SB51: Bill Text

SB51,12,24 (a) Duties of the department that require policy determinations.

SB51,13,3 (b) The sources and amounts of revenues for the administration of the department and the board and for financing the payment of health care services that are provided to residents under the health plan.

SB51,13,4 (c) Information provided by the regional consumer health councils.

SB51,13,8 (d) Development of a system for determination and periodic review of areas in this state, and specific populations within those areas, that are medically underserved; and development of plans for providing health care services to those areas and populations, including the establishment of community health centers.

SB51,13,12 (e) Development of a system for periodic reviews and evaluations of all aspects of the operation of the health plan, including the adequacy, cost, effectiveness, and quality of health care services provided. These reviews and evaluations shall be made available to the public by the board.

SB51,13,14 (f) Development of a notice and hearing procedure for review of complaints of residents about the health plan, in accordance with the requirements of ch. 227.

SB51,13,15 (g) Other issues that the board determines are relevant to the health plan.

SB51,13,16 (h) State statutory changes that may be necessary to effect pars. (a) to (g).

SB51,13,20 (4) By January 1, April 1, July 1, and October 1 of each year, the board shall report to the governor on the revenues and expenditures of the health plan for the calendar quarter immediately preceding the most recently completed calendar quarter.

SB51,14,2 (5) (a) The board may appoint up to 2 advisory committees, each with not more than 12 members, that shall be advisory to the secretary. Appointees shall reflect as much as possible a balance of gender, race, age, sexual orientation, ethnicity, religion, disability, and geographic area. The board may determine the length of terms of advisory committee members and the frequency of meetings, and may terminate the committees.

SB51,14,3 (b) If appointed under par. (a), all of the following apply:

SB51,14,6 1. Only one advisory committee shall reflect the interests and concerns of consumer advocacy and may not include a health care provider or representative of a health care provider or the agency or organization of a health care provider.

SB51,14,9 2. Only one advisory committee shall reflect the interests and concerns of health care providers and agencies and organizations of health care providers and may not include a representative of a consumer advocacy agency or organization.

SB51,14,13 3. An advisory committee shall report annually to the board and the secretary concerning the committee's activities in the immediately preceding fiscal year, shall provide advice relative to health policy issues, and shall make recommendations concerning departmental policies and procedures.

SB51,14,15 152.30 Regional consumer health councils. (1) Each regional consumer health council shall do all of the following:

SB51,14,20 (a) Elect one member of the regional consumer health council to serve as a member of the board under s. 15.20 (1). If the term of the member who is so elected expires with respect to the regional consumer health council or with respect to the board under s. 15.20 (1), the regional consumer health council shall elect a current member of the council to serve as a member of the board in his or her stead.

SB51,14,24 (b) Study and continuously monitor the delivery and quality of and access to health care services in the region of the regional consumer health council and recommend to the board and regional office ways to improve the quality of and help ensure access to health care services.

SB51,15,3 (c) Recommend to the board payment rates and conditions appropriate to specific regional needs and advise on regional health care policy issues and administrative policies and procedures.

SB51,15,6 (d) Study and continuously monitor the unmet health care service needs in the region of the regional consumer health council and recommend to the board ways by which the needs may be met.

SB51,15,10 (e) Report at least annually to the board with respect to the health care needs, problems, and concerns of the region, including any issues elicited at public hearings under par. (g), and provide to the board recommendations to alleviate these needs, problems, and concerns.

SB51,15,13 (f) Require reports from and advise the member of the staff of the appropriate regional office whose duties are specified under s. 152.40 (1), concerning issues that arise under pars. (b) to (e).

SB51,15,17 (g) In at least 2 localities of the region, hold public hearings at least annually to elicit public opinion concerning the health plan under this chapter. The council shall give notice of each hearing by publishing a class 1 notice, under ch. 985, at least 15 days before the hearing in a newspaper covering the affected area.

SB51,15,18 (h) Perform other duties as required by the board.

SB51,15,21 (2) Each regional consumer health council may, for cause, recall the member elected under sub. (1) (a) and may elect another member to fulfill that term on the board if all of the following are done:

SB51,15,24 (a) The elected member of the board for whom recall is sought receives notice of the recall at least 10 working days before the meeting at which the recall is voted upon.

SB51,16,3 (b) Notice of the vote to recall the elected member is made on the agenda of the meeting of the regional consumer health council that is immediately prior to the meeting at which recall is voted upon.

SB51,16,9 (2m) The regional consumer health council may appoint a regional advisory committee. If appointed, the regional advisory committee shall consist of 18 members 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, and may consist of consumer advocates and health care providers.

SB51,16,12 (3) The staff of the appropriate regional office shall provide services to each regional consumer health council to deal with issues of health consumer advocacy and health ombudsman functions.

SB51,16,17 152.40 Department of health planning and finance. (1) The department shall administer the health plan under this chapter, including establishing a regional office in each of the regions specified under s. 15.207 (1) (a) 1. to 6. Each regional office shall have at least one staff member who acts in a full-time capacity as a regional consumer advocate and health care ombudsman.

