AB955: Bill Text

This bill establishes a universal health plan for Wisconsin, effective July 1, 2001, under which each state resident shall, with certain exceptions, receive reasonable medical services necessary to maintain health, enable diagnosis or provide treatment or rehabilitation for an injury, disability or disease.

This bill creates a department of health planning and finance that is directed and supervised by an 11-member health policy board that is also created in the bill. The bill also creates 6 regional health councils that are attached to the department of health planning and finance and that report quarterly to the health policy board on the health care needs, problems and concerns of the region. The bill requires appropriation of general purpose revenues to the department of health planning and finance for operation of the health policy board for fiscal year 1997-98 and 1998-99 and requires that the health policy board consider numerous issues related to the formation of a universal health plan in this state. The board is required to meet semimonthly beginning on January 1, 1999, to formulate decisions on these issues, including those raised in reports to the board by the regional health councils, and to convey these decisions to and cooperate with the legislative reference bureau in the drafting of proposed legislation for introduction in the legislature on or before January 11, 2000. The legislative reference bureau must prepare the proposed legislation that relates to the board's decisions in proper form for introduction.

For further information see the state fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB955, s. 1 Section 1. 15.01 (4) of the statutes is amended to read:

AB955,2,11 15.01 (4) "Council" means a part-time body appointed to function on a continuing basis for the study, and recommendation of solutions and policy alternatives, of the problems arising in a specified functional area of state government, except the Milwaukee river revitalization council has the powers and duties specified in s. 23.18, the council on physical disabilities has the powers and duties specified in s. 46.29 (1) and (2), the state council on alcohol and other drug abuse has the powers and duties specified in s. 14.24, the regional health councils have the powers and duties specified in s. 52.30 (1) and, before January 1, 2001, the council on health care fraud and abuse has the powers and duties specified in s. 146.36.

AB955, s. 2 Section 2. 15.07 (1) (a) 7. of the statutes is created to read:

AB955,3,2 15.07 (1) (a) 7. Members of the health policy board appointed under s. 15.20 (1) (a) shall be appointed as provided in that section.

AB955, s. 3 Section 3. 15.07 (2) (h) of the statutes is created to read:

AB955,3,5 15.07 (2) (h) The chairperson of the health policy board shall serve for a period of 3 years.

AB955, s. 4 Section 4. 15.07 (5) (m) of the statutes is created to read:

AB955,3,7 15.07 (5) (m) Voting members of the health policy board, $50 per day.

AB955, s. 5 Section 5. 15.07 (5m) (c) of the statutes is created to read:

AB955,3,12 15.07 (5m) (c) Health policy board. Members of the health policy board may be reimbursed for lost wages if required by their employers to use leave without pay in order to attend meetings of the health policy board, and they may be reimbursed for actual and necessary child care expenses without proof of financial hardship.

AB955, s. 6 Section 6. 15.20 of the statutes is created to read:

AB955,3,19 15.20 Department of health planning and finance. (1) There is created a department of health planning and finance under the direction and supervision of the health policy board. The health policy board shall consist of the following members, each of whom is to serve for a 6-year term and, if reappointed, for an additional 6-year term and none of whom may be a health care service provider or administrator of a health care facility or organization:

AB955,3,21 (a) One member appointed by and from the current membership of each of 6 regional health councils as specified under s. 15.207 (1) (b).

AB955,3,24 (b) Five members, appointed by the governor, who reflect as much as possible a balance of gender, race, age and the interests of management, labor and disabled individuals.

AB955, s. 7 Section 7. 15.207 of the statutes is created to read:

AB955,4,4 15.207 Same; councils. (1) Regional health councils. (a) There are created 6 regional health councils that are attached to the department of health planning and finance under s. 15.03, one of which is established in each of the following areas of this state:

AB955,4,7 1. The northern region, consisting of Ashland, Bayfield, Douglas, Florence, Forest, Iron, Langlade, Lincoln, Marathon, Oneida, Portage, Price, Sawyer, Taylor, Vilas and Wood counties.

AB955,4,10 2. The southern region, consisting of Adams, Columbia, Crawford, Dane, Dodge, Grant, Green, Iowa, Jefferson, Juneau, Lafayette, Richland, Rock, Sauk and Vernon counties.

AB955,4,13 3. The western region, consisting of Barron, Burnett, Buffalo, Chippewa, Clark, Dunn, Eau Claire, Jackson, La Crosse, Monroe, Pepin, Pierce, Polk, Rusk, St. Croix, Trempealeau and Washburn counties.

AB955,4,16 4. The northeastern region, consisting of Brown, Calumet, Door, Fond du Lac, Green Lake, Kewaunee, Manitowoc, Marinette, Marquette, Menominee, Oconto, Outagamie, Shawano, Sheboygan, Waupaca, Waushara and Winnebago counties.

AB955,4,18 5. The southeastern region, consisting of Kenosha, Ozaukee, Walworth, Washington, Waukesha and Racine counties.

AB955,4,19 6. The area within Milwaukee County.

AB955,4,21 (b) Each regional council shall consist of the following members, to serve for 3-year terms:

AB955,4,24 1. In the northern region, a total of 16 members, consisting of one member from each county in that region. The county board of supervisors of each county in that region shall appoint the member from that county.

AB955,5,3 2. In the southern region, a total of 15 members, consisting of one member from each county in that region. The county board of supervisors of each county in that region shall appoint the member from that county.

AB955,5,6 3. In the western region, a total of 17 members, consisting of one member from each county in that region. The county board of supervisors of each county in that region shall appoint the member from that county.

AB955,5,9 4. In the northeastern region, a total of 17 members, consisting of one member from each county in that region. The county board of supervisors of each county in that region shall appoint the member from that county.

AB955,5,12 5. In the southeastern region, a total of 12 members, consisting of 2 members from each county in that region. The county board of supervisors of each county in that region shall appoint the 2 members from that county.

AB955,5,17 6. In the area within Milwaukee County, a total of 12 members, consisting of 6 members who are residents of the city of Milwaukee and are appointed by the mayor of the city of Milwaukee, and 6 members who are residents of Milwaukee County but are not residents of the city of Milwaukee and are appointed by the county executive of Milwaukee County.

AB955, s. 8 Section 8. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table

AB955, s. 9 Section 9. 20.430 of the statutes is created to read:

AB955,6,4 20.430 Health planning and finance, department of. There is appropriated to the department of health planning and finance for the following programs:

AB955,6,6 (1) Health policy board. (a) General program operations. The amounts in the schedule for the general program operations of the health policy board.

AB955, s. 10 Section 10. Chapter 52 of the statutes is created to read:

AB955,6,9 Chapter 52 Universal health plan

AB955,6,10 52.01 Definitions. In this chapter:

AB955,6,11 (1) "Block grant" has the meaning given in s. 16.54 (2) (a) 3.

AB955,6,12 (2) "Board" means the health policy board.

AB955,6,13 (3) "Department" means the department of health planning and finance.

AB955,6,14 (4) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).

AB955,6,16 (5) "Medicare" means coverage under part A or part B of Title XVIII of the federal social security act, 42 USC 1395 to 1395ddd.

AB955,6,17 (6) "Resident" means an individual who lives or is employed within this state.

AB955,6,23 52.10 Universal health plan. There is created a universal health plan in this state, under which each resident shall receive reasonable medical service necessary to maintain health, enable diagnosis or provide treatment or rehabilitation for an injury, disability or disease, paid for by a single payer, except that no coverage is provided for orthodontia for persons who are age 18 or older that is not medically necessary or for the performance of cosmetic surgery.

AB955,7,3 52.20 Health policy board; powers and duties. The board shall consider and formulate policy on at least all of the following issues with respect to the formation of a universal health plan in this state:

AB955,7,7 (1) Other than premiums, copayments, deductibles or other forms of direct payment by patients, the sources of revenues for the administration of the department and the board and for financing the payment of medical services that are provided to residents under the universal health plan, including all of the following:

AB955,7,13 (a) Use of federal, state and local moneys that fund, as of the effective date of this paragraph .... [revisor inserts date], health care services, including medicare, medical assistance, health care services under ss. 49.025, 49.027 and 49.029, services under the health care program for low-income families under s. 49.665, services provided under federal block grants, alcohol and other drug abuse services and services provided by local public health agencies.

AB955,7,18 (b) Imposition of a tax on employers, based on the amount of wages that they pay, that generates, in the aggregate, revenues that are at least equal to amounts that employers contribute, as of the effective date of this paragraph .... [revisor inserts date], for employe health care benefit costs, including the costs of worker's compensation attributable to health care for injured employes.

AB955,7,22 (c) Imposition of a graduated income tax on individuals that generates, in the aggregate, revenues that are not greater than expenditures that individuals make, as of the effective date of this paragraph .... [revisor inserts date], for health care costs for which coverage under disability insurance policies is not obtained.

AB955,7,25 (d) An indexing of the sources of revenues under this subsection that provides for revenue growth that is equivalent to the anticipated growth of health care costs under the universal health plan.

AB955,8,3 (2) The likelihood of and procedures necessary for obtaining waivers to 42 USC 1396 to 1396v or statutory changes to 42 USC 1396 to 1396v in order to effect all of the following:

AB955,8,5 (a) Administration of the medical assistance program in this state by the department, rather than by the department of health and family services.

AB955,8,7 (b) Use of federal financial participation to fund a portion of the administrative costs, after June 30, 2000, of the department.

AB955,8,13 (c) Use of federal financial participation, after June 30, 2001, to fund, under the universal health plan, the health care services received by a percentage of the residents that corresponds to the percentage of the residents, as determined by the board, that is eligible to receive health care services under the medical assistance program or under the health care program for low-income families under s. 49.665 on July 1, 2001.

