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1. The northern region, consisting of Ashland, Bayfield, Douglas, Florence,
4Forest, Iron, Langlade, Lincoln, Marathon, Oneida, Portage, Price, Sawyer, Taylor,
5Vilas, and Wood counties.
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2. The southern region, consisting of Adams, Columbia, Crawford, Dane,
7Dodge, Grant, Green, Iowa, Jefferson, Juneau, Lafayette, Richland, Rock, Sauk, and
8Vernon counties.
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3. The western region, consisting of Barron, Burnett, Buffalo, Chippewa,
10Clark, Dunn, Eau Claire, Jackson, La Crosse, Monroe, Pepin, Pierce, Polk, Rusk, St.
11Croix, Trempealeau, and Washburn counties.
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4. The northeastern region, consisting of Brown, Calumet, Door, Fond du Lac,
13Green Lake, Kewaunee, Manitowoc, Marinette, Marquette, Menominee, Oconto,
14Outagamie, Shawano, Sheboygan, Waupaca, Waushara, and Winnebago counties.
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5. The southeastern region, consisting of Kenosha, Ozaukee, Walworth,
16Washington, Waukesha, and Racine counties.
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6. The area within Milwaukee County.
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(b) Each regional health council shall consist of the following members, none
19of whom may be a health care provider, as defined in s. 152.01 (6), an administrator
20or owner of a health care facility or organization, or an elected public official, to serve
21for no more than 3 3-year terms:
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1. In the northern region, a total of 16 members, consisting of one member from
23each county in that region. The county board of supervisors of each county in that
24region shall appoint one person from that county.
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12. In the southern region, a total of 15 members, consisting of one member from
2each county in that region. The county board of supervisors of each county in that
3region shall appoint one person from that county.
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3. In the western region, a total of 17 members, consisting of one member from
5each county in that region. The county board of supervisors of each county in that
6region shall appoint one person from that county.
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4. In the northeastern region, a total of 17 members, consisting of one member
8from each county in that region. The county board of supervisors of each county in
9that region shall appoint one person from that county.
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5. In the southeastern region, a total of 12 members, consisting of 2 members
11from each county in that region. The county board of supervisors of each county in
12that region shall appoint 2 persons from that county.
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6. In the area within Milwaukee County, a total of 12 members, consisting of
146 persons who are residents of the city of Milwaukee and are appointed by the mayor
15of the city of Milwaukee, and 6 persons who are residents of Milwaukee County but
16are not residents of the city of Milwaukee and are appointed by the county executive
17of Milwaukee County.
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18Section
9. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
19the following amounts for the purposes indicated:
-
See PDF for table ![PDF](https://docs.legis.wisconsin.gov/assets/image/file_acrobat.gif)
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1Section
10. 20.430 of the statutes is created to read:
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220.430 Health planning and finance, department of. There is
3appropriated to the department of health planning and finance for the following
4program:
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5(1) Health planning and finance. (a)
General program operations. The
6amounts in the schedule for the general program operations of the department of
7health planning and finance.
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(b)
Universal health plan services and benefits. The amounts in the schedule
9for health care services and benefits provided under s. 152.10 (4).
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(i)
Gifts and grants. All moneys received from gifts, grants, bequests, and
11devises to carry out the purposes for which made.
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(m)
Federal funds; state operations. All moneys received from the federal
13government, as authorized by the governor under s. 16.54, for the purposes for which
14made and received.
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15Section
11. 59.17 (2) (c) of the statutes is amended to read:
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59.17
(2) (c) Appoint the members of all boards
and, commissions
, and councils 17where appointments are required and where the statutes provide that the
18appointments are made by the county board
or, by the chairperson of the county
19board
, or by the county executive. All appointments to boards
and, commissions
, and
20councils by the county executive are subject to confirmation by the county board.
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21Section
12. 59.53 (24) of the statutes is created to read:
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59.53
(24) Regional health council. The board shall appoint members of a
23regional health council, as specified in s. 15.207 (1) (b) 1. to 5.
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24Section
13. 62.09 (8) (cm) of the statutes is created to read:
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162.09
(8) (cm) The mayor of the city of Milwaukee shall, with the advice and
2consent of the common council of that city, appoint 6 members of a regional health
3council, as specified under s. 15.207 (1) (b) 6.
SB133, s. 14
4Section
14. Chapter 152 of the statutes is created to read:
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Chapter 152
6
Universal health plan
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7152.01 Definitions. In this chapter:
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8(1) "Block grant" has the meaning given in s. 16.54 (2) (a) 3.
