2003 - 2004 LEGISLATURE
April 2, 2003 - Introduced by Senators Carpenter and Risser, cosponsored by
Representatives Miller, Young, Pocan, Berceau, Plouff and Coggs.
Referred to Committee on Health, Children, Families, Aging and Long Term
Care.
SB90,1,6
1An Act to amend 15.01 (4) and 59.17 (2) (c); and
to create 15.07 (1) (a) 8., 15.07
2(2) (m), 15.07 (5) (z), 15.07 (5m) (c), 15.20, 15.207, 20.430, 59.53 (24), 62.09 (8)
3(cm) and chapter 152 of the statutes;
relating to: establishing a publicly
4financed health care system for residents of this state, creating the Department
5of Health Planning and Finance, Health Policy Board, and regional health
6councils, granting rule-making authority, and making appropriations.
Analysis by the Legislative Reference Bureau
Under current law, payment for medical services received by residents of this
state is made from a combination of federal moneys (such as under the Medicare,
Medical Assistance (commonly referred to as "Medicaid"), and various block grant
programs), general purpose revenues (such as the "state share" of the joint
federal-state Medical Assistance Program, the Badger Care Program, state
contributions to relief block grants for health care services, and moneys appropriated
for specific medical purposes, such as cancer control grants), local moneys (such as
funding for medical relief health care services and county nursing homes and
hospitals), private health insurance coverage purchased by individuals or provided,
in part, as employee benefits, and out-of-pocket payments by health care
consumers.
This bill establishes a universal health plan for Wisconsin, under which,
beginning July 1, 2006, each state resident, with certain specified exceptions, shall
receive reasonable medical services necessary to maintain health, enable diagnosis,
or provide treatment or rehabilitation for an injury, disability, or disease. Specified
persons who are excepted from the July 1, 2006, beginning date are phased in for
eligibility that begins July 1, 2007.
To administer the universal health plan, the bill creates a Department of
Health Planning and Finance (DHPF), with six regional offices, that is directed and
supervised by an 11-member Health Policy Board that is also created in the bill. The
Health Policy Board appoints the secretary of health planning and finance and is
required to review that appointment after 36 months. The bill also creates six
regional health councils that are attached to DHPF and that report at least twice a
year 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 DHPF for
operation of the Health Policy Board for the 2003-05 fiscal biennium and requires
that the Health Policy Board consider numerous specified issues related to the
formation of a universal health plan in this state.
Under the bill, by July 1, 2005, DHPF must begin implementation of processes,
in light of policies determined by the Health Policy Board, to effect numerous
matters, including specifying the amounts and sources of funds to finance payment
to providers under the universal health plan, applying for waivers to federal
Medicaid statutes and rules, and establishing a listing of approved medicinal
substances and formulae. The secretary of health planning and finance and the
secretary of administration must, until September 1, 2005, meet at least
semimonthly to formulate decisions on issues concerning the universal health plan
and DHPF and how the scope and functions of DHPF affect the scope and 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 the duties or powers of any
other state agency. The Health Policy Board must convey the decisions to the
Legislative Reference Bureau for drafting of necessary proposed legislation for
introduction in the legislature in 2006. The Legislative Reference Bureau must
prepare, in proper form for introduction, the proposed legislation that relates to the
decisions.
For further information see the state and local 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:
SB90, s. 1
1Section
1. 15.01 (4) of the statutes is amended to read:
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15.01
(4) "Council" means a part-time body appointed to function on a
3continuing basis for the study, and recommendation of solutions and policy
4alternatives, of the problems arising in a specified functional area of state
1government, except the Wisconsin land council has the powers specified in s. 16.965
2(3) and (5) and the powers granted to agencies under ch. 227, the Milwaukee River
3revitalization council has the powers and duties specified in s. 23.18, the council on
4physical disabilities has the powers and duties specified in s. 46.29 (1) and (2),
and 5the state council on alcohol and other drug abuse has the powers and duties specified
6in s. 14.24
, and the regional health councils have the powers and duties specified in
7s. 152.30 (1).
SB90, s. 2
8Section
2. 15.07 (1) (a) 8. of the statutes is created to read:
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15.07
(1) (a) 8. Members of the health policy board elected under s. 15.20 (1)
10shall be elected as provided in that subsection.
SB90, s. 3
11Section
3. 15.07 (2) (m) of the statutes is created to read:
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15.07
(2) (m) The chairperson of the health policy board shall serve for a period
13of 3 years and may be reelected for 2 additional successive terms.
SB90, s. 4
14Section
4. 15.07 (5) (z) of the statutes is created to read:
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15.07
(5) (z) Members of the health policy board, $50 per day.
