SB44-SSA1, s. 2067 12Section 2067. 149.10 (8b) of the statutes is repealed.
SB44-SSA1, s. 2068 13Section 2068. 149.14 (5) (e) of the statutes is amended to read:
SB44-SSA1,812,2314 149.14 (5) (e) Subject to sub. (8) (b), the department may, by rule under s. 149.17
15(4), establish for prescription drug coverage under sub. (3) (d) copayment amounts,
16coinsurance rates, and copayment and coinsurance out-of-pocket limits over which
17the plan will pay 100% of covered costs under sub. (3) (d). The department may
18provide subsidies for prescription drug copayment amounts paid by eligible persons
19under s. 149.165 (2) (a) 1. to 5.
Any copayment amount, coinsurance rate, or
20out-of-pocket limit established under this paragraph is subject to the approval of the
21board. Copayments and coinsurance paid by an eligible person under this paragraph
22are separate from and do not count toward the deductible and covered costs not paid
23by the plan under pars. (a) to (c).
SB44-SSA1, s. 2069 24Section 2069. 149.143 (1) (a) of the statutes is repealed.
SB44-SSA1, s. 2070 25Section 2070. 149.143 (1) (b) (intro.) of the statutes is repealed.
SB44-SSA1, s. 2071
1Section 2071. 149.143 (1) (b) 1. of the statutes is renumbered 149.143 (1) (am),
2and 149.143 (1) (am) 1., 2., 3. and 4., as renumbered, are amended to read:
SB44-SSA1,813,113 149.143 (1) (am) 1. First, from premiums from eligible persons with coverage
4under s. 149.14 (2) (a) set at a rate that is 140% to 150% of the rate that a standard
5risk would be charged under an individual policy providing substantially the same
6coverage and deductibles as are provided under the plan and from eligible persons
7with coverage under s. 149.14 (2) (b) set in accordance with s. 149.14 (5m), including
8amounts received for premium and, deductible, and prescription drug copayment
9subsidies under s. 149.144 and under the transfer to the fund from the appropriation
10account under s. 20.435 (4) (ah)
, and from premiums collected from eligible persons
11with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b).
SB44-SSA1,813,1312 2. Second, from moneys specified under sub. (2m), to the extent that the
13amounts under subd. 1. a. are insufficient to pay 60% of plan costs.
SB44-SSA1,813,2414 3. Third, by increasing premiums from eligible persons with coverage under s.
15149.14 (2) (a) to more than the rate at which premiums were set under subd. 1. a.
16but not more than 200% of the rate that a standard risk would be charged under an
17individual policy providing substantially the same coverage and deductibles as are
18provided under the plan and from eligible persons with coverage under s. 149.14 (2)
19(b) by a comparable amount in accordance with s. 149.14 (5m), including amounts
20received for premium and, deductible , and prescription drug copayment subsidies
21under s. 149.144 and under the transfer to the fund from the appropriation account
22under s. 20.435 (4) (ah)
, and by increasing premiums from eligible persons with
23coverage under s. 149.146 in accordance with s. 149.146 (2) (b), to the extent that the
24amounts under subd. 1. a. subds. 1. and b. 2. are insufficient to pay 60% of plan costs.
SB44-SSA1,814,5
14. Fourth, notwithstanding subd. 2. par. (bm), by increasing insurer
2assessments, excluding assessments under s. 149.144, and adjusting provider
3payment rates, subject to s. 149.142 (1) (b) and excluding adjustments to those rates
4under s. 149.144, in equal proportions and to the extent that the amounts under
5subd. 1. a. to c. subds. 1. to 3. are insufficient to pay 60% of plan costs.
SB44-SSA1, s. 2072 6Section 2072. 149.143 (1) (b) 2. of the statutes is renumbered 149.143 (1) (bm).
