SB51,12,2424 (a) Duties of the department that require policy determinations.
SB51,13,3
1(b) The sources and amounts of revenues for the administration of the
2department and the board and for financing the payment of health care services that
3are provided to residents under the health plan.
SB51,13,44 (c) Information provided by the regional consumer health councils.
SB51,13,85 (d) Development of a system for determination and periodic review of areas in
6this state, and specific populations within those areas, that are medically
7underserved; and development of plans for providing health care services to those
8areas and populations, including the establishment of community health centers.
SB51,13,129 (e) Development of a system for periodic reviews and evaluations of all aspects
10of the operation of the health plan, including the adequacy, cost, effectiveness, and
11quality of health care services provided. These reviews and evaluations shall be
12made available to the public by the board.
SB51,13,1413 (f) Development of a notice and hearing procedure for review of complaints of
14residents about the health plan, in accordance with the requirements of ch. 227.
SB51,13,1515 (g) Other issues that the board determines are relevant to the health plan.
SB51,13,1616 (h) State statutory changes that may be necessary to effect pars. (a) to (g).
SB51,13,20 17(4) By January 1, April 1, July 1, and October 1 of each year, the board shall
18report to the governor on the revenues and expenditures of the health plan for the
19calendar quarter immediately preceding the most recently completed calendar
20quarter.
SB51,14,2 21(5) (a) The board may appoint up to 2 advisory committees, each with not more
22than 12 members, that shall be advisory to the secretary. Appointees shall reflect
23as much as possible a balance of gender, race, age, sexual orientation, ethnicity,
24religion, disability, and geographic area. The board may determine the length of

1terms of advisory committee members and the frequency of meetings, and may
2terminate the committees.
SB51,14,33 (b) If appointed under par. (a), all of the following apply:
SB51,14,64 1. Only one advisory committee shall reflect the interests and concerns of
5consumer advocacy and may not include a health care provider or representative of
6a health care provider or the agency or organization of a health care provider.
SB51,14,97 2. Only one advisory committee shall reflect the interests and concerns of
8health care providers and agencies and organizations of health care providers and
9may not include a representative of a consumer advocacy agency or organization.
SB51,14,1310 3. An advisory committee shall report annually to the board and the secretary
11concerning the committee's activities in the immediately preceding fiscal year, shall
12provide advice relative to health policy issues, and shall make recommendations
13concerning departmental policies and procedures.
SB51,14,15 14152.30 Regional consumer health councils. (1) Each regional consumer
15health council shall do all of the following:
SB51,14,2016 (a) Elect one member of the regional consumer health council to serve as a
17member of the board under s. 15.20 (1). If the term of the member who is so elected
18expires with respect to the regional consumer health council or with respect to the
19board under s. 15.20 (1), the regional consumer health council shall elect a current
20member of the council to serve as a member of the board in his or her stead.
SB51,14,2421 (b) Study and continuously monitor the delivery and quality of and access to
22health care services in the region of the regional consumer health council and
23recommend to the board and regional office ways to improve the quality of and help
24ensure access to health care services.
SB51,15,3
1(c) Recommend to the board payment rates and conditions appropriate to
2specific regional needs and advise on regional health care policy issues and
3administrative policies and procedures.
SB51,15,64 (d) Study and continuously monitor the unmet health care service needs in the
5region of the regional consumer health council and recommend to the board ways by
6which the needs may be met.
SB51,15,107 (e) Report at least annually to the board with respect to the health care needs,
8problems, and concerns of the region, including any issues elicited at public hearings
9under par. (g), and provide to the board recommendations to alleviate these needs,
10problems, and concerns.
SB51,15,1311 (f) Require reports from and advise the member of the staff of the appropriate
12regional office whose duties are specified under s. 152.40 (1), concerning issues that
13arise under pars. (b) to (e).
SB51,15,1714 (g) In at least 2 localities of the region, hold public hearings at least annually
15to elicit public opinion concerning the health plan under this chapter. The council
16shall give notice of each hearing by publishing a class 1 notice, under ch. 985, at least
1715 days before the hearing in a newspaper covering the affected area.