SB90, s. 5
16Section
5. 15.07 (5m) (c) of the statutes is created to read:
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15.07
(5m) (c)
Health policy board. Members of the health policy board may
18be reimbursed for lost wages if required by their employers to use leave without pay
19in order to attend meetings of the health policy board, and they may be reimbursed
20for actual and necessary child care expenses without proof of financial hardship.
SB90, s. 6
21Section
6. 15.20 of the statutes is created to read:
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2215.20 Department of health planning and finance. There is created a
23department of health planning and finance under the direction and supervision of
24the health policy board. The health policy board shall consist of the following
25members, each of whom is to serve for a 6-year term and, if reelected or reappointed,
1for an additional 6-year term and none of whom may be a health care provider, as
2defined in s. 152.01 (6), an administrator or owner of a health care facility or
3organization, or an elected public official:
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4(1) One member elected by and from the current membership of each of the 6
5regional health councils specified under s. 15.207 (1) (b).
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6(2) Five members, nominated by the governor and with the advice and consent
7of the senate appointed, who reflect as much as possible a balance of genders, races,
8ages, sexual orientations, ethnicities, religions, geographic areas, and the interests
9of management, labor, and individuals with disabilities.
SB90, s. 7
10Section
7. 15.207 of the statutes is created to read:
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1115.207 Same; councils. (1) Regional health councils. (a) There are created
126 regional health councils that are attached to the department of health planning
13and finance under s. 15.03, one of which is established in each of the following areas
14of this state:
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1. The northern region, consisting of Ashland, Bayfield, Douglas, Florence,
16Forest, Iron, Langlade, Lincoln, Marathon, Oneida, Portage, Price, Sawyer, Taylor,
17Vilas, and Wood counties.
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2. The southern region, consisting of Adams, Columbia, Crawford, Dane,
19Dodge, Grant, Green, Iowa, Jefferson, Juneau, Lafayette, Richland, Rock, Sauk, and
20Vernon counties.
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3. The western region, consisting of Barron, Burnett, Buffalo, Chippewa,
22Clark, Dunn, Eau Claire, Jackson, La Crosse, Monroe, Pepin, Pierce, Polk, Rusk, St.
23Croix, Trempealeau, and Washburn counties.
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14. The northeastern region, consisting of Brown, Calumet, Door, Fond du Lac,
2Green Lake, Kewaunee, Manitowoc, Marinette, Marquette, Menominee, Oconto,
3Outagamie, Shawano, Sheboygan, Waupaca, Waushara, and Winnebago counties.
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5. The southeastern region, consisting of Kenosha, Ozaukee, Walworth,
5Washington, 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
8of whom may be a health care provider, as defined in s. 152.01 (6), an administrator
9or owner of a health care facility or organization, or an elected public official, to serve
10for 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
12each county in that region. The county board of supervisors of each county in that
13region shall appoint one person from that county.
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2. In the southern region, a total of 15 members, consisting of one member from
15each county in that region. The county board of supervisors of each county in that
16region 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
18each county in that region. The county board of supervisors of each county in that
19region 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
21from each county in that region. The county board of supervisors of each county in
22that 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
24from each county in that region. The county board of supervisors of each county in
25that region shall appoint 2 persons from that county.
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16. In the area within Milwaukee County, a total of 12 members, consisting of
26 persons who are residents of the city of Milwaukee and are appointed by the mayor
3of the city of Milwaukee as provided under s. 62.09 (8) (cm), and 6 persons who are
4residents of Milwaukee County but are not residents of the city of Milwaukee and are
5appointed by the county executive of Milwaukee County.
SB90, s. 8
6Section
8. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
7the following amounts for the purposes indicated:
-
See PDF for table ![PDF](https://docs.legis.wisconsin.gov/assets/image/file_acrobat.gif)
SB90, s. 9
8Section
9. 20.430 of the statutes is created to read:
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920.430 Health planning and finance, department of. There is
10appropriated to the department of health planning and finance for the following
11program:
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12(1) Health planning and finance. (a)
General program operations. The
13amounts in the schedule for the general program operations of the department of
14health planning and finance.
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(b)
Universal health plan services and benefits. The amounts in the schedule
16for 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
18devises to carry out the purposes for which made.
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1(m)
Federal funds; state operations. All moneys received from the federal
2government, as authorized by the governor under s. 16.54, for the purposes for which
3made and received.
SB90, s. 10
4Section
10. 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 6where appointments are required and where the statutes provide that the
7appointments are made by the county board
or, by the chairperson of the county
8board
, or by the county executive. All appointments to boards
and, commissions
, and
9councils by the county executive are subject to confirmation by the county board.
