Amendment ASA1-SB55

SB55-ASA1, s. 2850Ld Section 2850Ld. 149.142 (2) of the statutes is amended to read:

SB55-ASA1,949,20 149.142 (2) The Except as provided in sub. (1) (b), the rates established under this section are subject to adjustment under ss. 149.143 and 149.144.

SB55-ASA1, s. 2850Le Section 2850Le. 149.143 (1) (b) 1. d. of the statutes is amended to read:

SB55-ASA1,950,2 149.143 (1) (b) 1. d. Fourth, notwithstanding subd. 2., by increasing insurer assessments, excluding assessments under s. 149.144, and adjusting provider payment rates, subject to s. 149.142 (1) (b) and excluding adjustments to those rates under s. 149.144, in equal proportions and to the extent that the amounts under subd. 1. a. to c. are insufficient to pay 60% of plan costs.

SB55-ASA1, s. 2850Lf Section 2850Lf. 149.143 (1) (b) 2. b. of the statutes is amended to read:

SB55-ASA1,950,6 149.143 (1) (b) 2. b. Fifty percent from adjustments to provider payment rates, subject to s. 149.142 (1) (b) and excluding adjustments to those rates under s. 149.144.

SB55-ASA1, s. 2850Lg Section 2850Lg. 149.143 (2) (a) 4. of the statutes is amended to read:

SB55-ASA1,950,11 149.143 (2) (a) 4. By the same rule as under subd. 3. adjust the provider payment rate for the new plan year, subject to s. 149.142 (1) (b), by estimating and setting the rate at the level necessary to equal the amounts specified in sub. (1) (b) 1. d. and 2. b. and as provided in s. 149.145.

SB55-ASA1, s. 2850Lj Section 2850Lj. 149.143 (2m) (b) 3. of the statutes is created to read:

SB55-ASA1,950,17 149.143 (2m) (b) 3. For distribution to eligible persons, notwithstanding any requirements in this chapter related to setting premium amounts. The department, with the approval of the board and the concurrence of the plan actuary, shall determine the policies, eligibility criteria, methodology, and other factors to be used in making any distribution under this subdivision.

SB55-ASA1, s. 2850Lh Section 2850Lh. 149.143 (3) (a) of the statutes is amended to read:

SB55-ASA1,951,3 149.143 (3) (a) If, during a plan year, the department determines that the amounts estimated to be received as a result of the rates and amount set under sub. (2) (a) 2. to 4. and any adjustments in insurer assessments and the provider payment rate under s. 149.144 will not be sufficient to cover plan costs, the department may by rule increase the premium rates set under sub. (2) (a) 2. for the remainder of the plan year, subject to s. 149.146 (2) (b) and the maximum specified in sub. (2) (a) 2., by rule increase the assessments set under sub. (2) (a) 3. for the remainder of the plan year, subject to sub. (1) (b) 2. a., and by the same rule under which assessments are increased adjust the provider payment rate set under sub. (2) (a) 4. for the remainder of the plan year, subject to sub. (1) (b) 2. b. and s. 149.142 (1) (b).

SB55-ASA1, s. 2850Li Section 2850Li. 149.143 (3) (b) of the statutes is amended to read:

SB55-ASA1,951,11 149.143 (3) (b) If the department increases premium rates and insurer assessments and adjusts the provider payment rate under par. (a) and determines that there will still be a deficit and that premium rates have been increased to the maximum extent allowable under par. (a), the department may further adjust, in equal proportions, assessments set under sub. (2) (a) 3. and the provider payment rate set under sub. (2) (a) 4., without regard to sub. (1) (b) 2. but subject to s. 149.142 (1) (b).

SB55-ASA1, s. 2850Lj Section 2850Lj. 149.143 (5) (a) of the statutes is amended to read:

SB55-ASA1,951,19 149.143 (5) (a) Annually, no later than April 30, the department shall perform a reconciliation with respect to plan costs, premiums, insurer assessments, and provider payment rate adjustments based on data from the previous calendar year. On the basis of the reconciliation, the department shall make any necessary adjustments in premiums, insurer assessments, or provider payment rates, subject to s. 149.142 (1) (b), for the fiscal year beginning on the first July 1 after the reconciliation, as provided in sub. (2) (b).