SB51,15,1818 (h) Perform other duties as required by the board.
SB51,15,21 19(2) Each regional consumer health council may, for cause, recall the member
20elected under sub. (1) (a) and may elect another member to fulfill that term on the
21board if all of the following are done:
SB51,15,2422 (a) The elected member of the board for whom recall is sought receives notice
23of the recall at least 10 working days before the meeting at which the recall is voted
24upon.
SB51,16,3
1(b) Notice of the vote to recall the elected member is made on the agenda of the
2meeting of the regional consumer health council that is immediately prior to the
3meeting at which recall is voted upon.
SB51,16,9 4(2m) The regional consumer health council may appoint a regional advisory
5committee. If appointed, the regional advisory committee shall consist of 18
6members who reflect as much as possible a balance of gender, race, age, sexual
7orientation, ethnicity, religion, geographic area, and the interests of management,
8labor, and individuals with disabilities, and may consist of consumer advocates and
9health care providers.
SB51,16,12 10(3) The staff of the appropriate regional office shall provide services to each
11regional consumer health council to deal with issues of health consumer advocacy
12and health ombudsman functions.
SB51,16,17 13152.40 Department of health planning and finance. (1) The department
14shall administer the health plan under this chapter, including establishing a
15regional office in each of the regions specified under s. 15.207 (1) (a) 1. to 6. Each
16regional office shall have at least one staff member who acts in a full-time capacity
17as a regional consumer advocate and health care ombudsman.
SB51,16,20 18(2) The department shall establish provider payment rates, taking into
19consideration regional, rural, and urban differences, and conditions of payment for
20the provision of health care services under the health plan.
SB51,16,22 21(3) The department shall, after review and approval by the board, promulgate
22as rules all of the following:
SB51,16,2423 (a) Guidelines for cost containment under the health plan, including the
24purchasing and distribution of major diagnostic, medical, and surgical equipment.
SB51,17,4
1(b) Criteria, as recommended by the medical advisory committee appointed by
2the secretary under sub. (7), for determining necessity for orthodontia and for the
3performance of reconstructive or cosmetic surgery for coverage under the health
4plan.
SB51,17,6 5(4) The department shall biennially evaluate and recommend to the board cost
6control measures for the health plan.
SB51,17,9 7(5) The department shall, by July 1, 2009, begin implementation of processes,
8in light of policies formulated or revised under s. 152.20 (3), to effect all of the
9following:
SB51,17,1310 (a) Specification of the amounts and sources of revenues to finance payment to
11providers under the health plan, which may not include any premiums, copayments,
12deductibles, and other forms of direct payment by patients, and which shall include
13all of the following:
SB51,17,1914 1. Use of federal, state, and local moneys that fund, as of July 1, 2010, health
15care services, including medicare, medical assistance, health care services funded by
16a relief block grant under s. 49.02, 49.025, or 49.029; health care services under s.
1749.665; veterans medical benefits; services specified in s. 152.10 (2) (k); services
18provided under federal block grants; alcohol and other drug abuse services; and
19services provided by local health departments.
SB51,17,2420 2. Use of revenues from a tax on employers, based on the amount of wages that
21they pay, that generates, in the aggregate, revenues that are at least equal to
22amounts that employers contribute, as of the effective date of this subdivision ....
23[revisor inserts date], for employee health care benefit costs, including the costs of
24worker's compensation attributable to health care for injured employees.
SB51,18,4
13. Use of revenues from a graduated income tax on individuals that generates,
2in the aggregate, revenues that are not greater than expenditures that individuals
3make, as of July 1, 2010, for health care costs for which coverage under disability
4insurance policies is not obtained.
SB51,18,75 4. An indexing of the sources of revenues under this paragraph that provides
6for revenue growth that is equivalent to the anticipated growth of health care costs
7under the health plan.
SB51,18,108(b) Application for waivers to 42 USC 1396 to 1396v or consideration of the
9feasibility of statutory changes to 42 USC 1396 to 1396v in order to effect all of the
10following:
SB51,18,1211 1. Administration of the Medical Assistance program in this state by the
12department, rather than by the department of health and family services.