AB955,8,15 (d) The formulation of criteria and procedures for payment of out-of-state health care costs incurred by residents specified in par. (c).

AB955,8,17 (e) Use of federal financial participation to fund the scope, or a portion of the scope, of medical services to be provided under the universal health plan.

AB955,8,20 (3) The likelihood of and procedures necessary for obtaining waivers to 42 USC 1395 to 1395ddd or statutory changes to 42 USC 1395 to 1395ddd in order to effect all of the following:

AB955,8,22 (a) Administration of the medicare program in this state by the department, rather than by private insurers.

AB955,8,24 (b) Use of federal funds under 42 USC 1395 to 1395ddd to fund a portion of the administrative costs, after June 30, 2000, of the department.

AB955,9,3 (c) Use of federal funds under 42 USC 1395 to 1395ddd to fund, under the universal health plan, the health care services received by residents who are eligible to receive services under 42 USC 1395 to 1395ddd beginning on July 1, 2001.

AB955,9,5 (d) The formulation of criteria and procedures for payment of out-of-state health care costs incurred by residents specified in par. (c).

AB955,9,8 (e) Use of federal funds under 42 USC 1395 to 1395ddd to fund the scope, or a portion of the scope, of medical services to be provided under the universal health plan.

AB955,9,10 (f) The assignment to the state, as represented by the department, of rights of an individual to payment for medical care from any 3rd party.

AB955,9,15 (4) The likelihood of and procedures necessary for obtaining waivers or statutory changes to federal laws, other than those specified in subs. (2) and (3), in order to use moneys available under those federal laws for payment of health care services or mental health services under the universal health plan or in order to provide services to all residents under the universal health plan.

AB955,9,17 (5) The establishment and maintenance of a health trust fund in the department, for receipt of revenues for the purposes specified in sub. (1).

AB955,9,20 (6) The scope of health care services and other benefits, if any, that shall be required to be provided under the universal health plan, including all of the following:

AB955,9,23 (a) Services of all persons licensed, certified, registered or permitted to treat the sick under chs. 441, 446, 447, 448, 449, 450, 451, 455 and 459 and services of professional counselors and marriage and family therapists under ch. 457.

AB955,9,25 (b) Health care and mental health treatment services provided by facilities or services governed under ss. 45.365, 46.03 (1), 49.70, 49.72 (1), 50.02, 50.03, 50.033, 50.034, 50.32 to 50.39, 50.49, 50.50, 50.91, 51.038, 51.08, 51.09, 58.05, 58.06, 251.05, 252.073, 252.076, 252.10 and 301.02 and the offices and clinics of persons licensed, certified, registered or permitted to treat the sick under chs. 441, 446, 447, 448, 449, 450, 451, 455 and 459.

AB955,10,5 (c) Services provided by social workers certified under ch. 457.

AB955,10,6 (d) Preventive health care services and health promotional programs.

AB955,10,9 (e) Long-term care and services provided in institutional and community-based settings as convalescent or custodial care or care for a chronic condition or terminal illness.

AB955,10,10 (f) Eyeglasses and contact lenses.

AB955,10,11 (g) Hearing aids, as defined in s. 459.01 (2).

AB955,10,12 (h) Prescription drugs, as defined in s. 450.01 (20).

AB955,10,13 (i) Prostheses, including dental prostheses.

AB955,10,14 (j) Medical supplies and equipment.

AB955,10,16 (7) The definition of the terms "health care provider", "health care facility" and "cosmetic surgery" for purposes of reimbursement under the universal health plan.

AB955,10,22 (8) The formulation of criteria for determining payment and the formulation of procedures for determining payment and negotiating applicable rates to be used for payment for health care providers, including health care facilities, under the universal health plan. The criteria and procedures for determining payment shall include the concept of periodic budgeting, including separately budgeting for operational costs, for health care facilities.

AB955,11,2 (9) The formulation of criteria and procedures to review and to provide funding for capital expenditures, from an account separate from that from which health care services are paid, for the establishment, maintenance or expansion of health care facilities.

AB955,11,4 (10) The formulation of prohibitions on issuance of disability insurance policies that duplicate the coverage provided under the universal health plan.

AB955,11,6 (11) The formulation of criteria and procedures for recovery of overpayments made to health care providers under the universal health plan.

AB955,11,8 (12) The creation of a timetable for the phasing in, no later than July 1, 2004, of services under the universal health plan for each of the following groups:

AB955,11,10 (a) Individuals, other than those specified in par. (b), who have no coverage under disability insurance policies.

AB955,11,14 (b) Individuals who have no coverage under disability insurance policies and who receive federally funded, state-funded or locally funded health care, treatment for nervous or mental disorders or treatment or prevention services for alcohol and other drug abuse.

AB955,11,18 (c) Individuals who are employes of state, county, city, village or town government and who, as a benefit of the employment, have coverage for themselves and family members under provisions of group disability insurance policies or under self-insured health plans.