by the plan under pars. (a) to (c).

16,2850j Section 2850j. 149.14 (6) (b) 1. of the statutes is repealed.

16,2850k Section 2850k. 149.14 (6) (b) 2. of the statutes is renumbered 149.14 (6) (b) and amended to read:

149.14 (6) (b) An eligible individual who obtains coverage under the plan on or after June 17, 1998, may not be subject to any preexisting condition exclusion under the plan. An eligible individual who is covered under the plan on June 17, 1998, may not be subject to any preexisting condition exclusion on or after June 17, 1998.

16,2850Lc Section 2850Lc. 149.142 (1) (b) of the statutes is amended to read:

149.142 (1) (b) The payment rate for a prescription drug shall be the allowable charge paid under s. 49.46 (2) (b) 6. h. for the prescription drug. Notwithstanding s. 149.17 (4), the department may not reduce the payment rate for prescription drugs below the rate specified in this paragraph, and the rate may not be adjusted under s. 149.143 or 149.144.

16,2850Ld Section 2850Ld. 149.142 (2) of the statutes is amended to read:

149.142 (2) The Except as provided in sub. (1) (b), the rates established under this section are subject to adjustment under ss. 149.143 and 149.144.

16,2850Ldc Section 2850Ldc. 149.143 (1) (intro.) of the statutes is amended to read:

149.143 (1) (intro.) The department shall pay or recover the operating costs of the plan from the appropriation under s. 20.435 (4) (v) and administrative costs of the plan from the appropriation under s. 20.435 (4) (u). For purposes of determining premiums, insurer assessments under s. 149.13, and provider payment rate adjustments, the department shall apportion and prioritize responsibility for payment or recovery of plan costs from among the moneys constituting the fund as follows:

16,2850Ldm Section 2850Ldm. 149.143 (1) (b) 1. a. of the statutes is amended to read:

149.143 (1) (b) 1. a. First, from premiums from eligible persons with coverage under s. 149.14 (2) (a) set at 150% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan and from eligible persons with coverage under s. 149.14 (2) (b) set in accordance with s. 149.14 (5m), including amounts received for premium and deductible subsidies under s. 149.144 and under the transfer to the fund from the appropriation account under s. 20.435 (4) (ah), and from premiums collected from eligible persons with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b), and from 50% of small employer insurer assessments under s. 149.135.

16,2850Le Section 2850Le. 149.143 (1) (b) 1. d. of the statutes is amended to read:

149.143 (1) (b) 1. d. Fourth, notwithstanding subd. 2., by increasing insurer assessments under s. 149.13 , excluding assessments under s. 149.144, and adjusting provider payment rates, subject to s. 149.142 (1) (b) and excluding adjustments to those rates under s. 149.144, in equal proportions and to the extent that the amounts under subd. 1. a. to c. are insufficient to pay 60% of plan costs.

16,2850Lem Section 2850Lem. 149.143 (1) (b) 2. a. of the statutes is amended to read:

149.143 (1) (b) 2. a. Fifty percent from insurer assessments under s. 149.13, excluding assessments under s. 149.144, and from 50% of small employer insurer assessments under s. 149.135.

16,2850Lf Section 2850Lf. 149.143 (1) (b) 2. b. of the statutes is amended to read:

149.143 (1) (b) 2. b. Fifty percent from adjustments to provider payment rates, subject to s. 149.142 (1) (b) and excluding adjustments to those rates under s. 149.144.

16,2850Lg Section 2850Lg. 149.143 (2) (a) 4. of the statutes is amended to read:

149.143 (2) (a) 4. By the same rule as under subd. 3. adjust the provider payment rate for the new plan year, subject to s. 149.142 (1) (b), by estimating and setting the rate at the level necessary to equal the amounts specified in sub. (1) (b) 1. d. and 2. b. and as provided in s. 149.145.

