AB955: Bill Text

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.

AB955,11,21 (d) Individuals, other than those specified in par. (c) or (h), who, by reason of their employment or as family members of individuals who are employed, have coverage under group disability insurance policies.

AB955,11,23 (e) Individuals who have coverage under individual disability insurance policies.

AB955,11,25 (f) Individuals who have coverage under the mandatory health insurance risk-sharing plan under ch. 149.

AB955,12,3 (g) Individuals who are eligible for benefits or services under s. 49.46, 49.47 or 49.665, medicare or federal block grants that provide health care services or mental health services.

AB955,12,6 (h) Individuals who are employes of self-insured employers, other than those specified in par. (c), and who receive health care benefits for themselves and family members under self-insured health plans.

AB955,12,7 (i) Individuals who receive medical benefits under worker's compensation.

AB955,12,9 (13) The determination of factors requisite to establishing an annual state health budget for the provision of services under the universal health plan.

AB955,12,13 (14) The scope of functions of the department and the attendant reduction of scope of the functions of the department of health and family services, the office of the commissioner of insurance, the board on aging and long-term care and any other applicable state agency powers or responsibilities.

AB955,12,15 (15) The solicitation and use of information provided by the health policy councils.

AB955,12,18 (16) The likelihood of and procedures necessary to obtain waivers or statutory change to 29 USC 1144 (a), or, alternatively, the means by which operation of the universal health plan may avoid conflict with 29 USC 1144 (a).

AB955,12,20 (17) The necessity of exempting operation of the universal health plan from ch. 133.

AB955,12,23 (18) Investigation of the feasibility of providing the state with subrogation rights to payments for injury or disease to residents that are provided under motor vehicle or other liability insurance policies or plans.

AB955,13,2 (19) Development of a system for determination and periodic review of areas in this state, and specific populations within those areas, that are medically underserved; and development of plans for providing health care services to those areas and populations that include establishment of community health centers.

AB955,13,5 (20) Development of a system for periodic reviews and evaluations of all aspects of the operation of the universal health plan, including the adequacy, effectiveness and quality of health care services provided.

AB955,13,8 (21) Development of a notice and hearing procedure for review of complaints of residents under the universal health plan, in accordance with the requirements of ch. 227.

AB955,13,10 (22) Means of containing costs for services provided under the universal health plan.

AB955,13,12 (23) Formulation of criteria and procedures for payment under the universal health plan of out-of-state health care costs incurred by residents.

AB955,13,14 (24) Other issues that the board determines are relevant to the universal health plan.

AB955,13,15 (25) State statutory changes that may be necessary to effect subs. (1) to (24).

AB955,13,17 52.30 Regional health councils; powers and duties. (1) Each regional health council shall do all of the following:

AB955,13,22 (a) Appoint one member of the regional health council to serve as a member of the board under s. 15.20 (1) (a). If the term of the member who is so appointed expires with respect to the regional health council or with respect to the board under s. 15.20 (1) (a), the regional health council shall appoint a current member of the council to serve as a member of the board in his or her stead.

AB955,14,2 (b) Study and continuously monitor the delivery and quality of and access to health care services in the region of the regional health council and recommend to the board ways to improve the quality of and help ensure access to health care services.

AB955,14,5 (c) Study and continuously monitor the unmet health care service needs in the region of the regional health council and recommend to the board ways by which the needs may be met.

AB955,14,8 (d) Report at least annually to the board with respect to the health care needs, problems and concerns of the region and provide to the board recommendations to alleviate these needs, problems and concerns.

AB955,14,9 (e) Perform other duties as required by the board.

AB955,14,12 (2) Each regional health council may, for cause, recall the member appointed under sub. (1) (a) and may appoint another member to fulfill that term on the board if all of the following are done:

AB955,14,14 (a) The appointed member of the board for whom recall is sought receives notice of the recall prior to the meeting at which recall is voted upon.

AB955,14,17 (b) Notice of the recall of the appointed member is made on the agenda of the meeting of the regional health council that is immediately prior to the meeting at which recall is voted upon.

AB955, s. 11 Section 11. 59.17 (2) (c) of the statutes is amended to read:

AB955,14,23 59.17 (2) (c) Appoint the members of all boards and, commissions and councils where appointments are required and where the statutes provide that the appointments are made by the county board or by the chairperson of the county board. All appointments to boards and, commissions and councils by the county executive are subject to confirmation by the county board.

AB955, s. 12 Section 12. 59.53 (24) of the statutes is created to read:

AB955,15,2 59.53 (24) Regional health council. Each board shall appoint members of a regional health council, as specified in s. 15.207 (1) (b).

AB955, s. 13 Section 13. 62.09 (8) (cm) of the statutes is created to read:

AB955,15,6 62.09 (8) (cm) The mayor of a 1st class city may, with the advice and consent of the common council of that city, appoint 6 members of a regional health council, as specified under s. 15.207 (1) (b) 6.

AB955, s. 14 Section 14. Nonstatutory provisions; health planning and financed.

AB955,15,12 (1) Health policy board; appointment of members. Notwithstanding the length of terms specified for the voting members of the health policy board under section 15.20 (1) (intro.) of the statutes, as created by this act, the initial members of the health policy board shall be appointed by the first day of the 3rd month beginning after the effective date of this subsection for the following terms:

AB955,15,17 (a) Two members specified under section 15.20 (1) (b) of the statutes, as created by this act, and 2 members specified under section 15.20 (1) (a) of the statutes, as created by this act, one of whom is appointed from the northern regional council and one of whom is appointed from the southeastern regional council, for terms expiring on May 1, 2002.

AB955,15,22 (b) Two members specified under section 15.20 (1) (b) of the statutes, as created by this act, and 2 members specified under section 15.20 (1) (a) of the statutes, as created by this act, one of whom is appointed from the northeastern regional council and one of whom is appointed from the regional council within the area of Milwaukee County, for terms expiring on May 1, 2004.

AB955,16,2 (c) One member specified under section 15.20 (1) (b) of the statutes, as created by this act, and 2 members specified under section 15.20 (1) (a) of the statutes, as created by this act, one of whom is appointed from the southern regional council and one of whom is appointed from the western regional council, for terms expiring on May 1, 2006.

AB955,16,10 (2) Health policy board; proposed legislation. The health policy board shall, beginning on January 1, 1999, and ending on September 1, 1999, meet at least semimonthly to formulate decisions on issues concerning the Wisconsin universal health plan, as specified in section 52.20 (1) to (24) of the statutes, as created by this act. The health policy board shall convey these decisions to and cooperate with the legislative reference bureau in the drafting of proposed legislation that is necessary to meet those issues, for introduction in the legislature on or before January 11, 2000, by the appropriate committee of the legislature.