AB133-ASA1,1155,1815
146.56
(1) Not later than July 1,
2001 2002, the department shall develop and
16implement a statewide trauma care system
. The department shall seek the advice
17of the statewide trauma advisory council under s. 15.197 (25) in developing and
18implementing the system.
AB133-ASA1,1155,20
20146.57 (title)
Statewide poison control
program system.
AB133-ASA1,1155,2222
146.57
(1m) Definitions. In this section:
AB133-ASA1,1155,2323
(a) "Appropriate health-oriented background" means one of the following:
AB133-ASA1,1156,3
11. Licensure as an emergency medical technician — basic, emergency medical
2technician — intermediate or emergency medical technician — paramedic under s.
3146.50 (5) (a).
AB133-ASA1,1156,44
2. Licensure as a licensed practical nurse under s. 441.10 (3).
AB133-ASA1,1156,105
3. Completion of a training program directed by a physician specializing in
6toxicology and, as determined by the medical director of a poison control center,
7background sufficient to understand and interpret standard poison information
8resources and to transmit that information understandably to both health
9professionals and the public under the direct supervision of a staff member specified
10under sub. (3m) (b) or the medical director.
AB133-ASA1,1156,1311
(b) "On-line staff member" means a member of the staff of a poison control
12center who personally responds to telephone inquiries received by the poison control
13center.
AB133-ASA1,1156,1414
(c) "Pharmacist" has the meaning given in s. 450.01 (15).
AB133-ASA1,1156,1515
(d) "Physician" has the meaning given in s. 448.01 (5).
AB133-ASA1,1156,1716
(e) "Poison control services" means poison prevention education, and rapid and
17accurate poison interpretation, poison intervention and management information.
AB133-ASA1,1156,1818
(f) "Registered nurse" means a nurse who is licensed under s. 441.06.
AB133-ASA1,1156,2019
(g) "School of pharmacy" means a school of pharmacy that is accredited by the
20American Council on Pharmaceutical Education.
AB133-ASA1,1156,2221
(h) "Triage" means assign priority order on the basis of where resources can
22best be used or are most needed.
AB133-ASA1,1157,824
146.57
(3) (a) The department shall implement a statewide poison control
25program system, which shall provide poison control services that are available
1statewide, on a 24-hour per day and 365-day per year basis and shall provide poison
2information and education to health care professionals and the public. From the
3appropriation under s. 20.435 (5) (ds), the department shall, if the requirement
4under par. (b) is met, distribute total funding of not more than $375,000 in each fiscal
5year to supplement the operation of the
program system and to provide for the
6statewide collection and reporting of poison control data. The department may, but
7need not, distribute all of the funds in each fiscal year to a single poison control
8center.
AB133-ASA1,1157,1310
146.57
(3m) Requirements of poison control centers. (a) A poison control
11center shall maintain telephone services capable of providing rapid, accurate and
12complete poison information that is accessible throughout the state and that is free
13to users through a statewide toll-free hotline.
AB133-ASA1,1157,1514
(b) An on-line staff member who interprets poison exposure data and provides
15poison intervention and management information shall be one of the following:
AB133-ASA1,1157,1616
1. A registered nurse.
AB133-ASA1,1157,1717
2. A pharmacist.
AB133-ASA1,1157,1818
3. A physician.
AB133-ASA1,1157,2019
4. A person who is certified by or eligible for certification by the American
20Association of Poison Control Centers as a specialist in poison information.
AB133-ASA1,1157,2121
5. A school of pharmacy graduate who is in residency training.
AB133-ASA1,1157,2322
6. A school of pharmacy enrollee who has completed the 2nd professional
23practice year.
AB133-ASA1,1158,324
7. A person who was employed as an on-line staff member on May 1, 1994, who
25has worked in that capacity at the poison control center for at least 3 years and who
1annually receives at least 16 documented hours of continuing education in
2interpreting poison exposure data and providing poison intervention and
3management information.
AB133-ASA1,1158,74
(c) An on-line staff member who is designated as a poison information provider
5may, if he or she annually receives at least 16 documented hours of job-relevant
6continuing education and has an appropriate health-oriented background, provide
7poison information to manage nontoxic exposures and routine follow-up.
AB133-ASA1,1158,118
(d) An on-line staff member who is designated as a poison information provider
9shall triage incoming telephone calls concerning toxic exposures and, for health care
10professionals, concerning drug interaction interpretations, and refer such calls to an
11on-duty staff member under par. (b).
AB133-ASA1,1158,1613
146.93
(1) (a) From the appropriation under s. 20.435
(1) (4) (gp), the
14department shall maintain a program for the provision of primary health care
15services based on the primary health care program in existence on June 30, 1987.
16The department may promulgate rules necessary to implement the program.
