AB100-engrossed,820,96
149.14
(7) (b) The
department organization has a cause of action against an
7eligible participant for the recovery of the amount of benefits paid which are not for
8covered expenses under the plan. Benefits under the plan may be reduced or refused
9as a setoff against any amount recoverable under this paragraph.
AB100-engrossed,820,1411
149.14
(7) (c) The
department organization is subrogated to the rights of an
12eligible person to recover special damages for illness or injury to the person caused
13by the act of a 3rd person to the extent that benefits are provided under the plan.
14Section 814.03 (3) applies to the
department organization under this paragraph.
AB100-engrossed,820,1816
149.14
(8) Subsidies. The board shall provide for subsidies for premiums,
17deductibles, and copayments for eligible persons with household incomes below a
18level established by the board.
AB100-engrossed,820,22
20149.141 Premiums. The board shall set premiums for coverage under the
21plan at a level that is sufficient to cover 60 percent of plan costs, as provided in s.
22149.143 (1).
AB100-engrossed,821,11
1149.142
(1) Establishment of rates. Except as provided in par. (b), the
2department The board shall establish
provider payment rates for covered expenses
3that consist of the allowable charges paid under s. 49.46 (2) for the services and
4articles provided plus an enhancement determined by the
department board. The
5rates shall be based on the allowable charges paid under s. 49.46 (2), projected plan
6costs
, and trend factors. Using the same methodology that applies to medical
7assistance under subch. IV of ch. 49, the
department
board shall establish hospital
8outpatient per visit reimbursement rates and hospital inpatient reimbursement
9rates that are specific to diagnostically related groups of eligible persons.
The
10adjustments to the usual and customary rates shall be sufficient to cover 20 percent
11of plan costs, as provided in s. 149.143 (3).
AB100-engrossed,821,16
15149.143 Payment of plan costs. The board shall pay plan costs, including
16any premium, deductible, and copayment subsidies, as follows:
AB100-engrossed,821,17
17(1) Sixty percent from premiums paid by eligible persons.
AB100-engrossed,821,18
18(2) Twenty percent from insurer assessments under s. 149.13.
AB100-engrossed,821,20
19(3) Twenty percent from adjustments to provider payment rates under s.
20149.142.
AB100-engrossed, s. 2054m
23Section 2054m. 149.146 (1) (a) and (b) of the statutes are consolidated,
24renumbered 149.14 (2) (c) and amended to read:
AB100-engrossed,822,14
1149.14
(2) (c)
Beginning on January 1, 1998, in In addition to the coverage
2required under
s. 149.14 pars. (a) and (b), the plan shall offer to all eligible persons
3who are not eligible for
medicare Medicare a choice of coverage, as described in
4section 2744 (a) (1) (C), P.L.
104-191. Any such choice of coverage shall be major
5medical expense coverage.
(b) An eligible person
under par. (a) who is not eligible
6for Medicare may elect once each year, at the time and according to procedures
7established by the
department board, among the coverages offered under this
section
8and s. 149.14. If an eligible person elects new coverage, any preexisting condition
9exclusion imposed under the new coverage is met to the extent that the eligible
10person has been previously and continuously covered under this chapter. No
11preexisting condition exclusion may be imposed on an eligible person who elects new
12coverage if the person was an eligible individual when first covered under this
13chapter and the person remained continuously covered under this chapter up to the
14time of electing the new coverage paragraph and par. (a).
AB100-engrossed,822,18
18149.155 Additional duties of board. The board shall do all of the following:
AB100-engrossed,822,20
19(1) Adopt policies for the administration of this chapter, including delegation
20of any part of its powers and its own procedures.
AB100-engrossed,822,22
21(5) Seek to qualify the plan as a state pharmacy assistance program, as defined
22in
42 CFR 423.464.
AB100-engrossed,822,24
23(6) Annually submit a report to the legislature under s. 13.172 (2) and to the
24governor on the operation of the plan.
AB100-engrossed,823,54
149.155
(2) The plan administrator shall perform Perform all eligibility and
5administrative claims payment functions relating to the plan.
AB100-engrossed,823,108
149.155
(3) The plan administrator shall establish Establish a premium billing
9procedure for collection of premiums from insured persons. Billings shall be made
10on a periodic basis as determined by the
department
board.
AB100-engrossed, s. 2058m
11Section 2058m. 149.16 (3) (c) of the statutes is renumbered 149.155 (4), and
12149.155 (4) (intro.), as renumbered, is amended to read:
AB100-engrossed,823,1513
149.155
(4) (intro.)
The plan administrator shall perform Perform all necessary
14functions to assure timely payment of benefits to covered persons under the plan,
15including:
AB100-engrossed,823,2221
149.17
(1) Subject to
ss. 149.14 (5m),
s. 149.143
and 149.146 (2) (b), a rating
22plan calculated in accordance with generally accepted actuarial principles.
AB100-engrossed,824,94
153.05
(6m) The department may contract with the group insurance board for
5the provision of data collection and analysis services related to health maintenance
6organizations and insurance companies that provide health insurance for state
7employees. The department shall establish contract fees for the provision of the
8services. All moneys collected under this subsection shall be credited to the
9appropriation under s. 20.435
(4) (1) (hg).
AB100-engrossed,824,1311
153.05
(14) With respect to health care information required to be collected
12under this section from health care providers that are not hospitals or ambulatory
13surgery centers, the department shall do all of the following:
AB100-engrossed,824,1614
(a) Develop procedures to ensure that data are submitted consistently and
15accurately, including clarifying the place-of-service codes and types of ancillary
16services that are required to be reported.
AB100-engrossed,824,1817
(b) Work directly with individual physician practice groups to identify and
18correct data submission errors.
AB100-engrossed,824,2019
(c) Develop and publish standard reports under s. 153.45 (1) (a) that are
20understandable by individuals other than medical professionals.
AB100-engrossed,824,2121
(d) Make program data available in a timely fashion.
AB100-engrossed,824,2422
(e) Enter into a memorandum of understanding with the department of
23regulation and licensing to improve the timeliness of updating physician information
24and to improve the assessment process under s. 153.60 (1).
AB100-engrossed,825,22
1153.60
(1) The department shall, by the first October 1 after the
2commencement of each fiscal year, estimate the total amount of expenditures under
3this chapter for the department and the board for that fiscal year for data collection,
4database development and maintenance, generation of data files and standard
5reports, orientation and training provided under s. 153.05 (9) (a) and maintaining
6the board. The department shall assess the estimated total amount for that fiscal
7year
, less the estimated total amount to be received for purposes of administration
8of this chapter under s. 20.435
(4) (1) (hi) during the fiscal year
, and the
9unencumbered balance of the amount received for purposes of administration of this
10chapter under s. 20.435
(4) (1) (hi) from the prior fiscal year
and the amount in the
11appropriation account under s. 20.435 (1) (dg), 1997 stats., for the fiscal year, to
12health care providers, other than hospitals and ambulatory surgery centers, who are
13in a class of health care providers from whom the department collects data under this
14chapter in a manner specified by the department by rule. The department shall
15obtain approval from the board for the amounts of assessments for health care
16providers other than hospitals and ambulatory surgery centers. The department
17shall work together with the department of regulation and licensing to develop a
18mechanism for collecting assessments from health care providers other than
19hospitals and ambulatory surgery centers. No health care provider that is not a
20facility may be assessed under this subsection an amount that exceeds $75 per fiscal
21year. All payments of assessments shall be credited to the appropriation under s.
2220.435
(4) (1) (hg).
AB100-engrossed,826,924
153.60
(3) The department shall, by the first October 1 after the
25commencement of each fiscal year, estimate the total amount of expenditures
1required for the collection, database development and maintenance and generation
2of public data files and standard reports for health care plans that voluntarily agree
3to supply health care data under s. 153.05 (6r). The department shall assess the
4estimated total amount for that fiscal year to health care plans in a manner specified
5by the department by rule and may enter into an agreement with the office of the
6commissioner of insurance for collection of the assessments. Each health plan that
7voluntarily agrees to supply this information shall pay the assessments on or before
8December 1. All payments of assessments shall be deposited in the appropriation
9under s. 20.435
(4) (1) (hg) and may be used solely for the purposes of s. 153.05 (6r).
AB100-engrossed,826,1711
153.65
(1) The department may, but is not required to, provide, upon request
12from a person, a data compilation or a special report based on the information
13collected by the department. The department shall establish user fees for the
14provision of these compilations or reports, payable by the requester, which shall be
15sufficient to fund the actual necessary and direct cost of the compilation or report.
16All moneys collected under this subsection shall be credited to the appropriation
17under s. 20.435
(4) (1) (hi).
AB100-engrossed,826,1919
157.061
(2g) "Cemetery board" means the board created in s. 15.405 (3m).
AB100-engrossed,827,1421
157.08
(2) (b) Before a cemetery authority sells or encumbers any cemetery
22land, except for a sale described in par. (a), the cemetery authority shall notify the
23department cemetery board in writing of the proposed sale or encumbrance. If
24within 60 days after the
department cemetery board is notified of the proposed sale
25or encumbrance the
department cemetery board notifies the cemetery authority in
1writing that the
department cemetery board objects to the sale or encumbrance the
2cemetery authority may not sell or encumber the cemetery land unless the
3department cemetery board subsequently notifies the cemetery authority in writing
4that the objection is withdrawn. The
department
cemetery board may object to a sale
5or encumbrance only if it determines that the cemetery authority will not be
6financially solvent or that the rights and interests of owners of cemetery lots and
7mausoleum spaces will not be adequately protected if the sale or encumbrance
8occurs. The
department cemetery board may, before the expiration of the 60-day
9period, notify the cemetery authority in writing that the
department cemetery board 10approves of the sale or encumbrance. Upon receipt of the
department's cemetery
11board's written approval, the cemetery authority may sell or encumber the cemetery
12land and is released of any liability under this paragraph. The
department cemetery
13board shall make every effort to make determinations under this paragraph in an
14expeditious manner.
AB100-engrossed,827,1916
157.08
(5) Subsections (1) and (2) (b) do not apply to a religious society
17organized under ch. 187, and sub. (2) (b) does not apply to a cemetery authority that
18is not required to be
registered licensed under s. 440.91 (1) and that is not organized
19or conducted for pecuniary profit.
AB100-engrossed,827,2321
157.11
(11) Exemption for certain nonprofit cemeteries. Subsection (9g) does
22not apply to a cemetery authority that is not required to be
registered licensed under
23s. 440.91 (1) and that is not organized or conducted for pecuniary profit.
AB100-engrossed,828,3
1157.128
(3) (b) A cemetery consisting of less than 20 contiguous acres may be
2dedicated by a cemetery authority that is not required to be
registered licensed under
3s. 440.91 (1) and that is not organized or conducted for pecuniary profit.
AB100-engrossed,828,115
157.19
(5) (a) This section does not apply to care funds under s. 157.11 (9g) that
6are deposited with a city or county as provided under s. 157.11 (9g) (a), to care funds
7of a cemetery for which a certification under s. 157.63 is effective, to preneed trust
8funds of a cemetery for which a certification under s. 440.92 (9) is effective, or to care
9funds or preneed trust funds of a cemetery authority that is not required to be
10registered licensed under s. 440.91 (1) and that is not organized or conducted for
11pecuniary profit.
AB100-engrossed,828,1513
157.625
(3) Section 157.62 does not apply to a cemetery authority that is not
14required to be
registered licensed under s. 440.91 (1) and that is not organized or
15conducted for pecuniary profit.
AB100-engrossed,829,217
157.65
(2) The department of justice or any district attorney, upon informing
18the department of justice, may commence an action in circuit court in the name of
19the state to restrain by temporary or permanent injunction any violation of this
20subchapter. The court may, prior to entry of final judgment, make such orders or
21judgments as may be necessary to restore to any person any pecuniary loss suffered
22because of the acts or practices involved in the action, if proof of such loss is submitted
23to the satisfaction of the court. The department of justice may subpoena persons and
24require the production of books and other documents, and may request the
25department of regulation and licensing board described in s. 15.405 (3m) or the
1department of commerce to exercise its authority under sub. (1) to aid in the
2investigation of alleged violations of this subchapter.
AB100-engrossed,829,74
165.755
(1) (a) Except as provided in par. (b), a court shall impose under ch. 814
5a crime laboratories and drug law enforcement surcharge of
$7 $8 if the court
6imposes a sentence, places a person on probation, or imposes a forfeiture for a
7violation of state law or for a violation of a municipal or county ordinance.
AB100-engrossed,829,9
9165.89 (title)
Grants to certain counties for law enforcement programs.
AB100-engrossed,829,13
10(4) Notwithstanding subs. (1) and (2) and any criteria and procedures
11developed under sub. (3), the department shall allocate $300,000 to Forest County
12each fiscal year from the appropriation account under s. 20.455 (2) (kq) to fund law
13enforcement services.
AB100-engrossed,829,15
15165.91 (title)
Grants to tribes for law enforcement programs.