SB44-SSA1, s. 2073 7Section 2073. 149.143 (2) (a) (intro.) of the statutes is amended to read:
SB44-SSA1,814,128 149.143 (2) (a) (intro.) Prior to each plan year, the department shall estimate
9the operating and administrative costs of the plan and the costs of the premium
10reductions under s. 149.165 and, the deductible reductions under s. 149.14 (5) (a),
11and any prescription drug copayment reductions under s. 149.14 (5) (e)
for the new
12plan year and do all of the following:
SB44-SSA1, s. 2074 13Section 2074. 149.143 (2) (a) 1. a. of the statutes is amended to read:
SB44-SSA1,814,2214 149.143 (2) (a) 1. a. Estimate the amount of enrollee premiums that would be
15received in the new plan year if the enrollee premiums were set at a level sufficient,
16when including amounts received for premium and, deductible, and prescription
17drug copayment
subsidies under s. 149.144 and under the transfer to the fund from
18the appropriation account under s. 20.435 (4) (ah)
and from premiums collected from
19eligible persons with coverage under s. 149.146 set in accordance with s. 149.146 (2)
20(b), to cover 60% of the estimated plan costs for the new plan year , after deducting
21from the estimated plan costs the amount available for transfer to the fund from the
22appropriation account under s. 20.435 (4) (af) for that plan year
.
SB44-SSA1, s. 2075 23Section 2075. 149.143 (2) (a) 1. b. of the statutes is amended to read:
SB44-SSA1,814,2524 149.143 (2) (a) 1. b. Estimate the amount of enrollee premiums that will be
25received under sub. (1) (b) 1. a. (am) 1.
SB44-SSA1, s. 2076
1Section 2076. 149.143 (2) (a) 2. of the statutes is amended to read:
SB44-SSA1,815,82 149.143 (2) (a) 2. After making the determinations under subd. 1., by rule set
3premium rates for the new plan year, including the rates under s. 149.146 (2) (b), in
4the manner specified in sub. (1) (b) 1. a. and c. (am) 1. and 3. and such that a rate for
5coverage under s. 149.14 (2) (a) is approved by the board and is not less than 140%
6nor more than 200% of the rate that a standard risk would be charged under an
7individual policy providing substantially the same coverage and deductibles as are
8provided under the plan.
SB44-SSA1, s. 2077 9Section 2077. 149.143 (2) (a) 3. of the statutes is amended to read:
SB44-SSA1,815,1310 149.143 (2) (a) 3. By rule set the total insurer assessments under s. 149.13 for
11the new plan year by estimating and setting the assessments at the amount
12necessary to equal the amounts specified in sub. (1) (b) 1. d. and 2. a. (am) 4. and (bm)
131.
and notify the commissioner of the amount.
SB44-SSA1, s. 2078 14Section 2078. 149.143 (2) (a) 4. of the statutes is amended to read:
SB44-SSA1,815,1815 149.143 (2) (a) 4. By the same rule as under subd. 3. adjust the provider
16payment rate for the new plan year, subject to s. 149.142 (1) (b), by estimating and
17setting the rate at the level necessary to equal the amounts specified in sub. (1) (b)
181. d. and 2. b.
(am) 4. and (bm) 2. and as provided in s. 149.145.
SB44-SSA1, s. 2079 19Section 2079. 149.143 (2) (b) of the statutes is amended to read:
SB44-SSA1,815,2520 149.143 (2) (b) In setting the premium rates under par. (a) 2., the insurer
21assessment amount under par. (a) 3. and the provider payment rate under par. (a)
224. 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) (b) (am) and (bm) in the current plan year.
SB44-SSA1, s. 2080
1Section 2080. 149.143 (2m) (a) 1. of the statutes is amended to read:
SB44-SSA1,816,42 149.143 (2m) (a) 1. The amount of premiums received in a plan year from all
3eligible persons, including amounts received for premium and, deductible, and
4prescription drug copayment
subsidies.
SB44-SSA1, s. 2081 5Section 2081. 149.143 (2m) (a) 2. of the statutes is amended to read:
SB44-SSA1,816,96 149.143 (2m) (a) 2. The amount of premiums, including amounts received for
7premium and, deductible, and prescription drug copayment subsidies, necessary to
8cover 60% of the plan costs for the plan year, after deducting the amount transferred
9to the fund from the appropriation account under s. 20.435 (4) (af)
.