AB133-ASA1,1158,25
18146.99 Assessments. The department shall, within 90 days after the
19commencement of each fiscal year, estimate the total amount of expenditures and the
20department shall assess the estimated total amount under s. 20.435
(1) (4) (gp) to
21hospitals, as defined in s. 50.33 (2), in proportion to each hospital's respective gross
22private-pay patient revenues during the hospital's most recently concluded entire
23fiscal year. Each hospital shall pay its assessment on or before December 1 for the
24fiscal year. All payments of assessments shall be deposited in the appropriation
25under s. 20.435
(1) (4) (gp).
AB133-ASA1,1159,22
149.10
(3e) "Fund" means the health insurance risk-sharing plan fund.
AB133-ASA1, s. 2256
3Section
2256. 149.12 (2) (d) of the statutes is renumbered 149.12 (2) (d) 1. and
4amended to read:
AB133-ASA1,1159,75
149.12
(2) (d) 1. Except
for a person who is an eligible individual as provided
6in subd. 2., no person who is 65 years of age or older is eligible for coverage under the
7plan.
AB133-ASA1,1159,99
149.12
(2) (d) 2. Subdivision 1. does not apply to any of the following:
AB133-ASA1,1159,1010
a. A person who is an eligible individual.
AB133-ASA1,1159,1211
b. A person who has coverage under the plan on the date on which he or she
12attains the age of 65 years.
AB133-ASA1,1159,1914
149.12
(3) (b) Persons for whom deductible or coinsurance amounts are paid
15or reimbursed under ch. 47 for vocational rehabilitation, under s. 49.68 for renal
16disease, under s. 49.685 (8) for hemophilia, under s. 49.683 for cystic fibrosis
or, 17under s. 253.05 for maternal and child health services
or under s. 49.686 for the cost
18of drugs for the treatment of HIV infection or AIDS are not ineligible for coverage
19under the plan by reason of such payments or reimbursements.
AB133-ASA1,1160,322
149.14
(2) (a) The plan shall provide every eligible person who is not eligible
23for medicare with major medical expense coverage. Major medical expense coverage
24offered under the plan under this section shall pay an eligible person's covered
25expenses, subject to sub. (3) and deductible
, copayment and coinsurance payments
1authorized under sub. (5), up to a lifetime limit of $1,000,000 per covered individual.
2The maximum limit under this paragraph shall not be altered by the board, and no
3actuarially equivalent benefit may be substituted by the board.
AB133-ASA1,1160,195
149.14
(3) Covered expenses. (intro.) Except as
provided in sub. (4), except
6as restricted by cost containment provisions under s. 149.17 (4) and except as
7reduced by the
board under s. 149.15 (3) (e) or by the department under
s. ss. 149.143
8or and 149.144, covered expenses for the coverage under this section shall be the
9usual and customary charges payment rates established by the department under
10s. 149.142 for the services provided by persons licensed under ch. 446 and certified
11under s. 49.45 (2) (a) 11. Except as
provided in sub. (4), except as restricted by cost
12containment provisions under s. 149.17 (4) and except as reduced by the
board under
13s. 149.15 (3) (e) or by the department under
s.
ss. 149.143
or and 149.144, covered
14expenses for the coverage under this section shall also be the
usual and customary
15charges payment rates established by the department under s. 149.142 for the
16following services and articles if the service or article is prescribed by a physician
17who is licensed under ch. 448 or in another state and who is certified under s. 49.45
18(2) (a) 11. and if the service or article is provided by a provider certified under s. 49.45
19(2) (a) 11.:
AB133-ASA1,1160,2121
149.14
(3) (d) Drugs requiring a physician's prescription
, subject to sub. (4c).
AB133-ASA1,1161,223
149.14
(4) (d) That part of any charge for services or articles rendered or
24prescribed by a physician, dentist or other health care personnel
which that exceeds
25the
prevailing charge in the locality where the service is provided payment rate
1established by the department under s. 149.142 and reduced under ss. 149.143 and
2149.144 or any charge not medically necessary.
AB133-ASA1,1161,44
149.14
(4) (g) Dental care except as provided in sub. (3) (m)
and (q).
AB133-ASA1,1161,76
149.14
(4) (n) Services or drugs for the treatment of infertility, impotence or
7sterility.
AB133-ASA1,1161,119
149.14
(4c) Coverage of prescription drugs. (a) The department may require
10a pharmacist or pharmacy that provides a prescription drug to an eligible person to
11submit a payment claim directly to the plan administrator.
AB133-ASA1,1161,1412
(b) The department may limit coverage of prescription drugs under sub. (3) (d)
13to those prescription drugs for which payment claims are submitted by pharmacists
14or pharmacies directly to the plan administrator.
AB133-ASA1,1161,2216
149.14
(4m) Payment is payment in full. Except for copayments, coinsurance
17or deductibles required or authorized under the plan, a provider of a covered service
18or article shall accept as payment in full for the covered service or article the payment
19rate determined under ss.
