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.
AB100-ASA1, s. 2258 14Section 2258. 153.01 (4) of the statutes is created to read:
AB100-ASA1,1360,1515 153.01 (4) "Department" means the department of health and family services.
AB100-ASA1, s. 2259 16Section 2259. 153.01 (4m) of the statutes is repealed.
AB100-ASA1, s. 2260 17Section 2260. 153.01 (6) of the statutes is repealed.
AB100-ASA1, s. 2261 18Section 2261. 153.05 (1) (c) 1. of the statutes is amended to read:
AB100-ASA1,1360,2319 153.05 (1) (c) 1. Identification of charges in each hospital's most recent entire
20fiscal year for up to 100 charge elements, as selected by the office department, and
21identification of the increase or decrease in charges for each of these charge elements
22from amounts charged during the hospital's entire fiscal year that is nearest in time
23to the hospital's most recent entire fiscal year.
AB100-ASA1, s. 2262 24Section 2262. 153.05 (1) (e) of the statutes is amended to read:
AB100-ASA1,1361,4
1153.05 (1) (e) Final audited financial statements of hospitals that include, for
2a hospital's most recent entire fiscal year, as dollar amounts, the amounts of revenue
3and expenditures for the hospital, in categories specified in rules promulgated by the
4commissioner department.
AB100-ASA1, s. 2263 5Section 2263. 153.05 (2) of the statutes is amended to read:
AB100-ASA1,1361,126 153.05 (2) The office department shall provide copies of reports published
7under ss. 153.10 to 153.35 at no charge to hospitals assessed under s. 153.60 (1) and,
8if assessed, at no charge to ambulatory surgery centers assessed under s. 153.60 (2).
9The office department shall provide copies of the reports to any person, upon the
10person's request, and the board shall advise the office department as to whether the
11copies shall be provided at no charge or at a charge not to exceed the cost of printing,
12copying and mailing the report to the person.
AB100-ASA1, s. 2264 13Section 2264. 153.05 (3) of the statutes is amended to read:
AB100-ASA1,1361,1614 153.05 (3) Upon request of the office department, state agencies shall provide
15health care information to the office department for use in preparing reports under
16ss. 153.10 to 153.35.
AB100-ASA1, s. 2265 17Section 2265. 153.05 (4) of the statutes is amended to read:
AB100-ASA1,1361,2418 153.05 (4) (a) The office department, under rules promulgated by the
19commissioner department, shall require hospitals to use, and private-pay patients
20and payers who are insurers to accept, uniform patient billing forms, shall require
21hospitals to submit to the office department the information provided on the billing
22forms, including, for an injury, the external cause of the event, and may require
23payers who are insurers to use a standard set of definitions for base data reporting
24under a uniform patient billing form.
AB100-ASA1,1362,6
1(b) The office department, under rules promulgated by the commissioner
2department, may require ambulatory surgery centers to use uniform patient billing
3forms and other information, and, if so requiring, shall require ambulatory surgery
4centers to submit to the office department the information provided on the billing
5forms, including, for an injury, the external cause of the event, using a standard set
6of definitions for base data reporting.
AB100-ASA1, s. 2266 7Section 2266. 153.05 (5) of the statutes is amended to read:
AB100-ASA1,1362,88 153.05 (5) The office department:
AB100-ASA1,1362,119 (a) Shall require hospitals to submit information regarding medical
10malpractice, staffing levels and patient case-mix, and expenditures related to labor
11relations consultants, as specified by the office department.
AB100-ASA1,1362,1612 (b) May require hospitals to submit to the office department information from
13sources identified under sub. (1) (a) to (e) that the office department deems necessary
14for the preparation of reports, plans and recommendations under ss. 153.10 to 153.35
15and any other reports required of the office department in the form specified by the
16office department.
AB100-ASA1,1362,2017 (bm) Shall require a hospital to submit to the office department information
18from sources identified under sub. (1) (e) by the date that is 4 months following the
19close of the hospital's fiscal year unless the office department grants an extension of
20time to file the information.
AB100-ASA1, s. 2267 21Section 2267. 153.05 (6) of the statutes is amended to read:
AB100-ASA1,1363,222 153.05 (6) If the requirements of s. 153.07 (2) are first met, the office
23department may contract with a public or private entity that is not a major
24purchaser, payer or provider of health care services in this state for the provision of
25data processing services for the collection, analysis and dissemination of health care

1information under sub. (1) or the department of health and family services shall
2provide the services under s. 153.07 (2).
AB100-ASA1, s. 2268 3Section 2268. 153.05 (6m) of the statutes is amended to read:
AB100-ASA1,1363,114 153.05 (6m) If the requirements of s. 153.07 (2) are first met, the office
5department may contract with the group insurance board for the provision of data
6collection and analysis services related to health maintenance organizations and
7insurance companies that provide health insurance for state employes or the
8commissioner department shall provide the services under s. 153.07 (2). The office
9department shall establish contract fees for the provision of the services. All moneys
10collected under this subsection shall be credited to the appropriation under s. 20.145
11(8)
20.435 (1) (kx).
AB100-ASA1, s. 2269 12Section 2269. 153.05 (7) of the statutes is amended to read:
AB100-ASA1,1363,1613 153.05 (7) The office department may require each insurer authorized to write
14disability insurance to submit to the office department information obtained on
15uniform patient billing forms regarding reported claims for health care services
16which insureds who are residents of this state obtain in another state.
AB100-ASA1, s. 2270 17Section 2270. 153.05 (8) of the statutes is amended to read:
AB100-ASA1,1364,218 153.05 (8) Beginning April 1, 1992, the office department shall collect, analyze
19and disseminate, in language that is understandable to lay persons, health care
20information under the provisions of this chapter, as determined by rules
21promulgated by the commissioner department, from health care providers, as
22defined by rules promulgated by the commissioner department, other than hospitals
23and ambulatory surgery centers. Data from physicians shall be obtained through
24sampling techniques in lieu of collection of data on all patient encounters and data

1collection procedures shall minimize unnecessary duplication and administrative
2burdens.
AB100-ASA1, s. 2271 3Section 2271. 153.05 (9) of the statutes is amended to read:
AB100-ASA1,1364,74 153.05 (9) The office department shall provide orientation and training to
5physicians, hospital personnel and other health care providers to explain the process
6of data collection and analysis and the procedures for data verification,
7interpretation and release.
AB100-ASA1, s. 2272 8Section 2272. 153.05 (11) of the statutes is amended to read:
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