Amendment SA1-SSA1-SB40

SB40-SSA1-SA1,262,2 (7) Payments to networks and providers. (a) Payments to health care networks. 1. On behalf of each participant who selects or has been assigned to a certified health care network that has been classified under sub. (5) (c) as the lowest-cost network or a low-cost network and as performing well on quality measures, the board shall pay monthly to the health care network the full risk-adjusted per-member per-month amount that was bid by the network. The dollar amount shall be actuarially adjusted for the participant based on age, sex, and other appropriate risk factors determined by the board. A participant who selects or is assigned to the lowest-cost network or a low-cost network shall not be required to pay any additional amount to the network.

SB40-SSA1-SA1,262,12 2. If a participant chooses instead to enroll in a certified health care network that has been classified under sub. (5) (c) as a higher-cost network, the board shall pay monthly to the chosen health care network an amount equal to the bid submitted by the network that the board classified under sub. (5) (c) as the lowest-cost network and as having performed well on quality measures. The dollar amount shall be actuarially adjusted for the participant based on age, sex, and other appropriate risk factors determined by the board. A participant who chooses to enroll in a higher-cost network shall be required to pay monthly, in addition to the amount paid by the board, an additional payment sufficient to ensure that the chosen network receives the full price bid by that network.

SB40-SSA1-SA1,262,18 3. The board may retain a percentage of the dollar amounts established for each participant under subds. 1. and 2. to pay to certified health care networks that have incurred disproportionate risk not fully compensated for by the actuarial adjustment in the amount established for each eligible person. Any payment to a certified health care network under this subdivision shall reflect the disproportionate risk incurred by the health care network.

SB40-SSA1-SA1,262,25 (b) Payments to fee-for-service providers. 1. The board shall establish provider payment rates that will be paid to providers of covered services and articles that are provided to participants who choose the fee-for-service option under sub. (2) (a). The payment rates shall be fair and adequate to ensure that this state is able to retain the highest quality of medical practitioners. The board shall limit increases in the provider payment rate for each service or article such that any increase in per person spending under the plan does not exceed the national rate of medical inflation.

SB40-SSA1-SA1,263,6 2. Except for deductibles, copayments, coinsurance, and any other cost sharing required or authorized under the plan, a provider of a covered service or article shall accept as payment in full for the covered service or article the payment rate determined under subd. 1. and may not bill a participant who receives the service or article for any amount by which the charge for the service or article is reduced under subd. 1.

SB40-SSA1-SA1,263,10 3. The board, with the assistance of its actuarial consultants, shall establish the monthly risk-adjusted cost of the fee-for-service option offered to participants under sub. (2) (a). The board shall classify the fee-for-service option in the same manner that the board classifies certified health care networks under sub. (5) (c).

SB40-SSA1-SA1,263,15 4. If the board has determined under sub. (5) (c) that there is at least one certified low-cost health care network in an area, which may be the lowest-cost health care network, and if the fee-for-service option offered in that area has been classified as a higher-cost choice under subd. 3., the cost to a participant enrolling in the fee-for-service option shall be determined as follows:

SB40-SSA1-SA1,263,22 a. If there are available to the participant 3 or more certified health care networks classified under sub. (5) (c) as low-cost networks, or as the lowest-cost network and 2 or more low-cost networks, the participant shall pay the difference between the cost of the lowest-cost health care network and the monthly risk-adjusted cost established under subd. 3. for the fee-for-service option, except that the amount paid may not exceed $100 per month for an individual, or $200 per month for a family, as adjusted for medical inflation.

SB40-SSA1-SA1,264,4 b. If there are available to the participant 2 certified health care networks classified under sub. (5) (c) as low-cost networks, or as the lowest-cost network and one low-cost network, the participant shall pay the difference between the cost of the lowest-cost health care network and the monthly risk-adjusted cost established under subd. 3. for the fee-for-service option, except that the amount paid may not exceed $65 per month for an individual, or $125 per month for a family, as adjusted for medical inflation.

SB40-SSA1-SA1,264,10 c. If there is available to the participant only one certified health care network classified under sub. (5) (c) as a low-cost network, or as the lowest-cost network, the person shall pay the difference between the cost of the lowest-cost health care network and the monthly risk-adjusted cost established under subd. 3. for the fee-for-service option, except that the amount paid may not exceed $25 per month for an individual, and $50 per month for a family, as adjusted for medical inflation.

SB40-SSA1-SA1,264,13 6. If the board has determined, under sub. (5) (c), that there is no certified lowest-cost health care network or low-cost health care network in the area, there shall be no extra cost to the participant enrolling in the fee-for-service option.