SB51,16,20 (2) The department shall establish provider payment rates, taking into consideration regional, rural, and urban differences, and conditions of payment for the provision of health care services under the health plan.

SB51,16,22 (3) The department shall, after review and approval by the board, promulgate as rules all of the following:

SB51,16,24 (a) Guidelines for cost containment under the health plan, including the purchasing and distribution of major diagnostic, medical, and surgical equipment.

SB51,17,4 (b) Criteria, as recommended by the medical advisory committee appointed by the secretary under sub. (7), for determining necessity for orthodontia and for the performance of reconstructive or cosmetic surgery for coverage under the health plan.

SB51,17,6 (4) The department shall biennially evaluate and recommend to the board cost control measures for the health plan.

SB51,17,9 (5) The department shall, by July 1, 2009, begin implementation of processes, in light of policies formulated or revised under s. 152.20 (3), to effect all of the following:

SB51,17,13 (a) Specification of the amounts and sources of revenues to finance payment to providers under the health plan, which may not include any premiums, copayments, deductibles, and other forms of direct payment by patients, and which shall include all of the following:

SB51,17,19 1. Use of federal, state, and local moneys that fund, as of July 1, 2010, health care services, including medicare, medical assistance, health care services funded by a relief block grant under s. 49.02, 49.025, or 49.029; health care services under s. 49.665; veterans medical benefits; services specified in s. 152.10 (2) (k); services provided under federal block grants; alcohol and other drug abuse services; and services provided by local health departments.

SB51,17,24 2. Use of revenues from a tax on employers, based on the amount of wages that they pay, that generates, in the aggregate, revenues that are at least equal to amounts that employers contribute, as of the effective date of this subdivision .... [revisor inserts date], for employee health care benefit costs, including the costs of worker's compensation attributable to health care for injured employees.

SB51,18,4 3. Use of revenues from a graduated income tax on individuals that generates, in the aggregate, revenues that are not greater than expenditures that individuals make, as of July 1, 2010, for health care costs for which coverage under disability insurance policies is not obtained.

SB51,18,7 4. An indexing of the sources of revenues under this paragraph that provides for revenue growth that is equivalent to the anticipated growth of health care costs under the health plan.

SB51,18,10 (b) Application for waivers to 42 USC 1396 to 1396v or consideration of the feasibility of statutory changes to 42 USC 1396 to 1396v in order to effect all of the following:

SB51,18,12 1. Administration of the Medical Assistance program in this state by the department, rather than by the department of health and family services.

SB51,18,14 2. Use of federal financial participation to fund a portion of the administrative costs, after June 30, 2010, of the department.

SB51,18,19 3. Use of federal financial participation, after June 30, 2010, to fund, under the health plan, the health care services received by a percentage of the residents that corresponds to the percentage of the residents, as determined by the board, that is eligible to receive health care services under the Medical Assistance program on July 1, 2010.

SB51,18,21 4. The formulation of criteria and procedures for payment of out-of-state health care costs incurred by residents specified in subd. 3.

SB51,18,23 5. Use of federal financial participation to fund the scope, or a portion of the scope, of medical services to be provided under the health plan.

SB51,18,25 (c) Application for waivers to Medicare or consideration of the feasibility of statutory changes to 42 USC 1395 to 1395hhh in order to effect all of the following:

SB51,19,2 1. Administration of the Medicare program in this state by the department, rather than by private insurers.

SB51,19,4 2. Use of federal Medicare funds to fund a portion of the administrative costs, after June 30, 2010, of the department.

SB51,19,7 3. Use of federal Medicare funds to fund, under the health plan, the health care services received by residents who are eligible to receive services under Medicare beginning on July 1, 2010.

SB51,19,9 4. The formulation of criteria and procedures for payment of out-of-state health care costs incurred by residents specified in subd. 3.

SB51,19,11 5. Use of federal Medicare funds to fund the scope, or a portion of the scope, of medical services to be provided under the health plan.

SB51,19,13 6. The assignment to the state, as represented by the department, of rights of an individual to payment for medical care from any 3rd party.

SB51,19,17 (d) Application for waivers or consideration of the feasibility of statutory changes to federal laws, other than those specified in pars. (b) and (c), in order to use moneys available under those federal laws for payment of health care services under the health plan or in order to provide services to all residents under the health plan.

SB51,19,20 (e) The establishment and maintenance, with reserves of no less than 5 percent of the total annual amount appropriated under s. 20.430 (1) (b), of a health trust fund in the department, for receipt of revenues specified in par. (a).

SB51,20,3 (f) The formulation of criteria for determining payment and the formulation of procedures for determining payment and negotiating applicable rates to be used for payment for health care providers, including health care facilities, under the health plan. The criteria and procedures for determining payment shall include periodic overall budgeting, including separately budgeting for operational costs; for health care facilities and services; for negotiations with professional groups or associations of practitioners; for consideration of inflation costs and increased patient populations; and for research and teaching.

SB51,20,7 (g) The development and implementation of a system to provide an electronic or other identification card, bearing a unique number that is not a social security number, to each health plan participant, for receipt of benefits under the plan, and to each health care provider, for receipt of reimbursement.