SB44-SSA1, s. 2082 10Section 2082. 149.143 (2m) (b) 1. of the statutes is amended to read:
SB44-SSA1,816,1511 149.143 (2m) (b) 1. To reduce premiums in succeeding plan years as provided
12in sub. (1) (b) 1. b. (am) 2. For eligible persons with coverage under s. 149.14 (2) (a),
13premiums may not be reduced below 140% of the rate that a standard risk would be
14charged under an individual policy providing substantially the same coverage and
15deductibles as are provided under the plan.
SB44-SSA1, s. 2083 16Section 2083. 149.143 (3) (a) of the statutes is amended to read:
SB44-SSA1,817,217 149.143 (3) (a) If, during a plan year, the department determines that the
18amounts estimated to be received as a result of the rates and amount set under sub.
19(2) (a) 2. to 4. and any adjustments in insurer assessments and the provider payment
20rate under s. 149.144 will not be sufficient to cover plan costs, the department may
21by rule increase the premium rates set under sub. (2) (a) 2. for the remainder of the
22plan year, subject to s. 149.146 (2) (b) and the maximum specified in sub. (2) (a) 2.,
23by rule increase the assessments set under sub. (2) (a) 3. for the remainder of the plan
24year, subject to sub. (1) (b) 2. a. (bm) 1., and by the same rule under which
25assessments are increased adjust the provider payment rate set under sub. (2) (a) 4.

1for the remainder of the plan year, subject to sub. (1) (b) 2. b. (bm) 2. and s. 149.142
2(1) (b).
SB44-SSA1, s. 2084 3Section 2084. 149.143 (3) (b) of the statutes is amended to read:
SB44-SSA1,817,104 149.143 (3) (b) If the department increases premium rates and insurer
5assessments and adjusts the provider payment rate under par. (a) and determines
6that there will still be a deficit and that premium rates have been increased to the
7maximum extent allowable under par. (a), the department may further adjust, in
8equal proportions, assessments set under sub. (2) (a) 3. and the provider payment
9rate set under sub. (2) (a) 4., without regard to sub. (1) (b) 2. (bm) but subject to s.
10149.142 (1) (b).
SB44-SSA1, s. 2085 11Section 2085. 149.144 of the statutes is amended to read:
SB44-SSA1,818,2 12149.144 Adjustments to insurer assessments and provider payment
13rates for premium
and, deductible , and prescription drug copayment
14reductions.
If the moneys transferred to the fund under the appropriation under
15s. 20.435 (4) (ah) are insufficient to reimburse the plan for premium reductions under
16s. 149.165 and deductible reductions under s. 149.14 (5) (a), or the department
17determines that the moneys transferred or to be transferred to the fund under the
18appropriation under s. 20.435 (4) (ah) will be insufficient to reimburse the plan for
19premium reductions under s. 149.165 and deductible reductions under s. 149.14 (5)
20(a), the
The department may shall, by rule, adjust in equal proportions the amount
21of the assessment set under s. 149.143 (2) (a) 3. and the provider payment rate set
22under s. 149.143 (2) (a) 4., subject to ss. 149.142 (1) (b) and 149.143 (1) (b) 1. (am),
23sufficient to reimburse the plan for premium reductions under s. 149.165 and,
24deductible reductions under s. 149.14 (5) (a). If the department makes the
25adjustment under this section, the
, and any prescription drug copayment reductions

1under s. 149.14 (5) (e). The
department shall notify the commissioner so that the
2commissioner may levy any increase in insurer assessments.
SB44-SSA1, s. 2086 3Section 2086. 149.145 of the statutes is amended to read:
SB44-SSA1,818,15 4149.145 Program budget. The department, in consultation with the board,
5shall establish a program budget for each plan year. The program budget shall be
6based on the provider payment rates specified in s. 149.142 and in the most recent
7provider contracts that are in effect and on the funding sources specified in s. ss.