SB40-SSA1-SA1,264,22 (8) Incentive payments to fee-for-service providers. Health care providers and facilities providing services under the fee-for-service option under sub. (2) (a) shall be encouraged to collaborate with each other through financial incentives established by the board. Providers shall work with facilities to pool infrastructure and resources; to implement the use of best practices and quality measures; and to establish organized processes that will result in high-quality, low-cost medical care. The board shall establish an incentive payment system to providers and facilities that comply with this subsection, in accordance with criteria established by the board.

SB40-SSA1-SA1,265,9 (9) Pharmacy benefit. Except for prescription drugs to which a deductible applies, the board shall assume the risk for, and pay directly for, prescription drugs provided to participants. In implementing this requirement, the board shall replicate the prescription drug buying system developed by the group insurance board for prescription drug coverage under the state employee health plan under s. 40.51 (6), unless the board determines that another approach would be more cost-effective. The board may join the prescription drug purchasing arrangement under this chapter with similar arrangements or programs in other states to form a multistate purchasing group to negotiate with prescription drug manufacturers and distributors for reduced prescription drug prices, or to contract with a 3rd party, such as a private pharmacy benefits manager, to negotiate with prescription drug manufacturers and distributors for reduced prescription drug prices.

SB40-SSA1-SA1,265,13 260.35 Subrogation. The board and authority are entitled to the right of subrogation for reimbursement to the extent that a participant may recover reimbursement for health care services and items in an action or claim against any 3rd party.

SB40-SSA1-SA1,265,17 260.37 Employer-provided health care benefits. Nothing in this chapter prevents an employer, or a Taft-Hartley trust on behalf of an employer, from paying all or part of any cost sharing under s. 260.20 or 260.30, or from providing any health care benefits not provided under the plan, for any of the employer's employees.

SB40-SSA1-SA1,265,19 260.40 Assessments, individuals and businesses. (1) Definitions. In this section:

SB40-SSA1-SA1,265,20 (a) "Department" means the department of revenue.

SB40-SSA1-SA1,265,24 (b) "Dependent" means a spouse, an unmarried child under the age of 19 years, an unmarried child who is a full-time student under the age of 21 years and who is financially dependent upon the parent, or an unmarried child of any age who is medically certified as disabled and who is dependent upon the parent.

SB40-SSA1-SA1,266,2 (c) "Eligible individual" means an individual who is eligible to participate in the plan, other than an employee or a self-employed individual.

SB40-SSA1-SA1,266,3 (d) "Employee" means an individual who has an employer.

SB40-SSA1-SA1,266,5 (e) "Employer" means a person who is required under the Internal Revenue Code to file form 941.

SB40-SSA1-SA1,266,12 (f) "Medical inflation" means the percentage change between the U.S. consumer price index for all urban consumers, U.S. city average, for the medical care group only, including medical care commodities and medical care services, for the month of August of the previous year and the U.S. consumer price index for all urban consumers, U.S. city average, for the medical care group only, including medical care commodities and medical care services, for the month of August 2007, as determined by the U.S. department of labor.

SB40-SSA1-SA1,266,14 (g) "Poverty line" means the federal poverty line, as defined under 42 USC 9902 (2), for a family the size of the individual's family.

SB40-SSA1-SA1,266,16 (h) "Self-employed individual" means an individual who is required under the Internal Revenue Code to file schedule SE.

SB40-SSA1-SA1,266,17 (i) "Social security wages" means:

SB40-SSA1-SA1,266,20 1. For purposes of sub. (2) (a), the amount of wages, as defined in section 3121 (a) of the Internal Revenue Code, paid to an employee by an employer in a taxable year, up to a maximum amount that is equal to the social security wage base.

SB40-SSA1-SA1,266,24 2. For purposes of sub. (2) (b), the amount of net earnings from self-employment, as defined in section 1402 (a) of the Internal Revenue Code, received by an individual in a taxable year, up to a maximum amount that is equal to the social security wage base.

SB40-SSA1-SA1,267,5 3. For purposes of sub. (3), the amount of wages, as defined in section 3121 (a) of the Internal Revenue Code, paid by an employer in a taxable year with respect to employment, as defined in section 3121 (b) of the Internal Revenue Code, up to a maximum amount that is equal to the social security wage base multiplied by the number of the employer's employees.

SB40-SSA1-SA1,267,7 (2) Individuals. Subject to sub. (4), the board shall calculate the following assessments, based on its anticipated revenue needs:

SB40-SSA1-SA1,267,9 (a) For an employee who is under the age of 65, a percent of social security wages that is at least 2 percent and not more than 4 percent, subject to the following:

SB40-SSA1-SA1,267,11 1. If the employee has social security wages that are 150 percent or less of the poverty line, the employee may not be assessed.