SB55-ASA1, s. 2850Lk Section 2850Lk. 149.143 (5) (b) of the statutes is amended to read:

SB55-ASA1,952,2 149.143 (5) (b) Except as provided in sub. (3) and s. 149.144, the department shall adjust the provider payment rates to meet the providers' specified portion of the plan costs no more than once annually, subject to s. 149.142 (1) (b). The department may not determine the adjustment on an individual provider basis or on the basis of provider type, but shall determine the adjustment for all providers in the aggregate, subject to s. 149.142 (1) (b).

SB55-ASA1, s. 2850Lm Section 2850Lm. 149.144 of the statutes is amended to read:

SB55-ASA1,952,18 149.144 Adjustments to insurer assessments and provider payment rates for premium and deductible reductions. If the moneys transferred to the fund under the appropriation under s. 20.435 (4) (ah) are insufficient to reimburse the plan for premium reductions under s. 149.165 and deductible reductions under s. 149.14 (5) (a), or the department determines that the moneys transferred or to be transferred to the fund under the appropriation under s. 20.435 (4) (ah) will be insufficient to reimburse the plan for premium reductions under s. 149.165 and deductible reductions under s. 149.14 (5) (a), the department may, by rule, adjust in equal proportions the amount of the assessment set under s. 149.143 (2) (a) 3. and the provider payment rate set under s. 149.143 (2) (a) 4., subject to s. ss. 149.142 (1) (b) and 149.143 (1) (b) 1., sufficient to reimburse the plan for premium reductions under s. 149.165 and deductible reductions under s. 149.14 (5) (a). If the department makes the adjustment under this section, the department shall notify the commissioner so that the commissioner may levy any increase in insurer assessments.

SB55-ASA1, s. 2850Ln Section 2850Ln. 149.145 of the statutes is amended to read:

SB55-ASA1,953,6 149.145 Program budget. The department, in consultation with the board, shall establish a program budget for each plan year. The program budget shall be based on the provider payment rates specified in s. 149.142 and in the most recent provider contracts that are in effect and on the funding sources specified in s. 149.143 (1), including the methodologies specified in ss. 149.143, 149.144 , and 149.146 for determining premium rates, insurer assessments, and provider payment rates. Except as otherwise provided in s. 149.143 (3) (a) and (b) and subject to s. 149.142 (1) (b), from the program budget the department shall derive the actual provider payment rate for a plan year that reflects the providers' proportional share of the plan costs, consistent with ss. 149.143 and 149.144. The department may not implement a program budget established under this section unless it is approved by the board.

SB55-ASA1, s. 2850m Section 2850m. 149.146 (1) (b) 1. of the statutes is repealed.

SB55-ASA1, s. 2850p Section 2850p. 149.146 (1) (b) 2. of the statutes is renumbered 149.146 (1) (b).

SB55-ASA1, s. 2850q Section 2850q. 149.146 (2) (am) 2. of the statutes is amended to read:

SB55-ASA1,953,13 149.146 (2) (am) 2. Except as provided in subd. subds. 3. and 5., if the covered costs incurred by the eligible person exceed the deductible for major medical expense coverage in a calendar year, the plan shall pay at least 80% of any additional covered costs incurred by the person during the calendar year.

SB55-ASA1, s. 2850r Section 2850r. 149.146 (2) (am) 3. of the statutes is amended to read:

SB55-ASA1,953,20 149.146 (2) (am) 3. If Except as provided in subd. 5., if the aggregate of the covered costs not paid by the plan under subd. 2. and the deductible exceeds $3,500 for any eligible person during a calendar year or $7,000 for all eligible persons in a family, the plan shall pay 100% of all covered costs incurred by the eligible person during the calendar year after the payment ceilings under this subdivision are exceeded.