16,2850Lgj Section 2850Lgj. 149.143 (2m) (b) 3. of the statutes is created to read:

149.143 (2m) (b) 3. For distribution to eligible persons, notwithstanding any requirements in this chapter related to setting premium amounts. The department, with the approval of the board and the concurrence of the plan actuary, shall determine the policies, eligibility criteria, methodology, and other factors to be used in making any distribution under this subdivision.

16,2850Lh Section 2850Lh. 149.143 (3) (a) of the statutes is amended to read:

149.143 (3) (a) If, during a plan year, the department determines that the amounts estimated to be received as a result of the rates and amount set under sub. (2) (a) 2. to 4. and any adjustments in insurer assessments and the provider payment rate under s. 149.144 will not be sufficient to cover plan costs, the department may by rule increase the premium rates set under sub. (2) (a) 2. for the remainder of the plan year, subject to s. 149.146 (2) (b) and the maximum specified in sub. (2) (a) 2., by rule increase the assessments set under sub. (2) (a) 3. for the remainder of the plan year, subject to sub. (1) (b) 2. a., and by the same rule under which assessments are increased adjust the provider payment rate set under sub. (2) (a) 4. for the remainder of the plan year, subject to sub. (1) (b) 2. b. and s. 149.142 (1) (b).

16,2850Li Section 2850Li. 149.143 (3) (b) of the statutes is amended to read:

149.143 (3) (b) If the department increases premium rates and insurer assessments and adjusts the provider payment rate under par. (a) and determines that there will still be a deficit and that premium rates have been increased to the maximum extent allowable under par. (a), the department may further adjust, in equal proportions, assessments set under sub. (2) (a) 3. and the provider payment rate set under sub. (2) (a) 4., without regard to sub. (1) (b) 2. but subject to s. 149.142 (1) (b).

16,2850Lj Section 2850Lj. 149.143 (5) (a) of the statutes is amended to read:

149.143 (5) (a) Annually, no later than April 30, the department shall perform a reconciliation with respect to plan costs, premiums, insurer assessments, and provider payment rate adjustments based on data from the previous calendar year. On the basis of the reconciliation, the department shall make any necessary adjustments in premiums, insurer assessments under s. 149.13, or provider payment rates, subject to s. 149.142 (1) (b), for the fiscal year beginning on the first July 1 after the reconciliation, as provided in sub. (2) (b).

16,2850Lk Section 2850Lk. 149.143 (5) (b) of the statutes is amended to read:

149.143 (5) (b) Except as provided in sub. (3) and s. 149.144, the department shall adjust the provider payment rates to meet the providers' specified portion of the plan costs no more than once annually, subject to s. 149.142 (1) (b). The department may not determine the adjustment on an individual provider basis or on the basis of provider type, but shall determine the adjustment for all providers in the aggregate, subject to s. 149.142 (1) (b).

16,2850Lm Section 2850Lm. 149.144 of the statutes is amended to read:

149.144 Adjustments to insurer assessments and provider payment rates for premium and deductible reductions. If the moneys transferred to the fund under the appropriation under s. 20.435 (4) (ah) are insufficient to reimburse the plan for premium reductions under s. 149.165 and deductible reductions under s. 149.14 (5) (a), or the department determines that the moneys transferred or to be transferred to the fund under the appropriation under s. 20.435 (4) (ah) will be insufficient to reimburse the plan for premium reductions under s. 149.165 and deductible reductions under s. 149.14 (5) (a), the department may, by rule, adjust in equal proportions the amount of the assessment set under s. 149.143 (2) (a) 3. and the provider payment rate set under s. 149.143 (2) (a) 4., subject to s. ss. 149.142 (1) (b) and 149.143 (1) (b) 1., sufficient to reimburse the plan for premium reductions under s. 149.165 and deductible reductions under s. 149.14 (5) (a). If the department makes the adjustment under this section, the department shall notify the commissioner so that the commissioner may levy any increase in insurer assessments.

16,2850Ln Section 2850Ln. 149.145 of the statutes is amended to read: