AB807: Bill Text

Analysis by the Legislative Reference Bureau

Under current law, payment for medical services that residents of this state receive 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 that individuals purchase or that is provided, in part, as employee benefits; and out-of-pocket payments that are made by health care consumers.

This bill establishes a health plan for Wisconsin, under which, beginning July 1, 2008, each state resident, with certain specified exceptions, shall receive reasonable medical services necessary to maintain health, enable diagnosis, and provide treatment or rehabilitation for an injury, disability, or disease. Specified persons who are excepted from the July 1, 2008, beginning date are phased in for eligibility that begins July 1, 2009.

To administer the 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 Health Policy Board also may appoint two advisory committees, which are advisory to the secretary of health planning and finance. The bill also creates six regional consumer 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. Each regional consumer health council may create a regional advisory committee. The bill requires appropriation of general purpose revenues to DHPF for operation of the Health Policy Board for the 2005-07 fiscal biennium and requires that the Health Policy Board consider numerous specified issues related to the formation of a health plan in this state.

Under the bill, by July 1, 2007, DHPF must begin implementation of processes, in light of policies determined by the Health Policy Board, to effect numerous health-related matters, including specifying the amounts and sources of funds to finance payment to providers under the 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, 2009, meet at least semimonthly to formulate decisions on issues concerning the 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 2008. 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:

AB807, s. 1 Section 1. 15.01 (3) of the statutes is amended to read:

AB807,3,6 15.01 (3) "Committee" Except as provided in ss. 152.20 (5) and 152.30 (2m), "committee" means a part-time body appointed to study a specific problem and to recommend a solution or policy alternative with respect to that problem, and intended to terminate on the completion of its assignment. Because of their temporary nature, committees shall, except as provided in ss. 152.20 (5) and 152.30 (2m), be created by session law rather than by statute.

AB807, s. 2 Section 2. 15.01 (4) of the statutes, as affected by 2005 Wisconsin Act 25, is amended to read:

AB807,3,16 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), and the state council on alcohol and other drug abuse has the powers and duties specified in s. 14.24, and the regional consumer health councils have the powers and duties specified in s. 152.30 (1).

AB807, s. 3 Section 3. 15.07 (1) (a) 7. of the statutes is created to read:

AB807,3,19 15.07 (1) (a) 7. Members of the health policy board elected under s. 15.20 (1) shall be elected as provided in that subsection.

AB807, s. 4 Section 4. 15.07 (2) (n) of the statutes is created to read:

AB807,3,22 15.07 (2) (n) The chairperson of the health policy board shall serve for a period of 3 years and may be reelected for 2 additional successive terms.

AB807, s. 5 Section 5. 15.07 (5) (m) of the statutes is created to read:

AB807,3,24 15.07 (5) (m) Members of the health policy board, $50 per day.

AB807, s. 6 Section 6. 15.07 (5m) (c) of the statutes is created to read:

AB807,4,4 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.

AB807, s. 7 Section 7. 15.20 of the statutes is created to read:

AB807,4,12 15.20 Department of health planning and finance. 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 reelected or reappointed, for an additional 6-year term and none of whom may be a health care provider, as defined in s. 152.01 (6), an administrator or owner of a health care facility or organization, or an elected public official:

AB807,4,14 (1) One member elected by and from the current membership of each of the 6 regional consumer health councils specified under s. 15.207 (1) (b).

AB807,4,18 (2) Five members, nominated by the governor and with the advice and consent of the senate appointed, who reflect as much as possible a balance of gender, race, age, sexual orientation, ethnicity, religion, geographic area, and the interests of management, labor, and individuals with disabilities.

AB807, s. 8 Section 8. 15.207 of the statutes is created to read:

AB807,4,23 15.207 Same; councils. (1) Regional consumer health councils. (a) There are created 6 regional consumer 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:

AB807,5,3 1. The northern region, consisting of Ashland, Bayfield, Douglas, Florence, Forest, Iron, Langlade, Lincoln, Marathon, Oneida, Portage, Price, Sawyer, Taylor, Vilas, and Wood counties.

AB807,5,6 2. The southern region, consisting of Adams, Columbia, Crawford, Dane, Dodge, Grant, Green, Iowa, Jefferson, Juneau, Lafayette, Richland, Rock, Sauk, and Vernon counties.

AB807,5,9 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.

AB807,5,12 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.

AB807,5,14 5. The southeastern region, consisting of Kenosha, Ozaukee, Walworth, Washington, Waukesha, and Racine counties.

AB807,5,15 6. The area within Milwaukee County.

AB807,5,19 (b) Each regional consumer health council shall consist of the following members, none of whom may be a health care provider, as defined in s. 152.01 (6), an administrator or owner of a health care facility or organization, or an elected public official, to serve for no more than 3 3-year terms:

AB807,5,22 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 one person from that county.

AB807,5,25 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 one person from that county.

AB807,6,3 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 one person from that county.

AB807,6,6 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 one person from that county.

AB807,6,9 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 2 persons from that county.

AB807,6,14 6. In the area within Milwaukee County, a total of 12 members, consisting of 6 persons who are residents of the city of Milwaukee and are appointed by the mayor of the city of Milwaukee as provided under s. 62.09 (8) (cm), and 6 persons 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.

AB807, s. 9 Section 9. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table

AB807, s. 10 Section 10. 20.430 of the statutes is created to read:

AB807,7,3 20.430 Health planning and finance, department of. There is appropriated to the department of health planning and finance for the following program:

AB807,7,6 (1) Health planning and finance. (a) General program operations. The amounts in the schedule for the general program operations of the department of health planning and finance.

AB807,7,8 (b) Health plan services and benefits. The amounts in the schedule for health care services and benefits provided under s. 152.10 (4).

AB807,7,10 (c) Job retraining and placement. The amounts in the schedule for job retraining and placement services under s. 152.40 (6).

AB807,7,12 (i) Gifts and grants. All moneys received from gifts, grants, bequests, and devises to carry out the purposes for which made.

AB807,7,15 (m) Federal funds; state operations. All moneys received from the federal government, as authorized by the governor under s. 16.54, for the purposes for which made and received.

AB807, s. 11 Section 11. 59.17 (2) (c) of the statutes is amended to read:

AB807,7,21 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, or county executive. All appointments to boards and, commissions, and councils by the county executive are subject to confirmation by the county board.

AB807, s. 12 Section 12. 59.53 (25) of the statutes is created to read:

AB807,7,25 59.53 (25) Regional consumer health council. The board shall appoint members of a regional consumer health council, as specified in s. 15.207 (1) (b) 1. to 5.

AB807, s. 13 Section 13. 62.09 (8) (cm) of the statutes is created to read:

AB807,8,4 62.09 (8) (cm) The mayor of the city of Milwaukee shall, with the advice and consent of the common council of that city, appoint 6 members of a regional consumer health council, as specified under s. 15.207 (1) (b) 6.

AB807, s. 14 Section 14. Chapter 152 of the statutes is created to read:

AB807,8,7 Chapter 152 health plan

AB807,8,8 152.01 Definitions. In this chapter:

AB807,8,9 (1) "Block grant" has the meaning given in s. 16.54 (2) (a) 3.

AB807,8,10 (2) "Board" means the health policy board.

AB807,8,11 (3) "Department" means the department of health planning and finance.

AB807,8,12 (4) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).

AB807,8,21 (5) "Health care facility" means a facility, as defined in s. 647.01 (4), or any hospital, nursing home, community-based residential facility, county home, county infirmary, county hospital, county mental health center, community health center, primary health center, tuberculosis sanatorium, adult family home, assisted living facility, rural medical center, hospice, or other place licensed, certified, or approved by the department of health and family services under s. 49.70, 49.71, 49.72, 50.02, 50.03, 50.032, 50.033, 50.034, 50.35, 50.52, 50.92 (2), 51.08, or 51.09 or a facility under s. 45.365, 51.05, 51.06, or 252.10 or ch. 233, or licensed or certified by a county department under s. 50.032 or 50.033.

AB807,8,23 (6) "Health care provider" means a provider of health care services or other benefits in this state that are specified under s. 152.10 (4).

AB807,8,25 (7) "Medicare" means coverage under part A or part B of Title XVIII of the federal Social Security Act, 42 USC 1395 to 1395ddd.

AB807,9,2 (8) "Reimbursement" means payment for the provision of services and other benefits that are specified under s. 152.10 (4).

AB807,9,3 (9) "Secretary" means the secretary of health planning and finance.

AB807,9,4 (10) "Veteran" has the meaning given in 38 USC 101 (2).

AB807,9,12 152.10 Health plan. (1) There is created a health plan in this state, under which, beginning on July 1, 2008, each eligible person, regardless of any preexisting condition, shall receive reasonable medical service necessary to maintain health, enable diagnosis, or provide treatment or rehabilitation for an injury, condition, disability, or disease, for which reimbursement shall be made by the department. Coverage is provided under the health plan for orthodontia or for the performance of reconstructive or cosmetic surgery that is determined to be necessary under criteria that are promulgated as rules by the department.

AB807,9,16 (2) Each individual in this state who is not excluded from residency, as specified in sub. (3) (c), is eligible for coverage under the health plan, except as provided in sub. (5), and except that all of the following may be phased in for eligibility under this subsection, beginning no later than July 1, 2009:

AB807,9,18 (a) Individuals, other than those specified in par. (b), who have no coverage under disability insurance policies.

AB807,9,22 (b) Individuals who have no coverage under disability insurance policies and who receive health care, treatment for nervous or mental disorders, or treatment or prevention services for alcohol and other drug abuse that are funded by state or local funding.

AB807,9,24 (c) Individuals who are employees of the state or any county, city, village, or town, 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.

AB807,10,5 (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.

AB807,10,7 (e) Individuals who have coverage under individual disability insurance policies.

AB807,10,9 (f) Individuals who have coverage under the health insurance risk-sharing plan under ch. 149.

AB807,10,11 (g) Individuals who are eligible for benefits or services under s. 49.46, 49.468, 49.47, or 49.665, Medicare, or block grants that provide health care services.

AB807,10,14 (h) Individuals who are employees 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.

AB807,10,15 (i) Individuals who receive medical benefits under worker's compensation.

AB807,10,18 (j) Veterans who receive medical benefits under s. 45.351 (1j) or 38 USC 1701 to 1774, or both, and the children of veterans who receive medical benefits under 38 USC 1801 to 1806.

AB807,10,20 (k) Members of federally-recognized American Indian tribes or bands who receive health and other services under 25 USC 1651 to 1683.

AB807,10,25 (3) (a) Any individual who is eligible under sub. (2) may receive services that are available under the health plan from any participating health care provider in this state. Services that correspond to those that are available under the health plan and that are provided to the individual in another state are reimbursable at rates under the health plan that are current at the time of service provision.

AB807,11,3 (b) No individual who is eligible under sub. (2) may under this section be required to pay an amount as a deductible or copayment as a condition for receipt of services under this section from a health care facility or health care provider.

AB807,11,7 (c) An individual who has a fixed habitation outside the state but not inside the state is not a resident for purposes of this chapter. Any reimbursement paid under the health plan for health care services rendered to an individual who is determined not to be a resident is a liability of the individual.

AB807,11,9 (4) Health care services and other benefits provided under the health plan shall include all of the following:

AB807,11,11 (a) Services of all persons licensed, certified, registered, or permitted to treat the sick under chs. 441, 446, 447, 448, 449, 450, 451, 455, 457, and 459.

AB807,11,13 (b) Health care services that are provided by health care facilities and the offices and clinics of persons under par. (a).

AB807,11,15 (c) Preventive health care services and health promotional programs, including well-child care, immunizations, screening, outreach, and education.

AB807,11,18 (d) Medical or surgical supplies and durable medical or surgical equipment, supplies and appliances, including valves, pacemakers, prostheses, eyeglasses, and hearing aids.

AB807,11,21 (e) Prescription drugs specified in the listing of approved medicinal substances and formulae under s. 152.40 (5) (m) and any other drugs specified by the department by rule.

AB807,11,22 (f) Blood and blood products.