SB55-ASA1, s. 2850s Section 2850s. 149.146 (2) (am) 5. of the statutes is created to read:

SB55-ASA1,954,5 149.146 (2) (am) 5. Subject to s. 149.14 (8) (b), the department may, by rule under s. 149.17 (4), establish for prescription drug coverage under this section copayment amounts, coinsurance rates, and copayment and coinsurance out-of-pocket limits over which the plan will pay 100% of covered costs for prescription drugs. Any copayment amount, coinsurance rate, or out-of-pocket limit established under this subdivision is subject to the approval of the board. Copayments and coinsurance paid by an eligible person under this subdivision are separate from and do not count toward the deductible and covered costs not paid by the plan under subds. 1. to 3.

SB55-ASA1, s. 2850w Section 2850w. 149.15 (1) of the statutes is amended to read:

SB55-ASA1,954,24 149.15 (1) The plan shall have a board of governors consisting of representatives of 2 participating insurers which that are nonprofit corporations, representatives of 2 other participating insurers, 3 health care provider representatives, including one representative of the State Medical Society of Wisconsin, one representative of the Wisconsin Health and Hospital Association and one representative of an integrated multidisciplinary health system, and 3 4 public members, including one representative of small businesses in the state, appointed by the secretary for staggered 3-year terms. In addition, the commissioner, or a designated representative from the office of the commissioner, and the secretary, or a designated representative from the department, shall be members of the board. The public members shall not be professionally affiliated with the practice of medicine, a hospital, or an insurer. At least 2 one of the public members shall be individuals reasonably expected to qualify for an individual who has coverage under the plan or the parent or spouse of such an individual. The secretary or the secretary's representative shall be the chairperson of the board. Board members, except the commissioner or the commissioner's representative and the secretary or the secretary's representative, shall be compensated at the rate of $50 per diem plus actual and necessary expenses.

SB55-ASA1, s. 2850x Section 2850x. 149.25 of the statutes is created to read:

SB55-ASA1,955,1 149.25 Case management pilot program. (1) Definitions. In this section:

SB55-ASA1,955,5 (a) "Chronic disease" means any disease, illness, impairment, or other physical condition that requires health care and treatment over a prolonged period and, although amenable to treatment, is irreversible and frequently progresses to increasing disability or death.

SB55-ASA1,955,8 (b) "Health professional shortage area" means an area that is designated by the federal department of health and human services under 42 CFR part 5, appendix A, as having a shortage of medical care professionals.

SB55-ASA1,955,11 (2) Program and eligibility requirements. (a) The department shall conduct a 3-year pilot program, beginning on July 1, 2002, under which eligible persons who qualify under par. (b) are provided community-based case management services.

SB55-ASA1,955,13 (b) To be eligible to participate in the pilot program, an eligible person must satisfy any of the following criteria:

SB55-ASA1,955,14 1. Be diagnosed as having a chronic disease.

SB55-ASA1,955,15 2. Be taking 2 or more prescribed medications on a regular basis.

SB55-ASA1,955,18 3. Within 6 months of applying for the pilot program, have been treated 2 or more times at a hospital emergency room or have been admitted 2 or more times to a hospital as an inpatient.

SB55-ASA1,955,22 (c) 1. Participation in the pilot program shall be voluntary and limited to no more than 300 eligible persons. The department shall ensure that all eligible persons are advised in a timely manner of the opportunity to participate in the pilot program and of how to apply for participation.

SB55-ASA1,956,2 2. If more than 300 eligible persons apply to participate, the department shall select pilot program participants from among those who qualify under par. (b) according to standards determined by the department, except that the department shall give preference to eligible persons who reside in medically underserved areas or health professional shortage areas.

SB55-ASA1,956,6 (3) Provider organization and services requirements. (a) The department shall select and contract with an organization to provide the community-based case management services under the pilot program. To be eligible to provide the services, an organization must satisfy all of the following criteria:

SB55-ASA1,956,9 1. Be a private, nonprofit, integrated health care system that provides access to health care in a medically underserved area of the state or in a health professional shortage area.

