SB55-ASA1, s. 2848m 15Section 2848m. 139.76 (1) of the statutes is amended to read:
SB55-ASA1,946,216 139.76 (1) An excise tax is imposed upon the sale, offering or exposing for sale,
17possession with intent to sell or removal for consumption or sale or other disposition
18for any purpose of tobacco products by any person engaged as a distributor of them
19at the rate of 20% 30% of the manufacturer's established list price to distributors
20without diminution by volume or other discounts on domestic products. On products
21imported from another country the rate of tax is 20% 30% of the amount obtained by
22adding the manufacturer's list price to the federal tax, duties and transportation
23costs to the United States. The tax attaches at the time the tobacco products are
24received by the distributor in this state. The tax shall be passed on to the ultimate
25consumer of the tobacco products. All tobacco products received in this state for sale

1or distribution within this state, except tobacco products actually sold as provided
2in sub. (2), shall be subject to such tax.
SB55-ASA1, s. 2848n 3Section 2848n. 139.78 (1) of the statutes is amended to read:
SB55-ASA1,946,84 139.78 (1) A tax is imposed upon the use or storage by consumers of tobacco
5products in this state at the rate of 20% 30% of the cost of the tobacco products. The
6tax does not apply if the tax imposed by s. 139.76 (1) on the tobacco products has been
7paid or if the tobacco products are exempt from the tobacco products tax under s.
8139.76 (2).
SB55-ASA1, s. 2848r 9Section 2848r. 146.185 (3) of the statutes is amended to read:
SB55-ASA1,946,2010 146.185 (3) From the appropriation under s. 20.435 (5) (fh) (kb), the
11department shall in each fiscal year award up to $200,000 in grants for activities to
12improve the health status of economically disadvantaged minority group members.
13A person may apply, in the manner specified by the department, for a grant of up to
14$50,000 in each fiscal year to conduct these activities. A grant awarded An awardee
15of a grant
under this subsection may not exceed 50% of the cost of the activities. An
16applicant's required contribution for a grant
shall provide, for at least 50% of the
17grant amount, matching funds that
may consist of funding or an in-kind
18contribution. An applicant that is not a federally qualified health center, as defined
19under 42 CFR 405.2401 (b) shall receive priority for grants awarded under this
20subsection.
SB55-ASA1, s. 2848s 21Section 2848s. 146.185 (4) of the statutes is amended to read:
SB55-ASA1,946,2522 146.185 (4) From the appropriation under s. 20.435 (5) (fh) (kb), the
23department shall award a grant of up to $100,000 $50,000 in each fiscal year to a
24private nonprofit corporation that applies, in the manner specified by the
25department, to conduct a public information campaign on minority health.
SB55-ASA1, s. 1412
1Section 1412. 146.55 (2m) (a) of the statutes is repealed and recreated to read:
SB55-ASA1,947,62 146.55 (2m) (a) The department shall contract with a physician to direct the
3state emergency medical services program. The department may expend from the
4funding under the federal preventive health services project grant program under
542 USC 2476 under the appropriation under s. 20.435 (1) (mc), $25,000 in each fiscal
6year for this purpose.
SB55-ASA1, s. 2850b 7Section 2850b. 146.65 of the statutes is created to read:
SB55-ASA1,947,13 8146.65 Rural health dental clinic. From the appropriation under s. 20.435
9(5) (dm), the department shall distribute funds to the rural health dental clinic
10located in Ladysmith that provides dental services to persons in the counties of Rusk,
11Price, Taylor, Sawyer, and Chippewa who are developmentally disabled or elderly or
12who have low income. The department shall also seek federal funding to support the
13operations of the rural health dental clinic.
SB55-ASA1, s. 2850c 14Section 2850c. 149.115 of the statutes is amended to read:
SB55-ASA1,947,20 15149.115 Rules relating to creditable coverage. The commissioner, in
16consultation with the department, shall promulgate rules that specify how
17creditable coverage is to be aggregated for purposes of ss. s. 149.10 (2t) (a) and 149.14
18(6) (b) 1. a.
and that determine the creditable coverage to which ss. s. 149.10 (2t) (b)
19and (d) and 149.14 (6) (b) 1. b. and d. apply applies. The rules shall comply with
20section 2701 (c) of P.L. 104-191.
SB55-ASA1, s. 2850d 21Section 2850d. 149.13 (4) of the statutes is created to read:
SB55-ASA1,947,2522 149.13 (4) Notwithstanding subs. (1) to (3), the department, with the
23agreement of the commissioner, may perform various administrative functions
24related to the assessment of insurers participating in the cost of administering the
25plan.
SB55-ASA1, s. 2850e
1Section 2850e. 149.14 (3) (nm) of the statutes is created to read:
SB55-ASA1,948,32 149.14 (3) (nm) Hospice care provided by a hospice licensed under subch. IV
3of ch. 50.
SB55-ASA1, s. 2850f 4Section 2850f. 149.14 (5) (title) of the statutes is amended to read:
SB55-ASA1,948,65 149.14 (5) (title) Deductibles, copayments and, coinsurance, and
6out-of-pocket limits
.
SB55-ASA1, s. 2850g 7Section 2850g. 149.14 (5) (b) of the statutes is amended to read:
SB55-ASA1,948,118 149.14 (5) (b) Except as provided in par. pars. (c) and (e), if the covered costs
9incurred by the eligible person exceed the deductible for major medical expense
10coverage in a calendar year, the plan shall pay at least 80% of any additional covered
11costs incurred by the person during the calendar year.
SB55-ASA1, s. 2850h 12Section 2850h. 149.14 (5) (c) of the statutes is amended to read:
SB55-ASA1,948,1813 149.14 (5) (c) If Except as provided in par. (e), if the aggregate of the covered
14costs not paid by the plan under par. (b) and the deductible exceeds $500 for an
15eligible person receiving medicare, $2,000 for any other eligible person during a
16calendar year or $4,000 for all eligible persons in a family, the plan shall pay 100%
17of all covered costs incurred by the eligible person during the calendar year after the
18payment ceilings under this paragraph are exceeded.
SB55-ASA1, s. 2850i 19Section 2850i. 149.14 (5) (e) of the statutes is amended to read:
SB55-ASA1,949,320 149.14 (5) (e) Subject to sub. (8) (b), the department may, by rule under s. 149.17
21(4), establish copayments for prescription drug coverage under sub. (3) (d) copayment
22amounts, coinsurance rates, and copayment and coinsurance out-of-pocket limits
23over which the plan will pay 100% of covered costs under sub. (3) (d)
. Any copayment
24amounts or rates amount, coinsurance rate, or out-of-pocket limit established are
25under this paragraph is subject to the approval of the board. Copayments and

1coinsurance
paid by an eligible person under this paragraph shall are separate from
2and do not
count toward the deductible and covered costs not paid by the plan under
3pars. (a) to (c).
SB55-ASA1, s. 2850j 4Section 2850j. 149.14 (6) (b) 1. of the statutes is repealed.
SB55-ASA1, s. 2850k 5Section 2850k. 149.14 (6) (b) 2. of the statutes is renumbered 149.14 (6) (b)
6and amended to read:
SB55-ASA1,949,117 149.14 (6) (b) An eligible individual who obtains coverage under the plan on
8or after June 17, 1998,
may not be subject to any preexisting condition exclusion
9under the plan. An eligible individual who is covered under the plan on June 17,
101998, may not be subject to any preexisting condition exclusion on or after June 17,
111998.
SB55-ASA1, s. 2850Lc 12Section 2850Lc. 149.142 (1) (b) of the statutes is amended to read:
SB55-ASA1,949,1713 149.142 (1) (b) The payment rate for a prescription drug shall be the allowable
14charge paid under s. 49.46 (2) (b) 6. h. for the prescription drug. Notwithstanding
15s. 149.17 (4), the department may not reduce the payment rate for prescription drugs
16below the rate specified in this paragraph, and the rate may not be adjusted under
17s. 149.143 or 149.144.
SB55-ASA1, s. 2850Ld 18Section 2850Ld. 149.142 (2) of the statutes is amended to read:
SB55-ASA1,949,2019 149.142 (2) The Except as provided in sub. (1) (b), the rates established under
20this section are subject to adjustment under ss. 149.143 and 149.144.
SB55-ASA1, s. 2850Le 21Section 2850Le. 149.143 (1) (b) 1. d. of the statutes is amended to read:
SB55-ASA1,950,222 149.143 (1) (b) 1. d. Fourth, notwithstanding subd. 2., by increasing insurer
23assessments, excluding assessments under s. 149.144, and adjusting provider
24payment rates, subject to s. 149.142 (1) (b) and excluding adjustments to those rates

1under s. 149.144, in equal proportions and to the extent that the amounts under
2subd. 1. a. to c. are insufficient to pay 60% of plan costs.
SB55-ASA1, s. 2850Lf 3Section 2850Lf. 149.143 (1) (b) 2. b. of the statutes is amended to read:
SB55-ASA1,950,64 149.143 (1) (b) 2. b. Fifty percent from adjustments to provider payment rates,
5subject to s. 149.142 (1) (b) and excluding adjustments to those rates under s.
6149.144.
SB55-ASA1, s. 2850Lg 7Section 2850Lg. 149.143 (2) (a) 4. of the statutes is amended to read:
SB55-ASA1,950,118 149.143 (2) (a) 4. By the same rule as under subd. 3. adjust the provider
9payment rate for the new plan year, subject to s. 149.142 (1) (b), by estimating and
10setting the rate at the level necessary to equal the amounts specified in sub. (1) (b)
111. d. and 2. b. and as provided in s. 149.145.
SB55-ASA1, s. 2850Lj 12Section 2850Lj. 149.143 (2m) (b) 3. of the statutes is created to read:
SB55-ASA1,950,1713 149.143 (2m) (b) 3. For distribution to eligible persons, notwithstanding any
14requirements in this chapter related to setting premium amounts. The department,
15with the approval of the board and the concurrence of the plan actuary, shall
16determine the policies, eligibility criteria, methodology, and other factors to be used
17in making any distribution under this subdivision.
SB55-ASA1, s. 2850Lh 18Section 2850Lh. 149.143 (3) (a) of the statutes is amended to read:
SB55-ASA1,951,319 149.143 (3) (a) If, during a plan year, the department determines that the
20amounts estimated to be received as a result of the rates and amount set under sub.
21(2) (a) 2. to 4. and any adjustments in insurer assessments and the provider payment
22rate under s. 149.144 will not be sufficient to cover plan costs, the department may
23by rule increase the premium rates set under sub. (2) (a) 2. for the remainder of the
24plan year, subject to s. 149.146 (2) (b) and the maximum specified in sub. (2) (a) 2.,
25by rule increase the assessments set under sub. (2) (a) 3. for the remainder of the plan

1year, subject to sub. (1) (b) 2. a., and by the same rule under which assessments are
2increased adjust the provider payment rate set under sub. (2) (a) 4. for the remainder
3of the plan year, subject to sub. (1) (b) 2. b. and s. 149.142 (1) (b).
SB55-ASA1, s. 2850Li 4Section 2850Li. 149.143 (3) (b) of the statutes is amended to read:
SB55-ASA1,951,115 149.143 (3) (b) If the department increases premium rates and insurer
6assessments and adjusts the provider payment rate under par. (a) and determines
7that there will still be a deficit and that premium rates have been increased to the
8maximum extent allowable under par. (a), the department may further adjust, in
9equal proportions, assessments set under sub. (2) (a) 3. and the provider payment
10rate set under sub. (2) (a) 4., without regard to sub. (1) (b) 2. but subject to s. 149.142
11(1) (b).
SB55-ASA1, s. 2850Lj 12Section 2850Lj. 149.143 (5) (a) of the statutes is amended to read:
SB55-ASA1,951,1913 149.143 (5) (a) Annually, no later than April 30, the department shall perform
14a reconciliation with respect to plan costs, premiums, insurer assessments, and
15provider payment rate adjustments based on data from the previous calendar year.
16On the basis of the reconciliation, the department shall make any necessary
17adjustments in premiums, insurer assessments, or provider payment rates, subject
18to s. 149.142 (1) (b),
for the fiscal year beginning on the first July 1 after the
19reconciliation, as provided in sub. (2) (b).
SB55-ASA1, s. 2850Lk 20Section 2850Lk. 149.143 (5) (b) of the statutes is amended to read:
SB55-ASA1,952,221 149.143 (5) (b) Except as provided in sub. (3) and s. 149.144, the department
22shall adjust the provider payment rates to meet the providers' specified portion of the
23plan costs no more than once annually, subject to s. 149.142 (1) (b). The department
24may not determine the adjustment on an individual provider basis or on the basis

1of provider type, but shall determine the adjustment for all providers in the
2aggregate, subject to s. 149.142 (1) (b).
SB55-ASA1, s. 2850Lm 3Section 2850Lm. 149.144 of the statutes is amended to read:
SB55-ASA1,952,18 4149.144 Adjustments to insurer assessments and provider payment
5rates for premium and deductible reductions.
If the moneys transferred to the
6fund under the appropriation under s. 20.435 (4) (ah) are insufficient to reimburse
7the plan for premium reductions under s. 149.165 and deductible reductions under
8s. 149.14 (5) (a), or the department determines that the moneys transferred or to be
9transferred to the fund under the appropriation under s. 20.435 (4) (ah) will be
10insufficient to reimburse the plan for premium reductions under s. 149.165 and
11deductible reductions under s. 149.14 (5) (a), the department may, by rule, adjust in
12equal proportions the amount of the assessment set under s. 149.143 (2) (a) 3. and
13the provider payment rate set under s. 149.143 (2) (a) 4., subject to s. ss. 149.142 (1)
14(b) and
149.143 (1) (b) 1., sufficient to reimburse the plan for premium reductions
15under s. 149.165 and deductible reductions under s. 149.14 (5) (a). If the department
16makes the adjustment under this section, the department shall notify the
17commissioner so that the commissioner may levy any increase in insurer
18assessments.
SB55-ASA1, s. 2850Ln 19Section 2850Ln. 149.145 of the statutes is amended to read:
SB55-ASA1,953,6 20149.145 Program budget. The department, in consultation with the board,
21shall establish a program budget for each plan year. The program budget shall be
22based on the provider payment rates specified in s. 149.142 and in the most recent
23provider contracts that are in effect and on the funding sources specified in s. 149.143
24(1), including the methodologies specified in ss. 149.143, 149.144 , and 149.146 for
25determining premium rates, insurer assessments, and provider payment rates.

1Except as otherwise provided in s. 149.143 (3) (a) and (b) and subject to s. 149.142
2(1) (b)
, from the program budget the department shall derive the actual provider
3payment rate for a plan year that reflects the providers' proportional share of the
4plan costs, consistent with ss. 149.143 and 149.144. The department may not
5implement a program budget established under this section unless it is approved by
6the board.
SB55-ASA1, s. 2850m 7Section 2850m. 149.146 (1) (b) 1. of the statutes is repealed.
SB55-ASA1, s. 2850p 8Section 2850p. 149.146 (1) (b) 2. of the statutes is renumbered 149.146 (1) (b).
SB55-ASA1, s. 2850q 9Section 2850q. 149.146 (2) (am) 2. of the statutes is amended to read:
SB55-ASA1,953,1310 149.146 (2) (am) 2. Except as provided in subd. subds. 3. and 5., if the covered
11costs incurred by the eligible person exceed the deductible for major medical expense
12coverage in a calendar year, the plan shall pay at least 80% of any additional covered
13costs incurred by the person during the calendar year.
SB55-ASA1, s. 2850r 14Section 2850r. 149.146 (2) (am) 3. of the statutes is amended to read:
SB55-ASA1,953,2015 149.146 (2) (am) 3. If Except as provided in subd. 5., if the aggregate of the
16covered costs not paid by the plan under subd. 2. and the deductible exceeds $3,500
17for any eligible person during a calendar year or $7,000 for all eligible persons in a
18family, the plan shall pay 100% of all covered costs incurred by the eligible person
19during the calendar year after the payment ceilings under this subdivision are
20exceeded.
SB55-ASA1, s. 2850s 21Section 2850s. 149.146 (2) (am) 5. of the statutes is created to read:
SB55-ASA1,954,522 149.146 (2) (am) 5. Subject to s. 149.14 (8) (b), the department may, by rule
23under s. 149.17 (4), establish for prescription drug coverage under this section
24copayment amounts, coinsurance rates, and copayment and coinsurance
25out-of-pocket limits over which the plan will pay 100% of covered costs for

1prescription drugs. Any copayment amount, coinsurance rate, or out-of-pocket
2limit established under this subdivision is subject to the approval of the board.
3Copayments and coinsurance paid by an eligible person under this subdivision are
4separate from and do not count toward the deductible and covered costs not paid by
5the plan under subds. 1. to 3.
SB55-ASA1, s. 2850w 6Section 2850w. 149.15 (1) of the statutes is amended to read:
SB55-ASA1,954,247 149.15 (1) The plan shall have a board of governors consisting of
8representatives of 2 participating insurers which that are nonprofit corporations,
9representatives of 2 other participating insurers, 3 health care provider
10representatives, including one representative of the State Medical Society of
11Wisconsin, one representative of the Wisconsin Health and Hospital Association and
12one representative of an integrated multidisciplinary health system, and 3 4 public
13members, including one representative of small businesses in the state, appointed
14by the secretary for staggered 3-year terms. In addition, the commissioner, or a
15designated representative from the office of the commissioner, and the secretary, or
16a designated representative from the department, shall be members of the board.
17The public members shall not be professionally affiliated with the practice of
18medicine, a hospital, or an insurer. At least 2 one of the public members shall be
19individuals reasonably expected to qualify for an individual who has coverage under
20the plan or the parent or spouse of such an individual. The secretary or the
21secretary's representative shall be the chairperson of the board. Board members,
22except the commissioner or the commissioner's representative and the secretary or
23the secretary's representative, shall be compensated at the rate of $50 per diem plus
24actual and necessary expenses.
SB55-ASA1, s. 2850x 25Section 2850x. 149.25 of the statutes is created to read:
SB55-ASA1,955,1
1149.25 Case management pilot program. (1) Definitions. In this section:
SB55-ASA1,955,52 (a) "Chronic disease" means any disease, illness, impairment, or other physical
3condition that requires health care and treatment over a prolonged period and,
4although amenable to treatment, is irreversible and frequently progresses to
5increasing disability or death.
SB55-ASA1,955,86 (b) "Health professional shortage area" means an area that is designated by the
7federal department of health and human services under 42 CFR part 5, appendix A,
8as having a shortage of medical care professionals.
SB55-ASA1,955,11 9(2) Program and eligibility requirements. (a) The department shall conduct
10a 3-year pilot program, beginning on July 1, 2002, under which eligible persons who
11qualify under par. (b) are provided community-based case management services.
SB55-ASA1,955,1312 (b) To be eligible to participate in the pilot program, an eligible person must
13satisfy any of the following criteria:
SB55-ASA1,955,1414 1. Be diagnosed as having a chronic disease.
SB55-ASA1,955,1515 2. Be taking 2 or more prescribed medications on a regular basis.
SB55-ASA1,955,1816 3. Within 6 months of applying for the pilot program, have been treated 2 or
17more times at a hospital emergency room or have been admitted 2 or more times to
18a hospital as an inpatient.
SB55-ASA1,955,2219 (c) 1. Participation in the pilot program shall be voluntary and limited to no
20more than 300 eligible persons. The department shall ensure that all eligible
21persons are advised in a timely manner of the opportunity to participate in the pilot
22program and of how to apply for participation.
SB55-ASA1,956,223 2. If more than 300 eligible persons apply to participate, the department shall
24select pilot program participants from among those who qualify under par. (b)
25according to standards determined by the department, except that the department

1shall give preference to eligible persons who reside in medically underserved areas
2or health professional shortage areas.
SB55-ASA1,956,6 3(3) Provider organization and services requirements. (a) The department
4shall select and contract with an organization to provide the community-based case
5management services under the pilot program. To be eligible to provide the services,
6an organization must satisfy all of the following criteria:
SB55-ASA1,956,97 1. Be a private, nonprofit, integrated health care system that provides access
8to health care in a medically underserved area of the state or in a health professional
9shortage area.
SB55-ASA1,956,1110 2. Operate an existing community-based case management program with
11demonstrated successful client and program outcomes.
SB55-ASA1,956,1412 3. Demonstrate an ability to assemble and coordinate an interdisciplinary
13team of health care professionals, including physicians, nurses, and pharmacists, for
14assessment of a program participant's treatment plan.
SB55-ASA1,956,1815 (b) The community-based case management services under the pilot program
16shall be provided by a team, consisting of a nurse case manager, a pharmacist, and
17a social worker, working in collaboration with the eligible person's primary care
18physician or other provider. Services to be provided include all of the following:
SB55-ASA1,956,1919 1. An initial intake assessment.
SB55-ASA1,956,2020 2. Development of a treatment plan based on best practices.
SB55-ASA1,956,2121 3. Coordination of health care services.
SB55-ASA1,956,2222 4. Patient education.
SB55-ASA1,956,2323 5. Family support.
SB55-ASA1,956,2424 6. Monitoring and reporting of patient outcomes and costs.
SB55-ASA1,957,2
1(c) The department shall pay contract costs from the appropriation under s.
220.435 (4) (u).
SB55-ASA1,957,11 3(4) Evaluation study. The department shall conduct a study that evaluates the
4pilot program in terms of health care outcomes and cost avoidance. In the study, the
5department shall measure and compare, for pilot program participants and similarly
6situated eligible persons not participating in the pilot program, plan costs and
7utilization of services, including inpatient hospital days, rates of hospital
8readmission within 30 days for the same diagnosis, and prescription drug utilization.
9The department shall submit a report on the results of the study, including the
10department's conclusions and recommendations, to the legislature under s. 13.172
11(2) and to the governor.
SB55-ASA1, s. 2850y 12Section 2850y. 150.345 of the statutes is created to read:
SB55-ASA1,957,15 13150.345 Nursing home bed transfers. (1) Notwithstanding ss. 150.33 and
14150.34, a nursing home may transfer a licensed bed to another nursing home, if all
15of the following apply:
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