8149.143 (1) and 149.144, including the methodologies specified in ss. 149.143,
9149.144, and 149.146 for determining premium rates, insurer assessments, and
10provider payment rates. Except as otherwise provided in s. 149.143 (3) (a) and (b)
11and subject to s. 149.142 (1) (b), from the program budget the department shall derive
12the actual provider payment rate for a plan year that reflects the providers'
13proportional share of the plan costs, consistent with ss. 149.143 and 149.144. The
14department may not implement a program budget established under this section
15unless it is approved by the board.
SB44-SSA1, s. 2087 16Section 2087. 149.146 (2) (a) of the statutes is amended to read:
SB44-SSA1,818,2117 149.146 (2) (a) Except as specified by the department, the terms of coverage
18under s. 149.14, including deductible reductions under s. 149.14 (5) (a) and
19prescription drug copayment reductions under s. 149.14 (5) (e)
, do not apply to the
20coverage offered under this section. Premium reductions under s. 149.165 do not
21apply to the coverage offered under this section.
SB44-SSA1, s. 2088 22Section 2088. 149.16 (1) of the statutes is repealed.
SB44-SSA1, s. 2089 23Section 2089. 149.16 (1m) of the statutes is created to read:
SB44-SSA1,818,2524 149.16 (1m) The plan administrator may be selected by the department in a
25competitive bidding process.
SB44-SSA1, s. 2090
1Section 2090. 149.16 (4) of the statutes is amended to read:
SB44-SSA1,819,42 149.16 (4) The If the plan administrator is the fiscal agent under s. 49.45 (2)
3(b) 2., the
plan administrator shall account for costs related to the plan separately
4from costs related to medical assistance under subch. IV of ch. 49.
SB44-SSA1, s. 2091 5Section 2091. 149.165 (4) of the statutes is amended to read:
SB44-SSA1,819,96 149.165 (4) The department shall reimburse the plan for premium reductions
7under sub. (2) and, deductible reductions under s. 149.14 (5) (a) with moneys
8transferred to the fund
, and prescription drug copayment reductions under s. 149.14
9(5) (e)
from the appropriation account under s. 20.435 (4) (ah) (v).
SB44-SSA1, s. 2092 10Section 2092. 150.963 (3) (e) of the statutes is amended to read:
SB44-SSA1,819,1411 150.963 (3) (e) Accept on behalf of the state and deposit with the state treasurer
12secretary of administration any grant, gift, or contribution made to assist in meeting
13the cost of carrying out the purposes of this subchapter, and expend those funds for
14the purposes of this subchapter.
SB44-SSA1, s. 2092c 15Section 2092c. 153.01 (4j) of the statutes is created to read:
SB44-SSA1,819,1916 153.01 (4j) "Entity" means a nonstock corporation organized under ch. 181 that
17is described in section 501 (c) (6) of the Internal Revenue Code and is exempt from
18federal income tax under section 501 (a) of the Internal Revenue Code, and that does
19all of the following:
SB44-SSA1,819,2020 (a) Represents at least 70% of the hospitals in Wisconsin.
SB44-SSA1,819,2221 (b) Receives oversight with respect to services performed by the entity under
22this chapter from a group that is composed of all of the following:
SB44-SSA1,819,2423 1. The secretary of health and family services, who shall serve as chairperson
24and nonvoting member of the group.
SB44-SSA1,819,2525 2. Two members designated by Wisconsin Manufacturers and Commerce, Inc.
SB44-SSA1,820,1
13. Two members designated by the Wisconsin Association of Health Plans, Inc.
SB44-SSA1,820,22 4. One member designated by the Wisconsin State AFL-CIO.
SB44-SSA1,820,33 5. Two members designated by the Wisconsin Hospital Association, Inc.
SB44-SSA1,820,44 6. One member designated by the speaker of the assembly.
SB44-SSA1,820,55 7. One member designated by the senate majority leader.