SB90, s. 11
10Section
11. 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
12regional health council, as specified in s. 15.207 (1) (b) 1. to 5.
SB90, s. 12
13Section
12. 62.09 (8) (cm) of the statutes is created to read:
SB90,7,1614
62.09
(8) (cm) The mayor of the city of Milwaukee shall, with the advice and
15consent of the common council of that city, appoint 6 members of a regional health
16council, as specified under s. 15.207 (1) (b) 6.
SB90, s. 13
17Section
13. Chapter 152 of the statutes is created to read:
SB90,7,1918
Chapter 152
19
Universal health plan
SB90,7,20
20152.01 Definitions. In this chapter:
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21(1) "Block grant" has the meaning given in s. 16.54 (2) (a) 3.
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22(2) "Board" means the health policy board.
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23(3) "Department" means the department of health planning and finance.
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24(4) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
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1(5) "Health care facility" means a facility, as defined in s. 647.01 (4), or any
2hospital, nursing home, community-based residential facility, county home, county
3infirmary, county hospital, county mental health center, community health center,
4primary health center, tuberculosis sanatorium, adult family home, assisted living
5facility, rural medical center, hospice, or other place licensed, certified, or approved
6by the department of health and family services under s. 49.70, 49.71, 49.72, 50.02,
750.03, 50.032, 50.033, 50.034, 50.35, 50.52, 50.92 (2), 51.08, or 51.09 or a facility
8under s. 45.365, 51.05, 51.06, or 252.10 or ch. 233, or licensed or certified by a county
9department under s. 50.032 or 50.033.
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10(6) "Health care provider" means a provider of health care services or other
11benefits in this state that are specified under s. 152.10 (4).
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12(7) "Medicare" means coverage under part A or part B of Title XVIII of the
13federal Social Security Act,
42 USC 1395 to
1395ddd.
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14(8) "Reimbursement" means payment for the provision of services and other
15benefits that are specified under s. 152.10 (4).
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16(9) "Secretary" means the secretary of health planning and finance.
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17(10) "Veteran" has the meaning given in
38 USC 101 (2).
SB90,8,25
18152.10 Universal health plan. (1) There is created a universal health plan
19in this state, under which, beginning on July 1, 2006, each eligible person shall
20receive reasonable medical service necessary to maintain health, enable diagnosis,
21or provide treatment or rehabilitation for an injury, condition, disability, or disease,
22for which reimbursement shall be made by the department, except that no coverage
23is provided for orthodontia or for the performance of reconstructive or cosmetic
24surgery that is not determined to be medically necessary under criteria that are
25promulgated as rules by the department.
SB90,9,5
1(2) Each individual in this state who meets requirements of residency, under
2criteria promulgated as rules by the department, is eligible for coverage, except as
3provided in sub. (5), under the universal health plan, except that all of the following
4may be phased in for eligibility under this subsection, beginning no later than July
51, 2007:
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(a) Individuals, other than those specified in par. (b), who have no coverage
7under disability insurance policies.
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(b) Individuals who have no coverage under disability insurance policies and
9who receive health care, treatment for nervous or mental disorders, or treatment or
10prevention services for alcohol and other drug abuse that are funded by state or local
11funding.
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(c) Individuals who are employees of the state or any county, city, village, or
13town, and who, as a benefit of the employment, have coverage for themselves and
14family members under provisions of group disability insurance policies or under
15self-insured health plans.
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(d) Individuals, other than those specified in par. (c) or (h), who, by reason of
17their employment or as family members of individuals who are employed, have
18coverage under group disability insurance policies.
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(e) Individuals who have coverage under individual disability insurance
20policies.
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(f) Individuals who have coverage under the health insurance risk-sharing
22plan under ch. 149.
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(g) Individuals who are eligible for benefits or services under s. 49.46, 49.468,
2449.47, or 49.665, Medicare, or block grants that provide health care services.
SB90,10,3
1(h) Individuals who are employees of self-insured employers, other than those
2specified in par. (c), and who receive health care benefits for themselves and family
3members under self-insured health plans.
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(i) Individuals who receive medical benefits under worker's compensation.
SB90,10,75(j) Veterans who receive medical benefits under s. 45.351 (1j) or
38 USC 1701 6to
1774, or both, and the children of veterans who receive medical benefits under
38
7USC 1801 to
1806.
SB90,10,88(k) Indians who receive health and other services under
25 USC 1651 to
1683.
SB90,10,11
9(3) (a) Any individual who is eligible under sub. (2) may receive services that
10are available under the universal health plan from any participating health care
11provider in this state.