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9(2) "Board" means the health policy board.
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10(3) "Department" means the department of health planning and finance.
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11(4) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
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12(5) "Health care facility" means a facility, as defined in s. 647.01 (4), or any
13hospital, nursing home, community-based residential facility, county home, county
14infirmary, county hospital, county mental health center, community health center,
15primary health center, tuberculosis sanatorium, adult family home, assisted living
16facility, rural medical center, hospice, or other place licensed, certified, or approved
17by the department under s. 49.70, 49.71, 49.72, 50.02, 50.03, 50.032, 50.033, 50.034,
1850.35, 50.52, 50.92 (2), 51.08, or 51.09 or a facility under s. 45.365, 51.05, 51.06, or
19252.10 or ch. 233, or licensed or certified by a county department under s. 50.032 or
2050.033.
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21(6) "Health care provider" means a provider of health care services or other
22benefits in this state that are specified under s. 152.10 (4).
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23(7) "Medicare" means coverage under part A or part B of Title XVIII of the
24federal Social Security Act,
42 USC 1395 to
1395ddd.
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1(8) "Reimbursement" means payment for the provision of services and other
2benefits that are specified under s. 152.10 (4).
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3(9) "Secretary" means the secretary of health planning and finance.
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4(10) "Veteran" has the meaning given in
38 USC 101 (2).
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5152.10 Universal health plan. (1) There is created a universal health plan
6in this state, under which, beginning on July 1, 2004, each eligible person shall
7receive reasonable medical service necessary to maintain health, enable diagnosis,
8or provide treatment or rehabilitation for an injury, condition, disability, or disease,
9for which reimbursement shall be made by the department, except that no coverage
10is provided for orthodontia or for the performance of reconstructive or cosmetic
11surgery that is not determined to be medically necessary under criteria that are
12promulgated as rules by the department.
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13(2) Each individual in this state who meets requirements of residency, under
14criteria promulgated as rules by the department, is eligible for coverage, except as
15provided in sub. (5), under the universal health plan, except that all of the following
16may be phased in for eligibility under this subsection, beginning no later than July
171, 2005:
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(a) Individuals, other than those specified in par. (b), who have no coverage
19under disability insurance policies.
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(b) Individuals who have no coverage under disability insurance policies and
21who receive health care, treatment for nervous or mental disorders, or treatment or
22prevention services for alcohol and other drug abuse that are funded by state or local
23funding.
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(c) Individuals who are employees of the state or any county, city, village, or
25town, and who, as a benefit of the employment, have coverage for themselves and
1family members under provisions of group disability insurance policies or under
2self-insured health plans.
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(d) Individuals, other than those specified in par. (c) or (h), who, by reason of
4their employment or as family members of individuals who are employed, have
5coverage under group disability insurance policies.
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(e) Individuals who have coverage under individual disability insurance
7policies.
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(f) Individuals who have coverage under the health insurance risk-sharing
9plan under ch. 149.
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(g) Individuals who are eligible for benefits or services under s. 49.46, 49.468,
1149.47, or 49.665, medicare, or block grants that provide health care services.
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(h) Individuals who are employees of self-insured employers, other than those
13specified in par. (c), and who receive health care benefits for themselves and family
14members under self-insured health plans.
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(i) Individuals who receive medical benefits under worker's compensation.
SB133,10,1816(j) Veterans who receive medical benefits under s. 45.351 (1j) or
38 USC 1701 17to
1774, or both, and the children of veterans who receive medical benefits under
38
18USC 1801 to
1806.
SB133,10,1919(k) Indians who receive health and other services under
25 USC 1651 to
1683.
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20(3) (a) Any individual who is eligible under sub. (2) may receive services that
21are available under the universal health plan from any participating health care
22provider in this state.
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(b) No individual who is eligible under sub. (2) may under this section be
24required to pay an amount as a deductible or copayment as a condition for receipt of
25services under this section from a health care facility or health care provider.
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1(c) An individual's state residency is presumed unless rebutted by clear and
2convincing evidence. If the presumption is so rebutted, any reimbursement paid
3under the universal health plan for health care services rendered to the individual
4is a liability of the individual.
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5(4) Health care services and other benefits provided under the universal health
6plan shall include all of the following:
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(a) Services of all persons licensed, certified, registered, or permitted to treat
8the sick under chs. 441, 446, 447, 448, 449, 450, 451, 455, 457, and 459.
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(b) Health care services that are provided by health care facilities and the
10offices and clinics of persons under par. (a).
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(c) Preventive health care services and health promotional programs, including
12well-child care, immunizations, screening, outreach, and education.
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(d) Medical or surgical supplies and durable medical or surgical equipment,
14supplies and appliances, including valves, pacemakers, prostheses, eyeglasses, and
15hearing aids.
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(e) Prescription drugs specified in the state formulary under the requirements
17of s. 152.40 (4) (n) and any other drugs specified by the department by rule.
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(f) Blood and blood products.
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(g) Long-term care services that are necessary for the physical health, mental
20and emotional well-being, and social and personal needs of individuals who have
21limited self-care capabilities, including services of health care facilities; home
22health care; hospice care; home-based and community-based services, including
23personal assistance and attendant care; and periodic needs assessments.
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(h) Mental health treatment and services, including substance abuse and brain
25injury treatment.
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1(i) Dental services, as specified under s. 49.46 (2) (b) 1.
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2(5) The universal health plan is the payer of last resort, and coverage under
3the universal health plan is supplemental to any health care coverage in force that
4is held by an individual.
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5(6) As a condition of participation by a health care provider in the universal
6health plan, the health care provider shall accept reimbursement only under the
7universal health plan for all services or other benefits that the health care provider
8provides under the universal health plan.
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9152.20 Health policy board; powers and duties. (1) The board shall
10approve and continually evaluate the listing of approved medicinal substances and
11formulae that is required under s. 152.40 (4) (n).
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12(2) The board shall biennially evaluate and oversee cost containment
13guidelines and policies, including the evaluation of mechanisms used to contain costs
14of providing services, and shall revise the guidelines and policies as necessary.
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15(3) The board shall review at least all of the following issues and formulate or
16revise policies, as appropriate, with respect to the issues:
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(a) Duties of the department that require policy determinations.
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(b) The sources and amounts of revenues for the administration of the
19department and the board and for financing the payment of medical services that are
20provided to residents under the universal health plan.
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(c) Information provided by the regional health councils.
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(d) Development of a system for determination and periodic review of areas in
23this state, and specific populations within those areas, that are medically
24underserved; and development of plans for providing health care services to those
25areas and populations, including the establishment of community health centers.
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1(e) Development of a system for periodic reviews and evaluations of all aspects
2of the operation of the universal health plan, including the adequacy, cost,
3effectiveness, and quality of health care services provided.
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(f) Development of a notice and hearing procedure for review of complaints of
5residents about the universal health plan, in accordance with the requirements of
6ch. 227.
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(g) Other issues that the board determines are relevant to the universal health
8plan.
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(h) State statutory changes that may be necessary to effect pars. (a) to (g).
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10(4) By January 1, April 1, July 1, and October 1 of each year, the board shall
11report to the governor on the revenues and expenditures of the universal health plan
12for the calendar quarter immediately preceding the most recently completed
13calendar quarter.
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14(5) The board shall establish payment rates, taking into consideration
15regional, rural, and urban differences, and conditions of payment for the provision
16of health care services under the universal health plan.
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17152.30 Regional health councils. (1) Each regional health council shall do
18all of the following:
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(a) Elect one member of the regional health council to serve as a member of the
20board under s. 15.20 (1). If the term of the member who is so elected expires with
21respect to the regional health council or with respect to the board under s. 15.20 (1),
22the regional health council shall elect a current member of the council to serve as a
23member of the board in his or her stead.
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(b) Study and continuously monitor the delivery and quality of and access to
25health care services in the region of the regional health council and recommend to
1the board ways to improve the quality of and help ensure access to health care
2services.
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(c) Recommend to the board payment rates and conditions appropriate to
4specific regional needs and advise on regional health care policy issues and
5administrative policies and procedures.
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(d) Study and continuously monitor the unmet health care service needs in the
7region of the regional health council and recommend to the board ways by which the
8needs may be met.
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(e) Report at least annually to the board with respect to the health care needs,
10problems, and concerns of the region, including any issues elicited at public hearings
11under par. (g), and provide to the board recommendations to alleviate these needs,
12problems, and concerns.
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(f) Require reports from and advise the member of the staff of the appropriate
14regional office whose duties are specified under s. 152.40 (1), concerning issues that
15arise under pars. (b) to (e).
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(g) In at least 3 localities of the region, hold public hearings at least annually
17to elicit public opinion concerning the universal health plan. The council shall give
18notice of each hearing by publishing a class 1 notice, under ch. 985, at least 15 days
19before the hearing in a newspaper covering the affected area.
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(h) Perform other duties as required by the board.