SB44-SSA1, s. 2092d 6Section 2092d. 153.05 (1) of the statutes is amended to read:
SB44-SSA1,820,107 153.05 (1) In order to provide to hospitals, health care providers, insurers,
8consumers, governmental agencies and others information concerning health care
9providers and uncompensated health care services, and in order to provide
10information to assist in peer review for the purpose of quality assurance, the:
SB44-SSA1,820,14 11(a) The department shall collect from health care providers other than
12hospitals and ambulatory surgery centers
, analyze, and disseminate health care
13information, as adjusted for case mix and severity, in language that is
14understandable to lay persons laypersons.
SB44-SSA1, s. 2092e 15Section 2092e. 153.05 (1) (b) of the statutes is created to read:
SB44-SSA1,820,2416 153.05 (1) (b) The entity under contract under sub. (2m) (a) shall collect from
17hospitals and ambulatory surgery centers the health care information required of
18hospitals and ambulatory surgery centers by the department under ch. 153, 2001
19stats., and the rules promulgated under ch. 153, 2001 stats., including, by the date
20that is 18 months after the date of the contract under sub. (2m) (a), all outpatient
21hospital-based services. The entity shall analyze and disseminate that health care
22information, as adjusted for case mix and severity, in the manner required under this
23chapter, under ch. 153, 2001 stats., and under the rules promulgated under ch. 153,
242001 stats., and in language that is understandable to laypersons.
SB44-SSA1, s. 2092f 25Section 2092f. 153.05 (2m) of the statutes is created to read:
SB44-SSA1,821,11
1153.05 (2m) (a) Notwithstanding s. 16.75 (1), (2), and (3m), by the date that is
2the first day of the 2nd month after the effective date of this paragraph .... [revisor
3inserts date], the department of administration shall, from the appropriation under
4s. 20.505 (1) (im), contract with an entity to perform services under this chapter that
5are specified for the entity with respect to the collection, analysis, and dissemination
6of health care information of hospitals and ambulatory surgery centers. The
7department of administration may not, by this contract, require from the entity any
8collection, analysis, or dissemination of health care information of hospitals and
9ambulatory surgery centers that is in addition to that required under this chapter,
10and may include in the contract only terms standard to contracts with the
11department of administration under subch. IV of ch. 16.
SB44-SSA1,821,2112 (b) Biennially, the group specified under s. 153.01 (4j) (b) shall review the
13entity's performance, including the timeliness and quality of the reports generated
14by the entity. If the group is dissatisfied with the entity's performance, the group may
15recommend to the department of administration that that department use a
16competitive request-for-proposal process to solicit offers from other organizations
17for performance of the services. If no organization responds to the request for
18proposal, the department of health and family services shall perform the services
19specified for the entity with respect to the collection, analysis, and dissemination of
20health care information of hospitals and ambulatory surgery centers under this
21chapter.
SB44-SSA1,822,222 (c) By April 1, 2004, and annually thereafter, the secretary of health and family
23services, as chairperson of the group specified under s. 153.01 (4j) (b), shall submit
24to the chief clerk of each house of the legislature for distribution to the legislature
25under s. 13.172 (2), a report concerning the content and number of reports and

1currency of information and reports generated in the previous calendar year by the
2entity under contract under s. 153.05 (2m).
SB44-SSA1, s. 2092g 3Section 2092g. 153.05 (3) of the statutes is renumbered 153.05 (3) (a) and
4amended to read:
SB44-SSA1,822,85 153.05 (3) (a) Upon request of the department for health care information
6relating to health care providers other than hospitals and ambulatory surgery
7centers
, state agencies shall provide that health care information to the department
8for use in preparing reports under this chapter.
SB44-SSA1, s. 2092h 9Section 2092h. 153.05 (3) (b) of the statutes is created to read:
SB44-SSA1,822,1310 153.05 (3) (b) Upon request of the entity under contract under sub. (2m) (a) for
11health care information relating to hospitals and ambulatory surgery centers, state
12agencies shall provide that health care information to the entity for use in preparing
13reports under this chapter.
SB44-SSA1, s. 2092i 14Section 2092i. 153.05 (5) of the statutes is renumbered 153.05 (5) (a) and
15amended to read:
SB44-SSA1,822,2016 153.05 (5) (a) Unless sub. (13) (a) applies, the department may require health
17care providers other than hospitals and ambulatory surgery centers to submit to the
18department information specified by rule under s. 153.75 (1) (n) for the preparation
19of reports, plans, and recommendations in the form specified by the department by
20rule.
