AB100-ASA1,1352,19 19146.92 Primary health care grant program. (1) In this section:
AB100-ASA1,1352,2320 (a) "Community-based nonprofit corporation" means a nonprofit corporation
21that is governed by a community-based board of directors and that is organized
22primarily to provide primary health care services in a geographic area, or to a
23population, that the department designates as medically underserved.
AB100-ASA1,1352,2524 (b) "Nonprofit corporation" means a nonstock, nonprofit corporation organized
25under ch. 181.
AB100-ASA1,1353,3
1(2) Prior to implementing the grant program under this section, the
2department shall consult with representatives of statewide organizations that
3represent primary health care providers.
AB100-ASA1,1353,6 4(3) From the appropriation under s. 20.435 (5) (gp), the department shall
5award $1,500,000 in grants in each fiscal year to community-based nonprofit
6corporations under a competitive process established by the department.
AB100-ASA1,1353,8 7(4) A community-based nonprofit corporation that receives a grant under this
8section shall do all of the following:
AB100-ASA1,1353,109 (a) Provide comprehensive primary health care services to any person
10regardless of insurance status or ability to pay.
AB100-ASA1,1353,1111 (b) Establish a sliding fee scale for uninsured, low-income persons.
AB100-ASA1, s. 3010p 12Section 3010p. 146.93 (title) of the statutes is amended to read:
AB100-ASA1,1353,13 13146.93 (title) Primary Supplemental primary health care program.
AB100-ASA1, s. 2237 14Section 2237. 146.93 (1) (a) of the statutes is amended to read:
AB100-ASA1,1353,1815 146.93 (1) (a) From the appropriation under s. 20.435 (1) (gp) (5) (kp), the
16department shall maintain a program for the provision of primary health care
17services based on the primary health care program in existence on June 30, 1987.
18The department may promulgate rules necessary to implement the program.
AB100-ASA1, s. 3011m 19Section 3011m. 146.93 (4) (d) of the statutes is created to read:
AB100-ASA1,1353,2220 146.93 (4) (d) The individual received health care services under this section
21on the effective date of this paragraph .... [revisor inserts date], and cannot be served
22by an entity that receives a grant under s. 146.92.
AB100-ASA1, s. 2238 23Section 2238. 146.99 of the statutes is amended to read:
AB100-ASA1,1354,6 24146.99 Assessments. The department shall, within 90 days after the
25commencement of each fiscal year, estimate the total amount of expenditures and the

1department shall assess the estimated total amount under s. 20.435 (1) (5) (gp) to
2hospitals, as defined in s. 50.33 (2), in proportion to each hospital's respective gross
3private-pay patient revenues during the hospital's most recently concluded entire
4fiscal year. Each hospital shall pay its assessment on or before December 1 for the
5fiscal year. All payments of assessments shall be deposited in the appropriation
6under s. 20.435 (1) (5) (gp).
AB100-ASA1, s. 2239 7Section 2239. Chapter 149 (title) of the statutes is created to read:
AB100-ASA1,1354,88 Chapter 149
AB100-ASA1,1354,109 Mandatory health insurance
10 risk-sharing plan
AB100-ASA1, s. 2240 11Section 2240. 149.10 (2f) of the statutes is created to read:
AB100-ASA1,1354,1212 149.10 (2f) "Commissioner" means the commissioner of insurance.
AB100-ASA1, s. 2241 13Section 2241. 149.10 (2m) of the statutes is created to read:
AB100-ASA1,1354,1514 149.10 (2m) "Department" means the department of health and family
15services.
AB100-ASA1, s. 2242 16Section 2242. 149.10 (4c) of the statutes is created to read:
AB100-ASA1,1354,1817 149.10 (4c) "Health maintenance organization" has the meaning given in s.
18609.01 (2).
AB100-ASA1, s. 2243 19Section 2243. 149.10 (4p) of the statutes is created to read:
AB100-ASA1,1354,2020 149.10 (4p) (a) "Insurance" includes any of the following:
AB100-ASA1,1354,2321 1. Risk distributing arrangements providing for compensation of damages or
22loss through the provision of services or benefits in kind rather than indemnity in
23money.
AB100-ASA1,1354,2524 2. Contracts of guaranty or suretyship entered into by the guarantor or surety
25as a business and not as merely incidental to a business transaction.
AB100-ASA1,1355,1
13. Plans established and operated under ss. 185.981 to 185.985.
AB100-ASA1,1355,32 (b) "Insurance" does not include a continuing care contract, as defined in s.
3647.01 (2).
AB100-ASA1, s. 2244 4Section 2244. 149.10 (5m) of the statutes is created to read:
AB100-ASA1,1355,65 149.10 (5m) "Limited service health organization" has the meaning given in
6s. 609.01 (3).
AB100-ASA1, s. 2245 7Section 2245. 149.10 (8c) of the statutes is created to read:
AB100-ASA1,1355,108 149.10 (8c) "Policy" means any document other than a group certificate used
9to prescribe in writing the terms of an insurance contract, including endorsements
10and riders and service contracts issued by motor clubs.
