SB45-SSA1, s. 2261j 16Section 2261j. 149.142 of the statutes is created to read:
SB45-SSA1,1162,25 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.
SB45-SSA1,1163,2
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.
SB45-SSA1,1163,4 3(2) The rates established under this section are subject to adjustment under
4ss. 149.143 and 149.144.
SB45-SSA1, s. 2261m 5Section 2261m. 149.143 (1) (intro.) of the statutes is amended to read:
SB45-SSA1,1163,116 149.143 (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:
SB45-SSA1, s. 2262b 12Section 2262b. 149.143 (1) (a) of the statutes is amended to read:
SB45-SSA1,1163,1413 149.143 (1) (a) First from the moneys transferred to the fund from the
14appropriation account under s. 20.435 (5) (4) (af).
SB45-SSA1, s. 2263b 15Section 2263b. 149.143 (1) (b) 1. a. of the statutes is amended to read:
SB45-SSA1,1163,2316 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).
SB45-SSA1, s. 2263bm 24Section 2263bm. 149.143 (1) (b) 1. b. of the statutes is amended to read:
SB45-SSA1,1164,3
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.
SB45-SSA1, s. 2263bn 4Section 2263bn. 149.143 (1) (b) 1. c. of the statutes is amended to read:
SB45-SSA1,1164,135 149.143 (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.
SB45-SSA1, s. 2263bp 14Section 2263bp. 149.143 (1) (b) 1. d. of the statutes is amended to read:
SB45-SSA1,1164,1915 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.
SB45-SSA1, s. 2264e 20Section 2264e. 149.143 (1) (b) 2. b. of the statutes is amended to read:
SB45-SSA1,1164,2221 149.143 (1) (b) 2. b. Fifty percent from adjustments to provider payment rates,
22excluding adjustments to those rates under ss. s. 149.144 and 149.15 (3) (e).
SB45-SSA1, s. 2265b 23Section 2265b. 149.143 (2) (a) 1. a. of the statutes is amended to read:
SB45-SSA1,1165,724 149.143 (2) (a) 1. a. Estimate the amount of enrollee premiums that would be
25received in the new plan year if the enrollee premiums were set at a level sufficient,

1when including amounts received for premium and deductible subsidies under s.
2149.144 and under the transfer to the fund from the appropriation account
under ss.
3s. 20.435 (5) (4) (ah) and 149.144 and from premiums collected from eligible persons
4with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b), to cover 60%
5of the estimated plan costs for the new plan year, after deducting from the estimated
6plan costs the amount available in for transfer to the fund from the appropriation
7account under s. 20.435 (5) (4) (af) for that plan year.
SB45-SSA1, s. 2265bm 8Section 2265bm. 149.143 (2) (a) 1. c. of the statutes is repealed.
SB45-SSA1, s. 2266g 9Section 2266g. 149.143 (2m) of the statutes is created to read:
SB45-SSA1,1165,1110 149.143 (2m) (a) The department shall keep a separate accounting of the
11difference between the following:
SB45-SSA1,1165,1312 1. The amount of premiums received in a plan year from all eligible persons,
13including amounts received for premium and deductible subsidies.
SB45-SSA1,1165,1714 2. The amount of premiums, including amounts received for premium and
15deductible subsidies, necessary to cover 60% of the plan costs for the plan year, after
16deducting the amount transferred to the fund from the appropriation account under
17s. 20.435 (4) (af).
SB45-SSA1,1165,1918 (b) Any amount by which the amount under par. (a) 1. exceeds the amount
19under par. (a) 2. may be used only as follows:
SB45-SSA1,1165,2420 1. To reduce premiums in succeeding plan years as provided in sub. (1) (b) 1.
21b. For eligible persons with coverage under s. 149.14, premiums may not be reduced
22below 150% of the rate that a standard risk would be charged under an individual
23policy providing substantially the same coverage and deductibles as are provided
24under the plan.
SB45-SSA1,1165,2525 2. For other needs of eligible persons, with the approval of the board.
SB45-SSA1, s. 2267j
1Section 2267j. 149.143 (3) (b) of the statutes is amended to read:
SB45-SSA1,1166,82 149.143 (3) (b) If, after increasing the department increases premium rates
3and insurer assessments and adjusting adjusts the provider payment rate under par.
4(a), the department and determines that there will still be a deficit and that premium
5rates have been increased to the maximum extent allowable under par. (a), the
6department shall may further adjust, in equal proportions, assessments set under
7sub. (2) (a) 3. and the provider payment rate set under sub. (2) (a) 4., without regard
8to sub. (1) (b) 2.
SB45-SSA1, s. 2267m 9Section 2267m. 149.143 (5) of the statutes is created to read:
SB45-SSA1,1166,1610 149.143 (5) (a) Annually, no later than April 30, the department shall perform
11a reconciliation with respect to plan costs, premiums, insurer assessments and
12provider payment rate adjustments based on data from the previous calendar year.
13On the basis of the reconciliation, the department shall make any necessary
14adjustments in premiums, insurer assessments or provider payment rates for the
15fiscal year beginning on the first July 1 after the reconciliation, as provided in sub.
16(2) (b).
SB45-SSA1,1166,2117 (b) Except as provided in sub. (3) and s. 149.144, the department shall adjust
18the provider payment rates to meet the providers' specified portion of the plan costs
19no more than once annually. The department may not determine the adjustment on
20an individual provider basis or on the basis of provider type, but shall determine the
21adjustment for all providers in the aggregate.
SB45-SSA1, s. 2267r 22Section 2267r. 149.144 of the statutes is amended to read:
SB45-SSA1,1167,11 23149.144 Adjustments to insurer assessments and provider payment
24rates for premium and deductible reductions.
If the moneys transferred to the
25fund under the appropriation
under s. 20.435 (5) (4) (ah) are insufficient to reimburse

1the plan for premium reductions under s. 149.165 and deductible reductions under
2s. 149.14 (5) (a), or the department determines that the moneys transferred or to be
3transferred to the fund under the appropriation
under s. 20.435 (5) (4) (ah) will be
4insufficient to reimburse the plan for premium reductions under s. 149.165 and
5deductible reductions under s. 149.14 (5) (a), the department shall may, by rule,
6adjust in equal proportions the amount of the assessment set under s. 149.143 (2) (a)
73. and the provider payment rate set under s. 149.143 (2) (a) 4., subject to s. 149.143
8(1) (b) 1., sufficient to reimburse the plan for premium reductions under s. 149.165
9and deductible reductions under s. 149.14 (5) (a). The If the department makes the
10adjustment under this section, the
department shall notify the commissioner so that
11the commissioner may levy any increase in insurer assessments.
SB45-SSA1, s. 2268m 12Section 2268m. 149.145 of the statutes is amended to read:
SB45-SSA1,1167,23 13149.145 Program budget. The department, in consultation with the board,
14shall establish a program budget for each plan year. The program budget shall be
15based on the provider payment rates specified in s. 149.15 (3) (e) 149.142 and in the
16most recent provider contracts that are in effect and on the funding sources specified
17in s. 149.143 (1), including the methodologies specified in ss. 149.143, 149.144 and
18149.146 for determining premium rates, insurer assessments and provider payment
19rates. Except as otherwise provided in s. 149.143 (3) (a) and (b), from the program
20budget the department shall derive the actual provider payment rate for a plan year
21that reflects the providers' proportional share of the plan costs, consistent with ss.
22149.143 and 149.144. The department may not implement a program budget
23established under this section unless it is approved by the board.
SB45-SSA1, s. 2269 24Section 2269. 149.146 (1) (a) of the statutes is amended to read:
SB45-SSA1,1168,4
1149.146 (1) (a) Beginning on January 1, 1998, in addition to the coverage
2required under s. 149.14, the plan shall offer to all eligible persons who are not
3eligible for medicare
a choice of coverage, as described in section 2744 (a) (1) (C), P.L.
4104-191. Any such choice of coverage shall be major medical expense coverage.
SB45-SSA1, s. 2270 5Section 2270. 149.146 (1) (b) 2. of the statutes is amended to read:
SB45-SSA1,1168,146 149.146 (1) (b) 2. An eligible person under par. (a) may elect once each year, at
7the time and according to procedures established by the department, among the
8coverages offered under this section and s. 149.14. If an eligible person elects new
9coverage, any preexisting condition exclusion imposed under the new coverage is met
10to the extent that the eligible person has been previously and continuously covered
11under this chapter. No preexisting condition exclusion may be imposed on an eligible
12person who elects new coverage if the person was an eligible individual when first
13covered under this chapter and the person remained continuously covered under this
14chapter up to the time of electing the new coverage.
SB45-SSA1, s. 2271 15Section 2271. 149.146 (2) (am) of the statutes is created to read:
SB45-SSA1,1168,1916 149.146 (2) (am) 1. For all eligible persons with coverage under this section,
17the deductible shall be $2,500. Expenses used to satisfy the deductible during the
18last 90 days of a calendar year shall also be applied to satisfy the deductible for the
19following calendar year.
SB45-SSA1,1168,2320 2. Except as provided in subd. 3., if the covered costs incurred by the eligible
21person exceed the deductible for major medical expense coverage in a calendar year,
22the plan shall pay at least 80% of any additional covered costs incurred by the person
23during the calendar year.
SB45-SSA1,1169,324 3. If the aggregate of the covered costs not paid by the plan under subd. 2. and
25the deductible exceeds $3,500 for any eligible person during a calendar year or $7,000

1for all eligible persons in a family, the plan shall pay 100% of all covered costs
2incurred by the eligible person during the calendar year after the payment ceilings
3under this subdivision are exceeded.
SB45-SSA1,1169,84 4. Notwithstanding subds. 1. to 3., the department may establish different
5deductible amounts, a different coinsurance percentage and different covered costs
6and deductible aggregate amounts from those specified in subds. 1. to 3. in
7accordance with cost containment provisions established by the department under
8s. 149.17 (4).
SB45-SSA1, s. 2276m 9Section 2276m. 149.15 (3) (e) of the statutes is repealed.
SB45-SSA1, s. 2277c 10Section 2277c. 149.15 (3) (g) of the statutes is created to read:
SB45-SSA1,1169,1411 149.15 (3) (g) Establish oversight committees to address various
12administrative issues, such as financial management of the plan and plan
13administrator performance standards. A representative of the department may not
14be the chairperson of any committee established under this paragraph.
SB45-SSA1, s. 2277d 15Section 2277d. 149.16 (4) of the statutes is created to read:
SB45-SSA1,1169,1716 149.16 (4) The plan administrator shall account for costs related to the plan
17separately from costs related to medical assistance under subch. IV of ch. 49.
SB45-SSA1, s. 2277f 18Section 2277f. 149.16 (5) of the statutes is created to read:
SB45-SSA1,1169,2019 149.16 (5) The department shall obtain the approval of the board before
20implementing any contract with the plan administrator.
SB45-SSA1, s. 2278b 21Section 2278b. 149.165 (4) of the statutes is amended to read:
SB45-SSA1,1169,2422 149.165 (4) The department shall reimburse the plan for premium reductions
23under sub. (2) and deductible reductions under s. 149.14 (5) (a) with moneys
24transferred to the fund from the appropriation account under s. 20.435 (5) (4) (ah).
SB45-SSA1, s. 2278c 25Section 2278c. 149.17 (2) of the statutes is amended to read:
SB45-SSA1,1170,2
1149.17 (2) A schedule of premiums, deductibles , copayments and coinsurance
2payments which that complies with all requirements of this chapter.
SB45-SSA1, s. 2278g 3Section 2278g. 149.17 (4) of the statutes is amended to read:
SB45-SSA1,1170,84 149.17 (4) Cost containment provisions established by the department by rule,
5including managed care requirements. The department shall obtain the approval of
6the board before promulgating a rule that establishes a cost containment provision
7that would have an effect on an eligible person's access to health care services, such
8as the creation of new prior authorization requirements.