SB51,20,11 (h) The formulation of criteria and procedures to review and to provide funding for capital expenditures, from an account separate from that from which health care services are paid, for the establishment, maintenance, or expansion of health care facilities.

SB51,20,13 (i) The formulation of criteria and procedures for recovery of overpayments made to health care providers under the health plan.

SB51,20,15 (j) The determination and use of factors requisite to establishing an annual state health budget for the provision of services under the health plan.

SB51,20,18 (k) Application for waivers of 29 USC 1144 (a) or consideration of the feasibility of statutory change to 29 USC 1144 (a) or the means by which operation of the health plan may avoid conflict with 29 USC 1144 (a).

SB51,20,21 (L) Investigation of the feasibility of providing the state with subrogation rights to payments for injury or disease to residents that are provided under motor vehicle or other liability insurance policies or plans.

SB51,20,23 (m) Formulation of criteria and procedures for payment under the health plan of out-of-state health care costs incurred by residents.

SB51,20,25 (n) Establishment of a listing of approved medicinal substances and formulae, including all of the following:

SB51,21,4 1. Negotiation with pharmaceutical manufacturers or distributors to obtain the lowest possible cost for each medicinal substance. The negotiation shall include as parties on behalf of the health plan the secretary of the department and the chairperson of the board.

SB51,21,6 2. Establishment of a single statewide price, under the health plan, for each medicinal substance.

SB51,21,8 3. Monitoring the listing to oversee its currency and revising the listing by January 1 and July 1 annually.

SB51,21,10 4. Negotiating a statewide uniform dispensing fee with representatives of pharmacists or pharmacies.

SB51,21,11 (p) Exemption of operation of the health plan from ch. 133, if necessary.

SB51,21,12 (q) Other issues relevant to the health plan, as determined by the board.

SB51,21,21 (6) From the appropriation under s. 20.430 (1) (c), the department shall, in cooperation with the department of workforce development and any other applicable state agency, as defined in s. 20.001 (1), provide job retraining or job placement services to individuals employed by insurers, as defined in s. 600.03 (27) and by health care providers whose employment is or will be terminated because of implementation of the health plan under this chapter. The department may award moneys as grants to applying organizations, under the department's request-for-proposal procedures, for the provision of job retraining or placement services under this subsection.

SB51,21,23 (7) The secretary shall create a medical advisory committee and appoint members of the committee, to recommend criteria under sub. (3) (b).

SB51, s. 15 Section 15. Nonstatutory provisions; health planning and finance.

SB51,22,5 (1) Health policy board; appointment of members. Notwithstanding the length of terms specified for the members of the health policy board under section 15.20 (intro.) of the statutes, as created by this act, the initial members of the health policy board shall be appointed or elected by the first day of the 4th month beginning after the effective date of this subsection for the following terms:

SB51,22,10 (a) Two members specified under section 15.20 (1) of the statutes, as created by this act, one of whom is elected from the northern regional consumer health council and one of whom is elected from the southeastern regional health council, and 2 members specified under section 15.20 (2) of the statutes, as created by this act, for terms expiring on May 1, 2011.

SB51,22,15 (b) Two members specified under section 15.20 (1) of the statutes, as created by this act, one of whom is elected from the northeastern regional consumer health council and one of whom is elected from the regional consumer health council for the area within Milwaukee County, and 2 members specified under section 15.20 (2) of the statutes, as created by this act, for terms expiring on May 1, 2013.

SB51,22,20 (c) Two members specified under section 15.20 (1) of the statutes, as created by this act, one of whom is elected from the southern regional consumer health council and one of whom is elected from the western regional consumer health council, and one member specified under section 15.20 (2) of the statutes, as created by this act, for terms expiring on May 1, 2015.

SB51,23,2 (2) Regional consumer health councils; appointment of members. Notwithstanding the length of terms specified for the members of regional consumer health councils under section 15.207 (1) (b) of the statutes, as created by this act, the initial members of the regional consumer health councils shall be appointed by the first day of the 3rd month beginning after the effective date of this subsection for the following terms:

SB51,23,4 (a) For the regional consumer health council under section 15.207 (1) (b) 1. of the statutes, as created by this act:

SB51,23,5 1. Five members, for terms expiring on July 1, 2012.

SB51,23,6 2. Five members, for terms expiring on July 1, 2013.

SB51,23,7 3. Six members, for terms expiring on July 1, 2014.

SB51,23,9 (b) For the regional consumer health council under section 15.207 (1) (b) 2. of the statutes, as created by this act:

SB51,23,10 1. Five members, for terms expiring on July 1, 2012.

SB51,23,11 2. Five members, for terms expiring on July 1, 2013.

SB51,23,12 3. Five members, for terms expiring on July 1, 2014.

SB51,23,14 (c) For each regional consumer health council under section 15.207 (1) (b) 3. or 4. of the statutes, as created by this act:

SB51,23,15 1. Five members, for terms expiring on July 1, 2012.

SB51,23,16 2. Five members, for terms expiring on July 1, 2013.