SB40-SSA1-SA1,267,16 2. If the employee has no dependents and his or her social security wages are more than 150 percent and 200 percent or less of the poverty line the assessment shall be in an amount, as determined by the board on a sliding scale based on the employee's social security wages, that is between zero percent and 4 percent of the employee's social security wages.

SB40-SSA1-SA1,267,22 3. If the employee has one or more dependents, or is a single individual who is pregnant, and the employee's social security wages are more than 150 percent and 300 percent or less of the poverty line the assessment shall be in an amount, as determined by the board on a sliding scale based on the employee's social security wages, that is between zero percent and 4 percent of the employee's social security wages.

SB40-SSA1-SA1,267,24 (b) For a self-employed individual who is under the age of 65, a percent of social security wages that is at least 9 percent and not more than 10 percent.

SB40-SSA1-SA1,268,4 (c) For an eligible individual who has no social security wages under sub. (1) (i) 1. or 2. or, from an employer, under sub. (1) (i) 3., 10 percent of federal adjusted gross income, up to the maximum amount of income that is subject to social security tax.

SB40-SSA1-SA1,268,7 (3) Employers. Subject to sub. (4), the board shall calculate an assessment, based on its anticipated revenue needs, that is a percent of aggregate social security wages that is at least 9 percent and not more than 12 percent.

SB40-SSA1-SA1,268,18 (4) Collection and calculation of assessments. (a) For taxable years beginning after December 31, 2008, the department shall impose on, and collect from, individuals the assessment amounts that the board calculates under sub. (2), either through an assessment that is collected as part of the income tax under subch. I of ch. 71, or through another method devised by the department. For taxable years beginning after December 31, 2008, the department shall impose on, and collect from, employers the assessment amounts that the board calculates under sub. (3), either through an assessment that is collected as part of the tax under subch. IV of ch. 71, or through another method devised by the department. Section 71.80 (1) (c), as it applies to ch. 71, applies to the department's imposition and collection of assessments under this section.

SB40-SSA1-SA1,268,20 (b) The amounts that the department collects under par. (a) shall be deposited into the Healthy Wisconsin trust fund under s. 25.775.

SB40-SSA1-SA1,268,24 (c) The board may annually increase or decrease the amounts that may be assessed under subs. (2) and (3). No annual increase under this paragraph may exceed the percentage increase for medical inflation unless a greater increase is provided for by law.

SB40-SSA1-SA1,269,2 260.49 Advisory committee. (1) Duties. The board shall establish a health care advisory committee to advise the board on all of the following:

SB40-SSA1-SA1,269,3 (a) Matters related to promoting healthier lifestyles.

SB40-SSA1-SA1,269,4 (b) Promoting health care quality.

SB40-SSA1-SA1,269,5 (c) Increasing the transparency of health care cost and quality information.

SB40-SSA1-SA1,269,6 (d) Preventive care.

SB40-SSA1-SA1,269,7 (e) Early identification of health disorders.

SB40-SSA1-SA1,269,8 (f) Disease management.

SB40-SSA1-SA1,269,10 (g) The appropriate use of primary care, medical specialists, prescription drugs, and hospital emergency rooms.

SB40-SSA1-SA1,269,11 (h) Confidentiality of medical information.

SB40-SSA1-SA1,269,12 (i) The appropriate use of technology.

SB40-SSA1-SA1,269,13 (j) Benefit design.

SB40-SSA1-SA1,269,14 (k) The availability of physicians, hospitals, and other providers.

SB40-SSA1-SA1,269,15 (L) Reducing health care costs.

SB40-SSA1-SA1,269,16 (m) Any other subject assigned to it by the board.

SB40-SSA1-SA1,269,17 (n) Any other subject determined appropriate by the committee.

SB40-SSA1-SA1,269,19 (2) Membership. The board shall appoint as members of the committee all of the following individuals:

SB40-SSA1-SA1,269,20 (a) At least one member designated by the Wisconsin Medical Society, Inc.

SB40-SSA1-SA1,269,22 (b) At least one member designated by the Wisconsin Academy of Family Physicians.

SB40-SSA1-SA1,269,23 (c) At least one member designated by the Wisconsin Hospital Association, Inc.

SB40-SSA1-SA1,270,3 (d) One member designated by the president of the Board of Regents of the University of Wisconsin System who is knowledgeable in the field of medicine and public health.

SB40-SSA1-SA1,270,5 (e) One member designated by the president of the Medical College of Wisconsin.

SB40-SSA1-SA1,270,8 (f) Two members designated by the Wisconsin Nurses Association, the Wisconsin Federation of Nurses and Health Professionals, and the Service Employees International Union.

SB40-SSA1-SA1,270,9 (g) One member designated by the Wisconsin Dental Association.

SB40-SSA1-SA1,270,11 (h) One member designated by statewide organizations interested in mental health issues.

SB40-SSA1-SA1,270,12 (i) One member representing health care administrators.

SB40-SSA1-SA1,270,13 (j) Other members representing health care professionals.".

SB40-SSA1-SA1,270,14 530. Page 1353, line 13: after that line insert:

SB40-SSA1-SA1,270,15 " Section 3085c. 285.59 (1) (b) of the statutes is amended to read:

SB40-SSA1-SA1,270,24 285.59 (1) (b) "State agency" means any office, department, agency, institution of higher education, association, society, or other body in state government created or authorized to be created by the constitution or any law which that is entitled to expend moneys appropriated by law, including the legislature and the courts, the Wisconsin Housing and Economic Development Authority, the Bradley Center Sports and Entertainment Corporation, the University of Wisconsin Hospitals and Clinics Authority, the Fox River Navigational System Authority, the Wisconsin Aerospace Authority, and the Wisconsin Health and Educational Facilities Authority, and the Healthy Wisconsin Authority.".

SB40-SSA1-SA1,271,1 531. Page 1353, line 22: after that line insert:

SB40-SSA1-SA1,271,2 " Section 3086p. 287.31 (6) of the statutes is amended to read:

SB40-SSA1-SA1,271,4 287.31 (6) Use of revenues. The newspaper recycling fees collected under sub. (5) shall be deposited in the recycling and renewable energy fund under s. 25.49.".

SB40-SSA1-SA1,271,5 532. Page 1354, line 3: after that line insert:

SB40-SSA1-SA1,271,6 " Section 3088d. 289.645 (6) of the statutes is amended to read:

SB40-SSA1-SA1,271,8 289.645 (6) Use of recycling fees. The fees collected under sub. (2) shall be deposited in the recycling and renewable energy fund.".

SB40-SSA1-SA1,271,9 533. Page 1354, line 3: substitute "$10" for "$6".

SB40-SSA1-SA1,271,13 534. Page 1354, line 9: after "July 1, 2007," insert " 85 cents per ton for solid waste disposed of after July 1, 2007, and before October 1, 2007, or the first day of the 3rd month beginning after the effective date of this paragraph .... [revisor inserts date], whichever is later,".

SB40-SSA1-SA1,271,16 535. Page 1354, line 10: delete "July 1, 2007" and substitute "October 1, 2007, or the first day of the 3rd month beginning after the effective date of this paragraph .... [revisor inserts date], whichever is later".

SB40-SSA1-SA1,271,17 536. Page 1356, line 8: after that line insert:

SB40-SSA1-SA1,271,18 " Section 3094h. 292.68 of the statutes is created to read:

SB40-SSA1-SA1,271,20 292.68 Reimbursement for disposal of PCB contaminated sediment. (1) Definitions. In this section:

SB40-SSA1-SA1,272,2 (a) "Disposal costs" means the costs of transporting PCB contaminated sediment to a hazardous waste disposal facility, the fees for disposing of the PCB contaminated sediment in the hazardous waste disposal facility, and the cost of any permits that an applicant is required to obtain in order to transport and dispose of the PCB contaminated sediment.

SB40-SSA1-SA1,272,5 (b) "PCB contaminated sediment" means sediment that contains polychlorinated biphenyls in a concentration of 50 parts per million or greater and that is dredged from the bed or bank of a navigable water in this state.

SB40-SSA1-SA1,272,9 (2) Program. The department shall administer a program to provide reimbursement to certain responsible parties for a portion of costs incurred for disposing of PCB contaminated sediment at an out-of-state hazardous waste disposal facility, as provided in this section.

SB40-SSA1-SA1,272,14 (3) Eligible person. A person is eligible for the program under this section if the person is a responsible party, under s. 292.11 or 42 USC 9601 to 9675, for the remediation of PCB contaminated sediment or has entered into a consent decree with the department or the federal environmental protection agency under which the person undertakes the remediation of PCB contaminated sediment.

SB40-SSA1-SA1,272,16 (4) Application. A person may seek reimbursement under this section by submitting an application to the department that contains all of the following:

SB40-SSA1-SA1,272,19 (a) Test results that show that the sediment on which the application is based contains polychlorinated biphenyls in a concentration of 50 parts per million or greater.

SB40-SSA1-SA1,272,21 (b) Documentation showing that the applicant is an eligible person under sub. (3).

SB40-SSA1-SA1,272,24 (c) Documentation showing that the PCB contaminated sediment was transported to and disposed of at a licensed hazardous waste disposal facility outside of this state and that disposal occurred on or after May 1, 2007.

SB40-SSA1-SA1,273,4 (d) Documentation showing the disposal costs, including information concerning the length and other terms of any contract for the disposal of the PCB contaminated sediment, and showing any other costs that the department determines to be reasonably necessary and attributable to the out-of-state disposal.