SB55-ASA1,956,11 2. Operate an existing community-based case management program with demonstrated successful client and program outcomes.

SB55-ASA1,956,14 3. Demonstrate an ability to assemble and coordinate an interdisciplinary team of health care professionals, including physicians, nurses, and pharmacists, for assessment of a program participant's treatment plan.

SB55-ASA1,956,18 (b) The community-based case management services under the pilot program shall be provided by a team, consisting of a nurse case manager, a pharmacist, and a social worker, working in collaboration with the eligible person's primary care physician or other provider. Services to be provided include all of the following:

SB55-ASA1,956,19 1. An initial intake assessment.

SB55-ASA1,956,20 2. Development of a treatment plan based on best practices.

SB55-ASA1,956,21 3. Coordination of health care services.

SB55-ASA1,956,22 4. Patient education.

SB55-ASA1,956,23 5. Family support.

SB55-ASA1,956,24 6. Monitoring and reporting of patient outcomes and costs.

SB55-ASA1,957,2 (c) The department shall pay contract costs from the appropriation under s. 20.435 (4) (u).

SB55-ASA1,957,11 (4) Evaluation study. The department shall conduct a study that evaluates the pilot program in terms of health care outcomes and cost avoidance. In the study, the department shall measure and compare, for pilot program participants and similarly situated eligible persons not participating in the pilot program, plan costs and utilization of services, including inpatient hospital days, rates of hospital readmission within 30 days for the same diagnosis, and prescription drug utilization. The department shall submit a report on the results of the study, including the department's conclusions and recommendations, to the legislature under s. 13.172 (2) and to the governor.

SB55-ASA1, s. 2850y Section 2850y. 150.345 of the statutes is created to read:

SB55-ASA1,957,15 150.345 Nursing home bed transfers. (1) Notwithstanding ss. 150.33 and 150.34, a nursing home may transfer a licensed bed to another nursing home, if all of the following apply:

SB55-ASA1,957,18 (a) The receiving nursing home is within the same area for allocation of nursing home beds, as determined by the department, as is the transferring nursing home, or is in a county adjoining that area.

SB55-ASA1,957,20 (b) The transferring nursing home and the receiving nursing home are owned by corporations that are owned by the same person.

SB55-ASA1,957,22 (c) The transferring and receiving nursing homes notify the department of the proposed transfer within 30 days before the transfer occurs.

SB55-ASA1,957,23 (d) The department reviews and approves the transfer.

SB55-ASA1,958,3 (2) Upon receiving the notification specified in sub. (1) (c), the department shall adjust the allocation of licensed beds under s. 150.31 for each nursing home in accordance with the transfer that was made.

SB55-ASA1, s. 2852g Section 2852g. 157.10 of the statutes is renumbered 157.10 (1) (a) and amended to read:

SB55-ASA1,958,9 157.10 (1) (a) While Except as provided in par. (b), while any person is buried in a cemetery lot, the cemetery lot shall be inalienable, without the consent of unless the cemetery authority, and on the consents to a conveyance of an interest in the cemetery lot.

SB55-ASA1,958,12 (2) Upon the death of the owner of a cemetery lot, ownership of the cemetery lot shall descend to the owner's heirs; but and any one or more of such heirs may convey to any other heir his or her interest in the cemetery lot.

SB55-ASA1,958,16 (3) No human remains may be buried in a cemetery lot except the human remains of one having an interest in the cemetery lot, or a relative, or the husband or wife of such person, or his or her relative, except by the consent of all persons having an interest in the cemetery lot.

SB55-ASA1, s. 2852h Section 2852h. 157.10 (1) (b) of the statutes is created to read:

SB55-ASA1,958,20 157.10 (1) (b) A person having an interest in a cemetery lot may, after providing written notice to the cemetery authority, convey the interest to his or her spouse, child, sibling, or parent without the consent of the cemetery authority.