AB100-ASA1, s. 3020p 11Section 3020p. 149.10 (8j) of the statutes is created to read:
AB100-ASA1,1355,1612 149.10 (8j) "Preexisting condition exclusion" means, with respect to coverage,
13a limitation or exclusion of benefits relating to a condition of an individual that
14existed before the individual's date of enrollment for coverage, whether or not the
15individual received any medical advice or recommendation, diagnosis, care or
16treatment related to the condition before that date.
AB100-ASA1, s. 2246 17Section 2246. 149.10 (8m) of the statutes is created to read:
AB100-ASA1,1355,1818 149.10 (8m) "Preferred provider plan" has the meaning given in s. 609.01 (4).
AB100-ASA1, s. 2247 19Section 2247. 149.10 (8p) of the statutes is created to read:
AB100-ASA1,1355,2220 149.10 (8p) "Premium" means any consideration for an insurance policy, and
21includes assessments, membership fees or other required contributions or
22consideration, however designated.
AB100-ASA1, s. 2248 23Section 2248. 149.10 (10) of the statutes is created to read:
AB100-ASA1,1355,2424 149.10 (10) "Secretary" means the secretary of health and family services.
AB100-ASA1, s. 2249 25Section 2249. 149.10 (11) of the statutes is created to read:
AB100-ASA1,1356,2
1149.10 (11) "State" means the same as in s. 990.01 (40) except that it also
2includes the Panama Canal Zone.
AB100-ASA1, s. 3025f 3Section 3025f. 149.12 (2) (f) of the statutes is created to read:
AB100-ASA1,1356,54 149.12 (2) (f) No person who is eligible for medical assistance is eligible for
5coverage under the plan.
AB100-ASA1, s. 3026c 6Section 3026c. 149.14 (4m) of the statutes is created to read:
AB100-ASA1,1356,127 149.14 (4m) Discounted payment is payment in full. A provider of a covered
8service or article shall accept as payment in full for the covered service or article the
9discounted reimbursement rate determined under ss. 149.143 (2) (a) 3. and (3),
10149.144 and 149.15 (3) (e) and may not bill an eligible person who receives the service
11or article for any amount by which the charge for the service or article is reduced
12under s. 149.143 (2) (a) 3. or (3), 149.144 or 149.15 (3) (e).
AB100-ASA1, s. 3026f 13Section 3026f. 149.143 of the statutes is created to read:
AB100-ASA1,1356,15 14149.143 Payment of plan costs. (1) The department shall pay or recover the
15operating, administrative and subsidy costs of the plan as follows:
AB100-ASA1,1356,1616 (a) First from the appropriation under s. 20.435 (5) (af).
AB100-ASA1,1356,1717 (b) The remainder of the costs as follows:
AB100-ASA1,1356,1818 1. A total of 60% from all of the following:
AB100-ASA1,1356,1919 a. The appropriation under s. 20.435 (5) (ah).
AB100-ASA1,1356,2120 b. Insurer assessments and provider reimbursement discounts under s.
21149.144.
AB100-ASA1,1356,2322 c. Subject to sub. (2) (a) 1. and s. 149.146 (2) (b), premiums collected from
23eligible persons.
AB100-ASA1,1356,2424 2. A total of 40% as follows:
AB100-ASA1,1357,2
1a. Fifty percent from insurer assessments, excluding assessments under s.
2149.144.
AB100-ASA1,1357,43 b. Fifty percent from discounts to provider reimbursement rates, excluding
4discounts under ss. 149.144 and 149.15 (3) (e).
AB100-ASA1,1357,8 5(2) (a) Prior to each plan year, the department shall estimate the operating,
6administrative and subsidy costs of the plan for the new plan year and, taking into
7consideration the funds expected to be available under s. 20.435 (5) (af) and (ah), do
8all of the following:
AB100-ASA1,1357,149 1. By rule set premium rates for the new plan year, including the rates under
10s. 149.146 (2) (b), by estimating the rates necessary to equal the amount specified in
11sub. (1) (b) 1. c., except that a rate for coverage under s. 149.14 may not be less than
12150% nor more than 200% of the rate that a standard risk would be charged under
13an individual policy providing substantially the same coverage and deductibles as
14are provided under the plan.
AB100-ASA1,1357,1715 2. By rule set the total insurer assessments under s. 149.13 for the new plan
16year by estimating the amount necessary to equal the amount specified in sub. (1)
17(b) 2. a. and notify the commissioner of the amount.
AB100-ASA1,1357,2018 3. By the same rule set the rate at which provider charges shall be discounted
19for the new plan year by estimating the rate necessary to equal the amount specified
20in sub. (1) (b) 2. b.
AB100-ASA1,1357,2521 (b) In setting the rates under par. (a) 1. and 3. and the amount under par. (a)
222. for the new plan year, the department shall include any increase or decrease
23necessary to reflect the amount, if any, by which the rates and amount set under par.
24(a) for the current plan year differed from the rates and amount which would have
25equaled the amounts specified in sub. (1) in the current plan year.
AB100-ASA1,1358,9
1(3) (a) If, during a plan year, the department determines that the moneys under
2s. 20.435 (5) (af) and (ah), the amounts set under sub. (2) (a) and any increases in
3insurer assessments and provider discounts under s. 149.144 are not sufficient to
4cover plan costs, the department may by rule increase the premium rates set under
5sub. (2) (a) 1. for the remainder of the plan year, subject to subs. (1) (b) 1. and (2) (a)
61. and s. 149.146 (2) (b), increase the assessments set under sub. (2) (a) 2. for the
7remainder of the plan year, subject to sub. (1) (b) 2. a., and increase the discount rate
8set under sub. (2) (a) 3. for the remainder of the plan year, subject to sub. (1) (b) 2.
9b.
AB100-ASA1,1358,1710 (b) If, after increasing premium rates, assessments and discount rates under
11par. (a), the department determines that there will still be a deficit and that premium
12rates have been increased to the maximum extent allowable under par. (a), the
13department shall further increase, in equal proportions, assessments set under sub.
14(2) (a) 2. and discount rates set under sub. (2) (a) 3., without regard to sub. (1) (b) 2.
15Insurers and providers affected by this paragraph may recover the assessment
16increase and the discount rate increase in the normal course of their respective
17businesses without time limitation, subject to s. 149.14 (4m).
AB100-ASA1,1358,22 18(4) Using the procedure under s. 227.24, the department may promulgate rules
19under sub. (2) or (3) for the period before the effective date of any permanent rules
20promulgated under sub. (2) or (3), but not to exceed the period authorized under s.
21227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) and (3), the department is not
22required to make a finding of emergency.
AB100-ASA1,1359,2 23(5) Notwithstanding sub. (2) (a) (intro.), the department shall set premium
24rates, insurer assessments and provider discount rates for the period beginning on
25January 1, 1998, and ending on June 30, 1998, in the manner provided in subs. (1),

1(2) (a), (3) and (4). This subsection applies to policies in effect on January 1, 1998,
2as well as to policies issued or renewed on or after January 1, 1998.
AB100-ASA1, s. 3027m 3Section 3027m. 149.15 (2m) of the statutes is created to read:
AB100-ASA1,1359,64 149.15 (2m) Annually, beginning in 1999, the board shall submit a report on
5or before June 30 to the legislature under s. 13.172 (2) and to the governor on the
6operation of the plan, including any recommendations for changes to the plan.
AB100-ASA1, s. 2250 7Section 2250. 149.16 (title) of the statutes is created to read:
AB100-ASA1,1359,8 8149.16 (title) Plan administrator.
AB100-ASA1, s. 2251 9Section 2251. 149.16 (1) of the statutes is created to read:
AB100-ASA1,1359,1110 149.16 (1) The department shall contract with an organization or other person
11to administer the plan.
AB100-ASA1, s. 2252 12Section 2252. 150.21 (1) of the statutes is amended to read:
AB100-ASA1,1359,1313 150.21 (1) The construction or total replacement of a new nursing home.
AB100-ASA1, s. 2253 14Section 2253. 150.21 (3) of the statutes is amended to read:
AB100-ASA1,1359,1615 150.21 (3) A capital expenditure, other than a renovation or replacement, that
16exceeds $1,000,000 by or on behalf of a nursing home.
AB100-ASA1, s. 2254 17Section 2254. 150.21 (4) of the statutes is amended to read:
AB100-ASA1,1359,1918 150.21 (4) An expenditure, other than a renovation or replacement, that
19exceeds $600,000 for clinical equipment by or on behalf of a nursing home.
AB100-ASA1, s. 3035v 20Section 3035v. 150.31 (4) of the statutes is amended to read:
AB100-ASA1,1359,2421 150.31 (4) The department may decrease the statewide bed limit in facilities
22primarily serving the developmentally disabled in order to account for any decreased
23use of beds at the a state centers center for the developmentally disabled due to the
24community integration program under s. 46.275.
AB100-ASA1, s. 2255 25Section 2255. 150.31 (5t) of the statutes is created to read:
AB100-ASA1,1360,3
1150.31 (5t) The department shall decrease the statewide bed limits specified
2in sub. (1) to account for any reduction in the licensed bed capacity of a nursing home
3that has relinquished use of a bed, as specified in s. 49.45 (6m) (ap) 4.
AB100-ASA1, s. 2256 4Section 2256. 150.35 (3m) (a) 3. of the statutes is amended to read:
AB100-ASA1,1360,85 150.35 (3m) (a) 3. All applications for activities that are specified in s. 150.21
6(3), that are renovations with capital expenditures which do not exceed $1,500,000
7and that do not include additions, the replacement of a nursing home or an increase
8in the bed capacity of a nursing home
.
AB100-ASA1, s. 2257 9Section 2257. 150.39 (2) of the statutes is amended to read:
AB100-ASA1,1360,1310 150.39 (2) The cost of renovating or providing an equal number of nursing home
11beds or of an equal expansion would be consistent with the cost at similar nursing
12homes, and the applicant's per diem rates would be consistent with those of similar
13nursing homes.
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