149.142, 149.143
, and 149.144
and 149.15 (3) (e) and may
20not bill an eligible person who receives the service or article for any amount by which
21the charge for the service or article is reduced under s.
149.142, 149.143
, or 149.144
22or 149.15 (3) (e).
AB133-ASA1,1161,2424
149.14
(5) (title)
Deductibles, copayments and coinsurance.
AB133-ASA1,1162,5
1149.14
(5) (e) Subject to sub. (8) (b), the department may, by rule under s. 149.17
2(4), establish copayments for prescription drug coverage under sub. (3) (d). Any
3copayment amounts or rates established are subject to the approval of the board.
4Copayments paid by an eligible person under this paragraph shall count toward the
5deductible and covered costs not paid by the plan under pars. (a) to (c).
AB133-ASA1,1162,77
149.14
(6) (title)
Preexisting conditions.
AB133-ASA1,1162,129
149.14
(8) Applicability of medical assistance provisions. (a) Except as
10provided in par. (b), the department may, by rule under s. 149.17 (4), apply to the plan
11the same utilization and cost control procedures that apply under rules promulgated
12by the department to medical assistance under subch. IV of ch. 49.
AB133-ASA1,1162,1513
(b) The department may not apply to eligible persons for covered services or
14articles the same copayments that apply to recipients of medical assistance under
15subch. IV of ch. 49 for services or articles covered under that program.
AB133-ASA1,1162,25
17149.142 Provider payment rates. (1) (a) Except as provided in par. (b), the
18department shall establish payment rates for covered expenses that consist of the
19allowable charges paid under s. 49.46 (2) for the services and articles provided plus
20an enhancement determined by the department. The rates shall be based on the
21allowable charges paid under s. 49.46 (2), projected plan costs and trend factors.
22Using the same methodology that applies to medical assistance under subch. IV of
23ch. 49, the department shall establish hospital outpatient per visit reimbursement
24rates and hospital inpatient reimbursement rates that are specific to diagnostically
25related groups of eligible persons.
AB133-ASA1,1163,2
1(b) The payment rate for a prescription drug shall be the allowable charge paid
2under s. 49.46 (2) (b) 6. h. for the prescription drug.
AB133-ASA1,1163,4
3(2) The rates established under this section are subject to adjustment under
4ss. 149.143 and 149.144.
AB133-ASA1,1163,116
149.143
(1) (intro.) The department shall pay or recover the operating
costs of
7the plan from the appropriation under s. 20.435 (4) (v) and administrative costs of
8the plan
from the appropriation under s. 20.435 (4) (u). For purposes of determining
9premiums, insurer assessments and provider payment rate adjustments, the
10department shall apportion and prioritize responsibility for payment or recovery of
11plan costs from among the moneys constituting the fund as follows:
AB133-ASA1,1163,1413
149.143
(1) (a) First from the
moneys transferred to the fund from the 14appropriation
account under s. 20.435
(5) (4) (af).
AB133-ASA1,1163,2316
149.143
(1) (b) 1. a. First, from premiums from eligible persons with coverage
17under s. 149.14 set at 150% of the rate that a standard risk would be charged under
18an individual policy providing substantially the same coverage and deductibles as
19are provided under the plan, including amounts received for premium and deductible
20subsidies
under s. 149.144 and under the transfer to the fund from the appropriation
21account under
ss. s. 20.435
(5) (4) (ah)
and 149.144, and from premiums collected
22from eligible persons with coverage under s. 149.146 set in accordance with s.
23149.146 (2) (b).
AB133-ASA1,1164,3
1149.143
(1) (b) 1. b. Second, from
the appropriation under s. 20.435 (5) (gh) 2moneys specified under sub. (2m), to the extent that the amounts under subd. 1. a.
3are insufficient to pay 60% of plan costs.
AB133-ASA1,1164,135
149.143
(1) (b) 1. c. Third, by increasing premiums from eligible persons with
6coverage under s. 149.14 to more than 150% but not more than 200% of the rate that
7a standard risk would be charged under an individual policy providing substantially
8the same coverage and deductibles as are provided under the plan, including
9amounts received for premium and deductible subsidies
under s. 149.144 and under
10the transfer to the fund from the appropriation account under
ss. s. 20.435
(5) (4) (ah)
11and 149.144, and by increasing premiums from eligible persons with coverage under
12s. 149.146 in accordance with s. 149.146 (2) (b), to the extent that the amounts under
13subd. 1. a. and b. are insufficient to pay 60% of plan costs.
AB133-ASA1,1164,1915
149.143
(1) (b) 1. d. Fourth, notwithstanding subd. 2., by increasing insurer
16assessments, excluding assessments under s. 149.144, and adjusting provider
17payment rates, excluding adjustments to those rates under
ss. s. 149.144
and 149.15
18(3) (e), in equal proportions and to the extent that the amounts under subd. 1. a. to
19c. are insufficient to pay 60% of plan costs.