SB45-SSA1, s. 2278r 9Section 2278r. 150.46 (3) of the statutes is created to read:
SB45-SSA1,1170,1110 150.46 (3) This subchapter does not apply to the nursing care facility operated
11by the department of veterans affairs under s. 45.385.
SB45-SSA1, s. 2280 12Section 2280. 153.05 (6m) of the statutes is amended to read:
SB45-SSA1,1170,1813 153.05 (6m) The department may contract with the group insurance board for
14the provision of data collection and analysis services related to health maintenance
15organizations and insurance companies that provide health insurance for state
16employes. The department shall establish contract fees for the provision of the
17services. All moneys collected under this subsection shall be credited to the
18appropriation under s. 20.435 (1) (4) (hg).
SB45-SSA1, s. 2280n 19Section 2280n. 153.50 (5m) of the statutes is created to read:
SB45-SSA1,1170,2220 153.50 (5m) Employers not to request patient-identifiable data.
21Notwithstanding subs. (4) and (5) no employer may request the release of or access
22to patient-identifiable data of an employe of the employer.
SB45-SSA1, s. 2281 23Section 2281. 153.60 (1) of the statutes is amended to read:
SB45-SSA1,1171,1924 153.60 (1) The department shall, by the first October 1 after the
25commencement of each fiscal year, estimate the total amount of expenditures under

1this chapter for the department and the board for that fiscal year for data collection,
2data base development and maintenance, generation of data files and standard
3reports, orientation and training provided under s. 153.05 (9) and maintaining the
4board. The department shall assess the estimated total amount for that fiscal year
5less the estimated total amount to be received for purposes of administration of this
6chapter under s. 20.435 (1) (4) (hi) during the fiscal year, the unencumbered balance
7of the amount received for purposes of administration of this chapter under s. 20.435
8(1) (4) (hi) from the prior fiscal year and the amount in the appropriation account
9under s. 20.435 (1) (dg) for the fiscal year, to health care providers who are in a class
10of health care providers from whom the department collects data under this chapter
11in a manner specified by the department by rule. The department shall obtain
12approval from the board for the amounts of assessments for health care providers
13other than hospitals and ambulatory surgery centers. The department shall work
14together with the department of regulation and licensing to develop a mechanism for
15collecting assessments from health care providers other than hospitals and
16ambulatory surgery centers. No health care provider that is not a facility may be
17assessed under this subsection an amount that exceeds $75 per fiscal year. Each
18hospital shall pay the assessment on or before December 1. All payments of
19assessments shall be deposited in the appropriation under s. 20.435 (1) (4) (hg).
SB45-SSA1, s. 2282 20Section 2282. 153.60 (3) of the statutes is amended to read:
SB45-SSA1,1172,621 153.60 (3) The department shall, by the first October 1 after the
22commencement of each fiscal year, estimate the total amount of expenditures
23required for the collection, database development and maintenance and generation
24of public data files and standard reports for health care plans that voluntarily agree
25to supply health care data under s. 153.05 (6r). The department shall assess the

1estimated total amount for that fiscal year to health care plans in a manner specified
2by the department by rule and may enter into an agreement with the office of the
3commissioner of insurance for collection of the assessments. Each health plan that
4voluntarily agrees to supply this information shall pay the assessments on or before
5December 1. All payments of assessments shall be deposited in the appropriation
6under s. 20.435 (1) (4) (hg) and may be used solely for the purposes of s. 153.05 (6r).
SB45-SSA1, s. 2283 7Section 2283. 153.65 of the statutes is amended to read:
SB45-SSA1,1172,14 8153.65 Provision of special information; user fees. The department may,
9but is not required to, provide, upon request from a person, a data compilation or a
10special report based on the information collected by the department. The
11department shall establish user fees for the provision of these compilations or
12reports, payable by the requester, which shall be sufficient to fund the actual
13necessary and direct cost of the compilation or report. All moneys collected under
14this section shall be credited to the appropriation under s. 20.435 (1) (4) (hi).
SB45-SSA1, s. 2283m 15Section 2283m. 154.17 (1) of the statutes is amended to read:
SB45-SSA1,1172,2116 154.17 (1) "Do-not-resuscitate bracelet" means a standardized identification
17bracelet of uniform size, color, and design, that meets the specifications established
18under s. 154.27 (1), or that is
approved by the department under s. 154.27 (2), that
19bears the inscription "Do Not Resuscitate" and signifies that the wearer is a qualified
20patient who has obtained a do-not-resuscitate order and that the order has not been
21revoked.
SB45-SSA1, s. 2283n 22Section 2283n. 154.19 (2) (b) of the statutes is renumbered 154.19 (2) (b)
23(intro.) and amended to read:
SB45-SSA1,1173,324 154.19 (2) (b) (intro.) After providing the information under par. (a), the
25attending physician, or the person directed by the attending physician, shall affix

1document in the patient's medical record the medical condition that qualifies the
2patient for the do-not-resuscitate order, shall make the order in writing and shall
3do one of the following, as requested by the qualified patient:
SB45-SSA1,1173,7 41. Affix to the wrist of the patient a do-not-resuscitate bracelet and document
5in the patient's medical record the medical condition that qualifies the patient for the
6do-not-resuscitate order
that meets the specifications established under s. 154.27
7(1)
.
SB45-SSA1, s. 2283p 8Section 2283p. 154.19 (2) (b) 2. of the statutes is created to read:
SB45-SSA1,1173,119 154.19 (2) (b) 2. Provide an order form from a commercial vendor approved by
10the department under s. 154.27 (2) to permit the patient to order a
11do-not-resuscitate bracelet from the commercial vendor.
SB45-SSA1, s. 2283q 12Section 2283q. 154.27 of the statutes is renumbered 154.27 (1) and amended
13to read:
SB45-SSA1,1173,1914 154.27 (1) The department shall establish by rule a uniform standard for the
15size, color, and design of all do-not-resuscitate bracelets. The Except as provided in
16sub. (2), the
rules shall require that the do-not-resuscitate bracelets include the
17inscription "Do Not Resuscitate"; the name, address, date of birth and gender of the
18patient; and the name, business telephone number and signature of the attending
19physician issuing the order.
SB45-SSA1, s. 2283r 20Section 2283r. 154.27 (2) of the statutes is created to read:
SB45-SSA1,1174,221 154.27 (2) The department may approve a do-not-resuscitate bracelet
22developed and distributed by a commercial vendor if the bracelet contains an emblem
23that displays an internationally recognized medical symbol on the front and the
24words "Wisconsin Do-Not-Resuscitate-EMS" and the qualified patient's first and
25last name on the back. The department may not approve a do-not-resuscitate

1bracelet developed and distributed by a commercial vendor if the vendor does not
2require a doctor's order for the bracelet prior to distributing it to a patient.
SB45-SSA1, s. 2288b 3Section 2288b. 165.755 (1) (a) of the statutes is amended to read:
SB45-SSA1,1174,84 165.755 (1) (a) Except as provided in par. (b), beginning on October 14, 1997,
5a court shall impose a crime laboratories and drug law enforcement assessment of
6$4 $5 if the court imposes a sentence, places a person on probation or imposes a
7forfeiture for a violation of state law or for a violation of a municipal or county
8ordinance.
SB45-SSA1, s. 2288f 9Section 2288f. 165.76 (1) (a) of the statutes is amended to read:
SB45-SSA1,1174,1410 165.76 (1) (a) Is in prison or a secured correctional facility, as defined in s.
11938.02 (15m), or a secured child caring institution, as defined in s. 938.02 (15g) or on
12probation, extended supervision, parole, supervision or aftercare supervision on or
13after August 12, 1993, for any violation of s. 940.225 (1) or (2), 948.02 (1) or (2) or
14948.025.
SB45-SSA1, s. 2288h 15Section 2288h. 165.76 (1) (ag) of the statutes is created to read:
SB45-SSA1,1174,1716 165.76 (1) (ag) Is in prison on or after August 12, 1993, and before January 1,
172000, for any violation of s. 940.225 (1) or (2), 948.02 (1) or (2) or 948.025.
SB45-SSA1, s. 2288i 18Section 2288i. 165.76 (1) (ar) of the statutes is created to read:
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