SB51,18,1413 2. Use of federal financial participation to fund a portion of the administrative
14costs, after June 30, 2010, of the department.
SB51,18,1915 3. Use of federal financial participation, after June 30, 2010, to fund, under the
16health plan, the health care services received by a percentage of the residents that
17corresponds to the percentage of the residents, as determined by the board, that is
18eligible to receive health care services under the Medical Assistance program on July
191, 2010.
SB51,18,2120 4. The formulation of criteria and procedures for payment of out-of-state
21health care costs incurred by residents specified in subd. 3.
SB51,18,2322 5. Use of federal financial participation to fund the scope, or a portion of the
23scope, of medical services to be provided under the health plan.
SB51,18,2524 (c) Application for waivers to Medicare or consideration of the feasibility of
25statutory changes to 42 USC 1395 to 1395hhh in order to effect all of the following:
SB51,19,2
11. Administration of the Medicare program in this state by the department,
2rather than by private insurers.
SB51,19,43 2. Use of federal Medicare funds to fund a portion of the administrative costs,
4after June 30, 2010, of the department.
SB51,19,75 3. Use of federal Medicare funds to fund, under the health plan, the health care
6services received by residents who are eligible to receive services under Medicare
7beginning on July 1, 2010.
SB51,19,98 4. The formulation of criteria and procedures for payment of out-of-state
9health care costs incurred by residents specified in subd. 3.
SB51,19,1110 5. Use of federal Medicare funds to fund the scope, or a portion of the scope, of
11medical services to be provided under the health plan.
SB51,19,1312 6. The assignment to the state, as represented by the department, of rights of
13an individual to payment for medical care from any 3rd party.
SB51,19,1714 (d) Application for waivers or consideration of the feasibility of statutory
15changes to federal laws, other than those specified in pars. (b) and (c), in order to use
16moneys available under those federal laws for payment of health care services under
17the health plan or in order to provide services to all residents under the health plan.
SB51,19,2018 (e) The establishment and maintenance, with reserves of no less than 5 percent
19of the total annual amount appropriated under s. 20.430 (1) (b), of a health trust fund
20in the department, for receipt of revenues specified in par. (a).
SB51,20,321 (f) The formulation of criteria for determining payment and the formulation of
22procedures for determining payment and negotiating applicable rates to be used for
23payment for health care providers, including health care facilities, under the health
24plan. The criteria and procedures for determining payment shall include periodic
25overall budgeting, including separately budgeting for operational costs; for health

1care facilities and services; for negotiations with professional groups or associations
2of practitioners; for consideration of inflation costs and increased patient
3populations; and for research and teaching.
SB51,20,74 (g) The development and implementation of a system to provide an electronic
5or other identification card, bearing a unique number that is not a social security
6number, to each health plan participant, for receipt of benefits under the plan, and
7to each health care provider, for receipt of reimbursement.
SB51,20,118 (h) The formulation of criteria and procedures to review and to provide funding
9for capital expenditures, from an account separate from that from which health care
10services are paid, for the establishment, maintenance, or expansion of health care
11facilities.
SB51,20,1312 (i) The formulation of criteria and procedures for recovery of overpayments
13made to health care providers under the health plan.
SB51,20,1514 (j) The determination and use of factors requisite to establishing an annual
15state health budget for the provision of services under the health plan.
SB51,20,1816(k) Application for waivers of 29 USC 1144 (a) or consideration of the feasibility
17of statutory change to 29 USC 1144 (a) or the means by which operation of the health
18plan may avoid conflict with 29 USC 1144 (a).
SB51,20,2119 (L) Investigation of the feasibility of providing the state with subrogation
20rights to payments for injury or disease to residents that are provided under motor
21vehicle or other liability insurance policies or plans.
SB51,20,2322 (m) Formulation of criteria and procedures for payment under the health plan
23of out-of-state health care costs incurred by residents.
SB51,20,2524 (n) Establishment of a listing of approved medicinal substances and formulae,
25including all of the following:
SB51,21,4
11. Negotiation with pharmaceutical manufacturers or distributors to obtain
2the lowest possible cost for each medicinal substance. The negotiation shall include
3as parties on behalf of the health plan the secretary of the department and the
4chairperson of the board.
SB51,21,65 2. Establishment of a single statewide price, under the health plan, for each
6medicinal substance.
SB51,21,87 3. Monitoring the listing to oversee its currency and revising the listing by
8January 1 and July 1 annually.
SB51,21,109 4. Negotiating a statewide uniform dispensing fee with representatives of
10pharmacists or pharmacies.
SB51,21,1111 (p) Exemption of operation of the health plan from ch. 133, if necessary.
SB51,21,1212 (q) Other issues relevant to the health plan, as determined by the board.
SB51,21,21 13(6) From the appropriation under s. 20.430 (1) (c), the department shall, in
14cooperation with the department of workforce development and any other applicable
15state agency, as defined in s. 20.001 (1), provide job retraining or job placement
16services to individuals employed by insurers, as defined in s. 600.03 (27) and by
17health care providers whose employment is or will be terminated because of
18implementation of the health plan under this chapter. The department may award
19moneys as grants to applying organizations, under the department's
20request-for-proposal procedures, for the provision of job retraining or placement
21services under this subsection.
SB51,21,23 22(7) The secretary shall create a medical advisory committee and appoint
23members of the committee, to recommend criteria under sub. (3) (b).
SB51, s. 15 24Section 15. Nonstatutory provisions; health planning and finance.
SB51,22,5
1(1) Health policy board; appointment of members. Notwithstanding the
2length of terms specified for the members of the health policy board under section
315.20 (intro.) of the statutes, as created by this act, the initial members of the health
4policy board shall be appointed or elected by the first day of the 4th month beginning
5after the effective date of this subsection for the following terms:
SB51,22,106 (a) Two members specified under section 15.20 (1) of the statutes, as created
7by this act, one of whom is elected from the northern regional consumer health
8council and one of whom is elected from the southeastern regional health council, and
92 members specified under section 15.20 (2) of the statutes, as created by this act, for
10terms expiring on May 1, 2011.
SB51,22,1511 (b) Two members specified under section 15.20 (1) of the statutes, as created
12by this act, one of whom is elected from the northeastern regional consumer health
13council and one of whom is elected from the regional consumer health council for the
14area within Milwaukee County, and 2 members specified under section 15.20 (2) of
15the statutes, as created by this act, for terms expiring on May 1, 2013.
SB51,22,2016 (c) Two members specified under section 15.20 (1) of the statutes, as created by
17this act, one of whom is elected from the southern regional consumer health council
18and one of whom is elected from the western regional consumer health council, and
19one member specified under section 15.20 (2) of the statutes, as created by this act,
20for terms expiring on May 1, 2015.
SB51,23,221 (2) Regional consumer health councils; appointment of members.
22Notwithstanding the length of terms specified for the members of regional consumer
23health councils under section 15.207 (1) (b) of the statutes, as created by this act, the
24initial members of the regional consumer health councils shall be appointed by the

1first day of the 3rd month beginning after the effective date of this subsection for the
2following terms:
SB51,23,43 (a) For the regional consumer health council under section 15.207 (1) (b) 1. of
4the statutes, as created by this act:
SB51,23,5 51. Five members, for terms expiring on July 1, 2012.
SB51,23,6 62. Five members, for terms expiring on July 1, 2013.
SB51,23,7 73. Six members, for terms expiring on July 1, 2014.
SB51,23,98 (b) For the regional consumer health council under section 15.207 (1) (b) 2. of
9the statutes, as created by this act:
SB51,23,10 101. Five members, for terms expiring on July 1, 2012.
SB51,23,11 112. Five members, for terms expiring on July 1, 2013.
SB51,23,12 123. Five members, for terms expiring on July 1, 2014.
SB51,23,1413 (c) For each regional consumer health council under section 15.207 (1) (b) 3. or
144. of the statutes, as created by this act:
SB51,23,15 151. Five members, for terms expiring on July 1, 2012.
SB51,23,16 162. Five members, for terms expiring on July 1, 2013.
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