SB44-SSA1, s. 2092j 21Section 2092j. 153.05 (5) (b) of the statutes is created to read:
SB44-SSA1,822,2522 153.05 (5) (b) Unless sub. (13) (b) applies, the entity under contract under sub.
23(2m) (a) may require hospitals and ambulatory surgery centers to submit to the
24entity information for the preparation of reports, plans, and recommendations in the
25form specified by the entity.
SB44-SSA1, s. 2092k
1Section 2092k. 153.05 (6) of the statutes is amended to read:
SB44-SSA1,823,52 153.05 (6) The department may contract with a public or private entity
3organization that is not a major purchaser, payer or provider of health care services
4in this state for the provision of data processing services for the collection, analysis
5and dissemination of health care information under sub. (1) (a).
SB44-SSA1, s. 2092L 6Section 2092L. 153.05 (6r) of the statutes is amended to read:
SB44-SSA1,823,197 153.05 (6r) The department shall study and, based on the results of the study,
8may develop and implement a voluntary system of health care plan reporting that
9enables purchasers and consumers to assess the performance of health care plans
10and the health care providers, other than hospitals and ambulatory surgery centers,
11that are employed or reimbursed by the health care plans. The department shall
12undertake the study and any development and implementation in cooperation with
13private health care purchasers, the board, the department of employee trust funds,
14the office of the commissioner of insurance, the interagency coordinating council
15created under s. 15.107 (7), major associations of health care providers, health care
16plans and consumers. If implemented, the department shall operate the system in
17a manner so as to enable purchasers, consumers, the public, the governor and
18legislators to assess the performance of health care plans and health care providers
19other than hospitals and ambulatory surgery centers
.
SB44-SSA1, s. 2093bg 20Section 2093bg. 153.05 (8) of the statutes is renumbered 153.05 (8) (a) and
21amended to read:
SB44-SSA1,824,922 153.05 (8) (a) Unless sub. (13) (a) applies, the department shall collect, analyze
23and disseminate, in language that is understandable to lay persons laypersons,
24claims information and other health care information, as adjusted for case mix and
25severity, under the provisions of this chapter, as determined by rules promulgated

1by the department, from health care providers, other than hospitals and ambulatory
2surgery centers,
specified by rules promulgated by the department. Data from those
3health care providers may be obtained through sampling techniques in lieu of
4collection of data on all patient encounters and data collection procedures shall
5minimize unnecessary duplication and administrative burdens. If the department
6collects health care provider-specific data from health care plans data that is specific
7to health care providers other than hospitals and ambulatory surgery centers
, the
8department shall attempt to avoid collecting the same data from those health care
9providers.
SB44-SSA1, s. 2093bh 10Section 2093bh. 153.05 (8) (b) of the statutes is created to read:
SB44-SSA1,824,1811 153.05 (8) (b) Unless sub. (13) (b) applies, the entity under contract under sub.
12(2m) (a) shall collect, analyze, and disseminate, in language that is understandable
13to laypersons, claims information and other health care information, as adjusted for
14case mix and severity, under the provisions of this chapter, from hospitals and
15ambulatory surgery centers. Data from hospitals and ambulatory surgery centers
16may be obtained through sampling techniques in lieu of collection of data on all
17patient encounters, and data collection procedures shall minimize unnecessary
18duplication and administrative burdens.
SB44-SSA1, s. 2093c 19Section 2093c. 153.05 (9) of the statutes is renumbered 153.05 (9) (a) and
20amended to read:
SB44-SSA1,824,2421 153.05 (9) (a) The department shall provide orientation and training to health
22care providers, other than hospitals and ambulatory surgery centers, who submit
23data under this chapter, to explain the process of data collection and analysis and the
24procedures for data verification, comment, interpretation, and release.
SB44-SSA1, s. 2093d 25Section 2093d. 153.05 (9) (b) of the statutes is created to read:
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