SB55-ASA1, s. 2852t Section 2852t. 157.635 (title) of the statutes is amended to read:

SB55-ASA1,958,23 157.635 (title) Regulations of religious cemetery affiliated with religious society authorities.

SB55-ASA1, s. 2852u Section 2852u. 157.635 of the statutes is renumbered 157.635 (2) and amended to read:

SB55-ASA1,959,6 157.635 (2) Nothing Except as provided in sub. (3), nothing in this subchapter prohibits a religious cemetery authority of a cemetery that is affiliated with a religious society organized under ch. 187 from prohibiting the burial of the human remains of an individual in the cemetery if the individual was in a class of individuals who are prohibited under regulations adopted by the religious cemetery authority or affiliated religious society from being buried in the cemetery.

SB55-ASA1, s. 2852v Section 2852v. 157.635 (1) of the statutes is created to read:

SB55-ASA1,959,8 157.635 (1) In this section:

SB55-ASA1,959,10 (a) "Affiliated religious society" means a religious society organized under ch. 187 that is affiliated with a religious cemetery authority.

SB55-ASA1,959,12 (b) "Religious cemetery authority" means a cemetery authority of a cemetery that is affiliated with a religious society organized under ch. 187.

SB55-ASA1, s. 2852x Section 2852x. 157.635 (3) of the statutes is created to read:

SB55-ASA1,959,19 157.635 (3) If an individual who is not prohibited under regulations adopted by a religious cemetery authority or affiliated religious society from being buried in a cemetery conveys his or her interest in a cemetery lot in the cemetery to his or her spouse, child, sibling, or parent, the religious cemetery authority may not prohibit the burial of the human remains of the spouse, child, sibling, or parent in the cemetery.

SB55-ASA1, s. 1413 Section 1413. 157.70 (2) (i) of the statutes is amended to read:

SB55-ASA1,959,24 157.70 (2) (i) Cause a cataloged burial site to be recorded by the register of deeds of the county in which the burial site is located. The historical society shall reimburse the county for the cost of recording under this paragraph from the appropriation under s. 20.245 (3) (1) (a).

SB55-ASA1, s. 1414 Section 1414. 165.055 (3) of the statutes is repealed.

SB55-ASA1, s. 2854m Section 2854m. 165.10 of the statutes is created to read:

SB55-ASA1,960,7 165.10 Civil rights enforcement. If any person, whether or not acting under color of law, interferes with the exercise or enjoyment by any individual of a right secured by the constitution or laws of the United States, or of a right secured by the constitution or laws of this state, the attorney general may bring an action for injunction or other appropriate equitable relief to protect the peaceable exercise or enjoyment of the right secured.

SB55-ASA1, s. 1415 Section 1415. 165.25 (4) (ar) of the statutes is amended to read:

SB55-ASA1,960,14 165.25 (4) (ar) The department of justice shall furnish all legal services required by the department of agriculture, trade and consumer protection relating to the enforcement of ss. 100.171, 100.173, 100.174, 100.175, 100.177, 100.18, 100.182, 100.20, 100.205, 100.207, 100.209, 100.21, 100.28, 100.37, 100.42, 100.50, and 100.51 and chs. 136, 344, 704, 707, and 779, together with any other services as are necessarily connected to the legal services.

SB55-ASA1, s. 2856d Section 2856d. 165.25 (10) of the statutes is created to read:

SB55-ASA1,960,24 165.25 (10) Report on restitution. Semiannually submit a report to the department of administration and the joint committee on finance regarding money received by the department of justice under a court order or a settlement agreement for providing restitution to victims. The report shall specify the amount of restitution received by the department of justice during the reporting period; the persons to whom the department of justice paid restitution and the amount that the department of justice paid to each recipient during the reporting period; and the department of justice's methodology for selecting recipients and determining the amount paid to each recipient.

SB55-ASA1, s. 2857t Section 2857t. 165.755 (1) (b) of the statutes is amended to read: